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HomeMy WebLinkAbout04641 - CATHOLIC CHARITIES SUBRECIPIENT Report: Expired Documents: Oldest Date=01/01/1950 and XREF= COMMUNITY&EC -Summary March 16, 2004 Document Number Document Description Approval Date Expiration Date Closed Date A4398 Sale City-owned 7,840 Sq Ft Parcel Via Olivera/indian Cyn 09/05/2001 09/01/2003 I tq�l Company Name: Burnett Companies Insurance Status: INACTIVE 40 (l� XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: Incomplete/Missing A4438 Downtown Pkg Structure 12/19/2001 12/01/2002 Company Name: Walker Parking Consultants Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4525 Implementation Of Business Visitation Program 07/03/2002 07/01/2003 Company Name: P. S. Economic Development Corp. Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4539 2 Way Conversion Indian/Palm Canyon 07/17/2002 07/01/2003 ����� I Company Name: C R A Reimbursement Agreement Insurance Status: INACTIVE 40 XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4589✓ Subrecipient Agreement, Construction Project 11/01/2002 11/01/2003 / Company Name: Desert Aids Project Insurance Status: Certificate and Policies are OK '21V�J� �y XREF: COMMUNITY& ECONOMIC DEVELOPMENT 6 Service: In File . 4641✓g Subrecipient Agr Motel Vouchers J 02/21/2003 02/01/2004 � Insurance Status: Letter EXPIRED printed February 03, 2QQ empany Name: Catholic Charities XREF: COMMUNITY& ECONOMIC DEVELOPMENT 1r� o(o Q Service: In File ✓ A4 691 Repair Of Desert Highland Mural Project At Desert Highland Unity Center 05/05/2003 06/01/2003 Company Name: Richard Wyatt Insurance Status: INACTIVE XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File Catholic Charities Subrecipient Agr AGREEMENT #4641 CM signed 2-21-03 per R20302 SUBRECIPIENT AGREEMENT g , � THIS AGREEMENT(herein "Agreement"), is made and entered into this1 day of 206, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation, and the Catholic Charities San Bernardino/Riverside , (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 seq.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et sec. ('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 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: CHIEF EXECUTIVE 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 Subcontractinq 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: - 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 etseec.); (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 -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). 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 - 5- WITH COPY TO: Burke, Williams & Sorensen, LLP 18301 Von Karman Avenue, Suite 1050 Irvine, CA 92612-1009 TO PROVIDER: CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE 1450 NORTH D STREET SAN BERNARDINO, CA 92405 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: d_r_,. t City Manager ATT E T: Agreement over/under $25,000 (�Ci lerk Reviewed and approved by APPROVED AS TO FORM: Procurement& Contracting Burke, Williams& Sorensen, LLP Initials I-L Hate P.O.Number City Afffim6l PROVIDER: CATHOLIC CHARITIES SAN BERNARDINO, CA 92405 J Dated: '2_� c�2_ By: e_�,;.va✓�-%ip„ � � 1 /Name: JANET GREEN Title: CHAIRMAN OF THE BOARD By: V me: MARYROSE WALLACE Title: TREASURER (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.) V I ' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California �I ss. County of an Bernardino jl C jl I� On December 27, 2002 , before me, Wilfrid C. Lemann �I Dale Name and Title of Officer(e.g 'Jane Doe,Notary Publm") I ( personally appeared Janet Green Ij( Name(s)of Signers) u�l 7 personally known to me n ❑ proved to me on the basis of satisfactory fit evidence l3 to be the personal whose named is{ara �^ subscribed to the within instrument and acknowledged to me that 4efshe/t4ey,executed the same in 44+s/her4theelr authorized jl OFFICIAL SEAL capacitypol and that by -his/herA49e&if WILFRID C.LEMANN 0 signature on the instrument the personw, or ?I _ -..,.. NC7All PUBLIC-CALIFORNI1 COMMISSION*1210858 C the entity upon behalf of which the perso* 1A SAN BERNARDINO COUNTY • acted, ecd ed the instrument. My Con"ission Exp,Feb.13,2003 t i WIT E my hand and official seal. jl place Notary Seal Above 6;gnatura of Nolery Pubba �I OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document ) I�r and could prevent fraudulent removal and reattachment of this form to another document. '�l I Description of Attached Document fil Title or Type of Document: Subrecipient Agreement Document Date: Number of Pages. 6 31 Signer(s) Other Than Named Above: MaryRose Wallaceit �I I� Capacity(ies) Claimed by Signer J Signer's Name Janet Green ❑ Individual ill Chairman of the Board ropotn,umbhara I� �] Corporate Officer—TItIe(s): � I� ❑ Partner—❑ Limited ❑ General I ` ❑ Attorney in Fact 'al ( ❑ Trustee ),I ❑ Guardian or Conservator JI Ili ❑ Other: I I� i¢(' Catholic Charities San Bernardino Signer Is Representing: �i )I ©1997 National Notary Association•9350 De Soto Ave PO Box 2402•Chatsworth,CA 91313-2402 s Prod.No.5907 Reorder Call Toll-Free 1-800-876-6827 ' �[.GP.4,F;Y .ea:�i.�;ra a�...;,,r,:c.rrJ;.,�U!4`:.:._ - ., .�T I�J+YYFM'M'4��1 d�W�'V+.V.yeMaw 7..p.nniY'YJ.r.✓'.�n... -. -� .� 'a��Y 1, CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT yny'- r,-r:-c-rti--r-crcrc:rcry-rcrcn.;;cr�,,c2�%�.c-�>.crcr..�rcacrcncc>.-cntir..cnc�r.�i'.cr:cocycncrs�r�.mc.cr-.-.-'r; h � State of California I� County of San Bernardino ss. I On December 27, 2002, before me, Wilfrid C. Lemann Data Name and Title of Officer(e.g.,"Jane Doe,Notary Public") I personally appeared Mary Rose Wallace Name(.)of Slgner(s) ❑personally known to me ❑ proved to me on the basis of satisfactory ,)) I evidence to be the person(s)- whose name(s-) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed 31 the same in his/herfthek authorized capacity0es), and that by +ris/her/flieir OFFICIALSCAL si nature on the instrument the erson s or WILFRID C.LEMANN 9 �j- p { )s NOTARY PUBLIC-CALIFORNU N the entity upon behalf of which the persons}, ,I t COMMISSION•1210858 C -I ( N SAN BERNARDINO COUNTY + acted, exec ted the instrument. ,I My Commission Exp.Feb.13,2003 �I WIT SS hand and official seal.) <O ) I ( Place Notary Seal Above Signature of Notary Public I OPTIONAL (; Though the information below is not required by law, it may prove valuable to persons relying on the document 5i and could prevent fraudulent removal and reattachment of this form to another document. I Description of Attached Document Title or Type of Document: Subrecipient Agreement I' I Document Date: Number of Pages: 6 (, Signer(s) Other Than Named Above: Janet Green t I Capacity(ies) Claimed by Signer ( Signer's Name: MaryRose Wallace _ 'l ❑ Individual - l I, Tap of thumb here ;) 13 Corporate Officer—THIe(s): Treasurer ❑ Partner—❑ Limited ❑ General ❑ Attorney in Fact .) t' ❑ Trustee 'I ❑ Guardian or Conservator ❑ Other: I [ Signer Is Representing: Catholic Charities San Bernardino Ali l- I ( .I 1997 National Notary Association•9350 Be Soto Ave.,PO Box 2402•Chatsworth,CA 91 31 3-24 02 Prod.No 6907 Rmerder Call Toll-Free 1-BOB-876-6827 .. � �. , ;, �. .. ,.,ee �, � � .� ,. ,r.� ., ;:.., � �: a .. :. - CITY OF PALM SPRINGS EXHIBIT A Scope of Services Project/Activity Title: Proiect Number: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 O b i ectives/Activities The intent of this program is to provide emergency housing assistance to homeless individuals. This will be accomplished through placement in the forty (40) bed Nightengale Manor Family Emergency Shelter for up to seven (7) weeks. If placement is not available, due to capacity limits, or practical for certain clients (i.e., single males) motel voucher will be made available for referrals to local motels and hotels for the homeless individuals. Efforts will also be given to find transitional and permanent housing when available. The Palm Springs Police Department will refer individuals for these services. Catholic Charities will serve 480 homeless individuals Valley-wide of which 35 very low to moderate income individuals will receive motel voucher 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 (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 an approximately thirty-five (35) very low to moderate income homeless individuals. TARGET DATE ACTIVITY#1 On-Going Distribute motel vouchers to clients, not to exceed seven weeks. 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 emergency housing services including motel voucher assistance to homeless individuals, 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: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 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 $ $ $ Equipment 7 Insurance $ $ $ 8 Other - Motel Vouchers $10,000. 00 $ $10,000.00 (35 x $285.71) TOTALS $10,000.00 $ $10,000.00 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 FEMA, EHAP, HOPWA, Ryan White Title I, United Way and private contributions. The Subrecipient shall receive monthly reimbursements in accordance with the aforementioned cost categories and line items. Payments, approved by the Subrecipient and based upon the actual number of clients and their lodging stay, shall be paid by the 301"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 Proiect/Activity Title: Proiect Number: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Catholic Mutual Relief Society Effective Dates of Policy 07/01/02 through 07/01/03 Claims Made Policy / / Per Occurrence Policy Limits of Liability $650 000 General Aggregate Deductibles Per Occurrence Annual Aggregate Additional Insured Endorsement (Certificate Holder) 4/yes ❑ No Original Certificate of Insurance Attached ❑Yes "to WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Combined Specialty Ins. Co. Effective Dates 01/01/03 through 01/01/04 Limits of Liability $100,000/$100,000/$500,000 Underlying Coverage Limits / Original Certificate of Insurance Attached ❑ Yes yNo CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title: Project Number: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 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—12110/01) MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME 1 2 3 4 6 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 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: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 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: 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 Project/Activity Title: Project Number: Catholic Charities/Motel Vouchers 0010 Name/Address of Provider: Catholic Charities San Bernardino/Riverside 1450 North D Street San Bernardino, CA 92405 BENEFICIARY QUALIFICATION STATEMENT Approved Currant Prior Tptal Grant Description "Grant Reimbursement Reimbursement' - YTD ( 'Balance Amount Period Period a Reimburs ement oved 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. 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 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. _Sent By: Catholic Charities; 908 348 1138; Jun'9'03 2:48PM; Page 2/4 • Sent`Sy: Catholic Charities; 909 348 1130; Feb-3-03 9:32AM; Page 2/2 'e0:eh 03 03 09 ", 3a Catholic Mutual 1909) 475-5144 p.2 B. 3, 20 9:52AM CMG 402 551 2913 CEFiTIFICA7E 0 LIABILITY INSURANCE fi; C•N•G• AGE 'INC. PA�QnFtO TNIB Gm z'M200] OAD, StlIIs. 1oQ ONLY IFCOMP LS ISNoEO Ai A NA OnANA, nE 61 •260Q AND CDNFEIIS NO RIONIY UPONR HE DAFORMAT1011 NOIOEp. THE CENTIFIC „ YFi A,LToX TNT IFRAG CERTIFICATE OOI!2r NOT AMENb, ATE THE COveRA6E AFfOAOED AY THE A>S't'BEL "�--(WUCIE+BELOW. ,Ix, wcwEQ f,Lw.,l R i `" —` WSUI AFFORDING COVII aEpNA I NAICR A ~ C oN SCLZ OF SAt1 110iN0 uw rEAA: COlAIBEO SPECIALTY I s.cul n v�. CO r SI SO1 120E E RIGB1,1 mEVnIN1. I`yp SAN EE:RNARDI AVE 92404 I4EOAOIe pp .y` '^N QKOIIEAo. „;! CDV AOfS TrrF roues or•I RANEE USreP/FLOW HAVEBEEN ISSUEd 1oTHEINBUREo . ANY REOI1BfEhK Tu'IM dR CdN01T10N DF ANY CON NAMFA ABOVE MR THE FdLICY PEAUTgI �: KIPS AI':(jp TAEAFip MA PYYNEOMMEODEWRIKEOME VMINT VA TDALLrNE RVI10 .No1WI rHSTM (NNG BBB LIMIT35�,�y�� RESPECT td yryNy�rW3 CERri SYr ^V•,HMAY NAVFBEENREOVCEp OY PI TERM EXCL qN FKA7E MAY BE 135UCD Of{ C1ANA3 O5 S ANO CONbftloNS of SUCH ��i EENu.LL ' .rY Ea..-..� rouerNwEEn r resins rau Ar •�„ ��, LOENCR LNIrC ��,, � .L LwEAIrt - EACMOGCMIINSS I •. uQGQ�Q - V4+1' wow n. I i,I;ra e..ni t PEAEONALLAbv W/AT -' tbVLA bwRAM4M PEP; QwyCAALA qi FOXY PI QQACQ"1E LOG rAQOUCTi-GOAIwWAI t `•.,IIk>; A4EQXOELLIU�' WrY �"�— -••w�._ q Jp AVTQd`J,' u:.y't ALLL TO$ IKi IIM0INOLEUNT I z'.r ECIIEOUL A wTq MFW AV i I Irvlfirr..,.1 I EFQO�AINRY j T ''���' QWAesI (M1 r�Nl AMAGE E e.M u�rt AWAUIQ TO T-EAALY.I r f i 4 ` OTNFA n1ar/ �yo!` ECCEEQA vna "u, AOTOOKv AOG t 4 Gk,„i oCCVII yuT.°�g1NM:woF EAUtoCCWNFNQ I YIAI 1i 4:15';�; OE OR pk ' t ti g AEIENTIQW INrLorq -'. A 1•LUIILrtr , TAT L ~` An rx "'"'E7°"'"Aym FEEunve 010006]245�00 1-07.-93 A drFl[EAMENKAe �.`y°��M`-� G x.xwYAEt«Lrr I '�f 1•U1-04 EY[AONAC41oiNT L O *y'li Q \ C.L,ONFACE•GlMr10rFF E 1 EL OIEGAEE•FOLICT wEi a •dam �r v 9i1tlN"rgMofO"EAgmkYl n 14IE/vL E14WVNQNEAOVEDEIEIOGIUIY�NE1lfECIALFPYYIYOt�s I i�gt COVIAART YERITH. CATBOLIC c,i THE CEFpIPICATB r,4< 40ARIIIES, 1450 NOR1'B 0 STREET, SAN 11EIO7AP➢INO, CA 92405, FOR M. ILIQI Ok 1�li d $. � l iNT1FlCTE HD DER Ij,G�S ti�rr'B; OANCELL�TION A , EWYLQANv aFrMAPIErACwFCE h:YI " .OwEIEA FLOAMCELLEO EEFOPET ��++' QATF}NEACaF,rNE IEIII:NG AQVIIEN NTLLfIpAAYQR p TIC EXMFAr10N �, N+, JT7l MOftEE TO TWL Id III wkTm '� fi1C[iIl11NElIlE ApLOC11,ywEQ To TX!LCAT EUTgNVA/TU ER 10 EMLL �, 1. a��!(' MMOEE NO OMIOAIIE:I OA t EIGfY OF MNr IOIb UPON THE WIIF AErAECINr"', :I AE•CNp OA AViumorLYRRENTA rh fi!V+".� ORD25 200T � �u� a pi �.�. p�y1, \u� OACDADCopi ATION17E1 I;i;6"' I ISA Sent By: Catholic Charities; 909 348 1130; Jan-9-03 2:48PM; Page 3/4 ENDORSEMENT CM T317,107ACIIEI)TO l.IatTI RCATR) Effective Date of Endorsement 7/l/2002 Charge_• etc" Cancellation Date of Endorscnlent�Zo(1:4_ Cerifioalc Holder 11,e Roulan Cau)ollc Bisllop of san Bemardino, (,,A, a Corporation Sale 1'lpl East Hlgblttnd Avenno Sint Bernardino,CA 92404 Cerilfiatte No. 8571 of Tile C,rtholic Mutual Relief Societv is amended as follows: &ECTIoN 11 -Ai)DiT10NAL PR(YIBCTFI)PERSON(S) It is understood mid agrccd that SLutiou A-Liability(only with respect to Coverage D-General Liability,Coverage F-Medical Payments to Others aril Coverage Ii-Counseling Errors and Omissions)is amended to include as an Additional Protected Per9on(s)members of the organizations shown in the schedule,but only with mspccl to their liability for the Protected Persou(s)activities or activities they perform on behalf of the Protected Person(s), It is flnther understnod and agreed that covenmgv extended under this endorsenem is lirnilul to and applies only with rc.gwt to liability assumed by contract or agteeinent;and this extension or coverage shall not.eidarge Ole scope Of coverago provided under this certificate or incruase the limit of liabiliry thereunder. Unless otherwise aLwcd by con(ml.or agn;emertt,cevetage exlonded under thts endorsetrwnt to the Additional Protec#od Person(s)will not precedc the effective date of this certificate of coverage endarsoment or extendboyond the cancellation date. Schedule-ADDPTIONAL PROTECrFD PERSON(S) City of palm Springs Remarks: Coverage only extends to claims directly arising out of C.DBG/Hottsing and Job Placement for Holueless Persons in P;dm Springs,CA for the teen oftho certificate. dTOMGd Rtyffcsetttativw PAS-122(1-49) Sent 8y: Catholic Charities; — — — — 909 348 1130 Jan-9-03 2:48PM; Page 4/4 ARM 2002 10;24AM CMG 402 551 2949 nu• �7�� r. „ j at4 1 i/26/2002 G4rt;ncate Holder This Cerditcate is isided L a roatter of informadoet ettly and The Adman Caihollc Bishop a San Bernardino,CA, confers no rights upon the holder of this certificate This certificate A Corporation Sole does not amond,extend or alter the coverage afforded Mom 1201 Bast 1ltgblaod AveauC Cmrp Atfa4h-wG,v rape San Bernardino,CA 92404 TM CATHOLIC MMAL AMIEF SOCIETY Cvr %d T,n fi m 10841 OLD MaL RD M 300 Catholic Charities OMAX44. NE 69154 1450 North D Street San Bernardino,CA 92405 a a This is to certify that the coverages 1lpted below have been issued to the cctiificate holder aimed above for the certificate indicated,notwithstanding any requirement,term or condition of any contract or other document with respect to which ibis cerKwite may he issued or may pertain,the coverage afforded described herein is subject to all the terms,exclusions and conditions of such coverage,Limits shoran may have been reduced by paid claims. YSpe of Cv+'erary Catlgtak Moubtr Carataee WrMtrn Cwera Rspira4ian fMdn Dak Daft P+ pgty Rawl 4 Pw4ml Property Getuttl LAabWty C�Ittrai App+gate Produda•CpnplOP Apg Deeurrenct Perromd k AO hOW 7 OCbtw Made Bath 4ccanwft Fire Dwtaac(Ary ano are) Mod EV(AV oat per) ExtgA Iaaptaiy risen Oraaraue O,her Excess Employcrs 9571 1/l/2002 7/1/2003 Bubo a Liability $l s0,0t10 Dutdpdon of Opetttlont/1:ocatiuWVehidadipedtl ttntn Cwofage verified for Catholic Chafitias for the term of the eox0ficatc. Total coverage is$250,000 each accidera,$250,000 each otnployea,S500,000 disease-policy limit. CMitS Excess S150,000 XS$100,000. doer at Co Mdj ' cdldlon Should any of the above described coverages be c4ncet1e4 before the expiration date thermf,the fsauing company will endeavor to well 3Q days written notice to the bower of certitkate named to the left,but faifare to mail such notice shall hnpose no obligation or liability of any fund upon the company, Its agents or representatives. 4elhntrttd ttcerereA4Fad 0309000464