HomeMy WebLinkAbout03836 - MIZELL SENIOR CENTER CDBG SUBRECIPIENT CARGO VAN R 19021 PALLY S City of Palm Springs
Community Redevelopment Agency
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MEMORANDUM
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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 fiends 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 ideiA fled closed contracts.
Mizell Senior Center
. Subrecipient Agreement
Purchase Cargo Van
AGREEMENT #3836
CM Signed, R19021, 8-12-97
SUBRECIPIENT AGREEMENT _- - -
THIS COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT (herein
"Agreements!) is made and entered into this %3 day of
c (nsd` , 1997, by and between the CITY OF PALM SPRINGS,
(herein-'"City) , a municipal corporation, and MIZELL SENIOR CENTER,
(herein "Subgrantee") .
R E C I T A L S•
A. The City has entered into various funding agreements with
the United States Department of Housing and Urban Development
("HUD") , which agreements provide funds ("CDBG Funds") to the City
under the Federal Housing and Community Development Act of 1974 (42
U.S.C. Section 5301 et seq. ) , as amended from time to time (the
"Act") , and the regulations promulgated thereunder (24 C.F.R.
Section 570 et sec. ("Regulations") .
B. The Act provides that the City may grant the CDBG Funds
to nonprofit organizations for certain purposes allowed under the
Act.
C. The Subgrantee is a nonprofit organization which operates
or desires to operate a facility which is eligible for a grant of
CDBG Funds which is located in the City of Palm Springs, County of
Riverside, State of California (the "Facility") .
D. The City desires to assist in the operation of the
Facility by granting CDBG Funds to the Subgrantee to finance all or
a portion of the cost of purchasing goods and equipment to be used
at the Facility (the "Equipment") on the terms and conditions more
particularly set forth herein. The Equipment, including the cost
thereof, is more particularly described in Attachment No. 1
attached hereto and incorporated herein by reference.
E. The City will enter into an agreement (the "Purchase
Agreement") with a supplier (the "Supplier") to purchase the
Equipment, which Purchase Agreement will provide that the City is
to pay the CDBG Funds granted to the Subgrantee hereunder directly
to the Supplier to cover all or a portion of the costs of the
Equipment, and Supplier is to deliver the Equipment to the City,
pursuant to the terms and conditions more particularly set forth
herein.
NOW, THEREFORE, the parties hereto agree as follows:
1. 0 RECITALS.
1. 1 Recitals. The above Recitals are incorporated
herein and made a part of this Agreement.
FS2\178\014004-0001\2063204.1 07/29/97 -1- 'ry��p"IIGp)/y,N )",,,,yy��9p10
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2. 0 SUBGRANTEE OBLIGATIONS.
2 . 1 Use of CDBG Funds. Subgrantee hereby agrees that
the CDBG Funds provided hereunder shall be used solely for the
Equipment pursuant to all the terms and conditions of this
Agreement. The CDBG Funds shall be used solely for the costs of
purchase of and delivery of the Equipment and related expenses, as
set forth in Attachment No. 1.
2 . 2 Representations and Warranties. Subgrantee hereby
represents and warrants to the City as follows:
(a) Subgrantee has read and is familiar with all of the
terms and provisions of the Act and the Regulations
applicable to Subgrantee.
(b) Subgrantee is a nonprofit organization permitted to
receive CDBG Funds under the Act and the Regulations.
(c) The use of the Facility, including the Equipment,
and the expenses to be covered by the CDBG Funds, as
described in this Agreement, are permitted uses of CDBG
Funds under the Act and Regulations.
(d) The purchase and delivery of the Equipment shall not
require the City or the Subgrantee to comply with the
Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, 42 U. S. C. Section 4601
et sea. , as amended from time to time.
2 . 3 Reports. Within ten (10) days following the
termination of this Agreement, and at such other times as the
Contract Officer shall request, Subgrantee 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 Subgrantee
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.
3 . 0 CITY OBLIGATIONS.
3 . 1 Agreement With Supplier. The City, in its sole and
absolute discretion, shall choose and engage the Supplier to supply
the Equipment. City shall prepare the bid package and supervise
the bidding process and the, work performed by the Supplier. The
Purchase Agreement with the Supplier shall include a schedule of
delivery of the Equipment which will, insofar as possible, be
coordinated with Subgrantee's necessary use of the Equipment and
the Facility. City shall endeavor to assure that the Equipment
F52\178\014084-0001\2063204.1 07/29/97 -2-
supplied is of good quality and workmanship and meets the needs of
the Subgrantee.
3 . 2 Interpretation of Purchase Agreement. City shall
have the obligation and responsibility to interpret the Purchase
Agreement, and the Equipment list in Attachment No. 1, and
Subgrantee shall be bound thereby.
3 . 3 Delivery of Equipment. Within fifteen (15) days of
receipt of the Equipment by City, City shall have the Equipment
delivered to Subgrantee or make arrangements for Subgrantee to pick
up the Equipment.
4 . 0 MUTUAL OBLIGATIONS.
4 . 1 Further Responsibilities of Parties. Both parties
agree to use reasonable care and diligence to perform their
respective obligations under this Agreement. Both parties agree to
act in good faith to execute all instruments, prepare all
documents, and take all actions as may be reasonably necessary to
carry out the purposes of this Agreement. Unless hereafter
specified, neither party shall be responsible for the obligations
of the other.
4.2 Compliance with Law: City Interpretation. 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, including, but not limited to, the Act and
the Regulations.
4 . 3 Special Requirements. Additional terms and
conditions of this Agreement, if any, which are made a part hereof,
are set forth in the "Special Requirements" attached hereto as
Attachment No. 2 and incorporated herein by this reference. In the
event of a conflict between the provisions of Attachment No. 2 and
any other provisions of this Agreement,the provisions of Attachment
No. 2 shall govern.
5.0 DISBURSEMENT OF CDBG FUNDS.
5. 1 Maximum Amount of CDBG Funds. The maximum amount of
CDBG Funds to be provided to Subgrantee (which funds will be paid
by City to Supplier pursuant to the terms of this Agreement) is
EIGHTEEN THOUSAND FOUR HUNDRED TWENTY-THREE DOLLARS ($18,423 . 00) .
Subgrantee hereby acknowledges that the City cannot guarantee that
the CDBG Funds will be received from HUD. The City' s obligation to
fund the Project is limited to the availability of CDBG Funds from
HUD. If the CDBG Funds are not forthcoming from HUD for any
reason, the City shall not have any obligation to fund the work
through any other source of funds, and the Subgrantee hereby
covenants and agrees to make any payments due to Supplier for the
costs of the Project.
FS2\170\014004-0001\2063204.1 07/29/97 -3-
•
5.2 Method of Pa ment. The City shall disburse the CDBG
Funds by making payment directly to the Supplier for the costs of
the Equipment in accordance with the terms of the agreement entered
into by and between the City and the Supplier pursuant to Section
3 . 1.
6.0 PERFORMANCE SCHEDULE.
6. 1 Time of Essence. Time is of the essence in the
performance of this Agreement.
6. 2 Force majeure. The time periods for performance
under this Agreement shall be extended because of any delays due to
unforeseeable causes beyond the control and without the fault or
negligence of the Subgrantee or the City, including, but not
restricted to, acts of God or of the public enemy, unusually severe
weather, fires, earthquakes, floods, epidemics, quarantine
restrictions, riots, strikes, freight embargoes, wars, litigation,
and/or acts of any governmental agency (except that acts or the
failure to act of the City shall not excuse performance by the
City) . In the event of such a delay, the party delayed shall
continue to exercise reasonable diligence to minimize the period of
the enforced delay.
Times of performance under this Agreement may also be extended
by mutual written agreement of the parties. The Contract Officer
shall have the authority on behalf of the City to approve
extensions of time not to exceed a cumulative total of one hundred
eighty (180) days. In no event shall Subgrantee be entitled to
recover damages against the City for any delay in the performance
of this Agreement, however caused, Subgrantee' s sole remedy being
extension of the Agreement pursuant to this Section.
7. 0 COORDINATION OF WORK.
7 . 1 Representative of Subgrantee. The following
principals of Subgrantee are hereby designated as being the
principals and representatives of Subgrantee authorized to act in
its behalf with respect to the work specified herein and make all
decisions in connection herewith:
Ben Green Executive Director
FS2\178\014084-0001\2063204.1 07/29/97 —4—
7 . 2 Contract Officer. The Contract officer shall be
such person as may be designated by the City Manager of City. It
shall be the Subgrantee's> responsibility to assure that the
Contract Officer is kept informed of the progress under this
Agreement and the Subgrantee shall refer any decisions which must
be made by City to the Contract Officer. Unless otherwise
specified herein, any approval of the City required hereunder shall
mean the approval of the Contract Officer. The Contract Officer
shall have authority to sign all documents on behalf of the City
required hereunder to carry out the terms of this Contract.
7 . 3 Prohibition Against Subcontracting or Assignment.
Subgrantee 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.
7 . 4 Independent Contractor. Neither the City nor any of
its employees shall have any control over the manner, mode, or
means by which Subgrantee, its officers, agents, or employees,
perform the services required herein, except as otherwise set forth
herein. Subgrantee 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. Subgrantee 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.
8. 0 COMPLIANCE WITH FEDERAL REGULATIONS.
8 . 1 The Subgrantee shall maintain records of its
operations and financial activities in accordance with the
requirements of the Act and the Regulations, 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 Act and
the Regulations, but in no case for less than three years after the
close of the Facility.
8 .2 The Subgrantee 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
regul'at:ions issued pursuant thereto;
FS2\178\014084-0001\2063204.1 07/29/97 -rj-
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 1,2259 , 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 Act 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;
j . The Program Income requirements as set forth
in 24 C.F.R. 570. 504 (c) and 570 . 503 (b) (8) ;
k. The Subgrantee 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 Subgrantee does not
assume the City ' s environmental
responsibilities described at 24 C.F.R.
570. 604; nor does the Subgrantee 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
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they relate to the acceptance and use of
federal, funds under the federally-assisted
program.
o. Title V'I of the Civil Rights Act of 1964 (P.L.
88-352) and implementing regulations issued at
24 CPR Part 1;
p. Title VIII of the Civil Rights Act of 1968
(P.L. 910-284) as amended; and
q. The lead-based paint requirements of 24 CPR
Part 35 issued pursuant to the Lead-Based
Paint Poisoning Prevention Act (42 U. S.C. 4801
et sec . ) ;
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
subreci.pient ' s control that was acquired or
improved in whole or in part with CDBG funds
(including CDBG funds provided to the
subreci.pient 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 any
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 if program income to the City.
(No payment is required after the period
of time specified in paragraph (s) of
this section. )
F52\170\014084-0001\2063204.1 07/29/97 -7-
t. Such other City, County, State o r
Federal laws, rules, regulations, executive
orders, or similar requirements which might be
applicable.
8 . 3 The City shall have the right to periodically
monitor the program operations of the Subgrantee under this
Agreement.
9. 0 INSURANCE AND INDEMNIFICATION.
9 . 1 Insurance. The Subgrantee 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 Subgrantee' s acts or omissions arising out of or
related to Subgrantee's performance under this Agreement.
Subgrantee 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 work
under this Agreement. The procuring of such insurance or the
delivery of policies or certificates evidencing the same shall not
be construed as a limitation of Subgrantee' s obligation to
indemnify the City, its officers, agents, or employees. The amount
of insurance required pursuant to this Section shall be as required
by the Contract Officer not exceeding Five Hundred Thousand Dollars
($500, 000) .
9 . 2 Indemnification. The Subgrantee shall defend,
indemnify, and hold harmless, the City, its officers, agents, and
employees, from and against any and all actions, suits,
proceedings, claims, demands, losses, costs, and expenses,
including legal costs and attorney' s 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 Subgrantee' s performance
under this Agreement, except for such loss as may be caused by
City' s own negligence or that of its officers, agents, or
employees.
10. 0 DISCRIMINATION, TERMINATION. AND ENFORCEMENT.
10. 1 Covenant Acxainst Discrimination. Subgrantee
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. Subgrantee shall take
affirmative action to insure that applicants are employed and that
F52\178\014084-0001\2063204.1 07/29/97 -8-
employees are treated during employment without regard to their
race, color, creed, religion, sex, marital status, physical or
mental disability, national origin, or ancestry.
10.2 Term. Unless earlier terminated in accordance with
Section 10. 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.
10. 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 as
long as such termination will not cause the City to violate or be
in default under its agreement with the Supplier. Upon receipt of
the notice of termination both parties shall immediately cease all
services hereunder except as may be specifically approved by the
other party. Upon such termination, both parties shall be entitled
to compensation for all services rendered prior to receipt of the
notice of termination and both parties shall be entitled to
reimbursement for any services which have been paid for but not
rendered.
11. 0 CITY OFFICERS ANI) EMPLOYEES.
11. 1 Non-liability of City Officers and Employees. No
officer or employee of the City shall be personally liable to the
Subgrantee, or any successor in interest, in the event of any
default or breach by the City or for any amount which may become
due to the Subgrantee or to its successor, or for breach of any
obligation of the terms of this Agreement.
11. 2 Conflict of Interest. No officer, agent, or
employee of the City shall have any financial interest, direct or
indirect, in this Agreement. nor shall any such officer or employee
participate in any decision relating to the Agreement which affects
his or her financial interest or the financial interest of any
corporation, partnership, or association in which he or she is,
directly or indirectly, interested, in violation of any State
statute or regulation. The Subgrantee warrants that it has not
paid or given and will not pay or give any third party any money or
other consideration for obtaining this Agreement.
12 . 0 LEGAL ACTIONS.
12 . 1 Applicable Law. This Agreement shall be construed
and interpreted both as to validity and to performance of the
parties in accordance with the laws of the State of California and
the United States, as applicable.
12 .2 Legal Action. In addition to any other rights or
remedies, either party may take legal action in law or in equity,
to cure, correct, or remedy any default, to recover damages for any
default, to compel specific performance of this Agreement, to
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obtain declaratory or injunctive relief, or to obtain any other
remedy consistent with the purposes of this Agreement.
13. 0 MISCELLANEOUS PROVISIONS.
13 . 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 by mailing in the United States mail,
certified mail, postage prepaid, return receipt requested, to the
addresses set forth below, or such other addresses as may from time
to time be designated by notice to the other party.
TO CITY: City of Palm Springs
P.O. Box 2743
Palm Springs, California 92263
Attn: City Manager
WITH COPY TO: Ru.tan & Tucker
611 Anton Blvd. , Suite 1400
Costa Mesa, California 92626-1998
F52\178\014084-0001\2063204.1 07/29/97 -1 0-
TO SUBGRANTEE: Mizell Senior Center
—780 S. Sunrise Way
halm Sgr4ngs, CA 92262
Any such notices shall be deemed to have been given upon receipt.
13 .2 Amendment. This Agreement may be amended at any
time by the mutual consent of the parties by an instrument in
writing.
13 . 3 Waiver. No delay or omission in the exercise of any
right or remedy by a nondefaulting party on any default shall
impair such right or remedy or be construed as a waiver. A party' s
consent to or approval of any act by the other party requiring the
party' s consent or approval shall not be deemed to waive or render
unnecessary the other party's consent to or approval of any
subsequent act. Any waiver by either party of any default must be
in writing and shall not: be a waiver of any other default
concerning the same or any other provision of this Agreement.
13 . 4 Interpretation. The terms of this Agreement shall
be construed in accordance with the meaning of the language used
and shall not be construed for or against either party by reason of
the authorship of this Agreement or any other rule of construction
which might otherwise apply.
13 .5 Integration. It is understood that there are no
oral agreements between the parties hereto affecting this Agreement
and this Agreement supersedes and cancels any and all previous
negotiations, arrangements, agreements, and understandings, if any,
between the parties, and none shall be used to interpret this
Agreement.
13 . 6 Corporate Authority. The persons executing this
Agreement on behalf of the: parties hereto warrant that (i) such
party is duly organized and existing; (ii) they are duly authorized
to execute and deliver this Agreement on behalf of said party;
(iii) by so executing this Agreement, such party is formally bound
to the provisions of this Agreement; and (iv) the entering into of
this Agreement does not violate any provision of any other
agreement to which said party is bound.
FS2\178\014084-0001\2063204.1 07/29/97 -1 1-
IN WITNESS WHEREOF, the parties have executed this Agreement
on the date first above written.
CITY 11
PALM SPRING ,
By:
Rob Parkins, Ci y Manager
ATTEST:
City Clerk
APPROVED AS TO FORM:RUTAN & TUCKER Mp Y 'i °°n0ayA ��
t _
\. r
City Attorney
SUBGRANTEE:
By:
Name:
Title:
Y.cu 1rc
FS2\178\014084-0001\2063204.1 07/29/93 -1 2-
AVrACHMENT NO. 1
EQUIPMENT
Eighteen Thousand Four]Hundred Twenty Three Dollars ($18,423.00)
in CDBG funds to be used to purchase a 1/4 - 1/2 ton cargo van for the
Mizell Senior Center.
F52\176\0140B4-0001\2063204.1 07/29/97 AT` ACHMENT NO. 1
0 0
ATTACHMENT NO. 2
SPECIAL REQUIREMENTS
The City of Palm Springs will provide up to the awarded amount of CDBG
funds ($18,423.00) for the purchase of a new or used van for the Mizell Senior
Center. The Mizell Senior Center shall be responsible to provide any
additional funds necessary to complete the purchase of the van.
FS2\170\014 0 0 4-0 001\2063204.1 07/29/97 ATTACHMENT NO. 2
DATE(MI
ACORP� GERTIFICA'110.bp JOILITY: INSUOP 6-12-97
rnQDUCEn THIS cEnuFICA1E IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ANNI-0 INJURANCI ADMJNISLRAIORS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. BOX 2083 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PALM SPRINGS, CA 92263 COMPANIES AFFORDING COVERAGE
COMPANY
_AME A______GREA_T -RIL
------ 0-
INSURED COMPANY
NORTHBROOK PROPERTY & CASUALTY
MIZELL SENIOR CENTER
480 S. SUNRISE WAY COMPANY c VL I
PALM SPRINGS, CA 92262
COMPANY
D HIM 1 1997
7
11119 IS 10 CERTIFY THAT THE POLICIFS OF INSURANCE LISTED SHOW IIAVr BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD""'
INDIGAIFID, NOTWITHSTANDING ANY REQUIREMENT, TERM On CONDIHON OF ANY CONIRACF OR CLIFF DOCUMENT WITH RESPECT 10 WHICH THIS
C!'PHIFICAHE MAY BE ISSUED Oil MAY PERTAIN, [HE INSURANCE AFFOHUED BY 111E POIHCIFS DESCRIBED HEREIN IS SUBJECT TO All THE TERMS,
EXCLUSIONS AND CONDITIONS 01: SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN DEDUCED BY PAID CLAIMS.
CO PE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS
LM ly DATE(MWDDNY) DATE(MMI)
GENERAL LIABILITY BODILY INJURY Occ- $
A X compnuorjsiv[ronm CAP 225-11-05-01 10-14-96 10-14-97 BODILY it'juny AGG 3
PrIrMI8FS/OPFnADONS FnOP[nBY DAMAGE OCC $
EXPLOSION&COLI-ArSE HAZA[ID HIOPERHY DAMAGE AGG S
PRCUUCTSCOMPLPTED OPER BI&PD COMBINED I_,000 000
GONT11ACIUAt BI&PO COMBINED AGO 1 ,000,000
IIJDFPENDFFN GOUTRACTons PERSONAL INJURY AGO
RROAD I CRY PINOPERTY DAMAGE Genera-L-Aggregate -2,-000-,0-0.0
I PFIIS NAIL INJURY
AUTOMOBILE LIABILITY BODILY INJURY $
ANY AUTO (pof person)
A F OWNED AUTOS(Pilvate Pass) BODILY INJURY
ALL OWIED AUTOS S
(01h.,Vain PrNalo Passvipor) (Per acc,dana)
I IIRFO AD[GS
PROPEnTY DAMAGE
LION-OWNED AUTOS
GARAGE LIABILITY BODILY
PROPERTY DAMAGE S
B X All scheduled Aggregate 1 ,000,000 COMBI14LD
EXCESS LIABILITY EACH OCCURRENCE $
UMOPFULA FORM AGGREGATE
OTHER THAN UMBRELLA FORM 3
JOIN-
WORKERS COMPENSATION AND TORY LIMITS ER
VVC SIATU
EMPLOYERS'UASIK BY
FIF EACH ACCIDENT S
INGL
PARTHFIISFXD
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DESCnIPTION OF OPEnATIONS4-CCATUNSNEHCLES/SPECIAL ITEMS
NON PROFIT SENIOR CENTER
CFRIIFI ATE HOLOITFIR CANCELLATION;
ADDITIONAL NAMED INSURED SHOULD ANY OF 711E ABOVE DESCRIBED POLICIES OF CANCELLED PFrQpE TflE
CITY OF PALM SPRINGS ALL OPERATIONS ExpinATION DATE THEnEOF, THE ISSUING COMPANY WILL QI MAIL
P. 0. BOX 2743 -30— DAYS vvnLTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFF,
PALM SPRINGS, CA 92263 3R7XVaIA1XAdMIX 9TXXAW'*XNXV MOAK X16 4VA14AIM U XX[AnX
AN R TORIZEO REPRESEN rA ING Richard F. Armpnto
4 Iq
STATE P.O. BOX 420807,SAN FRANCISCO, CA 94142-0807
COMPENSATION
I N S U R A N C E
FUND; ,CERTIFICATE of WORKERS' COMPENSATION INSURANCE
SEPTEIiBER '3, 1997 POLICYNUMBER: 0669923 - 97
CERTIFICATE EXPIRES: 8'6'-913A
CITY OF PALM SPIINGS
ATTN. JUDY SUMICI3-CITY ( LERX
P 0 BOX 2743
PALM SPRINGS CA 92263-2743 )ITO rl ;.
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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 ten days'advance written notice to the employer.
We will also give you TEN 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 to which this certificateof 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.
AUTHORIZED REPRESENTATIVE c - PRESIDENT
EMPLOYER 'S LIABILT.TY LT.MI'1' INCLUDING DEFENSE COSTS: s1,0.00 ,000 PER OCCURRENCE
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EMPLOYER • • - I
PALM SPRINGS SENIOR CENTER
MIZELL SENIOR CENTER
480 S SUNRISE WAY
PALM SPRINGS CA 92262 p
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