HomeMy WebLinkAbout05068 - OPERATION SAFE HOUSE INC CDBG SUBRECIPIENT AGR SUBRECIPIENT AGREEMENT ��,��,��
THIS AGREEMENT (herein "Agreement"), is made and entered into thisl� day of ,
2001, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and
charter 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 seq.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et seq. ("Regulations"); and
WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit
organizations for certain purposes allowed under the Act; and
WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible
for a grant of CDBG funds and the City desires to assist in the operation of the program by granting
CDBG Funds to the Provider to pay for all or a portion of those costs incurred in operating the program
permitted by the Act and the Regulations on terms and conditions more particularly set forth herein;
NOW, THEREFORE,the parties hereto agree as follows:
1.0 SERVICES OF PROVIDER.
1.1 Scope of Services. Provider agrees to provide to City all of the services
specified and detailed in its application for funding and Exhibit A, and to conduct all programs specified
therein in a manner to reflect credit upon the City and Provider. Provider represents and warrants to
City that it is able to provide, and will use funds granted by the City to provide the services represented
in the 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.
1A Financial Reporting. Any Provider receiving or due to receive or due to
receiver $20,000.00 or more from the City during the 2005 — 2006 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.
2.0 COMPENSATION.
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 EIGHTEEN THOUSAND DOLLARS ($15,000.00) (the "Contract
Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this
reference; and as herein provided. The budget cost categories set out in Exhibit B are general
guidelines and if mutually agreed by both parties, may be amended administratively by no more than
10%, without the requirement of a formal amendment to this Agreement, but in no event shall such
adjustments increase the Contract Sum. The Provider shall submit to the City monthly statements on
reimbursable expenditures pursuant to the attached Budget along with pertinent supporting
documentation. The City shall promptly review the monthly expenditure statements and, upon
approval, reimburse the Provider its authorized operating costs.
2.2 Payroll Records. In cases where the contract sum will reimburse payroll
expenses as part of operations, the Provider will establish a system of maintaining accurate payroll
records which will track daily hours charged to the project by the Provider's respective employees, as
set forth in OMB Circular A-122 Attachment B.6.
2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance
of at least 25% of the total grant by the 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
3.2 Contract Officer. The Contract Officer shall be such person as may be
designated by the chief administrative officer of City.
3.3 Prohibition Against Subcontracting or Assignment. Provider shall not contract
with any other entity to perform in whole or in part the services required hereunder without the express
written approval of the City. Neither this Agreement nor any interest herein may be assigned or
transferred, voluntarily or by operation of law, without the prior written approval of the City.
3.4 Independent Contractor. Neither the City nor any of its employees shall have
any control over the manner, mode or means by which Provider, its agents or employees, perform the
services required herein, except as otherwise set forth herein. Provider shall perform all services
required herein as an independent contractor of City and shall remain at all times as to City a wholly
independent contractor with only such obligations as are consistent with that role. Provider shall not at
any time or in any manner represent that it or any of its agents or employees are agents or employees
of City.
4.0 COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider shall maintain records of its operations and financial activities in
accordance with the requirements of the Housing and Community Development Act and the
regulations promulgated thereunder, which records shall be open to inspection and audit by the
authorized representatives of the City, the Department of Housing and Urban Development and the
Comptroller General during regular working hours. Said records shall be maintained for such time as
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4.2 The Provider certifies it shall adhere to and comply with the following as they
may be applicable:
(a) Submit to City through its Community and Economic Development
Department monthly reports on program status;
(b) Section 109 of the Housing and Community Development Act of 1974,
as amended and the regulations issued pursuant thereto;
(c) Section 3 of the Housing and Urban Development Act of 1968, as
amended;
(d) Executive Order 11246, as amended by Executive Orders 11375 and
12086, and implementing regulations at 41 CFR Chapter 60;
(e) Executive Order 11063, as amended by Executive Order 12259, and
implementing regulations at 24 CFR Part 107;
(f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as
amended, and implementing regulations;
(g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and
implementing regulations;
(h) The relocation requirements of Title II and the acquisition requirements
of Title III of the Uniform Relocation Assistance and Real Property
Acquisition at 24 CFR Part 42;
(i) The restrictions prohibiting use of funds for the benefit of a religious
organization or activity as set forth in 24 CFR 570.200 (j);
(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
to the acceptance and use of federal funds under the federally-
assisted program;
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(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 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
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).
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5.2 Indemnification. The Provider shall defend, indemnify and hold harmless the
City, its officers and employees, from and against any and all actions, suits, proceedings, claims,
demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death
of person(s), for damage to property (including property owned by the City) arising out of or related to
Contractor's performance under this Agreement, except for such loss as may be caused by City's own
negligence or that of its officers or employees.
6.0 DISCRIMINATION, TERMINATION AND ENFORCEMENT.
6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its
heirs, executors, assigns, and all persons claiming under or through them that there shall be no
discrimination against or segregation of any person or group of persons on account of race, religious
creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
pregnancy, 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 parry 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
WITH COPY TO:
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn: City Attorney
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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
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executed the same in-tws/her/thetr authorized capacityoe r executed the same In his/hedthen authorized capacity(4es)-
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person, or the entity upon behalf of which the person(s,Y person*'or the entity upon behalf of which the persoDka�,'
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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 0008
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
O b i ectives/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#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: On-site preparation shall include block wall/chain-link fence demolition and
grubbing/grading 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
Prolect/Activity Title. Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0008
Name/Address of Provider:
Operation Safe House, Inc.
42-600 Cock St, Ste 201-A 9685 Hayes St
Palm Desert, CA 92211 Riverside, CA 92503
BUDGET SUMMARY
COST CATEGORY 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 $18,000. $376,436. $394,436.
On-Site Improvements
$18,000. $376,436. $394,436.
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 totaling $2.81VI which includes Riverside County CDBG for $250,000.
Payments, approved by the Subrecipient, shall be paid by the 301" 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 2005-06 Program Year—July 1,
2005 through June 30, 2006.
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Proiect/Activity Title: Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0008
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 07/01/05 to 07/01/06 & 07/01/06 to 07/01/07
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 o No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company State Compensation Insurance Fund
Effective Dates 01/01/05 to 01/01/06 & 01/01/06 to 01/01/07
Limits of Liability $1 000 000 Per Occurrence
Underlying Coverage Limits
Original Certificate of Insurance Attached ❑ Yes o No
.•.� oATEnwmml,.
: xA.ro.....r. Fl. „. .....J.4. ...ray.°w�E,..:.. 07/16/2Do07
PRODLIM Nicholas Goldwarm THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Hub International of California ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4371 Latham Street Suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO SOX 5345 COMPANIES AFFORDING COVWAGE
Riverside, CA 92501 COMPANY Nonprofits' insurance Alliance oP
951-788-5500 . £ax951-788-2994 A
INLUIIED COMPANY
operation safe House B
A omlxecreia Non-Profit Corporation
96" Hayes Street COMPANY
C
Riverside CA 92503
COMPANY
D
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSVED TO THE RtSuReb NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOLIMEMENT,TERM OR CONDITION OP ANY CONTRACT Olt OTHER DOCUMENT WITH RESPECT 70 WHICH THIS
CERYIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONOTJONS OP SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
ED LTIsTeo"YP WSURANCE POLICY NUMaoI UATFI��"I PATRIIMMI UNITS
A DMIeIAL uABA1TY 2007-077 22-NPO 07/02/2007 7/01/2000 GENERAL AOOPMENIT • 2,000,(IOD
X C9MMERCA GENDtAL LIABILITY PRODUCTS.COMPIOP AGO $ 2,000,000
" cUIMSMADEI OCCUR PERSONAL A ADV NJURY 01 000 OOD
OWNER'S B CONTRACTOR'S PROT TACK 000,RRIENCS sI,0D0 000
rIRE DAMAGE MaMA Nm,ko * 200,000
ED M C-1 IM, WWI A 10,000
A AOTOMOB U"1UTT 2007-07 722-N8O I07/02/2007 7fol/2008 �COMNINtovNOLEUMR 42,OOD,000
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I page 9 item *44.
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City of Palm Springs SHOULD ANY OF THE ^KOW DESCRIBED POLICIES as GANCRIIO avOME W
3200 R. TahVitz Canycn Hay EkPIRAT E Ie HI ON DATE TNEIDT. TTSUINa COMPANY WILL ENDEAVOR TO MAm.
3p
Palm Springs. CA 92262 YS)DAYS WRITTEN NOTICE TO TTVNeme91RRCATE HOLDER NAMED TO TER IAFT,
aUT IIYWRa TO MAIice L o7UCH NOTIC!SMW M"69 Tel OBLIGATION ON LMSNITV
OF ANY AMC UPON TER COMPANY, ITS AOEWS ON 110"I lTA77M.
AUTHORIIDO IMM96MYATNE
POLICY NUMBER: 2007-07722-NPO COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modrftes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVFPAGE PART
SCHEDULE
Nama Of Additional Insured Persona Or Or anlzation s
Any person or organization that you are required to add as an additional insured on this policy, under
a written contract or agreement currently in 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 onlywilh 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 person or organlzation.
Information required to complete this Schedule if not shown above will be shown in the DeclaraVons.
Section If - Who Is An Insured is amended to in-
clude as an additional insured the person(s)or organi-
zation(s) shown in the Schedule, but only with respect
to Nobility for 'bodily injury', 'property damage" or
'personal and advertising injury' caused, in whale or
in pan,by your acts or omissions or the acts or omis-
sions of those acting on your behalf-
A. In the performance of your ongoing operations;or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04 ®ISO Properties,Inc.,2004 page 1 of 1 []
SECTION IV-COMMERCIAL GENERAL LIABILITY b. To sue us on this Coverage Part unless all of
CONDITIONS its terms have been fully mmpiied with.
1. Bankruptcy A person or organization may sue us to recover on
Bankruptcy or insolvency of the insured or of the an agreed settlement or on a final judgment
nsured s estate will not relieve us of our oblige-
against an insured obtained after an actual trial;
lions under this Coverage Part. burl we will not be liable for damages that are not
payable under the terms of this Coverage Part or
1 Duties In The Event Of Occurrence,Offense,• that are in excess of the applicable limit of insu•
Claim Or Suit ance 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"occurrence"or an offense and the claimant or the claimant's legal reprosen-
which may result in a claim. To the extent pos- tative.
sible,notice should include: 4. Other Insurance
(1) How, when and where the "occurrence' or If other valid and collectible insurance is available
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 of this Coverage Part,our obligations
persons and witnesses;and are limited as follows:
(3) The nature and location of any injury or a. Prim"Insurartce
damage arising out of the "occurrence" or This Insurance is primary except when b.below
offense. applies. If this insurance is primary, our obltga-
b. If a clairn is made or "suit" is brought against tions are not affected unless any of the other
any insured, you must: insurance is also primary. Then, we will share
(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. b. Excess Insurance
You must see to It that we receive written no- Thls Insurance is exce33 over:
tics of the claim or"suiC as soon as practica- (1) Any of the other insurance, whether pd-
be. mary, excess, contingent or on any other
c. You and any other involved insured must: basis:
(1) Immediately sand us copies of any de- (a) That is Fire, Extended Coverage,
mands, notices, summonses or legal Pa. Builders Risk, Installation Risk or similar
pars received in connection with the claim coverage for"your work";
or"suit'; (4) That is Fire insurance for premises
{2) Authorize us to obtain records and other rented to you or temporarily occupied by
information; you with permission of the owner;
(3) Cooperate with us in the investigation or (c) That is insurance purchased by you to
settlement of the claim or defense against cover your liability as a tenant for"prop-
the"suit";and erty damage" to premises rented to you
or temporarily occupied by you with
(4) Assist us, upon our request, In the en- permission of the owner,or
forcement of any right against any person or (d) If the loss arises out of the maintenance
organization which may be liable to the in. or use of aircraft, 'autos"or watercraft to
sured because of injury or damage to which the extent not subject to Exclusion g. of
this insurance may elso apply. Section I - Coverage A - Bodily injury
d. No insured will, except at that insured's own And Property Damage Liability.
cost, voluntarily make a payment, assume any
obligation, or incur any expense, other than for 12) Any other primary insurance a to
first aid,without our consent. you covering liability for damageess a arising
out of the premises or operations for which
3. Legal 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 Part
a. To join us as a party of dherwise,bring us into
a"suit"asxing for damages from an insured;or
CG 00 0107 98 Copyright, Insurance Services Otfrce,Inc„ 1997 Page 9 of 13 ❑
When this insurance Is excess,we will have no S. Representations
duty under Coverages A or B to defend the In- By accepting this policy, you agree:
sured against arty'suit'if anyother insurer has
e duty to defend the insured against that"Bull-. a. The statements in the Declarations are aecu-
If no other insurer defends,we will undertake to rate and complete;
do so, but we will be entitled to the insured's D. Those statements are based upon representa-
rights against all those other insurers. tons you matte 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 share of 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 loss in the absence any rights or duties specifically assigned in this
of this Insurance;and Coverage Part to the first Named Insured,this in-
surance applies:
(2) The total of al deductible and seff-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, if any, with b. Separately to each insured against whom clalm
any other insurance that is not described to this is made or"suit"is brought.
Excess Insurance provision and was not
bought speclficaly to apply in excess of the S. Tran*fiW Of Rights Of Recovery Agalrtst Others
Limits of Insurance shown in the Declarations To Us
of this Coverage Part. If the insured 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 insumd
by equal shares, we will follow this method must do nothing after loss to impair them. At our
request, the insured will bring "suit" or transfer
also. under this appmalch each insurer contrib- those rights to us and help us enforce them.
utes equal amounts until it has paid its opptira-
ble limit of insurance or none of the loss re- 9. When We Do Not Rarmw
mains,whichever comes first. If we deride not to renew this Coverage Part, we
If any of the other insurance does not permit will mail or deliver to the first Named Insured
contribution by equal shares,we will contribute shown in the Declarations written notice of the
by limits, Under this method, each insurer's nonrenswal not less than 30 days before the expi-
share is based on the ratio of its applicable limit ration date.
of insurance to rite total applicable limits of in- If notice is mailed,proof of mailing will be sufficient
surance of all insurers. proof of notice.
5, Premium Audit SECTION V-DEFINITIONS
a. We, will compute as premiums for this Cover- 1. "Advertisement" means a notice that is broadcast
age Pert in accordance with our rules and or published to the general public or spacific mar-
rates. ket segments about your goods, products or Ser-
b. Premium shown in this Coverage Part as ad- vices for the purpose at attracting customers or
vance premium is a deposit premium only. At supporters.
the dose of each audit period we will compute y, -Auto"mean-,a land motor vehicle, trailer or semi-
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 "aute
first Named Insured. If the sum of the advance does not ircluds'mobile equipment".
and audit premiums paid for the policy period is 1 "Bodsy Injury' means badly injury, sickness or
greater than rite earned premium,we will return disease sustained by a person, including death re-
the excess to the first Named Insured. sulfng from any of these at any time.
c. The first Named Insured must keep records of 4. "Coverage territory'means:
the info maHon we need for premium computa-
tion, and send us copies at such times as we a. The United States of America fincluding its
may request, territories and possessions), Puerto Rico and
Canada;
Page 10 of 13 Copyrigh6 Insurance Services Office, Inc 1997 CG 00 11111 07 98 ❑
CERTHOLDERCOPY SK
STATE P.C. BOX 420807, SAN FRANCISCO,CA 94142-0807
compEM3ATION
Ie6Ugw MC
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01-16-2007 GROUP, 000636
POLICY NUMBER: COMBIB-2007
CERTIFICATE ID: 20
CERTIFICATE EXPIRES 01-01-2004
Dt-ol-2ooT/oI-orzooa
CITY OF PALM SPRINGS SK
3200E TANWITZ CANYON MAY
PALM SPRINGS CA 91162-6959
This is to certify that we have Issued a valid Workers' Compensation Insuranos policy in a form app+oved by the
California Insurance Commissioner to the employer rowed below for Of, policy period indicated
This policy is roil wbiJsct to cancellation by the fund except upon 30 days advance wrictpn notice to " emgoyw.
We will also give you 30 days advance notice should this policy be caneanad prior to its normal expiration.
This Certificate of insurance is not an insurance policy and does not attend, extend or altw the coverage afforded
by the
esop�eie tloneedh,herteR Net(�otnq My Fo firemen ka m or condition
nit It m contract or other document
insurainev nny may pertain, the insurance
afforded by the policy described Wain is subject W all the terms,, exclusions.
And conditions, of such policy.
ORIZEO REPRESEVTATI PRESIDENT .
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,6010, PER OCCURRENCE.
ENDORSEMENT 00015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2007-07-16 IS
ATTACHIM TO AND FORMS A PART OF THIS POLICY. NAVE OF ADDITIONAL INSUR90I
CITY OF PALM SPRINGS
—_El"SEMEN' N2066 ENTITLED CERTIFICATE FOLDERS' NOTICE EFFECTIVE 01-61-2006 IS
ATTACttE0 TO AND FORTIS A PART OF THIS POLICY.
DMRSENErn 02570 ENTITLED VAIVER OF SU11ROGATIONI EFFECTIVE 2007-07-16 IS
ATTACHED TO AND FORMS A PART DF THIS POLICY, THIRD PARTY NAME:
CITY OF PALM SPRINGS
i
EMPLOYER
OPERATION SAFE HOUSE SK
OUS HAVES ST
RIVERSIDE CA S2502
I15,SK1
ntev,a-del PRIMED 0 -16-2007 ,
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Project/Activity Title: Protect Number:
Operation Safe House, Inc/SafeHouse of the Desert 0008
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 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 borders cannot be included as household members.
2. Circle your combined gross annual income(Riverside-San Bernardino,CA—02/11/05)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $19,500 $22,250 $25,050 $27,850 $30,050 $32,300 $34,500 $36,750
Below 50%
LOW INCOME $31.200 $35,650 $40,100 $44,550 $48,100 $51,700 $55,250 $58,800
51 —80%
MODERATE
INCOME $46,750 $53,450 $60,100 $66,800 $72,150 $77,500 $82,850 $88,200
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
❑ 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, yes 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 Block Grant(CDBG)program purposes only and will be kept confidential.
CITY OF PALM SPRINGS
EXHIBIT E
Program Progress Report
Project/Activity Title: Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0008
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: Project Number:
Operation Safe House, Inc/SafeHouse of the Desert 0008
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
Approved Current Prior Total Grant PP ����
Description Grant Reimbursement Reimbursement YTD Balance
Amount Period Periodts) Reimbursement (Overt 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 $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 subreapients 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
19K 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 worker's
representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places
available to employees and applicants for employment or training