HomeMy WebLinkAbout04705 - MIZELL SENIOR CENTER SUBRECIPIENT MEALS ON WHEELS NEV VEHICLE Q F 4AL-A1�,40�5 City of Palm Springs
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Community Redevelopment Agency
MEMORANDUM
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Date: August 14, 2003
To: Barbara White, Assistant City Clerk
From: John Raymond, Director of Community& Economic Develo
Subject: Closing/termination of expired contracts
Yesterday I sent over a long list of expired contracts that had been reviewed by Dale Cook, the
Community Development Administrator, with instructions to close the ones indicated. These
were mostly CDBG contracts that have expired, the services provided, and the finds paid out.
The purpose of this memo is to inform you that I reviewed the list and concur with the
recommendation to close those indicated. Please keep a copy of this memo in the file of each of
the ideAlfied closed contracts.
Page: 9
Report: Expired Contracts: Oldest Date = I I and XREF= COMMUNITY& ECONOMIC DEV-Summary July 24, 2003
Contract Number Description Approval Date Expiration Date Closed Date
enter �6ICii2993� S�
@a 'b"CtA fjo,.l.� . Insurance Status: _
XREF: COMMUNITY & ECONOMIC DEVELOPMENT
-amIi�r-Ir�eem{�Io«
A4705 C D B G 02-03 Subrecipient Meals On Wheels 05/30/2003 07/01/2003 ?, a
Contractor:Mizell Senior Center Insurance Status: r
XREF: COMMUNITY& ECONOMIC DEVELOPMENT
Service: In File
A4706 C D B G 02-03 Subrecipient Agr Adult Education-Operations 05/30/2003 07/01/2003
Contractor :Palm Springs Unified School District Insurance Status: -----
XREF: COMMUNITY& ECONOMIC DEVELOPMENT r i
Service: In File W
e
r.96f2Wsft3 01IQ4 @64 —
Insurance Status:
XREF: COMMUNITY& ECONOMIC DEVELOPMENT
c`„--..• In Prnrocc
` " END OF REPORT ` * * * * *
Mizell Senior Center
• . Subrecipient Agr
AGREEMENT #4705
CM signed 5-30-03 p/R20302
SUBRECIPIENT AGREEMENTTHIS AGREEMENT (herein "Agreement"), is made and entered into this 3rd day of -April ,
2003, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation, and the
Mizell Senior Center, (herein "Provider").
WHEREAS, the City has entered into various funding agreements with the United States
Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG
Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C.
Section 5301 et sec.), as amended from time to time (the "Act"), and the regulations promulgated
thereunder(24 C.F.R. Section 570 et seq. ("Regulations"); and
WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit
organizations for certain purposes allowed under the Act; and
WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible
for a grant of CDBG funds and the City desires to assist in the operation of the program by granting
CDBG Funds to the Provider to pay for all or a portion of those costs incurred in operating the program
permitted by the Act and the Regulations on terms and conditions more particularly set forth herein;
NOW, THEREFORE, the parties hereto agree as follows:
1.0 SERVICES OF CONTRACTOR.
1.1 Scope of Services. In compliance with all terms and conditions of this
Agreement, the Provider shall provide those services specified in the "Scope of Services" attached
hereto as Exhibit"A" and incorporated herein by this reference. Provider warrants that all services will
be performed in a competent, professional and satisfactory manner.
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.
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 DOLLARS ($7,000.00) (the "Contract Sum") in
accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference;
and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if
mutually agreed by both parties, may be amended administratively by no more than 10%, without the
requirement of a formal amendment to this Agreement, but in no event shall such adjustments
increase the Contract Sum. The Provider shall submit to the City monthly statements on reimbursable
expenditures pursuant to the attached Budget along with pertinent supporting documentation. The City
shall promptly review the monthly expenditure statements and, upon approval, reimburse the Provider
its authorized operating costs.
2.2 Payroll Records. In cases where the contract sum will reimburse payroll
expenses as part of operations, the Provider will establish a system of maintaining accurate payroll
records which will track daily hours charged to the project by the Provider's respective employees, as
set forth in OMB Circular A-122 Attachment B.6.
2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance
of at least 25% of the total grant by the end of each fiscal year quarter (September 30, December 30,
March 31, and June 30) shall result in the immediate forfeiture of 25% of the total grant.
3.0 COORDINATION OF WORK.
3.1 Representative of Provider. The following principals of Providers are hereby
designated as being the principals and representatives of Provider authorized to act in its behalf with
respect to the work specified herein and make all decisions in connection therewith:
Marty Hoffman Executive Director
Tom Johansen, Chief Financial Officer
3.2 Contract Officer. The Contract Officer shall be such person as may be
designated by the chief administrative officer of City.
3.3 Prohibition Against Subcontracting or Assignment. Provider shall not contract
with any other entity to perform in whole or in part the services required hereunder without the express
written approval of the City. Neither this Agreement nor any interest herein may be assigned or
transferred, voluntarily or by operation of law,without the prior written approval of the City.
3.4 Independent Contractor. Neither the City nor any of its employees shall have
any control over the manner, mode or means by which Provider, its agents or employees, perform the
services required herein, except as otherwise set forth herein. Provider shall perform all services
required herein as an independent contractor of City and shall remain at all times as to City a wholly
independent contractor with only such obligations as are consistent with that role. Provider shall not at
any time or in any manner represent that it or any of its agents or employees are agents or employees
of City.
4.0 COMPLIANCE WITH FEDERAL REGULATIONS.
4.1 The Provider shall maintain records of its operations and financial activities in
accordance with the requirements of the Housing and Community Development Act and the
regulations promulgated thereunder, which records shall be open to inspection and audit by the
authorized representatives of the City, the Department of Housing and Urban Development and the
Comptroller General during regular working hours. Said records shall be maintained for such time as
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:
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(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 If 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 to promote religious interests as set forth in 24
CFR 570.200 0);
Q) The labor standard requirements as set forth in 24 CFR Part 570,
Subpart K and HUD regulations issued to implement and
requirements;
(k) The Program Income requirements as set forth in 24 C.F.R.
570.504(c) and 570.503(b)(8);
(1) The Provider is to carry out each activity in compliance with all
Federal laws and regulations described in 24 C.F.R. 570, Subpart K,
except that the Provider does not assume the City's environmental
responsibilities described at 24 C.F.R. 570.604; nor does the
Provider assume the City's responsibility for initiating the review
process under the provisions of 24 C.F.R. Part 52;
(m) Executive Order 11988 relating to the evaluation of flood hazards and
Executive Order 11288 relating to the prevention, control and
abatement of water pollution;
(n) The flood insurance purchase requirements of Section 102(a) of the
Flood Disaster Protection Act of 1973 (P.L. 93-234);
(o) The regulations, policies, guidelines and requirements of 24 CFR
570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB
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Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate
to the acceptance and use of federal funds under the federally-
assisted program;
(p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and
implementing regulations issued at 24 CFR Part 1;
(q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended;
(r) The lead-based paint requirements of 24 CFR Part 35 issued
pursuant to the Lead-Based Paint Poisoning Prevention Act (42
U.S.C. 4801 et seq.);
(s) Maintain property inventory system to numerically identify HUD
purchased property and document its acquisition date as is set forth
in OMB Circular A-110 Attachment N Property Management
Standard 6d; and
(t) Reversion of asset. Upon the Expiration of the agreement, the
subrecipient shall transfer to the City any CDBG funds on hand at the
time of expiration and any accounts receivable attributable to the use
of CDBG funds. Additionally, any real property under the
subrecipient's control that was acquired or improved in whole or in part
with CDBG funds (including CDBG funds provided to the subrecipient
in the form of a loan) in excess of$25,000 is either:
(i) Used to meet one of the national objectives in Section
570.208 (formerly Section 570.901) until five years after
expiration of the agreement, or for such longer period of time
as determined to be appropriate by the City; or
(ii) Not used in accordance with paragraph (s)(i) above, in which
event the subrecipient shall pay to the City an amount equal
to the current market value of the property less any portion of
the value attributable to expenditures of non-CDBG funds for
the acquisition of, or improvement to, the property. The
payment is program income to the City. (No payment is
required after the period of time specified in paragraph (s) of
this section.)
(i) Such other City, County, State, or Federal laws, rules, and regulations,
executive orders or similar requirements which might be applicable.
4.3 The City shall have the right to periodically monitor the program operations of
the provider under this Agreement.
5.0 INSURANCE AND INDEMNIFICATION.
5.1 Insurance. The Provider shall procure and maintain, at its cost, and submit
concurrently with its execution of this Agreement, public liability and property damage insurance
against claims for injuries against persons or damages to property resulting from Provider's acts or
omissions arising out of or related to Provider's performance under this Agreement. Provider shall also
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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, color,
creed, religion, sex, marital status, physical or mental disability, national origin, or ancestry 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, or ancestry.
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
Attn: City Manager
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WITH COPY TO:
Aleshire&Wynder, LLP
18881 Von Karman Avenue, Suite 400
Irvine, CA 92612-1500
TO PROVIDER:
urr+ Srw.ci�d w.vy
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.
CITY OF PALM SPRINGS, CALIFORNIA
Dated: ��
t�1� Z� d By: 1'
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ity Ma \ er
ATTEST:r
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APPROVED AS TO FORM: IN
Aleshire&Wynder, LLP 77,/
City Attorney IIL;'
PROVIDER:
Mizell Senior Center
Dated: 5 /7 O 3 By: "&-- ri go
Name: G/giz/2 4: ccv
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By:
Name:
Title: C r'o
(Corporations require two NOTARIZED signatures; 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.)
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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subscribed to the within instrument and
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SS my hand and offi seal.
Se
Slgnalure of Nolary Public
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OPTIONAL
Though the information below not required by law,it may prove valuable to persons relying on the document and could prevent
IQ fraudulent removal and reattachment of this form to another document.
Description of Attached Document
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10, Title or Type of Document:
Document Date: Number of Pages it
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
In Signer's Name.
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CITY OF PALM SPRINGS
EXHIBIT A
Scope of Services
Proiect/Activity Title: Project Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
Objectives/Activities
The intent of this program is to provide nutritional assistance to low-income seniors through daily meals,
as well as provides the function of vital human contact, information outreach and monitors the well being
of isolated homebound elderly. This will be accomplished through the acquisition of a new Neighborhood
Electric Vehicle (NEV) with an after-market service utility box. The replacement of an existing a high
mileage costly later model gasoline van with a NEV will provide relief to annual fleet operations and
maintenance costs. The NEV will supplement the delivery fleet with a cost-efficient, virtually
maintenance-free and environmentally friendly vehicle for close proximity deliveries. The Riverside
County Office On Aging annually contracts with Mizell for congregate and home delivered meals, serving
40,000 meals and 150 clients in Palm Springs.
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 hundred and fifty (150) very low to
moderate income Palm Springs residents.
TARGET
DATE ACTIVITY#1
On-Going Deliver meals to Palm Springs residents. Maintain records of names, addresses,
demographics and service dates for all assistance.
Objective 5: Maintain records for all CDBG activities related to this program.
TARGET
DATE ACTIVITY#1
On-Going Document and maintain all records related to this program, including those required, in
accordance with HUD Regulations, in a stable and secure location.
ACTIVITY#2
Monthly Submit quarterly reports—referenced Exhibit E.
Objective 6: Manacle/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: Acquire a NEV in accordance with an 'open competitive' procurement process as outlined
in proposal.
TARGET
DATE ACTIVITY#1
06/30/03 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
07/15/03 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/ActivltV Title: Project Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
BUDGET SUMMARY
COST CATEGORY CDBG OTHER TOTAL
SHARE SOURCES COST
1 Personnel $ $ $
2 Consultant/Contract Services $ $ $
3 Travel $ $ $
4 Space Rental $ $ $
5 Consumable Supplies $ $ $
6 Rental, Lease or Purchase of $7,000. $ $7,000.
Equipment
7 Insurance $ $ $
8 Other $ $ $
$7,000. - 0 - $7,000.
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.
EXHIBIT B—Budget Summary
Page 2 of 2 Pages
DETAIL BUDGET
DESCRIPTION OF ACTIVITY/ CDBG SHARE OTHER TOTAL
PAY ITEMS SOURCES COST
NEV(including Fees, Taxes & License $4,500. 0- $4,500.
Service Utility Box w/ Identification $2,500. -0 - $2,500.
$7,000. -0 - $7,000.
Progress payments, approved by the Subrecipient and based upon the percentage of completion of
the work with a 10% retention, shall be paid by the 30`h day of each month, provided that the
payment application has been submitted to the City on or before the first working day of the month
The Subrecipient shall receive reimbursements in accordance with the aforementioned cost
categories and line items.
Services are to be performed over the twelve-month period of this 2002 — 03 Program Year— July
1, 2002 through June 30, 2003.
s �
CITY OF PALM SPRINGS
EXHIBIT C
Insurance Inventory
Project/Activity Title: Project Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
INSURANCE INVENTORY
LIABILITY INSURANCE POLICY
Name of Provider's Insurance Company Philadelphia Insurance Companies
Effective Dates of Policy 10/14/2002 to 10/14/2003
Claims Made Policy / / Per Occurrence Policy
Limits of Liability $2,000,000 Aggregate
Deductibles:
Per Occurrence $1000.00
Annual Aggregate $5000.00
Additional Insured Endorsement (Certificate Holder) 0 Yes No
Original Certificate of Insurance Attached Q Yes No
WORKER'S COMPENSATION POLICY
Name of Provider's Insurance Company State Compensation Insurance Fund
Effective Dates 08/06/2002 to 08/06/2003
Limits of Liability $1,000,000 Per Occurrence
Underlying Coverage Limits Per Statute as set by State Law
Original Certificate of Insurance Attached �x Yes No
CITY OF PALM SPRINGS
EXHIBIT D
Beneficiary Qualification Statement
Project/Activity Title: Proiect Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider: Date:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
BENEFICIARY QUALIFICATION STATEMENT
This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the
described projectlactivity. 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—12/10101)
MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD:
INCOME 1 2 3 4 5 6 7 8
LEVEL
VERY LOW
INCOME $17,600 $20,100 $22,650 $25,150 $27,150 $29,150 $31,200 $33,200
Below 50%
LOW INCOME $28,150 $32,200 $36,200 $40,250 $43,450 $46,700 $49,900 $53,100
51 —80%
MODERATE
INCOME $42,300 $48,350 $54,400 $60,400 $65,250 $70,100 $74,900 $79,750
120%
3. What racelethnicity 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 for Community Development Block Grant(CDBG)program purposes only and will be kept confidential.
CITY OF PALM SPRINGS
EXHIBIT E
Quarterly Program Progress Report
Proiect/Activity Title: Project Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider: Date:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
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 OF PALM SPRINGS
EXHIBIT F
Request for Reimbursement
Project/Activity Title: Project Number:
Mizell Senior Center
Meals-On-Wheels Delivery NEV
Name/Address of Provider: Date:
Mizell Senior Center
480 South Sunrise Way
Palm Springs, CA 92262-7641
BENEFICIARY QUALIFICATION STATEMENT
A roved Current Pnor Total Grant
Rp
.Description 'Grant . Reimbursement Reimbursement YTD Balance
Amqunt Period Periods) Reimbursement (Over/Under)
TOTAL
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.
0
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.0
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
1 oFa a= amAndPd 19 I I S C 1701, Section 3 requires that to the greatest extent feasible opportunities for training
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 worker's
representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places
available to employees and applicants for employment or training.
ACORD CERTIFICA OF LIABILITY INSUR E DATE
_ 02/06/2003
'PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Weingarten & Hough ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 1866 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Palm Springs CA 92263-
INSURERS AFFORDING COVERAGE
INSURED INSURERA PHILADELPHIA INSURANCE COMPANY
Mizell Senior Center INSURER B'
480 S. Sunrise INSURER
INSURER D.
Palm Springs CA 92262- 1 INSURER
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,
INSR 7ypE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE MM/DD/Y1' DATE MM/DD/Yy
A GENERAL LIABILITY PHPK032484 2003 10 14/2002 10 14
/ / / EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000
CLAIMS MADE E OCCUR / / / / MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,006
POLICY JECT [71 LOD
A AUTOMOBILE LIABILITY PHPK032484 10/14/2002 10/14/2003
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $ 1,000,000
ALL OWNED AUTOS / / / / BODILY INJURY
X SCHEDULED AUTOS (Per person) $
X HIRED AUTOS
a
I � BODILY INJURY
X NON-OWNED AUTOS �qdS„ _'=.� o �
t (Per aoaidenl) $
I V �r
PROPERTY DAMAGE
(Per accident) $
GAR AGE LIABILITY 6 oB' u AUTO ONLY-EA ACCIDENT $
ANY AUTO YI6D'=' �_ �- ¢ 't�i i / / / / OTHERTHAN EAACCAUTO ONLY
$
AGO
EXCESS LIABILITY / / / / EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE / / / / $
RETENTION $ Is
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'LIABILITY / / / / TORV LIMITS ER
EL EACH ACCIDENT
EA
$
E L.DISEASE-EA EMPLOYEE$
E L.DISEASE POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OPERATIONS OF THE INSURED FOR THE CERTIFICATE HOLDER REGARDING CDHG. CITY OF PALM SPRINGS IS NAMED AS AN ADDITIONAL
INSURED PER THE ATTACHED ENDORSEMENT.
CERTIFICATE HOLDER X I ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
CITY OF PALM SPRINGS FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ORANY KIND UPON THE
P.O. BOX 2743 ;INSURER,IT AGENTS OR REPRESENTATIVES. 41i
AUTHORIXED(4PRESEVTATIVE
PALM SPRINGS CA 92263-
ACORD 25-S(7197) ') �/9 ACORD CORPORATION 1988
n.INS025S(9910).02 ELECTRONIC LASER FO MS,INC - DO)327-'0545 If! Page 1 of
V, V1*
• C06RCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
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.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in
the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by
or rented to you.
CG 20 26 1185 Copyright,Insurance Services Office,Inc., 1984
35/23/2003 16:20
• NO.057 P032
CEROATE HOLDER COPY
STATE P.O. BOX 420807,SAN FRANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
MAY 23, 2003 GROUP:
POLICY NUMBER: 669923-2002
CERTIFICATE ID: 15
CERTIFICATE EXPIRES: 08-06-2ooa
02-06-2002/06-0a-2003
CITY OF PALM SPRINGS ..
COMMUNITY & ECONOMIC DEVELOPMENT
3200 TA14QUITE CANYON WAY
PALM SPRINGS CA 92252
This Is to certify that we have issued a valid Worker's Compensation Insurance policy in a form approved by the California
Insurance Commissioner to;tlre,employer named below for the policy pedod,Indlcated.
This policy is not subject to cancellation by the Fund except upon 34 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
policies 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 may pertain,the insurance afforded by the policies
described herein is subject to all the terms,exclusions,and conditions,of such policies-
AUTHORIYEO nEPRE9E14TATIVE PRESInEMT
EMPLOYER'S LTABILITY LIMIT INCLUDING DEFENSE COSTS! $1,000,000 PER OCCURRENCE
ENDORSEMENT #2065 ENTITLED CERTIFICPTE HOLDERS' NOTICE EFFECTIVE 08-06-2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
PALM SPRTNGS SEN?OR CENTER (A NON-PROFTT CORP.) DBA:
M1ZELL SENIOR CENTER
480 S SVNRISE WAY
PALM SPRINGS CA 92262
SCIF 10262E IFPF-UI:AD 1