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HomeMy WebLinkAbout04591 - POLICE ACTIVITIES LEAGUE PAL SUBRECIPIENT ti VA rA.1 s City of Palm Springs '- Community Redevelopment Agency MEMORANDUM fP i �"41IFORL�� Date: August 14, 2003 To: Barbara White, Assistant City Clerk From: Jolm 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 funds 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 idei lfied closed contracts. Page: a Report: Expired Contracts: Oldest Date= / / and XREF= COMMUNITY&ECONOMIC DEV-Summary July 24, 2003 Contract mber Description Approval Date Expiration Date Closed Date / A4524. C D B G 2001-02, Meals On Wheels 04/04/2001 04/01/2002 Contractor:Mizell Senior Center Insurance Status:A policy will expire soon. XREF: COMMUNITY& ECONOMIC DEVELOPMENTsbC Service: In File 671 A4525 Implementation Of Business Visitation Program 07/03/2002 07/01/2003 /�Contractor:P. S. Economic Development Corp. Insurance Status: XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File -A*5S9- Vib UJI 111ulaill fle11111 UMbn gft► C Insurance Status: XREF: COMMUNITY& ECONOMIC DEVELOPMENT A4591 C D B G 02-03 Subrecipient Agr Scholarships 11/13/2002 06/30/2003 � �/�(� Contractor:P A L Insurance Status: XREF: COMMUNITY&ECONOMIC DEVELOPMENT Service: In File A4603 Lease Tramway Gas Station 12/04/2002 06/01/2003 1� Contractor:Burnett Development Insurance Status: XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: Lease Agreement CA A4631 Subrecipient Agr Food Vouchers 04/03/2002 04/01/2003 Contractor:A I D S Assistance Program Insurance Status: XREF: COMMUNITY& ECONOMIC DEVELOPMENT 02r Service: In File A4685 Collect& Recycle Services For Special Event 4-26-03 04/23/2003 06/01/2003 Contractor:Nxtcycle, Inc Insurance Status: I XREF: COMMUNITY& ECONOMIC DEVELOPMENT C( Service: In File PAL Subrecipient Agr AGRECMENT #4591 SUIBRECIPIENT AGREEMENT :—CM Signed 6-2-03 p/R20302 THIS AGREEMENT (herein "Agreement"), is made and entered into this day of�< ^� 2003, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporati n� and the Palm Springs Police Department Police Activities League , (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 sefr.), as amended from time to time (the "Acf), and the regulations promulgated thereunder(24 C.F-R. Section 570 at 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 TEN THOUSAND DOLLARS ($10,000.00) (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 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: o FF r G�K ETYI A2 bra 6- &�Z: i T" 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 Assi nment. 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: - 2 - (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 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 -3 - 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 at semi.); (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 subrecipients 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 Providers performance under this Agreement. Provider shall also -4- 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). 52 Indemnification. The Provider shall defend, indemnify and hold harmless the City, its officers and employees, from and against any and all actions, suits, proceedings, claims, demands, losses, costs, and expenses, including legal costs and attomeys'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 - 5 - WITH COPY TO: Burke, Williams & Sorensen, LLP 18301 Von Kerman Avenue, Suite 1050 Irvine, CA 92612-1009 T��]]O PROVIDER: ROM SOriru;s /—Lne. rdO z..7ir+ 7—A 14 6Z Q I T-7— k.1ce..� cfi- 9-z G 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: By / City Manager Cm"2�� City Clerk APPROVED AS TO FORM: By TRs rCfl)1 E,0,/kN, ,,;QQj;t Burke, Williams&Sorensen, LLP ON '�?_C --3 Ci rney PROVIDER: t 4-1�e. �J rxe-rH sPh��43 �ocrc.r .Qcrrv,n�r � y� Dated: By: Name: C,�o.-5c Title' Z>, y�r3Urc�2 By: Name: 1 ,L-A Trul 4 f Title: —f Pe"L r,ner (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.) -6- CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT h State of California fC; ye r s I (� SS. � Gauntry of II". q On 1L��r` `f, d , before me, IA it it Date Name en0 Tltle or 0(flccr JIr,c Doc ary Not Publllc) a n a f� 'p personally appeared e; �IDV^✓_ iGYfS rUV�I Ilj.l F Namc(s(of S,gner(a) 171 "=1 personally known to me h proved to me on the basis of satisfactory h u evidence r, to be the person(s) whose names) y+5/are subscribed to the within instrument and F11 acknowledged to me that V,ef re/they executed Ml7LANI@ ALEXA.NDER the same in hfsH,er/their authorized ',I µ` a cerm,sslor t3125sa capacity(ies), and that by Ntsfher/their r' a NOt.2y =bb,c - callrornia RNersica CDLnty signature person(s), or on the Instrument the person or MY co ESD ree Jul s,2oD5 v the entity upon behalf of which the person(s) acted, executed the instrument. IT E55 y hand ax d offi�al seal Place Norury seal Above slklnewr Vote,y I' Im I� I(' N OPTIONAL Though the information below ry nol requirad by law, it may prove valuable to persons relying on the document titl and could prevent fraudulent removal and reattachmcnr of ill form to another document I•n }II Description of Attached Document n Tltic or Type of Document. c51(/ !" %� V1 C 1, RDocument Date '-3l e.2— Number of Pages. 't Signer(s) Other Than Named Above ;CI Gapacity(ies) Claimed by sig 1 'All Signer's Name �P6(LI� L�J. I� LL Individual y` Top of lhur,lb hurt U R' Corporate Officer—Title(s) FX1°04 ffi14( bfaaw _ 17 �r•1 I I Partner—I I limited 711 General ❑ Attorney in Facl 7re��ru>�c r U Trustee , LI Guardian or Conservator I_t ❑ Other: fl Signer Is Representing. 01 19M Nrmml Not,,Aoo.ale,-925u Di Smo Ave 70 Po•Nn^•Lhal,wotln CAmnjecu:•wwm naounaLrvu,y„q lNo ,aer RMOrdv call Toll rrLe 1-800-876-6827 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Actiyity Title: Project Number: PS Police Department-- 0018 Police Activities League (PAL)/Scholarships Name/Address of Provider: Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 O biectives/Activities The intent of this program Is to provide a variety of activities to engage their youth in positive, wholesome and character building activities in well-supervised and safe settings with educational, recreational and athletic programs. The Palm Springs PAL Chapter is affiliated with the California Police Activities League, which is a 501(c)(3) California nonprofit organization and was incorporated in 1971. This will be accomplished through scholarship funding for at-risk low and moderate-income youth in the Desert Highland Gateway Veteran Tract neighborhoods. PAL will serve 1,500 youth City-wide of which 29 very low to moderate income youth will receive scholarship assistance. 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 Re- 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 twenty-nine (29) ven/ low to moderate-income Desert Highland Gateway and Veteran Tract youth. TARGET DATE ACTIVITY#1 On-Going Provide Police Activities League program opportunities to eligible Palm Springs youth living in the Desert Highland Gateway and Veteran Tract neighborhoods. Applicants must meet criteria in Exhibit D. 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 Police Activities League program opportunities to eligible Palm Springs outh living in the Desert Highland Gateway and Veteran_ Tract neighborhoods 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 Proiect/Activity Title: Proiect Number: PS Police Department— 0018 Police Activities League (PAL)/Scholarships Name/Address of Provider: Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $ $ $ 2 Consultant/Contract Services $ $ $ 3 Travel $ $10,260. $10,260, 4 Space Rental $ $ S 5 Consumable Supplies $ $2,100. $2,100. 6 Rental, Lease or Purchase of $ $2,400. $2,400. Equipment 7 Insurance $ $ $ 8 Other $10,000. $4,200. $14,200. Scholarships ($350) S $3,600. $3,600. Overhead $ $3,000. $3,000. Uniforms $10,000. $25,560. $35,560. 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 include fundraising activities conducted by Agua Caliente Tribe, Lions Club, Village Pub, City of Palm Springs and private donations. The Subrecipient shall receive reimbursements in accordance with the aforementioned cost categories and line items. The program will pay for 29 scholarships at $350.00 each. Payments, approved by the Subrecipient and based upon the actual number of income eligible scholarships awarded in the prior period, shall be paid by the 30'" 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 2002 —03 Program Year—July 1, 2002 through June 30, 2003. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Project/ActivitV Title: Protect Number: PS Police Department— 0018 Police Activities League (PAL)/Scholarships Name/Address of Provider: Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Providers Insurance Company Clarendon America Ins Co and American National Life Ins Effective Dates of Policy 01/01/03 to 01/01/04 Claims Made Policy / / Per Occurrence Policy_/ / Limits of Liability $5 DDO 000 General Aggregate _ Deductibles: Per Occurrence 1 OOO.OD Annual Aggregate 1 ODO 000.00 Additional Insured Endorsement (Certificate Holder) U/Yes in No Original Certificate of Insurance Attached ❑Yes Ao WORKER'S COMPENSATION POLICY Name of Providers Insurance Company No Paid Employees—N/A Effective Dates Limits of Liability Underlying Coverage Limits Original Certificate of Insurance Attached 0 Yes V No CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement ProiectlActivity Title: Project Number: PS Police Department— 0018 Police Activities League (PAL)I Scholarships Name/Address of Provider, Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described projecVactivity. 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,roamers,or borders cannot be included as household members. 2. Circle your combined grass annual income(Riverside-San Bernardino,CA-12110101) MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME 1 2 3 4 6 6 7 8 LEVEL VERY LOW INCOME $17,600 S20,100 $22,650 $25,150 $27,150 $29.160 $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 S42,300 W,350 $54,400 $60.400 $65,250 $70,100 $74,900 $79,750 120 3. What rdcelethnicity,do you Identify yourself as; please note that this self-identification Is voluntary in accordance with equal opportunity laws? t7 White 0 American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian 0 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:0 Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4- Please Check,,ecs 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 YHIS 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(ODBG)program purposes a Federally-funded program,governmental mpoNng purposes to monitor compliance. CITY OF PALM SPRINGS EXHIBIT B Quarterly Program Progress Report ProiectlActivity Title: Project Number: PS Police Department— 0018 Police Activities League(PAL)/Scholarships Name/Address of Provider: Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced: #of Households #of Persons 0-50%below 51-80%below 120% below ♦ Number of First-Time Female Headed Households: ♦ Counts by Race/Ethnicity: White — American Indian or Alaska Native AND White Black/African American Asian AND White` Asian — Black/African American AND White, American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander —Other. HISPANICILATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Prolect/ActivitV Title. Pro'ec�t Number: PS Police Department— 0018 Police Activities League (PAL)/Scholarships Name/Address of Provider: Palm Springs Police Department Police Activities League 2363 East Tahquitz Canyon Way Palm Springs, CA 92262-7009 BENEFICIARY QUALIFICATION STATEMENT 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-Satan 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 eonstmction, 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 prier to the execution of this contract, shall he 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 IOW-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, prionty 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. Notifii Lions 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, d 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 CERTIFICATE OF LIABILITY INSURANCE 03/1"32 0 PRODUCER (260)482-5455 FAX (260)483-6297 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Diller-Smith & Assoc I ates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2526 SCOtswo I de Dr. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P,O. Box 8517 Ft. Wayne, IN 46808 INSURERS AFFORDING COVERAGE NAIC N INSURED C81 i forn I a Po I i ce Act I v i t 1 es League! #2 INSURER A- CLARENDON AMER I CA INSURANCE CO. 2000 East 14th Street INSURERS: AMERICAN NATIONAL LIFE INSURANCE CO.OF TEXJ San Leandro, CA 94577 INSURERC INSURER e INSURER B COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANOINC ANY REOUIREMRNT,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 Dv TYPE OF INSURANCE POLICY NUMBER POLJ3AICY ECTIYE POMCYEXPIRAMN LIMITS CENERALLIABILRY ECP0003D5-00 01/Ol/2003 01/Ol/2004 EAGXOCCURRENCE $ 1,000,000 X COMMERCIALGEHERALLIABILITY DAMAGETORENTED 5 50,000 CLAIMS MADE FXI OCCUR MED EXP(Ay om pu=n) s NONE A X INCLUDES ATHLETIC PERSONALAADVIMURY S 1,000,000 PARTICIPANTS GENERM.AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 5 1,000.000 POUCY JECT n LOG AUTOMOBILE LIABILITY EP0000305-00 01/01/2003 01/01/2004 COMBINED SINGLE LIMIT $ ANYAUTO (E'xT4nB 1,000,000 ALL OWNED AUTOS EOWLYINJURY A SCXEWLED AUTOS (Pwp-n ) S x HIRGD AJTw^ BODILY INJURY i X NON-OWNED AUTOS Wee fmd-m (Pb a�n�enIOM1AGE i GARAGE LLABILRY AUTO ONLY-EAACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO DNLT: AEG i ExcELvumRE_A LIABILITY EEXO-00026-00 O1/O1/2003 01/01/2004 EACH OCCURRENCE S 4,000,00 X OCCUR ❑CWMS MADE AGGREGATE i 5,ODD,OD A s DEDUCTIBLE $ AeNTION i i WORKERS COMPENSATN]N AND ITO WCS7 TLI- OTIF T�1lLOYEJLS'LMRILITY ANY PROPRIETORIPARTNERADCECUTIVE R.L•EACHACC@ENT i OFM14 MEWE,R EXCLUDED? EL DISEASE-FA EMPLOYE S ITypS,dru+iW yRdu SPECIAL PROVISIONS Wow EL DISEASE-POLICY LIMIT i DC EI�ENT/MEDICAL FLD02-34200-BC 01/01/2003 01/01/2004 A0 & D $50,000 B ACCIDENT MEDICAL EXCESS-MAX. BENEFIT $50,000 DED. ; NONE Dn"sExuA�oA�YJ E/MOLESTAIf ION POL#'ECP 000305-00 EFF: 1/1/03 TO 1/1/04 $25,000 PER OCCURRENCE AGGREGATE: S100.000 ERTIFICATE HOLDER IS AN ADDITIONAL INSURED. CEPTIFICATE HOLDERCANCELLATION 514OULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E RAMM DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL PALM SPRINGS 30 DAYS WRITTEN NOMETO THE CERTIFX:AYE HOLDER NAMED TO THE LEFT, ATT: GEORGE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIADAM 2363 E TAHQUITZ CYN WY. OF ANY KIND UPON THE INSURER,ITS AGENTS OR KTRESENTATIVES. PALM SPRINGS, CA 92262 AUTHORIZED REPRESENTATIVE John Lefever/SAA ACORD n(2801/06) ©ACORD CORPORATION 1988