HomeMy WebLinkAboutCAMBODIAN FAMILY, THE 7 - 2005
INSURANCE ON Fill
WORK MA Y PROCEED
UNTIL INSURflNCE EXPIRES
3.. '7 - D ~
CLERK OF COUNCil ---
DATE, SEP 1 9 2005
A-2005-189
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AGREEMENT BETWEEN
THE CITY OF SANTA ANA
AND
THE CAMBODIAN FAMILY
FOR USE OF EMPOWERMENT ZONE FUNDS
This Agreement, made and entered into this 1st day of July, 2005, 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 Califomia ("CITY"), and The Cambodian
Family ("CONTRACTOR").
W!INE~S!;IH
Recitals:
1. 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").
2. 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. 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 in readjustment of the
amount of funds CITY is otherwise obligated to pay to CONTRACTOR
under Paragraph II hereof.
B. 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 governing CONTRACTOR operations hereunder.
C. 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
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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, 2005 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, 2006, 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.
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CITY, SAEC and the United State Government 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
California 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.
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J. Without prejudice to any other provisions of this Agreement, CONTRACTOR
shall, where applicable, maintain the confidential nature of information
provided to it concerning 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.
M. 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.
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 "Exhibitp,"
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
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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.
Q. 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 PO' attached hereto and incorporated
herein by this reference.
T. CONTRACTOR shall comply with general proVIsions, assurances, and
certifications attached hereto as "ExhibitG" and incorporated herein.
II. 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 2005-06 FEZ program year amounts expended by CONTRACTOR in
carrying out said program for fiscal year 2005-06 pursuant to this Agreement up to
a maximum aggregate payment of eighty five thousand six hundred twenty nine
dollars ($85,629) for CONTRACTOR'S performance in accordance with the
payment schedule attached hereto as "Exhibit A". Payments shall be made to
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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. 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.
B. 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;
2. Proceeds from the disposition of equipment purchased with FEZ
funds.
3. 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;
4. 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;
5. Payments of principal and interest on loans made using FEZ funds;
6. Proceeds from the sale of loans made with FEZ funds;
7. Proceeds from the sale of obligations secured by loans made with
FEZ funds;
8. Interest earned on funds held in a revolving fund account;
9. 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.
C. 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.
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1. Interest earned 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 eamed on the investment of amounts reimbursed to the FEZ
program account prior to the use of the reimbursed funds for eligible
purposes.
D. 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 retumed 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.
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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
And,
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
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:
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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 perso'ns,
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 attorney 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.
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B. Automobile Liabilitv Coveraqe. 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.
C. Workers' Compensation. 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.
D. Equipment Coveraqe. 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.
XI. 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.
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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
C~ .
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
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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 INCOME" 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.
D. The grant of funds by CITY to CONTRACTOR pursuant to this Agreement
may be terminated for convenience upon two weeks written notice to
CONTRACTOR.
E. In the event this Agreement is terminated as set forth in subparagraphs
XII.A. through XIID., inclusive, CONTRACTOR agrees to immediately return
to CITY upon CITY's demand and prior to any adjudication of
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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 Execuiive
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.
XV. LAWS GOVERNING THIS AGREEMENT
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.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of
the date and year written below.
C-<,d/ '
Patricia E. Healy
Clerk of the Council
CITY OF SANTA ANA
ATTEST:
r;" /-"" 2'"
" .
,. / /
l /a'k:~/jL u., L -__
David N. Ream
City Manager
-.,
APPROVED AS TO FORM:
RECOMMENDED FOR APPROVAL
deL ~
Joseph W. Fletcher
City Attorney
mPatricia C. W taker, Executive Director
V Community 0 elopment Agency
CONTRACTOR:
DATED
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Name: R-IF/CA /-frJlt.c.H
Title: ~)(J;w.nvt= JJ/('lll~
Federal Tax 10: qs- - 3%5'18'3/
Page 14 of 14
THE CAMBODIAN FAMILY
Daisy Wheel Program
July 1, 2005 - June 30, 2006
BUDGET FORM
Administrative Proaram Total FEZ Match/In-Kind
Personnel
Salaries' $ 10,609 $ 46,213 $ 56,822 $ 90,840
Benefits 2,652 11,553 14,205 21,802
Other (list) . - - - -
Total Personnel 13,261 57,766 71,027 112,642
ODeratina EXDenses
Rent' 7,752 7,752 38,160
Utilities 600 600 4,620
Phone/Fax/Internet fees 1,056 1,056 1,020
Janitorial Maintenance/Suoplies 1,200 1,200
Insurance 420 420
Equipment Rental/Maintenance' 540 540
Office Supplies 500 500 3,600
Professional Services 720 720
Audit 856 856
Staff Trainina 50 50
Travel/MileaQe 660 660
Trainina Supplies 87 87
Other (list) .
FeeslMembership/Subscription 50 50
Postaae 111 111
Total Ooeratina EXDenses - 14,602 14,602 47,400
GRAND TOTAL $ 13,261 $ 72,368 $ 85,629 $ 160,042
. Attach a separate sheet detailing these costs.
EXHIBIT A
Personnel
THE CAMBODIAN FAMILY
Daisy Wheel Program
July 1, 2005 - June 30, 2006
Budget Detail Sheet
FTE Funded
Annual Salary by FEZ Administrative
Program
Total Amount
Requested from FEZ
Executive Director
Secretary
Finance Manager
Bookkepper
Computer Specialist
ES Coordinator
Assistant ES Coordinator
Quality Control SpedalisVCounselor
Employment Specialists
Family Coaches
Total Salaries
Benefits @ 25% of total salaries
Total Personnel
Operating Expenses
Rent - 680 sq. ft. x $.95/sq. ft. x 12 months
$67,025 3% $ 2,011 $ $ 2,011
27,144 3% 814 814
49,339 10% 4,934 4,934
37,271 5% 1,864 1,864
39,463 2.5% 987 987
50.425 5% 2,521 2,521
45,936 20% 9,187 9,187
35,496 2.5% 887 887
29,232 40% 11,693 11,693
29,232 75% 21,924 21,924
10,609 46,213 56,822
2,652 11,553 14,205
13,261 57,766 71,027
Equipment Rental/Maintenance - $45/mo x 12 months
copy machine, fax, drinking water system, and company van maintenance services.
Other
FeesiMembership/Subscription
Postage - stamp
EXHIBIT A
7,752
7,752
540
540
50
111
50
111
THE CAMBODIAN FAMILY
Daisy Wheel Program
July 1, 2005 - June 30, 2006
In-Kind Detail Sheet
PERSONNEL
TOTAL
In-Kind
PrOD10 - Chlldca",
Projed Coordinator/Childcare Teacher
Childcare Assistants
Santa Ana Colleae ~ ESL Classes
ESL Instructors
ESL Instructors
Total Salaries
Benefits @ 24% of total salaries
$18.5/hr x 40 hrslwk x 52 weeks $ 38,480
$12/hr x 30 hrslwk x 52 weeks $ 18,720
$35/hr x 20 hrslwk x 46 weeks $ 32,200
$20/hr x 12 hrslwk x 6 weeks $ 1,440
$ 90,840
$ 21,802
$ 112,842
Total Personnel
OPERATING EXPENSES
PrOD10 - Chlldca",
Childeare project supplies and materials
Rent
Telephone
Utilities
Refuaee Emolovrnent Services Proaram -ESL Classes
Rent
Utillties
$300/month x 12 months
$2080/month x 12 months
$85/month x 12 months
$250/month x 12 months
$1100/month x 12 months
$135/month x 12 months
$ 3,600
$ 24,960
$ 1,020
$ 3,000
$ 13,200
$ 1,620
$ 47,400
$ 160,042
Total Operating Expenses
GRAND TOTAL
EXHIBIT A
The Cambodian Family
FEZ Daisy Wheel Network Program
Scope of Work
2005-2006
I. TERM
July I, 2005 through June 30, 2006
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 Empowerment Zone.
11I. POPULA nON TO BE SERVED
The population to be served are Federal Empowerment Zone residents 18 years and older.
Eligibility will be determined by age, address, and by Right to Work documentation.
IV. PROGRAM DESIGN, ELEMENTS, AND OUTCOMES FOR THE CAMBODIAN FAMILY
A. Program Design:
I. 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;
2. Develop an Individual Service Plan including notifying achievement objectives.
B. Program Elements:
I. 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,
111. education, and
iv. supportive services
C. Performance Outcomes
I. 90 FEZ residents will be served within 10 months.
2. Of the 90 FEZ residents served, 45 (50%) will be provided additional services within 10 months.
3. Of the 90 FEZ residents served, 36 (40%) will be provided with work experience, receive On-the-Job
Training, receive retention services, attend English as a Second Language classes, be provided with
skill upgrades, have access to paid internships, etc. within 10 months.
4. Of the 90 FEZ residents served, 27 (30%) will be placed in unsubsidized employment within 10
months.
Cumulative Planned Enrollments:
Jan. - March
81
I A;~ill
I JUIY;6Sept'l Ocl';4Dec. I
Cumulative Planned Placements:
July - Sept.
5
Oct. - Dec.
16
Jan. - March
24
April
27
EXHIBIT B
V. SERVICES WILL BE PROVIDED AT:
The Cambodian Family
1111 E. Wakeham Ave. Ste. E
Santa Ana, CA 92705
VI. WORK CENTER RESPONSIBILITIES
I. 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 forms such as application, screening/intake tool, ISP, referral form, MIS forms, etc.
4. Perform Program Monitoring
5. Perform Program Reporting
6. Provide partners with on-going technical assistance
7. Provide a quarterly FEZ newsletter
8. Facilitate monthly meetings
9. Provide job development I job placement enhancement services to partner agencies
10. Conduct a mid year progress review to access programmatic performance and fiscal accountability
VII. The Cambodian Family RESPONSIBILITIES
I. The Cambodian Family 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 self-sufficiency:
. Case management
. Job readiness
. Job development & job placement
. Coordinate on-site recruitments
. Community forums on job related services
2. Evaluate participants for eligibility and assign those eligible for program services.
3. Report progress and job placements to WORK Center FEZ staff.
4. Incorporate all service navigator partners' information into each other's marketing materials.
5. Attend monthly partner meetings.
6. Provide WORK Center FEZ staff with monthly and quarterly progress reports.
7. Provide WORK Center FEZ staff with necessary information for conducting informal and formal
monitoring of program progress.
8. Meet performance measures. All staff and agencies participating in this project will be held
accountable for achieving their agency FEZ performance measures.
9. Submit Monthly Statistics Report documentation to FEZ Liaison staff by the 5ht of every month.
Report should include new enrollments and a continuous Activity Enrollment Form
10. Maintain a current and complete file (electronic as well as a hard copy) for each FEZ participant:
eligibility documentation; registration form; enrollment form; assessment; Individual Service Plan
(ISP); EEO/Grievance; case notes; supportive services documentation; attendance records; training
documentation; etc.
II. Comply with allowable expenses. To be allowable, costs must: a.) be reasonable for the performance
of the program; b) conform 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 uniformly to both
federally-financed and other activities of the organization; d.) be determined 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.
12. Submit in triplicate, a monthly Invoice on City of Santa Ana, Federal Empowerment Zone Program
Subrecipient 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 Bea Gonzalez by the tenth
(lOth) 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 I.
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. SUB RECIPIENT 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 Coonerative Aereements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) 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 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 shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
(3) The undersigned 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 under
grants, loans, and cooperative agreements) and that all subrecipients shall certifY and disclose
accordingly.
This certification is a material representation offact 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.
TI-..e.... G'l......bcx!,Q.V1, h..rl.-1;t.,
Grantee/Contractor Organization (
{/qis'tr w~eel ivd<v~
rogram Title
12~
Name of CertifYing Officer
EXHIBIT D
Part [
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form still be completed by the reporting entity, whether subawardec 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 Conn 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. Identity the type of covered Federal Action for which lobbying activity is amVor has been secured to influence the outcome of a covered Federal
action.
2. Identity the status of the covered Federal action.
3. Identity the appropriate classification of this report. If this is a followup report caused by a material change to the infonnation previously reported,
enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this
covered Federal action.
4. Enter the full 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 III 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. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include 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 identitying number available for the Federal action identified in item I (e.g.) Requ~st for Proposal (RFP)
number; invitation for Bid (IFB) 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 b)' the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
I O. (a) Enter the full name, address, city, state and zip code of the lobb)'ing 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) perfonning services, and include full 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 will be made (planned). Check all boxes that apply, if this is a material change report, enter the
cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply, ifpaymenl 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, specity nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perfo"", and the date(s) for any
services rendered. Include all 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 certitying official shall sign and date the fonn, print hislher name, title, and telephone number.
Public reporting burden for this collection of infonnation 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 collection ofinfonnation. Send comments
regarding the burden estimate or any other aspect of this collection ofinfonnation, 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 SUB RECIPIENT's Agreement with the Santa Ana
Empowerment Corporation.
Subcontractor! Assignee further agrees to be bound to all of the terms and provisions of
SUB RECIPIENT's Agreement with the Santa Ana Empowerment Corporation.
Executed this 02 ~ day of l Jivru; , .200S"
BY: t4J~ ~
Name: 'iftf=l<r'1 7i/~:5oH
Title: 1=.Xecuntlc. JyREL~
EXHIBIT E
Certification ReaardinQ DruQ-Free Workplace Reauirements
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) 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;
(b) Establishing a drug-free awareness program to inform employees about-
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) 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);
(d) Notifying the employee in the statement required by paragraph -(a) that,
as a condition of employment under the contract, the employee will _
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five days after
such conviction.
EXHIBIT F
Pg.2
(e) 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;
(t) 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
(2) 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;
(g) Making a good faith effort to continue to maintain a drug-free workplace
through implementation of paragraphs (a), (b), (c), (d), (e) and (t).
B. 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.
Dated:
6/~f/OS-
fj1k~
Program Operator
EXHIBIT F
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE
WORKPLACE REQUIREMENTS
Name:
Name of Contractor: It.. ~ r", M bncL..." t=-o. No: ~
Contractor Number: Fe..! IV:it q S' - 38S'i 11'31
Date: JuVle. -:2...<{ I .zoo~
f(fFK.A HI,6? r.6H-
The Contractor shall insert in the space provided below the site(s) expected to be used
for the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each site):
/ III E Wa. ke.ho...'VI Ave., S',,; -f. €.; 5q....J-Q 4". Q , Ora V>,l~ Co" c4 <f2.7cS-
EXHIBIT F
Assurances & Certifications
Selected providers will be required to sign and submit "actual" assurances and certificates
as required by the Santa Ana Empowerment Corporation Board on all contracts.
I recognize that [must give assurances for each item below. If I cannot, this proposal will
be automatically rejected. Please initial each box.
1&
~
l8'
~
~
I am authorized by my Board of Directors, Trustees, other legally qualified officer, or as the owner
of this agency or business to submit this proposal.
We are not currently on any Federal, State of Cali fomi a. or local Debarment list.
We will provide records to show that we are fiscally solvent, ifneeded.
We have, or will have, all of the fiscal control and accounting procedures needed to ensure that
Empowennent Zone funds will be used as required by law and contract.
We have additional funding sources and will not be dependent on Empowerment Zone funds alone.
We will meet the applicable Federal, State. and local compliance requirements. These include, but arc
not limited 10:
lEecordS accurately reflect actual perfonnance. - - - i Formatted: Bullets and Numbering I
aintain record confidentiality, as required.
Reporting financial, participant, and perfonnance data. as required.
rgJComply with State and Federal fiscal and program activity audits.
~Complying with Federal and State non~discrimination provisions.
li:!Meeting requirements of Section 504 of the Rehabilitation Act of 1973.
DS:JMeeting requirements of the American's with Disabilities Act of 1990. (submit completed survey)
~eeting all applicable labor law, including Child labor Law standards.
~Agree to provide a drug free workplace.
18Agree to insure the City of Santa Ana through General Liability Insurance and Automobile Liability
[8Coverage in the amount of$ 1 ,000,000.00 policy.
'[gAgree to provide all participants w'ith Grievance Procedures.
rlJAgree to insure proposer's employees through Workers Compensation Insurance
(including part-time employees)
w~ will not:
~P~mpowerment Zone resident in a position that will displace a current employee. ! Formatted: Bullets and Numbering I
[8JUse Empowerment Zone money to assist, promote, or deter union organizing.
~Use funds to employ or train of persons in sectarian activities.
~Use funds for Empowerment Zone residents in the construction, operation, or maintenance of any part
ofa facility to be used for sectarian instruction or religious worship.
~Use Empowennent Zone funds for activities that would interfere w'ith or replace regular academic
~uirements for eligible youth who are not dropouts.
~Use Empowerment Zone funds to carry out programs funded under the School-to-Work Opportunities.. - - [Formatted: Bullets and Numbering I
Act of 1994
at all of the above are true.
q
EXEettnvf b/~(
Title
Date
Certification Regarding
Debannent, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debannent
and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were
published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION
- Attached)
(I) The prospective reCipient of federal assistance funds certifies, by submission of this
proposal, that neither it nor its principals are presently debarred, suspended, proposed for
debannent, declared ineligible, or voluntarily excluded from participation in this transaction
by any federal department or agency.
(2) Where the prospective recipient of federal assistance funds is unable to certifY to any of the
statements in this certification, such prospective participant shall attach an explanation to
this proposal.
R/FI<ET /-III? s,C:I-I EXf. Uf n tiE lJ/l?ftc/tJR
Name and Title of Authorized Representative
€~~
bJx~S-
Date I /
I
ACORQ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
02/08/2006
PRooueER (714)838-1912 FAX (714)838-7568 THIS CERTIFICA TE IS ISSUED AS A MA TTER OF INFORMATION
Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lic #0747473
Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC#
INSURED Cambodian Family ,4-~[)()'f- ~3 INSURER A Philadelphia Ind. Ins. Co.
1111 East Wakeham Avenue 4- ;;I{XJ4-;).03- DI INSURER 8:
Suite E A-;;.ro5 -D18- rx:4> INSURER C
Santa Ana, CA 92705 A-.;>.a:>5- liN INSURER 0
..
INSURER E
THE POLlClES OF INSURANCE LISTED BELQWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS,
II~~~ ~'1:CJ:r TYPE OF INSURANCE POLlCY NUMBER POL-ICY EFFECTIVE POLlCY EXPIRATION LIMITS
~NERAL LIABILITY PHPK155246 03/09/2006 03/09/2007 ~~_?CC~RRENCE , 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED , 400,000
~ ~ CLAIMS MADE [!] OCCUR MEO EXP (Anyone person) , 5,000
A - PERSONAL & ADV INJURY , 1,000,000
GENERAL AGGREGATE , 3,000,000
~.
GEN'!... AGGREGATE UMIT APr~Y PER PRODUCTS. COMP/OP AGG , 1,000,000
h ,hPRo.
POLICY JECT lOC
AUTOMOBILE LIABILITY PHPK155246 03/09/2006 03/09/2007 COMBINED SINGLE LIMIT
-.. ,
ANY AUTO (Eaacddent) 1,000,000
f.-
All OWNED AUTOS BODilY INJURY
f.- ,
SCHEDULED AUTOS (Per person)
A X
HIRED AUTOS 800ll Y INJURY
X ,
NON-OWNED AUTOS (Per accident}
X $0 Deductible PROPERTY DAMAGE
2. (Peraccidenl) ,
==i~GE LIABILITY AUTO ONLY. EA ACCIDENT ,
ANY AUTO OTHER THAN EA ACC ,
AUTO ONLY AGG ,
3ESS1\lMBRELLA l.IABll.lTY /~ p;i' 1,,- EACH OCCURRENCE ,
OCCUR 0 CLAIMS MADE 0::<./"Lj AGGREGATE ,
.~ ,
~
DEDUCTIBLE ,
RETENTION , ,
WORKERS COMPENSATION AND '1 ~5i~J~'<1 IOJ,t<.
EMPLOYERS' UABILlTY .-
ANY PROPRIETORfPARTNER/EXECUTIVE EL.. EACH ACCIDENT ,
OFFICER/MEMBER EXCLUDED? EL-_ DISEASE - EA EMPLOYE ,
It yes, describe under EL DISEASE - POLICY LIMIT
SPECIAL PROVISIONS below ,
~HER . PHPK155246 03/09/2006 03/09/2007 $1,000,000 Each Claim
A use & Molestatlon $1,000,000 Aggregate
$0 Deductible
DESCRIPTION OF OPERA no~ I LOCATIONS I VEHICLES / EfLUSIONS I'DDED BY ENDON'EMENT I SPe:C~L PROVISJON\
"Except 10 days or non payment 0 prem,um. E"1' oyee D,s onesty 200,000/$2,500 Oed.
Professional Liability $1,000,000 Each Occ/$3,OOO,OOO Aggregate. City of Santa Ana
's named additional insured per contract with named insured. Schedule of vehicles
nd drivers on file. "Non Profit organization"
COVERAGES
The City Of Santa Ana: Its Officers,Employees
Agents, representatives
20 Civic Center Plaza (101-30)
Santa Ana, CA 92705
CANCEL 11 N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPlRA TtON DATE THEREOF, THE ISSUING IN$URER WILL r,)6(X~li MAlI..
30.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
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CERTIFICATE HOLDER
ACORD 25 (2001/08) FAX: (714)571-1974
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@ACORDCORPORATION 1988
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AoomONALINSURED ENDORSEMENT
Insurance Company ,_'pHILADELPHIAl~!DEMNITY INSURANCE COMPANY
This at'ldorsemel'lt modlfies such insurance as IS afforded by the provisions of Policy
#PH P f( 1 ~ " j " . ralalit'lg to me folloWing: '
1 ' The Cily of Santa Ana. 20 CMc: Center Plaza. Santa Ana, Catlfomla 92701;
its officers. employees. agents and repre~es are named as additional Insureds
radditJonal insureds.) with reg<;rd to liabUity and defense of sUits arising from the
o!'€r;ljjons and,uses petfooned bv 01 on beha~ 01 the named insured
2 .. Wrthrespect to ~msarislng out 01 theoperatiillns and QsesperfO(l'rted by
or onbetlll\fQf~ flaI'tled insUled,such insuranCElas 15 afforqsr;j by-this poliCy is p(ilnary
at'ldlshot addllioneJ to .oroontributirlg witheny other insUfa.t'lC(il ~by oder \l1e
benefit oHlle addltfQrlalinsured$ Except in the c/!$e of sole negligence or willful
misconduct. .
3,. 1b!slOsuranceappfies separately to e~ii1$t1rt!dagajnst whom. claim .is
madaor $lJitiSl:lr()light~t wllh resp~cl to the CQll1pany'slftrjitsofliabflity . The
inclustonof fSny~or or9S"li<:alionas an Insured shaU nota.ffe<:t arlY rightwt\ieh such
person oror~n would h<we as a claimarnif not so included.
4.. Wl!tt(~to the ad~inllure:ls, thjsinsU~$halJ not be CaocellaO.
or lTI~redUC<<lincoverage olnmits.~afterthirty (8O}dayswri!ten fl()~ nas
beengi1lent<:>U1e..C1ty' \1fSanta )\ria, 20 eMs Clll'lt$rPI9Ul,$antciAn6..Califomia. 92701,.
(Compl.etion of W~ (ollowIng, lnclUQlng countersIgnatUre, jS required to make tills
endorsement ~ectllre.)'
EffecllvQ ,__.03(U2J06
,thiselldorsemef\tfoJ'tn as sparta!
~......._-~.~_....._._---_.
Policy 1/
PHPK155246
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Issued to _THE CAj>1BODIAN :l<'AMILY_.~" '.
Named Insured . ~ ~
CountersIgned by _.. .. .... .... " ..
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