HomeMy WebLinkAbout05457 - FAMILY YMCA OF THE DESERT CDBG SUBRECIPIENT AGR 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 PY 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,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$336,623.`
Public Services ......... ......... ......... 7$ 7.682•
TOTAL PROGRAMMATIC FUNDS.................................. . ,„,.,........$414,305
ADMIN (includes Citizen Participation & Fair Housing) ..-- 10$ 3,576
TOTAL CDBG 2007—2008 ENTITLEMENT,,,,,,„--------------------------------------- 1S5 7.881.
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 s
Strategic Plan Goals), to which the proposed allocation relates.
_IL la$29
r Efficienc Improvements s $29'744' 47V
relates-
Family nle,rgy-CA i the Impsort __—IwaArorks-1 Noo Hsng CD D2&3.. ....._
96,879.
Besert7kYp5 Non-Hsng CD 1 00
Relrn-eprirrcrs•peparkiuA^�^4�� �=R.BPr^r�� ^^— Non-Hsng CD 1 95,000
JemesfirJ2ss'>si 'DeSert�Fhglvland Unity Center Energy-Efficiency
__improvements
Ar 1,rG Mizell Senior Center- Non-Hsng 1
rJ''rJ_I y, Vehicle
_ Meals On Wheels&Outreach Hybrid Vehi _ _ ___ _ __ ____—____________ 27.200
Court p.4 Sunup Rota Foundation IncNon-5ng 1 ""- ----------._"15,000.
Cou Appointed Special Advocates for Riverside County, - Non n
P�rr - Su p Pe Children of the Desert- Non
1 Springs ry g 16,482
1-Smile
Fa f,,r the
wealth arc----------------Deser---------.---------..... . H.....1��---_ 00
� -Hsng 1
Earii
^ Ho Chil ho udoralf$jPers de .. --- --- ....1.9�
p
g'Co Hsng 4 15,000.
FsirwHousi _ ____ __
W4)ep9ftnneat-of.Cocw�iic Developmen �-t n/a 75,833
Gel+e„reI-RrogranrFedtizen Participation— ., .,,, „ . ............ -
RS,papwaut.frt.6prwrrrdgily-&•Economic Development— n/a 12,743
ladiFeOhPr raFn�Adminielrabon Costs
TOTAL FUNDING(Annual Allocation $517,881.
Hsng = Housing Goals
Hmis= Homeless Goals
Non-Hsng = Non-Housing Goals
Non-Hsng CD= Non-Housing Community Development Goals oaiecicoec07-O9/AnniPInFndngSumry M.ryo7
SUBRECIPIENT AGREEMENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this 12th day of July,
_2007, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and
charter city, and the Family YMCA of the Desert, (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 seg.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 at seg. ("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 22, 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 reporls 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 W1 of the current fiscal year.
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 TWENTY-NINE THOUSAND AND SEVEN HUNDRED FORTY-
FOUR DOLLARS ($29,744.00) (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.
22 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 13.6.
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:
Terri Bona, Director of Fund Development
Alison Elsner, Associate Executive Director
Rob Ballew, Chief Executive Officer
3.2 Contract Officer. The Contract Officer shall be such person as may be
designated by the chief administrative officer of City.
3.3 Prohibition Against Subcontracting or Assi nment. Provider shall not contract
with any other entity to perform in whole or in part the services required hereunder without the express
written approval of the City. Neither this Agreement nor any interest herein may be assigned or
transferred, voluntarily or by operation of law, without the prior written approval of the City.
3,4 Independent Contractor. Neither the City nor any of its employees shall have
any control over the manner, mode or means by which Provider, its agents or employees, perform the
services required herein, except as otherwise set forth herein. Provider shall perform all services
required herein as an independent contractor of City and shall remain at all times as to City a wholly
independent contractor with only such obligations as are consistent with that role. Provider shall not at
any time or in any manner represent that it or any of its agents or employees are agents or employees
of City.
4.0 COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider shall maintain records of its operations and financial activities in
accordance with the requirements of the Housing and Community Development Act and the
regulations promulgated thereunder, which records shall be open to inspection and audit by the
authorized representatives of the City, the Department of Housing and Urban Development and the
Comptroller General during regular working hours. Said records shall be maintained for such time as
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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-annual reports on program status;
(b) Section 109 of the Housing and Community Development Act of 1974,
as amended and the regulations issued pursuant thereto;
(c) Section 3 of the Housing and Urban Development Act of 1968, as
amended;
(d) Executive Order 11246, as amended by Executive Orders 11375 and
12086, and implementing regulations at 41 CFR Chapter 60;
(e) Executive Order 11063, as amended by Executive Order 12259, and
implementing regulations at 24 CFR Part 107;
(f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as
amended, and implementing regulations;
(g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and
implementing regulations;
(h) The relocation requirements of Title II and the acquisition requirements
of Title III of the Uniform Relocation Assistance and Real Property
Acquisition at 24 CFR Part 42;
(i) The restrictions prohibiting use of funds for the benefit of a religious
organization or activity as set forth in 24 CFR 570.200 0);
0) 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);
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(a) 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 segJ;
(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 properly 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 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 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:
Family YMCA of the Desert
43-930 San Pablo
Palm Desert, CA 92260
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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ry - CITY OF PALM SPRINGS
ATTTE T: _ _ _ a municipal corporation
/b7 �
Clerk City Manager
APPROV S TO FORM:
By: A ( �j� �f APPROVED BY COW COUNCIL
City Attorney
PROVIDER: Check one. —individual —Partnership _Corporation
(Corporations require two notarized signatures: One signature must be from the Chairman of
Board, President, or any Vice President. The second signature must be from the Secretary,
Assistant Secreta asur�er, ASsistant Treasurer, or C 'ief Financial Cffcer).
Sy
: By:
Notarized Signature of Chairman of Board, Not rized Sig ature Secretary, Asst Secreta ,
President or any Vice President Treasurer,Asst Treasurer or
Chief Financial Officer
Name: y9.� y '� i� Name, Ab�c.q n 9 1 • 1-yaq,�,
Title: 7�-e-(�-,J 6,t-7— Title: -r f cc,
State of Lod L=ILA = State of Ok It'-YWgr�+
County of as County oft Lcrn�r:ti,Vie- as
On��� <TGL n c)00.) before me, On ��y -bL �QC�� before me.
/`-J personally appeared /'C _I �P CL�MIY c�rR .personally appeared
personally known '�-JO S8 �� 74-. personally known
to me(or-p d-To-r vrrllt�basis-af-satrsfacte�errcef to me (er-pr ta-m saiiz`n.etety-avideace}
to be the per on(s) whose name(&}ish subscribed to the to be the persons-whose name* is/are-subscribed to the
within instrument and acknowledged to me that helshekhey within instrument and acknowledged to me that he/she�
executed the same In his/hentheif authorized capacity(des} executed the same in his4rerlthe*authorized capacity(ieo.
and that by hiafheNtheir signature(o on the instrument the and that by his4P&RU*;-signature(5)-an the instrument the
person(o,, or the entity upon behalf of which the person(ej' person(.$), or the entity upon behalf of which the person(s)
acted,executed the instrument acted,executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal. /1
Notary � c Notary
Signature. Signature:
Notary Seal: Notary Seal:
R.J.SELDoMROGE
R.J.5ELdOMRIGGE _61MVC01nm-
CommRsion*1542124
Ccmmiulon#1542124 Notary Public•CaMiornia
=� Notary Pubic CaAlamla RweakM Cou*
Riverside County Ex0fi+Jon 7.2009
My Comm.Erpiim Jan 7,2
YMCA_SubroclpAgrmnt Ju107
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Proiect/Activity Title, Proiect Number
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider,
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92250 Palm Springs, CA 92263-9530
O biectives/Activities
The intent of this program is to provide after-school programs for at-risk children of low and moderate
income households This will continue the YMCA's energy conservation efforts to the facility by
upgrading the roofing system on the lower roof section of the gym and replacing the gyro's seven
evaporative coolers These improvements would replace aged and non-efficient systems with more
energy-saving ones, which will reduce operational costs. The YMCA also serves as one of the City's
emergency shelters under the Fire Department's Emergency Preparedness Plan and houses one of the
Fire Departments Disaster Medical Assistance Packages on their premise. YMCA primarily serves the
Veterans' Tract neighborhood of the city and that Census Tract of 700 Palm Springs' residents of which
358 are low to moderate-income 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 keeoino 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 one thousand one hundred and forty-one
(1,141) low and moderate-income Palm Springs residents with improved access to the,
facility.
TARGET
DATE ACTIVITY#1
On-Going Provide direct client programming for Palm Springs residents. Maintain records of
names, addresses, demographics and service dates for all assistance.
Objective 5: Maintain records for all CDBG activities related to this program.
TARGET
DATE ACTIVITY#1
On-Going Document and maintain all records related to this program, including those required, in
accordance with HUD Regulations, in a stable and secure location.
ACTIVITY#2
On-Going Submit Semi-Annual reports—referenced Exhibit E.
Objective 6: Manage/monitor program activities.
TARGET
DATE ACTIVITY#1
On-Going Perform monitoring activities necessary to ensure that the program is being conducted in
compliance with the CDBG policies, federal regulations, and local statues, including
Davis-Bacon Act, Copeland Act, and Non-discrimination / EEO requirements.
Objective 7: Upgrade the roofing system on the lower roof section of the gym and replace the gym's
seven evaporative coolers.
TARGET
DATE ACTIVITY 41
On-Going Conduct program activities to improve availability/accessibility in accordance with an
'open competitive' procurement process as stipulated in the proposal and in consultation
with the City
Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final
reimbursement
TARGET
DATE ACTIVITY#1
07/15/02 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,
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
BUDGET SUMMARY
COST CATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel - 0 - - 0 - - 0 -
2 Consultant/Contract Services - 0 - - 0 - - 0 -
3 Travel - 0 - - 0 - - 0 -
4 Space Rental - 0 - - 0 - - 0 -
5 Consumable Supplies - 0 - - 0 - - 0 -
6 Rental, Lease or Purchase of $23,600, - 0 - $23,6 00.
Equipment
7 Insurance - 0 - - 0 - __ 0 _
8 Other $6,174. - 0 - $6,174.
Roofing Contracts
$29,744. - 0 - $29,744.
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.
Progress payments, approved by the Subrecipient and based upon the percentage of completed
work, as outlined in the respective Professional Service Agreement and the Construction
Agreement with a 10% retention, 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.
The Subrecipient shall receive reimbursements and/or its suppliers/vendors shall receive direct
payments by way of a two-party check, in accordance with the aforementioned cost categories and
line items which are subject to receipt of an acceptable requisition in the form of a monthly Request
for Reimbursement.
Services are to be performed over a twelve month period of July 1, 2007 through June 30, 2008
with funds allocated from 2007—08 Program Year.
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Prolect/ActIVItV Title: Project Number:
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Desert Empire Insurance
Effective Dates of Policy 111/07 to 1/1/08
Claims Made Policy / / Per Occurrence Policy /X /
Limits of Liability $4,000,000 General Aggregate
Deductibles:
Per Occurrence $2,000,000
Annual Aggregate $4,000,000
Additional Insured Endorsement (Certificate Holder) 0 Yes 0 No
Original Certificate of Insurance Attached 0 Yes ❑ No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company_ Desert Empire Insurance
Effective Dates 6/1/07 to 6/1/08
Limits of Liability
Underlying Coverage Limits
Original Certificate of Insurance Attached E Yes ❑No
Client#:1047 2FAMIYMC
,T�CORD- CERTIFICATE OF LIABILITY INSURANCE 07103/2007 1
u PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Desert Empire Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Services,Inc. LIC#OF09643 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
77-564 Country Club Drive
Palm Desert,CA 92211 INSURERS AFFORDING COVERAGE NAIC$
INSURED wGURERA. Discover RE 44440
Family YMCA of the Desert INg11RER B: Virginia Surety Company,Inc 5177
43-930 San Pablo Ave.
INSURER C
Palm Desert,CA 92260 INSURER D:
INSURER E:
COVERAGES
THe POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 SUCK
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR k5-D9 POLIICYrCFFFOCTIVE POLICY EXPIRATION LIMITS
LTR NSR TYPE OF INSURANCE POLICYNUMBER
A GENERAL LIABILITY D217POO244 01/01/07 01/01/08 EACH OCCURRENCE s2000 000
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 DO OOD
CLAIMS MADE OCCUR MED EXP(Any ono poraon) $5000
PERSONAL i ADV INJURY S20D0 DOD
GENERAL AGGREGATE sa 00D DOD
GEN%AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOP AGG S2000000
P0410Y DPRO-CT LOC
A AUTOMOBILE LIABILITY 0217A00941 01/01/07 01/01/08 COMBINED SINGLE LIMIT
X ANYAMTO (EaaccJdonl) 52,000,000
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per person)
X HIRED AUT09
BODILY INJURY
S
X NON•OWNEO AUTOS (Pnr ncrlgont)p
PROPERTY DAMAGE S
(Per aed0en)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGO E
EXCESSNMBRELLA MBILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE E
S
DEDUCTIBLE y
RETENTION S 1 15
B WORKERS COMPENSATION AND VSQSWPOODOB0402 06/01/07 06/01/08 X WC STATM- OYH-
EMPLOYERS'LIABILITY
ANY PROPRIETOWPARTNEWEXECUTIVE EL.EACH ACCIDENT S1,000,000
OFFICER/MEMBER EXCLUDEDT E.L.DISEASE-EAEMPLOYEE $1,000,000
SPECAL PROVISIONS hd. E.L.DISEASE-POLICY LIMIT 1 51,000,000
OTHER
DESCRIPTION OK OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADpEO BY ENDORSEMENT/SPECIAL PROVISIONS
10 Day Notice will be given if cancelled for non payment.
City of Palm Springs,its officers,officials,employees&volunteers are included as
additional insured by written agreement per form CG2011 01196 attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Palm Springs DAM THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n DAYS WRrMN
Attn:City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
Box 2743 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Palm Springs, CA 92262 REPRESENTATIVES.
AUTHORITEO REPRESENTATIVE
lejwvt &Vwr
ACORD 25(2001108)1 of 2 #S1062381M105018 2RBRI O ACORD CORPORATION 1988
' POLICY NUMBER: 1)217P00244 COMMERCIAL GENERAL LIABILITY
CG 20 11 01 96
TITS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED- MANAGERS OR LESSORS OF
PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
1. Designation of Premises (Part Leased to You):
ANY LEASED PREMISES
2. Name of Person or Organization (Additional Insured):
ANY PERSON OR ORGANIZATION THAT IS REQUIRED BY CONTRACT OR
AGREEMENT.
3. Additional Premium: INCL.
(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement)
WHO IS AN INSURED (Section U)is amended to include as an insured the person or organization shown in the Schedule
but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you
and shown in the Schedule and subject to thefollowing additional exclusions:
This insurance does not apply to:
1. Any"occurrence"which takes place after you cease to be a tenant in that premises.
2. Structural alterations,new construction or demolition operations performed by or on behalf of the person or organization
shown in the Schedule_
CG 20 110196 Copyright,Insurance Services Office,Inc., 1994 Page 1 of 1 ❑
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Protect/Activity Title. Protect Number:
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3501 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
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 fallowing 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,roamers,or boAveem cannot be Included as household members.
2. Circle your combined gross annual income(Riverside-San Bernardino,CA—03120107)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME S20,700 $23.700 $26,650 S29,600 S31,950 $34 350 S36,700 $39,050
Below 50%
LOW INCOME $33,150 $37 900 S42 600 $47,350 $51 150 S54,950 $58,700 $62 500
51 —80%
MODERATE
INCOME S49,700 $56,800 $63 900 S71,000 576,700 $62 400 S88,000 $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
0 Asian ❑ Black/African American AND White
❑ American Indian or Alaskan Native 0 American Indian/Alaska Native AND Black/African American
❑ Native Hawaiian or Other Pacific Islander Ll Other.
HISPANIC/LATINO ETHNICITY ❑ Yes 0 No If yes, check one 13 Mexican/Chicano
0 Puerto Rican
❑ Cuban
F3 Other:
4. Please check,)res or no,d you are a female Head of -lousehold? El 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 confidential and is only uuhzed for Community Dovolopment Block Grant(CDBG)program purposes,a
Federally-funded program governmental reporting purposes to monitor compliance
CITY OF PALM SPRINGS
EXHIBIT E
Semi-Annual Program Progress Report
Project/Activity Title: Prolect Number
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider:
Family YMCA of the Desert
43-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
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
Proieet/Activity Title: Project Number.
Family YMCA of the Desert
Energy-Efficiency Improvements 0001
Name/Address of Provider-
Family YMCA of the Desert
4$-930 San Pablo Avenue 3601 E Mesquite Ave
Palm Desert, CA 92260 Palm Springs, CA 92263-9530
BENEFICIARY QUALIFICATION STATEMENT
FApp',o�'ted Current Prior Total GrantPescriptlon Gan Reimbursement Roimhursement YTo Balanca
Amout Period Period(s) Reimbursement (Ovorl Under)
Rental, Lease or $23,500.
Purchase of Equipment
Other $6,174.
Roofing Contracts
TOTAL $29,744 = ]���
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
2768-276a-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 oAveers
issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided
under this Contract and binding upon the CITY the PROVIDER and any of the PROVIDER'S subrecipients and
subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S
subrecipientS and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through
which Federal assistance is provided The PROVIDER certifies and agrees that no contractual or other disability exists
which would prevent compliance with these requirements
The PROVIDER further agrees to comply with these "Section 3" requirements and to Include the following language in all
subcontracts executed under this Agreement:
"The work to be performed under this contract is a project assisted under a program providing direct Federal financial
assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of
1968. as amended, 12 U.S C 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 law-and very
low-income persons rending 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 rending 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 hazard), housing construction, or other public construction project are given to business
concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in
which the CDBG-funded project is located, where feasible priority should be given to business concerns which provide
economic opportunities to law-and very low-income residents within the service area or the neighborhood in which the project
is located,and to law-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 nonce 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.