HomeMy WebLinkAbout05514 - SHELTER FROM THE STORM INC CDBG SUBRECIPIENT AGR SUIBREC9RI'ENT AGREFIVIENT
THIS AGREEMENT (herein "Agreement"), is made and entered into this 19th day of August,
2005, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and
charter city, and the Shelter From The SLorm _Inc., (herein "Provider").
WHEREAS, the City has entered into various funding agreements with the United States
Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG
Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C.
Section 5301 at sec.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et sag. ("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 Art 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 Ciry 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
:n 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 compelentjurisdichon.
1 3 Reports. No later than ten (10) days prior to any payment date specified in
Section 2.2, within ten (10) days following the termination of this Agreement, and of 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 520,000.00 or more from the City during the 2004 — 2005 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
-cords 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
de+ail to demonstrate contract compliance and be balanced to bank statements. Any organization
receiving or due to receive less than `620,000.00 in the current fiscal year from the City shall provide a
copy of the organization's most recent charitable trust report to the Attorney General, or other financial
information satisfactory to City's Finance Director. The financial information provided for in this
paragraph shall be furnished not later than January 31" of the current Fiscal year.
G�fGFi1'.11L2;u
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20 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 THOUSAND.._ DOLLARS ($20,000 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 Agrccrncnt, but in no event shall such
adjustments increase the Contract Sun! The Provider shall submit to the City monthly statements on
reimbursable expenditures pursuant to the attached Budge: along wish pertinent supporting
documentation. The City shall promptly review the monthly expenditure statements and, upon
approval, reimburse the Provner 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 Providers respective employees, as
set forth in OMB Circular A-122 Attachment B.G
2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance
of fil least 25% of the total grant by the end of each fiscal year quarter (September 30, December 30,
March 31, and June 30) shall -esult 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:
Lynn Moriarty, Executive Dirctor
3.2 Contract Officer. The Contract Officer shall be such person as may be
designated by the chief ndminisiratioe officer of City.
3.3 Prohibition Ar_iainst Subcontracting or_Assianment. Provider shall not contract
with any other entity to perform in vvhoba or in par'. the services required hereunder without the express
v✓ntten aoproval 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
3A 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 shell 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.
,1.0 C0MPLIAI\r1E 'W17H FEDERAL REGULATIONS.
41 The Provider shall ma4dain 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 end the
Comptroller General during regular niorking hours. Said records shall be maintained for such 'Lime as
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may be required by the regulations of tl,e Housng and Conimunily Development Act, bui 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 monthly reports on program status;
(b) Section 109 of the Housing and Community Development Act of 1974,
as amended and the regulationS issued pursuant (hereto;
(r,) Section '; of 'he 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) =xeculive Order 11063, as amended by Executive Order 12259, and
implementing regulations at 24 CFR Part 107,
(f) Sertion 501 of the Rehabilitation Act of 1973 (P.L. 93-112), as
amencied. and implementing regulations;
(c) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and
implementing regulations,
(h) The relocation requirements of Tifle II and the acquisition requirements
of Title III of the Uniform Relocation Assistance and Real Property
Acquie.ition at 24 CFR Part 42;
(1) 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,
S ubparl K and !IUD regulations issued to irnplcment and
requirements,
(R) i he Program Income requirements as set forth in 24 C.F.P..
570.504(c) and 570.503(b)(8),
(1) The Provider is to carry out each activity in compliance with all
redera! laws and regulations described in 24 C.P.R. 570, Subpart K,
exceot that the P•ovider does not assume the City's environmental
responsibilities described at 24 C.F.R. 570.6K nor does the
Provider assume the City's responsibility for initiating the review
prcress under the provisions of 24 C.F.R. Part 52,
(m) Executive Order 11988 relating to the evaluation of flood hazards and
Ererulivo Order 11288 relating to the prevention, control and
abate.nent Cf Water pollution;
(n) — flood ir1Suran.:c purchase requirements of Section 102(a) of the
!rod Di-,aster Protection Act of 1973 (P.L. 93-234),
, 3 .
(o) The regulations, policies, guidelines and requirements of 24 CFR
570, the "Common Rule", 24 CFR Part 85 and subpart J; OMB
Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate
to the acceptance and use of federal funds under the federally-
assisted program,
(p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and
implementing regulations issued at 24 CFR Part 1;
(q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended;
(r) — lead-basec paint requirements of 24 CFR Part 35 issued
pursuant to the Lead-Eased Paint Poisoning Prevention Act (42
Ii.S.C. 4.10-1 et secs.);
(a) Maintain properly 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) Rove,sinn 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 account- receivable attributable to the use
C,7BG ft.rds F,ddRionelly, any real property under the
aubreci ient's r;ontrol that was acquired or improved in whole or in part
with CDBG funds (including CDBG funds provided to the subrecipient
r the fcrm of 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
(i1) Not used in accordance with paragraph (s)(i) above, in which
Event the subrecipient FhaR pay to the City an amount equal
in. [he current m�,rkel v:ihie of the property less any portion of
the value _ttrijutable tc expenditures of non-CDBG funds for
the arnuisition of, or improvement to, the property. The
paymr,-,t is program in-orrie 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,
executr✓e orders or similar requirements which might be applicable.
4.3 The City shall have fhe right ro nenodicafly monitor the program operations of
the Provider under this Agreement.
5.0 INSURANCE AND INC) MNIFICAI'ION_.
5A 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 notica of the pionos-d ancellaiion lt^ City, A cerbi;cate evidencing the
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foregoing and naming the City as an adoitional inured shall be delivered to and approved by the City
prior to commencement of the services hereundei. The procuring of such insurance or the delivery of
policies or certificates evidencing the same ;hall not be construed as a limitation of Provider's
obligation to indemnify the City, its officers, or employees. 7ne 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 Ad r(zn lnt, erc,r_pt for such lo:;s as may be caused by CriN's own
negligence or that of its officers ur amplcvuo:.
6.0 DISCRIMINATION TERMINtkTION. AND ENFORC EIVIENT.
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 rersnn or group of persons or, account of race, religious
creed, color, national origin, ancesI'yT 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 perfc-mince of this Agreement. Provider shall take
affirmative action to insure; that ❑ppli::"ntn are employed and V-at employees are treated during
employment without regard to f,e— ran,e color creed, religion. Sex, marital status, physical or mental
disability, national origin, ancestry or Fny other tresis 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 !orce and effect until completion of the services, but
not exoceding one (1) year from Ilia date here-of
6.3 e'en ina,(nn Prior,to _Cxpir,-Non of _Term. Either parhr may terminate this
Agreement at any time, with or without cai_irn i_ipnn flit ty (30) days' written notice to the other party.
Upon receipt of the notice of term;nation :he Provic , r shell immedialely cease all services hereunder
except as may be. specifically approved by Ilia Contracr O'ficer. Provider shall be entitled to
compensation for 0 services -::ndererl prier to receipt or the novice of terrnina'ion and City shall be
antitled to reimbursement..for any services w'lich have be&n paid for but not randered
7.0 MISCELLANEOUS PP,O"ISION
7.1 Notic- Any 7clrce, demand, request, document, consent, approval, or
communication either party desires or is required to give to the other oarty shall be in writing and either
served personally or sen' by p,cpard, first-class mad to the Pddresn set forth below, or such other
addresses as may from time to time In designated by mail
TC CITY
Cit!i of Palm Springs
3200 East Tahquiiz Canyon Way
n'a'm Springs CA 92262-6959
Atin: City Manager
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'A'ITH COPY TO-
City of Palm Springs
3200 Fast Tahquitz Canyon Way
Palm Springs, CA 92262-6959
Attn• City Attorney
TO PROVIDER:
S; elter From The Storm, Inc.
73555 Alessandro Dr., Suite D
silrn Desert, CA 92234
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 [he date
first written above.
[ End --Signatures on Next F'agc ]
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CITY OF PALM SPRINGS
ATT _ a rnunici al c orporation
y lark Vol
CityManeger
APPROV ��FpM: APPROVED BY CITY COUNCILBy,
City Attorney
IPF:OVi DER: Check one: Individua� 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 Sc( rotary, Tree urer, Assistant Treasurer, or Chief Financial Officer).
Notbrvhd Signal'ure of Chairman of Board, Notarized Signature Secretary, Asst Secretary,
President or any Vice President Treasurer, Asst Treasurer or Chief Financial Officer
/i
Name._ J _ a� Name.
Title: 1// Title:
Slate Stale of 1
Ccun ty of'E'v. 5'4r:,�, fss County of Ls
On 14- c(4 4- _�9 s before me On _ before me,
kClm0H Leneutlimary Public -..
personally appeared ,personally appeared
.��j f. J��CaO L�f --personally known _ personally known
To me(or proved to me on the basis of satisfactory evidence) to me(or proved to me on the bases of satisfactory evidence)
lu be the person(* wnose name(S) isla-e subscribed to the to be the person(5) whose name(s) is/are subscribed to the
wilhin instrument and arknowleclged fc me that IlelWekNF*j wdnin instrument And acknowledged to me that he/she/they
executed the same in hisllaawltl;W aulhnru-ed executed the same in his/her/their authorized capacily(ies),
and that by his/fier(ll r signaturo(�,) on the instrument Ihp and that by hlslherhheir signathire(s) on the instrument [lie
person(p) or the entity upon behalf of which 1hr. per5on(di person(s) or the entity upon behalf of which the person(s)
acted,executed the In5lrument acted executed the instrument
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Notary — —
Signature'� Signature:
Notary Seal: Notary Seal:
EDMOND LEOEUF
Comma aloe B 1529941
i Nolory Public-California
Rlveraklo County
011MyComm.
Eq*as Dec 22,2008
I
$ubrecipAgrmnt Juloalal
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Notarized Sign tine of Chair of Board,
PressU ent or any Vice President. 7y-i{/y,
� �
Title:
State Of ������,��_,,�f[[� fh�
County nf�IAG �ss
Can��''�� W&t4ST 9-11.,RAp,n�n�rj _ before me
FAI' �A A'D�V (7�i, Personallyappeared
FA r _I— j . ftL� _ per;onhlly known
o me(
to be the persoriA whose name(, islx"subccnhed to the
within Instrument and acknowledged to me that hplc=•errtrry
executed the same in his/ h««authorized c2paaty4et}-
and that by his/herfkheir signature(PI on the instrument the
personf,C or the entity upon behalf of which the pcisonfyYf
acted executed the instrument.
WITNESS Imy2nd and ofAcial seal.
..
otary
Signature:
N
Notary Seal.
MELISSA N.SHRAGGE
Cafnmlulon/1442199
Notary Pubic-Ca110npa
San lsnXNdnn Cou*
My Comm.EOUSIP20.2C0
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Proiect(Activity,Title: Proiect Number:
Shelter From The Strom/PS Center Operations 0008
Name/Address of Provider:
Shelter From The Storm, Inc.
73555 Alessandro, Ste. D
Palm Desert, CA 92260
O b'ectives/Activities
The intent of this program is to provide domestic violence outreach and advocacy center, located in Palm
Springs. This will be accomplished through the staffing of an Outreach Center facilitating a full range of
'on-the-scene' crisis counseling and supportive services for two hundred and seventy(275) residents.
The Provider shall be responsible for the completion of the following objectives/activities in a manner
acceptable and satisfactory to the City and consistent with the standards required as a condition of
providing these CDBG funds.
Objective 1: Assist the City by timely providing any additional information requested.
TARGET
DATE ACTIVITY#1
On-Going Make readily available any information relative to the successful implementation of the
activity.
Objective 2: Establish and maintain a programmatic and financial record keeping process.
TARGET
DATE ACTIVITY#1
On-Going Establish and maintain an efficient program process/procedure for proper record keeping,
Set-up a filing system for CDBG files only. Document and maintain all records related to
this program in a stable and secure location
Objective 3: Advertise, market and publicize the program to facilitate positive promotion for all parties
(i,e„ Provider, City, CDBG, etc.)_
TARGET
DATE ACTIVITY#1
On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun.
Submit final publication to City.
Objective 4: Enroll and income qualifies at least an approximately two hundred and seventy (275)
residents.
TARGET
DATE ACTIVITY#1
On-Going Distribute motel vouchers to clients. Maintain records of names, addresses,
demographics and service dates for all assistance.
Objective 5: Maintain records for all CDBG activities related to this program.
TARGET
DATE ACTIVITY#1
On-Going Document and maintain all records related to this program, including those required, in
accordance with HUD Regulations, in a stable and secure location.
ACTIVITY#2
Monthly Submit quarterly reports—referenced Exhibit E.
Objective 6: Manage/monitor program activities.
TARGET
DATE ACTIVITY#1
On-Going Perform monitoring activities necessary to ensure that the program is being conducted in
compliance with the CDBG policies, federal regulations, and local statues, including
Davis-Bacon Act, Copeland Act, and Non-discrimination / EEO requirements.
Objective 7; Provide emengencv 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 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final
reimbursement.
TARGET
DATE ACTIVITY#1
07/151M Provide an evaluation and final report on all programmatic and financial activities.
General Administration
Provide the management oversight and leadership to address specific operational tasks in meeting the
established perFormance levels, as well as perform supportive activities (i,e., clerical, monitoring, etc.)
CITY OF PALM SPRINGS
EXHIBIT B
Budget Summary
Proiect/Activity Title: Protect Number,
Shelter From The Strom/ PS Center Operations 0008
Name/Address of Provider:
Shelter From The Storm, Inc.
73555 Alessandro, Ste. D
Palm Desert, CA 92260
BUDGET SUMMARY
COST CATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel $20,000. $11,884. $31,884.
2 Consultant/Contract Services $ $ $
3 Travel $ $750. $750.
4 Space Rental $ $2,400. $2,400.
5 Consumable Supplies $ $1,000. $1,121M
6 Rental, Lease or Purchase of $ $2,500. $2,500.
Equipment
7 Insurance $ $ $
8 Other $ $g00. $900.
Tele hone
$ $1,000, $1,000.
Client Education Material
$20,000. �!!,434. $40,434.
TOTALS
"If costs are to be shared by other sources of funding, including CDBG funds from other
jurisdictions, identify the source of funding, grantor/lending agency, and cost category information.
Other funding sources primarily are fundraising activities conducted by Shelter From the
Storm's auxiliary, Angels'Alliance($10,764).
EXHIBIT B—Budget Summary
Page 2 of 2 Pages
DETAIL BUDGET
DESCRIPTION OF ACTIVITY/ CDBG OTHER TOTAL
PAY ITEMS SHARE SOURCES COST
Personnel - $14,772. $8,778. 523,550.
Salaries—Outreach Advocate
Benefits--Outreach Advocate $5,228. `63,106. $8,334.
Other Costs- -0 - `b8,550. $8,550.
Operations & Overhead Expenses
Total $20,000. L1213,434. $40,434.
The Subrecipient shall submit monthly reimbursement of Personnel Salaries/Benefits for Outreach
Advocate at Palm Springs facility based on prorated salary and actual fringe benefits in
accordance with the aforementioned cost categories. In no month shall the Subrecipient submit
for reimbursement more than '% of the total annual budget. Payments, approved by the
Subrecipient, shall be paid by the 30t" 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 2004-05 Program Year—July 1,
2004 through June 30, 2005.
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Project/Activity Title: Project Number:
Shelter From The Strom/ PS Center Operations 0008
Name/Address of Provider: Date:
Shelter From The Storm, Inc.
73555 Alessandro, Ste. D
Palm Desert, CA 92260
INSURANCEINVENTORY
LIABILITY INSURANCE POLICY
Name of Providers Insurance Company Philadelphia Insurance Companies
Effective Dates of Policy, 07/01/04 through 07/01/06 -
Claims Made Policy / / Per Occurrence Policy 1 1
Limits of Liability General Agore ate $2.000,000
Deductibles.
Per Occurrence
Annual Aggregate
Additional Insured Endorsement (Certificate Holder) Pi Yes ❑ No
Original Certificate of Insurance Attached ❑ Yes Q No
WORKER'S COMPENSATION POLICY
Name of Providers Insurance Company State Compensation Insurance Fund
Effective Dates 04101/04 through 04/01/05
Limits of Liability_ $1.000.000 Per Occurrence
Underlying Coverage Limits
Original Certificate of Insurance Attached ❑ Yes d No
i
ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID T-1 H 07 1107 DATE ImMIDO/
SHEL 07
PBDDIDER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Curtis & Harris InsUrEN1ce Sery ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CA License 4 OF3071S HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.O. Box 8777 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Palm Springa CA 92263
Phone: 760-778-6787 Faxt760-780-7676 INSURERS AFFORDING COVERAGE NAIC0
INSURED INSURERA PnA1.m1p6in ivP . co�T.nY
INSURER B
Shelter from the Storm INSURERD
73-555 Alessandro Dr. , Ste. D INSURER
Palm Desert CA 92260 -- ------
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED GELOW HAVE BEEN ISSUED TO THE.INSURED NAMED ABOVE'OR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH 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 GXC LUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHC WN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE Of INSURANCE POLICY NUMBER PATE NMtOpmIV POATEYMru�o�O LIMITS
GENERAL LIABILITY EACH OCCURRENCE * 1000000
A X X COMMERCIAL GENERAL LIABILITY pgpK243274 07/01/07 07/01/08 PREMISES Eo;C;Urenm $1000_00
�OIAIMS MADEFYI OCCUR MED EXP(Any am P.=nl SSOOO
PERSONAL SAOV INJURY S1000000
X MISC PROF LTAB OENERALAGGREGATE $2000000
GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOPAGG 51000000—^
X POLICY PRO LOC prof La.a6 1000000
ECT
AUTOMOBILE LIABILITY DOMDINED SINGLE LIMIT
X ANYAUTO (Eaa=id.nt) s1000000
ALL D WNED AUTOS EOOILY INJURY
S
SCHEDULEDAUTOS PHPK243274 07/01/07 07/01/08 (PPr Corson)
A X HIREDAUTo9 —�`
BODILY I INJURY S X NON OWNED AUTOS (Pereccidont
PROPERTY DAMAGE $
(P.rewident)
GARAGE LIABILITY AUTO ONLY-GACCIOENT S
ANY AUTO OTHERTHAN EA AGO S __`------
AUTO ONLY AGG 5
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S2000000__
A X X OCCUR CLUMSMADE PHPK243274 07/01/07 07/01/08 AGGREGATE _ _ s2DOODOO
DEDUCTIBLE S
X RETENTION $10000 S
WORKERS COMPENSATION AND TWQ 5TA U- Eft
EMPLOYERS'LRBILRT — -- ---
ANYPHOPRIETORIPARLNERIEXECUTIVE EL EACHACC@ENT 5
OFFICERIMEMBER EXCLUDED? F.L DISCASE�EAEMPLOYEE S
It you d..VIUO Untler --'-
SPECIAL PROVISIONS b1.o E L DISEASE.POLICYLIMIT 5
OTHER
DESCRIPTION OF OPERATIONS[LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENT I SPECIAL PROVISIONS
VERIFICATION OF INSURANCE FOR THE NAMED INSURED FOR THE CERTIFICATE HOLDER
RE CONTRACTS A5266 AND AS514. THE CITY OF PALM SPRINGS, ITS OFFICIALS
AGENTS AND EMPLOYEES ARE ADDITIONAL, INSURED. COVERAGE IS PRIMARY AND
NON-CONTRIBUTORY. 10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM.
CERTIFICATE HOLDER CANCELLATION
CITYOFP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
PATE THEREOF,THE.ISSUING INSURER WILLtl�'Ai pll"IO�MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT IGMI0N2TCOG=SHA4L
THE CITY OF PALM SPRINGS IMPOSE NO OBLIGATION OR L BILITY OF Ay KIND UPON THE INSURER,ITS AGENTS OR
DALE COOK
3200 E. TAHQUITZ CYN WAY REPRESENTAirvEry,
PALM SPRINGS CA 92262 AUTHORIZED REPRESEN A 1
Huh CurtisIV WE
ACORD 25(20D1108) (DACORO CORPORATION 1988
POLICY NUMBER PHPK243274 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED- CONTROLLING INTEREST
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: THE CITY OF PALM SPRINGS, ITS OFFICIALS,AGENTS
AND EMPLOYEES
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
1. WHO IS AN INSURED(Section 11)is amended to b. Premises they own,maintain or control while
include as an insured the person(s)or organizadon(s) you lease or occupy these premises.
Shown in the Schedule,but only with respect to their
Liability arising out of: 2. This insurance does not apply to structural
alterations,new construction and demolition
a.Their financial control of you;or operations performed by or for that person or
organization.
CG 20 05 11 85 Copyright, Insurance Services Office,Inc„ 1994
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE
06/06/2007
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Hough&Weingarten -p ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5 4 C� HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P 0 Box 1866 �.� 7 (� ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
r / INSURERS AFFORDING COVERAGE
Palm Springs CA 92263-D /�
INSURE /v" INSURER&PHILADELPHIA INSURANCE COMPANY
SHELTER FROM THE STORM ,�. INSURER
73555 AT SSANDRO DR. STE. D f INSURER
INSURER D
Palm Desert CA 92260— INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
DISH TYPE OF INSURANCE POLICY NDMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE MMIDOM' DATE MMmoryY
A GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(MZ ene fire) 5 100,000
CLAIMS MADE FXI OCCUR LIHPK177874 07/01/2006 07/01/2007 MED EXP(Any one person) $ 5,000
X PROFESSIONAL LIAE PERSONAL&AOV INJURY $ 1,000,000
x / / / / GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS•COMP/OP AGG 5 1,000,000
POLICY 29 LDG
A AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) 5 1,000,000
ALL OWNED AUTOS / / / / BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS PHPK177874 07/01/2006 07/01/2007
BODILY INJURY
X NON-OWNED AUTOS (Per accident) S
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY,EA ACCIDENT S
ANYAUTO I I I / OTHER THAN EAACC T
AUTO ONLY. AGG $
A Excr=LIABILITY PHUB065748 07/01/2006 07/01/2007 EACH OCCURRENCE $ 2,000,000
X OCCUR F—ICLAIMS MADE AGGREGATE $ 2,000,000
5
DEDUCTIBLE
X RETENTION $10,000 S
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'LIA6ILITY / / / / TORY LIMBS ER
E.L EACH ACCIDENT $
EL DISEASE-EA EMPLOYEE$
E L.DISEASE•POLICY 41MIT S
OTHER
A EVSINESS INT$RRVPTIN PHPKI77874 07/01/2006 07/01/2007 r' _ 1,OODr000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EYCWSIONS ADDED BY ENDORSEMENT/5PECIAL PROVISIONS
n
OPERATIONS OF THE INSURED FOR THE CERTIFICATE HOLDER. REFERENCE CONTRACT A5266. CITY OF PALM'SPPRINGS''IS ;MvIT'IONAL
INSDRED. 10 DAY NOTICE OF CANCELLATION FOR NONPAYbTSNT OF FEjW1UH. ti
_ `J
CERTIFICATE HOLDER X I ADDITIONAL INSURED;INSURER LE,,tR; CANCELLATION -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES�BE GAMCELLED'11EFORE THE
— (760) 322-6235 EXPIRATION DATE THEREOF, THE ISSUING INSURER WIL�4NDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER 01AED TO THE LEFT,BUT
CITY OF PALM SPRINGS FAILURE TO Do$0 SHALL IMPOSE O OBLIGATION OR LIABILITY OF ANY KIND UPON THE
ATTN: DALE COOK INSURER,IT$AGENTS OR REPRES TATIVE77.
P, O- BOX 2743 AUTHORIZED REPRESENTATIVq_ ,J
PALM SPRINGS CA 92263- 6- 4-
ACORD 25-S(7197) ®ACORD CORPORATION 1988
kINS025S(991o)o2 ELECTRONIC LASER FORMS INC •1800)327-05,15 Papa 1 of 2
i
POLICY NUMBER: P14PT"77874 COMMERCL sENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE,READ IT CAREFULLY.
ADDITIONAL INSURED-CONTROLLING INTEREST
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCUDULE
Name of Person or Organization: CITY OF PALM SPRINGS
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
1. WHO 1S AN INSURED(Section 11) is amended b. Premises they own, maintain or control while
to include as an insured the person(s) or organi- you lease or occupy these premises,
zntion(s)shown in the Schedule,but only with
respect to their liability arising out of: 2. This insurance does not apply to structural altera-
tions,new construction,and demolition opera-
a.Their financial control of you; or [ions performed by or for that person or organiza-
tion.
'i
CG 20 05 11 85 Copyright,Insurance Services Office,Inc., 1984
I
POLICYHOLDER COPY SK
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
L N SURA NCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2006 GROUP: 000488
POLICY NUMBER OODDOBZ-2008
CERTIFICATE IL). 1
CERTIFICATE EXPIRES: 04-01-2007
04-Oi-20OB/04-01-2007
CITY OF PALM SPRINGS SK
CI7Y CLERKS OFFICE
P 0 BOX 2743
PALM SPRINGS CA 92263
This is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 80 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy he cancelled prior to its normal expiration
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of Insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
t7ORfZREPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1.000,000 PER OCCURRENCE.
ENDORSEMENT N2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
SHELTER FROM THE STORM, INC. A NON-PROFIT,
MUTUAL BENEFIT CORPORATION
73555 ALESSANDRO OR
PALM DESERT CA 92260
M0409
(REv.2-05) PRINTED 03-19-2006
POLXCYH0LDFR COPY SK
STATE P.C. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2007 GROUP: 000498
POLICY NUMBER: 0000092-2007
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 04-01-2008
04-01-2007/04-01-2009
CITY OF PALM SPRINGS SK
CITY CLERKS OFFICE
IF 0 BOX 2743
PALM SPRINGS CA 82263
This is to certify that we have issued a valid Workers' Compensation insurance policy In a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you an) days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded
by the polley listed herein Notwithstanding any requirement term or condition of any conti'aeL or other document
with respect to which this certificaLe of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms. Exclusions, and conditions, of such policy.
tT �C �r
0911EI REPRESENTATI PRESIDENT
EMPLOYER'S LIABXLITY LIMIT INCLUDING DEFENSE COSTS: t1,000,000 PER OCCURRENCE.
ENDORSEMENT #2086 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY,
EMPLOYER
SHELTER FROM THE STORM, INC. A NON-PROFIT,
MUTUAL BENEFIT CORPORATION
73556 ALESSANDRO DR
PALM DESERT CA 92250
M0409
IREV.2.057 PRINTED : 03-16-2007
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Proiect/Activity Title: Project Number
Shelter From The Strom/ PS Center Operations 0008
Name/Address of Provider. Date:
Shelter From The Storm, Inc.
73556 Alessandro, Ste- D
Palm Desert, CA 92260
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. Pleaso answer each at 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,momers,or borders cannot be included as household members.
2. Circle your combined gross annual income(Riverside-San Bernardino,CA—01/28104)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME f 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $19,000 $21,700 S24,450 $27150 $29,300 $31,500 $33,650 $35,850
Below 50%
LOW INCOME $30,400 S34,750 $39,100 S43,450 $46,900 $5,400 $53,850 $57,350
51-80%
MODERATE
INCOME $45,600 $52,100 S58,650 $65,160 S70350 $75,550 $80,800 $86,000
120%
3. What racefethnicity 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
Cl Asian ❑ Slack/African American AND White
❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Blac_k/African American
❑ Native Hawaiian or Other Pack Islander ❑ Other.
HISPANIC/LATINO ETHNICITY 0 Yes ❑ No If yes, check one, ❑ Mexican/Chicano
❑ Puenc Rican
d Cuban
❑ Other.
4. please check,�s or no if you are a female Head of Household? 0 YES ❑ NO
ACKNOWLEDGEMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE.
NAME: DATE:
ADDRESS: PHONE NO:
SIGNATURE:
The information you provide on this form is for Community Development Block Grant(ODBG)program purposes only and volt be kept mnfidenbal.
CITY OF PALM SPRINGS
EXHIBIT E
Program Progress Report
Proiect/Activity Title: Project Number:
Shelter From The Strom / PS Center Operations 0008
Name/Address of Provider: Date:
Shelter From The Storm, Inc.
73555 Alessandro, Ste. D
Palm Desert, CA 92260
PROGRAM PROGRESS REPORT Period:
DIRECT BENEFIT REPORT
♦ Number of First-Time Program Beneficiaries Serviced:
#of Households #of Persons
0-50%below 51-80%below 120% below
♦ Number of First-Time Female Headed Households:
♦ Counts by Race/Ethnicity:
White, not Hispanic Origin Black, not Hispanic Origin
Hispanic American Indian/Alaskan Native
Asian Pacific Islander Multi-ethnic
ACCOMPLISHMENT NARRATIVE
LEVERAGING RESOURCES NARRATIVE
Signed Title Date
CITY GP PALM SPRINGS
EXHIBIT F
Request for Reimbursement
Pralect/Actiylty Title: Proiect Number-
Shelter From The Strom / PS Center Operations 0008
Name/Address of Provider: Date,
Shelter From The Storm, Inc.
73555 Alessandro, Ste. D
Palm Desert, CA 92260
A roved current Prior Total Grant
PP
Deacriptlon Grant Reimbursement Reimbursauwnt YTb Balance,
Amourlk Period Period(s) Reimbursement (Over/Under)
Salaries-Outreach
Advocate $14,772.
Benefits-Outreach
Advocate $5,228,
TOTAL �20,000.
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 venfied by original signatures.
CITY OF PALM SPRINGS
EXHIBIT G
Employment Restrictions
1. Labor Standards
The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as
amended, the provisions of Contract Work Hours and Safety Standards Act, the Copeland "Anti-Kickback"Act (40 U.S.C.
276a-276a-5;40 USC 327 and 40 USC 276c)and all other applicable Federal, state and local laws and regulations pertaining
to labor standards insofar as those ads 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 contrail, shall comply
with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the
regulations of the Department of labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of
apprentices and trainees to journeyworkers; provided,that if wage rates higher than those required under the regulations are
Imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require
payment of the higher wage- The PROVIDER shall cause or require to be Inserted in full,in all such contracts subject to such
regulations,provisions meeting the requirements of this paragraph.
2. "Section 3 Clause"
a. Compliance
Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135, and all applicable rules and orders
issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided
under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER's subreclplents and
subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S
subreelpients 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 $" 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-meome 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 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 ODBG-
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 ODBG-funded project is located- where feasible, priority should be given to business concerns which provide
economic opportunities to low-and very low-income residents within the service area or the neighborhood in which the project
is located, and to low-and Very low-income participants in other HUD programs.
The PROVIDER eertrles and agrees that no contractual or other legal incapacity exists which would prevent compliance with
these requirements.
b. Notifications
The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective
bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or worker's
representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places
available to employees and applicants for employment ortraining.