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HomeMy WebLinkAboutWOMEN'S TRANSITIONAL LIVING 12r AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Sr. Deputy Clerk of the Council (M -30). Call 647 -5238 if you have any questions. The agreement with W Cff"� Z la4QtA'OY�C [ XX.tnt �, No. ft — aIO&o —O &— O'Ig was completed on y a o o- and final payment has been made. Department: Signature: v Date: _a ) I Q City of Santa Ana Revised 8 -7 -03 Clerk of the Council INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES y -4 —L7 CLERK OF COUNCIL DATE: AGREEMENT BETWEEN THE CITY OF SANTA ANA AND D'. GDf (a) WOMEN'S TRANSITIONAL LIVING CENTER FOR USE OF (j (70res) COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS (With Provisions Relating to Compliance with Title X and 24 CFR Part 35 Relating to Lead Based Paint) A -2006- 092 -049 5/05 This Agreement, made and entered into this 1st day of July, 2006, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ( "CITY ") and fst #c l xvt tg l ........... t ae; a California nonprofit corporation ( "SUBRECIPIENT "), WITNESSETH Recitals: A. The CITY, as an entitlement recipient and grantee of the United States Department of Housing and Urban Development ( "HUD") Community Development Block Grant ( "CDBG ") Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq. ( "CDBG REGS "); and B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the Housing and Community Development Act of 1974, Public Law 93 -383, as amended ( "ACT "); and C. The SUBRECIPIENT is a private nonprofit agency that has been selected by the CITY to receive CDBG funds and administer such financial assistance; and to provide the services described in Exhibit A, in accordance with the schedule of performance included therein, hereinafter referred to as "said program ". SUBRECIPIENT represents that it is qualified and willing to operate said program and certifies that the activities carried out with funds provided under this Agreement will meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208). D. SUBRECIPIENT agrees that it will adhere to the performance measurements and outcomes as indicated on Exhibit A -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 SUBRECIPIENT pursuant to this Agreement. E. Title X of the 1992 Housing and Community Development Act (Title X) established requirements relating to lead based paint ( "LBP ") in housing receiving federal assistance, in particular requirements relating to (i) notification (including pamphlet distribution, disclosure to purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or lead hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing, and/or risk assessment), (iii) lead hazard reduction (including paint stabilization, interim controls, standard treatments, or abatement depending on the requirements for housing activity type), (iv) ongoing maintenance, if required, and (v) response to children with environmental intervention blood lead 1 5/05 levels, as required; and F. 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 establish specific rules regarding notification to owners and occupants about the existence of LBP hazards, identification of LBP hazards, and control of LBP hazards; and G. Residential structures built after January 1, 1978 are exempt from lead -based paint requirements as the use of lead -based paint was banned for use in residences after this date by Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be applicable if the structures involved were built after January 1, 1978. H. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs, sets forth specific requirements relating to housing providers, such as SUBRECIPIENT, who administer local programs that provide supportive housing for special needs populations and are funded by HUD Office of Community Planning and Development ( "CPD ") programs, including CDBG funds, as provided to SUBRECIPIENT under this Agreement; and I. In connection with the grant of funds under this Agreement, CITY requires that SUBRECIPIENT comply and evidence of compliance with all applicable requirements of Title X and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support services, or operations, and Subpart J relating to rehabilitation, as and when applicable; and J. In connection with the grant of funds under this Agreement, CITY requires that SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as and when applicable; and K. 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 Attachment No. 3 entitled Sample Summary Risk Assessment Notice Format'; provided however, that such attachments are not intended to modify or limit SUBRECIPIENT'S obligation to fully comply with all applicable provisions of Title X and the implementing regulations in the LBP Regs; and L. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all responsibilities set forth in Subpart K of the LBP Regs; and M. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of such funds; and 2 5/05 WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a substantive part of this Agreement and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and SUBRECIPIENT: L SUBRECIPIENT'S OBLIGATIONS A. Non -Profit Status - Representations and Warranties (1) SUBRECIPIENT acknowledges that its operations and the services it provides to the community are subject to Subpart K (and, in some instance(s) Subpart J and/or Subpart M) of the LBP Regs. (2) SUBRECIPIENT acknowledges that its operations and the services it provides includes: (a) acquisition, leasing, or ownership of residential property for the purpose of providing affordable housing for persons with special needs, such as transitional housing, or (b) housing for persons with special needs, such as the disabled, or (c) financial assistance to assist transitional housing participants to move to permanent housing by paying for the first month's rent or security deposit, or (d) tenant -based rental assistance to program participants who choose their own housing units, and by provision of such services such housing is subject to the requirements of the LBP Regs. (3) Representations: (a) Authority. SUBRECIPIENT is a duly organized and existing non - profit corporation in good standing and authorized to do business under the laws of the State of California. 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. SUBRECIPIENT is a qualified provider of the services to be provided hereunder. (c) Familiarity With Services Required. By executing this Agreement, SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to be performed and provided hereunder, (ii) it has carefully considered how the services should be performed, and (iii) it fully understands the facilities, difficulties and restrictions attending performance of the services under this Agreement, inclusive of compliance with the LBP REGS. Should 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 SUBRECIPIENT'S risk until written instructions are received from CITY'S representative. 5/05 (d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement will not constitute a default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party or by which it is bound. (e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened bankruptcy proceeding. (t) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a current or threatened litigation that would or may materially affect SUBRECIPIENT'S performance under this Agreement. (g) Application Veracity. All provisions of and information provided in SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true and correct in all material respects. (h) No Pending Investigation. SUBRECIPIENT is not aware that it is the subject of any current or threatened criminal or civil action investigation by any public agency, including without limitation a police agency or prosecuting authority, that would relate to affect performance of the Agreement or provision of services hereunder. (4) Compliance with Subpart K of LBP Rees. Subpart K — Acquisition, Leasing, Support Services, or Operation (a) SUBRECIPIENT acknowledges and agrees that it shall comply with and implement the requirements set forth in Title X and the LBP Regs to eliminate, as far as practicable, LBP hazards in all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT. (b) SUBRECIPIENT shall provide a notice to all residents /occupants of residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from 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 hazard information pamphlet in accordance with Section 35.130 of the LBP Regs to all occupants, owners, and purchasers of housing. (i) The pamphlet shall be the EPA/HUD /Consumer Product Safety Commission lead hazard information pamphlet or an EPA - approved 5/05 equivalent. The current form and version of the pamphlet is attached as Attachment No. 1 to this Agreement. (ii) SUBRECIPIENT shall cause to be disclosed to all purchasers and lessees available information and knowledge regarding the presence of LBP 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 of the presumption of LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead hazard reduction work in accordance with 24 CFR 35, Subpart A. The current form and version of such notice is attached as Attachment No. 3 to this Agreement. (d) Lead Hazard Evaluation (24 CFR 35.125). SUBRECIPIENT 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 assistance from SUBRECIPIENT. (1)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 1, 1978. (ii) To the extent that the assistance provided by SUBRECIPIENT to persons or households meets one or more of the exemptions set forth in the LBP Regs, then compliance with the notification, evaluation, reduction, clearance and other requirements of the LBP Regs is not required related to the subject housing unit due to such exemption. (iii) SUBRECIPIENT shall comply with the applicable provisions of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs as to all tenant -based long term housing assistance, i.e., assistance to persons/households residing in housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs 5/05 require evidence of compliance prior to occupancy. Funding to be provided hereunder is conditioned 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 inspection of each dwelling unit prior to occupancy and prior to compliance with applicable notification, evaluation by visual assessment, reduction through paint stabilization utilizing safe work practices, and clearance requirements of the LBP REGS. (e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above. (1) If paint stabilization occurs, SUBRECIPIENT shall cause paint stabilization of each deteriorated surface and clearance of residential units pursuant to Section 35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is occupied, immediately after receipt of the CDBG FUNDS hereunder. (2) Safe Work Practices shall be used in all LBP hazard reduction work. (3) Clearance shall be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is complete. Confirmation of clearance by written certification of a qualified inspector is required on an annual basis in connection with submittal of the April 15 quarterly report. (f) Ongoing Maintenance. SUBRECIPIENT shall incorporate ongoing LBP maintenance activities into regular building operations in accordance with Section 35.1355(a) for all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above. 5/05 (1) Ongoing maintenance includes confirmation of clearance which shall be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is complete. (2) Ongoing maintenance also includes confirmation of clearance by written certification of a qualified inspector on an annual basis in connection with submittal of the April 15 quarterly report. (3) A part of such ongoing maintenance obligation includes notification of the results of clearance confirmation and annual confirmation of clearance. a. SUBRECIPIENT shall cause to be provided a notice to all occupants of all residential property that is under its ownership, possession, or control and/or residential property occupied by persons or families that receive financial or other assistance from SUBRECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results of the clearance examination and the results of annual certification. (g) Units Cleared Prior to Date of Agreement; Confirmation of Clearance. In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard reduction, and lead hazard clearance have been completed on the subject dwelling units prior to the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15 quarterly report a certificate from a qualified inspector evidencing a recent inspection and confirmation of clearance of LBP and LBP hazards from the subject dwelling unit(s). 5. LBP Informational Summary. For purposes of information only and in no respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY has caused to be prepared an information summary relating to the LBP REGS and application to dwelling units that may be occupied by recipients of services and/or funding from SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and hereby fully incorporated by this reference, is such information summary. CITY staff will cooperate with and make themselves available to SUBRECIPIENT to assist in implementation of compliance with the LBP REGS as to residential dwelling units to be assisted by SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP REGS and implementing guidance published and provided by HUD relating to compliance with such LBP REGS. B. Amount of Grant and Quarterly Disbursement. The amount granted to SUBRECIPIENT is $5_,000 ( "CDBG FUNDS "), and such funds shall be expended by SUBRECIPIENT on or before June 30, 2007. The CDBG 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 from SUBRECIPIENT, with the final payment subject to the satisfaction of the condition precedent of submittal of complete reporting information due on or before July 15th of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be 5/05 obligated to perform such duties as would normally extend beyond the term, including but not limited to obligations with respect to indemnification, audits, reporting, data retention/reporting, and accounting. C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit B ", attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT under Paragraph II hereof. D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before June 30, 2007 and to use said funds to pay for necessary and reasonable costs allowable under the federal law and regulations to operate said program. Said amounts shall include, but not be limited to, wages, administrative costs, and employee benefits comparable to other similarly situated employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B ", attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income received from said funds only for the same purposes for which said funds may be expended pursuant to the terms and conditions of this Agreement. E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's operations hereunder. 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, SUBRECIPIENT shall immediately make good -faith efforts to gain compliance with local, state or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. SUBRECIPIENT must make all corrections required to bring the facility /property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY pursuant to this Agreement shall be maintained in an account in a federally insured banking or savings and loan institution with record keeping of such accounts maintained pursuant to applicable OMB Circular A -110 requirements. SUBRECIPIENT is not required to maintain separate depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to 8 5/05 account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB Circular A -110 requirements. H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT receives Three Hundred Thousand Dollars ($300,000.00) or more in federal funds, SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in accordance with the standards as set forth and published by the United States Office of Management and Budget. SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the year following the program year in which this Agreement is executed. Further, SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable provisions of Title X and the LBP Regs. I. Record Keening /Reporting. SUBRECIPIENT shall keep and maintain complete and adequate records and reports to assist CITY in meeting and maintaining its record keeping responsibilities under the CDBG REGS, Title X, and the LBP Regs, including the following: (1) Records a. Documentation evidencing program income requirements in conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24 CFR 570.208(a)(2)(B) of the income level of persons and/or families participating in or benefiting by the SUBRECIPIENT program. b. Documentation of the number of persons and/or families participating in or benefiting by the SUBRECIPIENT program. c. Household information shall include number of persons, identification of head of household, race /ethnicity, and income verification. d. Documentation of all CDBG FUNDS received from CITY. e. Documentation of expenses as identified in the Budget Proposal, including evidence of incurring the expense, invoices for goods or services, copies of any and all contracts or documentation pertaining to costs for subcontractors, plus all other invoices for which CDBG FUNDS were expended, and any payments therefor. f Any such other related records as CITY shall reasonably require or as required to be maintained pursuant to the CDBG REGS. g. Documentation evidencing compliance with all applicable provisions of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J and/or Subpart M. (i) Specific documentation, as required, evidencing compliance with all applicable provisions of such LBP Regs 9 5/05 including: (i) notification, including distribution of the lead hazard information pamphlet (Attachment No. 1), disclosure and notices of hazard evaluation and reduction (Attachments No. 2 and 3); (ii) evaluation of lead hazard(s), including paint testing and risk assessment; (iii) reduction of lead hazard(s), including safe work practices and clearance, and confirmation of clearance; and (iv) ongoing maintenance, as and if applicable for multifamily properties. (ii) In this regard SUBRECIPIENT shall track information on all persons/households assisted and the housing units assisted with the CDBG FUNDS. Attachment No. 5 hereto is a sample form for tracking persons/households and housing units assisted with the CDBG FUNDS. All categories of information set forth in such tracking form shall be prepared and submitted to the CITY with the April 15 quarterly report. (iii) In the event that such information and reports are not complete and reasonably satisfactory information submitted in order for CITY staff to review and evaluate compliance with applicable CDBG REGS and LBP Regs, then the final quarterly disbursement payment shall be withheld from the SUBRECIPIENT. (iv) Documentation of clearance confirmation as provided in Section L(1)(g) hereinabove. (2) Reports (i) Payment Request. Concurrently with the submittal of each quarterly report, on or before the 15th day of October, January, April and July, SUBRECIPIENT shall submit both: an original invoice and true copies of invoices, receipts, agreements or other documentation supporting and evidencing how the CDBG FUNDS have been expended during the applicable quarter. (ii) Quarterly Activity Report: Including in such reports evidence of compliance with all applicable provisions of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J, as further described in subsection (d) hereinafter, and Subpart M, if SUBRECIPIENT provides long term tenant -based rental assistance. SUBRECIPIENT agrees to provide CITY with written cumulative (year -to -date) reports of its activities on or before the 15th day of October, January, April and July for the 10 5/05 period beginning July 1, 2003 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) Any such other reports as CITY (or HUD) shall reasonably require and/or request, including but not limited to the following information: the receipt of program income [as defined at 24 CFR 570.500(a)] by SUBRECIPIENT in the operation of said program shall be recorded by SUBRECIPIENT and reported to CITY; monthly records of all ethnic and racial statistics of persons and families benefited by SUBRECIPIENT in the performance of its obligations under this Agreement, including, but not limited to, the number of low and moderate income persons and households assisted in accordance with federal income limits and the number of female heads of households. (3) 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 transitional or permanent housing operated or administered by the SUBRECIPIENT), then the SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECIPIENT and/or the property owner(s), as applicable, has performed ongoing maintenance of the subject property. Ongoing maintenance shall include evidence of an annual clearance certification of the subject residential property conducted by a DHS certified technician to ensure that LBP hazard reduction measures are maintained. All maintenance activities shall be conducted to ensure the threat of LBP hazards is minimized. (4) Recordkeeping under the LBP Rees. The SUBRECIPIENT shall keep records of distribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other lead hazard evaluation, reduction, safe work practices, and clearance activities. (a) The SUBRECIPIENT shall keep records evidencing distribution of all lead hazard information pamphlet(s). (b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation report, LBP hazard reduction documentations, (such as job specifications), and all clearance or abatement report(s). (c) The SUBRECIPIENT shall keep ongoing maintenance records and records of relevant building operations for use during reevaluations of subject property for LBP and/or LBP hazards. 11 5/05 1. Such records shall be maintained for not less than longer of (A) three (3) years after the activities cease or (B) the period required by applicable program regulations. Under the CDBG REGS records shall be retained for not less than four (4) years after the activities cease. 2. The SUBRECIPIENT shall provide a copy of any of the above records to the CITY or to HUD upon request of either or both. (d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental assistance payments directed to a housing unit or housing units for more than 100 days, or it is anticipated that during the last quarter of funding that such rental assistance payment will be for more than 100 days, then the April 15 quarterly report shall contain information and evidence of compliance with the requirements herein relating to tracking of housing units, cumulative days of rental assistance, proper notifications to occupants and owners, HQS inspection, visual assessment, work write -up, stabilization and clearance of LBP and LBP hazards, if any. The proposed form of such tracking information is attached hereto as Attachment No. 5 and fully incorporated by this reference. In the event such April 15 quarterly report does not fully satisfy the reporting requirements set forth herein and in the LBP Regs, then the final installment payment of the CDBG FUNDS shall be withheld from disbursement to SUBRECIPIENT. 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 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 Records/Required Length of Record Keening. All accounting records, reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and thereafter for five (5) years after completion of an audit in conformity with the CDBG BEGS, 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, 12 5/05 or created or maintained in compliance with, Title X and/or the LBP Regs shall be retained and maintained by SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure statement(s), and clearance report(s). In the event SUBRECIMENT does not make the above - referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. L. Compliance with Law/Program Income. SUBRECIPIENT acknowledges that the funds being provided by CITY for said program are received by CITY pursuant to the ACT as amended and that expenditures of these funds shall be in accordance with the ACT and all pertinent regulations issued by agencies of the federal government, including, but not limited to, all regulations found at Title 24 of the Code of Federal Regulations. Program income received by SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement. SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement. M. Standine. SUBRECIPIENT shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY. N. Confidentiality. Without prejudice to any other provisions of this Agreement, SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided to it concerning participants in accordance with the requirements of federal and state law. However, SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by SUBRECIPIENT, costs incurred and services rendered hereunder. O. Independent Contractor. SUBRECIPIENT agrees that the performance of obligations hereunder are rendered in its capacity as an independent contractor and that it is in no way an agency of CITY. P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse the CITY of all such funds that were obtained/spent under fraudulent circumstances. Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non- expendable personal property acquired under the terms of this Agreement. Said record shall be made available to CITY upon request. The term 'non- expendable personal property" shall include leased and purchased equipment. 13 5/05 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. Lobbvine. SUBRECIPIENT certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to SUBRECIPIENT under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions (see C -1). T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to CDBG activities assisted under the terms of this Agreement, or who are in a position to participate in a decision - making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a CDBG- assisted activity of SUBRECIPIENT, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer, or elected or appointed official of CITY, or of any designated public agencies, or the SUBRECIPIENT. U. Davis -Bacon Act. All laborers and mechanics employed by contractors or subcontractors in the performance of construction work, including alterations and repairs, in excess of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a -5. Any such construction contract shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5. 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. §5.5(a)(3). No payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless 14 5/05 there is on file with the agency a certification by the contractor that the contractor and its subcontractors have complied with the provisions of 29 C.F.R. §5.5.. A breach of the contract clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a contractor /subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews /investigations shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)]. V. Drug Free Workplace. SUBRECIPIENT certifies that it has established the following drug -free workplace policy: 1. The unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace for any employee involved in a federally funded program. 2. As an employee working in conjunction with a federally funded program, the employees of SUBRECIPIENT will be required to: a) Abide by the terms above in statement 1. b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any criminal drug statute conviction for a violation occurring in the workplace not later than five days after such conviction. 3. The United State Department of Housing and Urban Development will be notified within ten days after receiving notice of any such violation. 4. Within 30 days of receiving such notice, appropriate personnel action will be taken against such employee, up to and including termination. Each such employee shall be required to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state or local health, law enforcement, or other appropriate agency. II. CITY'S OBLIGATIONS A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall pay to SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for CITY's 2006 -07 CDBG program year amounts expended by SUBRECIPIENT in carrying out said program for 2006 -07 pursuant to this Agreement up to a maximum aggregate payment of Five Thousand Dollars ($5�O00 ) in installments determined by CITY. Payments shall be made to SUBRECIPIENT through the submission of invoices on a quarterly basis (October, January, April and July) in a form prescribed by CITY, detailing such expenses. CITY shall pay such invoices within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been incurred and documented within the scope and provisions of this Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this Agreement, and in compliance with Title X and the LBP Regs. [C WOM B. Audit of Account. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of the Code of Federal Regulations and other applicable federal laws and regulations. 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 grants 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 SFR 58, the CITY is responsible for undertaking environmental review and maintaining environmental review records for each applicable project. E. Performance Monitorine: CITY shall monitor the performance of the SUBRECIPIENT against goals and performance standards required herein. Substandard performance as determined by the CITY will constitute non - compliance with this Agreement. If action to correct such substandard performance is not taken by the SUBRECIPIENT within a reasonable period of time after being notified by the CITY, contract suspension or termination procedures will be initiated. III. SUBRECIPIENT agrees that no person on the ground of race, age, color, national origin, religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with CDBG funds. IV. CONFLICT OF INTEREST Pursuant to the conflict of interest requirements set forth in 24 CFR 576.5 and OMB Circulars 1 -102 and A -1107, SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct or indirect control of any CDBG monies granted to the CITY, inclusive of the subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its board of directors and list of officers. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection with the provision of the services SUBRECIPIENT shall provide with CDBG funds in accordance with 24 CFR 570.2000): 16 5/05 A . SUBRECIPIENT shall not discriminate against any employee or applicant for employment on the basis of religion and shall not limit employment or give preference in employment to persons on the basis of religion. B. SUBRECIPIENT shall not discriminate against any person applying for the services SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and shall not limit such services or give preference to applicants for such services on the basis of religion. C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct any religious worship or services, or engage in any religious proselytizing, or exert any religious influence in the provision of the services in said program. The parties agree that this covenant is intended to and shall be construed for the limited purpose of assuring compliance with respect to the use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the establishment of religion as set forth in the establishment clause under the First Amendment of the United States Constitution and Article I, Section 4 of the California Constitution, and is not in any manner intended to restrict other activities of SUBRECIPIENT. D. Where the services to be provided under said program are rendered on property owned by the primarily religious entity SUBRECIPIENT, CDBG funds may also be used for minor repairs to such property which are directly related to the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the CDBG expenditure for rendering the services under said program. VI. PROHIBITION OF NEPOTISM SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate family" means spouse, child, mother, father, brother, sister, brother -in -law, sister -in -law, father -in- law, mother -in -law, son -in -law, daughter -in -law, aunt, uncle, niece, nephew, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VII. NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: City of Santa Ana Community Development Agency (M -25) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702 -1988 17 5/05 TO SUBRECIPIENT: Kathy Strong Director of Contracts Administration Women's Transitional Living Center P.O. Box 6103 Orange, CA 92863 VIII. ASSIGNABILITY None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal obligations of SUBRECIPIENT pursuant to this Agreement. IX. HOLD HARMLESS SUBRECIPIENT shall indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all damages to or for loss of use of property and for injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and including attorney fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPIENT's performance of this Agreement. X. INSURANCE A. In accordance with the provisions of Section 3300 of the Labor Code, if SUBRECIPIENT has any employees it is required to be insured against liability for worker's compensation or to undertake self - insurance. Prior to commencing performance of this Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor workers' compensation coverage, it must execute a Declaration available from the CITY, and update as is necessary. B. SUBRECIPIENT shall undertake self - insurance, or shall obtain, at its sole cost, a policy or policies of commercial general liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall: (1) name the City of Santa Ana, its officers, agents, representatives, employees and volunteers as additional insureds; (2) be primary with respect to 18 5/05 insurance or self - insurance programs maintained by the CITY; (3) contain standard separation of insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit instituted arising out of SUBRECIPIENT's operations hereunder. SUBRECIPIENT shall: (a) prior to exercising any right under this Agreement, furnish properly executed certificates of insurance and additional insured endorsement to the CITY which shall clearly evidence all coverages required above; (b) provide that such insurance shall not be materially changed or terminated except on 30 days prior written notice to the CITY; (c) maintain such insurance for the period covered by this Agreement; and (d) replace such certificates for policies expiring prior to the expiration of this Agreement. XI. REVERSION OF ASSETS A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(8).] B. Any real property under SUBRECIPIENT's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000.00 must either be: 1. Used, where CITY has given written approval, to meet one of the national objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement, or for such longer period of time as determined to be appropriate by CITY; or 2. If not used in accordance with subparagraph A above, SUBRECIPIENT shall pay to CITY an amount equal to the current fair market value of the property less any portion of the value attributable to the expenditure of non -CDBG funds for acquisition of, or improvement to, the property. Such payment is program income to CITY. C. Subject to the obligations set forth herein, title to equipment acquired under the terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment which has been acquired in accordance with this Agreement and all applicable regulations is no longer needed for said program, disposition of said equipment will be made as follows: 1. Items of equipment with a current per unit fair market value of less than $5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY. 2. Items of equipment with a current fair market per unit value of $5,000.00 or more may be retained or sold and CITY shall have the right to an amount calculated by multiplying the current market value or proceeds from the sale by CITY's share of federal funds used to acquire the equipment, in accordance with 24 CFR 85.32(e)(2). D. SUBRECIPIENT hereby agrees, upon the demand of CITY, to execute, acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder 19 5/05 or under any document, instrument or agreement executed in furtherance of the services and activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignment(s), quit claim deed(s) or such other and further instruments, documents and agreements as may be necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or local accounts or program funds or allocation of funds to which CITY is or may be entitled, either for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the performance of this Agreement or any previous agreements relating to the same subject matter or activities as this Agreement, together with any instruments, loans, grants or advances by SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof. SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI. REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements pertaining to program income shall not be affected by the termination of this Agreement and shall survive the date of termination of this Agreement for such period of time as CITY and/or HUD deems necessary for the responsibilities, duties and obligations to be performed and completed to the satisfaction of CITY and HUD. XII. TERMINATION A. This Agreement may be terminated on thirty (30) days' written notice by either party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of this Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such notice, unless such default is cured before the effective date of termination stated in such notice. If terminated for cause, CITY shall be relieved of further liability or responsibility under this Agreement, or as a result of the termination thereof, including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any payments made for services not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining substitute performance. D. The grant of funds under this Agreement may be terminated for convenience in accordance with 24 CFR 85.44. 20 5/05 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 described 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 subparagraphs XII.A. through XII.E., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used, and to comply with paragraph "XI. REVERSION OF ASSETS" of this Agreement. XIIL LIMITATION OF FUNDS The United States of America, through HUD, may in the future place programmatic or fiscal limitations on the use of CDBG funds which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to implement a reduction in funding, in whole or as to a cost category, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days written notice to SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions. In no event, however, shall any revisions made by CITY affect expenditures and legally binding commitments made by SUBRECIPIENT before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines. XIV. EXCLUSIVITY AND AMENDMENT OF AGREEMENT This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of CITY's CDBG funds by SUBRECIPIENT and contains all the covenants and agreements between the parties with respect to such employment in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and SUBRECIPIENT. 21 5/05 XV. LAWS GOVERNING THIS AGREEMENT This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XVI. VALIDITY The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. XVII. MISCELLANEOUS PROVISIONS 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 5/05 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and year written below. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: LISA E. STORCK Assistant City Attorney CITY OF SANTA ANA A k ?4- kl DAVID N. RRAM City Manager SUBRECIPIENT: DATE: Name: Rocio Cepmalez. t�%So-) Title: Executive Director Tax ID: 51-0201813 23 City of Santa Ana Community Development Block Grant Scope of Work Name of Organization- Women's Transitional Living Center, Inc. (WTLQ Name of Funded Program- Independence from Dependence Annual Accomplishment Goal L Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the funded program, named above, during the 12 -month contract period. 2,500 PERSONS II. Number of only unduplicated Santa Ana residents to be served by the funded program, named above, during the 12 -month contract period. 120 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 "Independence from Dependence" program is a supportive services program designed to promote independence through becoming safe, becoming addiction -free, acquiring permanent housing and/or getting ajob. The program will work with at least 120 residents of Santa Ana, providing at least 5,600 hours of supportive services for adults and another 6,000 hours of services for children. Outcomes will be mental health stability, decrease in addiction, increase in independence, and linkage to other supportive services and housing. Services provided will include: shelter, food, clothing, case management, legal/immigration advocacy, social service assistance, counseling, educational classes, 24/7 hotline, transportation, translation, substance abuse treatment, crisis counseling, referral/resource assistance, a therapeutic children's program, gang intervention program, ESL /Advanced English classes, process /empowerment groups, medical screening/care, job training, work experience, career counseling, job placement, and housing/financial advocacy. IV. Activities funded by this grant — How will CDBG funds be used for the funded program? Narratively describe the budget for the funded program illustrated in Exhibit B and B -1. CDBG funds will be used to partially pay the salary of a Bilingual Child Advocate who is responsible for children's activities /education in the Children's Program. This advocate performs developmental assessments (in conjunction with a counselor), tests the children for emotional symptoms that may interfere in the child's ability to perform in school, creates daily activities for the children, enrolls children in local schools, transports children as necessary, and is responsible for all information entered into the database for activites that children partake in. Exhibit A Page 1 of 2 Schedule of Performance Estimate the number of only unduplicated Santa Ana residents to be served by the funded program during the 12 -month contract period per quarter. (How many new Santa Ana clients will be served each quarter.) Quarter 1: Julyl — September 30 30 Persons Quarter 2: Octoberl — December 31 30 Persons Quarter 3: January 1 — March 31 30 Persons Quarter 4: April 1 — June 30 30 Persons 120 Total number of unduplicated Santa Ana residents to be served. (Must equal the number for II above.) Schedule of Invoicing Estimate the amount of grant funds to be requested during the 12 -month contract period on a quarterly basis. Quarter 1: Julyl — September 30 $1250 Quarter 2: Octoberl —December 31 $1 Quarter 3: January 1 — March 31 $ l Quarter 4: April 1— June 30 $1 $S,OOOTotal Grant (Must equal the Total Program Budget indicated on Exhibit B.) Exhibit A Page 2 of 2 CITY OF SANA ANA Community Development Block 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 ". Exhibit A -1 Page 1 of 4 Fulfillment Tracking HUD Objective to be fulfilled HUD Outcome to be fulfilled illustrated by HUD Indicator Suitable Creating Specific Outcome Activity/Program Outcome Tracking Goal Living Decent Economic Availability/ fordability Sustainability Indicator# Environment Housing pponom.ic Accessibility h' (Please see page 4 of 4 for desc.) mi -Crime Services Track the reduction in Redeme response time to response tlme and the serious comes to the City's umber of cnmieill ow- and Moderateincome ❑ apprehended as a result. ama by at least 3 minutes exulting in the apprehrnsion /� of 1,500 criminals Nat may X X Z Nemd'e escape. "•5-year goal to be hieved by FY 09110 Fair Housing Services Peuvide fair housing service 1. Provide fair housing d ongoing analysis of ommsain,, education and impediments to fair housing ordmcement services to ❑ ,000 Santa Ana households. X X L a• "5 -year goal to be hieved by FY 09/10 2. Annually asuasactions eliminate impedimenta to fail /� housing. X X L Homelessness Prevention reank assisted individuals 50°o ofassisted individuals who retained their housing or and households will retain tilities for al least 6 months eir housing or utilities for El after assistance was at least 6 months after X X 14 lhmvidsd. assistance is provided. 1 mergency Shelter Track individuals who SW/, of etved support services that were IirdsN on to e or IndividualsPoouseholas that re 12 or ❑ ore additional support provided with emergency shelw will transition to X X sme and/or a ppropnate common com housing Hs housing. ansitional housing). �� Transitional Housing Track homeless individuals % of homeless individuals who participated in participating in transitional transitional housing Program housing program will be p ❑ Nat were placed in laced in pormarmat housing. A X ent housing. uppomm Services Track individuals who 50%7f individuals/(amilies eived support services ving support smites mwem braid to one or will be linked to one or more ® ore additional support alkational support service X X evxe aad/or appropriate author appropriate housing. nursing. Exhibit A -1 Page 1 of 4 Exhibit A -1 Page 2 of 4 Fulfillment illustrated by TrackinE HUD Ob ective to be fulfdled HUD Outcomes to be fulfilled HUD Indicator Suitable Creating ng Specific Outcome Activity/Program Outcome Tracking Goal Living Decent 800no Availability/ Affordability Sustainabili Indicator # Environment Housing pportunitic Accessibility (Please sec page 4 of 4 for desc J for Serve. I. Trackeasistediamor 1.80 %ofassistedsemor citoons douncmainea cituar, wiuremam ❑ independent for at least l independent for at least l year alter services were corsair services arc X X provided. provideri. . Track seniors receiving .90 %of seniors receiving centrals that were linked to lanais will be linked b the ❑ theservireev.ught, orvices sought, X X rte/ er-Oompied umberofownersasaidei Phy,mal,irfiat, end comfort sing Rehabilitation to rchabiliure their primary ill be improved for Low residence for me following md Moderate income income categories: ouseholds by improving ❑ - Extremely Low Income omcs We Icvel that mats -Very Law Income exceeds HUD housing X X - Moderate Income jusality standards. Special Needs Categories -large Families Had Elderly Services Track frail elderly )0% of flail elderly individuals that were linked ndividuals will be linked to ❑ to the services Wright. cou services sought X A X 2 G Disabled Services Track disables persons Support independent living hose independent living for 90% of disabled persons ❑ was supported by City funds. assisted by City funds. A X X G 2 Services for Mentally 111 reek individuals assisted 100'6 of individuals assisted ith City resources that were with City resources will be ❑ mcivided an entry point into provided an entry point into he regional mental health are system and linked m at the regional moral health at are System to and linked X X least one additional mortal least one additional mensal alth supportive service. health supportive service. Services for Substance Track how many individuals Provide entry into the ddicted with substance addiction in regional recovery system for were provided an entry into 25 individuals with the marched) recovery system substance addiction and link and lances to addamm l em m additional services. X X * " "5 -year goal to be thieved by FY 09/10 Youth Services 1. Track improvement in 1. For education -based -test, post-test scares. rogfams, improve pre -test F_] ost -test scores by 50% X X 2. Truk number of 2, Provide opportunities for F-1 individuals exposed to the xposare to the fine arks. r1 fine m . X X L 3. Track chdither/youlh 3, 90% of ohildren/youth L1 seeking referrals that were IiNcM seeking mfr mis will be X vice to the sere sought linked to the services sou sought X L and Moderate- it Mites rack program participants 0°t- of Panamint parvirea is o -F2 ome that were linked to smicee ill Baked m sarvicip ['w- sought. ought. X X El Exhibit A -1 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 of tests 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 clients' emotional wellbeing. Exhibit A -1 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 shelter 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 -1 Page 4 of 4 Organization Name Program Name Program Year 2006 -2007 Final Budget Women's Transitional Living Center Inc. (WTLC) Independence from Deoendence Expenditures LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED FOR 06 -07 (Total Funds for Program must equal Total Program Budget above) Source Santa Ana CDBG Expenses Funded by Expenses Funded Government Grants Total Program Total Organizational Category Santa Ana CDBG by Other Sources $ Budget Private donations Budget Administrative Staff Salaries & Benefits $ - $ - $ 336,565 Program Staff Salaries & Benefits $ 5,000 $ 844,651 $ 849,651 $ 979,005 Contractual /Professional Services: List below _ ,. , 1 $ 2 $ 3 $ Office Supplies $ 4,000 $ 4,000 $ 27,000 Rent $ - $ 27,041 Communications $ 13,600 $ 13,600 $ 31,450 Utilities $ 20,800 $ 20,800 $ 47,775 Insurance $ 15,500 $ 15,500 $ 35,000 Other:List below , ..:..: 1 Maintenance $ 11,950 $ 11,950 $ 37,000 2 Audit/Legal $ - $ 25,000 3 Depreciation $ - $ 111,782 4 $ 5 $ Total $ 5,000 $ 910,501 $ 915,501 $ 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 Santa Ana CDBG Government Grants $ 534,558 Foundation/corporate grants $ 228,600 Program income CaIWORKS, CACFP $ 98,000 Private donations $ 54,343 Total Funds for Program $ 915,501 Exhibit H Page 1 of 1 2006 -2007 Funded Personnel Name of Organization: Name of Program ADMINISTRATIVE STAFF Inc. Position Title Annual Salary Annual Benefits Total Compensation CDBG Funds Requested for this position % of time spent on funded program Of this time percent of time serving Santa Ana % of Total Compensation Eligible Bilingual Child Advocate $ 29,450 $ 10,896 $ $ 5,000 100% 20% 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% Total Amount Requested $ Must equal amount indicated on Exhbit B PROGRAM STAFF Position Title Annual Salary Annual Benefits Total Compensation CDBG Funds Requested for this position % of time spent on funded program Of this time percent of time serving Santa Ana % of Total Compensation Eligible Bilingual Child Advocate $ 29,450 $ 10,896 $ 40,346 $ 5,000 100% 20% 20% $ 0% $ 0% $ - 0% $ 0% $ 0% $ E$ 0% $ - 0% $ 0% Total Amount Requestedi Requested $ 5,000 Must equal amount indicated on Exhbit B CONTRACTUAL /PROFESSIONAL SERVICES Position Title Annual Contract Amount Annual Benefits Total Compensation CDBG Funds Requested for this position % of time spent on funded ro ram Of this time percent of time serving Santa Ana % of Total Compensation Eligible $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% $ 0% Total Amount Requested $ 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 B -1 Page 1 of 1 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: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any 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. Transitional Livi Grantee /Contactor Program Title EXHIBIT C Page 1 of 2 SUBRECIPIENT warrants the following: 1. SUBRECIPIENT will comply with Public Law 88 -352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 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) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process under Executive Order 12372. EXHIBIT C Page 2 of 2 WIT, =MWCT=fiUlTlF7fias ,: 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. in Protect Your Family From Lead In . United States EPA Environmental Protection Agency ���.. United States Consumer Product Safety Commission United states IIIIIIII $; Department of Housing and Urban Development Are You To Buy, or Home Built Before W any 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. ederal law requires that individuals receive certain information before renting, buying, or renovating pre -1978 housing: '?z 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. Lead From Paint, Dust, and Soil Dangerous Managed 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. r bodies. 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. People can get lead in their body if they: Childhood lead ® Breathe in lead dust (especially during renovations that disturb painted poisoning surfaces). remains a ® Put their hands or other objects major covered with lead dust in their mouths. environmen- ®Eat paint chips or soil that contains tal health lead. problem in the U.S. 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. Even children ® Children's growing bodies absorb more who appear lead. healthy can * Babies and young children often put r have danger- their hands and other objects in their ous levels mouths. These objects can have lead lead in their dust on them. bodies. 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 Brain or Nerve Damage disorder, and decreased intelligence. Rearing ♦ Speech, language, and behavior Problem problems. ♦ Poor muscle coordination. ♦ Decreased muscle and bone growth. sl owed r tth ♦ 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. Digestive In adults, lead can cause: Problems ♦ Increased chance of illness during Reproductive pregnancy. Problems (Adults) ♦ Harm to a fetus, including brain damage or death. Lead affects ♦ Fertility problems (in men and women). the body in ♦ High blood pressure. many ways. ♦ Digestive problems. ♦ Nerve disorders. ♦ Memory and concentration problems. ♦ Muscle and joint pain. E3 i In general, Many homes built before 1978 have lead - the older Our based paint. The federal government banned lead -based paint from housing in home, the 1978. Some states stopped its use even more likely it earlier. Lead can be found: has lead- ♦ In homes in the city, country, or suburbs. based paint. ♦ 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 To reduce your child's exposure to lead, get your child checked, have your home children and tested (especially if your home has paint home tested in poor condition and was built before if you think 1978), and fix any hazards you may have. your home Children's blood lead levels tend to increase has high lev- rapidly from 6 to 12 months of age, and tend to peak at 18 to 24 months of age. els of lead. 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. d 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. 4 Lead -based paint is usually not a hazard if it is in good condition, and it is not on an Lead from impact or friction surface, like a window. It paint chips is defined by the federal government as which you paint with lead levels greater than or equal can See, and 1.0 milligram per square centimeter, or more than 0.5% by weight. leach dust, Deteriorating lead -based paint (peeling which you chipping chalking cracking or damaged) can't always is a hazard and needs immediate attention. See, can (Both It may also be a hazard when found on sur- be serious faces that children can chew or that get a hazards. 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 (pg/ft2) and higher for floors, including carpeted floors. ® 250 pg/ftz and higher for interior window sills. Lead in soil 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: ® 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. Checking Your Home for Lead ,s I; 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 wont 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 1 1) 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. T irour 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 soil. ® Make sure children eat nutritious, low -fat meals high in iron and calcium, such as spinach and dairy products. Children with good diets absorb less lead. Reducing Lead Hazards In The Home Always use a professional who is trained to remove lead hazards safely. 0 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 (ug/ft2) for floors, including carpeted floors; ® 250 Ng/ft2 for interior windows sills; and * 400 µg/ft2 for window troughs. Call your state or local agency (see bottom of page 1 1) for help in locating certified professionals in your area and to see if financial assistance is available. ITM 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 walls): ® 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- cially children and pregnant women) out of the apartment or house until the work is done and the area is prop- erly cleaned. If you can't move your family, at least completely seal off the work area. ® Follow other safety measures to reduce lead hazards. You can find out about other safety measures by calling 1 -800- 424 -LEAD. Ask for the brochure "Reducing Lead Hazards When Remodeling Your Home." This brochure explains what to do before, during, and after renovations. If you have already completed renova- tions or remodeling that could have released lead -based paint or dust, get your young children tested and follow the steps outlined on page 7 of this brochure. 9 M AN While paint, dust, and soil are the most common sources of lead, otherlead sources also exist. a� r ,4�' 10 ® Drinking water. Your home might have plumbing with lead or lead solder. Call your local health department or water supplier to find out about testing your water. You cannot see, smell, or taste lead, and boiling your water will not get rid of lead. If you think your plumbing might have lead in it: • Use only cold water for drinking and cooking. • Run water for 15 to 30 seconds before drinking it, especially if you have not used your water for a few hours. ® The job. If you work with lead, you could bring it home on your hands or clothes. Shower and change clothes before coming home. Launder your work clothes separately from the rest of your family's clothes. Old painted toys and furniture. �► Food and liquids stored in lead crystal or lead-glazed pottery or porcelain. ® Lead smelters or other industries that release lead into the air. ® Hobbies that use lead, such as making pottery or stained glass, or refinishing furniture. �r Folk remedies that contain lead, such as 11 greta" and "azarcon" used to treat an upset stomach. For More Information The National Lead Information Center Call 1 -800- 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.gov/lead and www.hud.gov /offices/leadV. EPAs Safe Drinking Water Hotline Call t -800- 426 -4791 for information about lead in drinking water. Consumer Product Safety Commission (CPSC) Hotline To request information on lead in consumer products, or to report an unsafe consumer product or a prod- uct- related injury call 1- 800 -638- 2772, or visit CPSC's Web site at: O 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.gov/lead or contact the National Lead Information Center at 1 -800- 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. Your Regional EPA Office can provide further information regard- ing regulations and lead protection programs. EPA Regional Offices Region 1 (Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont) Regional Lead Contact U.S. EPA Region 1 Suite 1 100 (CPT) One Congress Street Boston, MA 02114-2023 1 (888) 372 -7341 Region 2 (New Jersey, New York, Puerto Rico, Virgin Islands) Regional Lead Contact US. EPA Region 2 2890 Woodbridge Avenue Building 209, Mail Stop 225 Edison, NJ 08837 -3679 (732) 321 -6671 Region 3 (Delaware, Maryland, Pennsylvania, Virginia, Washington DC, West Virginia) Regional Lead Contact U.S. EPA Region 3 (3WC33) 1650 Arch Street Philadelphia, PA 19103 (215) 814 -5000 Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) Regional Lead Contact U.S. EPA Region 4 61 Forsyth Street, SW Atlanta, CA 30303 (404) 562 -8998 Region 5 (Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin) Regional Lead Contact US. EPA Region 5 (DT -8J) 77 West Jackson Boulevard Chicago, IL 60604 -3666 (312) 886 -6003 12 Region 6 (Arkansas, Louisiana, New Me)ico, Oklahoma, Texas) Regional Lead Contact US. EPA Region 6 1445 Ross Avenue, 12th Floor Dallas, TX 75202 -2733 (214) 665 -7577 Region 7 (Iowa, Kansas, Missouri, Nebraska) Regional Lead Contact U.S. EPA Region 7 (ARTD -RALI) 901 N. 5th Street Kansas City, KS 66101 (913) 551 -7020 Region 8 (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming) Regional Lead Contact U.S. EPA Region 8 999 18th 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 Toxics Section WCM -128 1200 Sbcth 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 Western Regional Center Consumer Product Safety Commission Consumer Product Safety Commission 201 Varick Street, Room 903 1301 Clay Street, Suite 610 -N New York, NY 10014 Oakland, CA 94612 (212) 620 -4120 (510) 637 -4050 Central Regional Center Consumer Product Safety Commission 230 South Dearborn Street, Room 2944 Chicago, IL 60604 (312) 353 -8260 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 booklet 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 EPA747 -K -99 -001 U.S. CPSC Washington DC 20207 June 2003 U.S. HUD Washington DC 20410 13 Disclosure of Information 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 Protect Your Family from Lead in Your Home. Agent's 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. Lessor Date Lessor Date Lessee Date Lessee Date Agent Date Agent Date Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards Lead Waming Statement Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including 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 seller's possession and notyy 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 (1) or (fl) below): (1) 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. Purchasers Acknowledgment (initial) (c) Purchaser has received copies of all information listed above. (d) Purchaser has received the pamphlet Protect Your Family from Lead in Your Home. (e) Purchaser has (check (1) or (ii) below): (i) _ received a 10 -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. Agent's Acknowledgment (initial) (fl Agent has informed the seller of the sellers 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. Seller Date Seller Date 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: ❑ ---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- 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): L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- ❑ ---------------------------------------------------------------------- F1---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- -------------------------------------------------------- -------- - - -- -- 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: Printedname: -------------------------------------------------------- Signature: ----------------------------------------------------------- Attachment 3 Page ] of 5 Date:---------------------------------------------------------------- Organization:-------------------------------------------------------- Streetand 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: r---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- 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: ---------------------------------------------------------------------- ---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ---------------------------------------------------------------------- L---------------------------------------------------------------------- r---------------------------------------------------------------------- ---------------------------------------------------------------------- �---------------------------------------------------------------------- ❑---------------------------------------------------------------------- L---------------------------------------------------------------------- E-------------------------------------------- -------------------- - - - - -- Contact person for more information about the risk assessment: Printed name: -------------------------------------------------------- ❑---------------------------------------------------------------------- Organization: -------------------------------------------------------- F---------------------------------------------------------------------- Street and city:----------------------------------------------------- 7---------------------------------------------------------------------- State: ZIP: Phone number: (_) --------------------------- Attachment 3 Page 2 of 5 L---------------------------------------------------------------------- Person who prepared this summary notice: Printed name:-------------------------------------------------------- ---------------------------------------------------------------------- Signature:----------------------------------------------------------- LDate: ---------------------------------------------------------------- ❑---------------------------------------------------------------------- Organization: -------------------------------------------------------- L---------------------------------------------------------------------- Street and city:----------------------------------------------------- L---------------------------------------------------------------------- State: ZIP: Phone number: ()--------------------------- L- -- - - - - -- - -- - - -- --------- -- - - - - -- ---- -- ------- -- ------- - - - - -- 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: L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- 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: L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- ❑---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- ---------------------------------------------------------------------- L---------------------------------------------------------------------- ❑---------------------------------------------------------------------- ❑---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- Fi---------------------------------------------------------------------- ---------------------------------------------------------------------- Contact person for more information about the presumption: Attachment 3 Page 3 of 5 Printed name: -------------------------------------------------------- ❑ ---------------------------------------------------------------------- Organization: -------------------------------------------------------- f]---------------------------------------------------------------------- Streetand city: ----------------------------------------------------- ❑ ---------------------------------------------------------------------- State: ZIP: Phone number: ()--------------------------- ❑---------------------------------------------------------------------- Person who prepared this notice of presumption: Printed name:-------------------------------------------------------- L---------------------------------------------------------------------- Signature:----------------------------------------------------------- LDate:---------------------------------------------------------------- ---------------------------------------------------------------------- Organization:-------------------------------------------------------- ----------------------------------------------------------------------- Street and city:----------------------------------------------------- -1 ---------------------------------------------------------------------- State: ZIP: Phone number: () --------------------------- - ---- -- --- ------ ----------- ----- - - - - -- 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: L---------------------------------------------------------------------- L---------------------------------------------------------------------- L---------------------------------------------------------------------- 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: L---------------------------------------------------------------------- L---------------------------------------------------------------------- li---------------------------------------------------------------------- L---------------------------------------------------------------------- ❑---------------------------------------------------------------------- L---------------------------------------------------------------------- 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: 1-------------------------------------------------- -------------- - - - - -- Attachment 3 Page 4 of 5 L---------------------------------------------------------------------- L---------------------------------------------------------------------- L------------------------------------------------ ---------------- - ----- Summary of results of clearance testing and soil analyses: (a) No clearance testing was performed. (b) Clearance testing showed clearance was achieved. (c) _ 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:-------------------------------------------------------- Streetand city:----------------------------------------------------- State: ZIP:----------------------------------------------------- Phone number: ( ) ------------------------------ ------------- - - -- -- [FR Doc. 99 -23016 Filed 9- 14 -99; 8:45 am] BILLING CODE 4210 -32 -P Attachment 3 Page 5 of 5 ATTACHMENT NO. 4 LBP INFORMATION SUMMARY ZERO /0 BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN HOMELESS SHELTER • STATUS: EXEMPT TITLE X 2. ZERO /0 BEDROOM > (MORE THAN) 100 DAYS IN UNIT • STATUS: OPEN ISSUE UNDER LBP REGS ZERO /0 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 of 2 • CLEARANCE BEFORE ANY MONEY DISBURSED; LBP COMPLIANCE: NOTIFICATION, EVALUATION, REDUCTION THROUGH CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT • MAYBE 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 100 DAYS OF ASSISTANCE. • EXEMPT TITLE X Attachment 4 Page 2 of 2 Attachment 5 Page I of I O O y A� n ,7 QQ d r i 7Q C x 0 C m CD O a y N d � •Z O. m y r, M T x O rn C A � 0 G ►� o c � c " o � o CL fox C d S � � o CL C b � � o o b z y C A 7 � A A O �h nm A C r rn C O A Attachment 5 Page I of I O O y A� n ,7 QQ d r i 7Q C x 0 C m CD O a AGQ,P,D� CERTIFICA" OF LIABILITY INSURE' FE 04%11 /1 /2pp6 PRDL JCER (310) 393 -9477 FAX (310)393 -7186 White & Company Insurance Inc P 0 Box 70 Santa Monica, CA 90406 -0070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT16N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURED Women's Transitional Living Center PO Box 6103 Orange, CA 92863 INSURERA Philadelphia Ins Co INSURER B: GENERAL LNBKM INSURER C: 04/04 /2006 INSURER O. EACH OCCURRENCE INSURER E: yTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR TYPE OF MSImANCE POLICY NUMBER POLICY EFFECTIVE DATE f POLICY EXPIRATION mw timuonrm LIAM'fS GENERAL LNBKM PUPKI64779 04/04 /2006 04/04/2007 EACH OCCURRENCE $ 1100010" X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 300, CLABAS MADE Q OCCUR MED EXP (Any a person) $ is, ..PERSONAL & ADV INJURY $ 1 000' A GENERAL AGGREGATE $ 2,000,00C GENL AGGREGATE LOW APPLIES PER PRODUCTS- COMP/OP AGO S 1,000, POLICY 7 LOC AUTOMOexELweIDTY ANY AUTO PHPKI64779 04 /04/2006 04/04/2007 COMBINED SINGLE LIMIT (Es a=kW) S 1,000, BODILY INJURY (PS Pal^) S A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NO"WNED AUTOS X X BODILY INJURY (PwaccidW) S X PROPERTY DAMAGE (Per guide ) S GARAGE WIBRRY AUTO ONLY- EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGO S ANY AUTO S ExCEBSIUYBPELLAL1ABILftY PMB061149 04/04 /2006 04/04/2007 EACH OCCURRENCE S 2,000, AGGREGATE $ 2,000, X OCCUR CLAM MADE $ A $ DEDUCTIBLE 1 RETENTION S _ WORKERS COMPENSATION AND EMPLOYERS•LNBILNY ANY PR OPRIETOFWARTNERIEXECUTNE OFFFFIICERIMEMBER EXCLUDEM 'DR'`•,i iii- ,�. '1 _. >»' "• Ld ' Y✓C STI OTH- E.L. EACM ACCIDENT $ E.L. DISEASE • EA EMPLOYEE S E.L. DISEASE - POLICYI MIT S SPECW� RWISO SEekw Lii1+ as„sta -T '�..., OTHER - •. ity Attor ,C, OF OPERATIONS I LOCATIONSI VENICLES / EXCLUSIONS AWED BY ENDORSEMENT/ SPECIAL PROVISIONS City of Santa Ana, its officers, agents, employees, and volunteers are additional insureds as per form I -NP -003 (OS /01) Item N - Funding Source and Primary Insurance as per form CGOO 01 07 98, both attached to the general liability policy and accompanying this certificate. *Except for 10 days written notice of cancellation for non - payment of premium. City of Santa Ana - CDBG M -2S ESG P.O. Box 1988 M -25 Santa Ana, CA 92702 ACORD 25 12DDimai C _ K SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL #1)LV)WM MAIL 30* DAYS wRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XX ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate folder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. F,bl9I2:1t lay Attor ... ACORD 25 (2001/08) PI -NP -003 (5/01) It is understood and agreed that the following exterrAOM only apply in the am that no other specific coverage for the indicated loss exposures are provided under this policy. if such specific coverage applies. the terms, corhdftians and limits of fret coverage are the sole and exclusive coverage applicable under this polky. Throughout this endorsernetht the words "you" and "your" refer to the Named insured shown in the Declarations. The words "we" "us" and "ofd" refer to the Company providing this insurance. This endorsement modifies insrance provided under the folli": COMMERCIAL GENERAL LIABILITY COVERAGE The following Is a summary of the Limits of insurance and additional coverage provided by this endorsnnert. For complete details on specific coverages, consult the policy corwact wording. A Mel 'catPWrmts- Llrrit/nvoseito $1400a 94W Y Parts - Ball tzvzb increased to $2 501YLnw of earrings incrao sed ib $Mo rich day. C Tff 3 sUVW Llab!ilty- for Rr4 Uyhbt ng FWcdcn &Mka and Leaks from W i ders - Umft /n 7olsed to W D. & 03*nsdDe9niA'cnofNAoIsAn /ntvrst E AmarxisafDrd/es /n TheEieit o'ortrrmost aafmOr Si'h, F. filroaab idWrVt/mdA&A"- Irlisy-indidasTde iwdcr Nc oadPf�fYlraBcny G ArrmxW01a1rilic nd8ai/ y /rytrytofndudeMe- AWArx,7rr;,1R• H. &wals GIsiridendPaFWP attrltuy-IWWu A&wcfPrcoovdsrinrnaNYa;. L Am ndsd L/nlnt"onsir Fa7tre To D/s:tase Haa rd r ./ A7&XJS tUtxraflzadcnaarc9a K Ad*i 67FIQlW /ndwnrifrcradah Dare» Coswege - ft uf!/ Pay cP to .1;251 GCb in d°lew w. for a'+'erf✓oyaa" in a ai Wnaf procesing (s�llrey to esteb7&W crite/ak t "Prcpety D~ - Iemwi errtusicn for •PrGaa eta r� resdtl V iron Bra use of ressors 0 force toprofsceparso saProoafy M. AdDWbla -MAd f fad /rtsrei- FtndngS"c4 X Ad*dtl WAdibad lrafW- MavgrrsorLesearscfPr&WsW a A&WG&wafAppregateum`t Per tocaffat .. T, P. Aia�- au+aei ►Nfa(e -aMt - maer /ehgtl, is lrxraxl to 59 fL; o ,y _ Ctiy Pttc; .c� Page 7 of 5 Inchdes copyright material of dre hrsUrame Servion otr". Inc. used Wilh it pemasion. PI -NP -003 (5101) A. Medkel Payrnerts If Medical Payments Coverage (Coverage C.) Is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all the terms of Limits Of Insurance (Section I I I) to the greater of: a. $15,000; or b. The Medical Expense Limit shown in the Declaration of this Coverage Part. 2. The requirement in the Insuring Agreement of Coverage C., that expenses must be Wxurred and reported to us within "one year" of the accident data its changed to "three years." 3. Exclusion a. of Coverage C. at your option, does not apply to your volunteer workers or any Person or organization under your direct supervision and control. & SlrpplMMI Lary Paymer" In the Supplementary Payments . Coverages A. and B. provision: 1. The limit for the coat Of bail bands is changed from $250 to $2,500; and 2. The limit for loss of earnings is changed from $250 a day to $50D a day. C. Fir% LlghtNna. Bocalo% SnckapW Lesksfrom Wlnklers It damage by fire to premises rated to you Is not otherwise exdtded from tlts Coverage Part, the word "fire" Is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective systems" where it appears in: 1. The Limits Of Insurance section of the Declarations as the Fire Damage Limit. That limit: a. Is clanged subject to all the terns of limit Of Insurance (Section III) to the greater of: (1.) ;3011.000; or (2J The arrant shown in the declarations as the Fire Damage Limit. b. Subject to a. above is the most we will pay to all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leeks from automatic fire protective systems or any combination thereof. 2. The last paragraph of Coverage A. (Section 1) after the Exclusions; 3. Paragraph 6, of Limits of Insurance (Section 111); 4. Paragraph b.(1)(b) of the Oduer Ins rance Condition (Section IV); and 5. Paragraph a. of the definition of "insured contract" D. WhoheAnlnared Who is An Insured (Section II) is Banged as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Coverage Part. paragraph 4.a is changed to read: a. Coverage under this provision Is afforded until the end of the policy period. 2. Each of the following is also an Insured: a. At the first Named Insred's option, your volurdeer workers; and b. Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not Include the furnishing or fell re to fumWu professional services of any physician or psychiatrist Inthe treatment of a patient. C. At the first Named Insured's option, any person or Organization under your direct supervision and control while providing for you private have respite or fester home care for the _ developmentally disabled. However, the insurance afforded by b. above is excess over any other insurance covering any Person or organization under your direct control or supervision. d. If you are an organization other can a partnership or joint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. e. Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, the insurance afforded by e. above, for ary organization and subsidiary thereof not named in the Declarations as a Named insured, does not apply to injury or damage with respect to which an insured ceder this Coverage Pat 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. Page 2 of 5 Ir1dedB9 copyrlgx maWW of ere h@rare:e servim o m, he. use with ids permission. .v A: PI -NP -003 (5/01) E, Outls In The Eianit Or OoarrorM Clalm Or Sut 1. The reWiremmerit In condition 2.a. (Conditions, Section IV) that you nxist see to it that we are notified as soon as practicable of an "occurrence' or on 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 executive officer or insurance manager, If you are a corporation. 2. The reWirement 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 considered breached unless 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 executive officer or insurance manager, if you are a corporation. F. Advertdnp Injury- TdoirlaedOr VWWblpadRtWiCa#M ,._ . <. - 1. The definition of "Personal and advertising Injury" items 14. (d),(e), (f) and (g) is changed to read: Personal and Advertising Injury" means injury arising out of one or more of the following offers: d. Oral, written, televised or videotaped publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Oral, written, televised or videotaped publication of material that violates a person's right of privacy: f. Misappropriation of advertising ids or style of doing business; or g. Infringement of copyright, title or slogan. 2. Exclusion a. (2) and a. (3) of Coverage B., Personal And Advertising Injury Liability, are cthaged to react: a. (2) Arising out of oral, written, 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, written, televised or videotaped publication of material whose first publication tools place before the beginning of the policy period. Q Sodb Irdury-MaM AngWvh The definition of "bodily injury" is changed to real: "Bodily Injury": a. Mean bodily injury, sickness or disease sustained by a person, and includes mental aguish resulting from my of these; and b. Except for mental anguish, includes death resulting from the foregoing (item a. above) at any time. H. Personal lnJury-AbuseOf Procrim mImlhetlot If Personal. ad Advertising Injury Liability Coverage (Coverage B.) is not otherwise excluded from this Coverage Pat: 1. The definition of "Personal and advertising in jury" is changed by: a. Revising item b. of that definition to read: - Malicious prosecution or abuse of process: b. Adding the following: "Personal Injury" 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 with the knowledge or consent of: (a) Achy, insured; or (b) Any executive officer, director, Mcklolder, partner or member of the insured; or (2) Directly or indirectly related to the employmerd, former or prospective employment, termination of employment, or application for employment of arty person or persons by an insured; or . _. ..� "ago �ej .�•�' Page 3 of 5 - hnchwks copyright ntatrikl of the Irstrance Services Oifke, Inc. used wish i6 i,1:Y PI -NP -003 (5/01) (3) Directly or indirectly related to the sale, rental, lease or sub -lease or prospective sales, rental, lease or sub -lease of arry roan, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, cart decision or administrative ruling. The Insurance afforded by HA A above does not apply to fines or penalties Imposed because of discrimination. 1. (1niMetiaW FaihreToDladoesH�arde It Is agreed tat, lased an our reliance on your representation as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall rat deny coverage under this Coverage Part because of such failure. J. LiberallaYim If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. K. EmptoyaIndemHirstion DdermCaaepe Under SUPPLBAENTAITYPAYMENfS. COVERAGESA AND B the following is added: 3. We will pay on your behalf defense costs incurred by an "employee" in a criminal proceeding. However, you must have a prior written agreement with such "employee" whereby you agree to Indemnify the "employee" for such defense costs and the agreement includes a provision for repayment of defense costs in the event of an advesejudgernent. The most we will pay for any "employee" who is alleged to be directly involved in a criminal proceeding Is $25,000 regardless of the number of employees, claims or "suits" brought or persons or organizations making claims or bringing "suits." L. Externded ePrgmV Da►nepef SECTION I - COVERAGEBm COVERAGEA, 2 Excludorm a is deleted and replaced by the following: a. Expected or Imexied Injury "Bodily Injury" or "Property Damage" expected or Intended from the standpoint of the inuured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect person or property. M. Additlixal Insured - Funding Source Under SECTION 11- WHOISAN INSURED the following Is added: 5. Any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises, This insurance does riot apply to structural alterations, new construction and demolition operations performed by or for that person or organization. N. Addltladinsred- ManaperaorLeeewedPrenlaee Under SECTION I I- WHOISAN INSURED the following Is added: 6. Arry person or organization with respect to their liability arising out of the ownership, maintenance or use of the part of the premises leased to you subject to the following additional exclusions: This instance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alterations, new corMnxtion or demolition operations performed by or on behalf of that person or organization. Page 4 of 5 lixWes copyrgA it ewol of the www" Services Office. Inc. used with its permission. PI -NP -003 (5101) O. General Aggreg tsLimit Par lorallon SECTION III- Limits of Inatranc% paragraph 2. Is amended to the following: The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or " property damage" Included in the 'products- completed operations hazard "; and c. Damages under Coverage B. A separate Location General Aggregate Limit applies to each "location ", and that limit Is equal to the amount of the General Aggregate Limit shown in the Declarations. SECTIONV- DEFlNITION$isamended by adding the following: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of -way of a railroad. P. Nortawited Watercraft SECTION 1- COVgRAGESi2Excludom paragraph g (2) is amended to read as follows: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This Provision applies to arty person, who with your consent, either uses or is responsible for the use of a watatraft. This insurance is excess over any other valid and collectible in surarnce available to the insured whether primary, excess or contingent. s TO FORIM .....s..i; i,y Auoraey Page 5 of 5 kxkdes copyr191t malarial or tee Irm"M Smites Office. Inc. used with as permission. 02/03/2004 16:37 3103937186 SECTION IV - COMMERCIAL. GENERAL Lf1(wary CONDmoms ' I- Aankruptcy J3anlauptcy or insolvency .of�'the' Insured or of the ufisureds estate will not relieve us of our obliga- ttons under this Coverage Part 2..;17irtiesin -The Event ..Of Occurrence; Offense, ;Crairn Or Suit ,aC You must sea to it that nova are notified as soon :c practbable of an..!ota arienca, or an offense which may result. in a: claim.. To the extent , possible, notice should'Btdude: ( ?)' How, when and wF":jha''ocamerioe• or _ offense took place; ' "' (2) The names and addresses of any Injured persons and witnesses; and (a) The nature and' location of any injury or damage - arising out of. the 'occurrence' or offense. b. if a claim 15 made or °sut't' Is brought against anY.'nsured; you must: (1) knmedletely record the specifics of the claim or'suir and the date received; and (2) NOW us as soon as practicable. You must see to it that we receive written no- 600 of the claim or 'suit' as soon as practica- ble. 0. You and any other involved insured must. (1) Immeillately send us copies of any do- ' mands, notice$, summonses or legal pa- pers received In connection with the claim or'sufr: (2) Authorize us to obtain records and other information; (3) Cooperate with us in the.investigation or settlement of the claim or defense against the 'suit•; and (4) Assist us, upon our request, in the en- forcement of any right against any person or organization which may be liable to the Insured because of irjuty or damage to which this Insurance may also apps. J. No inured will, except at that insureds own cost. voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid without our consent 3. Legal Acton Against Us '. No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us Into a 'suit' asking for damages from an insured; or WHITE .& CO PAGE 02/03 b To sue us on this. Coverage. Part uriless all of its terms have beentully ompliedwith. A person or organization.rtiay sue us to recover on an agreed setttement'or' on a final judgment against an inured o6tarned after an actual trial. but we will not be liable for damages that are not payable under the tennis of this Coverage:Parr or that, are in excess of the applicable limit of knurry once. An agreed settlement means a settlement and release of Ilabildy 'signed by us, the''lnsured - and:the claimant or theclalmanCs legal represerr. . tathie, c r.: " -1k; Other insurance � : if ~valid and cobadtlbfe insurance Is available to the insured for a Ions we cover under Cover -' ages A or B of this Coverage PaM our obligations are limited as follows_ a. Prknary Insurance This insurance is prmLary except when b. be- low applies. If this insurance Is primary, our obligations are not affected unless any of the other. insurance Is also primary. Than, we will share with all that other insurance by the method described in o. below. b. Excess Insurance This insurance is excess over (1) Any of the other insurance, whether pri- mary, excess. contingent or on an14 other basis: (a) That is Fire. Extended Covews, Builders Risk, Installation Risk of skni- lar coverage for "your work': (b) That id Fere insurance for premises rented to you or temporarily occupied by you with permission of the owner, (c) That is insurance purchased by you to cover your liability as a tenant for "property damage' to premises rented to you or temporarily occupied by you with permission of the owner; or (d) tf the loss arises out of the maintenance or use of aircraft, 'autos' or watercraft to the extent not subject to Exclusion 9. of section I - Coverage A - Bodily In- jury And Property Damage Liability. (2) Any other primary insurance available to you covering liability for damages arising out of the premises or operations for which, you have been added as an additional irr, sured by attachmew of an endorsement CO 00 0107 90 Copyright, Insurance Services Office, .Inc., 1997 Page 9 of 13 u2iuui2004 16:37 31039371.86 WHITE & 00 J When this insurance IS excess, we will' haVe.ro duty urdeF;CoYeragM A or 6 to defoe�rftba ur -. sured again any'sutt''if any other insur6rhas a duty to dst efend the Insured against that *suit` If' rip Other., Insur* defends, we will Xmilertake to do so, but we wil be emitled to the iiisuredsf rights.against'ad those other insurers-, When, this- insurance is excess over other -9 1- surance, tire: wol pay only' our sham-.10't the amount of the lose, if any: that exc� the. .S.Gm.Oh .:, . (T) The total arnouht that all'such other thsur= ahce,svotdd• Pay -for the loss in therabserim . of this insurance; and -(2) The total of all deductible and self-in§ured artfounts urideir all that other insurance. We• wPI share. the rernaGting.loss, W any; with' any'otther'ihsoranoeVIM ii not described in this Excess insurance provision and Was not bought .spectiraly to apply In excess of the Limns of Insurance shown in the Decleratlorts of this Coverage, Part. O. Method Of Sharing' It aH' "of tfie outer insuraripe, .permits contribu- tbn` by equal shares, we will follow this method also: Under this approach each insurer con - tribisfes equal amounts unto it has paid its ap. plicable limn of insurance or none or the loss remains, whichever comes first. if." of the -other insurance does not permit contribution Vy equal shares, we will contribute by. omits: Under this method, each insurer's sharb` Is based on the ratio of its applicable limn of insurance to the total applicable omits of Insurance of all insurers. M Premium Audit a. We will compute an premiums for this Cover- age Part in accordance with our rules and rates, b. Premium shown in this coverage Part as ad- vance premium is a deposit premium only, At the close of each audit period we will Compute ._ the earned premium for that period. Audit premiums are due and payable on notice to the first Named Insured. it the sum of the ad- vance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named. iri_ sured. G The first Named Insured must keep records of the information we need for premium compu- tation, and send us copies at such times as we may request Page 10 of 13 PAGE 03/03 8. Represft etions . By acceptitrg this polioXj you agree:.: c m The staterooms in. the Deckuatioit's .ale accu- rate arid:complete _ b. Those statements are based upon representa- tions you:made to us; and r c; We have. issued this policy in relteix6it upon your representations. x: 7. Separatibiw011 Insureds Exoepf'witlr .. pact to the Limits: W liiiurarice, and any rtgfMs or dudes specdically,:a. geed in this Covl #ra PaR to ' irhe fii at Name c 'lioured, this Insurar4.2 .. , . +:•c; . a. As it each Named Insured were the only Named insured; and b. Separately to each insured against whom claim is made or "sun' b brought 8 Transfer Of Rights Of Recovery Against Others To Us ` If the insured has rights °to recover all or:pad bf any payment we have made under this Coverage Part, those rights are transferred to us.- The in - .. sunlid must do nothing after loss to impair them. At our request, the Insured will Wing 'suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew It we decide not to renew this Coverage Part, we Will mail or deliver to the first Named Insured shown in the Declarations written notice: of the nonrenewal not less than 30 days gore tare expi- ration date. If notice is mailed, proof of mailing will be suffi- cient proof of notice. SECTION V - DEFINITIONS I. 'Achrertisement' means a notice that is broadcast or published to the general public or specific mar- ket segments about your goods, products of serv- ices for the purpose Of attracting customers or -supporters, 2. 'Auto' means a land motor vehicle, trailer or semitrailer designed for travel on public roads, in- cluding any attached machinery or equipment. But "auto' does.not include 'mobile equipment'. 3. 'Bodily inW means bodily injury, sidmess or 011383 from any of these person, Including g death re. 4. ' Coverage territory means: a The United States of America (Incluakig its territories and Possessions), Puerto' Rico and Canada; copyright, Insurance Services office, Itx9j, X1997. CG go 0b,F 9t [ c . CERTHOLDER COPY SP STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02 -14 -2008 GROUP: POLICY NUMBER: 1610814 -2006 CERTIFICATE ID: 76 CERTIFICATE EXPIRES: 03 -28 -2007 03 -28- 2008/03 -28 -2007 CITY OF SANTA ANA SP JOB:ALL CALIFORNIA OPERATIONS ATTN: MIKE LINARES ESQ -CDA PO BOX 1988 M -25 SANTA ANA CA 92705 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved 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 30days 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. =1ORIZE1REP4RE/SENTAT41iij PRESIDENT EMPLOYER'S LIABILITY LIMIT 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 8103 ORANGE CA 92863 [SLC,SPj 4REV.2-05) PRINTED : 02 -14 -2008 0 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND 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 SP JOB:ALL CALIFORNIA OPERATIONS ATTN: MIKE LINARES ESQ -CDA PO BOX 1988 M -25 A— a. oO(D — Q &p SANTA ANA CA 92705 04 9 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved 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 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. tTHORI�ZEO REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03 -28 -2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER WOMEN'S TRANSITIONAL LIVING CENTER, INC PO BOX 6103 ORANGE CA 92863 SP e- P M0408 IREV.2 -051 PRINTED : 02 -17 -2007 SP