HomeMy WebLinkAbout04138 - SHELTER FROM STORM CDBG SUBRECIPIENT R 19490 ?ALAI City of Palm Springs
rt �� Community Redevelopment Agency
' MEMORANDUM
.qI�F��,�\P
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 fiuids 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 ideijified closed contracts.
Page: 4
Report: Expired Contracts: Oldest Date= / / and XREF=COMMUNITY&ECONOMIC DEV-Summary July 24, 2003
Contract Number Description Approval Date Expiration Date Closed Date
A4016�— 1998-99 CDBG Subrecipient Agreement 08/11/1998 08/01/1999 L.���32ae g83r
Contractor :Food In Need Of Distribution Insurance Status:A policy has Expired.
XREF: COMMUNITY& ECONOMIC DEVELOPMENT J
Service: in File
A4138u1 1999-2000 CDBG Subrecipient 09/08/1999 09/01/2000
Contractor:Shelter From The Storm Insurance Status: Certificate and Policies are OK Cam?
XREF: COMMUNITY& ECONOMIC DEVELOPMENT ir"a/
Service: In File
A4145 CDBG 1999/2000 Subrecipient Agreement 10/18/1999 10/01/2000
Contractor:Boys &Girls Club Insurance Status: Certificate and Policies are OK �t KCh -9 10
XREF: COMMUNITY& ECONOMIC DEVELOPMENT i pal
Service: In File / 93
A4146 CDBG 1999/2000 Subrecipient Agreement 10/11/1999 10/01/2000 �� a�
Contractor:Mizell Senior Center Insurance Status:A policy will expire soon.
XREF: COMMUNITY& ECONOMIC DEVELOPMENT
Service: In File 97/,k-,-��
F=
A4147, � 99-00 Subrecipient Agr 10/11/1999 10/01/2000 /��
Contractor:P.S. Youth Center Insurance Status:A policy will expire soon. /����/�-
XREF: COMMUNITY&ECONOMIC DEVELOPMENT /Ic &W/,
Service: In File ,
A4148/ CDBG 1999-2000 Subrecipient Agreement 10/11/1999 10/01/2000
Contractor:Fair Housing Council Of Riversode County Insurance Status: Certificate and Policies are OK
XREF: COMMUNITY& ECONOMIC DEVELOPMENTS
Service: In File
A414 CDBG 1999-2000 Subrecipient Agreement 10/11/1999 10/01/2000
Contractor:Food In Need Of Distribution Insurance Status:A policy has Expired.
XREF: COMMUNITY& ECONOMIC DEVELOPMENT
Service: In File
Shelter from the Storm
1999/2000 Subrecipient Agr
AGREEMENT#4138
R19490, CM signed 9-8-99
SUBRECIPIENT AGREEMENT
THIS AGRKE,,,T�(herein�'Agreejnpnt") , is made and entered into this
day of 19 f, by and between the CITY OF PALM
SPRINGS, (he , unicipal corporation, and SHELTER FROM THE
STORM, INC. , (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 seq.
("Regulations") ; and
WHEREAS, the Act provides that the City may grant the CDBG Funds
to nonprofit organizations for certain purposes allowed under the Act;
and
WHEREAS, the Provider is a nonprofit organization which operates a
program which is eligible for a grant of CDBG funds and the City desires
to assist in the operation of the program by granting CDBG Funds to the
Provider to pay for all or a portion of those costs incurred in
operating the program permitted by the Act and the Regulations on terms
and conditions more particularly set forth herein;
NOW, THEREFORE, the parties hereto agree as follows :
1 . 0 SERVICES OF CONTRACTOR.
1 . 1 Scope of Services . In compliance with all terms and
conditions of this Agreement, the Provider shall provide those services
specified in the "Scope of Services" attached hereto as Exhibit "A" and
incorporated herein by this reference. Provider warrants that all
services will be performed in a competent, professional and satisfactory
manner.
1 .2 Compliance with Law. All services rendered hereunder
shall be provided in accordance with all ordinances, resolutions,
statutes, rules, and regulations of the City and any Federal, State or
local governmental agency of competent jurisdiction.
1 .3 Reports. No later than ten (10) days prior to any
payment date specified in Section 2.2, within ten (10) days following
the termination of this Agreement, and at such other times as the
Contract Officer shall request, Provider shall give the Contract Officer
a written report describing the services provided during the period of
time since the last report and accounting for the specific expenditures
of contract funds hereunder, if applicable. At the times and in the
manner required by law, the Provider shall provide to the City, the
Department of Housing and Urban Development, the Comptroller General of
the United States, any other individual or entity, and/or their duly
authorized representatives, any and all reports and information required
for compliance with the Act and the Regulations .
• •
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:
(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;
3
0
i) The labor standard requirements as set forth in 24
CFR Part 570, Subpart K and HUD regulations issued
to implement and requirements;
(j) 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.
(o) Title VI of the Civil Rights Act of 1964 (P.L. 88-
352) and implementing regulations issued at 24 CFR
Part l;
(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
4
• •
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 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
•
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, California 92263
Attn: City Manager
6
MMMENPNPW-
0 s
WITH COPY TO:
Rutan & Tucker
611 Anton Blvd. , Suite 1400
Costa Mesa, California 92626-1998
TO CONTRACTOR:
lynn Moriarty
Executive Dirartnr
` Sheitgr From Thp Storm
P 9 Dax 1�755
Palm Desert, CA 92255-11155
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 ALM SPRINGS, CALIFORNIA
\ 1-
Dated: By:
City Manage
A TES ) `-
APPROVED aT"E CITY MANAGER
tJ3V
jam"'---��ty Clerk �D
APPROVED AS TO FORM;
RUTA�TUCKE
CitK A torney
CONTRACTOR:
shelter Fl=em The Storm
/ r �
Dated: By: ��y7/l ✓ ��
T
Name: -unJrrtGu.oee'
T' e:T2-,siDF,�,
By:
Nam
Title:
(Corporations require two NOTARIZED signatures; one from each of the following:
A. Chairman of Board, any Vice President; AND B. Secretary, Assistant
Secretary, Treasurer, Assistant Treasurer, or Chief Financial Officer. )
7
SHELTER FROM THE SOM i
PALM SPRINGS OUTREACH
EXHIBIT"A"
SCOPE OF SERVICES
Under the project, Shelter From The Storm will establish a Domestic Violence Outreach and Advocacy
Center, based in Palm Springs,that will specifically focus on serving families victimized by domestic
violence who live in the community.
The new center will provide the following:
• A comprehensive range of crisis counseling and support services for battered women and their
children in a highly accessible community setting,including crisis intervention and
counseling,assistance with restraining orders,connections to emergency food and shelter,
options planning,and referrals to other community services, such as hospitals and emergency
rooms,clinics,physicians, schools and churches and synagogues.
• Ongoing advocacy on behalf'of clients in the interactions with law enforcement,the courts,
government benefits programs and other service providers.
• Regular distribution of emergency cards with Shelter From The Storm's 24-hour Crisis Line
number to the local police officers and other service providers in Pahn Springs.
• Collaboration and training for a wide range of local service providers on how to recognize the
signs of domestic violence and respond to those in need. Outreach will be provided to social
service agencies;police officers;personnel within hospitals,emergency rooms and clinics;
private physicians;school staff;business leaders;and congregations of churches and
synagogues.
The establishment of a Domestic Violence Outreach and Advocacy Center in the City of Palm Springs,
with a Outreach Advocate devoting 100%time to serving residents,will enable Shelter From The Storm to
introduce domestic violence education earlier in the abuse cycle and offer women and their children
intervention options in a more accessible and familiar environment. We anticipate that this new program
will reach an estimated 250 women and children and service providers and other interested community
members annually.
EXHIBIT"A"
8
SHELTER FROM THE STORM,INC.
• Palm Springs CDBG-Proposed Uses of Funds
7/1199-6/30100
Jul-99 Aug-99 Sep-99 Oct-99 Nov-99 Dec-99 Jan-00 Feb-00 Mar-00 Apr-00 May-00 Jun-00 Total
Wages-Domestic Violence Advocate(1) 1,178.50 1,17850 1,76775 1,17850 1,17850 1.178.50 1.17850 1,17650 1.76775 1.178.50 1,178.50 1,178.50 15,320.50
Payroll taxes(2) 13140 131.40 19710 131 40 131 a0 131 A0 13140 131 40 17648 90A6 9016 9016 1,563.87
Workers'Compensation Insurance(3) 731 7.31 1096 7.31 7.31 7.31 7.31 7.31 1096 7.31 731 7.31 94.99
Employee Health and Dental Benefits - - - - - - - - _ _ _ _ -
Employee Compensated Absence Benefits - - - - - - - _ _ _ _ _ -
Mileage to Indio Court(4) 20.64 - - - - - - - _ _ _ _ 20.64
Office Supplies - - - - _ _ _ _ _ _ _ _ -
Telephone - - - -Fax Machine - - _ _ _ _ _ _ -
Copier Rental and Supplies - - - - - _ _ _ _ - _
$1,33785 $1.317.21 $1,975.81 $1,31Z21 $1,317.21 $1,31721 $1,317.21 $1,317.21 $1,955.19 $1,27596 $1,275.96 $1,27596 17,000.00
(1)- 32 hrs I week @$9 207/hour
(2)- 7.65%of all wages,and 3 5%of the first$7,000 of wages
(3)- 62 per$100 of wages
(4)- Residual amount based on total award of$17,000
A
ac40iM® CERTIFICAT OF LIABILITY INSUR 0 °„0199
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Coachella Valley Insurance Svc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
LIc. #0542476 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
81-657 Dr. Cameon Blvd., #138 COMPANIES ARBING-CAVERA_GE
Indio CA =01-5517
COMPANY
pLM INSURED A Non - Ins. Alliance
O 2 COMPANY
Shelter lrom the Storm n, B
P.O. Box 14155 U uf_� COMPANY
Palm Desert CA 92255 RECEIVED C J
C�ryC4�Q� COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE-POLICIES OF INSURANCEt.ISTED 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
00 TYPE OF INSURANCE POLICY EFFECTIVE POLICY EAPIRATION IlafB
LTR POLICY NUMBER DATE (MWDDIYY) DATE (MMIDDNY)
A GENERAL LIABILITY N99-1513 11/04/99 11/04/00 GENERAL AGGREGATE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO $ 1 000,000
CLAIMS MADE O OCCUR PERSONAL S ADV INJURY 5 1,000,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE(Any we fire) S 100,000
MED EXP(Any one person) $ 10,000
A AUTOMOBILE LIABILITY N99-1513 11/04/99 11/04/00
ANY AUTO COMBINED SINGLE LIMIT 5 1 000,000
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Per person) $
X HIRED AUTOS
X NONOWNED AUTOS BODILY INJURY $
(Per accident)
PROPERTY DAMAGE 5
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
E
ANY AUTO
OTHER THAN AUTO ONLY .
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE $
OTHER THAN UMBRELLA FORM 5
WORKERS COMPENSATION AND —
EMPLOYERS'LIABILITY T Y IT
EL EACH ACCIDENT $
PAPTNERSEERSIE%ECUTIVE
THE INPROPRIETORI INCL EL DISEASE-POLICY LIMIT $
OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE $
OTHER
A Building YAB00121381513 11/04/99 11/04/00 Special Form W/Theft 1,000,000
A Contents YABO01213B1513 11/04/99 11/04/00 Replacement Cost 315,000
A Computer Equipment YA600121381513 11/04/99 11/04/00 901/ Coinsurance 16,000
QESCRIPTION OF OPEPATIONSI.00ATIONSIVEHICLESS gCIAL ITEMS,
Gertl icata O er Is named as ad�Itlona Insured. Endorsement attached.
Notice of cancellation for non-payment of premium is 10 days.
CERTIFICATE.HOLDER .
cnNCEtuna4;;,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Palm Springs EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Office Of the Cdy Clerk 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
32DPm TahgSerinMLISZ Canyon Way CA J,j28j, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE CO ANY,ITS AGENTS OR REPRESENTATIVES
AUnHORIZED REPRESENT Angola M. Gonzalo )ln/
ACORD 1 25S
l .... .m' . wanmm
11-23-1999 3:55PM FROM SFTS 760 770 7582 P. 2
__...� - SK
STATE P.O. BOX 807, SAN FRANI0,5CO.C71, 94tfx.1=,9807..
COMPENSATION .. / d
INSURANCE
FUND CERTIFICATE OF WOOKERS',GWYB°ENSATEON INSURANCE,
: .POLICY',kiiily1gj R: 498-99 UNIT 90C OO92
ISSUE OATS: 04-01-99 CERTIFICATE EXRI ES. 04-6i-
°F pAc is
CITY OF PALM SPRINGS CITY CLERKS OFFICE,
P O BOX 2743. FCFIvE4 co
PALM SPRINGS CA 92263
This is to certify that we have issued a valid Workers' dompansatiort I uLarcl policy in a form approved by the
California insurance Commissioner to tlw'employq:riamedb'lo'vd for tf,e.,pbh"cjti`'Per iod indicated.
This policy is not subject to cancsllai;by the Ftmtf-excapf upon d0days' adGande written notice to, the employer.
We will also give you 10,days' advance notice ShoWel This policy ba;;daricelled:,'prior to its normal-'expiration..
This certificate of insurance is not an Insurance policy and does not"amend: 'extend'dr alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of;any contract or other document
with respect to which this certificate of Insurance may be Issued or may pertain, the insurance afforded by the
policies described herein,is subject to all the terms.,explusions and conditions of such.goliciea.
i �
51
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z;w
1VIDENT
EMPLOYERS LIABILITY LxoIT ^xNCLUOIhIG+OEIFEN5EtjOO1006 1�10 F'ER, OCIPUR,RENCE.
EMPLOYER ..
.LEGAL NAME
SHELTER FROM THE STORM, INC. SHELTER FROM THE STORM, INC.
P 0 BOX 14155 A NON-PROFIT, MUTUAL BENEFIT CORPORATIO:
PALM DESERT CA 92255
REMVED MAR 2 6.i�9 PRINTED. 03-18-98 P0409
. :s . .: , .
DEC-21-2001 FRI 10:54 AM WETAGMTEN & HOUGH FAX NO, 76 59117 P. 01
DDNYj i.
12 21/01
PRODUCER
Weingarten & Hough-Lic#0086542 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
P 0 Box 1866 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Palm Springs CA 92263 COMPANIES AFFORDING COVERAGE
(760) 325-2526 COMPANY
A Philadelphia Insurance Companies
INSURED COMPANY 1 1*
Shelter from the Storm is
P. 0. Box 14153 COMPANY
C -18a2' 2
Palm Desert CA 92211-4155 COMPANY W
' 7 0) 328-7233 1 D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co M
TYPE OF INSURANCE POLICY NUMBER POLIEFFECTIVE POLICY EXPIRATION
LTR I DATE(MM/DDrM DATE(MMIDDNY) LIMITS
A GENERAL LIABILITY GENERAL AGGREGATE s2 , 000 , 000
COMMERCIAL GENERAL LIABILITY PHPK007644 07/01/01 07/01/02 PRODUCTS�COMPIOP AGG $110001 000 CLAIMS MADE FX7 OCCUR PERSONAL&ADV INJURY S1, 000, 000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S1 000, 000
F113E DAMAGE(Any--III-) 111 100 , 000
MEDEXP(My one pe n) S 1 , 000
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE UMIT Ii
ALL OWNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (Per Person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Paracdcleno
PROPERTY DAMAGE S
GARAGE LIABILITY AUTO ONLY-FA ACCIDENT 5
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
5 AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE s
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND STATJTORY OMITS
EMPLOYERS'
LIABILITY EACH ACCIDENT !I
THE PROPRIETOR/ INCL DISEASE-POLICY POLICY LIMIT $
PARTNERS/EXECUTIVE
—t
OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE 41
OTHER
DESCRIPTION OF OPERATiONS/LDCATIONTNEHICLESJBPECIAL ITEMS
CITY OF PALM SPRINGS IS ADDITIONAL INSURED AS REGARDS CDBG #A4297 FOR
SHELTER FROM THE STORM. 30 DAY NOTICE OF CANCELLATION APPLIES .
FAXED TO TRICIA AT 322-8332
............ .....
SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
CITY OF PALM SPRINGS 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P . 0. BOX 2743 OUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIQATICIN OR LIABILITY
PALM SPRINGS, CA. 92263 Or ANY KIND WH Lj COMPANY, ITS AGENTS OR RLPRESENTAMEs.
AUTHORIIZEVIREPR ATV
XXX: . .........
SK
o APR 1 2002
STATE P.O. BOX 807, SAN FRANCIS_CO,CA 94101 b8,OZ �� b CEIVED
COMPENSATION
INSURANCE
FUND CERTIFICATE OF ,WORICIERS COMPENSATION INSURANCE
POLICY.NUMBER: 488-02' UNIT 0000092
ISSUE DATE: 04-01-02 - CERTIFICATE EXPIRES,: '04-01-03
CITY, OF PALM SPRINGS
CITY CLERKS OFFICE
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 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 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 polity and does not 'amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or'other document,
with respect to which this certificate of insurance may be,issued or may"pertain, the insurance afforded, by the
policies described herein is subject to all the terms, exclusions and conditions of such policies.
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1;000,000.00 PEROCCURRENCE.
EMPLOYER LEGAL NAME
SHELTER FROM THE STORM, INC. .IY SHELTER FROM THE STORM, INC. -
PO BOX 14155 A NON-PROFIT,>MUTUAL BENEFIT CORPORATION
PALM DESERT CA 92255
'PRINTED: P0408
.• A BLUE PATTERNED BACKGROUND SCIF 10265(REV.24M)