Loading...
HomeMy WebLinkAbout04479 - FIND FOOD IN NEED DISTRIBUTION CDBG SUBRECIPIENT 4 ?A Al s City of Palm Springs Al Ao G� Community Redevelopment Agency M1 � AA MEMORANDUM Two wIPO , �g1xFORN�� 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 funds paid out. The purpose of this memo is to inform you that I reviewed the list and concur with the reconunendation to close those indicated. Please keep a copy of this memo in the file of each of the ideliifred closed contracts. Page: 7 Report: Expired Contracts: Oldest Date= / / and XREF=COMMUNITY&ECONOMIC DEV-Summary July 24, 2003 Contract Number Description Approval Date Expiration Date Closed Date A4336 C D B G Subreceipient 2000-01 Swimming Pool Renovations 04/05/2000 04/01/2001 Contractor:Boys & Girls Club Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4438 Downtown Pkg Structure 12/19/2001 12/01/2002 I Contractor:Walker Parking Consultants Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4452 C D B G 01-02 Food Vouchers Subrecipient 04/04/2001 04/01/2002 Contractor:Aids Assistance Program 9 Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A447 2001-02 C D B G Subrecipient Agreement 04/18/2002 04/01/2003 Contractor:Food In Need Of Distribution Insurance Status: A policy has Expired. _ XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File �2/3��✓�� A448 C D B G 2001-02 Subrecipient Agreement, Fair Housing Services 04/18/2002 04/01/2003 Contractor:Fair Housing Council Of Riverside County Insurance Status: Certificate and Policies are OK XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A4481 2001-02 C D B G Subrecipient Agreement 04/18/2002 04/01/2003 Contractor:Shelter From The Storm Insurance Status: A policy has Expired. <� XREF: COMMUNITY& ECONOMIC DEVELOPMENT y' Service: In File A448 C D B G, 2001-02 Subrecipient Agreement 05/03/2002 05/01/2003 Contractor:Catholic Charities Insurance Status: Certificate and Policies are OK �� XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File FIND Subrecipient Agreement AGREEMENT #4479 R20021, 4-18-02 SUBRECIPIENT AGREEMENT — — — THIS AGREEMENT (herein "Agreement"), is made and entered into this Ikday of e �c 2002rby and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation, and the (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 sue.), 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 TWENTY THOUSAND DOLLARS ($20,000.00) (the "Contract Sum") in accordance with the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City monthly statements on reimbursable i��P''Jd�cs L':46 dW 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;jdecisions in connection therewith: ti S�Si V 1 C3 i tti 6 "1 r G sCl 4 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: -2 - (a) Submit to City through its Economic Development Division 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 labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; Q) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (k) 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; (1) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11288 relating to the prevention, control and abatement of water pollution; (m) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); (n) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate to the acceptance and use of federal funds under the federally-assisted program. -3 - (0) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (p) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended; and (q) 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.); (r) 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. (s) 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.) (t) 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 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 -4- 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 parly 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 WITH COPY TO: Burke, Williams &Sorensen, LLP 18301 Von Karman Avenue, Suite 1050 Irvine, CA 92612-1009 - 5 - TO PROVIDER: 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: City Manager — City Clerk APPROVED AS TO FORM: Burke, Williams & Sorensen, LLP Ci A rney PROVIDER: Dated: By: Name: Title: �`['•R ^`//?'1 By: € �✓ Nam GY�e Title: 77E 465�rz'Ic—, (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.) APPROVED BY THE CMI�W�Mkrvl2tt - 6 - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT r.�rcr,`rcr��xv`.ercr.rtrcr-r;-;c;cr- -r-rcr-�.crcr;erce-,-rcrc_rc,�;crec�zrcr. :.ct re -n:�'.ercrcr--rcr�_r�_ :�.�v I� State of California County of AIgeksCr_1D ss. I On ��`�,9 �� , before me, _ h9�V "am,� I�A�� y`g��„,.7�i;,�, �1I Dale ,,p Name and Title of Officer(e g„"Jane Doe,Notary Public") 1 personally appeared U lC T BeV_ _S-_il I � � Neme(a)of Signers) PP,11 ivt personally known to me )' ❑ proved to me on the basis of satisfactory evidenceI to be the person(-s) whose nl is/are subscribed to the within instrument and acknowledged to me that he/s+re/they executed the same in his/hes/threir authorizedI capacityQef), and that by hIs/hleF/theiY Ff s's 4P�1�E E9 {a P� signatures} on the instrument the person(s), or the entity upon behalf of which the persorl its, .,tW(�i YtEl y V C ��'.Y+2�lyouns acted, executed the instrument. I WITNESS my hand and official seal. Place Notary Seal Above }' Sgnalure of Nolary Public OPTIONAL men �I Though the information below is not required by law, it may prove valuable to persons relying on the docut �I and could prevent fraudulent removal and reattachment of this form to another document. I`�I Description of Attached Document Title or Type of Document: Cp pOppW&k��.,p eAl�c p y op TS Rai N l Ca 6 l am' 6;Document Date: b Number of Pages: ���9G,�i Signer(s) Other Than Named Above.�AW Iy2 ( UI I� Capacity(ies) Claimed by Signer Signer's Name: (.�EL ly �C k .L I ❑ IndividualI Top oP Ihum6 here I� Corporate Officer—Title(s): '�`e���=�mU��� I. ❑ Partner—❑ Limited ❑ General I� ❑ Attorney in FactI fi ❑ Trustee ❑ Guardian or Conservator Ifiq ❑ Other: �I `( , p Ifi Signer Is Representing: JT 1997 National Nolary Aesomation•9350 De Soto Ave PO.Box 2402•Chatm.dh,CA 91313-2402 Prod No 5907 Reorder Call Toll-Free 1-800-876-8827 v STATE OF CALIFORNIA ) ss. COUNTY OF RIVERSIDE ) On April 4, 2002, before me, the undersigned Notary Public,personally appeared DAVID B. MULE, known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. .GGG GAP MRICIA a qr-Rce Notary Public � �# t1304 r6 o C * One 23.70LYi 4 w hr � CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activity Title: Proiect Number: Food In Need of Distribution (FIND)/Walk-In Cooler Name/Address of Provider: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 O biectives/Activities The intent of this program is to provide nutritional assistance to low income, no income homebound seniors, families and their children, including recovery homes and five homeless sites. This will be accomplished through the removal and replacement of an existing walk-in cooler at FIND's warehouse that will increase storage for fresh products — fruits, vegetables and diary. FIND is affiliated with America's Second Harvest and the only certified food bank in eastern Riverside County, serving 30,602 clients Valley-side and 1,976 Palm Springs' clients. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the City by timely providing any additional information requested TARGET DATE ACTIVITY#1 On-Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process TARGET DATE ACTIVITY#1 On-Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise market and publicize the program to facilitate positive promotion for all parties (i.e., Provider. City CDBG etc.). TARGET DATE ACTIVITY#1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. • • Objective 4: Enroll and income qualify at least a total of one thousand nine hundred seventy-six (1976)very low income Palm Springs residents TARGET DATE ACTIVITY#1 On-Going Distribute food to Palm Springs residents and organizations serving the homeless and needy. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: Maintain records for all CDBG activities related to this program TARGET DATE ACTIVITY#1 On-Going Document and maintain all records related to this program, including those required, in accordance with HUD Regulations, in a stable and secure location. ACTIVITY#2 Monthly Submit quarterly reports—referenced Exhibit E. Objective 6: Manage/monitor program activities. TARGET DATE ACTIVITY#1 On-Going Perform monitoring activities necessary to ensure that the program is being conducted in compliance with the CDBG policies, federal regulations, and local statues, including Davis-Bacon Act, Copeland Act, and Non-discrimination/ EEO requirements. Objective 7: Acquire and install walk-in cooler in accordance with an 'open competitive' procurement process 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/ActiyitV Title: Project Number: Food In Need of Distribution (FIND)/Walk-In Cooler Name/Address of Provider: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 BU©GET 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 $20,000. $3,000. $23,000. Equipment 7 Insurance $ $ $ 8 Other $ $ $ $ $ $ $20,000. $3,000. $23,000. 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. Other funding sources include Desert Healthcare Foundation, Palm Desert Foundation, Jewish Federation and other governmental grants (i.e., Office on Aging, County CDBG, etc). EXHIBIT B—Budget Summary Page 2 of 2 Pages DETAIL BUDGET DESCRIPTION OF ACTIVITY/ CDBG SHARE OTHER TOTAL PAY ITEMS SOURCES COST Walk-In Cooler Sales Tax $15,500. - 0 - $15,500. Labor(Delivery, Demo & Installation $4,500. $3,000. $7,500. Total .'' .$20;000i . 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 301h 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 cast categories and line items. Services are to be performed over the twelve-month period of this 2001 — 02 Program Year— July 1, 2001 through June 30, 2002. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Project/Activity Title: Proiect Number: Food In Need of Distribution (FIND)/Walk-In Cooler Name/Address of Provider: Food In Need of Distribution— FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Nonprofits ' Insurance Alliance Effective Dates of Policy 12/15/2001 — 12/15/2002 Claims Made Policy_ / / Per Occurrence Policy Limits of Liability $1 ,000 , 000 per occurrence: Aggregate/Products $2 000, 000 Deductibles: Per Occurrence $0 Annual Aggregate Additional Insured Endorsement (Certificate Holder) diYes ❑ No Original Certificate of Insurance Attached ❑ Yes ixNo WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Clarendon National Insurance Co. Effective Dates 07/01 /2001 — 07/01 /2002 Limits of Liability $1 , 000, 000 Underlying Coverage Limits Original Certificate of Insurance Attached ❑ Yes XNo CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Project/Activity Title: Project Number: AIDS Assistance Program /Food Vouchers Food In Need of Distribution (FIND)/Walk-In Cooler Name/Address of Provider: Date: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described 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—03/29/01) MEDIAN INCOME NUMBER OF PERSONS IN YOUR HOUSEHOLD: LEVEL 1 2 3 4 5 6 7 8 VERY LOW INCOME $17,450 $19,950 $22,450 $24,950 $26,950 $28,950 $30,950 $32,950 Below 50% LOW INCOME $27,950 $31,950 $35.950 $39,900 $43,100 $46,300 $49,500 $52,700 51 —80% MODERATE INCOME $41,950 $47,900 $53,900 $59.900 $64,700 $69,500 $74,300 $79,100 120% 3. Do you identify yourself as: ❑ White ❑ Black ❑ Hispanic ❑ Asian Pacific Islander ❑ American Indian/Alaskan Native 4. Please circle, 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: Food In Need of Distribution (FIND) /Walk-In Cooler Name/Address of Provider: DATE: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced: #of Households #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: Food In Need of Distribution FIND)/Walk-In Cooler Name/Address of Provider: Date: Food In Need of Distribution—FIND PO Box 41; 68-615 Perez Road, Bldg 14B Cathedral City, CA 92235-0041 BENEFICIARY QUALIFICATION STATEMENT Approved Current Prior Total Grant Description Grant Reimbursement Reimburs')ent YTD Balance Amount . Period Periotl s Reimbursemen (t 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. 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 protect 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. t;tK_I II-ICATP OF LIABILITY_ I_N_ SUfR' �N__CE I DATE(P.+rnIDDIYY) IL__01/0 7/ZOO Z PRODUCER (760)347-5552� FAX ( 347-2858 7HISCF.RTITICAIE L. IEU AS AMAfTER Or INFORMATION Coachella Valley Insurance ServiL Lnc. ONLY AND CONFER., RIGHTS UPONTIIECERIIFICAIF HOt UER. THIS CERTIFICATE DOES NOT AMEND,EXTENT)OR License #0542476 AL1ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81-5S7 Dr. Carreon Blvd #B8 Indio, CA 92201 INSURERS AFFORDING COVERAGE INSURED F.I.N.D.-- - INSURER Nonprofits' insurance Al lianc 68615 Perez Road 114SURER B Cathedral City, CA 92234 INSURER INSURER IJ - - - - -- -. - - II ISURER B COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BFF_II(SITIED TO HIE INBtJRED NAMED MOVE FOR TIIE FOLICY PFRIOD INDICATED N01 WIT((STANDING ANY REQUIREMENT, TERM OR C019DIII014 OF AIJY CONTRACT OR OTI IER DOCUMENT VVI Ili RFSPEC T TO VVI(ICI-I THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLLJS1014S AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IPISR POLICY ff EGIIVE POLICY EXPIRATION LTR TYPE OFINSURANCE POLICY NUTABER DATE 1 MM IYY O E MMIDDIYV LR4ITS J d1 �1_ _.� GENERAL LIABILITY Z00108944NPO 12/15/2001 IZ/15/2002 EACHOCCURRENCE $ I 1_0_00,01)I X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one l,e) $ _ 1_0_0_,00f lCLAIMS MADE X CCCUR MED EXP(Any one peison)- $ 10,()()( A PERSOI I&A ADV It DURY f 1,DD0,D01 GENERAI_AGGREGATE E _2,0_00,_00( GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00( Pao. — ---------—, -- --- --- --- - POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f ANY AUTO (Ea occident) ALL OWNED AUTOS BOO{LY INJURY E SCHEDULED AUTOS (For person) MIRED AUTOS BODILY INJURY E NON-OWNED AUTOS (Per nccldenp PROPERIY DAMAGE $ (Par�ccidrnq GARAGE LIABILI fY AUTO ONLY-EA ACCIDEFII E ANY AUTO EAACC E ._, OI HER Ti IAN -- --_- --_— ---- AUTO OI-ILY EXCE5S LIABILITY t EACH OCCURRENCE_ -;CCIIR CLAIMS MADE AGGREGATE_._- $_'._—__ RETEfJTIOTJ f 5 - WORKERSCOMPENSATIONAND TORY LIMI IS ER EMPLOYERS'LIABILRY --____—.._-- - --y - --_-- -_---- -- ELEACHACCIDENi E EL DISEASE-EAEMPLOYEE E E.L.DISEASE-POLICYLIMIf $ -- OTHEfi DESCRIPTOR OF OPERATIONSILOGATIONSNEHICLES[EXCLUSION ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ertirate bolder is named additional insured as respect General Liability otice of cancellation for non-payment of premium is 10 days. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLANON SHOULD ANY OF THE ABOVE OFSCRIRED POLICIES BE CANCELLED BEFORE THE EYRIRAI IOU DATE THERFOS-,THE ISSUING COMPANY WILL MIXMX")S MAIL -3 U-_ DAIS VJRITI EII NOTICE TO I HE CFRTIFiCAI F HOLDER NMAED TO TI IE LEF 1, City Clerl(' City of Palm Springs �4%%tXlKdrr;t�XSX?4K Nei%IW)5X�€XN14% hX,xuXMrXd4)I.X',w¢XJi{�(NuXNW?(IXKX%X P.O. Box 2743 iSX#1FXJEKJ(dSJfY16)kXj61b1tAfJG WCs'F7ft("0_(MK%'*XtYiNKX_XXXXXXX Palm Springs, CA 92263-2743 nuODy- EPP ENrnT -CORD 25-S(7/97) OACORU CORPORATION 19W 02 28 2002 13:27 FAX 41DN1 DATE(MMIDONY) ACLORD� CERTIFICAS OF LIABILITY INSU NCE 02/28/ZOOZ PRODUCER (760)347-5552 FAX (f6O)347-2858 7111S CERTIFICATE I EDASAMAT7EROFINFORMATION Coachella Valle Insurance Service, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Y HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR License #0542476 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 51-557 Dr. Carreon Blvd #BE INSURERS AFFORDING COVERAGE Indio, CA 92201 —_— INSURED F.I,N.D. INSURERA. Clarendon National Insurance C 6861S Perez Road INSURERS: Cathedral City, CA 92234 —L__— INSURER E. _ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR COINDI PON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TFIIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY 7"HE POLICIES DESCRIBED HEREIN IS SUBJEOT TO ALL THE TERMS,EXCLUSIONS AND CDNDITION5 OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS SWSR 1g TYPE OF RI&LmANCIi POLICY NUMBER POL>iICVE- -CTI POLICY E%I�RAN LIMITS__ ,AJB n}NDDIYI' D TE _OENERALLIABILITY EACH OCCURRENCE _- CCMMERCIALGENERALLIABILITY PRE DAMAGE(Any o lim) $ CLAIMS MADE OCCUR MED EXP(An y.ne prawn) ; _- PERSONAL&ADVINJURY A __ J GENERAL A,GGREGALE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP)OPAGG __-I POLICY 0,IE6T I I We ..........,,..,°.,— AUTOMOBILE L(ABIUTY COMBINED SINGLE-LIMIT ANY AUTO Sin AaiAan4 ; ALLOLNNEDAUTOS BODILY INJURY - --- SCHEDULEDAIITOS (Per p.rson) ; _ HIREDALIFOS BODILY IPLIURY NONOWNEDAUTOS (Per accid.nt) S PROPERTY DAMAGE ; (PM eccideM) GARAGE LIAMUTY — -- AUTO ONLY-EA_P MRMT ; - _ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESSLIABI.ITY Y— EACH OCCURRENCE S _I OCCU71 �CV%A%MADE AGGREGATE --- -- 3 ; OEOIICTIDLE RETFUr1I L S __ .. �VORt("F.S COMPENSATION AND +-r Ql Q�490�701 Q7�01�2001 (17�01�2D�2 TORY LlM1T5 E _ GMPI.OYEPS LIABILITY A I E.L.EA_a4ACCIDENT s —1,000,(Y E L DISEASE_FA EMPLOYEE $ 1,QOD,w __ �_� E.L.DISEhSE.POucYDMR S 11000104 OTHER INSCRIPTION OF OPERATIONSM1 ATI NSIVEHWLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS otice of cancellation for non-payment of premium is 10 days. CERTIFICATE HOLDER ADDITIONALINSURED;INSURERLETTEn'— CANCELLATION T SIIVUI D PINY OF THE ABOVE DESCRIBED POUMES BE CANCELLED BEFORE THE EXPInATION DATE THEREOF,TI IE ISSUING COMPANY WILL IlrXikXllti{DfiYI MAR _3O DAYS MITTEN NOTICE TO U M CERTIFICATE HOLDER NAMED TO THE LEF T. City Clerk, City of Palm Springs XX P.O. Box 2743 XIMXdIMIIDBAf)IIEXbm*NYAMM 1 A'rltYl0hXd0tlIXXXXXXXX Palm Springs„ RR CA 92263-2743 AUTHOED REPRESENTATIVE. L/` ACOP,D 2"(TW) rOACORO ORPORATION 15 ACOR4M CERTIFICAT F LIABILITY INSURAN OATE(MMIDD YYY) 02/24/2003 PRODUCER (760)347-5552 FAX (76 47-2858 THIS CERTIFICATE IS ISTUED AS A MATTER OF INFORMATION Coachella Valley Insurance Service, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic# 0542476 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 81-557 Dr. Carreon Blvd B8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Indio, CA 92201-SS17 INSURERS AFFORDING COVERAGE NAIL'# r INSURED F.I.N.D. INSURERA: Nonprofits' Insurance Allianc PO Box 41 INSURERB. State Compensation Ins. Fund 04028 = � Cathedral City, CA 92235 INSURER C: NSI DRER E:. INSU COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINI 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 2002-08944-NPO 12/15/2002 12/15/2003 EACH OCCURRENCE $ 1,000,000 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE FX] OCCUR MED EXP(Any one person) S 10,000 A PERSONAL&ADV INJURY $ 1,000,000 ff-- GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PRO- ECT I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OW NEO AUTOS (Per accident) PROPERTY DAMAGE $ (Peracadenp GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY, AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 1641745-02 07/01/2002 07/01/2003 WC STATu- OTH- EMPLOYERS'LIABILITY .ANY PROPRIETOR/PARTNERIEXECUTIVE _ E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS iii1otice of cancellation for non-payment of premium is 10 days. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Palm Springs EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Office of the City Clerk 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, atti Patricia A. Sanders BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. Box 2743 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Palm Springs, CA 92263 AUTHORIZED REPRESENTATIVE II^^ � Q, Tina Matuska/FEL "vl�l ACORD 25(2001/08) ©ACORD CORPORATION 1988