HomeMy WebLinkAboutSANTA ANA BOXING CLUB 1 - 2002
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CLERK OF COUNC'lGREEMENT BETWEEN THE CITY OF SANTA ANA AND
DAT';./ \t{/ 01.- ORANGE COUNTY YOUTH COMMISSION FOR USE OF
v COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
'v\J~ (lJ This Agreement, made and entered into this l s-!:b-- day of PrR (<.. \ L , -ZC;O L
c:> ~ by and between the City of Santa Ana, a charter city and municipal corporation of the State of
(, \. California ("CITY") and ORANGE COUNTY YOUTH COMMISSION, a California nonprofit
OX corporation ("SUBRECIPIENT"),
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"" Ii: ;iii 5Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG")
~ ~ ~ J ::Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG
~ ~ ~ ~ds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq.
en l3 !2: ~DBG REGS")' and
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(3 A. The CITY, as an entitlement recipient and grantee of the United States Department of
B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the
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. 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:
I. SUBRECIPIENT'S OBLIGATIONS
A. Non-Profit Status - Representations and Warranties.
(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.
SUBRECIPIENT 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.
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(b) Experience. SUB RECIPIENT 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.
(d) No Conflict. To the best of SUBRECIPIENT'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.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened
bankruptcy proceeding.
(I) 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. SUBRECIPIENT 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.
B. Amount of Grant and Ouarterlv Disbursement. The amount granted to
SUBRECIPIENT is $ 8,500 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT within a time period not exceeding twelve (12) consecutive months following
the date of this Agreement. The CDBG FUNDS shall be disbursed by CITY to
SUBRECIPIENT on a quarterly basis (October, January, April and July) 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 15 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 indemnification, audits,
reporting, data retention/reporting, and accounting.
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 A,"
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
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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, 2003 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. SUBRECIPIENT 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-lIO 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-II 0 requirements.
H. Audit Report Reauirements. SUBRECIPIENT agrees that if SUBRECIPIENT
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.
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L Record Keeoing/Reporting. SUBRECIPIENT 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, 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 SUBRECIPIENT 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.
1. 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: SUBRECIPIENT agrees to keep 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, the number
of female heads of households assisted, new program information and year-to-
date program statistics on expenditures, caseload and activities..
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J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUB RECIPIENT'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 Keeping. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUBRECIPIENT 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 five (5) years after completion of an audit in conformity with the CDBG REGS., s.
Records which relate to (a) complaints, claims, administrative proceedings or litigation arising
out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which
CITY or any other governmental agency takes exception, shall be retained beyond the five (5)
years until complete resolution or disposition of such appeals, litigation claims, or exceptions. 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.
1. Compliance with Law/Program 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
SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUBRECIPIENT 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,
SUBRECIPIENT 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.
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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 or 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
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-1).
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,
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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
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 I.
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 ofreceiving 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,
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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 SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's 2002-2003 CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2002-2003 pursuant to this Agreement up to a maximum aggregate
payment of EIGHTY-FIVE HUNDRED Dollars ($ 8,500) 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 and provisions of this
Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this
Agreement.
B. 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.
III. 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 SUBRECIPIENT. 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 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.
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B. SUBRECIPIENT shall not discriminate against any person applying for the services
SUBRECIPIENT 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
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 SUB RECIPIENT.
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.
SUBRECIPIENT 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
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TO SUBRECIPIENT:
OC Youth Commission
Santa Ana Boxing Club
1850 E. 17th Street I SalCe.. ,u t
Santa Ana, CA 92705
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.
IX. HOLD HARMLESS
SUBRECIPIENT shall indenmify, defend 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 oflimitation, 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. If SUBRECIPIENT 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
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insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUBRECIPIENT's operations hereunder.
SUBRECIPIENT 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 of this Agreement.
XI. REVERSION OF ASSETS
A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use ofCDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property under SUBRECIPIENT's control that was acquired or improved
in whole or in part with CDBG 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 CFR 570.208 until five (5) years after expiration of this Agreement, or for
such longer period oftime 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-CDBG 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:
1. Items of equipment with a current per unit fair market value of less than
$5,000.00 maybe 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 CFR 85.32(e)(2).
D. 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 assigrunent(s),
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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, CDBG 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
SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
REVERSION OF ASSETS," and in paragraph "XII. 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 of termination, and except for reimbursement
of (1) any payments made for services not subsequently performed in a timely and satisfactory
mauner, 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 XII.A.
through XII.D., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
12
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070102
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
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 comrnitted 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
13
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070102
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
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
indenmifY 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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
DATED:
\0, l~ -02
CI27~
DAVID N. REAM
City Manager
ATTEST:
APPROVED AS TO FORM:
.
U;- .~
,j-rJOSEPH W. FLETCHER
City Attorney
PATRICIAE. HEALY
Clerk of the Council
SUBRECIPIENT:
DATE:
(9 tJ4kmaA-d./ JJ. tl~ /I v;'
Name: i7esrcl.L f:' K65~1'art~ r.. I ~
Title: (!)rCl/1ge 1!&0n Ir 'jf9t<./-,( CJn1ml~SIM
Tax ID: J/- / 16'7)"1 t) "'"
14
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VI.
GOALS AND OBJECTIVES'
IMPLEMENTATION STRATEGY
In the space below, please list the primary goals and objectives for your program. Provide
projected numbers of Santa Ana residents to be served, and the kinds of services they would
receive if your program is funded. Also describe the specific actions and tasks tnat would be
performed on a day-to-day basis to achieve these goals.
See Appendix A for examples.
Goal: To prevent youth delinquency by providing an after-school recreational program.
1. Enroll 16 more teenagers in the program (20 currently enrolled)
TASK/ACTION:
A. Ask teachers at the Community Day, Sierra Intermediate or School Santa Ana High
school who might really benefit from our after-school boxing program and invited
individually
B. Make a recruitment presentation at the Community Day School or other public scho.ols in
the area.
2. Provide 2 hours of after-school boxing training and character development at the Santa Ana
Boxing Gym.
TASK/ACTION
A. Train Volunteers
B. Purchase new equipment
C. Ensure condition of gym
D. Schedule volunteer assistants and trainers
E. Invite teenagers, get parent permission slips and dub dues.
3. Keep Good Records
ACTIONITASKS
A. Keep insurance up to date
B. Take attendance
C. Share anadotal stories with office and other volunteers
D. Check with teachers on academic performance
4. Offer Remedial Reading Programs
TASK/ACTIONS ,
A. Work with Orange County Literacy Collaborative to provide proper program
B. Assess students reading ability
C. Offer classes on altemative days.
~
EXHIBIT ~
~
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Attachment 4
PROGRAM BUDGET PROPOSAL
Organization Name: Oranoe County Youth Commission
Program Name: Santa Ana Boxino Club - An After-school Teen Prooram
CATEGORY SANTA ANA GRANT OTHER SOURCES PROGRAM TOTAL
REQUESTED
Administrative Staff $ 2,000 $ 2,000 $ 4,000
Office Rent, Phone,
Copier, Recruitment
Program Staff Salaries 3,000 5,000 8,000
& Benefits
Supplies, Bathroom, 2,000 1,000 3,000
Painting, Remodeling, . .
Rent/Lease 0 12,000 12,000
Communications
Professional Services
Conferences &
Meetings
Travel Expenses 500 500 1,000
Insurance 1,000 0 1,000
Other (Please Specify)
'..
TOTAL $8,500 $ 20,500 $ 29,000
NOTE: All expenditures must be fully documented by receipts, time records, invoices,
canceled checks, inventory records or other appropriate documentation that fully and
completely discloses the amounts and nature of the expenditures.
EXJli.BJ r E.
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Attachment 5
CDBG FUNDED PERSONNEL
ADMINISTRATIVE STAFF
CDBG % of Time
Total Funds Position is
Position Title Annual Salary Annual Compensation Requested Dedicated to
Benefits Proaram
Administration 20,000 20,000 2,000 20%
.
PROGRAM STAFF
CDBG % of Time
Total Funds Position is
Position Title Annual Salary Annual Compensation Requested Dedicated to
Benefits Proaram
Club Director 5,000 0 0 100%
Trainer 3,000 3,000 3,000 100%
CONTRACT PERSONNEL
.. CDBG % of Time
Total Funds Position is
Position Title Annual Salary Annual Compensation Requested Dedicated to
Benefits Proaram
-
(2<ttI($1t 1)
ffi212-
"'"
...."
Certification Regarding Lobbying
Certification for Contracts. Grants. Loans. and Coooerative 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 of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all sub awards 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 of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
@.e YcJu(fl (J;/J1/11IjS/~11
Grantee/Contactor Organization
Stt/lk !411VL J3~11 tY.C</::>
Progr Title
a~Nnarr.e r: A V//<<.
Name of Certifying Officer
~ilUl4.J. JJ. atAicv
Signature
Date
EXHIBIT C
Page 1 of2
"""'
..."
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT 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 CPR
Part 1.
2. No person in the United States shall on the ground ofrace, 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. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHmIT C
Page 2 of2
"'"
"'"
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
Approved by OMB
0348-0046
See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
o a. contract Oa. bid/offer/application D a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year quarter___
e. loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name
o Prime o Subaward.. and Address of Prime:
Tier ___. if known:
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:
$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, M/): different from No. 10a)
(last name, first name, M/l:
fanach ConMualion Shealfs) SF-LLLA, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ ------ o aclual o planned o a. retainer
o b. one-time ree
12. Form of Payment (check all that apply): D c. commission
o a. cash o d. conllngenl fee
o b. in-kind; specify: nature ----- o e. deferred
value --- o f. other; specify:
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:
fanach Continuation Sheetfs) SF-LLLA, if necessary)
15. Continuation Sheet(s) SF-LLLA attached: DYes ONo
16 InfCNTnalion requested through thlll form is authorized by tiUt 31 U.S.C. HctIon Signature:
. 1352. This dlsdosulll of lobbying activities II a material repreeenlation of fact
upon which reliance was placed by the tier above when this transaction we. made Print Name:
or enlllf8d Into. Thl. disdosure 18 requlllld pul8Uanllo 31 U.s.C. 1352. Thi,
Informaticn will be reported to the ConI1"IIS semhannualy and will be available for Title:
pubHc: Inspectkn. Ally per9Ol\ who falls to RIe tn. requlnM:l dlsdclure shall be
subject to 8 civil penalty cfnct less tnal $10,000 and nctmcre tnan $100.000 fer Telephone No.: Date:
each such fallure.
.. .. ...... .. .... ... .......... ... ... .1 Authorized for Local Reproduction
Federal Use Only: ....... .. ..... ... . ... ... . .... Standard Form LLL (Rev. 7-97)
... .-
'-
..."
INSTRUCTIONS FOR COMPLETION OF SF.LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a malerialchange to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make
payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress. an officer or employee of
Congress. or an employeeof a Memberof Congress in connection with a covered Federal action. Use the SF-LLLA Continuation Sheatfor additional information if
the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional Information,
1. Identify the type of covered Federal action for which lobbying activity is andlor has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this Is a followup report caused by a material change to the infonnaUon previously reported, enter
the yearend quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriateclassificallon
of the reporting entity that designates if it is, or expects to be, a prime or subaward reclpienl Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1 st lIer. Subawards include but are not limited to subcontracls, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee,"then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the nameof the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, If known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified In Item 1 (e.g.. Request for Proposal (RFP) number:
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the applicatlon/proposalcontrol number
assigned by the Federal agency). Include prefixes, e.g., nRFP.OE.90-001."
g. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the awarcinoan
commitment for the prime entity identified In item 4 or 5.
10. (a) Enter the full name, address. city, State and zip code of the lobbying entity engaged by the reporting entity identified In item 4 to influence the covered
Federal action.
(b) Enter lhe full names of the individual(s) performing services, and Include full address if different from 10 (a), Enter last Name, First Name. and
Middle Initial (MI).
11. Enter the amount of compensatlonpald or reasonablyexpectedto be paid by the reporting entity (Item 4) to the lobbying entity (item 10). Indicate whether
the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this Is a material change report, enter the cumulative
amount of payment made or planned to be made.
12. Check the appropriatebox(es). Check all boxes that apply. If paymenlis made through an in.kind contribution, specify the nature and value of the in-klnd
payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Providea specific and detailed descriptlon of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services
rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal officlal(s) or
employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLLA Continuation Sheel(s) Is attached.
16. The certifying official shall sign and date the form, print hlslher name, title, and telephone number.
According to the Paperwork Reduction Act. as amended, no persons are required to respond to a collection of informaDon unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMS No. 034s.0046. Public reporting burden for this collection of Information is
estimated to Bverage 30 minutes per response, including time for reviewing Instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collecllon of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.
Se~t By: Reindeer Insurance Servicef
. (. \
562 406 8837;
Feb-25-03 0:25PM;
Page 1/1
ACORD',. CERTIFICATE OF LIABILITY INSURANCE
Norwalk
15621.408-8838
CA 90650
llATljlllOlllllYY)
1/22/2003
THIS CERTIFICATE I8I8SUfD All A MATTQ. OF INFORMA1ION
ONLY AND CONFERS MD RIGHTS UPON THE CllRTIFICATE
HOlDER. THIS CI!JII11I'1CATE DOES MDT AMINO. EXTEND OR
"'~TeR THE COVERAOE~ IIYlH!! POLICIES IIEl..OW.
PRWUCI" Reindeer Insurance S.rvlces
14037 S. Plonee, 81
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Orange County Youth Commission
. 1ll$O E. 17th 8tJeet" 218
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INSURER B;
INSURERS AFFORDING COVERAGE
CI....n!lon Amertca I!"l',ur.iic. Company .
Amltrican Nat'1 LIfe In.,ul'llnce Co. of T~ll.1lI
S.nta An
COVERAGES
THE POUClES OF INSURANCf I.lSTED BELOW HAVE BEEN ISSUEtl TO THE INSUREC NAMED ABOVE FOR THE POliCY PERIOtlINDlCATED. NOlWlTHllTIINtllNG
ANY REQUIftEMeNT, TERM OR CONDITION OF /\NY COi'ITRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICI\TE MIIY BllSSUED OR
WlY PERTIIlN, THE INSURANCE AFFORDED BY THE POuCIES DES~IBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS /\NO CONomoNS OF SUCH
POLICIES. AGGR&GIITE LIMITS SHOWN MAY Hl\VE &EEN REDUCED BY PIIIO Cl.I\lMS.
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DUCRtfl'TION Of OPIM l1OH8r\.OCA TtofWII!HICL.ESlEXCLU8IONS AOiHm IIY ENDOMSOIENTISPIiCIAI. PROVIIEINI
City of Santa Ana, It'. omeers, agents, employe.. and volunteers are named.. AdditIOnal
Inlured as respects thier interest in connection with the named insured. Certific.te Holder i.
named 18 Additional Insured.
FLD02-32486-BC
10116/2002
10116/2003
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SHOULD MlV OF TH.E A8CVI tel: I POLICId _ CANCB.L&D IIMJIIIi TliIIi! DPIIU.11DN
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city of Slnta Ana, It's offtce..., Igents,
employ... and volunteers
PO Box 1888 M-211
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PAGE e!/&l
CZarelldtm America lnsrmmce Cf1mpanY
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COMMERCIAL CUlIR.-U. (l.....ttyCOvtRAGE r.uu
WHO IS MlINStJR!D (S..ciml J1) If _Ildcd to include U ........d lilt pm"" or ......oIion ,bawn
mlbc S.hod~1o \Nl 0Dly ..mil. ..1JlOCI to lilbillty anaUt& out of yaIlr 011""- <II ptmim 0"'- by I)f
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wlth ""mod inlll",d.
IT IS AG1l.EED 'I'K}. T ANY INSuaANCS MAJNT A1NED lI'Y THI> CITY OF SANTA IoNA SHALL
APPl. Y IN EXCIlSS OF, AND NOT coNn18UTE wrrn.INSUltANCE PltOVWl!l) BY THlS
pOlleY. .
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FRAZIER INSURANCE AGENCY, INC.
. P.O. Box 1250
MidlOthlan, VIrginia 23113
Ph. 804-754.71110 . FAX &04-754-7613
Feb 26 03 11:33a YOUT~ COMMISSION
Ulf14}'O'J 12:04 FAX 260 672. SS'""" AME.RIC.AN SPECI~LTY
714-54<'-7746
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p. I
III 0021004
rn..
Dat. 15ouea; 14-Pob-03
~RTlF1CATE OF INllURNICE
CERTIFICATEHOLDER
CITY OF SANTA ANA
COMMUNITY oevELOPMENT AGENCY
POBOX 1988
SANTA ANA. CA 92702
P ObUCER NSUR@D
American Spec:laICy InsuPOinoe Scrvreas, Inc. UJ'llt9d S~te& Amateur Boxing, l"c.
142 North Main Street One Olym~ie Plaza
Roal'lCb. Indiana 467&3 Cor"",do Spring.. CO 80909
'T'hla Cl.l1JficzIle il f.ss;uad as 21 matter or SANTAANA BOXING cLUe
intOlTTll6on only and confers ng r];I113 upan 'BSO ~ 17TM ST. ST~ 218
Iho "'rllflcaleholder. This eortificate do.. SANTA ANA, CA 92705
nolamend. exlalld. or alter the CQwrage
afford.d by lIle policy below.
CO ERAGES -11t1 IS TO CERTIFY THAT THE POUCIES OP INSURANCE L sTI!D BEL AVE IlEEN ISSUED TO E INSURED ED AllDVE
FOR THE POLICY PERIOD INDICATED. NOTWITtlSTANDING ANY lIiQUIREMENT, ~RM OR C0I\l0IT10N OF ANYC:DNlRAC:T OR OTt!ER , .
OOCUM~T W/TM RE$PECT TO WHICH THIS CERTIFICATE MAY BE lS$UED OR MAY PERTAIN. TME INSURANCE Al'FOIIDED BY THE POLICIES
DESCRIBED HERBIN IS SUBJECT TO ALL THE ~RlrIlS. EllClUSION$ AND CONDITION OF SUCH POLICIES. LllollT5 $HOWN MAY HAVE 8EEN
REDUCED 8Y PAID CLAIMS.
Unrled $lete$ Fidelity a',,' GIl8..''Y Com""ny GL Policy Numb.. DOB4LOIl4ll6
Etl'._:01..JAN-oJ 12:01 AM I!xpires:01-.lAN.o4 12:01 AM
N DDLLAIIS
Pro<luelll-Completea Operallo"" Aggregate Umlt
P.....'" alld Aclvert!:ling Injury Umit
Eaoh Ocwrrwnc:e Lilli!
Damase 10 Premises Rented 10 Yau (Ally On.
Premises)
MBdical e en~e Limrt An One Pf:rson
',000,000
1.000.000
1.000.000
1.000.000
50.000
El<oIuded
ADIl NAl.INFORMATION I RESTRI ONS I SPE ITEM'
. The Cerlir"",tehordel is <)Ilry an A~dition.lln.ured "illl ,espect to liab/IUy caUHd by the neSige11! acts or omissions of the Named Insured, and anry with
resp.cllO sup.Nised eM. approved praCllces an" ltainlng 01 USA Boxins member ath:s1e. lor USA 8...;ns .""CII01l0d OlIenlS.
.. Covel'a!l8 Is eKCIYded fQr i&lny m-artial ans. kic.k-boxing, or other act:ivltie$ nOI.specifically ep~oved in advance by USA Soxlng, regardlesS ofwhethBr or not
lhey lIf. part of a USA Solling sanotioned aClilllly or crue aclivily.
. Covarag. Is .lIeclive Feb"'"')' 14. 2003 IM>ugh December 31.2003.
C CEU.ATlON . SHOULD ANY OF T E ABOVE DESCRIBED I' C1EB Bi CANCELED BEF E THE EXPI TIO DATE I!OF, T E SumG
I COMPANY WILL ENDEAVOR TO MAtL 30 DAYS WRITTI!N NOTICE TO THE C1!RTIFlCA~HOLDER, BUT FAILURE TO MAIL SUCH NOTlCl! S11AI.L
, IMPOSE NO OBLIGATION OR LIABI1.I'1Y OF ANY KIND UPON THE COIIIPANY. ITS AGENTS OR RE"IIESEIIITATlVES.
FOtm 11I0. USAB lIIlDllOl
Certi1lcole lIlo. 1foo225112
Oa. .
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Dallld/-iarA!l
Authorized Representative
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FOP"
"ED AS TO .
Af'PBOv
,Mf[tl-oRCK---
LISA 'w Alton,e"i
'''(7) J)
. . CERTIFICATE~~F LIABILITY INSURANCL, DATE IMMlDDIYYYY
ACORD. OP ID P~ 10/11/02
SANTA-4
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ISU Ins Srv - Fullerton Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1150 E Orangethorpe Ave,#101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Placentia CA 92870
Phone. 714-577-5800 Fax:714-577-5888 -.I "./ INSURERS AFFORDING COVERAGE NAlC#
INSURED A ~ 1-f)() 2. - IU:>" , I INSURER A: Scottsdale Insurance
INSURER B:
Santa Ana Boxing Club I INSURER C:
Orange County Youth Commission
1850 E. Seventeenth #218 ' INSURER 0:
Santa Ana CA 92705 I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
R PIN
L TR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMlDDIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE
A
COMMERCIAL GENERAL LIABILITY CLS 0 8 215 4 8
CLAIMS MADE [!] OCCUR
Owner/Cont Prot.
01/24/02
01/24/03 PREMISES (Ea occurence)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPfOP AGG
$1000000
$ 50000
$1000
.1000000
$1000000
$1000000
GEN'L AGGREGATE LIMIT APPLIES PER:
~PRO- ,-------.
POLICY I JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' UABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED?
~~~~\~tS~~~VIS?ONS below
OTHER
~
aura Sheedy
Deputy City Atto ney
COMBINED SINGLE LIMIT $
(EaaCddent)
BODILY INJURY I
(Per person) $
BODILY INJURY $
(Peracddent)
PROPERTY DAMAGE $
(Peraccidenl)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
AGGREGATE $
$
$
$
ER
$
E.L DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
SCHEDULED AUTOS
HIRED AUTOS
~
I I NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA UABlLlTY
OCCUR D CLAIMS MADE
DESCRIPTION OF OPERATIONS' LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder shall be named Additional Insured with respects to
General Liability policy limits per special endorsement required for all
named additional insureds.
*10 day cancellation for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRA
DATE THEREOF, THE ISSUING INSURER WILL lill MAIL 30* DAYS WRITT
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1"'1 f JlijFl- -- -- -- [II
City of Santa Ana
Community Development Agency
20 Civic Center Plaza
Santa Ana CA 92702-1988
...
-- -.
AUTHORIZED REPRESENTATIVE
James D. He ker
ACORD 25 (2001/08)
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)
SEP-26-2002 THU 09:25 AM~ULLERTON INSURANCE FAX NO, '""",,775888 p, 04/04
FI<OI-l : FAX NO. :714-647-6549 S..p. 25 2602 ~4:07PH p]: C,
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EXHmITB
.6,P.DlTIONAL INSURED ENDO~.!illr
FOR ~QMMER(:IAL QIDfflRAJ, LIABILITY PO~
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Insunncc Company SCOTTSDALE INSURANCE COMPANY
This endorsement mo(!illes such in.UnllC~ ns i$ nfl'orded by the provisions o~ pcllqy
# CLS0821548 _rclatingtolltefoUowing:
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1. Th. Community Redevelopment Agency, the City o(SOl\t. Aitll, 20 Civic Center
PllIZll. SanlaAna, California 92701; j~ officers, employ~", agmtll, volunteers mld
TqIresentIl!iY" ue nall\cd ali additional insureds ("addition;] insureds") with regDrd to liability ,
and dciense of sllit. nrising from tho operations llI'l(\ IlSe. perfonned by or on behalf ofl~ nllmM' I':'
insured.
"I
2. Wilh res pee! 10 claims arisirig o\n DE the; oporaliol1i and llSes perl'Omted by. or 011
behalf ofLhe X1aln~d insurcd, S\leh insurance 1Ii is afforded by !hill Jloli~y Is primary and iillQt ';' ,
additional to or contributing with 1Il\}' o!h~ WunI:lCO camed by or for thc bCllatltpfmel. ' ,"
odditional in.areel:;. . : ,;
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3. This illsur:lnce appU.. sopnralcly to caclt Ulsured Against wllom claim is mad~ or
5uil i. brought clCCCpt with respect to the compony! limits <II Jjabllily. Tho inelu'uon.ot'any
p~rSOll at orgtlnl2allon a.. :In inSllte<l thall nol affect any right which ouch plOl'SOI1 or org>llizlltiOlI
\VO\lld havCl as a claimant ifnot so included.
"
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4. With taspecl to the addllional insureds, thi! inxuranec .ballno! be cancelled, or
materially reduced ill covem!!. Oi' lil1lits ClI~opt afler lItirty (30) days wIllian 1J0liee l1llS been
gillen to tho City DfSamil Ana. 20 Civic CClllcr Plan, Sllnla AnI!, CalifOrnia 92701 1 I)'
(ComplatiOl\ 9(the .(illlowillS, including COUnterslgllature, is required 10 make this. f'ldOl'lllilD~1
~rrcctlvo,) . .
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Eff~"tiYe !U25 /02
PolicYl1 --(:T.80821548'. _0'_ _.
ISsUed (0 Santa An'!..!loxing.~
N!l1l1..d Insured
Coumersigned by _ " (J - ~ Ib
~Senl'\tiVC
, this el1dorsomt>lll fonn as a pare of
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APPROVED AS TO FORM
t!JJ..r oI.e.1 _
/Laura Sheedy I
Deputy City Attorney
9
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POLICY ENDORSEMENT # 02
Insured copy
'...,
This Endorsement is Attached to and made part of Policy # CLS0821548
Issued to: SANTA ANA BOXING CLUB
Agent: ISU INS SVCS/FULLERTON INSURAI
Insurance Company: Scottsdale Insurance Company
Producer: Yates & Associates Insurance Service
Effective date of this Endorsement is 9125/02 at 12:01 AM Standard Time.
X Additionallnsured(s)
X Forms Added
In consideration of an additional premium of $450.00 (fully eamed), it is hereby agreed that the following additional insured is made
part of the policy perfonm "Additional insured Endorsement For Commercial General Liability Policy" attached.
THE COMMUNITY REDEVELOPMENT AGENCY,
THE CITY OF SANTA ANA,
ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS
AND REPRESENTATIVES
20 CIVIC CENTER PLAZA
SANTA ANA ,CA 92701
All other Terms and Conditions remain the same.
An .<OV 1::.0 AS fO FORM
/6!~~
I-aura Sheedy
kpulY City Attorney
Issue Date: 10/4102
/7 J
I!.~ /.
Issued By: ~
&!mpany Representative
Other - shown above
Braker Fee
Policyllnspection Fee
State Tax
Stamp Fee
Total
/ ' .0
/?_:;'-'cffU/tu./
d I
450.00
0.00
0.00
13.50
1.13
464.63