Loading...
HomeMy WebLinkAboutO.C. CONSERVATION CORPS 6City of Santa Ana ='.. Clerk of the Council ~~~ AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. r~''±a ,~P~ -~ ~~ ~: ~3 Return form to the Clerk of the Council Office (M-30). -, t , ~~ Call 647-5237 if you have any questions. `-f'~~' ~~ The agreement with Orange County Conservation Corps No. A-2004-164 and final payment has been made. was completed on June 30, 2005 Department: CDA/SAWC Phone/Ext.: X2623 Signature: Date: `"April 1, 2008 Revised 07-23-07 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES "7 - é){] -Q§ CLERK OF COUNCIL ~ \ DATE: \0 -d-'-V\ c-: eDIf- (fi.N4) A-2004-164 AGREEMENTBEnNEEN THE CITY OF SANTA ANA AND ORANGE COUNTY CONSERVATION CORPS FOR USE OF EMPOWERMENT ZONE FUNDS This Agreement, made and entered into this 1st day of July, 2004, by and between the City of Santa Ana a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("CITY"), and Orange County Conservation Corps "CONTRACTOR"). Recitals: 1. 2. WlINESSEIH The City of Santa Ana, through the Santa Ana Empowerment Corporation (SAEC), is the recipient of Empowerment Zone ("FEZ") funds from the United States Department of Housing and Urban Development ("HUD"). CITY desires to engage CONTRACTOR to provide the services at the cost set forth in Exhibit A and for the services set forth Exhibit B, hereinafter referred to as "said program" and CONTRACTOR represents that it is qualified and willing to operate said program. WHEREFORE, for and in consideration of the respective and mutual covenants hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereby agree as follows: I. CONTRACTOR'S OBLIGATIONS A. B. CONTRACTOR agrees to use all federal funds provided by CITY to CONTRACTOR pursuant to this Agreement to operate said program, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein. CONTRACTOR'S failure to perform as required may, in addition to other remedies set forth in this Agreement, result ih readjustment of the amount of funds CITY is otherwise obligated to pay to CONTRACTOR under Paragraph II hereof. C. CONTRACTOR agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. CONTRACTOR shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies goveming CONTRACTOR operations hereunder. CONTRACTOR agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should CONTRACTOR fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and Page 1 of 14 , regulations relating thereto, CONTRACTOR shall immediately make good- faith efforts to gain compliance with local, state or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. CONTRACTOR shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. CONTRACTOR must make all corrections required to bring the facility/property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. D. All funds received by CONTRACTOR from CITY pursuant to this Agreement shall be separately accounted for apart from any other funds of CONTRACTOR, or of any principal or member of CONTRACTOR. CONTRACTOR agrees that if CONTRACTOR receives $300,000 or more in any Federal funds, CONTRACTOR shall have an annual audit conducted by a certified public accountant in accordance with the standards as set forth and published by the United States Office of Management and Budget Circular A-133. CONTRACTOR shall provide CITY with a copy of said audit by October 1 of the year following the program year in which this Agreement is executed. E. CONTRACTOR shall keep records of all funds received from CITY under the terms and conditions of this Agreement in accordance with the procedures set forth in the "Agreement Accounting and Administrative Handbook", a copy of which shall be provided to CONTRACTOR by CITY. CONTRACTOR agrees to keep monthly records of all ethnic and racial statistics of persons and families benefited by CONTRACTOR in the performance of its obligations under this Agreement, including, but not limited to, the number of low and moderate income persons and households assisted in accordance with federal income limits, number of female heads of households, and number of senior citizens assisted. CONTRACTOR agrees to provide CITY with written cumulative (year-to- date) reports of its activities on or before the 15th day of July, October, January and April for the period beginning October 1, 2004 and through and including the previous three-month reporting period setting forth the activities, program accomplishments, new program information and year-to- date program statistics on expenditures, caseload and activities. When appropriate, pictures should be included. This agreement shall terminate on June 30, 2005, unless extended by mutual consent of the parties. Any extension shall be in writing, and executed by the Executive Director of the Community Development Agency and General Counsel on behalf of CITY. Page 2 of 14 CITY, SAEC and the United State Govemment and/or their representatives shall have access for purposes of monitoring, auditing, and examining CONTRACTOR's activities and performance, to books, documents and papers, and the right to examine records of CONTRACTOR's subcontractors, bookkeepers and accountants, employees and participants in regard to said program. CITY, SAEC and the United States Government and/or their representatives shall also schedule on-site monitoring at their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants in said program and entering any premises or any site in which any of the services or activities funded hereunder are conducted or in which any of the records of CONTRACTOR are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. In the event CONTRACTOR does not make the above-referenced documents available within the CITY of Santa Ana, California, CONTRACTOR agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. F. All accounting records and evidence pertaining to all costs of CONTRACTOR and all documents related to this Agreement shall be kept available at the location where CONTRACTOR conducted the program, as well as in the County of Orange, for the duration of the Agreement and thereafter for five (5) years after completion of an audit. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY or any other governmental agency takes exception, shall be retained beyond the five (5) years until resolution or disposition of such appeals, litigation, claims, or exceptions. G. CONTRACTOR agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement. CONTRACTOR agrees that it has read, understood and shall follow the legal obligations referred in Exhibit C. H. CONTRACTOR shall be in good standing, without suspension by the Califomia Secretary of State, Franchise Tax Board and Intemal Revenue Service. Any change in the corporate status or suspension of CONTRACTOR shall be reported immediately to CITY. I. Subreceipient acknowledges and warrants that it shall at all times comply with the laws, regulations and policies governing the use of FEZ funds, including but not limited to, the limitations on use of FEZ funds set forth in P.L. 106-74 (2000), 24 CFR section 598.215 and Federal Register, April 16, 1998. Page 3 of 14 J. Without prejudice to any other provisions of this Agreement, CONTRACTOR shall, where applicable, maintain the confidential nature of information provided to it conceming participants in accordance with the requirements of federal and state law. However, CONTRACTOR shall submit to CITY, SAEC and or HUD or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by CONTRACTOR, costs incurred and services rendered hereunder. K. CONTRACTOR agrees that the performance of obligations hereunder are rendered in its capacity as an independent contractor and that it is in no way an agency of CITY. L. CONTRACTOR agrees that if CONTRACTOR violates any of the terms and conditions of this Agreement or any prior Agreement whereby FEZ funds were received by CONTRACTOR, or if CONTRACTOR reports inaccurately, or if on audit there is a disallowance of certain expenditures, CONTRACTOR agrees to remedy the acts or omissions causing the disallowance or repay CITY all amounts spent in violation thereof. CONTRACTOR agrees to maintain a record for each item of non- expendable personal property acquired under the terms of this Agreement. Said record shall be made available to CITY upon request. The term "non- expendable personal property" shall include leased and purchased equipment. M. N. CONTRACTOR hereby certifies and agrees that it will not use funds provided through this Agreement to pay for entertainment, meals or gifts. O. CONTRACTOR certifies that no appropriated funds may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. CONTRACTOR shall sign a certification to that effect in a form as set forth in "Exhibit 0," attached hereto and by this reference incorporated herein. CONTRACTOR shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to CONTRACTOR under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned Page 4 of 14 a. II. shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions. P. CONTRACTOR agrees that except for the use of FEZ funds to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to FEZ activities assisted under the terms of this Agreement, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a FEZ-assisted activity of CONTRACTOR, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer, or elected or appointed official of CITY, or of any designated public agencies, or the CONTRACTOR. CONTRACTOR acknowledges and warrants that prior to having any contractor perform work paid for by FEZ funds, that it shall be responsible (i) for providing such contractor with a copy of this Agreement, and (ii) ensuring that any such contractor executes and provides to the Executive Director of the Community Development Agency a letter in substantially the form of Exhibit E hereto, agreeing to be bound by the terms of this Agreement. R. CONTRACTOR acknowledges and warrants that during the term of this Agreement it shall to the maximum extent feasible collaborate with other CONTRACTOR to ensure that duplication of services is avoided. Such collaboration shall include, but not be limited to, regular attendance (i.e., an attendance record exceeding 50%) and active participation in the appropriate committee or committees established pursuant to the Strategic Plan. S. CONTRACTOR agrees to provide a drug-free work place and to execute a certification as set forth in "Exhibit F" attached hereto and incorporated herein by this reference. T. CONTRACTOR shall comply with general provisions, assurances, and certifications attached hereto as "Exhibit G" and incorporated herein. CITY'S OBLIGATIONS Upon execution of this Agreement by CONTRACTOR, CITY shall pay to CONTRACTOR from FEZ funds, when, if and to the extent received from HUD, for CITY's 2004-05 FEZ program year amounts expended by CONTRACTOR in carrying out said program for fiscal year 2004-05 pursuant to this Agreement up to a maximum aggregate payment of one hundred and one thousand, one hundred fifteen dollars ($101,115) for CONTRACTOR'S performance in accordance with the payment schedule attached hereto as "Exhibit A". Payments shall be made to Page 5 of 14 CONTRACTOR through the submission of periodic invoices, in a form prescribed by CITY, detailing such expenses. CONTRACTOR agrees to submit the above- stated document to the FEZ Navigator Office, 1000 E. Santa Ana Blvd., Suite 200, Santa Ana, CA 92701. CITY shall pay such invoices within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been incurred within the scope of this Agreement and that CONTRACTOR is in compliance with the terms and conditions of this Agreement. CITY has the right to de-obligate the funds hereunder and take such funding back from CONTRACTOR due to any of the following reasons: (a) lack of performance by CONTRACTOR; (b) lack of fiscal accountability of CONTRACTOR; or (c) decrease in available funding. III. PROGRAM INCOME A. B. C. For the purposes of this Article (III) "Program income," shall mean gross income received by the CONTRACTOR directly generated from the use of FEZ funds, except as provided below in Paragraph III.C. When such income is generated by an activity that is only partially assisted with FEZ funds, the income shall be prorated to reflect the percentage of FEZ funds used. Program income includes, but is not limited to the following: 1. Proceeds from the disposition by sale or long term lease of real property purchased or improved with FEZ funds; Proceeds from the disposition of equipment purchased with FEZ funds. Gross income from the use or rental of real or personal property acquired by the CONTRACTOR with FEZ funds, less the costs incidental to the generation of such income; Gross income from the use or rental of real property owned by the CONTRACTOR that was constructed or improved with FEZ funds, less the costs incidental to the generation of such income; Payments of principal and interest on loans made using FEZ funds; Proceeds from the sale of loans made with FEZ funds; Proceeds from the sale of obligations secured by loans made with FEZ funds; Interest eamed on funds held in a revolving fund account; Funds collected through special assessments made against properties owned and occupied by households not of low and moderate income, where such assessments are used to recover all or part of the FEZ portion of a public improvement. 2. 3. 4. 5. 6. 7. 8. 9. Program income does not include income on grant advances from the U.S. Treasury. The following items of income earned on grant advances must be remitted to HUD for transmittal to the U.S. Treasury. Page 6 of 14 D. 1. Interest eamed from the investment of the initial proceeds of a grant advance by the U.S. Treasury; 2. Interest earned on loans or other forms of assistance provided with FEZ funds that are used for activities determined by HUD either to be ineligible or to fail to meet a national objective or other federal criteria. 3. Interest earned on the investment of amounts reimbursed to the FEZ program account prior to the use of the reimbursed funds for eligible purposes. The receipt of program income (as defined in Paragraph iliA hereinabove) by CONTRACTOR in the operation of said program shall be recorded by CONTRACTOR and reported to CITY. E. Program income received by CONTRACTOR shall be returned to CITY unless otherwise provided for in this Agreement. IV. NONDISCRIMINATION CONTRACTOR agrees that no person on the ground of race, color, national origin, religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with FEZ funds. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES If CONTRACTOR is a religious entity, CONTRACTOR hereby agrees that in connection with the provision of the services CONTRACTOR shall provide with FEZ funds: A. CONTRACTOR shall not discriminate against any employee or applicant for employment on the basis of religion and shall not limit employment or give preference in employment to persons on the basis of religion. B. CONTRACTOR shall not discriminate against any person applying for the services CONTRACTOR agrees to provide under the terms of this Agreement on the basis of religion and shall not limit such services or give preference to applicants for such services on the basis of religion. C. CONTRACTOR shall NOT provide religious instruction or counseling, conduct any religious worship or services, or engage in any religious proselytizing, or exert any religious influence in the provision of the services in said program. Page 7 of 14 D. Where the services to be provided under said program are rendered on property owned by the primarily religious entity CONTRACTOR, FEZ funds may also be used for minor repairs to such property which are directly related to the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the FEZ expenditure for rendering the services under said program. VI. PROHIBITION OF NEPOTISM CONTRACTOR agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by CONTRACTOR. For the purposes of this section, the term "immediate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, step-parent and stepchild. The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VII. NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: Santa Ana WORK Center WORK Center Director 1000 E. Santa Ana Blvd., Suite 200 Santa Ana, California 92701 Telefacsimile (714) 565-2602 And, CLERK: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 82702-1988 Telefacsimile (714) 647-6956 TO CONTRACTOR: Page 8 of 14 VIII. ASSIGNABILITY CONTRACTOR shall not assign nor transfer any interest in this Agreement, whether by assignment or novation, without the prior written consent of CITY; provided, however, that claims for money due or to become due CONTRACTOR from CITY under this Agreement may be assigned to a bank, trust company or other financial institution, or to a trustee in bankruptcy, without such approval. Notice of any such assignment or transfer shall be promptly fumished to CITY. IX. HOLD HARMLESS CONTRACTOR shall indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all damages to or for loss of use of property and for injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and including attomey fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of CONTRACTOR, its officers, directors, employees, agents, subcontractors and suppliers arising out of CONTRACTOR's performance of this Agreement. X. INSURANCE CONTRACTOR shall obtain and maintain for the entire term of this Agreement comprehensive general public liability insurance, in companies acceptable to the City, authorized to issue such insurance in the State of California. Said insurance shall consist of the following: A. Commercial General Liabilitv. CONTRACTOR agrees to obtain and keep in force during the term of this Agreement a policy of comprehensive commercial public liability insurance insuring the State of California, CITY, and CONTRACTOR against any liability for accident, injury or death arising out of or in consequence of this Agreement. Such insurance shall be in an amount not less than One Million Dollars ($1,000,000.00) for any injury to or death of any person or persons in any single accident or occurrence. Said policy of comprehensive public liability insurance shall be endorsed to provide to CITY and to the State of California, Employment Development Department, at least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents, employees, and volunteers, and the State of California, its officers, employees, and volunteers as additional insureds; and state that such coverage is primary to any other coverage or self-insurance of the State of California and CITY. Governmental entities may substitute a certificate of self-insurance. Page 9 of 14 B. C. XI. Automobile Liabili Covera e. CONTRACTOR shall also obtain and maintain, during the effective period of this Agreement, broad form automobile liability coverage with a $1,000,000 limit unless reduced by CITY, which applies to both owned/leased and non-owned automobiles used by CONTRACTOR employees or participants in performance of this Agreement, or, in the event that CITY will not utilize such owned/leased automobiles but intends to require employees, participants or other agents to utilize their own automobiles in the performance of this Agreement, CONTRACTOR shall secure and maintain on file from all such employees, participants, or agents as self-certification of automobile insurance coverage. Governmental entities may substitute a certificate of self- insurance. D. Workers' ComDensation. If CONTRACTOR is an "employer", as set forth in California Labor Code Section 3300 et seq., or utilizes participants as "employees," as set forth in California Labor Code Section 3350 et seq., CONTRACTOR shall obtain and keep in force during the term of this Agreement full Workers' Compensation insurance coverage for injuries suffered by participants. Said insurance policy shall guarantee CITY at least thirty (30) days written notice of cancellation or modification. CONTRACTOR shall carry medical and accident insurance for those participants not qualifying as "employees" for Worker's Compensation Coverage, pursuant to California Labor Code Section 3350, et seq. EauiDment Coveraae. CONTRACTOR shall purchase a policy or policies of insurance covering loss or damage to any and all Equipment provided to or purchased by CONTRACTOR in accordance with this Agreement. Said insurance shall be in the amount of the full replacement value thereof, providing protection against the classification of fire, extended coverage, vandalism, malicious mischief, theft, and special extended perils. Governmental entities may substitute a certificate of self-insurance. E. Proof of Insurance. Certificates and endorsements (Exhibit H) must be submitted and approved by CITY prior to any work under this Agreement. CONTRACTOR understands that CITY will make no payments under this Agreement until the required certificates and endorsements have been approved by CITY. REVERSION OF ASSETS A. Upon the expiration of this Agreement, CONTRACTOR shall transfer to CITY any FEZ funds on hand at the time of the expiration of this Agreement as well as any accounts receivable attributable to the use of FEZ funds. Page 10 of 14 B. Any real property under CONTRACTOR's control that was acquired or improved in whole or in part with FEZ funds in excess of $25,000.00 must either be: 1. Used, where CITY has given written approval, to meet one of the national objectives stated under federal law until five (5) years after expiration of this Agreement, or for such longer period of time as determined to be appropriate by CITY; or 2. If not used in accordance with subparagraph A above, CONTRACTOR shall pay to CITY an amount equal to the current fair market value of the property less any portion of the value attributable to the expenditure of non-FEZ funds for acquisition of, or improvement to, the property. Such payment is program income to CITY. C. Subject to the obligations set forth herein, title to equipment acquired under the terms of this Agreement will vest upon acquisition in CONTRACTOR. When said equipment which has been acquired in accordance with this Agreement and all applicable regulations is no longer needed for said program, disposition of said equipment will be made as follows: 1. Items of equipment with a current per unit fair market value of less than $5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY. 2. Items of equipment with a current fair market per unit value of $5,000.00 or more may be retained or sold and CITY shall have the right to an amount calculated by multiplying the current market value or proceeds from the sale by CITY's share of federal funds used to acquire the equipment. C. CONTRACTOR hereby agrees, upon the demand of CITY, to execute, acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder or under any document, instrument or agreement executed in furtherance of the services and activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignment(s), quit claim deed(s) or such other and further instruments, documents and agreements as may be necessary, in the sole and absolute discretion of CITY, to vest in CITY all of CONTRACTOR's right, title and interest (if any it may have) in and to CITY, SAEC, FEZ or other federal, state and/or local accounts or program funds or allocation of funds to which CITY is or may be entitled, either for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the performance of this Agreement or any previous agreements relating to the same subject matter or activities as this Agreement, together with any instruments, loans, grants or advances by Page 11 of 14 CONTRACTOR on behalf of CITY, in furtherance of the activities hereunder or thereof. CONTRACTOR's obligations and responsibilities set forth in this paragraph "XI. REVERSION OF ASSETS," and in paragraphs "XII. TERMINATION" and "III. PROGRAM I NCOME" shall not be affected by the termination of this Agreement and shall survive the date of termination of this Agreement for such period of time as CITY and/or HUD deems necessary for the responsibilities, duties and obligations to be performed and completed to the satisfaction of CITY and HUD. XII. TERMINATION A. This Agreement may be terminated on thirty (30) days' written notice by either party. In the event of such termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by CONTRACTOR of the terms and conditions of the this agreement or applicable State or Federal requirements. In the event of such suspension or termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. In the event CONTRACTOR defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of this Agreement by written notice to CONTRACTOR, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such notice, unless such default is cured before the effective date of termination stated in such notice. If terminated for cause, CITY shall be relieved of further liability or responsibility under this Agreement, or as a result of the termination thereof, including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any payments made for services not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining substitute performance. The grant of funds by CITY to CONTRACTOR pursuant to this Agreement may be terminated for convenience upon two weeks written notice to CONTRACTOR. D. E. In the event this Agreement is terminated as set forth in subparagraphs XII A through XII.D., inclusive, CONTRACTOR agrees to immediately retum to CITY upon CITY's demand and prior to any adjudication of Page 12 of 14 , CONTRACTOR's rights, any and all funds not used, and to comply with paragraph "XI. REVERSION OF ASSETS" of this Agreement. XIII. LIMITATION OF FUNDS The United States of America, through HUD, may in the future place programmatic or fiscal limitations on the use of FEZ funds which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of CONTRACTOR's authority to commit and spend funds, or may restrict CONTRACTOR's use of both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to implement a reduction in funding, in whole or as to a cost category, with respect to funding for this Agreement, CITY's Executive Director or delegate is authorized to act for CITY in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. Where CITY has reasonable grounds to question CONTRACTOR's fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days written notice to CONTRACTOR of its intention to so act, pending an audit or other resolution of such questions. In no event, however, shall any revisions made by CITY affect expenditures and legally binding commitments made by CONTRACTOR before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines. XIV. EXCLUSIVITY AND AMENDMENT OF AGREEMENT This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of CITY's FEZ funds by CONTRACTOR and contains all the covenants and agreements between the parties with respect to such employment in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and CONTRACTOR. LAWS GOVERNING THIS AGREEMENT xv. This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XVI. VALIDITY The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. Page 13 of 14 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and year written below. DATED: CITY OF SANTA Ana, a municipal Corporation of the }!te of Califomia (2~ß;a David N. Ream City Manager . APPROVED AS TO FORM: ATTEST: PATRICIA E. HEALY, Clerk of the Council ä'Q,M(L , );; :t- -{i, BEN KAUFMAN, City General Coun el DATED: 1~ CONTRACTOR: ¡7 ~ /J ~t~,","'"","V"""'Ó ~. . ~ 0f Federal Tax ID: 33 - O;Ç(p 31 g I c:tJ Patricia C. Whitaker, Executive Director Community Development Agency Page 14 of 14 Santa Ana WORK Center Rev 7/04 FEZ Daisy Wheel Proposal PY 2004/05 OCCC Direct Program Expenses FEZ FEZ OCCC Staff WageslSalaries Time % Amount Administrative Staff Finance Manager R. Smith 42,973 5% 2,149 Admin AssVPayroll A. Duran 27,851 5% 1,393 Director of Cms Development C. Gonzalez 50,398 5% 2,520 Subtotal Admin WageS/Salaries 6,061 Employer Taxes 839 Workers Compensation 102 Benefits 360 Subtotal Admin Taxes/Benefits 1,301 Total Administrative Staff Expenses $ 7,362 Proaram Staff FEZ Program Specialist J. Betancourt 38,522 40% 15,409 Crew Supervisor E. Moran 25,230 40% 10,092 Subtotal Program Wages/Salaries 25,501 Employer Taxes 3,011 Workers Compensation 431 Benefits 1,920 Subtotal Program Taxes/Benefits 5,362 Program Expenses (page 2) Project Transportation 4,704 Occupancy 5,525 Outreach 1,251 Subtotal Program Expenses 11,480 Total Program Expenses $ 42,343 Corpsmember (Cms) Expenses Average FEZ Total FEZ Cms Stipends # of Cms Hourly Rate Hours Wages Amount Cms Wages 20 $ 7.15 32,454 Cms Hours/Paid Work Experience 4,539 Carry-ins 5 Employer Taxes 2,483 Workers Compensation 5,835 Cms Bonus 7,038 Supportive ServiceslTraining 20 $ 200 3,600 Subtotal FEZ Cms Expense 51,410 Total FEZ 101,115 OCCC Cash & In Kind OCCC Staff Salaries & Wages (pg 2) In-kind $ 11,182 Emp!oyer Taxes 994 Workers Compensation 189 Benefits 768 Subtotal Taxes & Benefits $ 13,133 OCCC Cash Match Cash $ 163,S37 OCCC Charter School In-kind $ 14,750 OCCC Program Expenses (pg 2) In-kind $ 15,496 Total OCCC Cash & In Kind $ 220,449 Orange County Conservation Corps FEZ Daisy Wheel Network Program Scope of Work 1. TERM July 1, 2004 through June 30, 2005 II. PURPOSE The FEZ Daisy Wheel Network Program will provide vocational/occupational training, employment strategies, education, and supportive services to individuals who reside in the Federal Empowennent Zone. III. POPULATION TO BE SERVED The population to be served are Federal Empowennent Zone residents 18 years and older. Eligibility will be detennined by age, address, and by Right to Work documentation. IV. PROGRAM DESIGN, ELEMENTS, AND OUTCOMES FOR ORANGE COUNTY CONSERVATION CORPS A. Program Design: a. Provide an intake assessment (for screening) of each FEZ resident that includes a review of academic and occupational skills levels as well as service needs; b. Develop an Individual Service Plan including notifying achievement objectives. B. Program Elements: a. The following program elements will be made available to eligible residents expected to enroll in the FEZ Daisy Wheel Network Program for participation in activities aimed at providing a comprehensive strategy that addresses employment and training needs: i. vocational/occupational training, ii. employment strategies, iii. education, and iv. supportive services C. Perfonnance Outcomes 1. 20 FEZ residents will be served 2. Ofthe 20 FEZ residents served, 10 FEZ will be provided additional services as needed 3. Ofthe 20 FEZ residents served, 8 will be provided with work experience, receive On-the-Job Training, receive retention services, attend English as Second LaGrange classes, be provided with skills upgrades, and have access to paid internships 4. Ofthe 20 FEZ residents served, 6 will be placed in unsubsidized employment V. SERVICES WILL BE PROVIDED AT: Orange County Conservation Corps 700 N. Valley St., Suite B Anaheim, CA 92801 EXHIBIT B VI. WORK CENTER RESPONSIBILITIES 1. Develop contracts for partners 2. Provide orientation and training on eligibility, referral process, assessment, MIS tracking system, joint policies and procedures, fiscal billing, documentation, etc. 3. Develop joint fonns such as application, screening/intake tool, ISP, referral fonn, MIS fonns, etc. 4. Perfonn Program Monitoring 5. Perfonn Program Reporting 6. Provide partners with on-going technical assistance 7. Provide a quarterly FEZ newsletter 8. Facilitate monthly meetings VII. ORANGE COUNTY CONSERVATION CORPS RESPONSIBILITIES 1. Orange County Conservation Corps will provide eligible FEZ residents with services designed to meet the FEZ Board requirements. A participant will be provided with one or more of the following services to assist them in obtaining unsubsidized employment and se1f- sufficiency: . Case management . Comprehensive support services . Job development . Placement and retention services . Job training / education 2. Evaluate participants for eligibility and assign those eligible for program services. 3. Perfonn client assessments. Assess education level of FEZ participants through TABE test and using ISP fonn. 4. Report progress and job placements to WORK Center FEZ staff. 5. Incorporate all service navigator partners' infonnation into each other's marketing materials. 6. Attend monthly partner meetings. 7. Provide WORK Center FEZ staff with monthly and quarterly progress reports. 8. Provide WORK Center FEZ staff with necessary infonnation for conducting infonna1 and fonna1 monitoring of program progress. 9. Meet perfonnance measures. All staff and agencies participating in this project will be held accountable for achieving their agency FEZ perfonnance measures. 10. Submit Monthly Statistics Report documentation to FEZ Liaison staff by the 5th of every month. Report should include new emollments and a continuous Activity Emollment Fonn. 11. Maintain a current and complete file (electronic as well as a hard copy) for each FEZ participant: eligibility documentation; registration fonn; emollment fonn; assessment; Individual Service Plan (ISP); EEO/Grievance; case notes; supportive services documentation; attendance records; training documentation; etc. 12. Comply with allowable expenses. To be allowable, costs must: a) be reasonable for the perfonnance of the program; b) confonn to any limitations or exclusions set forth in the program as to types or amount of cost items; c) be consistent with policies and procedures that apply unifonn1y to both federally-financed and other activities of the organization; d) be detennined in accordance with generally accepted accounting principles (GAAP); e) not be included as a cost or used to meet cost sharing or matching requirements of any other federally-financed program in either the current or a prior period; and, f) be adequately documented. EXHIBIT B 13. Submit in triplicate, a monthly Invoice on City of Santa Ana, Federal Empowerment Zone Program Sub recipient Request for Reimbursement, showing in detail the amount of money already expended. Accounting records must be supported by source documentation such as cancelled checks, paid bills, payrolls, and attendance records. Submit the above stated documents to Osie1 "Ozzie" Madrigal by the tenth (10th) day of the month following the month in which services are performed. EXHIBIT B SUBRECIPIENT warrants the following: I. SUBRECIPIENT will comply with Public Law 88-352, title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000 ET SEQ.) and implementing regulations in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction on the locality as determined in accordance with the Davis-Bacon Act, as amended, 40 U.S.C. § §276a-276a-5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY's environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY's responsibility for initiating the review process under Executive Order 12372. EXHIBIT C Certification Regarding Lobbying Certification for Contracts. Grants. Loans. and CooDerative Allreements The undersigned certifies, to the best of his or her knowledge and belief, that: (I) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperaive agreement. (2) If any funds other than Federal appropriated foods have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Fonn-LLL, "Disclosure Fonn to Report Lobbying," in accordance with its instructions. (3) The oodersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts ooder grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. {~~t:ü",- Co on Program Title EXHIBIT D Part I INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form stm be completed by the reporting entity, whether subawardee or prime Federal recipient, at the Initiation or receipt of a covered Federal action, or a material change to a previous filling, pursuant to title 31 U.S.c. section 1352. The filling of a form be required for each payment or agreement to make payment for any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a member of Congress an officer or employee of Congress, or an employee of a Member of Congress in connection with a Federal Action. Used the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filling and material change report. Refer to the Implementing guidance published by the Office of Management and Budget for additional infonnation. 1. Identify the type of covered Federal Action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a fo]]owup report caused by a material change to the information previously reported, enter the year and quarter in which the change occuITed. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the fu]] name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g, the first subawardee of the prime is the I S1 tier. Seaboard include but are not limited to subcontracts, subcontracts, subgrants and contract awards under grants. 5. If the organization filling the report in item 4 checks "subwardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. ¡ncJude Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. lncJude at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Gaurd. 7. Enter the Federal program name or description for the covered Federal action (iteml). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item I (e.g.) Request for Proposal (RFP) number; invitation for Bid (lFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g. "RFP~DE-90~001." 9. For a covered Federal action where these has been an award or loan commitment by the Federa1 agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include fu]] address if different from 10 (a). Enter Last Name, First Name, and Middle initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or wi11 be made (planned). Check a11 boxes that apply, if this is a material change report, enter the cumulative amount of payment made or p1anned to be made. 12. Check the appropriate box(es). Check a11 boxes that appJy, if payment is made through an in~kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed, or wi\1 be expected to perform, and the date(s) for any services rendered. Include a11 preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted. 15. Check whether or not a SF-LLL~A Continuation Sheet(s) is attached. 16. The certifying official shan sign and date the form, print hislher name, title, and te1ephone number. Public reporting burden for this co11ection of information is estimated to average 30 minutes per response, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the coUection of information. Send comments regarding the burden estimate or any other aspect of this co11ection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C.20503. EXHIBIT D Part II ACKNOWLEDGEMENT OF SUBRECIPIENT AGREEMENT To: Patricia C. Whitaker Executive Director Santa Ana Empowerment Corporation From: Subcontractor/Assignee Subcontractor/Assignee hereby stipulates that it has been provided with a copy, has read, and is familiar with all of the terms of SUBRECIPIENT's Agreement with the Santa Ana Empowerment Corporation. Subcontractor/Assignee further agrees to be bound to all of the terms and provisions of SUBRECIPIENT's Agreement with the Santa Ana Empowerment Corporation. Executed this No -+f- day Of~, ")')~ BY: ~c Name: t . 70Vf Title: {?K.t:::ú.A-n vG D¡wcnn'l..- 'Û)oq . EXHIBIT E . . Certification Reaardina Drua-Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug-free workplace by: (a) (b) (c) (d) (e) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; Establishing a drug-free awarenoss program to inform employees about - (1 ) (2) (3) The dangers of drug abuse in the workplace; The contractor's policy of maintaining a drug-free workplace; Any available drug counseling, rehabilitation, and employee assistance program; and the penalties that may be imposed upon employees for drug abuse violatiòns occurring in the workplace; (4) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy' of the statement required by paragraph (a); Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the contract, the employee will - (1 ) (2) Abide by the terms of the statement; and Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; EXHIBIT F - .. Pg.2 B. (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - (1 ) Taking appropriate personnel action against such an employee, up to and including termination; or Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; . . (2) (g) , Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). The contractor shall insert in the space provided on the attached "Place of Performance" form the site{s} for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code). the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U,S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. . O.U'''"Y-~-'-t'y Pu~ tor Dated: 1 ìÑ 0+ ~ .. - . DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE , FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Name: t2~ ~ ~~ ~ 'Name of Contractor: tL GÚ-/ S ~ Contractor 'Number: Date: '7/'YrP/o</- The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract convered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): , ~Jt¡t~~t~~~TGat¡ , .' . 4) 5) 6) Subcontractor agrees that in addition to those agreements and obligations specified in the contract boiler plate and scope of work, it will also adhere to and obey the following provisions, assurances, and certifications. ARTICLES 1 ) Subcontractor assures and certifies that it will not use any funds appropriated under this agreement for religious activity or anti-religious activity, or to promote or oppose any political candidate, parties, and/or beliefs. 2) Contractor assures and certifies that where applicable, classroom training instructors are properly credentialed, and training curriculums comply with State Education Codes. 3) Subcontractor assures and certifies that any requested modification to this agreement must be submitted in writing, explaining requested changes and rationale. Subcontractor further assures that no modification will be implemented without prior written approval from the Santa Ana WORK Center. Contractor assures and certifies that they are in good standing with the California Secretary of State Franchise Tax Board and Internal Revenue Service. Subcontractor agrees to cooperate with any monitoring, inspection, audit, or investigations of activities related to this agreement as may be scheduled and conducted by the Santa Ana WORK Center or the Santa Ana Empowerment Corporation. Subcontractor agrees to acknowledge (give credit) the Santa Ana WORK Center and the Santa Ana Empowerment Corporation as the source of funds in all oral presentations, written document, publicity, and advertisements regarding any activities that ensue from this agreement. EXHIBIT G Andreini & Company 300 Esplanade, Suite 100 Oxnard, CA 93030 (805) 981-9585 F: (805) 981-0161 .....1 1111 lilliÎ íl......I'llilll ÎÎIIIIIIIJ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE DATE (MM/DDIYY) ACORD~ '"'."."'. '#~.:" :"'.':. ";'ff"..."........ PRODUCER COMPANY A PHILADELPHIA INDEMNITY INS CO INSURED A- ..JJ4- \ VI :r ORANGE COUNTY CONSERVATION A-;<c.>>-\-\lL>,-\ CORPS FAX NO. 1(714)-956-1944 700 N. VALLEY STREET, STE. AB ANAHEIM CA 92801 COMPANY B STATE COMPENSATION INS FUND COMPANY C THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TEAM 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. I - co TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POUCY EXPIRATION UMITS LTR DATE (MMlDDIYY) DATE (MMIODIYY) A GENERAL UABIUTY PHPK088626 07/20/04 07/20/05 GENEflAL AGGREGATE . COMMERCIAL GENERAl LIABILITY PRODUCTS - COMP/OP AGG . CLAIMS MADE [i] OCCUR PERSONAL & ADV INJURY . OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE . FIRE DAMAGE (Anyone fire) . 1 MED EX? (Anyone person) S A AUTOMOBILE LlABIUTY PHPK088626 07/20/04 07/20/05 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) . SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) . NON-OWNED AUTOS PROPERTY DAMAGE . GARAGE LlA.BIUTY AUTO ONLY - EA ACCIDENT . ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT . AGGREGATE S EXCESS UABIUTY EACH OCCURRENCE . UMBRELLA FORM AGGREGATE . OTHER THAN UMBRELLA FORM . B WORKERS COMPENSATION AND 46-14482..04 07/01/04 07/01/05 OTH- ER EMPLOYERS' LlABIUTY SI THE PROPRIETORI INCL EL DISEASE - POLICY LIMIT . PARTNERSÆXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE . OTHER A AUTO PHYSICAL PHPK088626 07/20/04 07/20/05 DEDUCTIBLE 1,000 COMP DAMAGE DEDUCTIBLE 1,000 COLL DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLESlSPECIAL ITEMS RE: GENERAL LIABILITY COVERAGE-THE CERT HOLDER ITS OFFICERS, EMPLOYEES AGENTS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. ADDITIONAL INSURED ENDORSEMENT,ATTCHED.*10 DAY NOTICE OF CANCEL FOR NON-PAY SHALL APPLY. CITY OF SANTA ANA ATTN:ESTHER AKHAVAN/PARK PLANNING 888 W. SANTA ANA BLVD., STE 200 SANTA ANA CA 92701 f~i . '. POLICY NUMBER: PHPK088626 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: CITY OF SANTA ANA ATTN: ESTHER AKHAVAN/PARK PLANNING 888 W. SANTA ANA BLVD., STE 200 SANTA ANA, CA 92701 (If no entry appears above, information required to complete this endorsement will be shown in the Deciarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. 11.11-. fÞ1~ CG 20 26 11 85 Copyright. Insurance !3.ervices Office. Inc., 1984 SP CERTHOLDER COpy ST"ATEi COMPENSATION INSURp..Nc;E FUND P.O. sox ~O7. SAN FRAOCISCO,CA.$4142-0~P7 C~TIPlCA.,", OF WOR~ERS'COMPENSA.TION \INSURANCE ISSUE DATE: 06-01-2004 CITY OF SANTA ANA ATTN: KIll PFEIFFER 20 CIVIC CENTER PLAZA SANTA ANA .CA 92701 SP GROUP: 000048 POLICY NUMBER: oot~5-2ooÌl CERTIFICATE 10:48 . CERTIFICATE .ExPIJ:!Es: 06-01-2005 06-0h2oo4/08-01-2oo5 JOB: ALLOP:9ATIONS This is to certi:fy that we have issued a valid Workers' Compensation insur~ce þolicy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notic. to the employer. We wHl also giVe. YOU'30days'~dvance notice should this, policy be cancelled prior to its nOrmal expiration. This certificate<of ,insurancf:t. is f10tan insurance policy and does not amend. extend or alter thecbverage' afforded by the p~lic:ies li~ted harein;,Notwithstandi"Q any ,requir~ment term, or cOfldi~iop of any contractor other docur,-,".r:1t with resp..,ct to ,which this"c'ertificate, °1' ir'l$ural1ce,.~..be "issued or maypert,in, ,..the insurance ~fforded by the policies 'described herein is subject to all the t~rms, eXêllJsiQnsand conditions of such policies. ~ ~~(!. &£.- AUTHORIZED .REPRESENT A TIVE PRESIDENT ~LOYE!I'S LIABILITY LIMIT INcLUOIfIG DEFEII$E CdST.S: $1,000,000.00 PER OCCURRENCE. ENoo'RSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTIÇlE EFFECTIVE 06-01-2004 IS ATTACHEOTO AND FORMS A PART QF THIS POLICY. EMPLOYER LEGAL "NAME, r~ ~ f . I'" ORANGE COUNTY CONSERVATION- CORPS lOON VAHEY ST STE ANAH£III CA 92801 ORANGE. COU"ITYi CONSERVATION CORP. (A NON PROFIT CORP.