HomeMy WebLinkAboutPIG'S TAIL USA, LLC 4 - 2013INS,IRR?ag- ON FILE
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ON-THE-JOB TRAINING AGREEMENT
UNDER THE WORKFORCE INVESTMENT ACT
N-2013-056
THIS AGREEMENT is made and entered into this 2nd day of May, 2013 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 Pig's Tail USA,
LLC (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 area 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 finds 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 market 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:
Term. The effective term of this Agreement is for the period beginning May 2, 2013,
and ending September 16, 2013. The term of this Agreement may be extended upon
agreement of all parties and execution of an amendment of the term.
2. Scone 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.
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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. Funding. CITY shall reimburse the EMPLOYER an amount not to exceed $3,200 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
tinder this Agreement shall be limited to the costs incurred during the basic work week,
excluding overtime and any paid holidays or sick leave.
4. Subcontracting 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. Employer Obli atg ions. 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. Employment 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.
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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 may 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 "Govermnental 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 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 a royalty-
free, nonexclusive and irrevocable license to reproduce, publish, use and to authorize others to
use all copyrighted material.
2. The DOL reserves a royalty-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
3
from or arising out of the negligent acts, errors or omissions of EMPLOYER, its
employees, agents or subcontractors.
10. 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.
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 Goverment take exception,
4
shall be retained beyond the three (3) years until resolution of disposition of such appeals,
litigation, claims, or exceptions.
12. Government Funding. 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 Cap. Based on the size of Employer, City's OJT payments to EMPLOYER
shall not exceed a maximum of fifty percent (50%) 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 amoimts 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.
5
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 reference
incorporated herein.
19. Prohibitions. The EMPLOYER shall not use any of the training fiords 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 101(31) of the Act and 663.700-
710 and regulations promulgated by the State or Federal Govermnent. 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 Work lp ace. The EMPLOYER agrees to provide a drug-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:
Pig's Tail USA, LLC
1601 E. St. Andrews Place, Unit B
Santa Ana, CA 92705
ATT: Rob Mitchell
6
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.
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 filly set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST:
Maria D. Hui?ar
Clerk of the Council
CITY OF SWNNTA ANA
Kevin O'Rourke
Interim City Manager
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
IkA?l C,
By: Lisa Storck
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
EMPLOYER:
Q
Rob Mitchel
Operations Manage
Tax ID#: 012-7760
4ndA 9k- OWMiaJ
Agreement # Exhibit A
TRAINING PLAN
L GENERAL
1. Name of OJT Employer: Pig'sTail USA, LLC
2. Address of OJT Work-site: 1601 E. St. Andrews Place. Unite B, Santa Ana, CA 92705
3. Phone Number: 714-566-0011
4. Training Supervisor: Rob Mitchell
5. Name of OJT Trainee: Victor Felix
6. Application Number of Trainee: 1017926
7. Proportion of trainees/employees: (at time Agreement entered into)
a. Total member of employer's regular employees 7
C. Cumulative number of trainees currently in OJT 1
II. OCCUPATION AND ON-THE-JOB TRAINING OUTLINE:
1. Case Number #: 1013644
2. Occupation/Product or Service: Hydraulic Components
3. Length of Time in Business: 1.5 years
4. ONET Code: Cutter/514031 SVP Level (4.0<6.0)
5. Hourly Starting Wage: $10
Start Date: 05/02/2013 End Date: 09/16/2013
Hours 640 or Days or Weeks
6. State and Federal Tax I.D.: State 012-7760
Federal 90-0774982
7. Basic Work Week Hours: 40
Outline of On-the-Job Training Plan and Method of Assessment:
ELEMENTS OF TRAINING HOURS OF TRAINING
1. Will be trained to support the company by performing duties to 400
include:
a. Cut HDPE pipe with a proprietary cutting machine, that measure
lengths and cutting radius of the material.
b. Package materials according to diameter sizing, length, and color
c. Mark identification numbers, trademarks, grades, marketing data, sizes,
or model numbers on products.
d. Read work orders to determine dimensions, cutting locations and
quantities to cut.
Measur ement Method: Q & A, task observation and inspection. Goal is to achieve rate
of proficiency within first Month and a half of training.
2.
A. Will be trained to feed various sizes of HDPE pipe through cutting 160
machine.
B. Will be trained to measure pipe dimensions as the product is being fed
through the cutting machine to ensure product is to specifications.
C. Will leans to stack items and load them on racks, conveyors or onto
trucks.
Measur ement Method: Q & A, task observation and inspection. Goal is to achieve rate
of profi ciency within subsequent three and a half months.
3. Will learn aspect of warehousing operations to include:
A. Receiving and counting stock items, packing and unpacking items to be 80
stocked in warehouse.
B. Will be trained to store item in orderly and accessible manner in the
warehouse.
C. Will be trained to marls stock items using identification tags, markings,
etc. Will determine proper storage methods, identification and stock
location.
D. Will learn to maintain records on use and/or damage of stock or stock
handling equipment. Will examine and inspect stock for wear or
defects, and advise management of any damage.
E. Will also perform inventory and shipping and receiving or product.
Will also be trained correct operation or forklift and will perform
palletizing duties.
Measur ement Method: Q & 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? Q&A, observation, product review/inspection,
etc.
PROFICIENT
II. COST COMPUTATION
Example: Hourly Reimbursement $ 5
MODERATE
MARGINAL
Hours 640 cost Per Trainee
= $ 3,200
III. Person(s) authorized to sign payment invoices for EMPLOYER: Pig'sTail USA, LLC
Robert Mitchell r C.O.O 04/23/2013
Print Name Signature Title Date
Print Name
Signature
Title
Date
3
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 marriageu 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.
EXHIBIT B
15, *Dot and **SVP code books will be used 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
EMPLOYER for each OJT trainee are subject to review.
P"U W4-A 04/23/2013
Employer ignature Date
EXHIBIT B
4e «(ft(/` IL -767
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Acc?Ata CERTIFICATE OF LIABILITY INSURANCE DATA 1MMI Y,
3/9/2013 13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT APPIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE.. DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT; If the certificate bolder Is an ADDITIONAL INSURED, the polleyIks) must he endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltlons of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the
certlfioate holder In lieu of such endorsement(s).
PROOUCHR NAME' Comm 9. _
Nickerson Tnaar$noo ServiOea, IRO. O a (310)926-6333
7 Ai n ,(510)926-5416
LTC 40491589 ..MAIL
2106 Went Lomita Blvd. INSURERf§(APPOROING OOVERAGE NNOW
Lomita CA 90717 _,
INSURCRA;3enti ®1 Ineuranoo Company LTD -_T
wsdREO INSURER a jHartford Underwriters Ins Co,
Pigs Tail USA LLC, DSA: Pro-Con Industries i RERC; .
1601-8 West St Andrew Place NSURERO
Santa Ana CA 92705 _
suRaR P<
COVERAGES CERTIFICATE NUMBERI3-14 BOP 12-13 WC REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED. BELOW HAVE BEEN 1550EDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 19 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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L R TYPE OF INSURANCE ? APO ICY NUMBER P0?E? LIMITS Nee ?Q
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PERSONA4d ADV INJURY 2,000,000
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GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGO S 4,000,000
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DESORIPTfON OF DPERATIQNS I LOCATION81 VRHICLES (AHati, ACORD 101, AddRlmml Remarks Sehnduln If ntnrn xionae In rnquirotll
City Of Santa Ana its officers, agents, and employeas are 6x coy included as additional insureds On the
liability With respect to claims arising out of the operations and uses performed by or on behalf of the
named insured, such insurance as is afforded by this policy is prJ.wary and is not additional, to or
contributing with ,any other insurance carxiod by or for the baratit of the additional .4noureds 30 days
notice of cancellation subject to 10 days notice for non payment of premium,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTION WILL BE DELIVERED IN
City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
20 Civic C
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Santa Ana, CA 92701
AUTHORIZED REPR0ENTATIVE
Sarah Kally/MjF
ACORD 26(2010105) d19SI1-2010/h R. ?AT.dC ,.A6Lrig.Ch$unved,
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Exhibit C Assisti'arl at . CIPV AtiorllAttarey VV
POLICY NUMBER; 72 SBA AK4112
COMMERCIAL GENERAL LIABILITY
CG 20 20 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED • DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organlzatlon(s)
City o'2 Santa Ana its officers, agents, and employees
Information required to complete this Schedule, If not shown above, will be shown in the Declarations,
section II - Who Is An Insured Is amended to
Include as an additional insured the person(s) or
organization(s) shown In the Schodulo, but only with
respect to liability for "bodily Injury", "property
damage" or "personal and advertising injury" caused,
In whole or In part, by your acts or omissions or the
acts or omissions of those noting on your behalf;
A. In the performance of your ongoing operations; or
B, In connection with your premises owned by or
rented to you,
CG 20 26 07 04
U ISO Properties, Ina, 2004
AV. 1,0 FORIA
oVtD Page 1 of 1 ?
r
`'A AttornoV
Assistant City yq
Exhibit C
Pigs Tail USA LLC
Policy ##72SSAAN4112
Eff: 1/19/2013 - 01/19/2014
,it
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
AMENDMENT OF OTHER INSURANCE CONDITION -
PRIMARY OR PRIMARY AND NON-(CONTRIBUTORY WHEN
REQUIRED BY WRITTEN CONTRACT OR WRITTEN
AGREEMENT
This endorsement modifles Insurance provided under the following:
UMBRELLA LIABILITY POLICY
1. Paragraph 15.2 of Section III - Who Is An
Insured Is replaced by the following;
2.. Any person or organization with whom you
agreed, because of a written contract, written
agreement or because of a permit issued by a
state or politleal subdivision, to provide
Insurance such as Is afforded under this policy,
but only with respect to your operations, "your
work" or facilities owned or used by you.
This provision does not apply:
a. Unless the written contract or written
agreement has been executed, or the
permit has been Issued prior to the
"bodily Injury" "property damage'", or
"personel and advertising Injury"; and
b. Unless the limits of liability specified in
such written contract, written agreement
or permit are greater than the limits
shown for'"underlying Insurance"; or
c. Beyond the period of time required by
the written contract or written
agreement.
In no event shall any coverage afforded to
any such person or organization apply to any
claim or "suit" to which "underlying Insurance"
does not apply. Coverage provided by this
policy for any such additional Insured will
follow the provisions, exclusions and
limitations of the "Lindariying Insurance'".
II. Solely as raspeots the Insurance afforded to any
person or organization qualifying as an
additional Insured under Paragraph I. above, the
Other Insurance condition in Section VI -
Conditions is replaced by the following:
G, Other Insurance
This policy shall apply In excess of all
"underlying Insurance" whether or not
valid and collectible. It shall also apply in
excess of other valid and collectible
Insurance (except other Insurance
purchased specifically to apply In
excess of this Insurance) which also
applies to any loss for which Insurance
Is provided by this policy.
These excess provisions apply, whether
such other Insurance Is stated to be:
a, Primary;
Is. Contrlbuting;
c. Excess; or
d, Contingent,
2. However, the following provisions apply
to other Insurance available to any
person or organization qualifying as an
additional Insured under Paragraph 6,2,
of Section III - Who Is An Insured, as
amended by Item h of this endorsement
and who is also an additional Insured
under the Commercial General Llabllity
Coverage Part scheduled in the
"underlying Insuranoe"
a. Primary Insurance When
Required By Contract
if you have agreed In a written
contract, written agreement or
permit to provide primary insurance
to the additional Insured, then, after
the "underlying Insurance" is
Form Xt. 24 37 0011 0 ; V011?
2011,ThaFlartfard ?4V'?'??1`V???/?No">C'2?
(Includes copyrighted matedal of Insurance Services Office, Inc., with Its permission.)
LISA STORCI4
Assistant City Attorney
Exhibit CIS
exhausted, this Insurance will be
primary. If other Insurance Is also
primary, we will share with all that
other Insurance by the method
described In Paragraph 3, below.
b. Primary And Non-Contributory To
Other Insurance When Required
By Contract
If you have agreed In a written
contract, written agreement, or
permit to provide Insurance to the
additional Insured that Is primary
and non-oontributory, than, after the
"underlying insurance" is exhausted,
this Insurance will be primary and
we will not seek contribution from
the additional Insured's own
Insurance,
Paragraphs a. and b. do not apply to
other Insurance on which the additional
Insured qualifies as an additional
Insured pursuant to the terms of that
policy or has been added as an
addltional Insured by endorsement.
1 Method Of Sharing
if all of the other Insurance permits
contribution by equal shares, we will
follow this method also, Under this
approach each Insurer oontributos equal
amounts until It has paid Its applicable
limit of insurance or none of the loss
remains, whichever comes first.
If any of the other Insurance does not
permit contribution by equal shares, we
will contribute by limits. Under this
method, each insurer's share is based
on the ratio of Its applicable limit of
insurance to the total applicable limits of
insurance of all Insurers,
III. The following is added to Section IV - Limits Of
Insurance:
H. How Limits Apply To Additional Insureds
If you have agreed in a written contract,
written agreement or permit that another
person or organization be added as an
additional insured on the Commercial
General Liability Coverage Part scheduled In
the "underlying Insurance" and such person
or organization also qualifies as an
additional insured under this policy, the most
we will pay on behalf of such Insured is the
leaser of
a. The limits of Insurance specified in the
written contract, written agreement or
permit, less any amounts payable by
any "underlying insurance"; or
b. The Limits of Insurance shown in the
Umbrella Liability Policy Declarations,
Such amount shall be a part of and not In
addition to the Limits of Insurance shown In
the Umbrella Liability Policy Declarations
and described In other provisions of this
Section.
??3N1
APPt?VT3 ;5 TO
Assiskant U,ttY / 1
Page 2 of 2 Form XL 24 37 00 11
Exhibit C
Certification Regarding 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 a drug-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 a drug-free awareness program to inform employees
about -
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug-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 -
0 ) 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
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 a drug-free
workplace through implementation of paragraphs (a), (b), (c), (d), (e)
and (f).
E. 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: 04/23/2013 & 4 WA
Employer Si nature
EXHIBIT D
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE
REQUIREMENTS
Name: Rob Mitchell
Name of Contractor: Piq'sTail USA, LLC
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):
1601 E. St. Andrews Place, Unit B
Santa Ana, CA 92705
EXHIBIT D
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 PartVII of the May 26,1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION -
Attached)
(1) 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 debannent, declared
ineligible, or voluntarily excluded from participation in this transaction by any federal department 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.
Rob Mitchell, Operations Manager
Name and Title of Authorized Representative
p 04/23/2013
Signature Date
EXHIBIT E
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective recipient of federal assistance finds 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 finds 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 tinder 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.
EXHIBIT E
MEMORANDUM
Kevin O'Rourke
To: City Manager
Linda Oberman
From: Economic Development Manager
Date: May 6, 2013
Subject: Workforce Investment Act -On The Job Training Agreements
On-the-Job Training (OJT) is a Workforce Investment Act training program in which an OJT
contract is designed for a particular individual and employer. An employer which hires a trainee
may be reimbursed up to 50 percent of the wages paid for the extraordinary cost of lower
productivity in participants, providing the training, and additional supervision.
OJT contracts are conducted through noncompetitive negotiations. Per State of California
Employment Development Department Directive 12-10, "Customized Training and On-The-Job
Training are exempt from Federal and State competitive procurement".
Please call me with any questions. Thank you.
rJ& ? , ./t
Linda A. Oberman