HomeMy WebLinkAboutWOMEN HELPING WOMEN 4 -2002
INSURANCE.Nor ON FILE
WORK MAY f'lOI PROCEED
CLERK OF COUNCllGREEMENT BETWEEN THE CITY OF SANTA ANA AND
DATE: 10- t tf,Ol- WOMEN HELPING WOMEN FOR USE OF
t', c 4) A COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
fl J This Agreement, made and entered into this _I Sib. day of~, zeo~
by and between the City of Santa Ana, a charter city and municipal corporation of the State of
California ("CITY") and WOMEN HELPING WOMEN, a Califomia.-nonprofit corporation
("SUBRECIPIENT"),
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WIINES.S.!HH
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 ofCDBG
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 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.
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 SUB RECIPIENT .
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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, difficultiesand..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 SUB RECIPIENT 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 $ 5,000 ("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. SUB RECIPIENT 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, wa'ges, 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. Seoaration 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 Reoort Requirements. 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 I of the
year following the program year in which this Agreement is executed.
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I. Record KeepingfReporting. 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:
(I) Records
a. Documentation evidencing program income requirements in
. conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 57Q.:i03(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.
I. 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 SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUB RECIPIENT'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 aQd .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
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 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.
L. 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 SUB RECIPIENT 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 SUBRECIPIEN.l',. 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 SUB RECIPIENT 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 Co" 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
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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 byconD;actors 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 Workolace. SUBRECIPIENT certifies that it has established the following
drug-free workplace policy:
1. 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 SUBRECIPIENT 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.
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IL CITY'S OBLIGATIONS
A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shaH
pay to SUBRECIPIENT from CDSG funds, when, if and to the extent received from HUD, for
CITY's 2002-2003 CDSG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2002-2003 pursuant to this Agreement uJ3 to-a maximum aggregate
payment of FIVE THOUSAND DoHars ($ 5,000) in installments determined by CITY. Payments
shaH 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 shaH 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 shaH include an audit of the account maintained by
SUSRECIPIENT in CITY's annual audit of aH CDSG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
m. NONDISCRIMINATION
SUB RECIPIENT agrees that no person on the ground of race, age, color, natiot1al 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 CDSG funds.
IV. CONFLICT OF INTEREST
SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct
or indirect control of any CDSG monies granted to the CITY, inclusive of the subject CDSG
FUNDS, shaH serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of
interest of any officer of SUBRECIPIENT shaH be fuHy disclosed in writing prior to the execution
of this Agreement and said writing shaH be attached and deemed fully incorporated as a part hereof.
Notice shaH 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 shaH provide with CDSG funds:
A. SUBRECIPIENT shaH not discriminate against any employee or applicant for
employment on the basis of religion and shaH not limit employment or give preference III
employment to persons on the basis of religion.
B. SUBRECIPIENT shaH 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
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shall not limit such services or give preference to applicants for such services on the basis of
religion.
C. SUB RECIPIENT 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 SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBa 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 CDBa
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
TO SUBRECIPIENT:
Women Helping Women
711 W. 17th Street, Suite A-IO
Costa Mesa, CA 92627
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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 assigrunent shall terminate or alter the legal
obligations of SUB RECIPIENT pursuant to this Agreement. .'. ."
IX. HOLD HARMLESS
SUBRECIPIENT shall indemnifY, 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 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 oftbis 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: (I) 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
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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
, 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 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-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 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 offederal 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 CITYassignment(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, 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 purpDse of the
performance of this Agreement or any previous agreements relating to the same subject matter or
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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 HOD
deems necessary for the responsibilities, duties and obligations to be performed and completed to
the satisfaction of CITY and HOD.
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
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 XII.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.
12
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XIII. LIMITATION OF FUNDS
The United States of America, through HOD, 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 HOD
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 HOD 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, fmancial 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 HOD 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.
13
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070102
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
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.
,
..4..
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: j/I...-p/~1.---
ATTEST: APPROVED AS TO FORM:
~
);;;t..;<-- c ~~
~JOSEPH W. FLETCHER
City Attorney
PATRICIA E. HEALY
Clerk of the Council
SUBRECIPIENT:
DATE:
f:-x. lie ~~(
33,- 01;;;1 b'1 (JO
14
~
Women Helping Women
'wi
Note that Women Helping Women has modifred the Obiectivesfrom the initial
proposal (application) with respect to the number of indivUJlUlls served as highlighted
and underlined below. The response below is taken directly from the application.
GOAL AND OBJECTIVESIIMPLEMENTATlON STRATEGY
In the space below, please list the primary goals and objectives for your progrom.
Provide projected numbers of Santa Ana residents to be served, ahtftlle kinds of
services they would receive if your progrom is funded. Also describe the specifIC
actions and tasks that would be performed on a day-to-day basis to achieve these goals.
Goal: to assist low-income women who face substantial barriers to employment
in their transition from dependence to economic self-sufficiency.
Objectives:
(1) Provide a professional wardrobe to 118 clients from Santa Ana.
Task/Action:
(A) Continue to accept referrals for eligible clients from nonprofit,
governmental, and faith-based agencies in Santa Ana that WHW
currently works with.
(B) Cultivate referrals from additional agencies in Santa Ana.
(C) Schedule appointment(s) for clients to use the clothes closet.
(D) Provide clients with the following items from the clothes closet free
of charge: 10 items of business clothing (suits, skirts, jackets, blouses,
dresses, pants), 4 pairs of shoes, I purse, 3 belts,S pieces of jewelry,
5 pieces of makeup,S undergarments, personal hygiene products, a
complimentary hair dresser/styling service and 5 pieces of casual
clothing.
(E) Provide an incentive for clients to secure employment by offering
them an additional 5 pieces of business clothing after the clients have
demonstrated proof of employment.
(2) Provide each of these 118 women an opportunity to utilize the services
provided in the Learning Center.
Task/Action:
(A) Schedule formalleaming center computer classes in Basic
Computing; Introduction to Windows; Microsoft Word and Microsoft
Excel at various skill levels; and PowerPoint presentations.
(B) Provide computer classes in both English and Spanish.
(C) Provide certificates for those who complete requisite classes.
(D) Schedule informal tutorial computer sessions where individual skill
level needs are addressed.
(E) Facilitate completion of the GEO program in both English and
Spanish.
(F) Provide assistance with resume preparation, cover letters, and other
skills associated with job search preparation/readiness.
(G) Provide access to the Learning Center during all the hours of
operation at WHW so that clients can practice skills.
Exhibit A
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Attachment 4
PROGRAM BUDGET PROPOSAL
200212003
Oraanlzatlon Name: Women HelDlnG Women
. ..
PrOGram Name: Women HelDlnG Women
CATEGORY SANTA ANA GRANT OTHER SOURCES PROGRAM TOTAL
REQUESTED
Administrative Salaries & $22,500.00 $22,500.00
Benefits
Program Salaries & $3,750.00 $81,545.00 $85,295.00
Baneflts
Supplies $4,675.00 $4,675.00
Rent $1,250.00 $19,150.00 $20,400.00
MalllCorrespondence $2,475.00 $2,475.00
Professional Services $17,600.00 $17,600.00
Conferences & $2,365.00 $2,365.00
Meetings
Travsl Expenses $1,000 $1,000.00
Insurance $2,970.00 $2,970.00
Total Utllltlea $5,984.00 $5,984.00
Leaming Center $5,000.00 $5,000.00
Program Expenses $1,540.00 $1,540.00
Administrative Expenses 1,606.00 $1,606.00
TOTAL $5,000.00 $168,410.00 $173,410.00
Note: The proposal raquests that the City of Santa Ana fund 10.4% of tha program coats under this CDBG grant
Exhibit B
-
.:r"'~ ':':'~';::~-~::'~'~\~\~7~~~-ij':~'"
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Certification Regarding Lobbying
.....
Certification for Contracts. Grants. Loans. and CooDerative Al!reements
The undersigned certifies, to the best of his or her knowledge and belief, that:
OLNo Federal appropriated funds have been paid or will be paid, ~y or.on b<<half of the
undersigned, to any person for influencing or attempting to influeri.ce';bitlfficer 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 subawards at all tiers (including subcontract, subgrants, 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.
SrFJ.Lt4~K
Name of Certifying fficer
~
Q'4.D2
Date
. .
EXHIBIT C
Page 1 of2
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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 24CFR
Part 1.
2. },!o..person in the United States shall on the ground of race, color,.!'eli~on, Ilational
origin, or sex, be excluded from participation in, or be denied the beile-tits'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 d:>es 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
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t
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Disclosure of Lobbying Activities
Approved by OMB 0348-0046
Complete this form to disdose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse side for Instructions and Public Reporting burden slalement)
1. Type of Federal Action 2. Status of Federal Action 3. Report Type
D a. contract o a. bid/offer/application o a. 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 lasl report (mm/ddJyyyy)_____
4. Name and Address10t Reporting Entity 5. It 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. Name and Address of Lobbying Registrant b. Individuals Perfonning Services (including address If cfrtferent from NO.1 Oa.)
(if individual. last name, first name, MI) ~ast name, first name, MI)
.
.
(attach continuation sheet(s) If necessary)
11.
Amount of Payment (check all that apply)
$ acllJal
planned
12.
13. Type of Payment (check all that apply)
D a. retainer
o b. one-time fee
D c. commission
D d. contingent fee
D e. deferred
D f. other (specify)
14. Brief Description of Services Performed or to be Perfonned and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted,
for Payment Indicated in Item 11
Form of Payment (check all that apply)
D a. cash
o b. in.klnd; specify: nature
value
(attach continuation sheet(s) if necessary)
15. Continuation sheets attached DYes D No
16. Information requested through this form is authorized by 8ec.319,
Pub. L. 101.121, 103 Stat. 750, as amended by sec. 10; Pub. L. 104- Signalure
65, Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities
is a material representation of fact upon which reliance was placed Print Name
by the above when this transaction was made or entered into. This
disclosure Is required pursuant to 31 U.S.C. 1352. This information Tille
will be reported to the Congress semiannually and will be available
for public inspection. Any person who fails to file the required Telephone No.
disclosure shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure~. Date (mm/ddlyyyy)
Federal Use Only:
Authorized for Local Reproduction
Standard Fonn-LLL (7/97)
\",.'
;1......::_,. ,.''':,''-7'
.,
~
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 material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required
for each payment or egreement to make payment to eny lobbying entity for influencing or attempting to infiuence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with
a covered Federal action. 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 ..hdlo( 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 informa-
tion previously reported, enter the year and quarter in which
the change occurred. Enter the date of the last previously
submitted report by this reporting entity for this covered
Federal action.
4. Enter the full name, address, city, state and zip code of the
reporting entity. Include Congressional District, if known.
Check the appropriate ciassification of the reporting entity
that designates if it is, or expects to be, a prime or subaward
recipient. Identify the tier of the subawardee, e.g., the first
subawardee of the prime is the lsttier. Subawards include but
are not limited to subcontracts, 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 Congres-
sional District, if known.
6. Enter the name of the Federal agency making the award or
loan commitment. Include at least one organizational level
below agency name, if known. For example, Department of
Transportation, United States Coast Guard:
7. Enter the Federal program name or description for the cov.
ered Federai 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 avail-
able 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 application proposal control number aSR
signed by the Federal agency). Include prefixes, e.g., "RFP-
"DE-90-00t:
9. For a covered Federal action where there has been an award
or loan commitment by the Federa~ agency, enter the Federal
amount of the award/loan commitment for the prime entity
identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the
registrant under the LObbying Disclosure Act of 1995 engaged
by the reporting entity identified in item 4 to influence the
covered Federal action.
(b) Enter the full names of the individual(s) performing ser-
vices, and include full address if different from 10 (a). Enter
Last Name, First Name, and Middle Initial (MI).
11. Enter the amount of compensation paid or reasonably ex-
pected to be paid by the reporting entity (item 4) to the
lobbying entity (item 10). Indicate whether the payment has
been made (actuai) or will be made (planned). Check all
boxes that apply. II this is a material change report, enter the
cumulative amount of payment made or planned to be made.
12. Check the appropriate box (es). Check all boxes that apply.
If payment is made through an in-kind contribution, specify the
nature and value of the inRkind payment.
13. Check the appropriate box (es). Check all boxes that apply"
If other, specify nature.
14. Provide specific and detailed description of the services that
the lobbist has performed, or will be expected to perform, and '
the date(s) of any services rendered. Include all preparatory
and related activity, not just the time spent in actual contact
with Federal officials. Identify the Federai official(s) or
employee(s) contacted or the officer(s), employee(s), or
Member(s) of Congress that were contacted.
15. Check whether or not a continuation sheet(s) are attached.
16. The certifying official shall sign and date the form, print his/her
name, title, and telephone number.
Public Reporting Burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Please do not
return your completed form to the Office of Management and Budget; s,end It to the address provided by the sponsoring agency.
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 Managemenf and Budget, Paperwork ReductiOlrProject (0348-0046), Washington, DC 20503.
Authorized for Local Reproduction
Standard Form-LLL (7/97)
,I
I
711 W, 17TH STREET, #A-10
COST A MESA, CA 92627
CERTIFCI.\TE OF INSURANCE 'wi 1~~/~;/fo~~E
PRODUCER Cert# 4357 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
HOLBERT INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
P.O. BOX 120B DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
SAN CLEMENTE, CA 92674-1208 POLICIES BELOW.
(949) 492-6138_
FAX (949) 361-4079 1..- fch -) I
,.1f1I COMPANY
iA A TRAVELERS INDEMNITY CO OF IL
COMPANY
B
COMPANY
C
COMPANY
o
COMPANIES AFFORDING COVERAGE
INSURED
WOMEN HELPING WOMEN
I COVERAGES -~
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, 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 LIMITS SHOWN MAY
HAVE BEEN REDUCED BY PAID CLAIMS.
C
L
aT POLICY EXPIRATION I -~
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LIMITS
TR, DATE (MMlDDIYY) DATE (MM/DDJYY)
! G;.NERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
880-466P105-A OCT 28 02 OCT 26 03 _..
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 2,000,000
FLAIMS MADE ~ OCCUR. PERSONAL & ADV INJURY $ 1,000,000
A X OWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE 1$ 1,000,000
-
- I FIRE DAMAGE(Any One Fire) 1$ 300,000
I
MED. EXPENSE(Any One Person~ :5 5,000
I
AUTOMOBILE LIABILITY ,
- ANY AUTO COMBINED SINGLE LIMIT 1$ 1,000,000
680-466P105-A OCT 28 02 OCT 28 03
- ,
I-- ALL OWNED AUTOS BOD!L Y INJURY
(Per Person) .
SCHEDULED AUTOS
AX HIRED AUTOS BODILY INJURY
c-:-:- $
~ NON-OWNED AUTOS (Per Accident)
I-- PROPERTY DAMAGE $
~RAGE LIABILITY AUTO ONLY - EAACCIDENT I' I
I-- ANY AUTO OTHER THAN AUTO ONLY: I
EACH ACCIDENT :5
I-- AGGREGATE .
EXCESS LIABILITY EACH OCCURRENCE .
B UMBRELLA FORM I AGGREGATE $
_ OTHER THAN UMBRELLA FORM i
WORKER'S COMPENSATION AND I STATUTORY LIMITS 1.-- _______J
EMPLOYERS' LIABILITY EACH ACCIDENT ,$
i ASiASE-"POLlCY LIMIT 1$
THE PROPRIETORJ R:INCL A PPROVE~ AS TO FO
PARTNERSIEXECUTIVE IlJ1SEASE-EACH EMPLOYEE I.
OFFICERS ARE: : EXCL
OTHER ,,( iJ Il
'a lA, l' C'.Y--<-....
7
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESISPECIAL ITEMS Lam" ' (
OPERATIONS OF THE NAMED INSURED
Deputy CllY Attorney
CERTIFICATE HOLDER AS ADDITIONAL INSURED
CITY OF SANTA ANA, M-25
COMMUNITY DEVELOPMENT AGENCY
PO BOX 2988 M-25
SANTA ANA, CA 92702
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
"
'-'
Oct. 08 2002 10:01AM P3
INSURANCE ON FILe
wORK MAY PROCEED
UNTIL INSVRANCj,EXPIRES
vLER/~ CO~IL() ~
nAif
ADDITIONAL INSURED ENDORSEMENT
fOR COMMERCIAL GENERAL LIABILITY POLICY
FAX NO. :714-647-6549
......,
JtXHIBIT B
Insurance Company ~ ~ Co tf .J{
Tris endorsement modifies such insurance as is afforded by the provisions of Policy
1080 . 'f/Pr.fJ /1J!5'-,4 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Calilornia 92701; its
officcrs, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
a"l!. uses ormed by or on behalf of the named insured.
With respect to c1ail11~ arising out of the operations and uses performed by or on
,chaif c namcd insured, such insurance as is afforded by this policy is primary and is not
Jdditio aI to or contributing with any other insurance canied by or for the benefit ofthe
'~~;:;onnsureds.
- , Th.is insurance applies separately to each insured against whom claim is made or
;':r. is 'brought except with respect to the company's limits of liability. The inclusion of any
person or organi7..lltion as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
gi.ven to the Clerk of the Council. City of Santa Ana. 20 Civic Center Plaza, Santa Ana,
r:~lifornia 92701.
c::cn of the following, including countersignature, is required to make this endorsement
c~=::cc-Jvc.)
10' dO-O / fo !O'dd'-O,;;l-
Effective / () - ,;t.. f' tJ OJ. -fo 10 -01-0 - tJ3 . this endorsement form as a part of
Policy # tP 30- 'f ~~ I' (05- It -----
"$uedto.:::Id~ ~J:,~ I~
Named Insured
Countersigned by
.-~~.~-._.~ti~
AU orized Represe a .
APPROVED AS TO FORM
r).;
...c.' ,('.R ",f./.
aura'ShC'l'dy --..;\~._..
D~puty City Altorney
8
,POLICY NUMBER: 680-4\-;105-A
...,; COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CARE FULL y,
ADDITIONAL INSURED----DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAl LIABILITY COVERAGE PART,
SCHEDULE
Name of Person or Organization:
CITY OF SANTA ANA, M.25
COMMUNITY DEVELOPMENT AGENCY
PO BOX 2988 M-25
SANTA ANA, CA 92702
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS
ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN CONNECTION WITH THE NAMED INSURED,
AhROVED AS TO FORM
/ .. o,tf
Lura'Sheedy -
Deputy City Attorney
Copyright, Insurance Services Office, inc. 1984
'W
'wi
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142.0807
COMPQN~A1"ON
INSURANCE
FUN D CERTIFICATE QF WORI<ERS' COMPENSATlOIllINSURANCE
OCTOBER 25, 2002
POLICY NUMBER: 1462781 - 02
CERTIFICATE EXPIRES: 10-1-03
,-
CITY OF SANTA 'ANA
CO~l'lUNHY DEVELOPl'lENT
PO BOX 1988 1'1-25
SANT A A!\IA CA 9Z70?
AGENCY
L
ThiS IS to certity that we have iSl;ued a valid Workers', C9mj'len$'lltionin$urance Policy in a form approved by theCalifomia
Insurance Commissioner to the-employer"amedoelow farihe"pol i-cy-period indicated. - ,__
This policy IS not subject to cancellation by the Fund except upon ~ days' advance written notice to the employer.
We will also give you ~~Nd'lys'~dV~nc; notic" sh.pold this polley be cancelled prior to its h9rmal expiratiOn.
This certific"te 0\ insurance is not <In insurance policy and <lOes nqt amerl~, extenefoc aijer the coverage afforded by the
poliCies listed her"in. Notwithsta~<lingaryreqUirern,,~t. term, or condition plan,. contrap! or other do~umen! Wlt~
respect to which this certificate of insurance m,ylj'e.i!oT~Becj or may pertain, the insurance afforded by; the pOlicies
described herein is subject to all the terms, extlusionsand condltions of l;uch politiel;.
.
/7~~~
AUTHORtZEDREPRESENTATlVE .,
K~
PRESIDENT
EMPLOYER'S LIABILITY ~Il'lr;T Ii'CLlJDING DEFENGE CO~TS: $1,000,000 PEl'< OCCURRENCE~
ENDORSEI1ENT 112065 ENTITLED CERTlnCATE HOLDERS'NOTICE EFFECTIVE
10/25/02 IS ATTACHED TO AND FPRl'lS A PAlll OF THIS POLtey.
-,
EMPLOYER
. APPRPVEP AS TO FORM
ut~O~1
Doputy City Altorn y
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