HomeMy WebLinkAbout05262 - SANTIAGO SUNRISE VILLAGE MHP CORP CDBG SUBRECIPIENT AGR Kathie Hart
From: Dale Cook
Sent: February 25, 2009 11!19 AM
To: Kathie Hart
Subject: RE: A5262 Santiago Sunrise--note to Dale-ok to close?
Yes, it's okay to close Also, do you have any word this morning about Arthritis'Agreement? There are anxious for their
check. Thanks.
From: Kathie Hart
Sent: Wednesday, February 25, 2009 10:48 AM i
To: Dale Cook
Subject: RE: A5262 Santiago Sunrise -- note to Dale - ok to close?
Does this mean it's ok to close?
Kathie
Kathie Hart, CIVIC
Chief Deputy City Clerk
City of Palm Springs
3200 E. Tahquitz Canyon Way
Palm Springs, CA 92262
(760) 323-8206 16 (760) 322-8332
Kathie.Hart@PaImSpringsCA.gov
From: Dale Cook
Sent: February 24, 2009 11:42 AM
To: Kathie Hart
Subject: Task Completed: A5262 Santiago Sunrise note to Dale - ok to close?
Subject: A5262 Santiago Sunrlse--noLe Lo Dale-ok to Close?
Due date: Mon 3/9/2009
Status: Completed
Complete: 1000/a
Date completed: Tue 2/24/2009
Total work: 0 hours
Actual work: 0 hours
Requested by:Kathie Hart
1
SUBRECIPIENT AGREEMENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this 9th day of May , 2007
by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter
city, and the Santiago Sunrise Village Mobile Home Park Corp_, (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 at 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.
12 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 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 2006 — 2007 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 chartable 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.
2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for
its services a sum not to exceed EIGHTY THOUSAND DOLLARS ($80.000.00) (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:
Aimee Molsberry
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.
34 Independent Contractor. Neither the City nor any of its employees shall have
any control over the manner, mode or means by which Provider, its agents or employees, perform the
services required herein, except as otherwise set forth herein. Provider shall perform all services
required herein as an independent contractor of City and shall remain at all times as to City a wholly
independent contractor with only such obligations as are consistent with that role. Provider shall not at
any time or in any manner represent that it or any of its agents or employees are agents or employees
of City.
4.0 COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider shall maintain records of its operations and financial activities in
accordance with the requirements of the Housing and Community Development Act and the
regulations promulgated thereunder, which records shall be open to inspection and audit by the
authorized representatives of the City, the Department of Housing and Urban Development and the
Comptroller General during regular working hours. Said records shall be maintained for such time as
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may be required by the regulations of the Housing and Community Development Act, but in no case
for less than three years after the close of the program,
42 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 Q);
Q) 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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(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 Vill 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
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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)
52 Indemnification. The Provider shall defend, indemnify and hold harmless the
City, its officers and employees, from and against any and all actions, suits, proceedings, claims,
demands, losses, costs, and expenses, including legal costs and 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.
7A Notice. Any notice, demand, request, document, consent, approval, or
communication either parry desires or is required to give to the other parry shall be in writing and either
served personally or sent by prepaid, first-class mail to the address set forth below, or such other
addresses as may from time to time be designated by mail.
TO CITY.
City of Palm Springs
3200 East Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn- City Manager
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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:
Santiago Sunrise Village MHP
P.O. Box 11927
Santa Ana CA 92711
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
ATT J . _ - �a IT upu orporation
By.
it lerk ��� t S��6 O City Manager
APPROVE TO FORM:
( / APPROVED BY MY C U AIL
City Attorney
PROVIDER: Check one: _Individual _Partnership 7/Corporation J
(Corpo rat�IQS requi o notarized signatures: One signature must be from the Chairman of
Boallf., Presi , or any Vice President. The secon ignatu mus be from the Secretary,
Ass _tant Se �ary, Treasurer, Assistant Treasurer, or hie Fi ncial Offic r).
By: uhr flrY By
Ni5tarized S nature of Chairman of Board, No ar ad Si a etary,Asst Secret ry,
President or any Vice President Treas reY,Asst Tr s r or Chief Financial Officer
Name: Richard Simonian Name: Shontele Ian
Title. Vice President Title: Chief Financial Officer
State of d. I kmL = State of Luki _
County
of /,1¢fl L -ss County of l�(('t G6 =ss
On l a O I1`1''"�1' 6 XT�m 1 �-- before me On f�a --before me,
(.Qli�(4uI_.t.f�li0�r;_d!. 'll1V C40(� personally appeared /t r'I L (' V IJbh.1aG, personally appeared
S ayl m'( (Y Qrdmuki � personally known SYILE"lY- eql� lIY l LL personally known
to me (or proved to me on the basis of satisfactory evidence) to me (or proved to me on the basis of satisfactory evidence)
to be the porson(s) whose name(s) is/are subscribed to the to be the person(s) whose name(s) islare subscribed to the
within Instrument and acknowledged to me that helshelthey within instrument and acknowledged to me that he/she/they
executed the same in his/hedtheir authorized capacity(ies), executed the same in his/her/their authorized capacity(ies),
and that by his/her/their signatum(5) on the instrument the and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) person(s), or the entity upon behalf of which the person(s)
acted,executed the instrument. acted,executed the instrument
WITNESS,oy hand and official seal. /J WITNESS ha and official Seal
Notary� d /�= Notary n
Signa e: / � `' " C�� Signat �L
Notary Seal: NotaryyS-ea�l:w
LAURIE R.CHAPLIN + t- - R.C7c,
�
_Omy
Commission:lr 1511078 _1 Commission A
Notary Public-California 5 Notary Public-
Orange County ' Orange C
Comm.Expires Sep 2,20081 My Comm.Expire8�
SantiagoSunnseMH_SubrecipAgrmnrJuiOO
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Proiect/ActivitV Title: Proiect Number
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider.
Santiago Sunrise Village MHP Corp
1500 E San Rafael Or
Palm Springs, CA 92262-1762
O b i ectives/Activities
The intent of this program is for this Mobilehome Non-profit to make its facilities ADA compliant. This will
be accomplished through the construction of a new parking area, just adjacent to the current playground
area, and the installation of new accessible playground equipment in a centralized safe location. These
improvements would meet the priority needs of the very-low and low income mobilehome owners and the
park. The Park has 175 mobilehome spaces and approximately 500 residents which 163 very-low and
low income residents will be served
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 keening 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: Construct a oarking area and install playground equipment that will benefit very-low and
low income qualified residents at least a total of one hundred sixty-three (163) Palm
Springs residents
TARGET
DATE ACTIVITY#1
On-Going Provide additional parking spaces and centralized safe playground areas for its residents.
Maintain records of names, addresses, demographics and service dates for all assisted.
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: Construct new parking area and install playground equipment both being ADA
accessible, 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 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
07/15/07 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
ProiectlActivity Title, Prolect Number
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA improvements
Name/Address of Provider:
Santiago Sunrise Village MHP Corp
1500E San Rafael Dr
Palm Springs, C8 92262-1762
COST CATEGORY MBG OTHER TOTAL
-1 SHARE SOURCES COST
4 Space Rental $ - 0 -
I Equipment
Construction Contracts
° |f costs are ipbe shared by other sources cf funding, including CDBG funds from other jurisdictions,
identify the source nf funding, grantor/lending agency, and cost category information.
Other funding sources include private donations.
P,ogresspayMento. approvedbythe8uUreuipientandbaseduponiheperoentagaof000np|uLionof
the work with m 10% retention, shall be paid by the 30m day ufeaoh nnonih, provided that the
payment application has been submitted to the City onor before the first working day of the month
The Subrecipient shall receive reimbursements in accordance with the aforementioned cost
categories and line items.
Services are to be performed over a twelve month period of July 1, 2006 through June 30, 2007
with funds allocated from 2OOR—D7 Program Year
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Project/Activity Title: Protect Number:
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider: Name/Address of General Contractor.-
Santiago Sunrise Village MHP Corp Santiago Communities, Inc. ^0
1500 E San Rafael Dr dba Santiago Construction
Palm Springs, CA 92262-1762 P.O. Box 11927
Santa Ana, CA 92711 [h
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company Probuilders Spc Ins. Co RRG
Effective Dates of Policy 1014/05-10/4/07
Claims Made Policy_ / / Per Occurrence Policy / !
Limits of Liability $1 million/$2 million
Deductibles:
Per Occurrence $3,500
Annual Aggregate N/A
Additional Insured Endorsement (Certificate Holder) X Yes ❑ No
Original Certificate of Insurance Attached X Yes ❑ No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company ACE Property & Casualty
Effective Dates 12/31/06-12/31/07
Limits of Liability WC Statutory— EL $1 million
Underlying Coverage Limits N/A
Original Certificate of Insurance Attached X Yes ❑ No
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Project/Activity Title: Project Number:
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider:
Santiago Sunrise Village MHP Corp
1500 E San Rafael Dr
Palm Springs, CA 92262-1762
INSURANCEINVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company Century Surety &James River Ins
Effective Dates of Policy 04/30/06 to 04/30/07 & 04/30/07 to 04/30/08
Claims Made Policy_ / / Per Occurrence Policy ! /
Limits of Liability $1,000,000/$2.000,000
Deductibles
Per Occurrence $1,000
Annual Aggregate N/A
Additional Insured Endorsement (Certificate Holder) 0 Yes ❑ No
Original Certificate of Insurance Attached ❑ Yes O No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company Exemption & Praetorian Ins
Effective Dates 12/31/05 to 12/31/06 & 12/31/05 to 12/31/07
Limits of Liability WC Statutory— EL $1,000,000
Underlying Coverage Limits N/A
Original Certificate of Insurance Attached 11 Yes 71 No
ACQRO.,. CERTIFICATE OF LIABILITY INSURANCE 30i26 2007
PRODUCER (619)666-4600, 11=(619)469-1569 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Alvarado Pacific Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Engel Graham & Buchanan ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
7777 Alvarado Rd. #605
La Mesa CA 515413649 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A.Cantu S11rCt
Santiago Sunrisa Village Mobile Home Park Corp INSURER B•l''ederal Insurance Company
95 Santiago Co>mroo-nities, SAC- INBuftER C'
P O Box 11927 INSURERD
Santa Ana C2& 92711 INSURER E.
OVFRAGFS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOPMfHSTANDING ANY
REOUIREMENT.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 P041CIE.5
0., AT 9rs qknw AvpPpm Ir.PD BYPAI I AIMS
INSR ADD"L POLICY EFFECTIVE POLICY EXPIRATION
L7R INSR TYPE OF INSURANCE POLICY NUMBER DATE MWODNY DAM(MMMONYI LIMITS
GENERAL LIABILITY CCP401062 04/30/2006 04/30/2007 A H • r• 5 1,000,000
x MNINTERCIALCENERALLIABIL Y PRFVl EgO RENTED pl S 50,000
.a. CLANIS&ADE H]OCCUR M XP ,c rl S 2,000
x 51,000 DaductiblB PERSONAL&A V INJURY s 1,000,000
OFNFR A FR .ATF 5 2,000,000
GEEN L AGGREGATE LIMIT APPLIES Pa. i"- MPnp Ar 5 1,000,001)
O-
7X POI ICY EC IOC
AUTOMOBILE LIABILITY COMBINED SIN01,F LIMIT
ANYAUTO NOT PROITEDED IEJ amEenll
ALLOW,NEDAUT05 BODILYINJURY S
SCHEDULED AUTOS (Fer Demn)
HIRED AUTOS BODILY INJURY S
NON-CM[D AUTOS IPer ameen[I
PROPERTY DAMAGE S
IPeranoden:I
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
ANY AUTO OTHERTHAN EA ACC S
AUTO ONLY: AO S
EXCESSIUNTERELLA LIABILITY 7994-04-00 1)4/30/2006 04/30/2007 g 2,000,000
% OCCLR CLAIMS NIACE AG FE 5 2,000,000
S 2,000,000
$ DEDUCTIBLE S
RRTENTI(1N C
WORKERS COMPENSATION AND WC STAN- OTH-
EMPLOYERT LIABILITY
ANY PROPkIETpP�PARTryERIExECU-IVE EL FACH ACMMPNT S
OFMCSIVOENIS'cF EXCLUDED?under F I.DISEASE•EA EMPLOYEE 5
Ryes,ALPR MBIO
SPECIAL PF `d151 rv2c mn F,I, DISEASE•POLICYLIMR S
OTH[R
DESCW PIION OF OPERATION52ACATIONSNDIICLCSIIXCLUSIONS ADDED 8Y ENOORSEMENTISPECtAt PROVISIONS
Corti.€i.catc holdcr is c .cd as additional insnrod - cndorsamant rending
CERTIFICATE HOLDER. CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Pal= springs aPIRATION DATE THEREOF, THE ISSUING INSURER W0.4 ENDEAVOR TO MAIL
3200 E. Tahquitz Canyon Way 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Palm Springs, CA 92262 FAILU 0 sD SHALL IMPOSE No Da CATION OR UASILITY OF ANY IGND UPON THE
INSUR R- SAGENTS OR REP ESE T YES.
AySH� ESENTATIV '
ACORD 25(2001f08) C ACORD CORPORATION 19BB
INS025(Dlos)oa, Page 1 of
ACORp-r, CERTIFICATE OF LIABILITY INSURANCE GA TIE o7"Y'
PRODUCER (619) 668-4600 FAX- (619)469-1569 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Alvarado Pacific Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
7777 Alvarado Rd. #605
T.a Mesa CA 91941-3649 INSURERS AFFORDING COVERAGE NAIC#
INSURED - INSURERA Tames River Insurance
Santiago'Sunrise Village ldnb'il'eho a Park' Corp, INSURERB Federal Ii38uranCe COm an
$ Santiago Communities, Inc. INSURER
P 0 Box IIS27 INSURER
Santa Ana CA 92711 INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICAYcD 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
A IM Z$HOWN MAY HAVE I3 #N_REDUCED BY PAID CLAIMS
INSR ADD•4 POLICY EPFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICYNUMSE,R DATEWMIDDffn DATE MMIDOW LIMITS
GENERAL LIABUJTY
H QCCtIRRPNCF 5 1,000,000
X COMMERCU�LGENERN-LIA9hRY DAMAGE TO_RENTED ^I S 50,000
A X CLAIMS MADE OCCUR CCR403062 4/3❑/2007 d/30/2006 MF.D PXP An,nnp ppnN S excluded
P Rs N F V 1,000,000
GENERAL AGGRF.r,ATE S 2,000,000
GENLAGGREGATF LIMIT APPLIES PER PRODUCTS-CnMPIOP A:M1 S 2,000,000
X POLICY PFC LCC
AUTOMOBILE LIADIUTY
COMBINED SINGI.E LIMIT $
ANY AUTO Es amdem)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUT05 (Per Fclsonl
HIRED AUTOS
BODILY INJURYS
NON•OWNED A1T05 Po,peFltlant)nt)
PROPERTY OAMAG'n
(Per amdenq
GARAGE UA61Lm
AUTO ONLY•EA ACCIDENT S
ANY AUTO
OTHER THAN EA ACC 5
AUTO ONLY AGG 3
FXCE_SWUMBRELLA LIABILITY EACI I QCCI S 2000000
OCCUR F MADE AGGREGATE 2000000
s
B DEDUCTIBLE 7924-04-00 4/30/2007 4/30/2008
RET NTION S
WORKERS COMPENSATION AND WC STATU- OTH
EMPLOYERS'LIABILITY Mir S F
ANY PROPRIETORJPARTNERIFCLCUTIVE F,I, EACH ACCIDENT
OFrICERmMEMSEREXCLUDEDI r yc;•Vescrne weer L D FISEASE-EA Eh1PLOYEES '
SPECIA1 PROVISIONS hnlnw EL DISEASE-POI-ICY LIMIT
OTHER
DESCRIPTION OF OPERATION$iWCATIONSNEHICLOSVCX'CLUSIONS ADDED BY ENDORSEMENDSPECIAL PROVISIONS
CCXt1£icate ho7,dor is raced as idditional Xninred as respects Operations e{ zhe named insured at 15D0 E San Rafael
Ative Palm spw;;ngs Ca 92262 w10 days notyLp of cancellation to be given �n the event of non psymenk at Pramivm
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLCO BEFORE TIIE
City of Palm springs EXPIRATION DATE THEREOP, THE ISSUING INSURER VOLL ENDEAVOR TO MAIL
3200 E Tahquizz Ca .ygn Way 10 DAYS WR)TTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.6UT
Palm Springs, , 92262 FALdRa,TO 00 50 SHALL IMPOSE NO DBLIGAnoN DR uaelurY O=nmr KIND uvCN THE
INSURkP.ITS AGENT5ORREPRESENTATIVES
AVTHOR:f�EP SENTATVp;,
'`r' ^;
ACORD 25(2001108( ... r 0 ACORD CORPORATION 1988
INS025 fOWSf coo P„o I of 2
Certificate of Exemption from
Workers' Compensation Insurance
TO: City of Palm Springs
AIfTN: City Clerk and Risk Manager
SUBJECT. Sole Proprietor/Partnership/Closely Held Corporation with No Employees
Please let this memorandum notify the City of Palm Springs that I am a
❑.sale proprietor
partnership
closely held corporation
and do not have any employees whose employment requires me to carry workers'
compensation insuranc . Therefore, I do not carry workers' compensation insurance
coverage. I further warrant that I understand the requirements of Section 3700, et seq.,
of the California Labor Code with respect to providing Workers' Compensation coverage
for any employees. I agree to comply with the code requirements and all other
applicable laws and regulations regarding workers' compensation, payroll taxes, FICA
and tax withholding and similar employment issues. I further agree to hold the City of
m Springs less from loss or liability which may arise from the failure to comply
i any su la or regulations.
r
' Risk Management Approval:
tract r ig lire
NYi4 a vv
.. oYL A t a C
Printed Name of Contractor
Lp r 7— �9 Date
Date
Ifdo�lGl/
C I
ACORD CERTIFICATE OF LIABILITY INSURANCE 31 6/2007Y'
PRODUCER (619)668-4600 FAX: (619)469-1569 THIS CERTIPICATE I$ ISSUED AS A MATTER OF INFORMATION
Alvarado Pacific Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
7777 Alvarado Rd, #605
La Mesa CA 91941-3649 INSURERS AFFORDING COVERAGE NAIC#
INSURED IN$URERA Praetorian IMST3ranCe
Santiago S=iSe Village MRP Corp INSURER
SG Santiago Co:munitics, Inc. 1 INsuRER c:
P O sox 11927 INSURL-R O•
Santa Ana CA 9272,1 INSURER
COVERAGES I
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THC INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY
REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE P0410CS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
WITS S r: y AICLAIMS
INSR ADD'L EFFECTIVE POLICY EXP+RATION
TYPE OF INSURANCE POLICY NUMBER DATEPOLICY MMfVB/YY DATE WMIDOIYY LIMITS
GENP,RALLIABILITY p S
CONINIERCIAL GENERAL LIABILITY �H�MOF TO c7t•On I 5
CLAIMS t•IACE ❑OCCUR ME EXP An one even 5
p ^n VI Y S
F A R- .A 5
GEN'LAGGREGATEUfJiTAPPLIE$PER PRCMUC MROFACC 5
PP.O•
POLIO .IFPT I I LOC
AUTOMOBILE LIABILITY
CDh+BMED SINGLE OMIT $
ANY AUTO (Ee amdenl)
ALL OWNED AUTO$ BODILY INJURY S
SCHEDULED AUTOS (Per pelscn)
HIRED AVT05 BODILY INJURY
NON•OVlNE0 AUTOS (PerA�d°'p 5
PROPERTY DAMAGE S
(Peramdent)
GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $
ANY AUTO
OThIER THAN EA ACC 5
AUTO ONLY AG 5
EXCESSNMBRELLA LIABILITY q S
OCCUR F�CLAMIS MADE Ap.REnATE S
S
DEDUCTIBLE $
RFTFNYION 5 IG
A WORKERS COMPENSATION AND WnrC STAN- OTH-
EMPLOYERS'UAMIJfY
ANY PROPRETO,PAMNER'EXECUTIVE E.LEACHA (DENT 5 11000,000
OFFICERJMENTER EKCLUDEDP P0011D10035ZS7 12/Sl/2006 12/31/2007
If yes,de CI a wder E.L DISGSE•G EMPLOYEE 5 1,0 D 01000
$PECIAI PROvLsmNS b,nx' FL DMIS49E-POLICYL11+IT 5 1,000,000
OTHER
DESCRIPTION OF OPPRATION&LOCAnONSNCHIOLESIEXCLUSIONSADDEDBYENDOR EMENTISPECIAL PROVISIONS
Proof of Insurance
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of Pals spring5 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
32 00 E. Tafy uitz Canyon Way 1D DAYS WRITTEN NOTICE TO THE CERTIRLATE HOLDER NAMED TO T14P LEFT,BUT
Palm Springs, CA 92262 FaJ4URE TO 50 SHA"IMBOSE NO OBLIGATION OR LIADIUTY OF ANY WND UPON THE
INSU ER�t{$AGENTS OR REFRE$ENTN6E ES.
AUTH REPRESENTATIV
ACORD 25(2001m ®ACORD CORPORATION 1938
M50261oro57 oea Page 1 c'2
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Project/Activity Title Protect Number:
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider:
Santiago Sunrise Village MHP Corp
1500 San E Rafael Dr
Palm Springs, CA 92262-1762
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the
described projeal/2ctivity. 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-Ontario,CA MSA—03108/06)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD;
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $20.150 $2300 $25,900 $28,750 $31 050 $33 350 $35 650 $37,350
Below 50%
LOW INCOME $32 200 $36,800 $41,400 $46,000 $49 700 S53 350 $57 050 S60 700
51 —80%
MODERATE
INCOME $48,300 555,200 $$2,100 509,000 $74,500 $80,000 $85,600 $91,100
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/Afncan American
❑ Native Hawaiian or Other Pacific Islander ❑ Other.
HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes check one: ❑ Mexican/Chicano
❑ Puerto Rican
❑ Cuban
Cl Other.
A. Are you female Head of Household? ❑ YES ❑ NO
S. Do you have a disability? ❑ YES ❑ NO If YES, please describe:
ACKNOWLEDGEMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME: DATE:
ADDRESS: PHONE NO:
SIGNATURE:
The information you provide on this form is confidential and is only utilized for Community Development Block 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
Prolect/AcLiyity Title: Project Number:
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider:
Santiago Sunrise Village MHP Corp
1500 E San Rafael Dr
Palm Springs, CA 92262-1762
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 Slack/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 m
Request for Reimbursement
Proiect/ActiviL Title' Project Num_ber:
Santiago Sunrise Village MHP Corp 0002
Parking Lot& Playground ADA Improvements
Name/Address of Provider:
Santiago Sunrise Village MHP Corp
1500 E San Rafael Dr
Palm Springs, CA 92262-1762
BENEFICIARY QUALIFICATION STATEMENT
'Approved' current Prior' Total Grant
Description Grant Reimbursement Reimbursement YTD Balance
Amount Period Period(s) Reimbursement (Over/Under)
TOTAL =1===
I CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the CD6G, 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.
2762-276a-5,40 USC 327 and 40 USC 275c)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 Campliance
Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135 and all applicable rules and orders
issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided
under this Contract and binding upon the CITY the PROVIDER and any of the PROVIDER'S subrecipients and
subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDERS
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.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 law-and very low-income residents within the service area or the neighborhood in which the project
is located,and to low-and very low-income participants in other HUD programs.
The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with
these requirements.
b Notifications
The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective
bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or workers
representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places
available to employees and applicants for employment or training