HomeMy WebLinkAboutWOMEN'S TRANSITIONAL LIVING 11
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AGREEMENT TERMINATION
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Revised 8-7-03
City of Santa Ana
Clerk of the Council
INSURANCE ON FIlE
WORK MAY PROCEED ..
UNTIL INSURANCE EXPIRb
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CLERK OF COUNCIL
DATE: 1-;:Z 7 -vip
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A-2006-068
5/05
AGREEMENT BETWEEN THE CITY OF SANTA ANA
AND WOMEN'S TRANSITIONAL LIVING CENTER
FOR THE USE OF EMERGENCY SHELTER GRANT FUNDS
(With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
THIS AGREEMENT, is hereby made and entered into this 1st day July, 2006, by and be-
tween the City of Santa Ana, a charter city and municipal corporation of the State of California
("CITY") and Women's Transitional Living Center, a California nonprofit organization
("SUBRECIPIENT").
WITNESSETH
Recitals:
1. CITY is the recipient of Emergency Shelter Grant ("ESG") funds from the United
States Department of Housing and Urban Development ("HUD") pursuant to the Stewart B.
McKinney Homeless Assistance Act: Emergency Shelter Grants Program 42 USC 11331 et seq.
2. CITY has approved the provision of federal funds under the ESG to be used in the op-
eration of an emergency shelter program for the homeless of the City of Santa Ana ("said pro-
gram") as further described by a Scope of Work and Schedule of Performance in Exhibit A, at-
tached hereto and by this reference incorporated herein.
3. SUB RECIPIENT represents that it has expertise and experience in the provision of
emergency shelter programs for the homeless and is willing to use said federal funds to operate
said program.
4. SUBRECIPIENT agrees to assist homeless individuals and families in obtaining:
appropriate supportive services including, but not limited to, temporary and permanent housing,
medical health treatment, mental health treatment, counseling supervision and other services es-
sential for achieving independent living, as well as other federal, state, local and private assis-
tance available for such individuals.
5. Title X ofthe 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
with particular requirements relating to (i) notification (including pamphlet distribution, disclo-
sure to purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or
lead hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing,
and/or risk assessment), (iii) lead hazard reduction (including paint stabilization, interim con-
trols, standard treatments, or abatement depending on the requirements for housing activity
type), (iv) ongoing maintenance, if required, and (v) response to children with environmental
intervention blood lead levels, as required; and
6. On September 15, 1999 HUD adopted implementing regulations to Title X that became
effective September 15,2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs."), which estab-
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lish specific rules regarding notification to owners and occupants about the existence of LBP
hazards, identification ofLBP hazards, and control ofLBP hazards; and
7. Residential structures built after January I, 1978 are exempt from lead-based paint re-
quirements as the use of lead-based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not
be applicable if the structures involved were built after January I, 1978.
8. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs, sets
forth specific requirements relating to housing providers, such as SUBRECIPIENT, who admin-
ister local programs that provide supportive housing for special needs populations and are
funded by HUD Office of Community Planning and Development ("CPD") programs, including
ESG funds, as provided to SUBRECIPIENT under this Agreement; and
9. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support ser-
vices, or operations, and Subpart J relating to rehabilitation, as and when applicable; and
10. In connection with the grant of funds under this Agreement, CITY requires that
SUB RECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as
and when applicable; and
II. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No. I entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No.2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards", and At-
tachment No.3 entitled "Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modifY or limit SUB RECIPIENT'S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP
Regs; and
12. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all respon
sibilities set forth in Subpart K of the LBP Regs; and
13. SUB RECIPIENT agrees that it will adhere to the performance measurements and out-
comes as indicated on Exhibit B-1 (Outcome Tracking). Failure to follow the measurements and
meet the stated outcomes may constitute breach of contract that could result in termination of
this Agreement or serve as reason for the City to recapture the grant funds awarded to
SUB RECIPIENT pursuant to this Agreement.
14. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure
of such funds; and
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WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a sub-
stantive part ofthis 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. SUBRECIPIENTS'S OBLIGATIONS
A. Non-Profit Status - Representations and Warranties.
(I) SUBRECIPIENT acknowledges that its operations and the services it provides to
the community are subject to Subpart K, and, in some instance(s) Subpart J and/or Subpart M, of
the LBP Regs.
(2) SUB RECIPIENT acknowledges that its operations and the services it provides in-
clude: (a) acquisition, leasing, or ownership of residential property for the purpose of providing
affordable housing for persons with special needs, such as transitional housing, or (b) housing
for persons with special needs, such as the disabled, or (c) financial assistance to assist transi-
tional housing participants to move to permanent housing by paying for the first month's rent or
security deposit, or (d) tenant-based rental assistance to program participants who choose their
own housing units, and by provision of such services such housing is subject to the requirements
of the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. 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.
(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 per-
formance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUBRECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
fact and shall not proceed except at SUBRECIPIENTS risk until written instructions are re-
ceived from CITY'S representative.
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(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 threat-
ened bankruptcy proceeding.
(1) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a cur-
rent or threatened litigation that would or may materially affect SUBRECIPIENT'S performance
under this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUB RECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
(4) Comnliance with Subnart K ofLBP Rel!s. Subpart K- Acquisition, Leas-
ing, Support Services, or Operation
(a) SUB RECIPIENT acknowledges and agrees that it shall comply with and im-
plement the requirements set forth in Title X and the LBP Regs to eliminate, as far as practica-
ble, LBP hazards in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other assis-
tance from SUB RECIPIENT.
(b) SUB RECIPIENT shall provide a notice to all residents/occupants ofresiden-
tial property that is under its ownership, possession, or control and/or residential property occu-
pied by persons or families that receive financial or other assistance from SUBRECIPIENT in
accordance with Section 35.125 of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a
visual assessment is not considered an evaluation for purposes of the LBP
Regs.
(c) Notification (24 CFR 35.130). SUBRECIPIENT shall provide the LBP haz-
ard information pamphlet in accordance with Section 35.130 of the LBP Regs to all occupants,
owners, and purchasers of housing.
(i) The pamphlet shall be the EP AlHUD/Consumer Product
Safety Commission lead hazard information pamphlet or an EPA-approved
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equivalent. The current form and version of the pamphlet is attached as At-
tachment No. I to this Agreement.
(ii) SUB RECIPIENT shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence ofLBP
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No.2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing of the results ofthe presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No.3 to this Agree-
ment.
(d) Lead Hazard Evaluation (24 CFR 35.125). SUB RECIPIENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(1).
(i) SUBRECIPIENT shall cause a visual assessment to identify
deteriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other assis-
tance from SUBRECIPIENT.
(I)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs. including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero-bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed after January I, 1978.
(ii) To the extent that the assistance provided by SUB RECIPIENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs. as to all
tenant-based long term housing assistance, i.e., assistance to persons/households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
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require evidence of compliance prior to occupancy. Funding to be provided hereunder is condi-
tioned upon evidence of compliance.
(1) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such
dwelling units includes, without limitation: notification, evaluation by visual assessment, paint
stabilization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy,
including occupancy in the same dwelling unit for more than 100 days, then the provisions of
Subpart M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed
by HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS inspec-
tion of each dwelling unit prior to occupancy and prior to compliance with applicable notifica-
tion, evaluation by visual assessment, reduction through paint stabilization utilizing safe work
practices, and clearance requirements ofthe LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(I) above.
(I) Ifpaint stabilization occurs, SUBREClPIENT shall cause paint stabi-
lization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the ESG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certifica-
tion of a qualified inspector is required on an annual basis in connection with submittal of the
April 15 quarterly report.
(1) Onl!:oinl!: Maintenance. SUB RECIPIENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
all residential property that is under its ownership, possession, or control and/or residential prop-
erty occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(I) above.
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(I) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is com-
plete.
(2) Ongoing maintenance also includes confirmation of clearance by writ-
ten certification of a qualified inspector on an annual basis in connection with submittal of the
April 15 quarterly report.
(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all oc-
cupants of all residential property that is under its ownership, possession, or control and/or resi-
dential property occupied by persons or families that receive financial or other assistance from
SUB RECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results ofthe
clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Al!reement: Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and con-
firmation of clearance ofLBP and LBP hazards from the subject dwelling unites).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions ofthe LBP REGS, the
CITY has caused to be prepared an information summary relating to the LBP REGS and applica-
tion to dwelling units that may be occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No.4 to this Agreement, attached and
hereby fully incorporated by this reference, is such information summary. CITY staff will coop-
erate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or re-
sponsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant; Quarterlv Disbursement and Match Funds. The amount
granted to SUBRECIPIENT is $25.000 ("ESG FUNDS"), and such funds shall be expended by
SUB RECIPIENT on or before June 30, 2007. The ESG FUNDS shall be disbursed by CITY to
SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete
quarterly activity report, with the final payment subject to the satisfaction of the condition prece-
dent 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
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with respect to indemnification, audits, reporting, data retention/reporting, and accounting.
In accordance with 42 USC 11375(a), SUBRECIPIENT agrees to match all federal funds
provided by CITY to SUBRECIPIENT with an equal amount of funds from sources other than
these or other ESG funds. SUBRECIPIENT cannot use ESG funds from other jurisdictions in
order to meet this match requirement. Match documentation showing new, previously unused
match dollars, must be provided with each quarterly report.
C. Use of Funds. SUBRECIPIENT agrees to use said funds pursuant to this
Agreement to pay for necessary and reasonable costs allowable under the federal law and regula-
tions to operate said program only. Said amounts shall include and will be limited to, essential
services, homeless prevention, and/or operations costs. Allowable program costs are detailed in
the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein.
SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this
Agreement, result in readjustment of the amount of funds CITY is otherwise obligated to pay to
SUB RECIPIENT pursuant to the terms hereof. SUB RECIPIENT agrees that the homeless shelter
and services under said program shall be made available for the entire period during which said
funds are provided.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
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 essential services, homeless
prevention, and/or operations costs. 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. SUB RECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUB RECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUB RECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
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, SUB RECIPIENT 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.
SUB RECIPIENT shall notity CITY immediately of any pending violations. Failure to notity CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUB RECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
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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 separate and apart from any other funds of
SUBRECIPIENT, or of any principal or member of SUBRECIPIENT, in an account in a federally
insured banking or savings and loan institution with record keeping of such accounts maintained
pursuant to applicable legal requirements. No monies shall be withdrawn from such account except
for expenditures relating to essential services, homeless prevention and/or operations costs, as
authorized hereunder.
H. Audit Report Requirements. SUB RECIPIENT agrees that if SUB RECIPIENT
receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds,
SUB RECIPIENT 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. SUB RECIPIENT 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. Further, SUB RECIPIENT
shall comply and/or cause compliance with audit report(s) required by applicable provisions of Title
X and the LBP Regs.
1. Record Keeoing/Reporting. SUB RECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the ESG REGS, Title X, and the LBP Regs, including the following:
(1) Records
a. Documentation evidencing income level of persons and/or families par-
ticipating in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUB RECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, age of children, seniors, income
verification.
d. Documentation ofhomelessness pursuant to 42 U.S.C. 11374(a)(4)
and 24 CFR 576.21.
e. Documentation of all ESG FUNDS received from CITY.
f. Documentation of expenses as identified in the Budget Proposal, in-
cluding 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 ESG FUNDS were expended, and payment therefor.
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g. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the ESG REGS.
h. Documentation evidencing compliance with all applicable provisions
of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing compli-
ance with all applicable provisions of such LBP Regs includ-
ing: (i) notification, including distribution of the lead hazard
information pamphlet (Attachment No. I), disclosure and no-
tices of hazard evaluation and reduction (Attachments No.2
and 3); (ii) evaluation oflead hazard(s), including paint test-
ing and risk assessment; (iii) reduction oflead hazard(s), in-
cluding safe work practices and clearance, and confirmation
of clearance; and (iv) ongoing maintenance, as and if appli-
cable for multifamily properties.
(ii) In this regard SUBRECIPIENT shall track information on
all personslhouseholds assisted and the housing units assisted
with the ESG FUNDS. Attachment No.5 hereto is a sample
form for tracking personslhouseholds and housing units as-
sisted with the ESG FUNDS. All categories of information
set forth in such tracking form shall be prepared and submitted
to the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not com-
plete and reasonably satisfactory information submitted in order
for CITY staff to review and evaluate compliance with applica-
ble ESG REGS and LBP Regs, then the final quarterly dis-
bursement payment shall be withheld from the
SUBRECIPIENT.
(iv) Documentation of clearance confirmation as provided
herein.
(2) Reoorts
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUB RECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
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other documentation supporting and evidencing how the ESG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant-based
rental assistance. SUB RECIPIENT agrees to provide CITY with
written cumulative (year-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
period beginning July I, and through and including the previous
three-month reporting period setting forth the activities, program
accomplishments, new program information and year-to-date
program statistics on expenditures, caseload and activities. When
appropriate, pictures should be included.
(iii) Quarterly certification of match, plus documentation of match
source.
(iv) Any such other reports as CITY (or HUD) shall reasonably
require and/or request, including but not limited to the follow-
ing information: monthly records of all ethnic and racial statistics
of persons and families benefited by SUBRECIPIENT in the per-
formance of its obligations under this Agreement, including, but
not limited to, the activities, program accomplishments, new pro-
gram information, match fund certification and current program
statistics on expenditures, caseload and activities. When appropri-
ate, pictures/slides should be included.
(3) Recordkeeping of Ongoing Maintenance under the LBP Regs. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or transi-
tional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUB RECIPIENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
residential property conducted by a DHS certified technician to ensure that LBP hazard reduc-
tion measures are maintained. All maintenance activities shall be conducted to ensure the threat
of LBP hazards is minimized.
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(4) Recordkeeoing under the LBP Regs. The SUB RECIPIENT shall keep records of dis-
tribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation re-
port, LBP hazard reduction documentations, (such as job specifications), and all clearance or
abatement report( s).
(c) The SUB RECIPIENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
I. Such records shall be maintained for not less than longer of
(A) four (4) years after the activities cease or (B) the period re-
quired by applicable program regulations. Under the ESG REGS
records shall be retained for not less than five (5) years after the
activities cease.
2. The SUBRECIPIENT shall provide a copy of any of the
above records to the CITY or to HUn upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days
of rental assistance, proper notifications to occupants and owners, HQS inspection, visual as-
sessment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The pro-
posed form of such tracking information is attached hereto as Attachment No.5 and fully incor-
porated by this reference. In the event such April 15 quarterly report does not fully satisfy the
reporting requirements set forth herein and in the LBP Regs, then the final installment payment
of the ESG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
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
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
12
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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 Keeoing. All accounting records,
reports, and evidence pertaining to all costs, expenses and the ESG 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 ESG REGS, except as
hereinafter provided relating to retention of any records or documentation existing, created, or
maintained in compliance with Title X or the LBP Regs. Records which relate to (a) complaints,
claims, administrative proceedings or litigation arising out of the performance of this Agreement,
or (b) costs and expenses of this Agreement to which CITY or any other governmental agency
takes exception, shall be retained beyond the five (5) years until complete resolution or
disposition of such appeals, litigation claims, or exceptions. All records relating to, or created or
maintained in compliance with, Title X and/or the LBP Regs shall be retained and maintained by
SUBREClPIENT indefinitely, including without limitation, all inspection report(s), disclosure
statement(s), and clearance report(s). In the event SUBRECIPIENT does not make the above-
referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to
pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location
where said records and books of account are maintained.
1. Comoliance with Law/Program Income. SUB RECIPIENT acknowledges that the
funds being provided by CITY for said program are received by CITY pursuant to applicable
ESG guidelines and that expenditures of these funds shall be in accordance with the ESG guide-
lines and all pertinent regulations issued by agencies of the federal government.
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, and all Program Re-
quirements. Program income received by SUB RECIPIENT shall be returned to CITY unless
otherwise provided for in this Agreement. SUB RECIPIENT agrees to comply fully with all fed-
eral, state and local laws and court orders applicable to its operation whether or not referred to in
this Agreement.
M. Standing. SUB RECIPIENT shall be in good standing, without suspension by the
Califomia Secretary of State, Pranchise 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,
SUB RECIPIENT shall, where applicable, maintain the confidential nature of information pro-
vided to it concerning participants in accordance with the requirements of federal and state law.
SUB RECIPIENT certifies that it will develop and implement procedures to ensure the confiden-
tiality of records pertaining to any individual provided family violence prevention or treatment
services under any project assisted under the Emergency Shelter Grants Program and that the
address or location of any family violence shelter project assisted under the Emergency Shelter
Grants Program will, except with written authorization of the person or persons responsible for
the operation of such shelter, not be made public (24 CPR 576.56). However, SUBRECIPIENT
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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 in-
curred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT agrees that the performance of obligations
hereunder are rendered in its capacity as an independent contractor and that it is in no way an agency
of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior Agreement
whereby ESG funds were received by SUB RECIPIENT, or if SUB RECIPIENT reports
inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees
to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in
violation thereof. If SUB RECIPIENT engaged in fraudulent activity to obtain and/or justifY
expenditure of the ESG funds granted hereunder, SUB RECIPIENT 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 in accordance with 24
CFR 85.32. 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
SUB RECIPIENT 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).
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T. Financial Interest. SUBRECIPIENT agrees that except for the use ofESG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to ESG activities assisted under the terms of this Agreement, or
who are in a position to participate in a decision-making process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a ESG-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. !i5.5.
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. !i5.5(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 of29 C.F.R. !i5.5. A breach of the contract clauses
in 29 C.F.R. !i5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. !i5.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. !i5.6(a)(3)].
V. Homeless Involvement. SUBRECIPIENT certifies that it will involve, to the
maximum extent practicable, homeless individuals and families in constructing, renovating,
maintaining, and operating facilities assisted under the ESG program, and in providing services for
occupants ofthese facilities [24 CFR 576.56(b); 42 USC I 1375( d)].
W. Drug Free Workplace. SUB RECIPIENT certifies that it has established the fol-
lowing drug-free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a con-
trolled 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 em-
ployees 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.
15
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3. The City and the United States 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.
5. 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.
X. Expenditure of Funds: SUB RECIPIENT must spend all of its grant amount within 24
months of the grant award (24 CFR 576.35). Any funds not obligated within said timeframe
shall be reallocated.
II. CITY'S OBLIGATIONS
A. CITY shall pay to SUBRECIPIENT from funds received under the ESG when, if and
to the extent received from HUD, amounts expended by SUBRECIPIENT in carryinpolltsaid
prograillpursuant tothis Agreement up to a maximum aggregate amount of ml1!i\'IiiJJOO:f:miIi~~
.~wmi!li,ilfilll~ ($~~~~~~) in installments determined by CITY. Payments shall be made to
SUB RECIPIENT through the submission of quarterly invoices (on or before the 15th day ofOc-
tober, 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 within the scope of this Agreement and that SUB RECIPIENT
is in compliance with the terms and conditions of this Agreement.
Costs incurred prior to the effective date of this Agreement, accrued as of the first day of
July I, for purposes identified herein will be allowable for reimbursement upon presentation of
evidence of and invoices for such expenditures.
B. Audit: CITY shall include an audit of the account maintained by SUBRECIPIENT in
CITY's annual audit of all funds pursuant to the Code of Federal Regulations and other applica-
ble federal laws and regulations.
C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day operations
of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant
program requirements and monitors grant and subgrant supported activities to assure compliance
with Federal requirements. Such monitoring covers each program, function and activity and
performance goals are reviewed periodically.
D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for
undertaking environmental review and maintaining environmental review records for each appli-
cable project.
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E. Performance Monitoring: CITY shall monitor the performance of the
SUB RECIPIENT against goals and performance standards required herein. Substandard per-
formance as determined by the CITY will constitute non-compliance with this Agreement. If
action to correct such substandard performance is not taken by the SUB RECIPIENT within a
reasonable period of time after being notified by the CITY, contract suspension or termination
procedures will be initiated.
III. NONDISCRIMINATION
SUBRECIPIENT agrees that no person on the ground of race, color, national origin, re-
ligion 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 ESG funds.
IV. CONFLICT OF INTEREST
Pursuant to the conflict of interest requirements set forth in 24 CFR 576.57 and OMB Circu-
lars 1-102 and A-I 10, SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY
having direct or indirect control of any ESG monies granted to the CITY, inclusive of the subject
ESG FUNDS, shall serve as an officer of SUB RECIPIENT . Further, any conflict or potential con-
flict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the exe-
cution of this Agreement and said writing shall be attached and deemed fully incorporated as a part
hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications
to its board of directors and list of officers
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a religious or denominational institu-
tion or organization or an organization operated for religious purposes that is supervised or con-
trolled by or in connection with a religious or denominational institution or organization;
B. Agrees that, in connection with said program:
I. It will not discriminate against any employee or applicant for employment on the
basis of religion and will not limit employment or give preference in employment to persons on
the basis of religion;
2. It will not discriminate against any person applying for participation in said pro-
gram on the basis of religion and will not limit such participation or give preference to persons
on the basis of religion;
3. It will provide no religious instruction or counseling, conduct no religious wor-
ship or services, engage in no religious proselytizing, and exert no other religious influence in
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said program;
4. The funds received under this Agreement shall not be used to construct, rehabili-
tate, or restore any facility that is owned by SUB RECIPIENT and in which said program is to be
implemented; provided that, minor repairs may be made if such repairs (I) are directly related to
said program; (2) are located in a structure used exclusively for non-religious purposes and (3)
constitute in dollar terms only a minor portion of the federal fund expenditure for said program.
VI. CONDITIONS ON PROVISIONS OF DEVELOPMENT AND IMPLEMENTING
HOMELESS PREVENTION ACTIVITIES
In addition to, and not in substitution for, other provisions of this Agreement regarding
said program using federal funds, SUBRECIPIENT:
A. Represents that it is, or may be deemed to be, a Homeless Prevention Program [24
CFR 576.2l(a)(4)] and will implement homeless prevention activities subject to the limitations
in 42 USC l1374(a)(4);
B. Agrees that, in connection with said program, if ESG funds are to be used to assist
families that have received eviction notices or notices of termination of utility services, the fol-
lowing conditions will be met:
I. The inability of the family to make the required payments must be the result of a
sudden reduction in income;
2. The assistance must be necessary to avoid eviction of the family or termination of
services to the family;
3. There must be a reasonable prospect that the family will be able to resume pay-
ments within a reasonable period of time; and
4. The assistance must not supplant funding for preexisting homeless prevention ac-
tivities from any other source.
VII. 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 "imme-
diate 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.
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VIII. 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 CA 92702-1988
TO SUB RECIPIENT:
Rocio Gonzalez
Executive Director
WTLC
P.O. Box 6103
Orange, CA 92863
IX. ASSIGNABILITY
None of the duties of, or work to be performed by, SUB RECIPIENT under this Agree-
ment shall be subcontracted or assigned to any agency, consultant, or person without the prior
written consent of CITY. SUB RECIPIENT 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 SUB RECIPIENT pursuant to this Agreement.
X. HOLD HARMLESS
SUB RECIPIENT shall defend, indemnify and save harmless CITY, its officers, agents,
employees, representatives and volunteers from and against any and all damages to property or
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, agents, employees, rep-
resentatives and volunteers from and against any and all claims, demands, suits, actions or pro-
ceedings 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 SUBRECIPI-
ENT's performance of this Agreement.
XI. TERMINATION
This Agreement may be terminated in accordance with Federal Register 24 CFR Part 576
as follows:
A. This Agreement may be terminated by CITY on thirty (30) days' written notice by ei-
19
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ther party. In the event of such termination, SUBRECIPIENT shall only be entitled to reim-
bursement 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 SUB RECIPIENT of Federal, state and/or local laws governing the use of
Emergency Shelter Grant funds. Furthermore, the SUBRECIPIENT shall comply with the Con-
ditional Use permit requirements. For failure to comply with the aforementioned terms, suspen-
sion or termination shall result, and SUB RECIPIENT shall only be entitled to reimbursement for
approved expenses incurred up to the effective date of suspension or termination.
C. In the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations
hereunder, CITY may declare a default and termination of the 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 no-
tice, 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 (I) any pay-
ments 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.
E. The grant of funds under this Agreement may be terminated due to the non-
performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work de-
scribed in Exhibits A and B or failure to meet the performance standards and program goals set
forth therein.
F. In the event this Agreement is terminated as set forth in Section X.A through X.E, in-
clusive, SUB RECIPIENT agrees to immediately return to CITY, upon CITY's demand and prior
to any adjudication of SUB RECIPIENT's rights, any and all funds not used under this Agree-
ment.
XII. LIMITATION OF FUNDS
The United States of America, through HUD, may, in the future, place programmatic or
fiscal limitations on the use of ESG funds which limitations are not presently anticipated. Ac-
cordingly, 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
20
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CITY in implementing and effecting such a reduction and in revising, modifying, or amending
the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall
be allowed to de-scope accordingly. Where CITY has reasonable grounds to question SUBRE-
CIPIENT'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 le-
gally binding commitments made by SUB RECIPIENT before it received notice of such revision,
provided that such amounts have been committed in good faith and are otherwise allowable and
that such commitments are consistent with HUD cash withdrawal guidelines.
XIII. INSURANCE
A. SUB RECIPIENT shall furnish CITY's Clerk of the Council with an insurance certifi-
cate from its workers' compensation insurance carrier certifying that it carries such insurance and
that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior
notice to CITY.
B. SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a pol-
icy or policies of commercial general liability insurance, or equivalent form, with a combined
single limit of not less than $1 Million Dollars per occurrence.
Such insurance shall: (I) name the City of Santa Ana, its officers, agents, employees and
volunteers as additional insureds; (2) be primary with respect to insurance or self-insurance pro-
grams 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 SUBRE-
CIPIENT's operations hereunder.
SUBRECIPIENT shall: (i) 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; (ii) provide that such insurance shall
not be materially changed or terminated except on thirty (30) days prior written notice to the
CITY; (iii) 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.
XIV. EXCLUSIVITY AND AMENDMENT TO AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing, be-
tween the parties hereto with respect to the use of CITY's ESG funds by SUB RECIPIENT 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 any-
one 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
21
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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 af-
fect 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
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A
waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be
performed by the other shall not be construed to be a waiver of any succeeding breach thereof or
of any other covenant, condition or agreement herein contained.
22
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date
and year first above written.
ATTEST:
LA
PATRICIA E. HE
Clerk of the Council
CITY OF SANTA ANA
a municipal corporation
ItntA'
(ll{ DA lD N. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
~:(~
By: LISA E. STORCK
Assistant City Attorney
SUBRECIPIENT:
Name:Rocio Gon
Title:Executiv. irector
Tax lD#51-020l813
DATED:
23
City of Santa Ana
Emergency Shelter Grant
Scope of Work
Name of Organization- Women's Transitional Living Center. Inc. (WTLC)
Name of Funded Program- Emergencv Shelter Programs
Annual Accomplishment Goal
I. Total number ofunduplicated clients (Santa Ana and Non-Santa Ana Residents) anticipated to be served by
the funded program, named above, during the l2-month contract period.
575 PERSONS
II. Number of only unduplicated Santa Ana residents to be served by the funded program, named above,
during the l2-month contract period.
108 PERSONS
Program and Funding Description
III. Description of Work - In the space below, describe the program to be funded during the 12-month
contract period.
The Emergency Shelter Programs (45/90-day program, Safety Net Motel Program) will provide safe, stable residences for victims of
domestic violence, with or without children. Clients are accepted regardless of mental health and/or substance abuse problems. These
shelters are the only ones in Orange County to accept this client population. During their stay, adults will become more emotionally
and fmancially stable, learn new job skills and/or finesse those already used in the job market. Any addictions will be overcome and,
upon leaving the program, clients will remain safe, increase their income, and be prepared to acquire permanent housing. Clients will
receive services such as case management, counseling, educational classes, legaVimmigration advocacy, job training/placement,
work experience, shelter, food, clothing, 24/7 hotline, substance abuse treatment, drug testing, a therapeutic children's program,
career classes, career clothing, and more - all designed to improve clients' financial and housing situations.
IV. Activities funded by this grant - How will ESG funds be used for the funded program? Narratively
describe the budget for the funded program illustrated in Exhibit B and B-1.
Funding will be used to partially pay the salary ($18,500) ofa Facility/Maintenance staff person. Three full-time facility personnel
are responsible for maintenance, repair, food/menu preparation, cleaning, picking up donations/food and more as needed.
Funding will also be used to pay for utilities ($2,500), office supplies ($2,000) and communications ($2,500). This includes gas,
electric and water under the utilities classification and internet and telephone under the communications classification and office
supplies for the emergency shelter program.
Exhibit A
Page 1 of2
Schedule of Performance
Estimate the number of only unduplicated Santa Ana residents to be served by the funded program during the
l2-month contract period per quarter. (How many new Santa Ana clients will be served each quarter.)
Quarter I: Julyl - September 30
Quarter 2: October! - December 31
Quarter 3: January I ~ March 31
Quarter 4: April 1 - June 30
~Persons
~Persons
~Persons
~Persons
lQLTotal number ofunduplicated Santa Ana residents to be
served. (Must equal the number for II above.)
Schedule ofInvoicing
Estimate the amount of grant funds to be requested during the l2-month contract period on a quarterly basis.
Quarter I: July I - September 30
Quarter 2: October! - December 31
Quarter 3: January I ~ March 31
Quarter 4: April 1 - June 30
$6.250
$6,250
$6.250
$6,250
$25,OOOTotal Grant (Must equal the Total Program Budget
indicated on Exhibit B.)
Exhibit A
Page 2 of2
.
CITY OF SANA ANA
Emergency Shelter Grant
Outcome Tracking
IMPORTANT: The City of Santa Ana is in the process of incorporating the new HUD Performance
Outcome Tracking guidelines, therefore this section is subject to change in order to be compliant with
HUD regulations. If the situation should occur that the current tracking system is not sufficient to meet
HUD regulations an amendment to this contract will be needed.
Instructions: From the list of activities below select the activity that best describes the purpose of the program that will be funded
in fiscal year 06-07 by these grant funds. Two activities have multiple outcomes, therefore if "Senior Services" or "Youth Services" is
selected, please select the one outcome that best describes the purpose of the funded program. ONLY if none of the activities listed
adequately describe the funded program, please select that last activity "Low- and Moderate Income Services".
Fulfillment
Tra~king HUn Objedive to be fullUted HUD Outcome to be fulfilled iUustrated by
HUn Indicator
Suitable Creating Specific Outcome
Activity/Program Outcome Tracking Goal Living Decent Economic A vailabilityl Affordability Sustainabilit Indicator #
Environment Housing Opportunitie Accessibility (Please see page 4
of 4 for desc.)
I.nti-CrimeServiccs Ire:klhereduclionin lReducc response lime to
sponsetimeandthe senous crimes in the City's
jnumberofcriminal lLow-andModeratc-Income
D apprehended as a result. area by at least 3 minutes
lresulting in the apprehension 2
fl,500criminalslhatmay X X
Iherwisecscape.
U*5_year goal to be
achieved by FY 09/10
air Housing Services Provide fair housing scrvice \.Providefairhousing
and ongoing analysis of ounseling, education and
impediments to fair housing. nforcement services to
D 7,000 Santa Ana households. X X 2
."5-yeargoal to be
chievedbyFY09/IO
. Annuallyassessactionsll: 2
Iiminate impediments to fai X X
ousing.
lHomelcssnessPrevention rack assisted individuals 0% of assisted individuals
!who retained their housing or ndhooseholds will retain
tiliticsforatleast6months their housing or utiHties for 14
D fter assistance was at least 6 months afier X X
jprovided. ssistance is provided.
IEmergencyShelter Track individuals who 50% of
!received support services individualSlhouscholdsthat 12 or
that were linked to one or re provided with cmcrgency
[8J !more additional support helterwill transition to X X
serviceandlorappropriate 'nterim housing (i.e., 13
ousmg. ransitionalhousing}.
ransitionalHousing Track homeless individuals % of homeless individuals
Iwho participated in articipating in transitional 2
~a:Sitionalhousingprogram oosing program will be X X
D at were placed in laced in permanent housing.
IPermancnthousing.
upportiveServices Track individuals who 5O%ofindividuals/families
lreccivcd support services lreceiving support services
that were linked to one or ill be linked to one or more 2
D more additional support dditionalsupportservice X X
serviccandlorappropriate ndlorappropriatehousing.
ousing.
Exhibit A-I
Page 1 of4
.
Fulfillment
illustrated by
Trackino Hun Ob' ective to be fulfilled Hun Outcomes to be fulmled Hun Indicator
Suitable Creating Specific Outcome
Activity/Program Outcome Tracking Goal Living Decent Economic Availability! Affordability Sustainabilit) Indicator #
Housing Accessibility (Please see page 4
Environment Iopportunitic of 4 fOf desc.)
SeniorServiccs L Track assisted senior I. 80''10 of assisted senior
citizens that remained itizenswill remain
0 independent for at least 1 independent for at least 1 X X 2
year aftcrscrvices were year,after services are
~ovidcd. rovlded.
2. Track seniors receiving . 90% of seniors receiving
fenalsthatwerclinkedto eferrals will be linked to the
0 lhe services sought. services sought. X X 2
Owner-Occupied umberofownersllSsisted hysical safety and comfort
ousingRehabiJitalion rehabilitate their primary ill be improved for Low
sidcnccforthefollowing nd Modcrate incomc
incnmccatcgories: ouseholds by improving
0 Extremely Low lncome omestoalcvelthatmeels 9
Very Low Income or exceeds HUD housing X X
Moderatclncome ualitystandards
Special Needs Categories
-Large Families
rail Elderly Services Track frail elderly 90% of frail elderly
individuals that were linked "ndividualswill be linked to 2
0 to the services soughL he services soughL X X
isabledServices rack disables persons Support independent living
hose indcpendcnt living for 90% of disabled persons 2
0 as supported by City funds. ssistedbyCityfunds. X X
ervices for Mentally III Track individuals assisted 100% of individuals assisted
with City resources that were ith City resources will be
0 provided an entry point into rovided ancntry point into
lheregional mental health he regional mental health X X 2
care system and linked to at are systcm and linked to at
least one addilional mental east one additional mental
health supportive service. ealth supportive scrvice.
ervices for Substance Track how many individuals f>rovide entry into the
ddicted ithsubstanceaddictionin egional recovery systcm for
were providcd an entry into Sindividualswilh
the regional recovery system substance addiction and link
0 and linked to additional hem to additional services. 2
servIceS. X X
....S-year goal to be
lChieved by FY 09/10
outhServices I. Track improvement in I. For education-based
Jre-test, post-test scores. ograms, improve pre-test 2
0 ost-testscoresby50% X X
2. Tracknumberof . Provideopportuniliesfor
0 individuals exposed to the xposure to the fine arts. X X 2
fine arts.
0 3. Trackchildrenlyouth .90%ofchildrcnlyouth
seeking referrals that were eking referrals will be X X 2
linked to the services sought. linked 10 the services sought.
Low_and Moderate- ~tCk program participants 190% of program participants
ncomeServices twerelinkedtoservices Iwill be linked to services 2
sought. sought. X X
0
Exhibit A-I
Page 2 of 4
Description of Outcome Tracking System:
Please describe your organization's outcome tracking system that will enable you to fulfill the outcome selected above.
WTLC utilizes a database called "Alice" to keep track of all client information (i.e., demographic information, services provided,
names of staff providing services, amount/date of services provided, intake/exit information, children's information, hotline
information). In addition to the client information kept on Alice, spread sheets are also maintained, outlining client test results
(outcome measurement pre/post-tests). For the outcome selected above (Supportive Services), a combination of Alice and spread sheets
would be utilized. Alice information would detail which supportive services were provided by WTLC and the amount each client
received, which services referrals were made to (i.e., housing, other shelter programs, financial assistance, medical, etc.), overall status
of client upon entering program and again upon exit (new finances acquired, jobs applied for, work experience) and follow-up
information. Spread sheets will be used to enter results aftests used to determine emotional improvement while in the shelter. Tests
used include: Beck Depression/Anxiety Inventories, Purpose in Life Test, Client Symptom Checklist (for adults and children), Gang
Intervention Test, and Client Satisfaction Surveys. These are all pre/post-tests and will be used to determine effectiveness of program
for clients1 emotional wellfbeing
Exhibit A-I
Page 3 of 4
Specific Outcome Indicators
2) Public service activities
Number of persons assisted:
. with new access to a service
. with improved access to a service
· where activity was used to meet a quality standard or measurably improved quality, report the number
that no longer only have access to substandard service
9) Owner occupied units rehabilitated or improved
Total number of units:
Number occupied by elderly
Number of units brought from substandard to standard condition (HQS or local code)
Number qualified as Energy Star
Number of units brought into compliance with lead safe housing rule (24 CFR part 35)
Number of units made accessible for persons with disabilities
12) Number of homeless persons given overnight shelter
13) Number of beds created in overnight sheIter or other emergency housing
14) Homelessness Prevention
· Number of households that received emergency financial assistance to prevent
homelessness
· Number of households that received emergency legal assistance to prevent
homelessness
Exhibit A-I
Page 4 of 4
Program Year 2006-2007
Final Budget
Organization Name Women's Transitional Living Center, Inc. (WTLC)
Program Name Emeraencv Shelter Proarams
Expenditures
Expenses Funded by Expenses Funded Total Program Total Organizational
Cate 0 Santa Ana ESG b Other Sources Bud et Bud et
Administrative Staff
Salaries & Benefits $ $ 336,565
Program Staff Salaries &
Benefj1s
Contractual/Professional
Services: List below
1 $
2 $
3
Office Su lies $ 2,000 $ 9,000 11,000 27,000
Rent 27,041
Communications $ 2,000 13,500 15,500 31 ,450
Utilities $ 2,500 21,553 24,053 47,775
Insurance 12,400 12,400 35,000
Other:List below
Facility
1 Personnel/Maintenance $ 18,500 $ 26,950 $ 45,450 $ 37,000
2 AudiULegal $ $ 25,000
3 Program Supplies $ 22.000 $ 22,000 $ 111,782
4 $
5 $
Total $ 25,000 $ 676,917 $ 701,917 $ 1,657,618
LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED FOR 06-07
(Total Funds for Program must equal Total Program Budget above)
Source Amount
Santa Ana ESG $ 25,000
Government Grants $ 403,525
Pro ram Income $ 174,775
Foundation/Cor orate Grants $ 98,617
Total Funds for Pro ram
Exhibit B
Page 1 of 1
$
701,917
2006-2007 Funded Personnel
Name of Organization:
Name of Program
Women's Transitional Living Center, Inc. (WTLe)
Emergency Shelter Programs
ADMINISTRA TIVE STAFF
Position Title Annual Annual Total ESG Funds % of time Of this time % of Total
Salary Benefits Compensation Requested for spent on percent of Compensation
this position funded time selVing Eligible
nrol!ram Santa Ana
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
Total Amount Reouested $ -
Must equal amount indicated on Exhbit B
PROGRAM STAFF
Position Title Annual Annual Total ESG Funds % of time Of this time % of Total
Salary Benefits Compensation Requested for spent on percent of Compensation
this position funded time serving Eligible
nrol!ram Santa Ana
Bililllrual Client Advocate/ $ - 0%
Case Manaller $ 35 700 $ 12579 $ 48 279 $ 20 000 100% 75% 75%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
Total Amount Renuested $ 20,000
Must equal amount indicated on Exhbit B
CONTRACTUAL/PROFESSIONAL SERVICES
Position Title Annual Annual Total ESG Funds % of time Of tbis time % cfTotal
Contract Benefits Compensation Requested for spent on percent of Compensation
Amount this position funded time serving Eligible
nroQram Santa Ana
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
$ - 0%
Total Amount Reauested $ -
Must equal amount indicated on Exhbit B
"'''''''Please note for personnel whose time is not directly traced to serving Santa Ana and instead a percentage is used please
confirm the percentage is accurate prior to requesting reimbursement.
Exhibit 8-1
Page 1 of1
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(I) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee 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.
Women's Transitional Living Center, Inc. (WTLC)
Grantee/Contactor Organization
Emergency Shelter Programs
Program Title
--
---...-
Rocio Watson
Name of Certifying Officer
LJ;:-
/
-
;/
Date
EXHIBIT C
Page I of2
SUBRECIPIENT warrants the following:
I. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis-Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUB RECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUB RECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of2
If you think your home has high
levels of lead:
.. Get your young children tested for lead, even if
they seem healthy.
.. Wash children's hands, bottles, pacifiers, and toys
often.
.. Make sure children eat healthy, low-fat foods.
.. Get your home checked for lead hazards.
.. Regularly clean floors, window sills, and other
surfaces.
.. Wipe soil off shoes before entering house.
.. Talk to your landlord about fixing surfaces with
peeling or chipping paint.
.. Take precautions to avoid exposure to lead dust
when remodeling or renovating (call 1-800-424-
LEAD for guidelines).
.. Don't use a belt-sander, propane torch, high
temperature heat gun, scraper, or sandpaper on
painted surfaces that may contain lead,
.. Don't try to remove lead-based paint yourself.
Are You Planning To Buy, Rent, or Renovate
a Home Built Before t 9781
Many houses and apartments built before 1978 have
paint that contains high levels of lead (called lead-
based paint). Lead from paint, chips, and dust can
pose serious health hazards if not taken care of properly.
OWNERS, BUYERS, and RENTERS are
encouraged to check for lead (see page 6)
before renting, buying or renovating pre-
1978 housing.
F ederallaw requires that individuals receive certain
information before renting, buying, or renovating
pre- 1978 housing:
~.,.""
i FOIl <
,R~lj
LANDLORDS have to disclose known infor-
mation on lead-based paint and lead-based
paint hazards before leases take effect.
Leases must include a disclosure about
lead-based paint.
SELLERS have to disclose known informa-
tion on lead-based paint and lead-based
paint hazards before selling a house. Sales
contracts must include a disclosure about
lead-based paint. Buyers have up to 10
days to check for lead.
RENOVATORS disturbing more than 2 square
feet of painted surfaces have to give you
this pamphlet before starting work.
IMPORTANT!
lead from Paint, Dust, and
Soil Can Be Dangerous If Not
Managed Properly
FACT: Lead exposure can harm young
children and babies even before they
are born.
FACT: Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead-based
paint that is in good condition is not a
hazard.
FACT: Removing lead-based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
Lead Gets in the Body in Many Ways
Childhood
lead
poisoning
remains a
major
environmen-
tal health
problem in
the U.S.
Even children
who appear
healthy can
have danger-
ous levels of
lead in their
bodies.
2
People can get lead In their body If they:
.. Breathe in lead dust (especially during
renovations that disturb painted
surfaces).
.. Put their hands or other objects
covered with lead dust in their mouths.
.. Eat paint chips or soil that contains
lead.
Lead Is even more dangerous to children
under the age of 6:
.. At this age children's brains and nervous
systems are more sensitive to the dam-
aging effects of lead.
.. Children's growing bodies absorb more
lead.
.. Babies and young children often put
their hands and other objects in their
mouths. These objects can have lead
dust on them.
Lead Is also dangerous to women of
childbearing age:
.. Women with a high lead level in their
system prior to pregnancy would expose
a fetus to lead through the placenta
during fetal development.
lead's Effects
It is important to know that even exposure
to low levels of lead can severely harm
children.
In children, lead can cause:
. Nervous system and kidney damage.
. Learning disabilities, attention deficit
disorder, and decreased intelligence.
. Speech, language, and behavior
problems.
. Poor muscle coordination.
. Decreased muscle and bone growth.
. Hearing damage.
While low-lead exposure is most
common, exposure to high levels of
lead can have devastating effects on
children, including seizures, uncon-
sciousness, and, in some cases, death.
Although children are especially
susceptible to lead exposure, lead
can be dangerous for adults too.
In adults, lead can cause:
. Increased chance of illness during
pregnancy.
. Harm to a fetus, including brain
damage or death.
. Fertility problems (in men and women).
. High blood pressure.
. Digestive problems.
. Nerve disorders.
. Memory and concentration problems.
. Muscle and joint pain.
Brain or Nerve Damage
Reproductive
Problems
(Adults)
lead affects
the body in
many ways.
3
.
Where Lead-Based Paint Is found
In general,
the older your
home, the
more likely it
has lead-
based paint.
Many homes built before 1978 have lead.
based paint. The federal government
banned lead-based paint from housing in
1978. Some states stopped its use even
earlier. Lead can be found:
.. In homes in the city, count'Y, or suburbs.
.. In apartments, single-family homes, and
both private and public housing.
.. Inside and outside of the house.
.. In soil around a home. (Soil can pick up
lead from exterior paint or other sources
such as past use of leaded gas in cars.)
Checking Your family for Lead
Get your
children and
home tested
if you think
YOUI' home
has high lev-
els of lead.
4
To reduce your child's exposure to lead,
get your child checked, have your home
tested (especially If your home has paint
In poor condition and was built before
1978), and fix any hazards you may have.
Children's blood lead levels tend to increase
rapidly from 6 to 12 months of age, and
tend to peak at 18 to 24 months of age.
Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usually recommended for:
.. Children at ages 1 and 2.
.. Children or other family members who
have been exposed to high levels of lead.
.. Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
.
Identifying lead Hazards
Lead-based paint is usually not a hazard if
it is in good condition, and it is not on an
impact or friction surface, like a window. It
is defined by the federal government as
paint with lead levels greater than or equal
to 1.0 milligram per square centimeter, or
more than 0.5% by weight.
Deteriorating lead-based paint (peeling,
chipping, chalking, cracking or damaged)
is a hazard and needs immediate attention.
It may also be a hazard when found on sur-
faces that children can chew or that get a
lot of wear-and-tear, such as:
. Windows and window sills.
. Doors and door frames.
. Stairs, railings, banisters, and porches.
Lead dust can form when lead-based paint is scraped, sanded, or
heated. Dust also forms when painted surfaces bump or rub togeth-
er. Lead chips and dust can get on surfaces and objects that people
touch. Settled lead dust can re-enter the air when people vacuum,
sweep, or walk through it. The following two federal standards have
been set for lead hazards in dust:
. 40 micrograms per square foot (J1gift2) and higher for floors,
including carpeted floors.
. 250 J.lgift2 and higher for interior window sills.
Lead In soli can be a hazard when children play in bare soil or
when people bring soil into the house on their shoes. The following
two federal standards have been set for lead hazards in residential
soil:
lead from
paint chips,
which you
can see, and
lead dust,
which you
can't always
see, can both
be serious
hazards.
. 400 parts per million (ppm) and higher in play areas of bare soil.
. 1,200 ppm (average) and higher in bare soil in the remainder of
the yard.
The only way to find out if paint, dust and soil lead hazards exist is
to test for them. The next page describes the most common meth-
ods used.
5
Checking Your Home for lead
Just knowing
that a home
has lead-
based paint
may not tell
you if there
is a hazard.
6
You can get your home tested for lead in
several different ways:
. A paint Inspection tells you whether your
home has lead-based paint and where it
is located. It won't tell you whether or not
your home currently has lead hazards.
. A risk assessment tells you if your home
currently has any lead hazards from lead
in paint. dust, or soil. It also tells you what
actions to take to address any hazards.
. A combination risk assessment and
inspection tells you if your home has
any lead hazards and if your home has
any lead-based paint, and where the
lead-based paint is located.
Hire a trained and certified testing profes-
sional who will use a range of reliable
methods when testing your home.
. Visual inspection of paint condition
and location.
. A portable x-ray fluorescence (XRF)
machine.
. Lab tests of paint. dust, and soil
samples.
There are state and federal programs in
place to ensure that testing is done safely,
reliably. and effectively. Contact your state
or local agency (see bottom of page 11) for
more information, or call 1.800-424.LEAD
(5323) for a list of contacts in your area.
Home test kits for lead are available, but
may not always be accurate. Consumers
should not rely on these kits before doing
renovations or to assure safety.
What You Can Do Now To Protect
Your Family
If you suspect that your house has lead
hazards, you can take some Immediate
steps to reduce your family's risk:
. If you rent, notify your landlord of
peeling or chipping paint.
. Clean up paint chips Immediately.
. Clean floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMONIA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
. Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
. Wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
. Keep play areas clean. Wash bottles,
pacifiers, toys, and stuffed animals
regularly.
. Keep children from chewing window
sills or other painted surfaces.
. Clean or remove shoes before
entering your home to avoid
tracking In lead from soli.
. Make sure children eat
nutritious, low-fat meals high
In Iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
., .
~::;? &:::;.i.':><t~';:;;<-';'
~
YOGURT
7
.
Reducing lead Hazards In The Home
Removing
lead
improperly
can increase
the hazard to
your family
by spreading
even more
lead dust
around the
house.
Always use a
professional who
is trained to
remove lead
hazards safely.
8
In addition to day-to-day cleaning and good
nutrition:
. You can temporarily reduce lead hazards
by taking actions such as repairing dam-
aged painted surfaces and planting grass
to cover soil with high lead levels. These
actions (called "interim controls") are not
permanent solutions and will need ongo-
ing attention.
. To permanently remove lead hazards,
you should hire a certified lead "abate-
ment" contractor. Abatement (or perma-
nent hazard elimination) methods
include removing, sealing, or enclosing
lead-based paint with special materials.
Just painting over the hazard with regular
paint is not permanent removal.
Always hire a person with special training
for correcting lead problems-someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly. Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Once the work is completed, dust cleanup
activities must be repeated until testing
indicates that lead dust levels are below the
following:
. 40 micrograms per square foot (j..tglft2)
for floors, including carpeted floors;
. 250 /lglft2 for interior windows sills; and
. 400 /lglft2 for window troughs.
Call your state or local agency (see bottom
of page 11) for help in locating certified
professionals in your area and to see if
financial assistance is available.
.
Remodeling or Renovating a Home With
lead-Based Paint
Take precautions before your contractor or
you begin remodeling or renovating any-
thing that disturbs painted surfaces (such
as scraping off paint or tearing out wails):
. Have the area tested for lead-based
paint.
. Do not use a belt-sander, propane
torch, high temperature heat gun, dry
scraper, or dry sandpaper to remove
lead-based paint. These actions create
large amounts of lead dust and fumes.
Lead dust can remain in your home
long after the work is done.
. Temporarily move your family (espe-
ciaily children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area.
. follow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
t -800-424-LEAD. Ask for the brochure
"Reducing Lead Hazards When
Remodeling Your Home." This brochure
explains what to do before, during,
and after renovations.
If you have already completed renova-
tions or remodeling that could have
released lead-based paint or dust, get
your young children tested and foilow
the steps outlined on page 7 of this
brochure.
If not
c.onducted
properly,
c.ertain types
of renova-
tions can
release lead
from paint
and dust into
the air.
9
Other Sources of Lead
While paint, dust,
and soil are the
most common
sources of lead.
other lead
sources also exist,
10
. Drinking water, Your home might have
plumbing with lead or lead solder. Call
your local health department or water
supplier to find out about testing your
water. You cannot see, smell, or taste
lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
. Use only cold water for drinking and
cooking.
. Run water for 15 to 30 seconds
before drinking it, especially if you
have not used your water for a few
hours.
. The job. If you work with lead. you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
. Old painted toys and furniture.
. Food and liquids stored in lead crystal
or lead-glazed pottery or porcelain.
. Lead smelters or other industries that
release lead into the air.
. Hobbles that use lead, such as making
pottery or stained glass. or refinishing
furniture.
. folk remedies that contain lead. such as
"greta" and "azarcon" used to treat an
upset stomach.
for More Information
The National Lead Information Center
Call1-SOO-424-LEAD (424-5323) to learn
how to protect children from lead poisoning
and for other information on lead hazards.
To access lead information via the web, visit
www.epa.govlIead and
www.hud,gov/offlceslIead/.
EPA's Safe Drinking Water Hotline
Call1-SOO-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission (CPSC) Hotline _____
:;:~';:' =::,~";, :~ ~~o m ~JJ
unsafe consumer product or a prod- . .
uct-related injury call 1-SOO-63S-
2772, or visit CPSC's Web site at: c:::::::=' ---=
www.cpsc.gov.
Health and Environmental Agencies
Some cities, states, and tribes have
their own rules for lead-based paint
activities. Check with your local agency to
see which laws apply to you. Most agencies
can also provide information on finding a
lead abatement firm in your area, and on
possible sources of financial aid for reducing
lead hazards. Receive up-to-date address
and phone information for your local con-
tacts on the Internet at www.epa.govlIead
or contact the National Lead Information
Center at 1-SOO-424-LEAD.
For the hearing impaired, call the federal Information
Relay Service at 1-800-877-8339 to access any of
the phone numbers in this brochure.
11
EPA Regional Offices
Your Regional EPA Office can provide further information regard-
ing regulations and lead protection programs.
EPA Regional Offices
Region t (Connecticut. Massachusetts,
Maine. New Hampshire. Rhode Island,
Vermont)
Regional Lead Contact
U.s. EPA Region I
Suite 1100 (CPT)
One Congress Street
Boston. MA 02114-2023
1 (888) 372-7341
Region I (New Jersey, New York.
Puerto Rico. Virgin Islands)
Regional lead Contact
liS. EPA Region 2
2890 \Abodbridge Avenue
Building 209, Mail Stop 225
Edison. NJ 08837-3679
(732) 321-6671
Region 3 (Delaware. Maryland.
Pennsylvania, Vlrglnla, Washington DC,
West Virginia)
Regional Lead Contact
liS. EPA Region 3 (3WC33)
1650 Arch Street
PhiladelphIa. PA 19103
(215) 814-5000
Region 4 (Alabama. Florida. Georgia.
Kentucky, MississippI. North Carolina.
South Carolina, Tennessee)
RegionaJ Lead Contact
liS. EPA Region 4
61 Forsyth Street. SW
Atlanta. GA 30303
(404) 562-8998
Region 5 (illinois. Indiana. Michigan.
Minnesota, Ohio. Wisconsin)
Regional Lead Contact
liS. EPA Region 5 (DT-8))
77 West Jackson Boulevard
Chicago. Il 60604-3666
(312) 886-6003
12
Region 6 (Arkansas, Louisiana. New
Mexico, Oklahoma, Texas)
Regional Lead Contact
liS. EPA Region 6
1445 Ross Avenue, 12th Floor
Dallas. rx 75202-2733
(214) 665-7577
Region 7 (Iowa, Kansas, Missouri,
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
(ARTD-RAlI)
901 N. 5th Street
Kansas City. KS 66101
(913) 551-7020
Region 8 (Colorado, Montana, North
Dakota. South Pakota. Utah. '^Yoming)
Regional lead Contact
US. EPA Region 8
999 18th Street, Suite 500
Denver. CO 80202-2466
(303) 312-6021
Region 9 (Arizona, California, Hawaii,
Nevada)
Regional lead Contact
US. Region 9
75 Hawthorne Street
San Francisco, CA 94105
(415) 947-4164
Region 10 (Alaska. Idaho. Oregon,
Washington)
Regional lead Contact
US. EPA Region 10
Toxlcs Section WCM-128
1200 Sixth Avenue
Seattle. WA 98101-1128
(206) 553-1985
CPSC Regional Offices
Your Regional CPSC Office can provide further information regard-
ing regulations and consumer product safety.
Eastern Regional Center
Consumer Product Safety Commission
201 Varick Street. Room 903
New York. NY 10014
(212) 620-4120
Western Regional Center
Consumer Product Safety Commission
1301 Clay Street. Suite 61 O-N
Oakland. CA 94612
(510) 637-4050
Central Regional Center
Consumer Product Safety Commission
230 South Dearborn Street, Room 2944
Chicago. Il 60604
(312) 353-8260
Hun Lead Office
Please contact HUD's Office of Healthy Homes and Lead Hazard
Control for information on lead regulations, outreach efforts, and
lead hazard control and research grant programs.
u.s. Department of Housing and Urban Development
Office of Healthy Homes and Lead Hazard Control
451 Seventh Street. SW. P-3206
Washington, DC 20410
(202) 755-1785
This document is in the public domain. It may be reproduced by an individual or
organization without permission. Information provided in this booldet Is based
upon current scientific and technical understanding of the Issues presented and
is reflective of the jurisdictional boundaries established by the statutes governing
the co-authoring agencies. following the advice given will not necessarily pro-
vide complete protection In all situations or against all health hazards that can
be caused by lead exposure.
U.S. EPA Washington DC 20460
U.S. CPSC Washington DC 20207
U.S. HUD Washington DC 20410
EPA747-K-99-001
June 2003
13
Disclosure of Infonnation on Lead-Based Paint and/or Lead-Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead-based paint Lead from paint paint chips, and dust can pose
health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant
women. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/or
lead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead
poisoning prevention.
Lessor's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (iI) below):
(i) Known lead-based paint and/or lead-based paint hazards are present in the housing
(explain).
(ii) _ Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the
housing.
(b) Records and reports available to the lessor (check (i) or (ii) below):
(i) Lessor has provided the lessee with all available records and reports pertaining to
lead-based paint and/or lead-based paint hazards in the housing (list documents
below).
(ii) _ Lessor has no reports or records pertaining to lead-based paint and/or lead-based
paint hazards in the housing.
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Proted Your Family from Lead in Your Home.
Agenfs Acknowledgment (initial)
(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.c. 4852(d) and
is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.
Date
Lessor
Date
Lessor
Lessee
Date
Lessee
Date
Agent
Date
Date
Agent
Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Lead Warning Statement
Every purchaser of any interest in residential real property an which a residential dwelling was built prior to 1978 is
natified that such property may present exposure to lead from lead-based paint that may place young children at risk
of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage,
including learning disabilities, reduced intelligence quotient behavioral problems, and impaired memory. Lead
poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real property is
required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspections
in the sellers possession and notifY the buyer of any known lead-based paint hazards. A risk assessment or inspection
for possible lead-based paint hazards is recommended prior to purchase.
Seller's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):
(i) Known lead-based paint and/or lead-based paint hazards are present in the housing
(explain).
(ii) _ Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to the seller (check (i) or (ii) below):
(i) _ Seller has provided the purchaser with all available records and reports pertaining to lead-
based paint and/or lead-based paint hazards in the housing (list documents below).
(ii) _ Seller has no reports or records pertaining to lead-based paint and/or lead-based paint
hazards in the housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
(d) Purchaser has received the pamphlet Proted Your Family from Lead in Your Home.
(e) Purchaser has (check (i) or (ii) below):
(i) _ received a lO-day opportunity (or mutually agreed upon period) to conduct a risk assess-
ment or inspection for the presence of lead-based paint and/or lead-based paint hazards; or
(ii) _ waived the opportunity to conduct a risk assessment or inspection for the presence of
lead-based paint and/or lead-based paint hazards.
Agenfs Acknowledgment (initial)
(t) Agent has informed the seller of the seller's obligations under 42 u.s.e 4852(d) and is
aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the
information they have provided is true and accurate.
Date
Seller
Date
Seller
Purchaser
Date
Purchaser
Date
Agent
Date
Agent
Date
Appendix A--Sample Summary Inspection Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations
Summary Notice of Lead-Based Paint Inspection
Address/location of property or structure(s) this summary notice
applies to:
J-------------------------------------_________________________________
J------------------------------------------____________________________
J-----------------------------------------_____________________________
Lead-based paint inspection description:
Date(s) of inspection:------------------------------------___________
Summary of inspection results (check all that apply) :
(a) No lead-based paint was found.
(b) ____ Lead-based paint was found.
(c) A brief summary of the findings of the inspection is
provided below (required if lead-based paint found) .
Summary of where lead-based paint was found. List at least the
housing unit numbers and common areas (for multifamily housing), and
building components (including type of room or space, and the
material underneath the paint) :
[----------------------------------------------------------------------
]----------------------------------------------------------------------
u----------------------------------------______________________________
l--------------------------------------________________________________
J--------------------------------------________________________________
l-------------------------------------------___________________________
j----------------------------------------------------------------------
c-------------------------------------_________________________________
[----------------------------------------------------------------------
]----------------------------------------------------------------------
J--------------------------------------________________________________
l----------------------------------____________________________________
j----------------------------------------------------------------------
]----------------------------------------------------------------------
Contact person for more information about the inspection:
Printed name:-------------------------------_________________________
Organization:-------------------------_______________________________
Street and city:---------------------------------____________________
[[Page 50231]]
State: ZIP:-----------------------------_________________________
Phone number: (____)-------------------------------------------------
Person who prepared this summary notice:
Printed name:------------------------------__________________________
Signature:-----------------------------______________________________
Attachment 3
Page 1 of5
.
Date:--------------------------------------------____________________
Organization:-------------------------------_________________________
Street and city:--------------------------------_____________________
State: ZIP: ---------------------------_______________________
Phone number: (____)-------------------------------------------------
Appendix B--Sample Summary Risk Assessment Notice Format
Note: This following appendix will not appear in the Code of
Federal Regulations
Summary Notice of Lead-Based Paint Risk Assessment
Address/location of property or structure(s) this summary notice
applies to:
0-------------------------------------------___________________________
D---------------------------------------_______________________________
0-------------------------------------------___________________________
Lead-based paint risk assessment description:
Date(s) of risk assessment:-------------------------------------_____
Summary of risk assessment results (check all that apply) :
(a) No lead-based paint hazards were found.
(b) ____ Lead-based paint hazards were found.
(c) ____ A brief summary of the findings of the risk assessment
is provided below (required if any lead-based paint hazards were
found) ,
Summary of types and locations of lead-based paint hazards, List at
least the housing unit numbers and common areas (for multifamily
housing), bare soil locations, dust-lead locations, and/or building
components (including type of room or space, and the material
underneath the paint), and types of lead-based paint hazards found:
]----------------------------------------------------------------------
u-------------------------------------_________________________________
0---------------------------------------_______________________________
[----------------------------------------------------------------------
[----------------------------------------------------------------------
j----------------------------------------------------------------------
J-----------------------------------___________________________________
j----------------------------------------------------------------------
D------------------------------________________________________________
L------------------------------------__________________________________
~----------------------------------------------------------------------
]----------------------------------------------------------------------
Contact person for more information about the risk assessment:
Printed name:-------------------------------_________________________
[----------------------------------------------------------------------
Organization:---------------------------_____________________________
j----------------------------------------------------------------------
Street and city:------------------------------_______________________
[----------------------------------------------------------------------
State: ZIP: Phone number: (____)---------------------------
Attachment 3
Page 2 of 5
. [----------------------------------------------------------------------
Person who prepared this summary notice:
Printed name:------------------------------------____________________
u----------------------------------------______________________________
Signature:---------------------------------__________________________
[ Date:------------------------------------____________________________
[----------------------------------------------------------------------
Organization:-------------------------------_________________________
l-------------------------------------_________________________________
Street and city:--------------------------------------_______________
0---------------------------------------_______________________________
State: ZIP: Phone number: (____)---------------------------
c-----------------------------------------_____________________________
Appendix C--Sample Summary Presumption Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations
Notice That Lead-Based Paint or Lead-Based Paint Hazards Are Presumed
to be Present
Address/location of property or structure(s) this notice of
presumption applies to:
J-----------------------------------------------------_________________
l--------------------------------------________________________________
J---------------------------------------_______________________________
Type of presumption (check all that apply) :
(a) Lead-based paint is presumed to be present.
(b) Lead-based paint hazard(s) is (are) presumed to be
present.
Summary of presumption. List at least the housing unit numbers and
common areas (for multifamily housing), bare soil locations, dust-
lead locations, and/or building components (including type of room
or space, and the material underneath the paint), and types of lead-
based paint hazards presumed to be present:
c--------------------------------------________________________________
[----------------------------------------------------------------------
[----------------------------------------------------------------------
----------------------------------------------------------------------
J-----------------------------------------------------_________________
1J-------------------------------------_________________________________
J-----------------------------------___________________________________
L-----------------------------------___________________________________
]----------------------------------------------------------------------
J-------------------------------_______________________________________
lJ-------------------------------------_________________________________
0-----------------------------------___________________________________
1_----------------------------------------------------__________________
[----------------------------------------------------------------------
l----------------------------__________________________________________
J-----------------------------------------------------_________________
0-----------------------------_________________________________________
Contact person for more information about the presumption:
Attachment 3
Page 3 of5
.
Printed name:-----------------------------------------_______________
L-------------------------------------------___________________________
Organization:--------------------------------________________________
1--------------------------------------________________________________
Street and city:-----------------------------------------____________
J-----------------------------------------------------_________________
State: ZIP: Phone number: (____)---------------------------
~----------------------------------------------------------------------
Person who prepared this notice of presumption:
Printed name:------------------------------------------______________
~----------------------------------------------------------------------
Signature:-------------------------------------______________________
~ Date:---------------------------------------_________________________
~----------------------------------------------------------------------
Organization:--------------------------------________________________
u-------------------------------------------___________________________
Street and city:------------------------------------------___________
J--------------------------------------________________________________
State: ZIP: Phone number: (____)---------------------------
L------------------------------------------____________________________
Appendix D--Sample Hazard Reduction Completion Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations.
Summary Notice of Completion of Lead-Based Paint Hazard Reduction
Activity
Address/location of property or structure(s) this summary notice
applies to:
[----------------------------------------------------------------------
~----------------------------------------------------------------------
J-----------------------------------------------------_________________
Summary of the hazard reduction activity:
Start and completion date(s) :------------------______________________
Activity locations and types. List at least the housing unit numbers
and common areas (for multifamily housing), bare soil locations,
dust-lead locations, and/or building components (including type of
room or space, and the material underneath the paint), and types of
hazard reduction activities performed at the locations listed:
[----------------------------------------------------------------------
J-----------------------------------------------------_________________
u-------------------------------_______________________________________
J-----------------------------_________________________________________
[----------------------------------------------------------------------
C-------------------------------_______________________________________
Date(s) of clearance testing and/or soil analyses: ____
Locations of building components with lead-based paint remaining in
the rooms, spaces or areas where activities were conducted:
[----------------------------------------------------------------------
Attachment 3
Page 4 of5
. -1----------------------------------------------________________________
U--------------------------------------------------____________________
[----------------------------------------------------------------------
Summary
(a)
(b)
(c)
of results of clearance testing and soil analyses:
No clearance testing was performed.
Clearance testing showed clearance was achieved,
Clearance testing showed clearance was not achieved.
Contact person for more information about the hazard reduction:
Printed name:--------------------------------------------------______
Organization:------------------------------------____________________
Street and city:-------------------------------------------------____
State: ZIP:------------------------------------------------_____
Phone number: (____)-------------------------------------------------
Person who prepared this summary notice:
Printed name:----------------------------------------------__________
Signature:-----------------------------------------------____________
Date:-------------------------------------------------_______________
Organization:------------------------------------____________________
Street and city:-------------------------------------------------____
State: ZIP:-----------------------------------------------------
Phone number: (____)-------------------------------------------------
[FR Doc. 99-23016 Filed 9-14-99; 8:45 am]
BILLING CODE 4210-32-P
Attachment 3
P.e5~5
ATTACHMENT NO, 4
LBP INFORMATION SUMMARY
1. ZERO/O BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
. STATUS: EXEMPT TITLE X
2. ZERO/O BEDROOM> (MORE THAN) 100 DAYS IN UNIT
. STATUS: OPEN ISSUE UNDER LBP REGS
ZERO/O BEDROOM> (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
. STATUS: OPEN ISSUE UNDER LBP REGS
SEE SUBPART K
CLEARANCE OF UNITS) WILL BE REQUIRED BY CITY FOR ALL HOUSING UNITS
(EVEN ZERO BEDROOM). FOR WHICH OCCUPANCY OCCURS BY ASSISTED
HOUSEHOLD FOR MORE THAN 100 DAYS, PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
3. ONE OR MORE (1+) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
. EXEMPT TITLE X
4. 1+ BEDROOMS> 100 DAYS IN RESIDENTIAL UNIT
. STATUS: SAME AS #2 ABOVE; CLEARANCE REQUIRED
. SEE SUBPART K
5. EMERGENCY RENTAL ASSISTANCE < 100 DAYS
. EXEMPT TITLE X
6. EMERGENCY RENTAL ASSISTANCE> TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
Attachment 4
Page 1 of2
. CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
. MAY BE CONSIDERED TENANT BASED RENTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
. SEE SUBPARTS K AND M
. PENDING HUD GUIDANCE
7. TB RA < 100 DAYS
. EXEMPT TITLE X
8. TBRA> 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
. SEE SUBPART M
. CLEARANCE BEFORE ANY MONEY DISBURSED;
LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
. HQS INSPECTION REQUIRED BEFORE OCCUPANCY
. CLEARANCE BEFORE ANY MONEY DISBURSED
9. TBRA < 100 DAYS -TENANT ENTERS INTO LONG TERM LEASE, CITY
GIVES LESS THAN 1 00 DAYS OF ASSISTANCE.
. EXEMPT TITLE X
Attachment 4
Page 2 of2
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_ .AC!)f1D. CERTIFICA' OF LIABILITY INSURJ ;E I OATE~
,. no 04/11/2006
PRO( ~)CER (310)393-9477 FAX (310)393-7186 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
White lit Company Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POBox 70 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELPW,
Santa Monica, CA 90406-0070
INSURERS AFFORDING COVERAGE NAIC #
""UIlED WOmen's Transit10nal LlVing Center IHSURER A:. Philadelphia Ins Co
PO Box 6103 INSURER B:
Orange, CA 92863 INSURER c:
INSURER 0:
lNSURER E:
cnVl'RAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
Nf"( REQUIREMENT, TERM OR COIlDlTlON OF AN"( CONTRACT OR OTHER DOCUMENr WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE 'NSURANCE AFFORDED BY THE POUClES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDrTlQNS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~ TYPE OF INSURANCE POLICY NUIIIlER POUCY EfFECTIYE POUCY EXPIRA110N LIIIIlS
GENERAL l...IABIU1Y PllPk164779 04/04/2006 04/04/2007 EACH OCCURRENCE S 1,000,000
-,.,-
X COtJNERCIAl GENERAL lIABUTY OAMAGI: 1?c~ENTED S 300,000
I ClAAOS IAADE 00 OCCUR MED EXP (AnY onit peISOn) s 15,000
A "PERSOrw: & 1DVlNJURY . 1 000:000
- GENERAl AGGREGATE S 2 000,000
- pRODUCTS - COMPlOP AGG 1,000,000
GEl'lL AGGREGATE LIMIT APAS PER: .
1 POliCY n ~ lOG
!-UTOMOIlILE UAIllUTY PllPKl64779 04/04/2006 04/04/2007 COMBINED SINGlE LIMIT
(Eaaccident) . 1 000.000
_ NfY AUTO
AlL OWNED AUTOS BODILY INJURY
X (Per person) S
A X SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
-X (Per aeddeol) .
f-'-'- NON-DWNED AUTOS
PROPERTY DAMAGE S
(Peraccidenl)
R;~ AUTO ONLY - EA ACCIDENT .
OTHER ~ EA ACe S
AUTO ONl. Y: AGG S
EXCESStUMBRELlA UABIl.ITY PIftlB061149 04/04/2006 04/04/2007 EACH OCCURRENCE S 2,000,001
~-OCCUR 0 ctAlMSlAADE AGGREGATE S 2,000,001
A $
R ~EOUCT1BLE S
RETEtmDN S H S
WORKERS COIIPENSA11ONANO APPRDV LID I\.~; ,efT ~ we ST"l"U- IOJ);'-
EMPLOYERS'LIABIl1TY
JNY PROPRJETORJPARTNERJEXECUTIVE '-/5 F:~j/;/ f? E.L EACH ACCIDENT S
OFFtcERJM&.tBER EXClUOEM E.L DISEASE - EA EMPLOYEE $
~.-...- c :7,-", E.L DISEASE - POliCY LMT S
ECLAL PRQVJStoNS below
OrnER LJa1.l.1 f"L'
AS':'lsta.1 City AttOJ"'-l.e~
DESCRFnON OF OPERAlIONS J LOCAl1ONSJ~ J EXa.USIOHS ADDED BY ENDORSEIIENT J SPEClAl. PROVISIONS form
.ity of Santa Ana, its off cers, agents, ~loyees, and volunteers are additional insureds as per
I-NP-003 (05/01) Item M - Funding Source and Pri...ry Insurance as per form CGoo 01 07 98, both
ttached to the general liability policy and acc~nying this certificate,
*Except for 10 days written notice of cancellation for non-payment of premium.
CE
LDE
C CEL
ION
City of Santa Ana - CDBG M-25
ESG
P.O. Box 1988 M-25
Santa Ana, CA 92702
SHOULD Nf'( Of THE ABOVE DESCRJBED POUCIES BE CANCElLED BEFORE TlIE
EXPlRAlJON DATE THEREOF, THE ISSUING INSURER WILL ~ MAIL
30* DAYS WRITTEN NOTICE TO THE CERTlACATE HOlDER NAMED TO THE LEFT,
16.'6lIlI~~"~~
~lOOfM~
AU1lfORIZED REPRESENTATIVE
Kathleen Benner, ACSR/KJB
ACORD 25 (2001/08) FAX: (714)647-6549
C - Q -
@ACORDCORPORA~ON1~
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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
hokIer in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this fonn 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 alier the coverage afforded by the poliCies listed thereon.
, '.' ,,' TO FO"y
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ACORD 25 (2001108)
.
PI-NP-003 (Stol)
THISENDORSEM~NT CHANGES THE POLICY. PLEAS: READ IT CAREFUL!. Y.
GENERAL LIABILITY OaUXE ENDORSEMENT
Ills lIlderslood and lJ!1eed that the following extensions only apply In 1he even! that no other speclflc
coverage for the indicated loss exposures are pt1JYlded under this policy, If such specific coverage applies.
the terms. conditions and limits of that coverage are the sole and exclusive coverage applicable under this
pol icy.
ThrOlJ!.ftltJl this ~ the words "you" and "yooT" refer to the Named Insured shown In the
Declarations. The words "we" "us" and "our" refer to the Company providing this Insurance.
This endorsemenl modlfles Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE
The following Is a summary of 1he Limits of Insurance and additional coverage provided by this
endorsemert. For complete details on specific coverages, consull the polley contract wording.
A Mtdca Payments- Unit Jncressedto$l5.DOa
B. SwIl!lIuiay Payments . Ball bonds /ncressed to $2,5lXYL<<is of 6lTnlngs /ncressed 10 $500 SBCh
d!Iy;
C. Ttna7I's LEgal Uatility - fa- Rre. Uglinlrg Exp/txion, thrJke WId Leaks from 5P1r/rJers-
Unil,ncressed to~ DOa
D. 81'4..k.,.,.J DfIIirtUonof VIhoisAn JfJ!Utd;
E. Ammdsd DUies In The EvtTt Of Om.rrenoe, aa/m (j Sit;
F. Broackned deI1n1Uon of Adoet/sng Irjll)' - indudes TtiltNised (j W,h ~ PublIcation;
G Muld!l1 delinlUon of Bodly Irjll)' to include MmtaI AngUsf/,'
H. BroadslQ/ deI1rtUon of Personal Irjll}' -lndudesAbuse of PrCJCell!ids:rininetlon,'
I. Ammdsd Unlntmtlona/ Fa/lire To DJs:i0S8~
J. Ammdsd Uberal2atlon Gause
K. I'dd<<I Enp/oyBfJ IndtinTifica/Jon Ddmss ~ - He will pay up to ~ (XJ(J In defense oos/s for
WI "etq:/o/8II' in a crlnim pr~ng fsiject to esIabIld1i;d criteria);
L "Prcperty Datmgd' - Rsrro.ed etduson fa- "Prcperty J;.,,<yI' resiUng /tom Ih8 usa of r--..,JJe
(cree to protect ptTSmS or prcpsty;
M. I'dd<<I b/;riet Mdliona/ InsrecI- Fllldng Su~
N. I'dd<<I b/;riet MdUona/ Insred - Mooagtrs or Lessors of Prsrises;
a I'dd<<I Gmera l'gfTegete Unil Per locaIilXf . ~.) LO ~
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Includes copyri~ malf!fial of Ihe lnstJ'"ance Services otrtt.e,. Inc. used wiCh iIs permission.
(
PI-NP-003 (5101)
A. Medical F'IIr/mfIU
If Medical Payments Cover1lge (C~ C.) Is not IlIherwIse excluded from this Cover1lge Part:
1. The Medical Expense Limit Is changed sul1lect to all the terms of Limits Of Insurance (Section III)
to the greater of:
a. $15,000; Of"
b. The Medical Expense Limit shown In the Declarations of this Coverage Part.
2. The requirement In the Insuring Agreemert of Coverage C., that expenses must be Il1CUI1'ed and
reported to us within "one year" of the acddent date Is changed to "lIYee years, "
3. Exclusion a. of Cover1lge C. at 'jf>>: option, does not apply to :;our wiunteer workers or I1II'J
per.;on or organization lI1der 'jf>>: direct supervision and COI1Irol.
B. SlppllIIlIriay ~
In the Supplementary Payments . COIIllrllgIlS A. and B. provlslon:
1. The limit for the cost of ball bonds Is changed from $250 to $2,500; and
2. The limit for loss of earnings Is changed from $250 a day to $500 a day.
C,. .Flr" LI!tmI~Expkl8011, &ook._L"'fran~lnlde"8 . .
If damage by fire to premises rented to you Is not otherwise excluded from this Coverage Part, the
Wllfd "fire" Is changed to "fire, ligtming, exploslon. smoke, or leakage from automatic fire protective
systems" where it appears In:
1. The limits Of Insurance section of the Declllnlllons as the Fire Damage Limit. Thalllmit:
a. Is changed sul1lect to all the terms of limit Of Insurance (Section Ill) to the l1eater of:
(1.) $300,000; or
(2.) The arnotB1l shown in the declllnlllons as the Fire Damage limit.
b. Subject to a. above Is the most we will pay to all damage proximately caused by the same
evert. whether such damage results from fire, li!tllnlng, explosion, smoke, or leaks from
aJtOmatic fire protective systems or I1II'J combination thereof.
2. The last parilQl1llil of Coverage A. (Section I) after the EXClusions;
3. Paragraph 6. of Limits of Insurance (SectIon III);
4. Paragraph b.(1)(b) of the Other Insurance Condltlon (SectIon IV): and
5. Paragraph a. of the defmltlon of "Insured contract"
0, Who IsAn IllIUI"ed
Who Is An Insured (Section II) is changed as follows:
1. If coverage for newly acquired or formed organizations Is not IlIherwlse excluded from lhls
Coverage Part. paragraph 4.a Is changed to read:
a. Coverage lI1der this provision Is afforded urtllthe end of the policy period.
2. Each of the following Is also an Insured:
a. At the first Named Insured's option, your wluriteer workers; and
b, YlU" medical directors and administrators, but only while acting within the scope of and dtJ"ing
the course of their duties as such. Such dtAles do not inclUde the lUnishlng or failure to
furnish professional 5efV.ices of any physk:ian or psyd)iatrist IMhetreatment of a patiert.
c. At the first Named Insured's option, any per.;on or organization II1der 'JOlX direct supervision
and contro/ while providing for you private home respite Of" foster home care for the
developmentally disabled. However, the Insurance afforded by b. above Is excess over any
other Insurance covering any per.;on or organization lI1der :;our direct control or supervision.
d. If you are an organlzallon other lhan a partnership or joint WIttKe, yoor managers and
supervisors are also Insufeds, but only with respect to their duties as yoor managers and
supervisors.
e, Ivry organization and subsidiary thereof which you control and actively manage on the
effective date of this Cover1lge Part.
However, the insurance afforded by e. above, for any organization and subsidiary thereof not
named In the DeclaratiOns as a Named Ill5II"ed, does not apply to ''lIUI)' or damage with respect
to which an insured under this Coverage Part Is also an insured under another policy, or would be
an insured under such policy but for its termination or the exhaustiOn of Its limits of insurance.
':c.' AS TO FO::
Page2of5
Includes ccpyrighI malerlaI d lhe IIl5lI"lIrlClI services Off"Ia!. Inc. USEd with its permlssion.
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PI.NP-003 (5/01)
E. Dull. In TheEwlnt Of Oa:lrr~ CI8lm Or &lit
1. The requirement In condition 2.a. (Cordltlons, Section IV) that you must see to It that we are
I10Ilfled as soon as practicable of an "occurrmce" or an offense, applies only when the .
"occurrence" or offense Is known to:
(a) You, If you are an individual;
(b) A partner, if you are a partnership: or
(c) An execullve officer or Insurance manager, If you are a corporation.
2. The requirement In condition 2.b. that you must see to It that we receive notice of a claim or "suit"
as soon as practicable will not be consldered breached ooiess the breach occurs after such claim
or "suit" is known to:
(a) You, If you are an individual;
(b) A partner. if you are a partnership; or
(c) An exect4lve officer or insurance manager, If you are a corporation.
F, AdwrlllIIng Inj\IrY- TekwIlled Or~~I'IIbIIc!atlcln
1. The definition of "Personal and advertising lnjlJry" items 14. (d). (e), (I) and (g) Is i:hanged to read:
"Personal and Advenlslng if!l1KY" means II!lIKY arising out of one or more of the followlng
offenses:
d. Oral, wrillen, televised or vldeolaped publlcatlon of material that slanders or libels a person or
llfgallzatlon or disparages a person's or organization's goods, prlKkJcts or services;
e. Oral, wrillen, televised or vldeolaped publication of material that violates a person's right of
privacy;
f. Missapproprlatlon of advertising ideas or style of doing buSiness; or
g. Infringement of copyright, title or slogan.
2. Exclusions a. (2) and a. (3) of Coverage a., Personal And Advertising InJIKY Liability. are changed
to read:
a. (2) Arising out of oral, wrlnen. televised or videotaped publication of material, if done by or at
the direction of the insured with knowledge of Its falsity;
a. (3) Arising out of oral, wrlnen, televised or videotaped publication of material who5e first
publication took place before the begimlng of the policy period.
G. BodIJy Inj\IrY - M.... ~
The defmitlon of "bodily irJjury" is cIlanged to read:
"Bodily I'!jury':
a. Means bodily injlKY, sickness or disease sustained by a person, and includes mental afllJJish
resuJtIng from ;ny of these; and
b, Excepl for mental anguish, includes death resulting from the foregoing (item a. above) at;ny
time.
H. f'irlllllllllnj\IrY - AbuIe Of PrOClllliDlecrlmlllllllon
If Personal and Advertising II1IIKY Liability Coverage (Coverage a.) Is not otherwise excluded from.lhls
Coverage Part:
1. The definition of "Personal and advertising inJIKY" is cIlanged by:
a. RevIsing item b, of that definition to read:
Malicious prosecution or abuse of process:
b. Adding the following:
"Personalll)/llry" also means discrimination based on race, color, religion, sex. age or national
origin, except when:
(1) Done intentionally by or at the direction of, or wilh the knowledge or consent of:
(a) Arry insured; or
(b) Arry executive officer, director, stockholder, partner or member of the Insured; or
(2) Directly or indirectly related 10 the employment, former or prospective employment.
termination of employment. or application for employment of;ny person or persons by an
insured; or
.. , ~ 'J I'i.,.;.~_i t!LS Ti) Fe
Includes "'PY'i!t1I material of Ihe ,-::; ~ 501fke. Inc. used wiIh iIs poiii.~:~?j;-
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PI-NP-003 (5/01)
(3) Directly or indirectly related 10 the sale, rental, lease or SlJb.1ease or prospective sales,
rental, lease or sub-lease of arry room, dwelling or premises by or at the direction of arry
Insured; or
(4) Insurance for such discrimination Is prohibited by or held In violation of law, public policy.
leglslallon, COlI"t decision or administrative ruling. -
The insurance afforded by H .1.b. above does not apply 10 fines or penalties ImpoSed because of
discrimination.
I. UnInlenl1on11 FlIIlureToD!ldoeeH_cta
It Is agreed that, based on our relil1nce on yoor represerutions as to existing hazards. If you should
1Il1ltertlona11y fail to disclose all such hmrds prior 10 the beglmlng of the polley period of this
Coverage Part. we shall not deny coverage under lhls Coverage Part because of such failure.
J, LlbnllZlItiQ'l
If we revise lhis ellcloIsehlelll to provide more coverage wllhout additional premium charge. we will
_automatically provide the. additional coverage to all endorsement hoi~ as.at: the!;la'J lhe revision is
effectlve in yoor sIaIe, . -. .... -.' .. -... .
K. Employee 1nd8l.liftClIIICln DlIlIIII8CcMrIlQll
Under Sl.IPI'LEMENTARYPAYMENT8- COVERAGESAAJ<<> B the following is added:
3. We will pay on yoor behalf defense costs incurred by an 'employee" in a criminal proceeding.
However, you must haVe a prior written ag-eement with such 'employee' whereby you;qee to
Indermify lhe "employee' for such defense costs and the qeement includes a provision for
repaymera of defense costs in the event of an adverseJudgeltl8lll.
The most we will pay for arry 'employee' who Is alleged to be directly illllOlved In a criminal
proceeding is $25,000 regardless of the number of employees. claims or "suits.. brougll or persons
or organizations making claims or bringing "suits."
L. ExInIed 'Prcprrty Olrnllglt'
s:cTION I" COVERAGES, COVERAGEA, 2. ExdIlllon8 & is deleted and replaced by the
following:
a. Expected or Intended l'!Jury
"Bodily Injury' or 'Property Damage" expected or intended from the Sl3ldpoint of the insured. This
exclusion does not apply to "bodily 1'!iWY" or "property damage' resulting from the use of
reasonable force 10 protect persons or property.
M, AckItIa1llIlnued - FundlngSuce
Under s:cTION II-WHOISAN INSURED the following is added:
5. Any person or organizatIOn with respect to their liability arising Olf of:
a. Their financial control of you; or
b. Premises they own, maintain or control while you lease or occupy these premises.
This il1Sll"ance does not apply to Sb1JCIuraI alterations, new construction and demolition operations
performed by or for that person or organization.
N. AdcItkIIlIIlnulll- M8IVIQIIrs or L..... ct Prlllllliee
Under s:cTION II- WHOISAN INSURED the follllWlng is added:
6. Any person or organlzalIon with respect to Ihelr liability arising Olf of lhe ownership, maintenance
or use of that part of the premises leased to you suI!Ject 10 the following additional exclusions:
This insurance does not apply 10:
a. Any "occurrence' which takes place after you cease to be a tenant In that premises.
b. Slructural alterations. new construclIon or demolition operations performed by or on behalf of
that person or organization.
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Page4of5
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PI-NP-003 (5/01)
O. GIrw8II.918 Limit Pw Ioc:Edllll
lECTlONIII-Llmltad 11lSll'~ paragraph 2. is amended to the follaMng:
The General A9!J"egate Limit is the most we will pay for the sum of:
a. Medk:al expenses lI1der Coverage C; .
b. Damages lI1der Coverage A. except damages because of "bodily injury" or "property damage"
Included In the "producls-c;ompleted operations ha2anI"; and
c. Damages lI1der Coverage B.
A separaIe location General Aggregate limit applies to each "Iocaion", and Ihat limit is equal to the
lIIllllII1l of the General A9!II eg.- limit shown in the Declarations.
lECTlONV - DEFINITIONS is amended by adding the followlng:
"LOCliIon" means premises involving the same or connecting lots, or premises whose connectioo is
irterrupled ooly by a street, rOlllJWay, W<IBW8y or rl!l1t-of.way of a railroad.
P. Ncln-clwnld W..CrlIft
SECTIoN 1- CO\f!:AAGES, 2.Elcdlllllllllt, PlrlllJ"eph ~ (2) is amended to read as follows:
(2) A wateraaft yoo do not OWn thalls:
(a) Less tha1 58 feet long; and
(b) Not being used 10 carry persclnS or property for a charge;
This provisioo applies to any person, Who with your consent, either uses or is responsible for the use
of a watercraft.
ThIs insurance is excess aver any other valid and collectible insurance available to the lRued
whether primary. excess or contingert.
-I
0.3 t3 TO FORM
-~-{(~ceJY
T-' ,,-,o,\.;-_'_.11 ...:;,y Attor:'~ey
Page5of5
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62/63/2664 16:37
3163937186
\>,!-UTE & CO
PAGE 62/63
','
.". ." .
SECT.JON IV -COMMERCIAL GENERAL ;,,'.; ',IL To.sue us on this. Coverage, .Part uriless allot. ,
l:.iABiU'f.YCONDl11ONS .~.:<., .: ,:, . itstermshavebeelil'tullV-complle<tWith, '.
i:~Ba;;kruptcy;<:' ".,::'. Ii. person or Orgl\r1~(IOIl. rilay. sue us to ,recover.
.' )'limkruptoy or imlolvency ':of:1he'lnsured or 01 the ".' on an agreed settlemem' or. on a final jUdgment
ihsul'lld's estate Will not rellOwe lIS 01 our obllga- .. agaln$t an mured oIiitaIhed after an actual triaJ; . .
:. tions I:I"lder this Coverage' p'atr.. . ..' but we will not be nabl!," for damages that are not
.' . . " . " . . payal:lle under the termii of this Coverage:Part or
z...:.Dutles In. ~ E'l/en1:Ot Occurrence; orren..... thai. are In excess of 111", appllcabla limit of Insut>-
',;,CJltim OrSuit.s ;... . ';'" :Bnce. An agreed settlement means a sejtlemeni'
. :.~' You must see.to itthat~ 8f8 notified as soon . :.... and. release-of 11ablIitY-"'Slgned by uS, the'ln~ '.
,":{!.-:;: ..~ J)I'actlcableof atr."~~ or an Olf__' .' ~,::.,:,,:a:n!i"the claimant or th!o:clalmant's legal ~ .':';"
:. .. WhICh may resUlt. In ai.cl8kn.. To the 'extent :-''''''':'l;d:ive, . ',.,'.' '. . ..
. '::':.. "l;lOSSible, notlceshould,[!'~ '. ...':~4..':oiherln$Um~ _.; '...., '. ...
. <i[::"'fl HOW, when' and ~:ihe"~' or: f/lfotner valid and ~~'irisu_ ~ available .'
c . olfenso took pr3ce; .' . to the insured for a loss we cover LUlder Cover-'
(2) The '11_ arid add-esses of any injured ages A or B 01 this Coverage Part, our ob6gatlons-
". pemons and witne""'!'S; and are Umite<.1 as follows: . .
. '(3) The natura and' location 01 any injUfy or a. Primary Insurance
.' .... . : ~. arising .out. of. the 'occurret'!ce' or Thb Insurance is primary except when b, be-
offen.ll8, low applies, If this InSuraJlClil Is prhJary, our'
b. If Ii Clam IS made or 'suli" Is brought agaInst obliga~ are not a~ect~ unless any of th,e
any.insured; you mUSt: other.msurance IS alsO pn~, Then, _ will
(1) 1m . .....~.leIy rd th pecifIcs' ~_ share with all that other Insurance by the
. .'!'~ . reeo e s o. u... method described in 0. below.
clam or "suit' and the date received; and
(2) Notify us as soon as practicable b, Exea't Insurance
You ml.lSt see to it that we receiv~ written no- This Insurance is excess over:
lice' of the claim or 'suit' as SOOn as practica- (1) Any of the ather insurance, whether pO-
ble. mal)', excess. contingent or on an\l. other
c. You and any other involved insured must basis:
(1) Immed'oltely send us copies of any de- (a) That Is Fire. Exterided. ~'!,
'. . mlinds;' notices, sutnmonses or legal pa_ Builder'S AISle, InstaIfation RISk "I" &,m..
pers received in connection with the clal'n Iar coverage for "your work'; '.
or 'suft"; (b) That is Fire insurance for premises
(2) Authorize us to obtain record$ and other mole<! l<> you ?r temporarily occupied by
information; you )Nith p&n"TlIsslon of the owner;
(3) Cooperate With us In the. investigation or (0) That is insumnce porchased by you to
settlement of the claim or defense against ;ovor your liab'" as a. tenant for
!he 'suit" and property damage to premISeS rented
. ' to you or temporarily occupied bv you
(4) Assist us, upon our request, in the en- with permission 01 the owner: or
forcement of any right against any person ' .
or organization which may be liable to the - (tl) If the loss arises out of the maintenance
insured because of injury or damage to or use 01 airctaft, ~autos' or watercraft
Which this insurance may also apply, to the extent not Slbject to Exclusion 9. ~
. of Sectlon I - Coverage A - BodIly in-
d. No insured will, excapt at that inStJred's own jury And Property Damage Liability,
cost, wlLW1lariIy make a payment. assume any .
obllgation, or incur any expenSe, other than for (2) Any other ~aJY. Insl,JranCe available. to
Ilrst aid, without our consent you covering 11ab1l1lY for damages arising
. . . out 01 the Pfemise!l or operations for which"
3. Legal Action AgaInst Us . you have been adied as an additional in-
No person or organiZation has a right under this sured by atlach_ of an endorsement.
Coverage part; ..
. ': t- '7 .C' ,..... ,_ - ~..~" '" 1
. a, To join us as a party or otherwise bring us into-' '.u ,'J '.J ,-,"',
a 'suit' asking for damages from an insured; or ';I-ff:{,-0,'!t:.;-..------.
. . .. .J .__ .~" ,.,.)
'<0.. ',y /\
CG 00 01 0798
Copyright, Insuran<:e SerVic," Offlce. .Ill!l-, 1997
Page90f13
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31039371.86
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When thb ins~ is excess,'we Wii,~.no .
duty \.IIdef". CoVeiagesA or B to. defeliicrttioHrr.
sure<,! agail}llt'"anj! ~suit"if any other ~rilr:has .
a duty to defend the insured-against tbat.:suit".
If" no other.".I",ur.er detend8, __ Will. .llndertake
to 00 so, but we Wi. bo enlitItld to the. iilsured's'
ri~agairlstall those other insurers.. ':. ..\ . . .
V\(hen.. t/Ila. ill$urance is excess over Other iri-
su.w.ce, Wei 'WilI pay' only' our sharB.:i>f Ihe
. aIno'!fll ot fhe..loss, if any, that ex~ 1he.
.~~. of: <:~~ :~~'..,..:;. . >.:~. '~~~~~~w:~.,':i.:,:,,",:.
. (1)- Th:eIOtiit! 8rryor,m IIiIll aJf' such oUi~i: lhSur~'
. .. ~.~Urd'pay'for the foss In Ihe<'~.
. 0' thi$. insurance' and. '. ;"..'-";..,.
. . ......:.1.... f ~,... . ':;". . .
.(2) .The tolaf 'of' iall dedllctible and self-inSUred
ariTol.ms urider all that otheT inSl.ll'ill1(le.
We'~ slta~.~ ~1ng..Ioss, it any; ~.
any 'dlher Insurance that Is ilol described In this
EXcess' '.riSUrance provlslor1 -and 'jl\IaS n!>t.
." '.bOilght .spec~aIy to apply in excess of the
limits of Insurance shown In "the Declarations
:'l'ItJ.is.~~ Part. .
c. MetIlad Of Sliar.ing' .
. If 'li."Oi !tie" bther Irl$;jraii~ .Permits conlrtbu-
. Iioh' b)' equal sliares, we' iirilI folow this method
also; Under 1his approach each insurer con-
tribUles equal amounts until it has paid its llJ>
pNcable limit ot insurance or. none of lhe foss
remains, Whichever comes IIrst.
If. any of the.other iosl.lllllCe does nol permit
COlIInbl:ltlon 'b1' equa/ shares, _ Will conlribule
. by. Dmits.. . Under' this -method, each insurer's
shM;- is bas~ on the ratio of its applic8b/e
limit of Insurance 10 the total applicable Omits
of Insurance of alllosurer.;. .
5. Premium Audit
a. We wiD compute all premiums for this Cover-
age Part in accordance with our rules and
rqtes.
b. Premium shown In this Coverage Part as ao.
vance premium is a deposit premium only. At
!he close of each audit period we will compute ._
the earned premium for that period,' Audit
.premlums are due and payable on notice to
the firsl Named Insured, If the sum of the ad-
vance and audit premllmS paid for tile policy
period Is greater than the earned premilim, ~
Wi. return the excess to the first Named. .In-
sured.
c. The first Named Insured ITlU$1 keep recoi-crs of
the infonnation we need for premIUm. compu-
tation, and send us coples at such Imas as we
may request .
Page 10 of 13
~lITE & CO
Pi\(>E 83/83
6. RepAiI h~';'Uoris- :
. .;.....;. " -: '
BY a~jtjls POIlaY; you agree:. ..-";;,1:"",
. , .
lIo The sfatl!inents In' the Qeclarat~iilf'are accu-
rate aocr complete; ;. ..... .
......... "".:")'
b. Those:statemenfs are based upo'!i . i'ePresenla-
tlons.you'made to us; and ,;."... .1 .
. -. . -..,.;
C. We h~ issued. this policY In ~I~ upon
younepresentations.. . ""<_' "J
7. SeParaticin;Qii"sunods.. <;;~. ::~ .'
Exi:ept~~~~ 10 'the. Umils: ~'{i~~~, .
and llIlY rights or ckIIles speciIlcaIiy,'.8!lSiilned In
this ~r;l9G.'~art to: the ~ N~;r~~; this
Ins~~~'" '. .. . !..;'~'';'.:'l.'
a. As it. each Nani'l'd In$ured were the only
NlIri.'ed Insui-ed; arid . . . .
b. Separately to each' b1sl.lred' agat\~ whom
. . .. claim Is made or 'suit' Is brolJljll
8, Transfer 'at 'Rights Of R.icovWyAg~in~rOthersTD Us . .
. If" ttie i11sured has r1ghts~ ti. ~ver all .or....p&r! Of
any payment we have made under this Coverage
. Part, those rights are transferred 10 us.' The In- .. .
$Urei:I must do nothing after loss to impair them.
At au- r~ the insured Will bring 'suit" or
transf"" those rights to us and help us enforce'
Ihllm.
9. . When We Do Not Ren_ .
It _ decide not to renew this Coverage Part, we
Will mail or deliver to the first Named Insured
sI1OwFl'in the Peclaralioris written ~'\of the'
nonrenewaJ ~ less than $0 days bet""" me expi-
ration date.
If noIice is mailed, proof of maili"lg wiD be suffi-
cient proof of notice,
SECTION V - DEFINITIONS
1. 'Advertisement' means a notice that Is broadcast
or published to the general pUblic or specjflc mer-
~et segments about your goode, productsol- SflIV-
ices for the- purpose of attracting customers or
. supporters., .
-~ .
2. 'Auto' means a land motor vehJcle, trailer or_
semnrailer designe(l for travel on public roads, in-
cluding any altached machinery or equipmenl 8irt
'auto' does.not include 'mobile equipment".
3. 'Bodily Inpyo means bodily injury, sickneSs- o~
disease sustained by a person, including death re-
sulting from any of these at any lime.
4. 'Covel"B!le territory" means:
... The United States of Amer1ca ('ilclwlng its
territories and possessions), poerto. Rico and
Canada; .
Copyright, Insurance ServIces OffICe, 11"llJlr:1 ~7
~,~~1\Cf7 98 I
Milt',
CERTHOLDER COPY
SP
STATE
COM.PENSATION
INSURANCE
FUND
P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 02-14-2006
GROUP:
POLICY NUMBER: 1610814-2006
CERTIFICATE 10: 76
CERTIFICATE EXPIRES: 03-28-2007
03-28-2006/03-28-2007
CITY OF SANTA ANA
ATTN: MIKE LINARES ESQ-CDA
PO BOX 19BB M-25
SANTA ANA CA 92705
SP
~DB:ALL CALIFORNIA OPERATIONS
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form ~pproved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an Insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstandinl;l any requIrement, term or condition of any contract or other document
with respect to which this certificate of Insurance may be issued or to which it may pertain. the insurance
afforded by the policy described herein is subject to all the terms. exclusions, and conditions. of such policy.
a:::-REPRESENTATI
EMPLOYER'S LIABILITY LIMIT
~
PRESIDENT
INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-28-2006 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
WOMEN'S TRANSITIONAL LIVING CENTER, INC SP
PO BOX 6103
ORANGE CA 92863
IREV.2-05J
PRINTED
ISt.C,SP]
02-14-2006
CERTHOLDER COPY
STATE
COMPENSATION
INSURANCE
FUND
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 03-28-2007
GROUP:
POLICY NUMBER: 1610814-2007
CERTIFICATE ID: 76
CERTIFICATE EXPIRES: 03-28-2008
03-28-2007/03-28-2008
CITY Of SANTA ANA
ATTN: MIKE LINARES ESQ-CDA
PO BOX 1988 M-25
SANTA ANA CA 92705
SP
uOB:ALL CALIfORNIA OPERATIONS
A- ;;).()Of.t, - () &; 2
-A.. ;J.cc Co - tt'l;:t - 0 '.Ft
This is to certify that we have issued a valid Workers' Compensation insurance policy in i form approved by the
California lnsur anee Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded
by the poliCY listed herein. Notwithstanding any requirement. term or condition of any contract or other document
with respect to whIch this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms. exclusions. and conditions. of such policy.
6::: REPRESENT A TI
EMPLOYER'S LIABILITY LIMIT INCLUDING DEfENSE COSTS:
~
PRESIDENT
$1,000,000 PER OCCURRENCE.
ENOORSEMENT #2065 ENTITLED CERTIfICATE HOLDERS' NOTICE EffECTIVE 03-28-2007 IS
ATTACHED TO AND fORMS A PART Of THIS POLICY.
EMPLOYER
A,riR.(}VED !~~; TC) FORM
L~if!r: S="Cdy
As..J.SEa.1t City Attcrr.cy
WOMEN'S TRANSITIONAL LIVING CENTER, INC SP
PO BOX 6103
ORANGE CA 92863
(REV.2-05)
PRINTED 02-17-2007
e.. P,
SP
M0408