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HomeMy WebLinkAbout04452 - AIDS ASSISTANCE PROGRAM CDBG SUBRECIPIENT 4 PAt,~1 s City of Palm Springs d t_-,k 1% Al 'z Community Redevelopment Agency M ' MEMORANDUM C q�FFOa N\�t' 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 fands 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 ideA feed 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 r� A4438 Downtown Pkg Structure 12/19/2001 12/01/2002 i Contractor;Walker Parking Consultants Insurance Status: Certificate and Policies are OK �� r XREF: COMMUNITY & ECONOMIC DEVELOPMENT l� Service: In File C D B G 01-02 Food Vouchers Subrecipient 04/04/2001 04/01/2002 �E A4452 Contractor :Aids Assistance Program Insurance Status: Certificate and Policies are OK f XREF: COMMUNITY& ECONOMIC DEVELOPMENT rp r Service: In File A4474 2001-02 C D B G Subrecipient Agreement 04l18/2002 04/01/2003 r ,.,. p I• Contractor:Food In Need Of Distribution Insurance Status:A policy has Expired. XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A448t1 r C D B G 2001-02 Subreci lent Agreement, Fair Housing Services 04/18/2002 04/0112003 Vie' ' f P 9 9 C %;sj ror .ri. s Contractor :Fair Housing Council Of Riverside County Insurance Status: Certificate and Policies are OKa DEVELOPMENT COMMUNITY & ECONOMIC ' XREF: Service: In File 1 '7 04/18/2002 04/01/2003 A44819/ 2001-02 C D B G Subrecipient Agreement � Contractor:Shelter From The Storm Insurance Status:A policy has Expired. XREF: COMMUNITY& ECONOMIC DEVELOPMENT Service: In File A448�/ 05/03/2002 05/01/2003 C D B G, 2001-02 Subrecipient Agreement t;,:%:�--,� tv•� Contractor:Catholic Charities Insurance Status: Certificate and Policies are OK XREF COMMUNITY& ECONOMIC DEVELOPMENT v % Service: In File • Aids Assistance Program CDBG Subrecipient Agr - AGREEMENT #4452 R20021, 4-4-01 SUBRECIPIENT AGREEMENT - - - - - - THIS AGREEMENT (herein "Agreement"), is made and entered into this day of 0a az� 1E'�4_ 200Q, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corpor ation, arld the j'rc.yg , (herein "Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et 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-FOUR THOUSAND SEVEN HUNDRED AND FIFTY DOLLARS ($24,750.00) (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 n,n,l•G`¢q4G i�'`'il'.(i'.r',L,J;r� Ji`� 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: 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; (a) 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- (o) 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 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 WITH COPY TO: Burke, Williams & Sorensen, LLP 18301 Von Karman Avenue, Suite 1050 Irvine, CA 92612-1009 - 5 - TO PROVIDER: AATT (� I +1L11�5 i^$S:S��Ne4 1 Ro40.jirh ISO (4103( -qI$2 PAL.in ST011SOa-5 , Cq 92zt,S 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, C -9RNI.AA Dated: By:-,_ City Manager dle/ T Clerk �a DANIFL [. FOATUNO Comm.k1230876 Int61;�•E>6 ' '+ C NOTARY?JBUCf San LIFORNIA APPROVED AS TO FORM: y,< M Camm- Evpi,es July 31,1003 lanclscu Burke, William ✓u& Sorensen, LLP 1 =>-•- -!" y --�_ City rney PROVIDER: Lh Dated: Z� fe(z By: �� Name: Title: By: I-f- f �i6k4— c„ "llat Name: Title: (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.) APP OVED E3Y"BHE tC7 V COUNCIL - 6 - CALIFORNIA ALL—PURPOSE ACKNOWLEDGEMENT STATE OF CALIFORNIA ) COUNTYOF VVOJc4�,°J:_Dt7 ) On. �Z I (Y) 1 before me, 7�04-A-v,�6 DATE 2 NAME,TITLE OF OFFICER-E.G.,'JANE DOE,NOTARY PUBLIC" personally appeared, \J \q-) personally known to me(or proved to me on the basis of satisfactory 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 the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrumentthe person(s),orthe entity upon behalf of which the person(s)acted, executed the instrument. 1 WITNESS my:ha;na d official/,, a[. E. FonTur�0 . ».it1230876 M11C CALIFORNIA _! '—r E Coumy al San Frail Loan, Eali6es July (SEAL) NOTARY PUBLI -SIGN LURE a OPTIONAL INFORMATION ; 1 � p TITLE OR TYPE OF DOCUMENT 77 DATE OF DOCUMENT 7 C� =BEROF PAGES 6 SIGNER(S)OTHER THAN NAMED ABOVE / — CALIFORNIA y ' f ALL-PURPOSE OUR I ' ' " ACKNOWLEDGEMENT STATE OF CALWORNIA ) COUNTY OF On. before me, \J L 1 f Vo DATE NAME,TITLE OF OFFICER-E.G.,"JANE DOE,NOTARY PUBLIC" personally appeared, kjM 4 't+t personally known to me(or proved to me on the basis of satisfactory 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 the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s),or the entity upon behalf of which the person(s)acted, executed the instrument. I DANIEL E. F WITNESS my ha and official eal. ,P �N LL� ORTUNO{ Ua Comm.R 12 PNBLIOCALIFOCH7fi r•.-?:411tf`� NOTAAY ANN I.w qi °s, Sys P+ of San N Id.V ComM Fqun¢o July 31,2003 ' ( (SEAL) NOTARY PUBLIC SIG TURE OPTIONAL INFORMATION TITLE OR TYPE OF DOCUMENT Uk C- ( \ (e U G' k(,y kk n DATE OF DOCUMENT '� NUUMB OF PAGES SU SIGNER(S)OTHER THAN NAMED ABOVE �� " CITY OF PALM SPRINGS EXHIBIT A Scope of Services Project Activity Title Proiect Number AIDS Assistance Program/ Food Vouchers Name/Address of Provider: AIDS Assistance Program PO Box 4182, 216 E Arenas Rd Palm Springs, CA 92263-4182 O bi ectives/Activities The intent of this program is to provide nutritional assistance to low income persons living with AIDS/HIV. This will be accomplished through twice monthly food voucher distribution to 425 clients in $45 redeemable food vouchers at local-area grocer for any item other than those classified as alcohol, tobacco and pet food. 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 gualifv at least a total of two hundred and forty-eight (248) Palm Springs residents from very low income individuals affected by HIV/AIDS TARGET DATE ACTIVITY#1 On-Going Distribute five hundred and fifty (550) food vouchers to Palm Springs residents. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: Maintain records for all CDBG activities related to this program TARGET DATE ACTIVITY#1 On-Going Document and maintain all records related to this program, including those required, in accordance with HUD Regulations, in a stable and secure location ACTIVITY#2 Monthly Submit quarterly reports—referenced Exhibit E. Objective 6: Manage/monitor program activities TARGET DATE ACTIVITY#1 On-Going Perform monitoring activities necessary to ensure that the program is being conducted in compliance with the CDBG policies, federal regulations, and local statues, including Davis-Bacon Act, Copeland Act, and Non-discrimination/ EEO requirements. Objective 7: Provide food voucher distribution activities to person living with HIV/AIDS as outlined in proposal. TARGET DATE ACTIVITY#1 On-Going Conduct program activities, as stipulated in the proposal. 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 Proiect Number: AIDS Assistance Program / Food Vouchers Name/Address of Provider: AIDS Assistance Program PO Box 4182, 216 E Arenas Rd Palm Springs, CA 92263-4182 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 $24,750.00 $350,000.00 $374,750.00 Food Vouchers ($45 x 550) $24,750.00 $350,000.00 $374,750.00 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 Angel Donor Program, Ryan White Title I, Wells Fargo Foundation, R.D. & Joan Dale Hubbard Foundation and Broadway Cares Equity Fights AIDS. The Subrecipient shall receive monthly reimbursements in accordance with the aforementioned cost 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 Proiect/Activity Title: Project Number: AIDS Assistance Program/ Food Vouchers Name/Address of Provider: Date: AIDS Assistance Program PO Box 4182, 216 E Arenas Rd Palm Springs, CA 92263-4182 INSURANCEINVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company �1 RJ 1e2�1 1e��o Effective Dates of Policy (D<I I i 9 /0 Claims Made Policy_ / / Per Occurrence Policv /X/ Limits of Liability Deductibles: Per Occurrence N owe Annual Aggregate Additional Insured Endorsement (Certificate Holder) Yes ❑ No Original Certificate of Insurance Attached 1;q Yes ❑ No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company c—T 1 R �., 11 VNJ Effective Dates Limits of Liability Underlying Coverage Limits__ U.J 0 Mc As)<l> Original Certificate of Insurance Attached ❑Yes X No CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activity Title Proiect Number AIDS Assistance Program /Food Vouchers Name/Address of Provider: Date: AIDS Assistance Program PO Box 4182, 216 E Arenas Rd Palm Springs, CA 92263-4182 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—03129/01) 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 Proiect Number: AIDS Assistance Program / Food Vouchers Name/Address of Provider: Date: AIDS Assistance Program PO Box 4182, 216 E Arenas Rd Palm Springs, CA 92263-4182 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 ProjecvActivity Title Project Number AIDS Assistance Program/ Food Vouchers Name/Address of Provider Date AIDS Assistance Program PO Box 4182. 216 E Arenas Rd Palm Springs, CA 92263-4182 BENEFICIARY QUALIFICATION STATEMENT Approved Current "Prior Total Grant Description Grant lRelrebursement Reimbursement YTD Balance' Amount Period . . Period(s) Reimbursement (Over/-Under) TOTAL E= I CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the CDBG, has not previously been billed for the costs covered by this invoice, (b) funds have not been received from the Federal Government or expended for such costs under the terms of the Agreement or grant pursuant to FMC-74-4 & 24 CFR Part 58;(c) this agency is in full compliance with all applicable provisions under the terms of the Contractor grant, and (d) this agency is in full compliance with all applicable tax laws and hereby affix original signatures. PREPARED BY: APPROVED BY: Name, Title, Date Name, Title, Date City of PALM SPRINGS Use Only Audited by: Examined by. Approved by: If necessary, additional sheet(s) must be attached detailing cost breakdowns, and verified by original signatures. CITY OF PALM SPRINGS EXHIBIT G Employment Restrictions 1 Labor Standards The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act, the Copeland "Anti-Kickback" Act (40 U.S C 276a-276a-5, 40 USC 327 and 40 USC 276c)and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of $2,000 00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to journeyworkers; provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any, to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. 2 "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these "Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.0 1701. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low-income residents of the project area and contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low-and very low-income persons residing in the metropolitan area in which the project is located." r 0 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. RESOLUTION NO. 20021 OF THE CITY COUNCIL OF THE CITY OF PALM SPRINGS, CALIFORNIA, APPROVING THE RECOMMENDED COMMUNITY DEVELOPMENT BLOCK GRANT FUNDING BUDGET FOR FISCAL YEAR 2001 - 2002; AUTHORIZE THE SUBMITTAL OF THE CONSOLIDATED PLAN ANNUAL PLAN UPDATE TO THE DEPARTMENT OF HOUSING & URBAN DEVELOPMENT; AND AUTHORIZE THE CITY MANAGER TO EXECUTE SUBRECIPIENT AGREEMENTS FOR 2001 - 2002 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM. WHEREAS, the City is eligible to receive an entitlement of $645,000 of Community Development Block Grant funds as entitlement city under the Department of Housing & Urban Development Regulations, and WHEREAS, the City has approximately $87,714 available in existing Community Development Block Grant accounts which need to be reprogrammed into new eligible projects; and WHEREAS, the funds must be used for eligible activities which principally benefit low and moderate income people, and WHEREAS, pursuant to the requirements of citizen involvement, a public hearing was held to receive citizen input on the allocation of these funds, and WHEREAS, the projects have been assessed by staff based on needs of low and moderate income neighborhoods to benefit the maximum number of people, and WHEREAS, the City Council held a public hearing on April 4, 2001 to receive public input on the allocation of these funds, and NOW, THEREFORE, be it resolved that the City Council of the City of Palm Springs, California, does hereby approve the following: SECTION 1. Allocations of Community Development Block Grant funding for 2001 - 2002: Entitlement Reprogrammed 2001-02 Allocation Allocation Allocation PS Planning & Building Dept—ADA $20,925. -0 - $20,925. PS Youth Center Improvements 51,000. - 0 - 51,000. F.I.N.D. 20,000. - 0 - 20,000. 13 4 � Resolution 20021 . Page 2 PS Engineering Dept—Sewer& Street Improvements 171,980: $87,714. 259,694. Boys & Girls Club Improvements 36,000. - 0 - 36,000. PS Facilities Dept— Baristo Park 10,000. - 0 - 10,000. Desert AIDS Project 40,225. - 0 - 40,225, Catholic Charities— Nightengale Improvements 19,120. - 0 - 19,120. AIDS Assistance Program 24,750. -0- 24,750. Catholic Charities — Motel Vouchers 10,000. - 0 - 10,000. Shelter from the Storm 20,000. - 0 - 20,000. PS Public Library— Literacy Program 10,000. - 0 - 10,000. PS Unified School Dist—Adult School Vocational Ed 12,000. - 0 - 12,000. Mizell Senior Center 20,000. - 0- 20,000. PS Community Redevelopment Dept— Senior Home Repair Program 50,00a - 0 - 50,000. Citizen Participation Newsletter 5,000. - 0 - 5,000. CDBG Program Administration 96,000. - 0 - 96,000. Fair Housing Council 28,000. - 0 - 28,000. TOTAL l$ Z14. $Z32 ZL SECTION 2. Staff is authorized to submit the 2001 - 2002 Consolidated Plan Annual Plan Update to the Department of Housing & Urban Development which accurately reflects the CDBG projects and budget approved by the City Council. SECTION 3. The City Manager is authorized to execute Subrecipient Agreements, in a form approved by the City Attorney, for the 2001 - 2001 Community Development Block Grant funds as allocated by this resolution. ADOPTED this 4th day of April 2001. AYES: Members Hodges, Jones, Oden, Reller—Spurgin and Mayor &leindienst NOES: None AB T: None City C rk City Man er REVIEWED AND APPROVED: C08G01-0ZCCReprt2 Mar01 14 qG Z ACORD CERTIFICA-6 OF LIABILITY INSUF�NC CAR PR DATE(MMIDD/YY) IDSA-1 01/31/02 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Casswood Insurance Agency,Ltd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Five Hal£moon Executive Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clifton Park NY 12065-5694 Phone; 518-373-8700 INSURERS AFFORDING COVERAGE INSURER Travelers Property Casualty INSURER B Aids Assistance Program INSURER P.O. BOX 4182 INSURER D. Palm Springs CA 92262 I INSURER E COVERAGES ANY REQUIREMENT,TERM OR CONDI'I ION 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 INS DATE(MMIDDIYY) Dg7� 1p Y0it LTR TYPE OFINSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 660619X4243TCT01 04/19/01 04/19/02 FIRE DAMAGE(Any one It re) $ 300,000 CLAIMS MADE lxl OCCUR MED EXP(Any one person) $ 5,000 X Host Liquor PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG S 1,000,000 POLICY PRO LOC ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYJURY $ SCHEDULED AUTOS (Perrper person) HIRED AUTOS BODILY accident) $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E L.EACH ACCIDENT $ ELL DISEASE CAEMPLOYE $ EL DISEASE-POLICY LIMIT $ The certificate holder is named as an additional insured as respects liability coverage CERTIFICATE HOLDER Y I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION CITYOFP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN City of Palm Springs NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Office of Redevelopment IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. Box 2743 Palm Springs CA 92263 REPRESENTATIVES, q FROM AIDS ASSISTANCE PROGRAM PHONE NO. : 760 325 8461 Mar. 05 2002 10:14AM P2 POLICYHOLDER COPY STATE P.O. BOX 420807,SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE FEBRUARY 19, 2002 GROUP: POLICY NUMBER: 1423e46-2001 CERTIFICATE ID: 2 CERTIFICATE EXPIRES: 10-01-20o2 10-01-2001/10-01-2002 CITY OF PALM SPRINGS OFFICE OF REDEVELOPMENT P 0 BOX 2743 PALM SPRINGS CA 92263 -' -' This is to certify that we have issued a valid Workers Compensation insurance policy in a form approvad by the California Insurance Commissioner to the employer named below for the policy period Indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend,extend or altar the coverage afforded by the policies listed herein. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this cerUficate of Insurance may be issued or may pertain,the insurance afforded by the policies described herein Is subject to all the terms,exclusions,and conditions,of such policies. AVTNOW20 R0AiSGNTATNE PR"IQENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE EMKOYKK AIDS ASSISTANCE PROGRAM PO BOX 4182 PALM SPRINGS CA 92263 SCIF 10255 IEPF-Ul:KH I AC-ORD. CERTIFICAlT OF LIABILITY INSU CI�, CSR GN I DATE(MM/DO/YY) DSA-1 07/10/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Casswood Insurance Agency,Ltd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Five Halfmoon Executive Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clifton Park NY 12065-5694 Phone: 518-373-8700 INSURERS AFFORDING COVERAGE INSURED INSURER Travelers Property Casualt'INSURER B. V ! 'i, 2(193 Aids Assistance Program INSURERC P.O. BOX 4182 INSURER O. Palm Springs CA 92262 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 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. FUDnIFFECTIVIF ILTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDNY) DATE MM/DD/YY N LIMITS GENERAL LIABILITY I I EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY 660619X4243TCT03 04/19/03 04/19/04 FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADElxl OCCUR MED EXP(Arry one parson) $ 5,000 X Host Liquor PERSONAL 3 ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 1,000,000 POLICY PRO- JE CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 660619X4243TCT03 04/19/03 04/19/04 (Eaacddenl) 51,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-0WNEDAUTOS (Per amldenl) $ PROPERTYOAMAGE $ (Peraaidenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANVAUTO OTHER THAN EA ACC $ AUTO ONLY AGG S EXCESS LIABILITY EACH OCCURRENCE $ OCCUR u CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ _ RETENTION S S WORKERS COMPENSATION AND TORY LiM''_ ER EMPLOYERS'LIABILITY El,EACH ACCIDENT $ EL DISEASE-EA EMPLOYEE $ EL DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Office at 1276 N Palm Canyon #108, Palm Springs, CA 92262. Cert£icate holder is additional insured with respections to operation of the named insured. CERTIFICATE HOLDER Y I ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION CTYPAI,M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Palm Springs DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL '40 DAYS WRITTEN Office of the Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Patricia Sanders IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. Box 2743 Palm Springs CA 92263 REPRESENTATIVES. AUT REPRE,�)T V ACORD 25S(7/97) (//T/// �/ ©ACORD CORPORATION 1986 SK STATE P.O. BOX 801, SAN FRANCISCO,CA 94101-0807 COMPENSATION INSURANCEFUND CERTIFICATE OF;WORKERS' COMPENSATION INSURANCE POLICY NUMBER: 1423846 - 02 ISSUE DATE: 10-01-02 CERTIFICATE EXPIRES: 10-01-03 CITY, OF PALM SPRINGS SOB: #0108 OFFICE. OF 'REDEVELOPMENT. P.O. BOX 2743 ` PALM SPRINGS - CALIFORNIA 92263 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10days' advance written notice to the employer. We will also give you 10:days' advance notice should this policy be cancelled prior to its normal expiration. This certificate.of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies. listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect m to which this certificate of, insurance ay 6e-jssued or may-pertain,' the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. PRESIDENT EMPLOYER'S: LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1�000,000.00 PER,OCCURRENCE. A EMPLOYER LEGAL NAME AIDS ASSrSTANCE PROGRAM AIDS ASSISTANCE -PROGRAM PO BOX 4182 (NON PROFIT CORPORATION) PALM SPRINGS CA 92263 PRINTED: 09-18-02 P0409