HomeMy WebLinkAboutREBUILDING TOGETHER O.C. 5 - 2002
Il'tliUkMvL UN F
WORK MAY PRoeml
UNTIL INSURANCE EXhkES
. 3-15~o3
CLERK OF COUJlCI},-:l.
DATE: \- Zq-U;;J
C " e~PA
FIN
'-'
...;, 4- J,.OO ?,-...)b 5-(P~
8/610 [ LS
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
REBUILDING TOGETHER ORANGE COUNTY FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
(With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
This Agreement, made and entered into this Is-\h day of A.?RLL , zooG., by
and between the City of Santa Ana, a charter city and municipal corporation of the State of
California ("CITY") and Rebuilding Together Orange County, a California nonprofit corporation
("SUBRECIPIENT"),
WIINE~~EIH
Recitals:
A. The CITY, as an entitlement recipient and grantee of the United States Department of
Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG")
Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG
funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq.
("CDBG REGS"); and
B. CITY has applied for and received CDBG funds from HUD pursuant to Title I ofthe
Housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"); and
C. The SUBRECIPIENT is a private nonprofit agency that has been selected by the CITY
to receive CDBG funds and administer such financial assistance; and to provide the services
described in "Exhibit A," hereinafter referred to as "said program" and SUBRECIPIENT represents
that it is qualified and willing to operate said program.
D. Title X of the 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
in particular requirements relating to (i) notification (including pamphlet distribution, disclosure to
purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or lead
hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing, and/or risk
assessment), (iii) lead hazard reduction (including paint stabilization, interim controls, standard
treatments, or abatement depending on the requirements for housing activity type), (iv) ongoing
maintenance, if required, and (v) response to children with environmental intervention blood lead
levels, as required; and
E. On September 15, 1999 BUD adopted implementing regulations to Title X that became
effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs."), which establish
specific rules regarding notification to owners and occupants about the existence of LBP hazards,
identification ofLBP hazards, and control ofLBP hazards; and
I
~
'wi
8/6/01 LS
F. Residential structures built after January 1, 1978 are exempt from lead-based paint
requirements as the use of lead-based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be
applicable if the structures involved were built after January 1, 1978.
G. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs,
sets forth specific requirements relating to housing providers, such as SUBRECIPIENT, who
administer local programs that provide supportive housing for special needs populations and are
funded by HUD Office of Community Planning and Development ("CPD") programs, including
CDBG funds, as provided to SUBRECIPIENT under this Agreement; and
H. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and evidence of compliance with all applicable requirements of Title X
and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support services, or
operations, and Subpart J relating to rehabilitation, as and when applicable; and
1. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as and
when applicable; and
1. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No.1 entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No.2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards", and
Attachment No.3 entitled Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modify or limit SUBRECIPIENT'S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP Regs;
and
K. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all
responsibilities set forth in Subpart K of the LBP Regs; and
L. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure
of such funds; and
WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a
substantive part of this Agreement and the following terms and conditions are approved and
together with all exhibits and attachments hereto, shall constitute the entire Agreement between the
CITY and SUBRECIPIENT:
2
'-"
'-'
8/6/0 I LS
I. SUBRECIPIENT'S OBLIGATIONS
A. Non-Profit Status - Representations and Warranties.
(1) SUBRECIPIENT acknowledges that its operations and the services it provides to the
community are subject to Subpart K (and, in some instance(s) Subpart J and/or Subpart M) ofthe
LBP Regs.
(2) SUBRECIPIENT acknowledges that its operations and the services it provides
includes: (a) acquisition, leasing, or ownership of residential property for the purpose of
providing affordable housing for persons with special needs, such as transitional housing, or
(b) housing for persons with special needs, such as the disabled, or (c) financial assistance to
assist transitional housing participants to move to permanent housing by paying for the first
month's rent or security deposit, or (d) tenant-based rental assistance to program participants
who choose their own housing units, and by provision of such services such housing is subject to
the requirements of the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. SUB RECIPIENT has full right, power and lawful authority to accept the funding
hereunder and to undertake all obligations as provided herein and the execution, performance
and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite
actions on the part of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be
provided hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUB RECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are
received from CITY'S representative.
(d) No Conflict. To the best of SUB RECIPIENT'S knowledge,
SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement
will not constitute a default or a breach under any contract, agreement or order to which
SUBRECIPIENT is a party or by which it is bound.
3
'-"
'....I
8/6/0 I LS
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or
threatened bankruptcy proceeding.
(1) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a
current or threatened litigation that would or may materially affect SUBRECIPIENT'S
performance under this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUB RECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
(4) Compliance with Subpart K of LBP Rel!s. Subpart K - Acquisition,
Leasing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shall comply with and
implement the requirements set forth in Title X and the LBP Regs to eliminate, as far as
practicable, LBP hazards in all residential property that is under its ownership, possession, or
control and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(b) SUBRECIPIENT shall provide a notice to all residents/occupants of
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUB RECIPIENT
in accordance with Section 35.125 of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a visual
assessment is not considered an evaluation for purposes of the LBP Regs.
(c) Notification (24 CFR 35.130). SUBRECIPIENT shall provide the LBP
hazard information pamphlet in accordance with Section 35.130 of the LBP Regs to all
occupants, owners, and purchasers of housing.
(i) The pamphlet shall be the EP A/HUD/Consumer Product
Safety Commission lead hazard information pamphlet or an EPA-approved
equivalent. The current form and version of the pamphlet is attached as
Attachment No.1 to this Agreement.
(ii) SUB RECIPIENT shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
4
'-'
-...J
8/6/0 I LS
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No.2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing ofthe results of the presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No.3 to this
Agreement.
(d) Lead Hazard Evaluation (24 CFR 35.125). SUB RECIPIENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(J).
(i) SUBRECIPIENT shall cause a visual assessment to identify
deteriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(l)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs. including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero-bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed after January I, 1978.
(ii) To the extent that the assistance provided by SUBRECIPIENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs. as to all
tenant-based long term housing assistance, i.e., assistance to persons/households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
require evidence of compliance prior to occupancy. Funding to be provided hereunder is
conditioned upon evidence of compliance.
(J) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
5
'-'
""'"
81610] LS
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such
dwelling units includes, without limitation: notification, evaluation by visual assessment, paint
stabilization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy,
including occupancy in the same dwelling unit for more than 100 days, then the provisions of
Subpart M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed
by HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS
inspection of each dwelling unit prior to occupancy and prior to compliance with applicable
notification, evaluation by visual assessment, reduction through paint stabilization utilizing safe
work practices, and clearance requirements of the LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(1) above.
(I) Ifpaint stabilization occurs, SUBRECIPIENT shall cause paint
stabilization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the CDBG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certification
ofa qualified inspector is required on an annual basis in connection with submittal of the April
15 quarterly report.
(f) Onl!oinl! Maintenance. SUBRECIPIENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
all residential property that is under its ownership, possession, or control and/or residential
property occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above.
(1) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is
complete.
6
'-
"-"
8/6/0 I LS
(2) Ongoing maintenance also includes confirmation of clearance by
written certification of a qualified inspector on an annual basis in connection with submittal of
the April 15 quarterly report.
(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all
occupants of all residential property that is under its ownership, possession, or control and/or
residential property occupied by persons or families that receive financial or other assistance
from SUBRECIPIENT in accordance with Sections 35.l25(b)(1) and (c), describing the results
of the clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Al!reement: Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and
confirmation of clearance ofLBP and LBP hazards from the subject dwelling unit(s).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty ofthe provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that may be occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No.4 to this Agreement, attached and
hereby fully incorporated by this reference, is such information summary. CITY staff will
cooperate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or
responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant and Ouarterlv Disbursement. The amount granted to
SUBRECIPIENT is $ 15.000 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 30, YEAR. The CDBG FUNDS shall be disbursed by
CITY to SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a
complete SUBRECIPIENT'S quarterly activity report, with the final payment subject to the
satisfaction of the condition precedent of submittal of complete reporting information due on or
before July 15th of the applicable funding year, as hereinafter more fully set forth.
SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the
term, including but not limited to obligations with respect to indenmification, audits, reporting,
data retention/reporting, and accounting.
7
'-'
.......
8/6/0 I LS
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit B",
attached hereto and by this reference incorporated herein. SUBRECIPIENT'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 SUBRECIPIENT under Paragraph II hereof.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, YEAR ONLY and to use said funds to pay for necessary and reasonable costs allowable
under the federal law and regulations to operate said program. Said amounts shall include, but not
be limited to, wages, administrative costs, and employee benefits comparable to other similarly
situated employees. Other allowable program costs are detailed in the Budget, as set forth in
"Exhibit B", attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use
all income received from said funds only for the same purposes for which said funds may be
expended pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder.
F. Zoning. SUBRECIPIENT 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
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT 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.
SUBRECIPIENT 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. SUB RECIPIENT 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.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained in an account in a federally insured banking or
savings and loan institution with record keeping of such accounts maintained pursuant to applicable
OMB Circular A-110 requirements. SUBRECIPIENT is not required to maintain separate
depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-I 10 requirements.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
8
'--'
.....,
8/6/0 I LS
receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUBRECIPIENT 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. SUBRECIPIENT 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. Further, SUB RECIPIENT
shall comply and/or cause compliance with audit report(s) required by applicable provisions of Title
X and the LBP Regs.
1. Record KeeoingjReoorting. SUB RECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the CDBG REGS, Title X, and the LBP Regs, including the following:
(1) Records
a. Documentation evidencing program income requirements in
conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24
CFR 570.208(a)(2)(B) of the income level of persons and/or families participating
in or benefiting by the SUB RECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and all contracts or documentation pertaining to costs for subcontractors,
plus all other invoices for which CDBG FUNDS were expended, and any payments
therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the CDBG REGS.
g. Documentation evidencing compliance with all applicable provisions
of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing
compliance with all applicable provisions of such LBP Regs
including: (i) notification, including distribution of the lead
hazard information pamphlet (Attachment No.1), disclosure
and notices of hazard evaluation and reduction (Attachments
9
'-'
-....J
8/6/01 LS
No.2 and 3); (ii) evaluation oflead hazard(s), including paint
testing and risk assessment; (iii) reduction oflead hazard(s),
including safe work practices and clearance, and
confirmation of clearance; and (iv) ongoing maintenance, as
and if applicable for multifamily properties.
(ii) In this regard SUB RECIPIENT shall track information on
all persons/households assisted and the housing units assisted
with the CDBG FUNDS. Attachment NO.5 hereto is a sample
form for tracking personslhouseholds and housing units
assisted with the CDBG FUNDS. All categories of
information set forth in such tracking form shall be prepared
and submitted to the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not
complete and reasonably satisfactory information submitted in
order for CITY staff to review and evaluate compliance with
applicable CDBG REGS and LBP Regs., then the final
quarterly disbursement payment shall be withheld from the
SUB RECIPIENT.
(iv) Documentation of clearance confirmation as provided in
Section 1.(1 )(g) hereinabove.
(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
other documentation supporting and evidencing how the CDBG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant-based
rental assistance. SUBRECIPIENT agrees to provide CITY with
written cumulative (year-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
period beginning July I, YEAR ONLY and through and including
the previous three-month reporting period setting forth the
activities, program accomplishments, new program information
10
"""
~
8/6/01 LS
and year-to-date program statistics on expenditures, caseload and
activities. When appropriate, pictures should be included.
(iii) Any such other reports as CITY (or HUD) shall
reasonably require and/or request, including but not limited to
the following information: the receipt of program income [as
defined at 24 CFR 570.500(a)] by SUBRECIPIENT in the
operation of said program shall be recorded by SUB RECIPIENT
and reported to CITY; monthly records of all ethnic and racial
statistics of persons and families benefited by SUBRECIPIENT 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 and the number of female heads of
households.
(3) Recordkeeoing of Ongoing: Maintenance under the LBP Regs. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or
transitional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUB RECIPIENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
residential property conducted by a DHS certified technician to ensure that LBP hazard reduction
measures are maintained. All maintenance activities shall be conducted to ensure the threat of
LBP hazards is minimized.
(4) Recordkeeoing under the LBP Regs. The SUBRECIPIENT shall keep records of
distribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation
report, LBP hazard reduction documentations, (such as job specifications), and all clearance or
abatement report(s).
(c) The SUBRECIPIENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
11
'-'
""""
8/6/01 LS
I. Such records shall be maintained for not less than longer of
(A) three (3) years after the activities cease or (B) the period
required by applicable program regulations. Under the CDBG
REGS records shall be retained for not less than four (4) years after
the activities cease.
2. The SUB RECIPIENT shall provide a copy of any of the
above records to the CITY or to HUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days of
rental assistance, proper notifications to occupants and owners, HQS inspection, visual
assessment, work write-up, stabilization and clearance ofLBP and LBP hazards, if any. The
proposed form of such tracking information is attached hereto as Attachment No.5 and fully
incorporated by this reference. In the event such April 15 quarterly report does not fully satisfy
the reporting requirements set forth herein and in the LBP Regs, then the final installment
payment of the CDBG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
1. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY 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 SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of RecordslRequired Length of Record Keening. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUB RECIPIENT and all documents related to this Agreement shall be maintained and kept
available at SUBRECIPIENT' S office or place of business for the duration of the Agreement and
thereafter for four (4) years after completion of an audit in conformity with the CDBG REGS,
except as hereinafter provided relating to retention of any records or documentation existing,
created, or maintained in compliance with Title X or the LBP Regs. 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 four (4) years until complete
12
\wi
...,
8/6/01 LS
resolution or disposition of such appeals, litigation claims, or exceptions. All records relating to,
or created or maintained in compliance with, Title X and/or the LBP Regs shall be retained and
maintained by SUBRECIPIENT indefinitely, including without limitation, all inspection
report(s), disclosure statement(s), and clearance report(s). In the event SUBRECIPIENT does not
make the above-referenced documents available within the city of Santa Ana, California,
SUBRECIPIENT 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.
L. Compliance with LawIProgram Income. SUBRECIPIENT acknowledges that the funds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these funds shall be in accordance with the ACT and all pertinent
regulations issued by agencies of the federal government, including, but not limited to, all
regulations found at Title 24 of the Code of Federal Regulations. Program income received by
SUB RECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUB RECIPIENT 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.
M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT 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,
SUB RECIPIENT shall submit to CITY and or HUD or its representatives, all records requested,
including audit, examinations, monitoring and verifications of reports submitted by
SUBRECIPIENT, costs incurred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT 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.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT
reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT
agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent
in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non-
expendable personal property acquired under the terms of this Agreement. Said record shall be
13
'"'"
'-'
8/6/0 I LS
made available to CITY upon request. The term "non-expendable personal property" shall include
leased and purchased equipment.
R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertainment, meals or gifts.
S. Lobbving. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.c. 1352) and regulations found at 24 CFR Part 87, which provide 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. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECIPIENT 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 SUBRECIPIENT 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 shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-l).
T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to CDBG 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 CDBG-assisted activity of
SUBRECIPIENT, 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 SUBRECIPIENT.
U. Davis-Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis-Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. 95.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
14
"-'
'wi
8/6/01 LS
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. 95.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.F.R. 95.5. . A breach of the contract
clauses in 29 C.F.R. 95.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. 95.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. 95.6(a)(3)].
V. Drug Free Workplace. SUBRECIPIENT certifies that it has established the
following drug-free workplace policy:
I. The unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the workplace for any employee involved in a federally funded program.
2. As an employee working in conjunction with a federally funded program, the
employees of SUB RECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any
criminal drug statute conviction for a violation occurring in the workplace not later than five
days after such conviction.
3. The United State Department of Housing and Urban Development will be notified
within ten days after receiving notice of any such violation.
4. Within 30 days of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
Each such employee shall be required 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.
II. CITY'S OBLIGATIONS
A. Pavment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall
pay to SUB RECIPIENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's Fiscal Year CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year Fiscal Year pursuant to this Agreement up to a maximum aggregate
payment of MONETARY GRANT AMOUNT Dollars ($ DOLLAR AMOUNT) in installments
determined by CITY. Payments shall be made to SUBRECIPIENT through the submission of
invoices on a quarterly basis (October, January, April and July) in a form prescribed by CITY,
detailing such expenses. CITY shall pay such invoices within thirty (30) days after receipt thereof
provided CITY is satisfied that such expenses have been incurred and documented within the scope
15
.....
'wi
8/6/0 I LS
and provisions of this Agreement and that SUBRECIPIENT is in compliance with the terms and
conditions of this Agreement, and in compliance with Title X and the LBP Regs.
8. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
Ill. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, age, 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 CDBG funds.
IV. CONFLICT OF INTEREST
SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct
or indirect control of any CDBG monies granted to the CITY, inclusive of the subject CDBG
FUNDS, shall serve as an officer of SUB RECIPIENT. Further, any conflict or potential conflict of
interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution
of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof.
Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its
board of directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision of the services SUBRECIPIENT shall provide with CDBG funds:
A. SUBRECIPIENT 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.
8. SUBRECIPIENT shall not discriminate against any person applying for the services
SUB RECIPIENT 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. SUBRECIPIENT 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. The parties agree that this covenant is
intended to and shall be construed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
16
'-
""-"'
8/6/0 1 LS
establishment of religion as set forth in the establishment clause under the First Amendment of the
United States Constitution and Article I, Section 4 of the California Constitution, and is not in any
manner intended to restrict other activities of SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBG 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 CDBG
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM
SUB RECIPIENT 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 SUBRECIPIENT. 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, stepparent 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:
City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, California 92702-1988
TO SUBRECIPIENT:
Rebuilding Together Orange County
625 S. Cypress Street
Santa Ana, CA 92701
VIII. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate
to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of SUBRECIPIENT pursuant to this Agreement.
17
'-'
'wi
8/6/0 I LS
IX. HOLD HARMLESS
SUBRECIPIENT 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 attorney fees and reasonable expenses for litigation or settlement, resulting
from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its
officers, directors, employees, agents, subcontractors and suppliers arising out of
SUBRECIPIENT's performance of this Agreement.
X. INSURANCE
A. In accordance with the provisions of Section 3300 of the Labor Code, if
SUBRECIPIENT has any employees it is required to be insured against liability for worker's
compensation or to undertake self-insurance. Prior to commencing performance of this
Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with
limits not less than $1,000,000 per accident. IfSUBRECIPIENT has no employees, nor workers'
compensation coverage, it must execute a Declaration available from the CITY, and update as is
necessary.
B. SUBRECIPIENT shall obtain, at its sole cost, a policy or policies of commercial
general liability insurance, or equivalent form, with a combined single limit of not less than
$1,000,000 per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents,
representatives, employees and volunteers as additional insureds; (2) be primary with respect to
insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of
insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUB RECIPIENT's operations hereunder.
SUB RECIPIENT shall: (a) prior to exercising any right under this Agreement,
furnish properly executed certificates of insurance and additional insured endorsement to the
CITY which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to the CITY;
(c) maintain such insurance for the period covered by this Agreement; and (d) replace such
certificates for policies expiring prior to the expiration ofthis Agreement.
XI. REVERSION OF ASSETS
18
'-'
....,
8/6/01 LS
A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any
COBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use ofCOBG funds. [24 CPR 570.503(b)(8).]
B. Any real property under SUB RECIPIENT's control that was acquired or improved
in whole or in part with COBG 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 in 24 CPR 570.208 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, SUBRECIPIENT
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-COBG 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 SUBRECIPIENT. 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:
I. 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, in accordance with 24 CPR 85.32( e )(2).
O. SUBRECIPIENT 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 assignrnent(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 SUBRECIPIENT's
right, title and interest (if any it may have) in and to CITY, COBG 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
SUB RECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
19
"-'
"-'
816/01 LS
REVERSION OF ASSETS." and in paragraph "XlI. TERMINATION" and other requirements
pertaining to 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, SUBRECIPIENT 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 SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT 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 SUBRECIPIENT, 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 oftermination, 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 under this Agreement may be terminated for convenience in
accordance with 24 CFR 85.44.
E. In the event this Agreement is terminated as set forth in subparagraphs XI!.A.
through XII.D., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
demand and prior to any adjudication of SUBRECIPIENT'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
20
'-'
....,;
816101 LS
limitations on the use of CDBG 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
SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT'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 City Manager 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 SUBRECIPIENT'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
SUBRECIPIENT 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 SUBRECIPIENT 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 CDBG funds by SUBRECIPIENT 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
SUBRECIPIENT.
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.
XVII. MISCELLANEOUS PROVISIONS
21
'-"
"""
8/6/01 LS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A
waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be
performed by the other shall not be construed to be a waiver of any succeeding breach thereof
or of any other covenant, condition or agreement herein contained.
22
"""
"'"
8/6101 LS
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
DATED:
~\~~'V
aTY~
6AVtD N. REAM
City Manager
ATTEST:
APPROVED AS TO FORM:
PATRICIA E. HEALY
Clerk ofthe Council
li~~ I/&rL
~'JOSEPH . FLETCHER
City Attorney
SUBRECIPIENT:
Non Profit Name
DATE: /'J..hD/b <-
11 !Jf~
Nam~~:' fttrf!.Y NIt{<.IIIUIi'~u
Title Print: P /< E SID 1'2- AJ r
Tax ID Print:
23
EXHIBIT A
'-'
"'-'
EXffiBIT A AND B
Annual goal: 20 unduplicated housing units
EXHIBIT B
Budget:
$5,000
$10,000
Program staff salaries
Building materials, supplies and labor
Exhibit A and B
'-'
""-"
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans. and Cooperative Agreements
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 cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
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 ofa
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 subcontract, sub grants, 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.
2oo.2.-o31(d,..i,I.c(;
.
N ftf?Y MrtRTIIVE-p..V
Name of Certifying Officer
'11Z CUlt fY! ~~
Sign ture
1.2./.3tJ~ ....
Date
EXHIBIT C
Page 1 of2
'-'
""""
SUBRECIPIENT warrants the following:
1. SUB RECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation 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 in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, 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
Page 2 of2
_'r'" .,:..,:u':~_"'-r-;~'~~V.i~~:~:~ttr'~~,:~~,~~~,~~ ~.
',- .' ~- .,'." .,.- ..;;._,)~,. .o!",.('7"" .'"..-:r"{i~""'~' ~"''''';:fI;',/,.'~I~-h': ,\l'~ "::.t{~~.,;,.~'(~;j~~f'f
~ ,,' ..-....'. " <f~-:~:~-:;.. '-'-~~}.:~:":;:"'--:::'~',:.;';W.:~.?:),:-,;(:;,::~~.:.}::'!::....,'::_,;:~.."~~.~.,:
Disclosure of Lobbying Activities Approved by OMB 0346-0046 .
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse side for Instructions and Public Reporting burden statement)
1. Type of Federal Action 2. Status of Federal Action 3. Report Type
o a. contract o a. bid/offer/application D 8. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only
d. loan year (yyyy) ___ quarter ____
e. loan guarantee
f. loan insurance date of last report (mmfdd/yyyy)_____
4. Name and Address Tof Reporting Entity 5. If Reporting Entity in No.4 is Subawardee, enter Name and Address
DPrime D Subawardee Tier , if known: of Prime
Congressional District, if known Congressional District, if known
6. Federal Department/Agency 7. Federal Program Name/Description
..
CFDA Number, if applicable
8. Federal Action Number, if known 9. Award Amount, if known
$
10a. Nam~ and Address of Lobbying Registrant b. Individuals Performing Services (iocluding address if different from No. 103.)
(if individual, last name, first name, MI) (last name, first name, MI)
..
$
actual
(attach contmuatlon sheet(s) if necessary)
13. Type of Payment (check all that apply)
D a. retainer
o b. one-time fee
o c. commission
D d. contingent fee
D e. deferred
D f. other (specifYL______________________.__________
planned
11. Amount of Payment (check all that apply)
12. Form of Payment (check all that apply)
Oa
Db
cash
in-kind; specify: nature
value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member{s) contacted,
for Payment Indicated in Item 11
(attach continuation sheel{s) if necessary)
15. Continuation sheets attached 0 Yes D No
16. Information requested through this form is authorized by Sec.319,
Pub. L. 101-121, 103 Stat. 750, as amended by sec. 10; Pub. L. 104-
65, Stat. 700 (31 U.S.C. 1352). This disciosure ofiobbying activities
is a material representation of fact upon which reliance was placed
by the above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S,C. 1352. This information
will be reported to the Congress semiannually and will be available
for public inspection. Any person who fails to file the required
disclosure shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
Federal Use Only:
Signature
Print Name
Title
Telephone No.
Date (mmldd/yyyy)
Authorized for Local Reproduction
Standard Form-LLL (7197)
~
....,;
"'"
'wi
Are You Planning To Buy, Rent, or Renovate
a Home Built Before 19781
Many houses and apartments built before 1978 have
paint that contains lead (called lead-based paint). Lead
from paint. chips. and .dust can pose serious health
hazards if not taken care of properly.
Federal law requires that individuals receive certain information
before renting. buying. or renovating pre-1978 housing:
._,,~
...~"'1
" f()8. \
ait(t J
1
]~'~
F:'~'\
\ e~J
~
LANDLORDS have to disclose known infor-
mation on lead-based paint and lead-based
paint hazards before leases take effect.
Leases must include a disclosure form
about lead-based paint.
SELLERS have to disclose known informa-
tion on lead-based paint and lead-based
paint hazards before selling a house. Sales
contracts must include a disclosure form
about lead-based paint. Buyers have up to
10 days to check for lead hazards.
RENOVATORS have to give you this
pamphlet before starting work. (After
June 1. 1999.)
IF YOU WANT MORE INFORMATION
on these requirements. call the
National Lead Information Clearinghouse
at '-800-424-LEAD.
This document is in the public domain. It may be reproduced by an individual or
organization without permission. Infamation provided in this booklet is based
upon current scientifIC and technical understanding of the issues presented and
is refiective of the jurisdictional boundaries established by the statutes governing
the co-authorilg agencies. fOllowing the advice given will not necessarily pro-
vide complete protection in all situations or against all health hazards that can
be caused by lead exposure.
'"
'-"
....J
IMPORTANT!
"
Lead From Paint, Dust, and
Soil Can Be Dangerous If Not
Managed Properly
FACT: Lead exposure can harm young
children and babies even before they
are born.
FACT: Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead-based
paint that is in good condition is not a
hazard.
FACT: Removing lead-based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
1
'-'
"'-"
Lead Gets in the Body in Many Ways
In the
United
States,
about
900,000
children ages
1 to 5 have a
blood-lead
level above
the level of
concern.
Even children
who appear
healthy can
have danger-
ous levels of
lead in their
bodies.
People can get lead in their body if they: ..
. Put their hands or other objects
covered with lead dust in their mouths.
. Eat pilint chips or soil that contains
lead.
. Breathe in lead dust (especially during
renovations that disturb painted
surfaces).
Lead is even more dangerous to children
than adults because:
. Babies and young children often put
their hands and other objects in their
mouths. These objects can have lead
dust on them.
. Children's growing bodies absorb more
lead.
. Children's brains and nervous systems
are more sensitive to the damaging
effects of lead.
2
""'"
lead's Effects
If not detected early. children with high
levels of lead in their bodies can suffer
from:
. Damage to the brain and
nervous system
. Behavior and learning
problems (such as hyperactivity)
. Slowed growth
. Hearing problems
. Headaches
lead is also harmful to adults. Adults
can suffer from:
. Difficulties during pregnancy
. Other reproductive problems (in both
men and women)
. High blood pressure
. Digestive problems
. Nerve disorders
. Memory and concentration problems
. Muscle and joint pain
....,
"
Aip,QdUOlill6
P""'IeIII.
(Multo)
Lead affects
the body in
many ways.
3
~
.....,;
Where Lead-Based Paint Is Found
In general,
the older your
home, the
more likely it
has lead-
based paint.
Many homes built before 1978 have lead- '"
based paint. The federal government
banned lead-based paint from housing in
1978. Some states stopped its use even
earlier. Lead can be found:
. In homes in the city. country. or suburbs.
. In apartments. single-family homes. and
both private and public housing.
. Inside and outside of the house.
. In soil around a home. (Soil can pick up
lead from exterior paint or other sources
such as past use of leaded gas in cars.)
Checking Your Family for Lead
Get your
children and
home tested
if you think
your home
has high lev-
els of lead.
4
To reduce your child's exposure to lead,
get your child checked, have your home
tested (especially if your home has paint
in poor condition and was built before
1978), and fix any hazards you may have.
Children's blood lead levels tend to increase
rapidly from 6 to 12 months of age. and
tend to peak at 18 to 24 months of age.
Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usually recommended for:
. Children at ages 1 and 2.
. Children or other family members who
have been exposed to high levels of lead.
. Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
""'"
....,J
Where lead Is likely To Be a Hazard
Lead-based paint that is in good condition
is usually not a hazard.
Peeling, chipping, chalking, or cracking
lead-based paint is a hazard and needs
immediate attention.
Lead-based paint may also be a hazard
when found on surfaces that children can
chew or that get a lot of wear -and-tear.
These areas include:
. Windows and window sills.
. Doors and door frames.
. Stairs, railings, and banisters.
. Porches and fences.
Lead dust can form when lead-based paint
is dry scraped, dry sanded, or heated. Dust
also forms when painted surfaces
bump or rub together. Lead chips and
dust can get on surfaces and objects
that people touch. Settled lead dust
can re-enter the air when people vac-
uum, sweep, or walk through it.
Lead in soilc an be a hazard when
children play in bare soil or when
people bring soil into the house on
their shoes. Call your state agency
(see page 11) to find out about test-
ing soil for lead.
J
Lead from
paint chips,
which you
can see, and
lead dust,
which you
can't always
see, can both
be serious
hazards.
DDD
DDD
DDD
DD
5
"
'-"
""""
Checking Your Home for Lead Hazards
just knowing
that a home
has lead-
based paint
may not tell
you if there
is a hazard.
6
You can get your home checked for lead haz- '"
ards in one of two ways, or both:
. A paint inspection tells you the lead
content of every different type of painted
surface in your home. It won't tell you
whether the paint is a hazard or how you
should deal with it.
. A risk assessment tells you if there are
any sources of serious lead exposure
(such as peeling paint and lead dust). It
also tells you what actions to take to
address these hazards.
Have qualified professionals do the work.
There are standards in place for certifying
lead-based paint professionals to ensure the
work is done safely, reliably, and effectively.
Contact your state lead poisoning prevention
program for more information. Call 1-800-
424-LEAD for a list of contacts in your area.
Trained professionals use a range of methods
when checking your home, including:
. Visual inspection of paint condition and
location.
. A portable x-ray fluorescence (XRF)
machine.
. Lab tests of paint samples.
. Surface dust tests.
Home test kits for lead are available, but
studies suggest that they are not always
accurate. Consumers should not rely on
these tests before doing renovations or to
assure safety.
'-'
...",
What You Can Do Now To Protect
Your Family
If you suspect that your house has lead
hazards, you can take some immediate
steps to reduce your family's risk:
+ If you rent. notify your landlord of
peeling or chipping paint.
+ Clean up paint chips immediately.
. Clean floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMONIA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
. Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
. Wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
. Keep play areas clean.W ash bottles.
pacifiers. toys, and stuffed animals
regularly.
. Keep children from chewing window
sills or other painted surfaces.
. Clean or remove shoes before
entering your home to avoid
tracking in lead from soil.
. Make sure children eat
nutritious, low-fat meals high
in iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
"
. t
,. .
~ ,: .......~'~..'j.~
7
........
'-'
How To Significantly Reduce Lead Hazards
Removing
lead
imp~operly
can Increase
the hazard to
your family
by spreading
even more
lead dust
around the
house.
Always use a
professional who
is trained to
remove lead
hazards safely.
,,6~\
.....,-,.'..'......~.:\.P...1..
. '\"- .j;}' -.::,
; . j
~'. . , /
-~--<<.- ":"., .:~
!~ ._,.:.~~
8
In addition to day-to-day cleaning and good -.
nutrition:
. You can temporarily reduce lead hazards
by taking actions such as repairing dam-
aged painted surfaces and planting grass
to cover soil with high lead levels. These
actions (called "interim controls") are not
permanent solutions and will need ongo-
ing attention.
. To permanently remove lead hazards,
you must hire a certified lead "abate-
ment" contractor. Abatement (or perma-
nent hazard elimination) methods
include removing, sealing, or enclosing
lead-based paint with special materials.
Just painting over the hazard with regular
paint is not enough.
Always hire a person with special training
for correcting lead problems-someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly. Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Call your state agency (see page 11) for
help with locating certified contractors in
your area and to see if financial assistance
is available.
"'"
'-'
Remodeling or Renovating a Home With
lead-Based Paint
Take precautions before your contractor or
you begin remodeling or renovations that
disturb painted surfaces (such as scraping
off paint or tearing out walls): .
. Have the area tested for lead-based
paint.
. Do not use a belt-sander, propane
torch, heat gun, dry scraper, or dry
sandpaper to remove lead-based
paint. These actions create large
amounts of lead dust and fumes. Lead
dust can remain in your home long
after the work is done.
. Temporarily move your family (espe-
cially children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area.
. Follow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
'-800-424-LEAD. Ask for the brochure
"Reducing Lead Hazards When
Remodeling Your Home." This brochure
explains what to do before.' during,
and after renovations.
If you have already completed renova-
tions or remodeling that could have
released lead-based paint or dust. get
your young children tested and follow
the steps outlined on page 7 of this
brochure.
...
If not
conducted
properly,
certain types
of renova-
tions can
release lead
from paint
and dust into
the air.
9
'-'
""""
Other Sources of Lead
F=4
k2~
1 q '., I
1.\ :j I J
\~'\.rj.!.!
.. I;
'i,
While paint, dust,
and soil are the
most common
lead hazards,
other lead
sources also exist.
10
. Drinking water. Your home might have
plumbing with lead or lead solder. Call
your local health department or water
supplier to find out about testing your
water. You cannot see, smell, or taste
lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
. Use only cold water for drinking and
cooking.
. Run water for 15 to 30 seconds
before drinking it, especially if you
have not used your water for a few
hours.
. The job. If you work with lead, you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
. Old painted toys and furniture.
. Food and liquids stored in lead crystal
or lead-glazed pottery or porcelain.
. Lead smelters or other industries that
release lead into the air.
. Hobbies that use lead. such as making
pottery or stained glass, or refinishing
furniture.
. Folk remedies that contain lead. such as
"greta" and "azarcon" used to treat an
upset stomach.
'"
~
.....,
For More Information
"
The National lead Information Center
Call1-800-424-lEAD to learn how to protect
children from lead poisoning and for other
information on lead hazards. (Internet:
www.epa.govllead and www.hud.gov/lea).
For the hearing impaired, call the Federal
Information Relay Service at 1-800-877-
8339 and ask for the National Lead
Information Center at 1-800-424-LEAD.
EPA's Safe Drinking Water Hotline
Call 1-800-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission Hotline
To. request information on lead in
consumer products, or to report an
unsafe consumer product or a prod-
uct -related injury call 1-800-638-
2772. (Internet: www@cpsc.gov).
For the hearing impaired, call TDD 1-
800-638-8270.
-rill
.-.:1 --
1:.--.... ._~_. ""I-__'~
~Z41b~~~"" " ..' .
State Health and Environmental Agencies
Some cities and states have their own rules for lead,based
paint activities. Check with your state agency to see if state
or local laws apply to you. Most state agencies can also pro-
vide information on finding a lead abatement firm in your
area, and on possible sources of financial aid for reducing
lead hazards. Receive up-to-date address and phone infor-
mation for state and local contacts on the Internet at
www.epa.gov/lead or contact the National Lead Information
Center at 1-800-424-lEAD.
11
'-"
EPA Regional Offices
....,
Your Regional EPA Office can provide further information regard- ..
ing regulations and lead protection programs.
EP A Regional Offices
Region 1 (ConnecticuL Massachusetts,
Maine, New Hampshire, Rhode Island,
Vermont)
Regional Lead Contact
U.S. EPA Region 1
Su~e 1100 (Cpn
One Congress Street
Boston, MA 02114-2023
1 (888) 372-7341
Region 2 (New Jersey, New York.
Puerto Rico, Virgin Islands)
Regional Lead Contact
U.S. EPA Region 2
2890 Wxldbridge Avenue
8uilding 209, Mail Stop 225
Edison, NJ 08837-3679
(732) 321-6671
Region 3 (Delaware. Washington DC,
Marytand. Pennsylvania, Virginia. West
Virginia)
Regional Lead Contact
U.S. EPA Region 3 (3WC33)
1650 Arch Street
Philadelphia. PA 19103
(215) 814-5000
Region 4 (Alabama, Florida. Georgia.
Kentucky. Mississippi. North Carolina,
South Carolina. Tennessee)
Regional Lead Contact
U.S. EPA Region 4
61 Forsyth StreeL SW
Atlanta. GA 30303
(404) 562-8996
Region 5 (Illinois. Indiana. Michigan.
Minnesota, Ohio. Wisconsin)
Regional Lead Contact
U.S. EPA Region 5 (DT-8"
77 West Jackson Boulevard
Chicago, IL 60604-3666
(312) 886-6003
12
Region 6 (Arkansas. Louisiana. New
Mexico. Oklahoma. Texas)
Regional Lead Contact
U.S. EPA Region 6
1445 Ross Avenue. 12th Floor
Dallas. TX 75202-2733
(214) 665-7577
Region 7 (Iowa. Kansas. Missouri.
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
(ARTD-RAU)
901 N. 5th Street
Kansas C~. KS 66101
(913) 551-7020
Region 8 (Colorado. Montana. North
Dakota. South Dakota. Utah. Wyoming)
Regional Lead Contact
U.S. EPA Region 8
999 18th StreeL Suite 500
Denver. CO 80202-2466
(303) 312-6021
Region 9 (Arizona. California. Hawaii.
Nevada)
Regional Lead Contact
U.S. Region 9
75 Hawthorne Street
San Francisco. CA 94105
(415) 744-1124
Region 10 (Idaho, Oregon. Washington.
Alaska)
Regional Lead Contact
U.S. EPA Region 10
Toxies Section WCM-128
1200 Sixth Avenue
Seattle. WA 98101-1128
(206) 553-1985
'-"
'wi
CPSC Regional Offices
Your Regional CPSC Office can provide further information regard- ...
ing regulations and consumer product safety.
Eastern Regional Center
6 World Trade Center
Vesey Street, Room 350
New York, NY 10048
(212) 466-1612
w.stem Regional Center
600 Harrison Street, Room 245
San Francisco, CA 94107
(415) 744-2966
Central Regional Center
230 50uth Dearborn Street
Room 2944
Chicago, IL 60604-1601
(312) 353-8260
HUD lead Office
Please contact HUD's Office of Lead Hazard Control for informa-
tion on lead regulations, outreach efforts, and lead hazard control
and research grant programs.
u.s. Department of Housing and Urban Development
Office of Lead Hazard Control
451 Seventh Street, SW, P-3206
washington, DC 20410
(202) 755-1785
13
'-'
~
Sample Disclosure Format for Target Housing Sales
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
.Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978
is notified that such property may present exposure to lead from lead-based paint that may place young children
at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological
damage, including leaming disabilities, reduced intelligence quotient, behavioral problems, and impaired memory.
Lead poisoning also poses a particular risk to pregnant WOmen. The seller of any interest in residential real property
is required to provide the buyer with any information on lead-based paint hazards fif3m risk assessments or
inspections in the sellers possession and notify the buyer of any known lead-based paint hazards. A risk
assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.
Seller's Disclosure (initial)
_ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below):
o Known lead-based paint and/or'lead-based paint hazards are present in the housing (explain).
o
Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b)
o
Records and reports available to the seller (check one below):
Seller has provided the punbaser with all available records ancteports pertaining to lead-based paint
andlor lead-based paint hazards in the hoeing Oist documents below).
o
Seller has no reports or re:ords pertaining to lead~based painland/or lead-based paint hazards in the
housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
_ (d) Purchaser has received the pamphlelProtect Your Family from Lead in Your Home.
_ (e) Purchaser has (check one below):
o Received a 1O-day opportunity (or mutually agreed upon periOd) to conduct a risk assessmentro
inspection for the presence of lead-based paint and/or lead-based paint hazards; or
o Waived the opportunity to conduct a ri$k assessment or inspectiofur the presence of lead-based paint
andlor lead-based paint hazards.
Agenfs Acknowledgment (initial)
_ (f) Agent has informed the seller of the seller's obligations under 42 I$.C. 4852(d) and is aware of hislher
responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge. thateh
information praJided by the signatory is true and accurate.
Seller
Date
Seller
Date
gent
Date
Agent
Date
Purchaser
Date
Purchaser
Date
, ,-
....~~,'?J"z;~ ~
'-' -.J
Sample Disclosure Format for Target Housing Sales
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards
.Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978
is notified that such property may present exposure to lead from lead-based paint that may place young children
at risk of developing lead poisoning. Lead poisoning in young children may produce pennanent neurological
damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory.
Lead poisoning also poses a particular risk to pregnant WOmen. The seller of any interest in residential real property
is required to provide the buyer with any infonnation on lead-based paint hazards trom risk assessments or
inspections in the sellers possession and notify the buyer of any known lead-based paint hazards. A risk
assessment or inspection for possible lead-based paint hazards is recommended priOr to purchase.
Seller's Disclosure (initial)
_ (a) Presence of lead-based paint afld/or lead-based paint hazards (check one below):
o Known lead-based paint and/or'lead-based paint hazards are present in the housing (explain).
o
Seller has no knowledge oHead-based paint andlor lead-based paint hazards in the housing.
Records and reports available to the seller (check one below):
Seller has provided the punbaser with all available records and"eports pertaining to lead-based paint
andlor lead-based paint hazards in the hoeing (list documents below).
(b)
o
I
t
o
Seller has no reports or re;ords pertaining to leacHJased painlandlor lead-based paint hazards in the
housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
_ (d) Purchaser has received the pamphlelProtect Your Family from Lead in Your Home.
_ (e) Purchaser has (check one below):
o Received a 1O-day opportunity (or mutually agreed upon period) to conduct a risk assessmentro
inspection for the presence of lead-based paint andlor lead-based paint hazards; or
o Waived the opportunity to conduct a risk a~essOlent or inspectiofur the presence of Iead-based paint
andlor lead-based paint hazards.
Agent's Acknowledgment (initial)
_ (f) Agent has informed the seller of the seIler's obligations under 421S.C. 4852(d) and is aware of hislher
responsibility to ensure compliance.
Certification of Accuracy
The followng parties have reviewed the information above and certify. to the best of their knowledge. thatElh
information prOJided by the signatory is true and accurate.
Seller
Date
Seller
Date
gent
Date
Agent
Date
Purchaser
Date
Purchaser
Date
A.n~frttI0T 2-
Federal Register/Vol. ~o. 178/Wednesday. September IS. 19"-"Rules and Regulations 50231
.
Appendix B-Sample Summary Risk
Assessment Notice Format
Note: This following appendix will not
appear In the Code of Federal Regulations
Summary Notice of Lead-Based Paint Risk
Assessment
Addressllocation of property or structure(s)
this summary notice applies to:
Lead-based paint risk assessment desaiption:
Date(s) of risk assessment
Summary of risk assessment results (check
all that apply):
(0) _ No lead-based paint hazards were
found.
(b) _ Lead-based paint hazards were
found.
(cl _ A brief swnmatY of the findings of
the risk assessment Is provided below
(required If any lead-based paint hazards
were found!.
Summary of types and locations of lead- .
... based paint hazatds. Us! at least the housing
., unit numbers and common aieas (for
multifamily housing). bare soU locations.
dust-lead locations. and/or building
components (including type of room or
space. and the material underneath the
paintl. and types of lead-based paint hazards
found:
Contact person for more information about
the risk assessment
Printed name:
Otganizatlon:
Street and city:
State: _ ZIP: _ Phone number. L-J
Person who prepared this summary notice:
Printed name:
e
Signature:
Date:
Organization:
Street and city:
State: _ ZIP; _ Phone number: L-J
Appendix C-Sample Summary
Presumption Notice Format
Note: The following appendix will not
appear In the Code of Fedend Regulations
Notice That Lead-Based Paint or Lead-Based
Paint Hazards Are Presumed to be Present
Addressllocatlon of property or structure(s)
this notice of presumption applies to:
Type of presumption (check all that apply):
(0) _ Lead-based paint is presumed to be
present. .
(bl _ Lead-based paint hazan:I(s) is(are)
presumed to be presenL
Summary of presumption. Us! at least the
housing unit numbers and common areas (for
multifamily housing). bare soU locations.
dust-lead locations. and/or building
components (Including type of room or
space. and the material underneath the
paint). and types of lead-based paint hazards
presumed to be present:
Contact person for more information about
the presumption:
Printed name:
Organization:
Street and city:
State: _ ZIP: _ Phone number. L-J
Person who prepared this notice of
presumption:
Printed name:
Signature:
Date:
"Organtzati?n:
A1TAC~e>0l 3,
Street and dty:
State: _ ZIP: _ Phone number: L-J
Appendix D-Sample Hazard
Reduction Completion Notice Fonnat
Note: The following appendix will not
appear in che Code of Federal Regulations.
Swnmary Notice of Completion of Lead-
Based Paint Hazard Reduction Activity
Addressllocatiofr13f property or structure(s)
this summary notice applies to:
Summary of the hazard reduction activity:
Start and completion date{s):
Activity locations and types. List at least the
housing unit numbers and common areas (for
multifamily housing). bare soil locations.
dust-lead locations. and/or buUdlng
components (indu<ii;ng type of room or
space. and the material Wldemeath the
paint). and types ofhazatdreductlon
activities perfonned at the locations listed:
Date(s) of clearance testing and/or soli
analyses: _
LocatIons of building components with lead-
based paint remaInIng In the rooms. spaces
or areas where ai:tlvitles were conducted:
Summary of results of clearance testing and
soli analyses:
(al _ No clearance testing was
performed.
(b) _ Clearance testing showed
clearance was achieved
(e) _ Clearance testing showed clearance
was not achieved.
Contact. person for more Infonnation about
the hazard reduction:
Printed name:
Organization:
Street and city:
State:_ZIP:
Phone number: ~
Person who prepared this swnmary notice:
Printed name:
Signature:
Date:
Organization:
Street and city:
Stall!: ZIP:
Phone number: ~
IFR Doc. 99-23016 FUed 9-14-99: 8:45 amI
BIUJNG COOE 421D-32-P
,r
;,-,
t'"
.......",
ATTACHMENT NO.4
LBP INFORMATION SUMMARY
1. ZERO/O BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
. STATUS: EXEMPT TITLE X
2. ZERO/O BEDROOM> (MORE THAN) 100 DAYS IN UNIT
. STATUS: OPEN ISSUE UNDER LBP REGS
ZERO/O BEDROOM> (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
. STATUS: OPEN ISSUE UNDER LBP REGS
. SEE SUBPART K
. CLEARANCE OF UNIT(S) WILL BE REQUIRED BY CITY FOR ALL HOUSING
UNITS (EVEN ZERO BEDROCM) FOR WHICH OCCUPANCY OCCURS BY
ASSISTED HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
. EXEMPT TITLE X
4. 1+ BEDROOMS> 100 DAYS IN RESIDENTIAL UNIT
. STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED
. SEE SUBPART K
5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS
. EXEMPT TITLE X
6. EMERGENCY RENTAL ASSISTANCE> TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
Attacbment No.4
LBP Information Summary
Page 1 of2
7/lllOILS
'-'
"""
· CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
· MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
· SEE SUBPARTS K AND M
· PENDING HUD GUIDANCE
7. TBRA < 100 DAYS
. EXEMPT TITLE X
8. TBRA> 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
. SEE SUBPART M
. CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
. HQS INSPECTION REQUIRED BEFORE OCCUPANCY
. CLEARANCE BEFORE ANY MONEY DISBURSED
9. TBRA < 100 DAYS - TENANT ENTERS INTO LONG TERM LEASE, CITY
GIVES LESS THAN 100 DAYS OF ASSISTANCE.
. EXEMPT TITLE X
[See HUD Interpretative Guidance: Online: Questions M4, K7, K4, for discussion]
Attachment No.4
LBP Information Summary
Page 2 of2
7/II10 I LS
11l
:!2
0
.s::.
Q)
11l
:l
0
J:
't:l
C
III
It) 11l
ci ~
z C
::::l
-
C Cl
Q) c
E Gi
.s::.
u :=
III Q
-
- Cl
<( c
:i
u
f!
I-
...
.E
E
...
0
u.
......
.....I
FRoM ?REBUILDING TOGETHER
FAX NO. :667 8174 ~Dec. 23 2002 09:49AM P2
:--ACORD- -",~''''''..''t~'<~~'~' ".""'"-,...~.~.- .. ',~,_....,...-,.. -. "U~~" .... -. .,.. .... -,.....~. .
"'~I; U~ fiiJlJ.' ll.I~ N.$ ".. - ',' "...,....... ~ '
. . !'\" R"'" . L ' . ~I 'BI ". ..11 :. ':':';J'}l,hJ".""~'. '::'<:~-"'''' :JT:(Mt.VClDIY'tJ;1
( . ,~.I:. ..j II .. ,. J.. ..., , . J:'1l;. '" ", -, ,
~..,.. ..,...._.._.. _ ....... . ..ol:,~~ _._.," ,.. ...I- I..{ .. .' ~ """ . ._ . ........... 1~...,Jj ':1"Of\Iil'_ ;:)4t03102 ~
PIiQCU1211 THIS Clllmfi1CATe III ISGUEa AS A /AATlaR elF INFORM..T10N
ADn Aio!< services ,l~. Of Washlr.g\on, D,CJ Homi ON~Y ANe CON~r:l'la..O RlQHT~ UPON niE CERTlFICATlt
1'~2Ott\Str...tNW HOl.llfiR. THU; CERTIFIcATE DOES NOT AMEND. EXTEND OF!
W..hl"~ DC 2003. .oI.TER'rW1i COVli!'lAGE /U' I'm "t TN PO ICII!a BELOW.
OMPANIES ..FFOROING CCl'lEMGE
'-"
PHONE .(1.l551l5'l-41;7
INSURED
"Rebuilding Togetherwitil
"Oh.'i.s.'ma& in Aprfj..and ft'g Afftl!.Mt.&
1SO<01!llll St:...1 NVI
W;;.shifigt~n. DC 20016 USA
FAX. (llo$j 407.7M7
<X)Np""y
P.
Columbia CasuallY
eo,..~A..~
Ii
CC"'~-'N\"
C
eO\olPAAOY
o
"_.eo~." :t~~~~~,.,....? "-~.~ - ~'*~~:~..~~
'IM"S ~O cEl'lTL"YTMATT~5 FOUCliS' oF INSIJIlA.'JCE ~lST~ saOl', ~VE !lI;EN 1S3UeO TO THE INSUI1ED i-IAil.o fi.'i5itE FoR T~. !'Ol!CY Pii!'lOO
INDiCA'TEo,.NOr.'/IThSTANDlNG AAY RE;~Ill..\4e..T, TE;l'N OR cc~'tm'al OF pm CON~IlACT CR 01HEi'\ =....~NT V.1TH _Fecr TO WHl~~ ,;;;$
CEI'liFlCAr. MM 5. lW.IED OR MAY FER'A~. 'IiiE IN......ANCE fJ'f'CROEO BY Tn;! POLIOE;S .~OCl'ilBr;o li=Ra~: is stlSJECT m A:.L THe rrJ'.M~'S
exCl.USIcNSWS. CQNOr1':ONS OF sue:.;: PCUCB : fJ,.,r,-S St-D'1l\'1II VlY HP>.'W Dew REDUCCD SY PA10C1Al1$. --
a> -..,~._.-.... i'Of,JCn:mr;:\"t 1OCl(;l'CP..IA.'U~ U\l.rt5
~R TI.T! 01 N~\2'Ict ........\"I ~n..... D.4.U: ~""'V) DA~ ~IWT)
~..
flD1lE........,~.G~iJI18r,ral
Mia' E<f' :NlvQl"\C ~~r:1
,
S1,OM.ceo I
$1.000,coo
$1.000.000
~'.OOO.OOO
$$0.\100
so.ec>\)
"
~w.DlUTY
~.. ~:~GOl~u,tl;:Lri"Y
~'x cu..:lI.S~:: Doc::u"
ow:.:t~'~~CONTi\~l'~.~"$ PROT
H
PCL,~7C3
~.ERC"'L QiNlAA.llI<ilJUT'(
O~(16!02
O:\l1!li03
GENEiYIL~~
"MQ",UC'rS.CCNP~PAOG
P:if'\.scNJ.L. S. ADV "-";"'UR.~
~H' L:C:CYj'l:M..'\I~S
~~o,u~::..m ,
i PON;:"1O
j .Al!..GWN"..J).1.()TOS
J JO'''OO_''''',JTOS
tiiliE\J Al,m)&
- "'O~ECAl.;-:'j~
-
-
Q)Ma'N!:' 51r;~.';; I..lMTi"
GARACi'!; UAa:UT'[
-
_ ~Y.li.riv
-
I
I
I
BOOIlYN.ll,l~(
1l'"9.'"'~m~
i BOO:\' y irt,J....t!?(
!!~"~Qr,l)
j
-i
"~~'~~of~~~~j
, '_m-' ,__ j
r;lC!':~LI.ur:...m
-=,-~SI'Ii"..I.AR:lRM
I OTH,gA.1'i1Atl UI.t~ELl.A FOS=,/,l
;;>~o,eriRn' D.w.AG!
---
...U'TOOl\,-y.E.\~lr'
OTHg,::;THA."I AUTaONl..Y:
~J.I:/;l~
....GGReGAn
9.CH OO""...AJRRS~~'
t,GGJ;a;.l.7ii
,
I
...-1
i
I
I WO;TAl\;' I I "T<" '''''''.' "w"'!!"'roW<"~,'
tTro=::v!'""rr!;1 I i=i=I ~"f:~'r:~'.""ll~l
s.~oj~DtNT ,
---I
-'"i
i
Of3C1<ll'1""'QFOl'f"-"noN""'O"'1ltlj~""'C'''''-$ --~
C!';"'t OF SANTA AM; CI1Y OF ORAN".: 0""" OF FULLEKTON; CJ'T'Y 0" LAGUA.... WOODS; SANTA ;<N'" FE"EIV.L EMPO\"EClMENTZO~~; II
COUNTY OF ORANGE M'~ INCWOED AS ADDI710N)J.IN5URe~. '
cERuEl~AT!:'~HOl.DER!.~~-;'4:fE.1]'~.A'!':...~~~~~~~t:~~P.&KCANCEL~11Ofr~~t:r.~{':)t&T.~~'~~~~t~)'~':l~~};.~r4.:,t'f:~~t'~U~.;tTI
. !J.k)IJL.D A.'ff CF THIi 1I$OvE" CI!;:~i!.EO PO..~$ B1;: CA.."iCfIJ.ED Bc~Tt..$ l
I
~IFA"-:CN !),Il,TE rrl~REOF. 1'1-110: ISJ;UI"IG c;.-oMF,u,y WIU, e"'~f~~-oR"~ MA:l. I
1
9- O.wQ 'I,I';:lI1"'\"l?l ~ .0 'tHli: C'.;:j;i:,:?IC.tt,':!: ~:.DEr!. ~~ TO 1;"!t:, ~e-r.'. J
!)lrr...,2."I...... ..... "'[' C>,.-."'';?".,.-.......... ......-..:to:: ....... ....., ~.~....,....o "~"',~I I
,_ _, .... ... - I
ALli,.CRlZSD K;PrtESENT,A'fl"t'i ---::-~ ~ --<II
~~ ~..~--
A~RD2s-S(;m~~\t~;~:~-;.=}~~:'rZ-~l.i!..r'j;~tI~k?~'J!1?~~~~;::-:~~~C:~:#~'=';~~.~;:~:h-'f.i~'~:'i\~I~?~'::i':7t.:)' ~;:;..t;.n6!AconDC6~AAtid.t."1~
C2ft!fica~~ !'lo; 570002407475 Hc.:rJO" Iden~11,u:
'wORKa:\S -::or~"'SAj1CS Al'lD
e.!PLOYF.~;r 1.IAeI:JrV
'l"HliP~~\t!7Or..r R"""
P^,~'~};;S::;I.i'TWE
or::;IC~.s ,!l.>:l:ti EXO.
APPROVED S TO FO M
~,o./atA
Ilimd...Sh'eedy 7
")
r,J",Ddr:.",S!:-I'JOUC!fl.IMI"
Q,O~~-G4~'~
R~SUIL.D,NG TOGEn4ECi ORANGE COUNTY
ATIN; Ll.!KEM"'N C'-Al'I.K
P.O. BOX 510SS
:FWI!IlG CA S261~.10Sa USA
FROM :'l<EBUILDING TOGET
JUt"I'-"'~ 1011"'."'" HER
FAX NO. :667 8174
.....roec. 23 2002 09' 50A
Attachment to ACORD Certl~ for R.bU~di"gTogo1l18r"'Uh '-.,,_ ' M P3
11= r=ntJ:I. eoodlticn>;md p"'yi;.io1l$"aolOd bolo....... !:l<:td>Y par;!\04 Ill"'e copUouoG Q:rti/'IC~ IS od<l\cio...t do$aifdod of me covaaf<
tffgrdc4 b~ Ihe ;...uret(s). '!'his atllIclt=ciltdO<:S DOt cc=ln olI tmo>. =4idons. ~ (lr""ci\l$ion. "".!alae<! in lbe policy-
'-'
(;OIl....
.....IIP
ROb"!d~iogO_w1l1l
C~Im" in April'ond i\'5 Millale.
~536 ~6\Il Eltree\ ~
. W...nn!lP'. OC 3lO16 U6~
r;O>l'Nt't '.
00""-
~
..
CQI.""""
thpoOeYbolow cloo,,,,,r ",e~ lilllitlnfanaaliou, ........lOtbe<;llrnspo.diDS poliCyO. tlIe ACORD
""dilie:.te form mr poli<:y IitDits.
,"" - !- - .. _.;: . - KuC'Vl.1..:.nEi. ,. ,f<J,lC'< .J'OI.1C'/ - -- - ---. ---. -' -
~I nn ort:-iJt:It....~(jJ. ".1ICI1"f ~gu.m!( ....".,.
I'O<.tCI'oi<Soumlll! .... ...n\
,
GEN.i\All.JAE!lCl1'Y
A ---"'M 00.15102 c3/l~'03 ~r.t-"'<l1 S1,ooo,000
eoMi._cw. ar<NBAl.
"i*& $1,000,000
Nl:[').OWl"tIQ,cw
I
AOOmONAL POLlCll!S
ca;t;RlptlOtll.CflO~llON':i'-<<:A'TlQ:>l~~l~
certif",at. Ne:
6?OO~'0747'6
FROM ~BUILDING TOGETHER
II\UII . r .'It\~~.Jrll~ 'I;
'-'
FAX NO. :667 8174
~ec. 23 2002 09:50AM P4
..-
,
\
,;0"'.'
\.
EXHIBITB
ADDITIONAL INStJRED Er..roORSEMENT
FOR COMMER.CIAL GBNBR.AL LIABILITY POLICY
.
.. InsuranceCompany C.O\l)vy\~'\CI. ~~~\}~lJtj--
T~dorsemenl modifies such insurance as is afforded by the:; pl~,visjons of Polic)'
#- 21.JtJt <I,P,j relating to Ihdollowing:
1. The City of Santa Ana, 20 Civi~ Center Plaza, Sa'll.l Ana, California 92701; its
officers, employees, agents, volWlteers and rcpltlSlmlanves are nlUnEld lIS additiolUll insun!ds
("additional illsll:edsOl) with regard to liability and defense of nits arising from the operations
and uses performed by or on behalf of the named il1S\lted.
2. With respect to claims arising out of the operations ;md uses pe.rrOll1led by or an
behalf of the named insured, such insurance as is afforded by this policy is primary a.!ld is not
additioIIR.! to or conttibutinz with any other ills~allce carried by Or for the benefit oflhe
adCltional insureds.
3, This i.nsnrance applies separatcly to each insured ag,linst whom claim is made or
suit is brot:.$hl except with respect to the company's limits of linbili ty. The inclusion of any
p=on Or orgllli2atlon as 2n insured shall not affect any risht which such pc:zson or org:m.ization
'.:ould have as a claimant if not so included.
4, With respect to the additional ilWUl'eds, this insurallce shall not be cancelled, or
llIaterially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Complelion of the followillg. including countersignature:, is ~equjrc-d t!J mnke thj~ endorsemem
cfiecuvc.)
Effccti ve
Policy #
Iss<led to
. this endorsement fOlm as a part of
o,ll
N'
.....~.___.._J..
cd
_~CL
Countersi
y
Authorized Represeotati;re
APPROVED AS TO FORM
)11 J
. 7-X/~ " /i :J {I
l!au'6 Sheedy l
'-",j.y City Attorney
to
FROM :'.1<EEU I LD I NG TOGETHER
I . "'-"'-'-.
~CORD
I Pf>OOIJeeR Noack & Dean IlnteTWesl
401 Watt Avenue
Sacramento, CA 95864
Employers Resource
160 Chesterfield Drive
Cardiff by tho Sea, CA 92007
...,. 23 2002 09: SiAM PS
CERTIFICATE OF LIABILITY INSURANCE ~~~ DAT~~:>2DiYY)
... _._. 11' IS CERTiFicATE IS IssueD AS A MATrER elf INFORMA:T10N
ON~ Y AND CONFERS NO RIGHTs UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED I3Y THE POLICIES BELOW.
f~~ja~Y . Sla;::::;::a;;;~::r::;V::;f--' . -:-1
Company ---i
-~- -I
~:, ------.. -=- .-- --- --~~1
'.......
FAX NO. :667 8174
J
r INSURFD
COVERAGES
THIS IS TO CIiRTlFY THAT THf pOLlcms OF INSUR.-\NC"F./JSTED aaow JIA.VE BEF.N ISSUED 1'0 THE rN..WR.'ED NAMED AnOVE; FOR 'J"H!i POLICY PEJUOD I
INIJJCA'l'nt>, NOrWrniST^ND[NG ANY RcQlllP.EME...~1"5, i'ER...\.f OR CONDITION Of !\NY CONTRACr OR OTHER DOC:OMcNT \\11TH RFSPJ..:CT TO WHICH nns .
CERTIFICATE MAYBE JSSUEJ) OR M ^ Y PERTAlN. TI-tE WSURAN(:i-; AFFORDED BY THF. P<)I,.rcIES DESCJUzu:[) HEREIN IS SllllJ r::cr TO ALL TKE TERMS,
~' '1 :-XCWSIONS AND COND!! LUNS (}f' SUCH POuC"H::$, LIM:JTS Sl.K)\V'N MA Y R~ VE 8.!:.J:!N _RfiQUC'ED BY PAID CLAIMS _ ___ -.J
CO ' , I POL.ICY EFFECTIVf I POLICY EXPIRATION I j
LT I TYP~OFINSURAlolCri I POUCYNtJM8=ft ' DATE (MMJODiY'Y) rOA...(.....,DlVYI U"T\. _ ....
l.!:Nl!RAL. UABJUTV : - I. ~ i GENERAl AGGREGATE _ _ ~_
IICOUUERCIALGENE~lABILITY i ! 1_~ou.?r3.cOMf'IOPA~G s ~
r .J ClAIMS W,CE ! J OCCu~" I . PERSONAl & ~.~v ":JURY S
nH OWNER'S &CONmACTOR'S PROT [. I ~CURANC' , _ ..... .'
Ii; -.- ~_ I . FrRE:.~MAGe(Anyonefire~ S
rL-8, AtITOMoel~I!UABIU~- .! --- "FOexP(~"",p'''''''J j... I
1 i COMDfNEO SJNCLE LlMIT $ I
! r I ANY~VTO I
I I J AlL AUTO I -.;OIlYl';:;;;;'~." I
' ~. SCHECULEOAllTOS I I (per"Cf"AIO) $ -'
I j HIRED AUTOS 8OO11Y INJURY , -..----1
: 1 NON-oW~eOAUTOS I (r"er aecideni)
, I i _ .....________1
-r.L=~_n- j ~. c::::;__ j;: . ~
; JA'lYAllTO U",) AS fa ! ORM IO'H"RTHANALITOONlY .1....
A 1ff~~ 1- ::~+-. -~-.-~.~--.1
C EXICu::::~: I /":I;;yS~i~. YA torney I [:~::~:^"ce --- ~___ "_;
j OTHERTHANUM8RE1...LAFORM I _1--____.. . I
i ~ORKiR6 .COMPENSATION AN~'--- --- no I ;'""1 we STATU-rroTIZi-
; EMPLOYERS' L1ABllITY 1:- ,T.:Oi:IV I JUITC:: LJ ~ER. I
1604493-02 11/11/2002 I 11I11/20Q3 I HeACHACClDeNT $1,000,000 _---.J
~l OIStASE - POLlCV LIMIT $1,000.000
_J~ I "'"^'":~' ,,==
A
I THE PROPRIETQRf n INCl
PAJrrNB'.SIEXECu fiVE ' _'
1 OFFICERS A~: TI EXCL
rTHE~" - ---
-1--.. _"_ .... ._.__. _,____..
DESCRIPTION Of' OPl!:RATIO~SNEHICLESrSrp:;(:JA.I_ ITEMS
i
I
i
__-1__
CUENT: ReBUILDING TOGETHER ORANGE COUNTY LicclI,e No.: N/A
O~LY EMPJ.OYEES OF r.M)lILOYER..~ RF;.SOVR('E AS I.O~G AS THEY ARF. PEltfOK.."1.I;'-iG WORK WlTliJ/\ '["HE NA TI;RF: AND SCOPE OJ.' THEIR
CMPLOYMENT ARE INSt:RW IT'WER "VIDE'iCE 01' COVERAGE PROVIIlEO.
:ERTIFICATE HOLDER
EVIDENCE OF INSURANCF:
FOl+ \!e..ifi~a.ti6n of <covc.-at;c
can (888) 559-2350
CANCELLATION
*10 d.)'I ror 1l.0U-pll)'lD!!nl Dfp.....mlU""
'il SHOULD AtN OF THE ABOVE. DE::;;CRICI2D PCUCIES BE CANCELLeD BliiiO~E: THE
EXPIRATION OA't'!: THEREOF. THE ISSUING COMPANY W1U, ENDEAVOR TO MAIL
I SO' DAYS WRmeN NOTICE '1'0 THE CERTIFICATE HOLOER NAME '1'0 THE
J LEFT,BUT FAllU~E TO MAIL SUCH NOTICE Sl1ALL IMPOSE NO 08UGATlON OR
LIARlllTV OF ANY KIND UPOO THE COMPANY. ITS AGENTS OR REPRESENTATNliS.
AUTHOAlZao REPRESENTATIVE:
\Villiam O'Keefe
~~
CORD 25-S (liSS)
A('.o1=:'1) ~FaORATION 1088