HomeMy WebLinkAboutBENCHMARK INTERNET GROUP-2015INSURANCE OR RILE
ViORK MAY PROCEED
URTtL iNSURANCE EXPIRES N-2015-028
CLERK OF COUNCIL .
DATE AgrcementNo.
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ON-THE-JOB TRAINING AGREEMENT
EB 2 Q 2015. UNDER THE WORKFORCE INVESTMENT ACT
THIS AGREEMENT is made and entered into this 19th day of January, 2015 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 Benchmark
Internet Group (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 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 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 team of this Agreement is for the period beginning January 19th,
2015 and ending July 19"', 2015. 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.
1
Said Trainee shall be referred by the City of Santa Ana W/O/R/K Center. Training must
significantly raise the Trainee fiom 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 $11,040.00 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.
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 tenninate, this
Agreement.
5. Employer 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 hisurance 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. Em llooyment 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.
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.
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 terns 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 subgram; (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 clairns, resulting
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 of comprehensive public liability insurance shall be endorsed to provide to
CITY and to the State of California, Employment Development Department, at least
thirty (30) days written notice prior to cancellation; name CITY, its officers, agents,
employees, and volunteers, and the State of California, its officers, employees, and
volunteers as additional insured; and state that such coverage is primary to any other
coverage or self-insurance of the State of Califorrda and CITY. Governmental entities
may substitute a certificate of self-insurance.
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 Government take exception,
91
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 fiords
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. 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 terns 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 tennination 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 propose 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.
61
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 Rinds 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 Government. 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 Wor lace. 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 WORK Center
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, CA 92701
Attention: WORK Center Director
EMPLOYER:
Benchmark Internet Group
10621 Calle Lee, Building 141
Los Alamitos, CA 90720
Daniel Miller
E
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 fully 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. Huizar
Clerk of the Council
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
By: Lisa Storck
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
1111.11V1 1/ .11LlV
Community Development Agency
CITY OF SANTA ANA
David Cavazos
City Manager
EMPLOYER:
Customer Service & Partner Director
Tax ID#: 20-3553119
Agreement # Exhibit A.
TRAINING PLAN
I. GENERAL
1. Name of OJT Employer: Benchmark Internet Group
2. Address of OJT Work -site: 10621 Calle Lee, Building 141, Los Alamitos, CA 90720
3. Phone Nunnber: (800)430-4095
4. Training Supervisor: Daniel Miller
5. Name of OJT Trainee: Marvin Del Cid
6. Application Number of Trainee:
Grant/Program: H1B OC Bridge 2 Engineering
8. Proportion of trainees/employees: (at time Agreement entered into)
a. Total number of employer's regular employees
C. Cumulative number of trainees currently in OJT
II. OCCUPATION AND ON-THE-JOB TRAINING OUTLINE:
Occupation: Software Developer, Appliations
2. Length of Time in Business: 10 Years
3. ONET Code: 15-1132.00 SVP Level: 7.0 to <8.0
4. Hourly Starting Wage: $23.00/hour
StartDate: 1/19/15
Hours 960
State and Federal Tax I.D.: State:
Federal
Basic Work Week Hours: 40
End Date: 7/19/15
Outline of On -the -Job Training Plan and Method of Assessment:
ELEMENTS OF TRAINING
HOURS OF TRAINING
1. Web Services, API builds, Data encoding, cURL, Data Transfer, Data
Parsing, 3rd party services client/app. authorization variations, BME API
240
usage, Git repository usage, SSH access and usage to Dev. Server and
Prod. Server
Code is evaluated daily from our in-house gitweb repository
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency
within flrst Month and a half of training,
2. Zapier Integrations regarding our php api wrapper combined with their
javascript bundles and server side parsing of json object for specific
240
structure of how Zapier's library is established.
Java wrapper demo build to be deployed on github, based upon bme api
wrapper and standing libraries for xml-rpc.
Code is evaluated daily from our in-house gitweb repository
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate of proficiency
within subsequent three and a half months.
3. POC and Development of specific integrations in PHP, with PHP-
cURL for SurveyMonkey Integration
240
Code is evaluated daily from our in-house gitweb repository
Measurement Method: Q & A tusk observation and inspection. Goal is to achieve rate ofprofieiency
within subsequent three and a halfmonths.
4. POC and Development build for integrations server to build bme client
240
list, map list with existing froms at Wufoo, validate and ship to bme via
api
w
Code is evaluated daily form our in-house gitweb repository
Measurement 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 MODERATE MARGINAL
H. COST COMPUTATION
Hourly Reimbursement: $11.50/hour (50% of $23.00/hour)
Training Hours: 960
Cost Per Trainee (Hourly Reimbursement X Training Hours) _ $ 11,040.00
III. Person(s) authorizes
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ASSURANCES
A. The EMPLOYER assures that:
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.
& 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.
EXEIIBIT 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 recgrfis, time and attendance records and job duties retained on file by the participating
JiNIPLO for each OJT_!rpir>zare subject to review.
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Employer Signature date
EXHIBIT B
,aco�zc�9 CERTIFICATE OF LIABILITY INSURANCE
1� /03/20 4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE'S HOLDER, THIS
CERTIFICATE DOES NOT APFIRMATIVELY 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), AUTHORRED
REPRESENTATIVE OR PRODUCER, AND, THE CERTIFICATE HOLDER.
IMPORTANT: It the cenitoato rotdor Is in ADDITIONAL INSURED. the pollcy(tea) Must W ondomod IP SUBROGATION IS WAIVED, eeejoot to
thetermsand conditions of the Palley,.. cortaln pnik lee may require an andoraome t. A statement onthis conit)cato does not confer rights to the
Cerltnoete holder In Ileo: Of Oath enddrsomen40).
PRODUCER
JOHNNY E ZANERCIK INS;. SERVICES
10234 Lakewood Blvd
Downey:, CA 90241
CON
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(562)g61-0301. ax(562)862-2823 '
ADREss zaneiroik@verizon.net
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INSURERA:LEADING INSURANCE COMPANY
INSURED BENCHMARK INTERNET GROUP, LLC
INSURER B 1co 01, F1TrSBUNZM' FA
10621 CALLE LEE, STE 141
INSURERc
LOS ALAMITOS, CA 90720
INSURER O;.
INSURER E.:..
INSURER F:
COVERAGES. CERTIFICATE: NUMBERi REVISION .Nt1MRBR•
THIS IS TO CERTIFY THAT -THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD _
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY; PERTAIN, THE INSURANCE. AFFORDED BY THE POLICIES: DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH: POLICIES LIMITSSHOWN MAY HAVESEEN REDUCED BY PAID CLAIMS. --
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* 10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT,
CERTIFICATE HOLDER. CANCELLATION.
.CITY OF SANTA ANA.:
ATTN:- PURCHASING.DEPART14ENT
20 CIVIC CENTER PLAZA
SANTA ANA., CA 92701
ACORD25 (2010/05)
SHOULDANYTHE ABOVE DESCRIBED. POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
The ACORD name and logo are registeredt%Tarks of ACORD
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Insurance Company Gi 191901 ✓(� �5NS•_ Cohl ` All
neat modifies such Insurance as is afforded by t e provisions of 'Policy
1. The City of Santa .Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers,
employees, agents and representative are named as additional insureds '("additional
insureds'] with regard to liability and defense of sults arising from the operations and uses
performed by or on behalf of the named insured.
2. 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 primary and is not
additional to or contributing with any other Insurance carried by or for the benefit of the
additional insureds,
3, This insurance applies separately to each Insured against whom claim is made or suit is
brought except with respect to the company's limits of liability. The inclusion of any person
or organization as an Insured shall not affect any right which such person or organization
would have as a claimant 9 notao included.
4. With respect the additional insureds, this insurance shall not be cancelled, or materially
reduced In coverage or limits except after thirty (30) days written notice has been given to
the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 82701.
(Compl®tiorfof
Countersigned by
cwMarsignature, Is required to make this endorsement etfective,)
this endorsement form as part of
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Gs INFORMATION PAGE
WEG WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURED: SEE ATTACHED ENDORSEMENT
NCCI Company Number: 20505
Company Code: S'
POLICY NUMBER: 1 76=WEG GE3565
Previous Policy Number: 176 WEG GB3565
HOUSING CODE: 76
1. Named Insured and Mailing Address: BENCHMARK INTERNET GROUP LLC
(No., Street; Town, State, Zip Codoj
FEIN Number: 203553119
State Identification Number(s);
10621 CALLS LEE
LOS ALAMITOS, CA 90720
The Named Insured is- LIMITED LIABILITY COMPANY
Business of Named Insured: CUSTOM COMPUTER PROGRAMMING &
Other Workplaces not shown above: SEE ATTACHED SCHEDULES
2. Policy Period: From `12/07L14 To '12/01/15
12:01 a.m., Standard tinge at the insured's mailing address,
Producer's Name: AP INTEGO INSURANCE GROUP LLC
PO, BOX 33015.
SAN ANTONIO, TX 78265
Producer's Code:. 250846
Issuing Office; THE HARTFORD
3600 WISEMAN BLVD,
SAN ANTONIO TX 78251
Total Estimated Annual Premium -
Suffix
LARS R NEWAL
1. 01
$750 CAA (INCLUSES INCREASED LIMIT MIN., PREM.)
Audit Period: ANNUAL Installment Term:
The policy is not binding unless countersigned by our authorized representative,
Countersigned by Lfu� _ ao `` `� 10./11/14
Autnorized Representative. Date
Form DVC 00 00 01 A (1) Printed in U.S.A. Paige 1 (Continued on next page)
Process Slate: 10/11/14 Policy Expiration D^tei: 12/0 � 15'
ORIGINAL
-- C-�r-:�> 0
INFORMATION PACE (Continued)
Policy Number: 76 WEG GB3565
3. A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the
states listed here: CA, IL, NY
B, Employers Liability Insurance: Part Two of the policy applies to work in each state listed In Item 3.A:
The limits of our liability under Pail Two are:
Bodily injury by Accident $1,000,000 each accident
Bodily injury by Disease $1,000,000 policy limit
Bodily injury by Disease $1"000'000 each employee
C. Other States insurance: Pad Three of the policy applies to the states, If:any, listed here::
ALL STATES EXCEPT ND, OH, WA, WY, AND
STATES DESIGNATED IN ITEM 3,A, OF THE INFORMATION PAGE,
D, This policy includes these endorsements and scheduler
WC 99 00 05 WC 00 01 14 WC 00 04 21C WC 00 04 22A WC 04 03 03
SEE ENDT
4, The
Classifications Total Estimated Rates Per
Coda Number and, Annual $160 of
($SE ATTACHED SCHEDULES,)
INCREASEDD, LIMITS PART TWO (9912)
TO EQUAL 'INCREASED LIMITS. MINIMUM PREMIUM (9648)
CA 'TERRITORIAL DIFFERENTIAL PREMIUM T125 (1.050)
TOTAL PREMIUM SUBJECT TO EXPERIENCE MODIFICATION
PREMIUM ADJUSTED BY: APPLICATION OF EXPERIENCE MODIFICATION
CA SMALL POLICY CREDIT
TOTAL ESTIMATED ANNUAL STANDARD PREMIUM
EXPENSE CONSTANT (0400)
TOTAL ESTIMATED STATE SURCHARGE
TERRORISM (9740)
TERRORISM (9740) PER CAPITA
CATASTROPHE (9741)
CATASTROPHE (9741) PER CAPITA
TOTAL ESTIMATED ANNUAL PREMIUM
Rates and Rating
1
149
59
6.0'
55
^115:
1,363
M
73
179
0
5
0
1,921
Total Estimated Annual Premium: $1,921
Deposit Premium;
Policy Minimum Premium: $750 CA (INCLUDES INCREASED LIMIT MIN. PREM,)
Interstate/Intrastate Identification Number:
Labor Contractors Policy Numbers
Form WC 00 00 01 A (t) Printed in U.S,A.
Process Date: 10/11/14
/ 001109478
NAICS:
SIC; 737 V b-4071 , , , g1,�-
W �dU (J
Page 2
Policy Expiration Date: 12/01/15
SCHEDULE OF OPERATIONS
This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is
indicated below:
INSURER: HARTFORD INSURANCE COMPANY OF THE Mtr)D CST
Company Code: G
Policy Number: 76 WEG G;33565 Schedule Number: 01-04-01
a Effective Date: 12/01/14 Effective hour is the same as stated on the Information Page of the policy.
w° Named Insured and Location Address of operations covered by this schedule:
N
BENCHMARK INTERNET GROUPLLC
10621 CALLE LEE
o LOS ALAMIT08 CA. 90720
FEIN: 2,03553119 U N:
4, The premium for this policy wits be determined by aur
Total
COMPUTER PROGRAMMING OR sbFTwARE
DE'V'ELOPMENT ALL EMPLOYEES :INCLUDING
CLERICAL OFFICE EMPLOYEES AND OUTSIDE
NAICS:
STC: 7371 No. OF L•MPLt 000019
Rates and Rating
TOTAL CLASS PREMIUM
1,178
CA TERRITORIAL DIFFERENTIAL PREMIUM T129 11050
5<9
CA SMALL POLICY CREDIT 9,00 PERCENT (9701)
-111
TOTAL ESTIMATED ANN(7AL STANDARD PREMIUM
1,126
CA SURCHARGE- :2,250 PERCENT
2..9
USER FUNDING ASSESSMENT 1,2247 PERCENT
16
FRAUD ASSgSSMENT 0:2544 PERCENT'
3
CA UNINSD EMPL BENEFIT TRUST FUND 0,1603 PERCENT
2
CA SUBSEQ INJ BENEFITS TRUST FUND 0.1291 PERCENT
2
CA OCCUP SAFETY AND HEALTH FUND 0,2166 PERCENT
3
CA LABOR ENFORCE AND COMPL FUND 0,2452 PERCENT
3
TERRORISM (9740) 765,000'
.020 7.57
TOTAL ESTIMATED ANNUAL PREMIUM
1,341
DEPOSIT PREMIUM - CA
1,341
Countersigned by
Authorized Representative
Form WC 99 00 05 (9) printed In U,S;A.
Process Date: 10/11/14
Policy Expiration Date:12/01/15
^^
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 -
Pg. 2
(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.
A
(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).
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. _ A //
Dated:
LW11 �.
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG-FREE
WORKPLACE REQUIREMENTS
Name: L)oyi
Name of Contractor:
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):
(06ZK�2L( 1 ��? , -0-111 u (Cl (
Los &206 �s
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 Part VII 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 debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by any federal department or
agency.
(2) Where the prospective recipient of federal assistance fiords is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this
proposal.
Name and Title of Authorized Representative
ignatur Date
EXHIBIT E
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 fiords shall provide hunediate written notice to the
person to which this proposal is submitted if at any time the prospective recipient of federal
assistance finds learns that its certification was erroneous when submitted or has become erroneous
by reason of changed circumstances.
4. The terns "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.
EXHIBIT E
r' SANTA ANA
`�WOlo'RK
CENTER
AMERICANS WITH DISABILITY ACT (ADA)
AND
EQUAL OPPORTUNITY (EO) LAW
I. Is there a minimum of 2 designated disabled parking slots?
Per Dept. of Rehab Sect, 504 YESE NOF]
II. Are parking slot occupants able to reach the building's entrance for the disabled
without having to go behind any other cars, or any other barriers (curb, sidewalks,
etc.)?
Per Dept. of Rehab. Sect. 504 YE�F NO[:]III. Is there a fiont door labeled with the international wheelchair access sign?
Per Dept. of Rehab. Sect, 504 YES NO[]
IV. Is the labeled entrance's threshold not higher than 1/z inch to allow for
wheelchair access? Per Dept. of Rehab. Sect. 504 YES' NO[:]
V. Is the door -handle to the labeled wheelchair entrance door, a lever handle (not a
round doorknob)?
Per Dept. of Rehab. Sect. 504 YES❑ NO❑
VI. If any services are available on second floor, does the building have an elevator?
Per Dept, of Rehab. Section 504 YES❑ NO[:] NA
VII. Does the classroom, working area, and break -room have enough room to maneuver a
wheelchair and/or crutches?
Per Dept. of Rehab. Sect. 504 YES(] NO❑
VIII. Does the school catalog/ employee manual, contain the organization's
Grievance Policy? Per CFR Title 20, 29, 41 YEly NO❑
IX. Is Grievance Procedure and contact person made available in writing to the
participant on first day of attendance?
Per CFR Title 20,29,41 YES7 NO[:]
X. If serving any Limited English individuals is the grievance procedure and procedures
available in their language?
Per CPR Title 20,29,41 YES[:] NO❑ NA�
XI. Is assessment used in a non-discriminatory way? (used to determine suitability( for
training and/or employment based on industry recognized required skills)?
Per CFR Title 20,29,41 YESY NO❑
XII. Is there at least one internationally labeled accessible restroom for the disabled?
Per Dept. of Rehab. Sect. 504 YES NO❑
XIII. Does toilet stall for the disabled have bars on each side ofl?
Per Dept. of Rehab. Sect. 504 YES NOF -1
XIV. Is there a telephone reasonably accessible to handicap individuals?
Per Dept. of Rehab. Sect. 504 YES NOF-1
XV. Is there a water fountain reasonably accessible to disabled individuals?
Per Dept. of Rehab. Sect. 504 YES NO❑
XVI. Are auxiliary (supplementary) aides available when requested by the individual?
Per CFR Title 20,29,41 YESY'-"? NOF -1
XVII, Do all contracts and agreements signed by the individual contain Employer Equal
opportunity employer language?
CFR Title 20,29,41 YES NOD
I certify that I have validated all responses:
Service Provider Information:
First N i
Service Provider Srgnatur
Business Address
�cz �96-
Business Phone Number
O WI� n r a f Dat
-1r-r-
Last Name
DI
ate
ll,Jgz,.Q
COMPLIANCE STATUS
Summary Sheet
Reviewer: Pow"W o /n Site Visit Date
Contract/Vendor Information:
Director/Supervisor Name: At ff e'
Business Name:
Address: l � 2 / `Gy. �, f c
Phone #: �S:��,1' 7Zc :Zzo
Program Element
Compliance
Status
Person
Responsible
Mods.
Mod. Cost
Time Frame
Location
Based on site visit and survey responses the site does not have any ADA
no � O issues to correct.
❑ Currently ADA accessibility not fully available. WIA funds will not be
released until the facility corrects issues to meet applicable Dept. of Rehab.
Section 504 requirements?
❑ Currently EO issue exist. WIA funds will not be released until the
organization corrects EO issues to meet applicable CFR 20, 29, 41
requirements.
I have been info ed of t & EO
Director/Supervisor
site visit review outcome(s).
Date
Certification Regarding
the
Americans with Disabilities Act
This certification is required by the regulation 101-336 (42 U.S. C. 512101) enforced through the
Department of Rehabilitation and mandated by the Governor of California. ADA has been in effect
since 1990, with the mission to provided equal protection to individuals with disabilities in the
public and private sector services, transportation, communications and employment.
I hereby certify that the following statement is correct and honestly states that our program facility is
in compliance with the Americans Act with Disabilities (ADA). I understand that
Title I — V of the Act also applies to Workforce Investment Act (WIA) participants entering training
under the Workforce Investment Board / Youth Council funding.
Service Provider Signature
t, P,(
Print First Name
Date
4 (�
Print Last Name
Cin r �nW l �� �ie i�21
Gap
l aaZ ( �� � � �JG I�� �� ���
S ���V✓ V�Y3�
Organization Name
l
qD 77n Organization Addrogd
E
We encourage you to bring your questions, suggestions
and complaints to our attention. We will carefully
consider each of these in our continuing effort to improve
operations,
If you feel you have a problem, present the situation to
your supervisor so that the problem can be settled by
examination and discussion of the facts. We hope that
your supervisor is able to satisfactorily resolve most
matters.
If you still have questions after meeting with your
supervisor or if you would like further clarification on the
matter, request a meeting with the Accounting/HR
Manager. (S)he will review the issues and meet with
you to discuss possible solutions.
Finally, if you still believe that your problem has not been
fairly or fully addressed, request a meeting with the
coo.
Your suggestions and comments on any subject are
important, and we encourage you to take every
opportunity to discuss them with us, Your job will not •
adversely affected in any way because you choose to
use this procedure.
13 04/12