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HomeMy WebLinkAboutPACIFIC CLEANING SERVICES 1 (2) - 2011+NSURANCE C "ILE APR ? G 2Qt?. WORK MAY F ?.??tED N-2011.-035 UNTIL INSUK?-.,•?? EXPIRES ?Jp Agreement No. ?__`?" ? ? ? 12io9 ??/ Gfl 1/UCrIS «'?'?-r` CLERK u;?y'?+®I ? 2,??1 y? ? DATE: S ? Jv+G VCrzc?ue z ON-THE-JOB TRAINING AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT THIS AGREEMENT is made and entered into this 16 day of March, 201 1 between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California (hereinafter "CITY") and Pacific Cleaning Services (hereinafter "EMPLOYER"). WITNESSETH Recitals: A. CITY has been designated a Local Workforce Investment Area ("LWIA") pursuant to Section 116 of the Workforce Investment Act ("WIA"), P.L. 105-220, 29 USC Section 2801, to receive federal funds to promote effective delivery of job training services to local azea residents. B. The State of California has created the California Workforce Investment Board pursuant to Section 111 of the Workforce Investment Act, P.L. 105-220, 29 USC 2821 to administer the WIA programs operated by the State of California. C. As a LWIA, CITY is entitled to receive federal funds to establish programs to prepare eligible unskilled youth, adults and dislocated workers for entry into the labor market, and to provide job training to those individuals who face serious barriers in obtaining productive employment ("said Program"). D. EMPLOYER is able and willing to train eligible unskilled applicants for entry into the labor mazket and is willing to operate said program pursuant to the WIA and applicable federal, state and local laws. WHEREFORE, for and in consideration of the respective and mutual covenants and promises hereinafter contained and made, and subject to all the terms and conditions hereof, the parties hereto do hereby agree as follows: 1. Term. The effective term of this Agreement is for the period beginning March 21, 201 1, and ending June 24, 2011. The term of this Agreement may be extended upon agreement of all parties and execution of an amendment of the term. 2. Scope of Work. The EMPLOYER shall employ and train one employee (hereinafter "Trainee") in the occupation and in accordance with the OJT Training Outline set forth in Exhibit A, attached hereto and incorporated herein by this reference. Said Trainee shall be referred by the City of Santa Ana W/O/R/K Center. Training must significantly raise the Trainee from his/her prior position in both level of skill and salary by the end of the training period. 3. Fundine. CITY shall reimburse the EMPLOYER an amount not to exceed $ 4.732.00 in accordance with the Cost Computation included in Exhibit A. EMPLOYER shall bill the CITY monthly on an invoice provided by CITY for actual and reasonable cost for providing the services described in this Agreement. Reimbursement of EMPLOYER under this Agreement shall be limited to the costs incurred during the basic work week, excluding overtime and any paid holidays or sick leave. 1 12/09 4. Subcontractin:? Prohibited. The EMPLOYER shall not subcontract or assign the OJT Training. Any attempt by the EMPLOYER to delegate or assign OJT training duties under this Agreement shall void, and permit CITY to immediately terminate, this Agreement. 5. Emulover Obligations. During the training, the EMPLOYER shall ensure that the Trainee: a. is on the EMPLOYER's payroll, not paid as a contracted employee/independent contractor; and, b. receives the same benefits as EMPLOYER'S other employees performing similar work; and, c. is paid the salary as indicated in Exhibit A with appropriate payroll taxes withheld and reported; and, d. is provided Worker's Compensation Insurance coverage, pursuant to state law; and, e. is provided by EMPLOYER with safety instructions and equipment necessary for reasonable protection against injury and damage. CONTRACTOR shall maintain appropriate standards for health and safety in work and training situations. Where special clothing or equipment is provided to the EMPLOYER'S regular employees, EMPLOYER shall provide the same type of clothing or equipment to the Trainee performing similar work. 6. Emylovment of Trainee. The EMPLOYER shall employ the Trainee as a regular member of EMPLOYER'S work force. If EMPLOYER wants to continue to employ the Trainee upon the successful completion of the training period under this Agreement, said employment shall be subject to the same conditions of employment applied to EMPLOYER'S other regular employees, including termination for unsatisfactory performance. 7. Patent, Copyrights and Rights in Data. The EMPLOYER will disclose to the CITY any invention, written product, computer program developed or data assembled as a result of performance of work under this Agreement within seventy four (74) days of invention, development or assembly. The CITY, State of California, and U.S. Department of Labor will have the right to patent any invention and copyright any written product or computer program or data generated by EMPLOYER. Upon written request, EMPLOYER will transfer all pertinent information, specifications and right, title and interest to the designated agency. 8. INVENTIONS, PATENTS AND COPYRIGHTS. A. Reporting Procedure. If any project- produces patentable items, patent rights, processes, or inventions in the course of work under a U.S. Department of Labor (DOL) grant or agreement, the CONTRACTOR shall report the fact promptly and fully to the CITY. The CITY shall report the fact to the Grant Officer, at the DOL. Unless there is a prior agreement between the CITY and the DOL and its representative on these matters, the DOL shall determine whether to seek protection on the invention or discovery. The DOL and its representative shall determine how the rights in the invention or discovery, including rights under any patent issued thereon, will be allocated and administered in order to protect the public interest consistent with the "Governmental Patent Policy" (President's Memorandum for Heads of Executive Departments and Agencies, August 23, 1971, and Statement of Government Patent Policy). B. Copyright Policy. 1. Unless otherwise provided in the terms of the grant or agreement, when copyright-able material is developed in the course of or under a DOL Grant or agreement, the author and the CITY which 2 12/09 developed the work is free to copyright material or to permit others to do so. The EMPLOYER and the Workforce Investment Board (WIB) shall have aroyalty-free, nonexclusive and irrevocable license to reproduce, publish, use and to authorize others to use all copyrighted material. 2. The DOL reserves aroyalty-free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes: (a) The copyright in any work developed under any grant, sub-grant, or contract under a grant or subgrant; (b) Any right of copyright to which a grantee, subgrantee or a EMPLOYER purchases ownership with grant support; and (c) EMPLOYER shall comply with the requirements of 29 CFR Part 97.34. C. Rights to Data. The DOL and the CITY shall have unlimited rights to any data first procured or delivered under this Agreement. 9. Hold Harmless. The EMPLOYER shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from and against any and all damages to property or injuries to or death of any person or persons, including property and employees or agents of CITY, and shall indemnify, defend and hold harmless CITY, and its officers, agents and employees, from any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not limited to, workers' compensation claims, resulting from or arising out of the negligent acts, errors or omissions of EMPLOYER, its employees, agents or subcontractors. 1 O. Insurance. The EMPLOYER shall obtain at its sole cost and file with the City of Santa Ana -Santa Ana W/O/R/K Center, upon execution of this Agreement; and maintain for the period covered by this Agreement, a policy or policies of commercial general liability insurance or a certificate of such insurance, satisfactory to the City Attorney of CITY, naming CITY, and its officers, agents and employees, as insured or additional insured (see attached Additional Insured Endorsement, Exhibit C), which provides coverage not less than that provided in the form of a comprehensive general liability insurance policy against liability for any and all claims and suits for damages or injuries to persons or property resulting from or arising out of operations of EMPLOYER, and its officers, agents, or employees. Said policy or policies of insurance shall provide coverage for both bodily injury and property damage in no less than One Million Dollars ($1,000,000). Said policy or policies shall also contain a provision that no termination, cancellation or change of coverage or of insured or additional insured shall be effective until after thirty (30) days notice thereof has been given in writing to CITY. EMPLOYER shall give to CITY prompt and timely notice of claims made or suit instituted against said policy. EMPLOYER shall procure and maintain at its own costs and expense, any additional kinds and amounts of insurance which, in its own judgment, may be necessary for its proper protection. 11. Record Keeping. CITY, the State of California and the United States government and/or their representatives shall have access for purposes of monitoring, auditing and examining of EMPLOYER' S activities, performance, books, documents, papers, and records of EMPLOYER'S subcontractors, bookkeepers and accountants, and employees and participants related, to this Agreement. Such agencies or representatives shall also schedule on-site monitoring in their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants and entering any premises or onto any site in which any of the services or activities funded hereunder are conducted or in which any of the records of EMPLOYER are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. In the event EMPLOYER does not make the above-referenced documents available within the City of Santa Ana, California, EMPLOYER 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. 3 12/09 All accounting records and evidence pertaining to all costs of EMPLOYER and all documents related to this Agreement shall be kept available at the location where EMPLOYER conducted the program, as well as in the County of Orange, for the duration of this Agreement and thereafter for three (3) years after completion of an audit. 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, the State of California or the United States Government take exception, shall be retained beyond the three (3) years until resolution of disposition of such appeals, litigation, claims, or exceptions. 12. Government Fundine. This Agreement is valid and enforceable only if sufficient funds are made available to the State by the United States Government for the same Fiscal Year as for this Program. In addition, this Agreement is subject to any additional restrictions, limitations, or conditions enacted by Congress or any statute enacted by Congress which may affect the provision, terms or funding of this Agreement in any manner. 13. Payment Can. Based on the size of EMPLOYER, CITY's OJT payments to EMPLOYER shall not exceed a maximum of sixty-five percent (651/6) of the wages paid by EMPLOYER during the training period specified in Exhibit A. 14. Amendment of Agreement. No alteration or variation of the terms of this Agreement shall be valid and/or binding unless made in writing and signed by both parties. There are no oral understandings or agreements between the parties. 15. Breach/Sanctions. If, through any cause, EMPLOYER violates any of the terms and conditions of this Agreement, or if EMPLOYER reports inaccurately or if any Audit Report makes disallowances, EMPLOYER shall promptly remedy its acts or omissions and/or repay CITY all amounts due CITY as a result of EMPLOYER's violation. For any such failures or violations, CITY shall also have the right at its sole discretion to either: (1) discontinue program support until such time as EMPLOYER fulfills its obligations or remedies all violations of this agreement or prior agreements; and/or (2) collect outstanding amounts as determined by CITY due CITY by offsetting or debiting from current claims or invoices, if after thirty (30) days' written notice EMPLOYER has failed to repay same or a repayment schedule has not been made; and/or (3) terminate this Agreement by giving written notice to EMPLOYER of such termination in accordance the notice provision in Paragraph XVIII herein below. 16. Termination. Either party may terminate this Agreement upon thirty (30) days prior written notice to the other party. However, the CITY may immediately terminate this Agreement at such time as funds are not made available to CITY through the United States Department of Labor or the State of California Employment Development Department for the purpose of carrying out this Agreement. 17. Independent Contractor. The EMPLOYER, and any agents and employees of the EMPLOYER, in the performance of this Agreement, shall act in an independent capacity as independent contractors and not as officers, employees, or agents of the CITY. This Agreement is not intended nor shall it be construed to create an employer-employee relationship between EMPLOYER and CITY, nor a joint venture relationship. The EMPLOYER shall not subcontract in the name of the CITY. 18. Equal Employment Opportunities. The EMPLOYER warrants that it will comply with Title VI of the Civil Rights Act of 1964, and the requirements relating to equal employment opportunities set forth in Executive Order No. 11246, as amended by E.O. 11375 and supplemented by the requirements of 41 CFR Part 60. EMPLOYER will also comply with all applicable federal and state laws and regulations, and particularly those assurances and certifications set forth in Exhibit B attached hereto and by this 12/09 reference incorporated herein. 19. Prohibitions. The EMPLOYER shall not use any of the training funds provided under this Agreement for political or sectarian activities. 20. Grievance Procedure. The EMPLOYER shall continue to operate, or shall establish and maintain a grievance or complaint handling procedure relevant to the terms and conditions of employment and the EMPLOYER's activities and programs, which shall meet at a minimum the requirements set forth in Section 1 O 1(31) of the Act and 663.700-71 O and regulations promulgated by the State or Federal Goveizunent. Employers that do not have a grievance or complaint handling procedure shall use the procedures prescribed by the CITY. 21. Guidelines. The CITY shall make the WIA applicable federal regulations and policy guidelines available to EMPLOYER at CITY - W/O/R/K Center, 1000 E. Santa Ana Blvd., Suite 200, Santa Ana, California 92701. The CITY shall also inform the EMPLOYER of changes in the WIA regulations or policy guidelines if such changes affect the operation of this Agreement. 22. Drug Free Workplace. The EMPLOYER agrees to provide adrug-free work place and to execute a certification as set forth in Exhibit D attached hereto and incorporated herein by this reference. 23. Notices. All notices, reports and correspondence between the parties hereto respecting this Agreement shall be in writing and deposited in the United States mail, postage prepaid, addressed as follows: CITY: City of Santa Ana -Santa Ana W/O/R/K Center 1000 E. Santa Ana Blvd., Suite 200 Santa Ana, CA 92701 Attention: WORK Center Director EMPLOYER: Pacific Cleaning Services 1220 Village Wav, #A Santa Ana, CA 92701 24. Debarment. To protect the public interest and ensure the integrity of Federal programs, CITY may only conduct business with responsible persons and may not make any award or permit any award to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension". See also 29 CRF Parts 97.35 and 98.510. EMPLOYER must review and sign Exhibit E "Debarment", which is attached hereto and incorporated herein by this reference. 24. Merger. This Agreement, together. with the attachments hereto, expresses the total understanding of the parties. There are no oral understandings of the parties or terms and conditions other than as stated herein. 5 12/09 25. 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. 26. 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 referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 6 12/09 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APR - 6 2011 Mazia D. Huizar Clerk of the Council CITY OF SANTA ANA ??i1??? David N. Ream City Manager APPROVED AS TO FORM: Joseph W. Fletcher City Attorney By: Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: Nancy '1'. Edwa s Interim Executive Director Community Development Agency EMPLOYER: ?? -L-? ? ,tee Name: Tamara Kyck ahn Title: Office Manager Tax ID#/SS#: 330-834-870 Federal 347-3575-3 State 7 Agreement # Exhibit A TRAINING PLAN I. GENERAL 1 . Name of OJT Employer: Pacific Cleaning Service 2. Address of OJT Work-site: 1220 Village Wav #A, Santa Ana. CA 92701 3. Phone Number: (9491 829-8790 4. Training Supervisor: Tamara Kvckelhahn 5. Name of OJT Trainee: Crystal Murillo 6. Enrollment Case Number of Trainee: 1 O 12792 7. Proportion of trainees/employees: (at time Agreement entered into) a. Total number of employer's regular employees 50 b. Cumulative number of trainees currently in OJT 2 II. OCCUPATION AND ON-THE-JOB TRAINING OUTLINE: 1. Vendor #: 2. Occupation/Product or Service: Customer service. sales, and marketin g of professional Cleaning Services including but not limited to Window Cleaning Service Window Washing, Stone and Concrete Cleaning, Gutter Cleaning, 3. Length of Time in Business: 25 years 4. ONET Code: 43-4051.00 SVP Level ( 4.0 to < 6.0) 5. Hourly Starting Wage: $14.00 Start Date: 3/21/11 End Date: 6/24/2011 Hours 520 or Days or Weeks 6. State and Federal Tax I.D.: State 347-3575-3 Federal 330-834-870 7. Basic Work Week Hours: 40 1 8. Outline of On-the-Job Training Plan and Method of Assessment: ELEMENTS OF TRAINING HOURS OF TRAINING 1. Under supervision -Learn the different services available to assist 2,O President, Office Manager and Marketing Manager. Measurement Method: Q 8z A, task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 2. Under supervision -Confer with customers (residential, contractor, property manager) by telephone to provide information about 200 services and promotions. Follow-up calls on proposals and estimates. Manage a project from start to finish. Measurement Method: Q 8c A, task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 3. Under supervision - Ta]ce and enter orders, cancel accounts, and obtain details of complaints (if any). 200 Maintaining and keeping current the customer databases Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken. Measurement Method: Q 8c A task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. 4. Under supervision -Collaborate with Account Receivable to determine charges for services requested, collect deposits or 100 payments, or arrange for billing_ Resolve customers' service or billing complaints in collaboration with management Assist administrative staff as needed Measurement Method: Q 8c A task observation and inspection. Goal is to achieve rate of proficiency within subsequent three and a half months. RATING LEVELS: Measurement method: how will it be determined if OJT participant acquired the skill? QBcA, observation, product review/inspection, etc. PROFICIENT MODERATE MARGINAL II. COST COMPUTATION Example: Hourly Reimbursement $ 9.1 O Hours 520 cost Per Trainee _ $ 4,732.00 III. Person(s) authorized to sign payment invoices fo/r EMPLOYER: Tamara K ckelhahn a ? & , i? ,fin -,- G, 0 /C?'/`'CJ? ?- 3/16/2011 Print Name Signature Title -/C r Date Print Name Signature Title Date EXHIBIT B ASSURANCES A. The EMPLOYER assures that: 1. It will comply with the requirements of the Workforce Investment Act (WIA), the California Unemployment Insurance Code, as amended, and the regulations and policies promulgated thereunder. 2. No OJT participant displaces a regular employee nor shall an OJT participant fill a position of a person who has been laid off from the same or similar position. 3. No current employees are receiving unemployment insurance benefits as a result of layoffs or work reductions. 4. No person in the United States shall on the grounds of race, color, sex, religion, national origin, age, disability, sexual orientation, or marital status be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives federal financial assistance and will immediately take any measure necessary to effectuate this Agreement. 5. It will comply with provisions of the Hatch Act, if applicable, which limits the political activities of employees. 6. Individuals receiving training on the job shall be compensated by the EMPLOYER at such rate, including periodic increases, as may be deemed reasonable under regulations prescribed by the Secretary of Labor, but in no event at a rate less than that specified in Section 6 (a) (1) of the Fair Labor Standards Act of 1938 or, if higher, under the applicable State or local minimum wage law. 7. Services and activities provided under this Agreement will be administered by or under the supervision of the EMPLOYER. 8. No relative by blood, adoption or marriage' of the EMPLOYER may be trained under this Agreement. 9. Appropriate standards for health and safety in work and training situations will be maintained. 10. Conditions of employment or training are appropriate and reasonable with regard to the type of work, the geographical region, and the proficiency of the trainee. 11. Training will not be for any occupation which requires less than six weeks of training according to the Specific Vocational Preparation Table (SVP Code). 12. Training will, to the maximum extent practicable, be consistent with every individual's fullest capabilities and lead to employment possibilities. 13. The program will, to the maximum extent feasible, contribute to the occupational development or upward mobility of individual participants. 14. Training will be in accordance with the training plan, which plan incorporates documentation that must be completed by EMPLOYER before end of contract. 15. EMPLOYER must use the Dot and ??`SVP code books to determine length of OJT period. The training time may not be longer than the SVP Code allows; however, contractors are encouraged to negotiate shorter training periods whenever applicable. 16. OJT trainees shall not number more than 40% of the EMPLOYERS work force. 17. All EMPLOYER training payments (reimbursements) must be exclusive of any and all EMPLOYER fringe benefits, paid holidays, paid sick days and overtime compensation. 18. The participating EMPLOYER must keep an accurate and up-to-date time sheet for the OJT trainee. 19. Payroll records, time and attendance records and job duties retained on file by the participating EMPL/O?Y/E?RO for/each OJT trainee are subject to review. ?? Df?-? ?? !?-?X?G? `"? 3/16/201 1 Service Provi r Signature Date Tamara Kvckelhahn Print First Name Print Last Name Pacific Cleaning Services 1220 Village Way #A. Santa Ana. CA 92701 Organization Name Organization Address 2 ACORD,a CERTIFICATE OF LIABILITY INSURANCE °A'?IM""°°""""') I _ 02/23/2n?T Van tore paolEiv ]:nauranaa eervivea, Inv. 26487 Rancho parkway Bvuth 6aka Foroat, CA 92630 PaoiFio Cleaning Barvivaa 3334 S Coast Hwy PHB 205 Corona Dal mar, CA 92629-2320 BTAR HOT CA PROB a COVERA6E5 . ?, . nc .IVauncu PwmeD ABOVE FOR THE P061CY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE CT 70 WHICH THI$ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE W3URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO L A L THE TERMS, EXCLUSIONS ANb CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE B EEN REDUCED BY PAID CLAIMS. 9R DD p0 6 pOLICYB IRAT N POLIOYNUMBER LVdI Ta A GENERAL UABIl1TY 715007BD900D0 09/21/10 09/21/11 X COMM IAL EACHOCCURRENCE $1,000, 000 ERC GENERAI. LIABILITY C O SEa Ea rra 3 300, 000 UVMS MADE OCCVR MEO EXP An ones eracn 610,000 PERSOr1At aAOVINJURY 51, ODD, ODO OENi GO OENERALAOGgEOATE g2, 000, 000 A REOAT6 LO.IITAPPLIEB PER: P o- X PRODUCTS-CObIP/OPAOp $2.000,000 POLICY LOC B AVTOMOBILH LIABILnY $621070 10/SB/30 10/1B/11 ANYAVTO GOMJJINEO SINGLE UAVi (Ea accidan0 $1.000, 000 ALL OWREO AVT09 X SGHEOULEO AUTOS X BODRYINJURY (Par Pe.sonj g HIAEDAVYOS X NON-0WNEOAVTOS ORM DOORYINJURY )Par ocddenq 8 ._i A.a TO AMAUE i e° e E R a g r a U d g DARAGS uaBlLln ? • AUTO ONLY-EAACCIDHNT g ANYAVTO ST ORCr ? OTHERTHAN EAACC 5 ? g AUTO ONLY: AGG g E%CH88NMBRELLA LGBILI7Y Tlt EA H r.55`5 OCCUR Q CLAIMS MADE ?` C OCCURRENCE g l / 1 /? DEDUCTIBLE AOOREGATE g g 8 RtTENRON 8 C WORXHR8COMPENBATONAND CPCA11919 OB/01/10 OS/O1/11 8 X EMPLOYERS' LIABILffY ANYPROPAIETORIPARTNERIF)f ECVTNE E.L. EACHACCIDENT g1, 000, 000 OFFICERR.IEMBER EXCLVOEO) Ilyyaaa daambaunder SPECW PA EL DISEASE-EA EMPLOYEE 1,000,000 g . D SIONSbelwv E.L. DISEASE-POLICYLIMIT 81,000,000 OTHER DEBCRIpRON OFOFER'ATONB l LOCATIONS/ V HHICLPS! BXCLUSIONa ADDED BY ENOORSSMBNT / BPHCIAL PROVISIONS Certificate Holder is Additional Inaurad as pnr written oontraat por attnvhad policy form. Haivar of Subrogation applies Primary Hon-Contributory wording app2las. The Clty of Banta, it?a officara, agents, aa.pl oyaoa and volvntaara era named aD additional insured. neeT'arlnw-ro u,.. ..e-r? OP Santa Ana 20 Civiv Center Blaze Banta Ana, CA 92702 ? VSA -r•_ ?r co.r non-payment or prnmlam. SHOULD ANYOF THE ABOVE DESCRIBHO POLICIa9 DE CANCELLED BEFORE THE EXPIRATR]N DATE THEREOF, TiIH 199VIN0 INBDRER WILL LK/T>?](?I?()I?ldA1L. 30 ppy9 WptTTEN NOTIC6 TO THE CERTIFICATD HOLDER NAMED TO THE LEFT, ?L>?I??p'{?'C11?jTq`(?X 19570449 ? EXHIBIT C IMPORTANT If the cerilflcate holder Is an ADDITIONAL INSURED, the policy(ies) must ba endorsed. A statement on this certlticete does not confer. rights to the certltlcale holder In lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to Iha terms and condlNons of the policy, certain policies may require an endorsement. A statement on this eertiflceta does not confer rights to the certificate holder Jn Ileu of such endorsement(s). DISCLAIMER The Certlllcate of insurance on the reverse side of this form does not constitute a contract between the Issuing Insurer(s), authorized representative or producer, and Ilse certificate holder, nor does II affirmatively or negatively amend, extend or alter the covarege afforded by the po{[cles listed thereon. ppP?i©VED AS TO FORM (?/. ? ? / / I/!?- -'-" L1SA-E. STORCK Assistant City Attorney ?? EXHIBIT C WORKERS COMPENSATION AND EMPLOYERS LIA6ILITY INSURANCE POLICY WC 00 03 '13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone Itablo for an Injury covered by this policy. We will not enforce our right against the person or organization named to the Schedute. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement sfiall not operate directly or indirectly to benefit anyone not named In the Schedule. Any person or organization for whom the insured has a written contract requiring waiver of subrogation. TIUs endorsement changes the policy to which It Is attached and is efleclfve on the dale Issued unless otherwise staled. (The Information below Is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective Policy No. CPCA11414 Insured Paclflc Ctoaning Servfces.lnc. Paallio Window and Pressure NVashing Premium Insurance Company Countersigned by Companion Property & Casualty insurance WC 00 03 13 (Ed. 4-64) ,z?i?R? A;3 TO POktM ®7BB3 Nettonot Connell on Compensellon Insurance. LISA E. $'?ORC,K Assistant City Attorney 3 /?' EXHIBIT C POLICY NUMBER: 7150078090000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION Thls endorsement motllfies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 20 10 03 97 Name of Person or Organization: (if no entry appears above, information required to complete this endorsamenf will be shown 1n the Declarations as applicable to this endorsement.) Who Is An Insured (Section II) is emended to inciude as an Insured the person or organization shown In the Schedule, but only with respect to liability arising aut of your ongoing operations pertormed for that insured CG 20 10 03 97 © ISO Proporties, Inc.,?2000 Rpp pVED AS TO FO??? -fpFtCK---- LtSA F_C?tY Attorn?:v Assistaant EXHIBIT C POLICY NUMBER: 7 1 5007 8090 000 CG 20 10 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART of Person or Organization: ' NAMED AS ADDITIONAL INSURED AS RESPECTS TO ONGOING ED BY THE NAMED INSURED AT: FS FURTHER AGREED COVERAGE AFFORDED 6Y TI-IlS POLICY SI-IALL BE PRIMARY ID NON-CONTRIBUTING FOR THE BENEFIT OF THE ADDITIONAL INSURED BUT ONLY ; RESPECTS TO LIABILITY ARISING OUT OF ONGOING OPERATIONS PERFORMED BY i AT THE DIRECTION OF THE NAMED INSURED FOR THE BENEFIT OF THE iDITIONAL INSURED. - IS FURTHER AGREED WE WAIVE ANY RIGHT OF RECOVERY WE MAY HAVE AGAINST THE ESIGNATED ADDITIONAL INSURED BECAUSE OF PAYMENT WE MAKE FOR BODILY INJURY ?R PROPERTY DAMAGE ARISING OUT OF ONGOING OPERATIONS PERFORMED 6Y OR T THE DIRECTION OF THE NAMED INSURED FOR THE BENEFIT OF THE ADDITIONAL (If no entry appears above, information required to complete thls endorsement will be shown In the Declarallons as applicable to this endorsement.) Who Is An Instsred (Section 11) is amended to Include as an insured the person or organization shown In fhe Schedule, but only with respect to liability arising out of your ongoing operations performed for that Insured GG 20 1 O 03 97 © 1S0 Properties, Inc., 2000 f?i.1PR0ii?? TU . „_._:? ?i?-- ?.- ;, ;.? ?, STORCK Alls3tstant Gity Attorney s3 EXHIBI C COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 1T CAREFULLY. COMMERCIAL AUTO AMENDMENT This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM Is amended to include the following clarifications and extensions of coverage. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. BLANKET ADDITIONAL INSURED D. COVERAGE EXTENSIONS - SUPPLEMENTARY SECTION 11 - LIABILITY COVERAGE, A.I. Who PAYMENTS Is An Insured Is amended by adding the following: SECTION 11 - LIABILITY COVERAGE, A.2.a. d. Any person or organization who Is a party to a Coverage Extensions, Supplementary Payments written agreement or contract with you in which (2) and (4) are replaced by the following: you agree to provide the type of Insurance (2) Up to $3.000 for the cost of ball bonds afforded under this Business Auto Coverage (Including bonds for related traffic law Form. violations) reqqulred because of an "accident" This provision applies to claims for "bodily Injury" or we cover. We do not have to furnish these "property damage" which occur after the execution bonds. of any written agreement or contract. (4) All reasonable expenses Incurred by the B. NEWLY FORMED OR ACQUIRED ORGANIZATIONS "insured" at our request, Including actual loss of SECTION 11 - LIABILITY COVERAGE, A.I. Who earntngs up to $350 a day because of time off from work. Is An Insured Is amended by adding the following: a. Any organization which you acquire or form E. PHYSICAL DAMAGE -TOWING after the effective date of this policy In which SECTION III - PHYSICAL DAMAGE COVERAGE, you maintain ownership or majority Interest. A.2. Towing Is replaced with the following: However: We will pay for towing and labor costs Incurred, (1) Coverage under this provision Is afforded subject to the following: only up to 180 days after you acquire or a. Up to $100 each time a covered "auto" of the form the organization, or to the end of the private passenger type Is disabled; or policy period, whichever Is earlier, b. Up to $500 each time a covered "auto" other (2) Any organization you acquire or form will than the private passenger type Is disabled. not be considered an "Insured" if.. However, the labor must be performed at the place A. The organization Is a partnership or a of disablement. joint venture; or F. PHYSICAL DAMAGE - TRANSPORTATION B. That organization is covered under EXPENSES other similar Insurance. SECTION III - PHYSICAL DAMAGE COVERAGE, (3) Coverage under this provision does not A.4. Coverage Extensions subparagraph a. apply to any claim for "bodily Injury" or Transportation Expenses is replaced by the "property damage" resulting from an following: "accident" that occurred before you formed (1) We will pay up to $75 per day to a maximum of or acquired the organization. $1.000 for temporary transportation expense C. SUBSIDIARIES AS INSUREDS Incurred by you because of the total theft of a SECTION 11 - LIABILITY COVERAGE, A.I. Who covered "auto" of the private passenger type. Is An Insured Is amended by adding the following: We will pay only for those covered "autos" for which you carry either Comprehensive or f. Any le9eBY Incorporated subsidiary in. which Specified Cause of Loss Coverage. We will you own more than 50% of the voting stock on pay for temporary transportation expenses the effective date of this policy. However. Incurred during the period beginning 48 hours "insured" does not include any subsidiary that is after the theft and ending, regardless of the an "insured" under any other automoblle liability policy's expirations, when the covered "auto" Is policy or was an "Insured" under such a policy returned to use or we pay for its "loss." but for termination of that policy or the ' o, 04 exhaustion of the policy s limits of liability. - TO r APpROttrt? ?$ CA7270(3-07) Includes copyrighted materiel of ISO Propertlos, Inc. wit Page 1 of 2 H y Attorney. it Assistant C / _ EXHI BIT C (2) If the. temporary transportation expenses you incur arise from your rental of an "auto" of the private passenger type, the most we will pay is the amount it costs to rent an "auto" of the pprivate passenger type which Is of the same Ilke kind and quality as the stolen covered "auto." O. HIRED AUTO PHYSICAL DAMAGE SECTION 111 -PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions Is amended by eddfng the following: o, if hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss, or Collision coverage is provided for any "auto" you own, then the Physical Damage coverages provided are extended to "autos" you hire, subject to the following limit and deducllble: (1) auto"nistthe essea of $50,OOD or Actual Cash Value or Cost of Repair, minus the deductible. (2) The deductible will be equal to the largest deductible applicable fo any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. (3) Subject to the above Ilmit, tleductiblo and excess provisions, we will provide coverage equal to the broadest coverage epplicable to any covered "auto" you own. The Insurance provided under this provision is excess over any other collectible Insurance. H. PERSONAL PROPERTY OF OTHERS SECTION 1l1 -PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extensions 1s amended by adding the following; d. We will pay up to $500 for toss to personal property of others in or on your covered "auto." Thies coverage applies only In the event of "loss° to your covered "auto" caused by fire, lightning, explosion, theft, mischief or vandalism, the covered "auto's" collision with another object, or the covered °auto's" overturn. No deductibles apply to this coverage. 1. AIRBAG COVERAGE if a Comprehensive, Specified Causes of Loss or Collision Coverage "loss" from one "accident" Involves two or more covered "autos", only the highest deducllble epplicable to those coverages will be applied to the °accident". This provision only applies if you carry Comprehensive, Collision or Specified Causes of Loss Coverage for those vehicles, end does not extend coverage to any covered "autos" for which you do not carry such coverage. K. WAIVER OF DEDUCTIBLE -GLASS REPAIR OR REPLACEMENT SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible Is amended by adding the following: If a Comprehensive Coverage deducllble fs shown In the Deciarallons tt does not apply to the cost of repairing or replacing damaged glass. L. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - 6USINESS AUTO CONDITIONS, A.2. Duties In the Event of Accident, Claim, Sutt or Loss Is amended by adding the following: d. Your obligation to notify us promptly of an "accltlent;' claim, "salt" or "loss" is sattsfled If you send us the required notice as soon as practicable after your Insurance Administrator or anyone else des[gnated by you to be responsible for insurance matters Is notified, or In any manner made aware, of en °accldent;' claim, "suit" or "toss." M. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES SECTION IV -BUSINESS AUTO CONDITIONS, B.2. Concealment, Misrepresentation, or Freud Is amended by adding the following: If you unintenflonelly fall to disclose any exposures existing at the inception date of this policy, we will not deny coverage under this Coverage Pert solely beoause of such failure to disolose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. N. MENTAL ANGUISH SECTION V -DEFINITIONS, C. Is replaced by the following: "Bodily Injury" moans bodily Injury, sickness or dlseese sustained by a person, Including mental anguish or death resulting from bodily Injury, sickness or dlseese. LIBERALIZATION If we revise this endorsement to provide greater coverage without additional premium charge, we wilt automalicafiy provide the additional coverage to all endorsement holders as of the day the revision is etfectlva (n your state. SECTION III -PHYSICAL DAMAGE COVERAGE, B.3.a. Exclusions Is amended by adding the following: If you have purchased Comprehensive or Collision O Coverage under this policy, the exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. J. LOSS TO TWO OR MORE COVERED AUTOS FROM ONE ACCIDENT SECTION III -PHYSICAL DAMAGE COVERAGE, Page 2 of 2 CA7270(3-07) i by adding the following: ??,? pa,1ZNj KppKOVED Aa ? T- __ Includes copyrighted material of 130 P as, n '?;?f@rrll?per?rhfasplf`CtC ?.- - ?Asslstant t;itY '`??OrneY '?? EXHIBIT C Certification Repardinp Drug-Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act_ CERTIFICATION A. The contractor certifies that it will provide adrug-free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing adrug-free awareness program to inform employees about (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining adrug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal -drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. EXHIBIT D DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Name: Tamara Kvckelhahn Name of Contractor: Pacific Cleaning Services Contractor Number: Date: The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract covered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): Pacific Cleaning Services 1220 Village Wav #A Santa Ana. CA 92701 EXHIBIT D Pg. 2 (e) Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - ( 1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee 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; (g) Making a good faith effort to continue to maintain adrug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). B. The contractor shall insert in the space provided on the attached "Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code) .the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Dated: 3/16/201 1 c=?????-? ? `?? K`?`" "-" -- Program Operator EXHIBIT D Exhibit E Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - Attached) (I) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal depart ment or agency. (2) Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Tamara Kvckelhahn. Office Manager Name and Title of Authorized Representative Signature ? Date INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective recipient of federal assistance funds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances- 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations- 5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. 6. The prospective recipient of federal assistance funds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals- Each participant may, but is not required to check the List of Parties Excluded from Procurement or Non-Procurement Programs- 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and/or debarment. On the Job Training Pre Award Survey BUSINESS NAME: Pacific Cleaning Services STATE TAX I.D. # 347-3575-3 ADDRESS: 1220 Village Wav, #A Santa Ana, CA 92701 FEDERAL TAX LD. # 330-834-870 YES NO 1. The business does provide worker's compensation coverage. X ? Policy Number: CPCA1 1414 2. The business does provide General Liability Insurance in the amount of X ? One Million Dollars ($1,000,000). Policy must identify the City of Santa Ana as the certificate holder. 3. The system used for business accounting does document cash received, state and federal tax withholdings, FICA deductions. X ? 4. The business has not been cited for any health, safety, wage and hour, or child labor violations during the past 12 months. X ? 5. The business maintains a grievance and/or complaint handling procedures for X ? employees. 6. The prospective OJT client is not a former employee of the business. X ? 7. Wages for the planned OJT position are wages comparable to similar positions. X 8. A written job description for this position is on file. X ? 9. Union concurrence has been obtained. X ? 10. Business license is current. X ? 1 1. The business has not had any employees laid off in the past 6 months. X ? 12. The business is financially stable and has the means to train and pay for the prospective OJT employee. X ? The employer stipulates and agrees by signing below that the establishment in which on-the j ob training will be given: (1) Has not been moved from any previous location less than 120 days prior to the effective date of the OJT contract. (2) Is not a branch, affiliate or subsidiary of a business entity in another location which has, at any time subsequent to the date of the OJT contract, relocated or expanded so as to cause an increase in unemployment or the closing down of operations in which the entity conducts business operatio ns. TOTAL WORKFORCE # 50 CONTRACT RECOMMENDED YES X NO ? ?" iicL's ? ' `??w? 3/16/11 ? /1??? i Employer z it a ???ate oordmat? Manager Date G 3/16 Program Supervisor/Director Date On-the-Job Training Contract Checklist Business Name: Pacific Cleaninct Services YES NO 1 . Pre Award Survey ? ? 2. OJT Agreement Template: Training Dates (pg 1), Funding (pg 1), Payment Cap (pg 13)1 and Employer Info (pg 5) must match Exhibit A -Training Plan info. 0-- ? 3. E hibit A: Training Plan JT's to employees do not exceed 1-5 ratio ?VP Level is =>3+ (training length) '?? ? ours of Training are reasonable 8'Cost Computation is in accordance with hourly wage of 65% of wages, or sliding scale based on number of employees per DOL waiver. 'igned by Employer 4. Exhibit B: Assurances 8- ? 5. Exhibit C: Insurance commercial/workers comp for 1,000,000 with Additional 19r' ? Insured Endorsement naming City of Santa Ana as Additional Insured. 6. Exhibit D: Drug Free Workplace Form completed and signed. ,q/ ? 7. Exhibit E: Debarment Certification signed. i;r" ? 8. s. ' ' B 9. NOT File: ? ADA Survey EEO & Grievance Procedures 100 Three copies of agreement and canary routing slip attached '2-' ? Comments: Program Supervisor Date