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HomeMy WebLinkAbout05460 - COURT APPOINTED SPECIAL ADVOCATES (CASA) OF RIVERSIDE COUNTY CDBG SUBRECIPIENT CITY OF PALM SPRINGS CONSOLIDATED PLAN ANNUAL PLAN UPDATE 2007 - 2008 FUNDING SUMMARY: The City received Request For Proposals (RFPs) from nineteen (19) funding requests totaling $1,215,727, compared to 15 proposals received last year, totaling $795,023 in requests. The following chart illustrates the proposed allocations of CDBG funds expected to be available during the FY 2007 - 2008 period in the City of Palm Springs. For specific project details, i.e., project description, location, proposed benefits, refer to attached tables - 'Listing of Proposed Projects'. This coming fiscal year funding consists of$517,881 in new entitlement funding. The total funds available for the 2007 — 2008 Fiscal Year, by authorized category of basic eligibility, are: Public Facilities& Improvements --------------------------""$336,623.*.................................... Public Services---""----- - TOTAL PROGRAMMATIC FUNDS...............................,,,,,-.......................$414,305. ADMIN (includes Citizen Participation &Fair Housing) ""--------------- 10$ 3,576•*** TOTAL CDBG2007--2008 ENTITLEMENT ---„--------------------------- $5178- 1. Public Facilities & Improvements will also be partially funded with program income and the reprogramming of unexpended activity funds, both from prior years and current. `• Public Service is calculated at 15% of new entitlement funding, Administration is calculated at 20% of new entitlement funding The following chart indicates the specific strategy (as referenced in the 2005 — 2010 Consolidated Plan Strategic Plan Goals), to which the proposed allocation relates. Fy � I hhg---- Non-Hsng 2 1 596,879.ily YMCA ie the Desert- Non-Hsng C❑nergy-Efficiency m,p _nblM1.T'..,.in�a�iigmeerm- ---- - CD &3 96,879.uiC_QILvaSTreeY.lw+� .,. .. _rt-AtBS-lamect•- Non-Hsng CD 1.�.. Nonng CD r99'�Pa� -Hsng CD 1 95,D00. mes�e'8 ie'DT!;"Hlghland Unity Center Energy-Efficiency provementsll Senior Center- Non-Hsng 1 eals On Wheels&Outreach Hybrid Vehrole 27,200. Appointed Special Advocates far Riverside County, Inc - Non-Hsng 1 pport Program _ ______ _____ Hm151 15,000. e e5 Th for P oqm Feundahon- Noes That Frt ry on-Hsng 116482 Spnngs Sunup y cto hood 0 gmm �. --- -kod .y.—_ crside- rt '- - Nan-Hsngi _ Childrenofthe Dese - rl ral Healthcare 19,OD0 eHionns •.,.. - ___ _. .. "Hsng 4Development— Va mmistyy-B-EconemcDe rticpment�_._. . ..ipation nla.__-___ .. _- -____ 12,743. TOTAL FUNDING(Annual Allocation $5177881 Hsng = Housing Goals Hmis = Homeless Goals Non-Hsng = Non-Housing Goals Non-Hsng CD = Non-Housing Community Development Goals oo1oGcoec07-0B/AnnIP1nFngngSumry Mayo? SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this k day of 200a, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Court Appointed Special Advocates (CASA) of Riverside County, 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. 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 2007 —2008 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 31st of the current fiscal year. ®fie-Gr(vAQ. 0D, AND/OR AUREENJE V 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for its services a sum not to exceed FIFTEEN THOUSAND DOLLARS ($15.000.00) (the "Contract Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City monthly statements on reimbursable expenditures pursuant to the attached Budget along with pertinent supporting documentation. The City shall promptly review the monthly expenditure statements and, upon approval, reimburse the Provider its authorized operating costs. 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: Deborah Sutton, 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 - 2- may be required by the regulations of the Housing and Community Development Act, but in no case for less than five years after the close of the program. 4.2 The Provider certifies it shall adhere to and comply with the following as they may be applicable: (a) Submit to City through its Community and Economic Development Department semi-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 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); (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); -3- (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate to the acceptance and use of federal funds under the federally- assisted program; (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C.4801 et 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 -4- foregoing and naming the City as an additional insured shall be delivered to and approved by the City prior to commencement of the services hereunder. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of Provider's obligation to indemnify the City, its officers, or employees. The amount of insurance required hereunder shall be as required by the Contract Officer not exceeding Five Hundred Thousand Dollars ($500,000). 5.2 Indemnification. The Provider shall defend, indemnify and hold harmless the City, its officers and employees, from and against any and all actions, suits, proceedings, claims, demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death of person(s), for damage to property (including property owned by the City) arising out of or related to Contractor's performance under this Agreement, except for such loss as may be caused by City's own negligence or that of its officers or employees. 6.0 DISCRIMINATION,TERMINATION,AND ENFORCEMENT. 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal, state or local law. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 of this Agreement, this Agreement shall continue in full force and effect until completion of the services, but not exceeding one(1)year from the date hereof. 6.3 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. Provider shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and City shall be entitled to reimbursement for any services which have been paid for but not rendered. 7.0 MISCELLANEOUS PROVISIONS. 7.1 Notice. Any notice, demand, request, document, consent, approval, or communication either 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 Tahquiiz Canyon Way Palm Springs, CA 92262-6959 Attn: City Manager -5 - WITH COPY TO: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER: CASA for Riverside County, Inc. PO Box 3008 Indio, CA 92202-3008 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] -6- CITY OF PALM SPRINGS ATT- mL I-cor raion ulr�yl' JIL A-,—A �fr i Clerk ��Z���® �f,,,_City Manager APPROV � TO F RM: APPROVED BY CITY COUNCIL By: City Attorne/ 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, Assistant Secretary, Treasurer, Assistant Treasurer, or Chief Financial Officer). By: D 1L - By: Notarized Signa ire of Chairman of Board, Notarized SI nature Secretary, AAst Secretary, President or any Vice President Treasurer, Asst Treasurer or Chief Financial Officer N ,A�ame: ��kr ��47� Name: �: i�l� S if�i%�✓3r.� Title: 1 G � ' �( � Title: State State of �r/%'�C�•�/�% County of pp f.�2'�'-' 'gyp-ss County of ,F�1,(+rSI P =ss On dTUc,/,a; � /(� , 2CZ)� before me, On f`c'yt'�I 2C°�"7 before me, ,c r, n_�� 1-C/C.+IS r`5/I'%�'b ' /L/,}/`k�40k personally appeared .�cai5 , �%�S� /��?4�.z �"��'.-✓k personally appeared A�� rr-- // ' rrr�(F,4 personally known CCl �-// L . Sit' ;)!personally known to me(or pf'oved to me on the basis of satisfactory evidence) to me(or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(S01 are-subscribed to the to be the person(s)-whose name(s)L�,afe subscribed to the within instrument and acknowledged to me that�e she/they within instrument and acknowledged to me that46ep/they executed the same n6ciiiheritheir authorized capacity(fesj; executed the same in hi ei/their-authorized capacity(ies), and that byMthev signature-(s)-on the instrument the and that by hifItheir signature(s)•on the instrument the persop(s), or the entity upon behalf of which the persoe.(W person(*,-or the entity upon behalf of which the perso5s) acted,executed the instrument. acted,executed the instrument. WITNESS my and and official seal. WITNESS my hand and official seal. Notary Notary Signature: r -" •--�� Notary Seal: Notary Seal: LOUIS RIVAS Commission S 1474963 LOUIS RIVAS 0MV Notary Public-California Commission t g7g963Santa Barbara County .'� Notary Public-California Comm.Expires Mar 7,2008 ' Santa Barbara County z My Comm.Expires Mar 7,2008- SubrecipAgrmnt.Jut07 -7- CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Proiect Number: Court Appointed Special Advocates(CASA)/ 0006 Support Program Name/Address of Provider: Court Appointed Special Advocates (CASA)for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 O bi ectives/Activities The intent of this program is to recruit, train and supervise an additional twenty(20) community volunteers to the total number of volunteers to thirty-four (34). These volunteers work with abused, neglected or abandoned children (birth to eighteen years old), who reside in foster or group homes and are dependents of the Juvenile Court System within the City. This will be accomplished through well-trained community volunteers who will become Sworn Officers of the Juvenile Courts and the `child's voice in court'. One major benefit of this mentoring approach, unlike other court principals who often rotate cases, the CASA volunteer is a consistent figure in the proceedings, and provides continuity for a child. 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 qualify at least a total of twenty (20) Palm Springs residents from very low income youth with new access to this service. TARGET DATE ACTIVITY#1 On-Going Twenty (20) Palm Springs residents will participate in CASA. 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: Establish New and/or Expanded Services for Seniors. At-Risk Youth Severely Disabled Adults. and Special need Population. TARGET DATE ACTIVITY#1 On-Going Conduct program activities to improve availability/accessibility, 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 B Budget Summary Proiect/Activity Title: Project Number: Court Appointed Special Advocates (CASA)/ 0006 Support Program Name/Address of Provider: Court Appointed Special Advocates (CASA) for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $15,000. $282,750. $297,750. 2 Consultant/Contract Services - 0 - - 0 - - 0 - Pa roll Processing 3 Travel - 0 - $14,240. $14,240. Mileage Reimbursement 4 Space Rental - 0 - - 0 - - 0 - 5 Consumable Supplies - 0 - $11,000. $11,000. Volunteer Training Material 6 Rental, Lease or Purchase of - 0 - - 0 - - 0 - Equipment 7 Insurance - 0 - $14,500. $14,500. Liability 8 Other - 0 - $5,500. $5,500. Background Checks $15,000. $327,990. $342,990. 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 Judicial Council of CA, United Way of the Desert and of the Inland Valleys, BetterWorld Together, Riverside County Transportation Committee, Target Stores, Individual Fundraising, and Contributed Program Services, all totaling $482,700. EXHIBIT B— Budget Summary Page 2 of 2 Pages DETAIL BUDGET DESCRIPTION OF ACTIVITY/ CDBG OTHER TOTAL PAY ITEMS SHARE SOURCES COST Personnel $15,000. $282,750. $292,750. Consultant/Contract Services -0- -0- -0- Space Costs -0- -0- -0- Equipment— -0- -0- -0- Purchase, Lease or Maintenance Consumable Supplies -0- $11,000. $11,000. Travel -0- $14,240. $14,240. Insurance -0- $14,500. $14,500. Liability Other Operational Costs -0- $5,500.00 $5,500. Total $15,000. $327,990. $342,990. The Subrecipient shall submit monthly reimbursement based on prorated and actual costs in accordance with the aforementioned cost categories and pay items. In no month shall the Subrecipient submit for reimbursement more than Y4 of the total annual budget. Services are to be performed over the twelve-month period of this 2007—08 Program Year—July 1, 2007 through June 30, 2008. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Proiect/Activity Title: Project Number: Court Appointed Special Advocates (CASA)/ 0006 Support Program Name/Address of Provider: Date: Court Appointed Special Advocates (CASA) for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company: Nonprofits' Insurance Alliance of California Effective Dates of Policy: 5/2/2007 to 5/2/2008 Claims Made Policy / / Per Occurrence Policy ! / Limits of Liability: $2,000,000 Deductibles: Per Occurrence$1,000,000 Annual Aggregate$2,000,000 Additional Insured Endorsement (Certificate Holder) 0 Yes ❑ No Original Certificate of Insurance Attached L(es Vlo WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company: Travelers Casualty Insurance Company of America Effective Dates: 111112006 to 11/1/2007 Limits of Liability: $1,000,000 Underlying Coverage Limits Original Certificate of Insurance Attached ❑Yes VNo Client#: 198 2CASAFOR ACORM CERTIFICATE OF LIABILITY INSURANCE 0DATE 5/3112°°"""' S/31l2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Services,Inc. LIC NOF09643 - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. rrt 77-564 Coury Club Dr.,#401 - - - - Palm Desert,CA.92211-.• INSURERS AFFORDING COVERAGE' '" NAIC#' INSURED INSURERA, NIAC 36684 CASA for Riverside County Inc INSURER B. P.O.Box 3008- - ' INSURER C: ' Indio,CA 92202 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR . MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND'CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR IYPE OF INSURANCE POLICY NUMBER POLIr.V EFFEDTIVE POLICY EXPIRATION DATE MMIDOIYY DATE MMIDDM LIMBS A GENERALLueIUTY 200704207NPO 05/02107 05/02108 EACH OCCURRENCE $1000000` X COMMERCIAL GENERAL LIABILITY _ DAMAGETO HEWEDPREMISES fE. $100 000 _ CLAIMS MADE OCCUR MED FXP(An,one person) $10000 RSONKEADV INJURY 0.000.000 t} GENERALAGGREGATE' s2_11M.000 GENIAGGREGIATE LRAR,APPLIES PER: PRODUCTS-COMP/OP AGO $ 000000 _ COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - ALLOWNEDAUTOB BODILY INJURY . $ SCHEDULED AUTOS - (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Peracodenl) GARAGE'LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC $ AUTO ONLY. AGG $ A EXCESSIUMBRELLA LIABILITY 200704207UMB 05/02/07 05/02/08 EACH OCCURRENCE $1000000 OCCUR CLAIMS MADE AGGREGATE $1 009 000 $ DEDUCTIBLE .. $ X RETENTION $1B 000 $ WORKERS COMPENSATION AND WCSTATU- I OTH- EMPLOYERS'LIABILITY LIMITS ANY PROPRIETOR/ RIE%ECUTIVE E.L.EACH ACCIDENT EXCLUDED? $ OFFICERIMEMBER EXCLUOED4 E.L.DISEASE-EA EMPLOYEE $ If SPECIAL PROVISIONS ISIO SPECIAL PROVIBIONS below E.L.DISEASE-PCLICV LIMIT $ A OTHER Directors& 200704207DO 05/02107 05/02/08 $1,000,000 Officers DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 Day Notice of Cancellation for non-payment of premium. Certificate Holder is named as additional insured with respects to General Liability only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Palm Springs DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *an DAYSWRITTEN 3200 East TahQuitZ Canyon Way NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL . Palm Springs,CA 92262 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE LW/V) ACORD 25(2001/08)1 of 2 9S104891/M704890 2NAYO © ACORD CORPORATION 1988 Y 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 ,t .. require* an,, endorsement. A, statement on this certificate does, not conferrights;'to the certificate-,"; holder in lieu of such endorsement(s). DISCLAIMER " The•Certffiadte,oflnsurance on fte r:veseside ofhthisform doesrnot.constittde a'contract between;'__' the issuing lnsurer(s),authorized representative or.-producer,and the certificate holder, nor does"it affimrativoLyror'negativety amend',:extend or alt&,Pe:coverage affordedbythe policies,ifsted't*mon:::,".i,o=,. ACORD 25S(2001108) 2 of 2. #S1048911M704890 " Nonprofits' Insurance Alliance of California_ n cww�w.via .,Arixiwuaaeoms ' - THIS ENDORSEMENT.CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR,ORGANIZ.A.TION This endorsement modifies insurance provided'under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE . .Name of Person or Organization: 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 only with respect to their liability arising out of their requirements foncertain performance placed upon you,as a nonprofit organization,in consideration forhnding or , . finaacial contributions you receive from them. The additional insured status will not be afforded with resp="to liability arising.opC'at er're1ated-W.yqur activities asa real estate tanner for that person or organization;, , (If no entry appeait above,information required to complete this endorsement will be shown itr;the Declarations as applicable.to ,. this endorsement.).. WHO IS AN INSURED(Section II)is amended to.include"as an insured the person or organization shown in the Schedule as an sured but only wits respect to liability arising out of your operations or premises owned by or rented to you. CG 2026 ACORD CERTIFICATE OF LIABILITY INSURANCE DD 06/08127 ' 06/08l200Z PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX AGENCY INC . .. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 150 SAWGRASS DRIVE -.e'I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ROCHESTER,NY 146W ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (877)362-67815.;:% ."' SV996 70A INSURERS AFFORDING COVERAGE NAIC$ MSUREO INSURER A.TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA CASA FOR RIVERSIDE COUNTY INC 44199 MONROE STREET INSURERS: STE D INSURER C INDIO;CA 92201 INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING 'ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE'ISSUED OR. MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR AO Vi POLICY EFFECTIVE POLICY EXPIRATION TYPE OFINSURANCE POLICYNUMBEA DATE MM/DDIYV DATE MM/DD/YY UMITS GENERAL LIANITV EACH OCCURRENCE COMMERCIAL GENERAL LIANUTY DAMAGE TO RENTED CLAIMSMADE OCCUR P M a wre $ _ MED EXP(ARY Me Orson PERSONAL A ADV MLLIR .• GENERAI AGGREGATE ,.,GENLA0GREGATrLWTAPPLIEBPER:'< - ICTS:COMROP AG . FpJCY" JECT ' Lam'. AUTOMOBILEU461UTY 4, COMBINED SINGLE OMIT ANYAUTO (EAAmdenll $ - ALLOWNEDAUTOS (BPODer IL IINeon,URY $ WHEOULED'AUTOS`HIRED AUTOS DCDILYINUURY _ NOR OWNED AUTOS (Per arcukrt) $ PROPERTY DAMAGE (Per amrJo A) $ - GARAGEUABIUTY, AUTOONLY EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG EXCESSNMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ REIENDON' $ $ A WORKERS COMPENSATION AND UB•8438C144-06 11/01/2006 11/01/2007 X I TGIRSTA lrs eR EMPLOYERS'LIABILITY ANY PROPRIETORYPARTNEP/EXECU IVE E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' EL DISEASE EA EMPLOYEE $1,000,000 S yOs,'dra O IZN SPECIAL PROVISX)NB belax EL DISEASE POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS IN THE EVENT OF NON-PAYMENT OF PREMIUM,ONLY TEN(10)DAYS NOTICE OF CANCELLATION SHALL BE GIVEN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABCVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF PALM SPRINGS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 3200 ETAHQUITZSPRINGS, WAY - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PALM SPRINGS,CA 92262 - ' IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES IF AUTHORREO REPRESENTATIVE ACORD 25(2001/08)' ACORD-CORPORATION 1988 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title: Project Number: Court Appointed Special Advocates (CASA)/ 0006 Support Program Name/Address of Provider: Date: Court Appointed Special Advocates (CASA) for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 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—03/20/07) MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME 1 2 3 4 5 6 7 8 LEVEL VERY LOW INCOME $20,700 $23,700 $26,650 $29,600 $31,950 $34,350 $36,700 $39,050 Below 50% LOW INCOME $33,150 $37,900 $42,600 $47,350 $51,150 $54,950 $58,700 $62,500 51 —80% MODERATE INCOME $49,700 $56,800 $63,900 $71,000 $76,700 $82,400 $88,000 $93,700 120% 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. Are you female Head of Household? ❑ 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 inrormahon you provide an this form is confidential and is only utilized for Community Development Block Grant(CDBG)program purposes, a Federally-funded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Quarterly Program Progress Report Project/Activity Title: Project Number: Court Appointed Special Advocates (CASA)/ 0006 Support Program Name/Address of Provider: Date: Court Appointed Special Advocates (CASA) for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 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 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 F Request for Reimbursement Proiect/Activity Title: Proiect Number: Court Appointed Special Advocates (CASA)/ 0006 Support Program Name/Address of Provider: Date: Court Appointed Special Advocates (CASA) for Riverside County, Inc. PO Box 3008; 44199 Monroe Street Indio, CA 92202-3008 Approved Current Prior Total Grant PP ���� Description Grant Reimbursement Reimbursement YTD Balance Amount Period Period(s) Reimbursement (Over/Under Personnel $15,000.00 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.