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HomeMy WebLinkAbout04920 - FOOD IN NEED OF DISTRIBUTION SPACE RENTAL DOCUMENT TRACKING Page: 10 Report: Expired Documents Summary August 3, 2007 Condition: Oldest Date= I I,ALL Groups,ALL Services,ALL XREFs Document# Description Aooroval Date Expiration Date Closed Date A4912 Pm 30292 Public Easement Appraisal Services Not To Exceed$8,500 07/07/2004 01/01/2005 Company Name: Anderson & Brabant, Inc Address: 353 W. 9th Ave, Escondido, CA 92025 Service: In File xRef: ENGINEERING Ins. Status: No Certificate on file. A4913 Tm 29077 Villas In Old Ps Tm 30941 48 @ Baristo Subdivision... 07/14/2004 07/01/2005 Company Name: Harris Realty Appraisal Address: 5100 Birch St., Ste, 200, Newport Beach, CA 92660-2160 Service: In File xRef: ENGINEERING Ins. Status: A policy has Expired �� A4919 Consultant To Creat New& Fully Operational Recycling Welpite 07/01/220g4 06/01/2005 Company Name: John Lennon Films Inc Address: ' Service: In File xRef: COMMUNITY& ECONOMIC DEVELOPMENT Ins.Status: No Certificate on file. Y A4920 Operational Expenses(space Rent) 04/03/2002 06/01/2004 Company Name: FpA?tlAg_N&pdofDistribution Ina Address: 68-615 Perez Rd. Bldg 1413, Cathedral City, CA 92234 Phone: Service: In File xRef: COMMUNITY& ECONOMIC DEVELOPMENT CA�1 Ins. Status: No Certificate on file �\ Food in Need of Distribution, In Space Rental AGREEMENT #4920 SUBRECIPIENT AGREEMENT RES 20302, 4-3-02 THIS AGREEMENT (herein "Agreement"), is made and entered into this 5Oh day of May-, 2004, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Food In Need of Distribution. 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 seci.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 at M. ("Regulations"); and WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit organizations for certain purposes allowed under the Act; and WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible for a grant of CDBG funds and the City desires to assist in the operation of the program by granting CDBG Funds to the Provider to pay for all or a portion of those costs incurred in operating the program permitted by the Act and the Regulations on terms and conditions more particularly set forth herein; NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF PROVIDER. 1.1 Scope of Services. Provider agrees to provide to City all of the services specified and detailed in its application for funding and Exhibit A, and to conduct all programs specified therein in a manner to reflect credit upon the City and Provider. Provider represents and warrants to City that it is able to provide, and will use funds granted by the City to provide the services represented in the Provider's application for funding. City provided funds shall be used only for those purposes specified in such application. 1.2 Compliance with Law. All services rendered hereunder shall be provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of the City and any Federal, State or local governmental agency of competent jurisdiction. 1.3 Reports. No later than ten (10) days prior to any payment date specified in Section 2.2, within ten (10) days following'the termination of this Agreement, and at such other times as the Contract Officer shall request, Provider shall give the Contract Officer a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of contract funds hereunder, if applicable. At the times and in the manner required by law, the Provider shall provide to the City, the Department of Housing and Urban Development, the Comptroller General of the United States, any other individual or entity, and/or their duly authorized representatives, any and all reports and information required for compliance with the Act and the Regulations. 1.4 Financial Reporting. Any Provider receiving or due to receive or due to receiver $20,000.00 or more from the City during the 2003 — 2004 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 st 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 SEVEN THOUSAND EIGHT HUNDRED SIXTY-EIGHT DOLLARS ($7,868.00) (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 Providers 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: LA 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 - 2 - 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 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 monthly reports on program status; (b) Section 109 of the Housing and Community Development Act of 1974, as amended and the regulations issued pursuant thereto; (c) Section 3 of the Housing and Urban Development Act of 1968, as amended; (d) Executive Order 11246, as amended by Executive Orders 11375 and 12086, and implementing regulations at 41 CFR Chapter 60; (e) Executive Order 11063, as amended by Executive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended, and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 0); 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); (I) 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; - 3 - (n) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); (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 seg.); (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: W 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 -4 - 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 foregoing and naming the City as an additional insured shall be delivered to and approved by the City prior to commencement of the services hereunder. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of Provider's obligation to indemnify the City, its officers, or employees. The amount of insurance required hereunder shall be as required by the Contract Officer not exceeding Five Hundred Thousand Dollars ($500,000). 5.2 Indemnification. The Provider shall defend, indemnify and hold harmless the City, its officers and employees, from and against any and all actions, suits, proceedings, claims, demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death of person(s), for damage to property (including property owned by the City) arising out of or related to Contractor's performance under this Agreement, except for such loss as may be caused by City's own negligence or that of its officers or employees. 6.0 DISCRIMINATION, TERMINATION AND ENFORCEMENT. 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal, state or local law. 6.2 Term. Unless earlier terminated in accordance with Section 6.3 of this Agreement, this Agreement shall continue in full force and effect until completion of the services, but not exceeding one (1)year from the date hereof. 6.3 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. Provider shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and City shall be entitled to reimbursement for any services which have been paid for but not rendered. 7.0 MISCELLANEOUS PROVISIONS. 7.1 Notice. Any notice, demand, request, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. TO CITY: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Manager -5 - WITH COPY TO: Aleshire &Wynder, LLP 18881 Von Karman Avenue, Suite 400 Irvine, CA 92612-6525 TO PROVIDER: i�a t:3eY `f/ 0- 4 T6 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 this Agreement on the date first above written. g CITY OF PALM SPRINGS CALIFORNIA Dated: e���' �� B City Manager TTES' �� /p/ _ �/ 4 �lC: N'.�IY�II �i11VVl�'�ia CJU �J V7'� City Clerk APPROVED AS TO FORM: Aleshire Wynder, LLP A_ City Attorney PROVIDER: A / Dated: �c��_C ����z�. � By: L.�)�e�"L'"r(%v Name: eq./6 . Title: By: �v51 Name: :> Title: ' (Corporations require two NOTARIZED signatures by attaching a California All-Purpose Acknowledgement; one from each of the following categories: A. Chairman of Board, President or any Vice President;AND B. Secretary,Assistant Secretary, Treasurer, Assistant Treasurer, or Chief Financial Officer.) SubredpAgnnnt -6 - h� State of California =?� ,. ss. �[- County of ld �;'_ �''a +y _tl m: `2 ,I On '.[ C7 C ��` - before me, AQLL' . e3�utn-S' x, .i I Data per,n a,d Tun ar ontan rya y,°dann ooa,l otary r��uc7 , ail personally appeared Nama(s)or Sgaar(r) f 1_ ,❑personally(mown to me • proved to me on the basis of satisfactory evidence In, n. ...i.,j•J•i::0'> °lames to be the person(8) whose name( is/'are rd Vie: � e �� JOF�I K.JA liu'� o.rs _O;L.,; r, subscribed to the within instrument and pr ? ho a, _rm� CC)dUaN�i #'i4s✓65,i 9 acknowledged to me that he/slfihey executed Itl ar'NOTARYPUBLIC-CALIFORNIA . ��c^ {� RNERSIMCOUNTY o the same in his/1-I�iiheir authorized I a t� My Comm.Exp.Sept.2,2007 � capacity(irs), and that by hisA e weir a L 00000noaoo 00o ca «oa o 000000 0000c signature{5)on the Instrument the person(;,), or 91 f9; the entity upon behalf of which the persolsfl acted, executed the instrument. .I ill WITIl E�SS my ha d end fitict I sea I v Sj f - �/�\\� 6tgnature of�uhito f: r[t fQa P M(Ip 11 Though the Information below is not required by law,it may prove valuable to persons relying on the document and could prevent "I tp; fraudulent removal and reattachment of this form to another document. II ©rz��rro�4)®r� ®u'aT4���O�¢➢ ®®�tnrrua�w4 >I Title or Type of Document CAI or)f r`-'c 5 o.-eetg eat Document Date: �� J/�- Number of Pages: -9 '(I Its �t �V Irr Signer(s)OtherThan Named Above:CdnA aP_ C. C^wV-' il�:� �cu�.S•,�Sst� �,�:ti`Yi,� I e7 Capachy(oss) CMmmsdl by 5ugieoarr =� Signer's Name: .. - &�;8_... if ❑ Individual Top of thumb here r, -'M--Corporate Officer—Tltle(s)- �(LSLS,c .uyt, It ❑ Partner—❑ Limited El General �I 4 ❑ Attorney-m-Fact ❑ Trustee �II 0 ❑ Guardian or Conservator) Is ❑ Other: it, II f, Signer Is Representing: 'P0 irs—\C�� 01999 Nationale lery Association•9360 be Solo Ave,P,0 Box 2,102•Chatsworth,CA tua 3-2492 www natmnelnetary org— PredNo5907 Rnorder Call Tal Fur 1-800 876 6827 CALW©RNEA ALL-PURPOSE ACKNOWLEDGMENT If State of California "II ss. Ix' County of It On_��\�P l-� before me, f�a �� 116 a c �� r Caro Nam n The of Cflmerre g,"Jane Doe,Nola PubLo") personally appeared a Nemdd)of S,gneru) ❑personally known to me f,v.quorcnn.cGA.row•AoS9>bmtwU4o.wvocOv<400v 71 proved to me on the bases of satisfactory JORI K. JACOPS I � m ° 9 COMM. #1437353 � evidence a e. te" NOTARY PUBLIC-CALIFORNIAfor RIVERSIDE COUNTY o to be the person( whose names) is/are My Comm.Exp.Sept.2,2007 subscribed to the within instrument and '_' O00000,o+>00000mo•000e0000000000000000o acknowledged to me that he/shoAbey executed `- the same in his/her4heir authorized l'I capacitypes), and that by his/lhor,th-eir signatureks)-on the instrument the personl or it the entity upon behalf of which the persons) acted, executed the instrument. ll u I W.TNES my he an'd ici seIF I Signalufe of ola Public if Fall ®PT 801VA� •I Though the information below 1s not refused bylaw,d may prove valuable to persons relying on the document and could prevent Ir I fraudulent removal and reattachment of this form to another document -' nl Description ®t Attached DWc4➢d7 enfl If. C- ; If Title or Type of Document: -t 2yy' xe rl �;T"SriCA0 cICM, A�-nV_Qg IF y f In f Document Date: 4 Numberof Pages. ,IfI Signers)Other Than Named Above: - C Q17_, Cappacity(•ses) Claimed by/ Signer q Signer's Name: 7r5.d k IA-3, q 41 �`•I f, ❑ Individual / c a Top ofmumbl here "Corporate Officer—Tltle(s): , N�-'Q O? "' �,.'4- ❑ Partner—❑ Limited Cl General '❑ Attorney-in-Fact ❑ Trustee ❑ Guardian or Conservator "I ❑ Other: Signer Is Representing: 0 'olaryA...rrdon•93500e Solo Ave„PO aon21o2•CM1alsworlM1,CA913132J02•www nabonalnolaryorg Prod No 5907 Reorder Call Tall Free 1-600-6766627 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/ActivityTitle: Project Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 O b i ect i ves/Activities The intent of this program is to provide nutritional assistance to low income, no income homebound seniors, families and their children, including recovery homes and five homeless sites. This will be accomplished through the reallocation of the awarded Public Facilities and Improvement funds to Public Services funds for the reimbursement of operational expenses, specifically for space rental. FIND is affiliated with America's Second Harvest and the only certified food bank in eastern Riverside County, serving 16,265 clients Valley-side and 1,386 Palm Springs' clients. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the City by timely providing any additional information requested. TARGET DATE ACTIVITY#1 On-Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process. TARGET DATE ACTIVITY#1 On-Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise market and publicize the program to facilitate positive promotion for all parties (i.e. Provider City CDBG etc.). TARGET DATE ACTIVITY#1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income qualify at least a total of one thousand three hundred eighty-six (1,386) very low income Palm Springs residents. TARGET DATE ACTIVITY#1 On-Going Distribute food to Palm Springs residents and organizations serving the homeless and needy. 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 food distribution assistance to low income persons 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 07/15/02 Provide an evaluation and final report on all programmatic and financial activities. General Administration Provide the management oversight and leadership to address specific operational tasks in meeting the established performance levels, as well as perform supportive activities (i.e., clerical, monitoring, etc.) CITY OF PALM SPRINGS EXHIBIT B Budget Summary Project/Activity Title: Project Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $ $ $ 2 Consultant/Contract Services $ $ $ 3 Travel $ $ $ 4 Space Rental $7,868. $86,548. $94,416. 5 Consumable Supplies $ $ $ 6 Rental, Lease or Purchase of $ $ $ Equipment 7 Insurance $ $ $ 8 Other $ $ $ TOTALS $7,868. 1 $86,548. 1 $94,416. *If costs are to be shared by other sources of funding, including CDBG funds from other jurisdictions, identify the source of funding, grantor/lending agency, and cost category information. Other funding sources include City of Rancho Mirage, Desert Healthcare Foundation, Palm Desert Foundation, Jewish Federation and other governmental grants (i.e., Office on Aging, County CDBG, etc). The Subrecipient shall receive reimbursements in accordance with the aforementioned cost categories and line items. Services are to be performed over the twelve-month period of July 1, 200 through June 30, 2004. 3 Y CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Project/Activity Title: Proiect Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: Food In Need of Distribution —FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Nonprofits' Insurance Alliance Effective Dates of Policy 12/15/2003 to 12/16/2004 Claims Made Policy / / Per Occurrence Policy / / Limits of Liability $1M per occurrence Aggregate/ Products $2M Deductibles: Per Occurrence N /A Annual Aggregate Additional Insured Endorsement (Certificate Holder) WYes ❑ No Original Certificate of Insurance Attached ❑ Yes V/No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Virginia Surety Effective Dates 07/01/04 to 07/01/05 Limits of Liability $1 M Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes V N0 Binder attached; Certificate forthcoming. Jul 12 04 07: 35a niel Tenold 760 328 6103 p. 2 D:.te: 07/08/2004 Time: 12:00 PH T.: Marilyn Fields P !1 (7601 328-3994 760-347-2950 CVIS Fag.: 002 ACORD„ CERTIFICATE OF LIABILITY INSURANCE of/08 2 o PRODUCER 1760)347-5552 FAX (760)347-2858 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Coachella Valley Insurance Service, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Licp D542476 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81-557 Dr. Carreon Blvd 88 1 Indio, CA 9 2201-551 7 _ INSURERS AFFORDING COVERAGE NAICN msuRBD F.I.N.D. INSMERA Nonprofits' Insurance Allianc P 0 Box 41 INELRERe Cathedral City, CA 92253 II�ERC )NE UFERD INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY 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. MR TR MEWNSL.UNC! TDIJCYNUMBFA .)ODI DATE POLICY6FECTNE TOLICYEDIPYUITmN LL1A75 GENERAL MBLI7Y 2003-08944-NPO 12/15/2003 1Z/15/2004 EACH WCURRBN E F 1,000,wc X COMMERCIAL CENERAL LIABILITY DAMAGE TO RENTED $ 100,00 ClNMs.A OCCUR MED EJN(Any an0 Fe .) F 10, A PERSONAL S ADV INJURY Y 1 ODD GENERAL AGGREGATE S 2,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AUG $ 2,000,00 PCUcY PEPT LOG AW011COLIU F LNY COMBII,ED SINGLE LIMIT ANY ALTO (Ea u.dMI 5 ALL OWNFDAIMI% BODILY NLIRY SCHEGLLEDNJTOS (Per Pcrsen) i HIREDAUTOS BODILY INJURY NO&O`NPIEDAUTOS (Ptt.ad¢NI $ FROPERTYDAMAGE 1 (Pttxdtl¢RR GARAGELUIRLRY A O ONLY.EAACCIDEW F my AUTO OTHER THIAd EAPCC S AUTO OrA-Y AUG F EACESBAAABREILALUIBLRY EACHCCCURRENCE 5 OCCUR ❑CWMS MADE ACGRCGATC S F DEDUCTIBLE F RETFMICN S F WDRNERS GOApENSARONAND YYCSTYATT ORs EMYLDYERS'LUBLnY T IMIT PIJY PROPRIETOPIPAMNUR ,ECUTIYE EL EACHACCIDEM I5 OFFICEWMEMVER EXCLUDEVI EL DISEASE-EA EMPLOYEE F Iryres.dF:cnb.uRd.r SPECIa.PROVISIONSbelwl EL DISEASE-POLICY LIMIT F O 'TER DESCPo MNOFOPEIU SILOCAT SIVEiIIG.ESIE%CWSp SAD UVENDORSEMENFISPECVLPROMC5 ertificate holder is named additional insured has respects to General Liability. ttached is the Additional Insured Endorsement 1CG 2026 (11/85). tite of cancellation for non-payement of premium is 10 days. CERTIFICATE HOLCANCELLATION SHOULD ANYOF THE A80YECE9CRIBC-0POLICES BE CANCELLT:U BEFORE TE EAPWITIDN GATE THEf+EOF,THE ISSLMIO WSURER WILL EIIDEAYOR TO MAIL 30 DAYSWRrnEPin METOTHECERWICATEHMDERIUMEDTOTHELEFT, City of Palm Springs BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO UEUW0ION OR UABLITY P 0 Box 2743 OFANYXMA NTHE RER,ITSAGB SMREPREBENTATNES. Palm Springs, CA 92263-2 743 AUTHDIMEDR MIIENTATTVE Tina Hatuska/FEL 1-�* qak,�- ACORD 25(2001108) OACORD CORPORATION 1988 JUL-01-2004 THU 10:29 AM FROM WARLIN INS, SVCS. FAX:76031647 PAGE 2 ACORD R, 1NSURANC:t BINDER DA/7 07/Ol2004, _ THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS fORM. . PRODUCER IH�NE In (7 311-1710 COMIANY IRINDER, [A" 760 6O 318-4799 IVIRGINIA SURETY JWISO03 ' J. WARLIN INSURANCE SERVICES 67-555 E. Palm cnyn. Dr., F-100 DATE' DATF�{ AM m. 'T I M E Cathedral City, CA. 92234 07/01/04 i2:0i 0 PM 09 '01 '.04 .'. Hnd THIS CINDER If ISSUED TO EXTEND MVCMOE IN THEAODVE NAMEO COWAW ODOR: iUE LmE• PFR ERPWINp POLICY A: AOENCYCUITOMIRID, DEeeRIPOON OI OP[RATIDNININICLgIPROPRATY 0"Wlni L,SMNN INSURED c I N n .TOO- Banki lnQn DART Sorting.and distributing of.food items Food in Need of Distribution to 190al people in need. . . 6B-615 Perea Rd. Bldg. 14B Cathedral City, CA 92234 1760 328-3663 COVERAOES LIMITS TYPEOFINIYRANCI COWRAONORMO peDU=S1-E COINML AMOUNT IROPIRTY CAVOEi Of LOGO I i IAeIC 0IROAO OlNO LINIPAA FAIIOr "4N r. EACN OCC9RRE.K. CcwuACUL OINSAKLMAITY W. • I. Cd MA[IE OSOVR MEO MP AAY,R,A,OAN i PERSONALAAOVJNJUAV _,•—•_ OENERN.AOOREGATE S RETRODATEFOACLAWSMADI. RROOVCTE.00AVNPA04 AUTOMOIILELMRIOI'Y • LOMRM[OIINIXLthAIT 1 I ANYANO I t00AY WJUflYIPrtpnap I ALLOWNEDAUTOe IOOILYIWVRYIP,naegm0 S _ ICH2DutlDA!40E P. PPOfITm cALgOG i•. NX$DAUTOC MEdG.LPAYMm•Ti i rid'N•DNNE'vn'vTdE .. ;S�•A:.Y.'.G'�:.YlRO? S UNINEMIEDMOTORST A i AUTOPNYCOALDARAOE DEDUOTIILE I ALL VIKWI OGNEDULED vElxctee ACTUALCAIHVALVE COLLISION: ITTATEDWOUNT i OTWRTLANCOU OTHER DAR,AEWDRITY �, .,..t. AWOONLY.PAACewNT 1, II�I�ANYAVTO OTHERTHANAUTOCNLM RAOHACOIODNT A 111 11' 400RCOAT[ i EXCESS WEEITY . .. " EACH OCCURRENCE T VMMILNRcSm ni:A' OTWEFTHANUA'SFiLLRfORM RETROCATFrOR CUUUi A'.RDC ICLPNNR r,n ACTC:ITWN I Policy Period X ;WffTATUTORVL ITE WORRERECOMDENIATION 07/01/0444 - 07/01/05' E.L.ucnADcnem !1 '000 000 IMPLOYER'I WeWTY Binder RJWIS003 .EL DIEEME.EA EMPLOYEE• 11 OOO,OOO CL D1WS.POLICYLIMIT 11 OOO OOO ePECUL OTHER ONL TAXCi ! COVHR4J;i ESTOVATEOTOTALPRRMIUM i NAMELAODRESS MORT4A4EE ADOITWPALW4URE0 C 1 N D Food Gann, Inc. ..M. LDSO W11-sured Food in Need of Distribution Lahr 69-515 Fo. Rd. T11d9 'iAQ A • Cathedfal'City, CA 92234 AUTiORMEOREPREIPWAMV (. P 760 328-3663 F 760 328-3994 ./V'i'NA f G✓i---� J, Warlin nau ence Sery Lie, #OB59688 ACORD76(2001101) NOTE:IMPORTANT STATE INFORMATION h��Y6 SE��D 3P CF. OACORD CORPORATION 1003 CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title: Project Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: Date: Food In Need of Distribution— FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described project/activity. Please answer each of the following questions. 1. How many persons are in your household? For this question a household is a group of related or unrelated persons occupying the same house with at least one member being the head of the household. Renters,roomers,or borders cannot be included as household members. 2. Circle your combined gross annual income(Riverside-San Bernardino,CA-02/20103) MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME 1 2 3r$40,800 5 6 7 8 LEVEL VERY LOW INCOME $17,850 $20,400 $22,950 $27,550 $29,600 $31,600 $33.650 Below 50% LOW INCOME $28,550 $32,650 $36,700 $44,050 $47,350 $50,600 $53,850 51—80% MODERATE INCOME $42,850 $48,950 $55,100 $61,200 $66,100 $71,000 $75,900 $80,800 120% 3. What race/ethnicity do you identify yourself as; please note that this self-identification is voluntary in accordance with equal opportunity laws? ❑ White ❑ American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian ❑ Black/African American AND White ❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes,check one: ❑ Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Please check, ves or no, if you are a female Head of Household? ❑ YES ❑ NO ACKNOWLEDGEMENT AND DISCLAIMER I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: DATE: ADDRESS: PHONE NO: SIGNATURE: The information you provide on this form is confidential and is only utilized for Community Development Block Grant(CDBG)program purposes,a Federally-funded program,governmental reporting purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT E Quarterly Program Progress Report Project/Activity Title: Project Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: DATE: Food In Need of Distribution-FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced: #of Households !>si-3y 6 #of Persons o 0-50%below 51-80%below 120% below ♦ Number of First-Time Female Headed Households: ♦ Counts by Race/Ethnicity: Iz-j' White American Indian or Alaska Native AND White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activity Title: Project Number: Food In Need of Distribution (FIND)/Operations Name/Address of Provider: Date: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 A roved PP Current Prior- Total Grant Description Grant Reimbursement Reimbursement YTD Balance Amount Period ,Period(s) (Reimbursement Over/Under) TOTAL 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. 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 acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of$2,000.00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to journeyworkers; provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full,in all such contracts subject to such regulations,provisions meeting the requirements of this paragraph. 2. "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3, the regulations set forth in 24 CFR 135, and all applicable rules and 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 PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these "Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.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 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 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. *r+ 07/14/04 PRODUCER THIS CERTIFICATE IS ISS .S A MAT TER OF INFORMATION ONLY AP CONFERS NO RIGCiTS JN THE CERTIFICATE HOLDER. TCI AU Insurance Services CERTIFICATES DOES NOT TWEND, EXTEND OR ALTER TIME COVERAC AFFORDED BY THE POLICIES BELOW. Po Box 281900 San Francisco, CA 94128 INSURERS AFFOMINC, COVERAGE HAOC/r _(8771 T34-4420 INSURER Virginia Suretv Coma Inc. INSURED FIND Food Sank, Inc. INSURER dba Food in Need of Distribution INSURERC 68-615 Perez Road, Building 14B Cathedral City, CA 92234 INSURER NSUHER E COVERtACES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER(\ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN59 01 POLICY EFFECTIVE POLICY EXPIRATION LTR II TYPE OF INSURANCE POLICY NUMBER DATE(MMi DATE MMI00/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 10 RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AEG $ PRO- POLICV JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aocltlenl) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNNED AUTOS (Per accident) — PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND A WC STATU- OTH, EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/E)(ECUTIVE 005-00020073 07/01/04 01/01/05 EL EACH ACCIDENT $1, 000, 0 OFFICER/MEMBER EXCLUDED EL DISGASE-EA EMPLOYEE 61, 000,0 yes,describeunder SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $1, 000, 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCE_LI-Xi. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEEOR City Clerk City of Palm Springs EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LER P.O. Box 2743 RAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND Palm Springs, CA 92263 THE INSURER,ITS AGENTS OR R RESENTATIVES. AUTHORIZED REPRESENTATIVE Attn: Project Nana er D78336 ACCRU 25(2001/08) ©ACC.IFID CCRPCRATICN AU Insurance Services Po Box 201900 _ - San Francisco, CA 94128 Attn: Project Manager City Clerk City of Palm Springs P.O. Box 2743 Palm Springs, CA 92263 "'"' ' •• `�i0i!S:�!E SS�3}iaF!33if�i!!IS[E!1➢!!bP'v!!!3�9P!ii!➢i!!!!!a!6!� c I � 4 I J. t Y 1 } t 4 h � 1 1 Y' 1 CONTRACT ABSTRACT Contract Company Name: Food In Need of Distribution, Inc. Company Contact: Dan Tenold, Executive Director Summary of Services: Operational Expenses (Space Rental) Contract Price: $7,868.00 Funding Source: CDBG 137-4803-63004 ($10,300) Contract Term: July 1, 2003 - June 30, 2004 Contract Administration Lead Department: Community & Economic Development Contract Administrator: Dale Cook Contract Approvals Council/ Community Redevelopment Agency Approval Date: April 3, 2002 Minute Order/ Resolution Number: 20302 Agreement No: D Contract Compliance Exhibits: Yes Signatures. Yes Insurance: Yes Bonds: N/A Contract prepared by: Dale Cook, Community Dever ppment Administrator Submitted on: July 12, 2004 By: fp v