HomeMy WebLinkAbout05268 - PALM SPRINGS UNIFIED SCHOOL DISTRICT CDBG SUBRECIPIENT AGR SUBRECIPIENT AGREEMENT ppQQ
THIS AGREEMENT (herein "Agreement"), is made and entered into this�91ay of_ OYt L,
2001, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and
charter city, and the Palm Springs Unified School District , (herein "Provider")-
WHEREAS, the City has entered into various funding agreements with the United States
Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG
Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C.
Section 5301 et sec.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et seMc. ("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 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 charitable trust report to the Attorney General,
or other financial information satisfactory to City' s Finance Director. The financial information
provided for in this paragraph shall be furnished not later than January 31 s`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 SEVENTEEN THOUSAND SEVEN HUNDRED and NINETY
DOLLARS (JIL 90.00) (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-
30 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:
Tracy Piper
3.2 Contract Officer, The Contract Officer shall be such person as may be
designated by the chief administrative officer of City.
3.3 Prohibition Against Subcontracting or Assignment. Provider shall not contract
with any other entity to perform in whole or in part the services required hereunder without the express
written approval of the City. Neither this Agreement nor any interest herein may be assigned or
transferred, voluntarily or by operation of law, without the prior written approval of the City.
3.4 Independent Contractor. Neither the City nor any of its employees shall have
any control over the manner, mode or means by which Provider, its agents or employees, perform the
services required herein, except as otherwise set forth herein. Provider shall perform all services
required herein as an independent contractor of City and shall remain at all times as to City a wholly
independent contractor with only such obligations as are consistent with that role. Provider shall not at
any time or in any manner represent that it or any of its agents or employees are agents or employees
of City.
4.0 COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider shall maintain records of its operations and financial activities in
accordance with the requirements of the Housing and Community Development Act and the
regulations promulgated thereunder, which records shall be open to inspection and audit by the
authorized representatives of the City, the Department of Housing and Urban Development and the
Comptroller General during regular working hours. Said records shall be maintained for such time as
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may be required by the regulations of the Housing and Community Development Act, but in no case
for less than three years after the close of the program.
4.2 The Provider certifies it shall adhere to and comply with the following as they
may be applicable:
(a) Submit to City through its Community and Economic Development
Department 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);
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 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 Providers 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 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:
PSUSD Adult Vocational Ed - Cafe Ramon
2248 Ramon Rd
Palm Springs, CA 92264-7917
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
ATTES :_ _ a municipal corporation
By. By ;--;*�%
y lerk �G f I FY too J' City Manager
APPROV TO FORM•
I ✓ APPROVED BY CITY COUNCIL
City Attorney ,�47 a`Q3 'w'0 (�
PROVIDER: Check one: _ Individual _ Partnership w 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:
No arized Signature Chairman of Board, fiedature Secr tary, Asst Secretary,
President or any Vice President Trereasurer or Chief Financial Officer
Name: Lorri S. McCune Naes Novak
Title: Superintendent of Schools Title: Asst. Supt. , Bus. Svcs.
State of Ca(s rye,q = state or CAL�ortiiA =
Countyof " M 'ct - sss Count/lyof-RiJaY$id.0 =_as
On 4qo' l (i goc�7 !1^ before me, On AMP I tlgi o2001 before me,
LA_IA.f A �.�e f�2 '� , personally appeared Laur A L-0batJV- ,personally appeared
r2t•r•i S. 0 GfAwe- personally known -?'144tC9 (JouN K personally known
to me(� prouod Soma an' p�^f} �,-' ,e) to me ( graved o o a s�ti f g m)
to be the persory(a) whose name(e) islem subscribed to the to be the person* whose nameke) ishe a subscribed to the
within instrument and acknowledged to me that1e/she/grey within instrument and acknowledged to me that hehheitl ey
executed the same in qie/her/their authorized cepacity(ee) executed the same in hisAm#lheir authorized capadty(iea},
and that by his/herAl+eir signature(ej on the instrument the and that by hisAHWULeii signaturei(or on the instrument the
person1p), or the entity upon behalf of which the persons) persen;4, or the entity upon behalf of which the pemonaaj
acted,executed the instrument. acted,executed the instrument.
WITNESS my hand and official seal WITNESS my hand and official seal.
Notary Notary
Signature,- Signature,
-
Notary Seal, Notary Seal
1OLANRA L.60YSE lAORA L BOYSE
Commission#1452045 COmmisslon# 1452045
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R"Micle County Notary alifornio
MyConrin.Expires Dec 17,2007 RNeraidtt County
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Project/Activity Title: Project Number:
Palm Springs Unified School District 0008
Ramon Alternative Center- Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date.
PSUSD Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
O b I ectives/Activities
The intent of this program is to provide hands-on educational and training in the field of Culinary Arts for a
new specialty high school program. It is an innovated program to prepare students for entry into culinary
careers to ensure a relevant curriculum to meet the educational needs of the students for successful
graduation. The program will enroll thirty (30) low-to-moderate at-risk students of which ten (10) youth
Palm Spring 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 anv 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
(Le. Provider, City, CDBG. etc.)_,
TARGET
DATE ACTIVITY#1
On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun.
Submit final publication to City
Objective 4: Enroll and income qualifies at least an approximately ten 10 at-risk Vouth.
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 MUD Regulations, in a stable and secure location
ACTIVITY#2
Monthly 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: Provide emergency housing services, including motel vouchers to homeless individuals,
as outlined_in_proposal.
TARGET
DATE ACTIVITY#1
On-Going Conduct program activities, as stipulated in the proposal.
Objective S: 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, (Ac.)
CITY OF PALM SPRINGS
EXHIBIT B
Budget Summary
Project/Activity Title: Project Number:
Palm Springs Unified School District 0008
Ramon Alternative Center-Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date:
PSUSD Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
_ �--BUDGET SUMMARY
COST CATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel $345,000. $345,000.
2 Consultant/Contract Services $
3 Travel: $5,000. $
Student Field Trips & Conferences
4 Space Rental $
5 Consumable Supplies $30,o00. $
Food Prep & Cookin2 Utensils
6 Rental, Lease or Purchase $100,000. $
of E ui ment
7 Insurance $
8 Other— $10,000. $10,000.
Operating Expenses
$17,790. S $
Scholarships $2,223.75/Student
Indirect Costs
TOTALS $17,790, $490,000. $507,790.
'If costs are to be shared by other sources of funding, including CDBG funds from other jurisdictions,
identify the source of funding, grantor/lending agency, and cost category information.
Other funding sources primarily are Carl Perkins Vocational &Technical Education and Title I federal funds.
The Subrecipient shall submit Request for Reimbursement in accordance with the aforementioned cost
categories. The program will pay for$2,223 for student scholarships, not to exceed $17,790. In no quarter
shall the Subrecipient submit for reimbursement more than '/a of the total annual budget. Payments,
approved by the Subrecipient, shall be paid by the 301h day of each month, provided that the payment
application has been submitted to the City on or before the first working day of the month.
Services are to be performed over the twelve-month period of this 2006-07 Program Year — July 1, 2006
through June 30, 2007.
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Praiect/Activity Title: Proiect Number:
Palm Springs Unified School District 0008
Ramon Alternative Center-Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date
PSUSD Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company S CA ReLiEF & SAFER
Effective Dates of Policy 07/01/06 to 07/01/07
Claims Made Policy ! Per Occurrence Policy
Limits of Liability $21,620 000
Deductibles:
Per Occurrence $50 000
Annual Aggregate
Additional Insured Endorsement (Certificate Holder) 0 Yes ❑ No
Original Certificate of Insurance Attached ❑ Yes 0 No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company Midwest Empolvers Casualty Company
Effective Dates 07/01/06 to 07/01/07
Limits of Liability $1 000 000
Underlying Coverage Limits
Original Certificate of Insurance Attached 0 Yes 10 No
So Cal ReLiEF CERTIFICATE OF COVERAGE ISSUE DATE 04/06/ 77
ADMINISTRATOR: LICENSE 0 0451271 THIS CERTIFICATE IS ISSUED AG A MATTER OF INFORMATION
Keenan & AS soC iate$ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3330 Vine Street, #200 HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR
Riverside, CA 32507 ALTERTHE COVERAGES AFFORDED SY THE COVERAGE
DOCUMENTS BELOW.
COVERED PARTY: ENTITIES AFFORDING COVERAGE
ENTITYA Southern California
Palm Springs Unified School District ReL>_EF
980 E. Tahquitz Canyon Way, Suite 200
Palm Springs, CA 92262
ATTN
MIS 15 TO CERTIFY THAT THE COVERAGES 415TED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FORTHE PERIOD INDICATED NOTVVMHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN
THE COVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS
ENT TYPE OF COVERAGE COVERAGE EFFECTIVEI MEMBER
L7R DOCUMENTS EXPIRATION DATE RETAINED LIMIT LIMITS
I DEDUCTIBLE
GENERAL LIABILITY
A [g]CENERAL LIABILITY SCROO19050 07/01/06 COMBINED SINGLE LIMIT
[ ] LAMS MADE[X]OCCURRENCE EACH OCCURRENCE
[XGOVERNMENT CODES 0 07/01/07 550, 000 51, 000, 000
t,%IERRORS&OMISSIONS
[ I
AUTOMOBILE LIABILITY
[,]{]ANY AUTO COMBINED SINGLE LIMIT
A SCROCIS050 07/01/06 EACH OCCURRENCE
[g]HIREO AUTO
[X]NON-OWNED AUTO 0 07/01/07 $50, 000 $ 1, 000, 000
[gJGARAGE LIABILITY
[XIAUTO PHYSICAL DAMAGE
-PROPERTY SCROO19050 07/01/06
A ALLRISK s5, OD0 s250, 000, 000
EXCLUDES EARTHQUAKE&FLOOD 0 07/0l/07 EACH OCCURRENCE
A STUDENT PROFESSIONAL LIABILITY SCROO19050 07/01/06
0 07/01/07 S50, 000 sINCLUDED
EACH OCCURRENCE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I RESTRICTIONS I SPECIAL PROVISIONS:
AS RESPECTS TO THE RAMON ALTERNATIVE CENTER - CAFE RAMON CULINARY ARTS
PROGRAM.
CERTIFICATE HOLDER: CANCELLATON . SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE
CANCELED�B�EdF.VOY.RYE THE EXPIRATION DATE THEREOF,THS ISSUING ENTITY/JPA
CITY OF PALM SPRINGS WILL 9NWW4K MAIL 30 DAYSWRTfENNOTICETO�ECERIIFICATF
P-0. SOX 2743 HOLDER NAMED TO THE LEFTa�syyLR¢�rfa+L�F:secL
PALM SPRINGS, CA 92262 � � "'�'�`
e4dCACD€RFxC�Rd ffiN�dnttl�/Y}t:]�����
ATTN: CITY CLERK AUTHORIZED REPRESENTATIVE
K&A..P/L.0620001 of 1 #S73936/M63218 TZS
A.G. 7333 G
SOUTHERN CALIFORNIA ReLiEF
ENDORSEMENT
ADDITIONAL COVERED PARTY
COVERED PARTY COVERAGE DOCUMENT ADMINISTRATOR
[DP
a1m Springs Unified School SCR00190500 KEENAN &ASSOCIATES
istrict
Subject to all its terms, conditions, exclusions and endorsements, such additional
covered party as is afforded by the coverage document shall also apply to the
following entity but only as respects to liability arising directly from the actions and
activities of the covered party described under "as respects" below.
Additional Covered Party:
CITY OF PALM SPRINGS
P.O. BOX 2743
PALM SPRINGS, CA 92262
As Respects:
AS RESPECTS TO THE RAMON ALTERNATIVE CENTER - CAFE RAMON
CULINARY ARTS PROGRAM.
THE CITY OF PALM SPRINGS, IT'S OFFICERS, OFFICIALS,
EMPLOYEES AND VOLUNTEERS ARE NAMED AS AD➢ITIONAL COVERED
PARTIES .
IN T14E EVENT OF ANY CLAIMS RELATED TO THIS PROJECT ONLY,
THIS OCVERAGE IS PRIMARY AND NON-CON'IRI3UTORY TO ANY
COVERAGE MAINTAINED BY THE CERTIFICATE HOLDER_
Authorized Representative
Client#: 641 PALMSPRU
AC0-00- CERTIFICATE OF LIABILITY INSURANCE 0615106°"Y" '
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Keenan &Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3610 Central Avenue,Suite 400 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Riverside,CA 92506
INSURERS AFFORDING COVERAGE NAIC 9
INSURED INSURER
SAFER(Schools Assn.Far Excess Risk
Palm Springs Unified School District IN
B
980 E.Tahquitz Canyon Way,Suite 200 INSURER c
Palm Springs,CA 92262
INSURER D
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD INDICATED NOTWITHSTANDING
ANY RECUIREMENT 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
5R DD• POLICY EFFECTIVE POLICY ekPIRATIDN
LTR NSR TYPE OF INSURANCE POLICY NUMBER ATE MM QATE tMMIDDINY) LIMITS
GENERAL LIABILITY MPRODUCTS-COMPOPAGO
RENCE
COMMERCIAL GENERAL LIABILITY ENTED
CLAIMS MADE ❑CCCVR ono parson)
ADV IN JURY S
REGATE
GEN L AGGREGATE LIMIT APPLIES PER. OMPIOPAGG S
POLICY PRO LOC
AUTOMOBILE LIABILITY COMBINED SW GLE LIMIT
ANY AUTO (En owdenl)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUY05 (Par parson)
HIRED AUTOS
BODILY t) S
NON-OWNED AUTOS (Ptlr acddnn0
PROPERTY DAMAGE
(Poraeeidant)
GARAGE LIABILITY AUTO ONLY•Fa ACCIDENT Is
ANY AUTO OTHER THAN EA ACC s
AUTO ONLY. AGG y
A EXCESSIUMBRELIA LIABILITY SA0000204 07101/06 07/01/07 EACH OCCURRENCE 54,000 000
X OCCUR 71 CLAIMS MADE AGGREGATE 521,620 00O
s
DEDUCTIBLE
X RETENTION s 1,000.000 s
WORKERS COMPENSATION AND
WC STATU- OTH•
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEkEGOTIVE EL EACH ACCIDENT
is
OFFILERIMEMBER EXCLUDEDi
'c L.DISEASE-EA EMPLOYEE 3
If SPEs ALLPRO ISIO
SPECIAL PROVISIONS holcw E.L.DISEASE-POLICY LIMIT I S
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
AS RESPECTS TO THE RAMON ALTERNATIVE CENTER-CAFE RAMON CULINARY ARTS
PROGRAM.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF TI IE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF PALM SPRINGS DATE THEREOF THE ISSUING INSURER WILL X9l BMXXR MAIL 40 DAYS WRITTEN
P.O,SOX 2743 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFf,AXXX/pWrypODJppppp6BJ:x
PALM SPRINGS, CA 92262 1M9mrR71R701xM.g1AKARXMR'r x•)oLxocXloalurRec�,txeamclOLxaecxx
R iLl(
AUTHORIZED REPRESENTATIVE
ATTN: CITY CLERK J
ACORD 25(2001108)1 of 2 #S78921M6108 M 0 ACORD CORPORATION 1988
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 certlGcate holder in lieu of such enddrsoment(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s)-
DISCLAIMER
The Certlfcete of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does It
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORN 25-5(2001108) 2 of 2 #S7892/M5108
Client#:641 PALMSPRU
ACORD- CERTIFICATE OF LIABILITY INSURANCE I 0DATBI
7113106omYl
PROOOCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION
License 90451271 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Keenan &Associates HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3550 Vine Streot#200
Riverside,CA 92507 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER Midwest Employers Casualty Company
Palm Springs Unified School District INSURER
980 E.Tahquitz Canyon Way,Suite 200 INSURER C
Palm Springs,CA 92262
NSURER O
INSURER E
COVERAGE$
THE POLICIES OF INSURANCE L15TED 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 SUSJEC77O ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INS OD' POMGY EFFECTIVE POLICY EXPIRATION
MNSRC TYPE OF INSURANCE POLICYNOMBER I DATE M DDVYY) nATg fMMfDDNYILIMITS
GENERAL 41ABILIW EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S
CLAIMS MADE ❑OCCUR MEO EXP(AnY ono P-nm) S
PERSCNAL 8 ADV INJURY
GEN ERAL AGGREGATE 5
GEN L AGGREGATE LIMIT APPLIE5 PER. PRODucTS-COMPfOP AGG S
POLICY 7 FFO LOC
AUTOMODILE LIABI4ITf
COMOINRO SINGLE LIMIT S
ANY AUTO (Ea aadd.ccldpnq
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Par pprpn)
HIRED AUTOS
BODILY INJURY
(Pnf pcGtlnnl)
NON-OWNED nUT05
PROPERTY DAMAGE S
(Ppr ncGdnnQ
GARAGE LIABILITY AUTO ONLY-GACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG 3
CXLESSIUMBRCLI-A LIABILITY EACW OCCURRENCE
OCCUR CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE S
RETENTION 5
A WORKERS COMPENSATION AND EWC006561 07/01/06 07/01/07 1 T'WC STATU•I X 0TH. y
EMPLOYERS LIAEaITY SIR S1,000,000 E L.EACH ACCIDENT 51,000000
ANY PROPRIETORIPARTNETEXECUTIVE
OFFICERIMEMBER EIXLLUDEDp EL DISCASE.Eq EMPLOYEE S1,DOO,000
Ifypp 6=08Undpr
SPECIAL PROVISIONS hnmw EL DISEASE•POLICY LIMIT ,1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
WC Limit$25,000,000
AS RESPECTS TO THE RAMON ALTERNATIVE CENTER-CAFE RAMON CULINARY ARTS
PROGRAM,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE BXPIRAnON
CITY OF PALM SPRINGS DATE THEREOF,THE ISSUING INSURER WILL KDOM90UM MAIL �ED_ DAYBWRITTEN
P.O,BOX 2743 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFi,�(x pnp x
PALM SPRINGS,CA 92262 100PAAK71>lrnr�w>•i7�Rlutro7[xM]Ixxx�mna7lxxlctlmuFlexx�mcRultoet�lAkYfltxp9q®cxx
x xx
AUTHORIZED REPRESENTATIVE
L
ACORD 25(2001108)1 Of 2 #S7893/M6581 TZB 8 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement($).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder In lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORQ 25-5(2001108) 2 of 2 NS7893IM6581
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Project/Activity Title: Project Number:
Palm Springs Unified School District 0008
Ramon Alternative Center- Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date:
PSUSD Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household (legal guardian) receiving benefit's farm the
described pro)ect/aclivity. 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,roomers,or boAveers cannot be included as household members
2. Circle your combined gross annual income(Riverside-San Bernardino-Ontario,CA MSA—03108106)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $20.150 $23,000 $25,900 S28.750 S31050 S33,350 $35,650 $37.350
Below 50
LOW INCOME $32.200 336 800 S41,400 S46,000 $49,700 $53,350 357 050 S60,700
51 -80%
MODERATE
-
INCOME $48,300 $55,200 $62,100 $69000 S74.500 S80,000 $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/Alaska Native AND White
❑ Black/African American 0 Asian AND White
❑ Asian ❑ Black/African American AND White
Q American Indian!Alaskan Native ❑ American Indian/Alaska Native AND Black/African American
0 Native Hawaiian/Other Pacific Islander ❑ Other Multi-Racial.
HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,check one: 0 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 Information you provide on this form is confidential and is only utlllzod 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
P_rolect/Activity Title: Proie_ct Number:
Palm Springs Unified School District 0008
Ramon Alternative Center- Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date:
PSUSL Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
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/Alaska Native AND White
Black/African American Asian AND White_
Asian Black/African American AND White
American Indian/Alaskan Native American Indian/Alaska Native AND Black/African American
Native Hawaiian/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
Prolect/Actiyity Title: project Number:
Palm Springs Unified School District 0008
Ramon Alternative Center-Cafe Ramon Culinary Arts Program
Name/Address of Provider: Date.
PSUSD Adult Vocational Education
2248 Ramon Rd
Palm Springs, CA 92264-7917
BENEFICIARY QUALIFICATION STATEMENT
Approved, Current Prier Total Grant PP ����
Description Grant. Reimbursement Reimbursement YTb Balance
'Amount Period Perlad(s) Reimbursement (Over!Under
TOTAL ' 17=L�J=L=E=]
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.