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HomeMy WebLinkAboutMercy House and Families Forward - 2021-07-01 (2) FOURTH AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS FOURTH AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY QF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the 1st day of July, 2023, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2021, as amended by the First, Second, and Third Amendments, dated July 1, 2022,November 1, 2022, and July 1,2023 (collectively, the"Original Agreement"); and WHEREAS, on May 2,2023,by Resolution No. 2023-19,the Huntington Beach City Council approved the FY 2023-2024 Annual Action Plan, which allocated $183,000 of Community Development Block Grant(CDBG)funds for administrative costs and housing services for the CITY's Tenant Based Rental Assistance (TBRA) Program; and WHEREAS, in addition to the $183,000 in CDBG funds described above, the CITY has $150,174 in unallocated CDBG funds carried-over from prior years, of which$35,000, is proposed to be allocated to the SUBRECIPIENT for administration costs related to implementing the TBRA Program; and WHEREAS, CITY and SUBRECIPIENT desire to amend the Agreement'as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 2. SUBRECIPIENT GRANT AMOUNT AND SCOPE OF SERVICES. Shall be amended as follows: a. The CITY has allocated Federal CDBG funds in the amount of Thirty Five Thousand Dollars($35,000)to the SUBRECIPIENT to assist with the program costs for activities described in the Scope of Services and Budget(Attachment 1). 2. 3. TIME OF PERFORMANCE. Shall be amended as follows: a. The services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Agreement may begin on July 1, 2023 and shall end on June 30, 2024. 23-13185/317013 3. 5. LEVELS OF PERFORMANCE. Shall be amended as follows: a. The SUBRECIPIENT agrees to provide the levels of program service as described in the Amended Scope of Services and Budget(Attachment 1). 4. 6. BUDGET. Shall be amended as follows: The budget detailed in the Scope of Services and Budget(Attachment 1)shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the CITY. 5. 7. PROJECT SCHEDULE/MILESTONES. Shall be amended as follows: Services of the SUBRECIPIENT shall start no sooner than on the first day of July 2023 and end on the thirtieth day of June 2024. Every effort shall be made by the SUBRECIPIENT to expend the allocated funds in their entirety by June 30,2024. If the SUBRECIPIENT does not expend all funds by June 30,2024, the CITY may reallocate the funds not yet drawn to another eligible CDBG Project. 6. 8. COMPENSATION AND METHOD OF PAYMENT. Shall be amended as follows: The CITY shall reimburse the SUBRECIPIENT with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1, 2023 and ending June 30, 2024. The CITY shall not provide any payments/reimbursements in advance of actual expenditures by the SUBRECIPIENT. Funding is contingent upon the CITY receiving Community Development Block Grant funds from HUD. The SUBRECIPIENT shall submit to the CITY a monthly "Payment Request" within fifteen (15) calendar days after the end of the first month with the final report for 2023/2024 fiscal year delivered by July 15, 2024. The reimbursement requests shall include documentation to verify that the expenditure of funds is consistent with the project description/definition as approved. Prior to reimbursing the SUBRECIPIENT, the CITY will verify that the SUBRECIPIENT has met all applicable regulations for the project. Payroll records,receipts,paid invoices including an itemized statement of all costs are samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. All other sections of the Original Agreement, as amended, shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Fourth Amendment to be executed by their respective officers duly authorized as of the date first written above. [SIGNATURE PAGE FOLLOWS] • CONSULTANT CITY OF HUNTINGTON BEACH, a MERCY I-..1.011SE municipal corporation of the State of California By: 42. ' V4�-'C,t torah Al A J s of Community Development `I Print name APPROVED AS TO FORM: ITS: (circle one) Chairman/President/ Vice President CGS( AND City Attorney By: CEIVE AND FILE: (*P401i l. Print name City Clerk ITS: (circle one) Chairman/President/ Vice President Date 3 ATTACHMENT 1 FY2023-24 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: • Between July 1 , 2023 and June 30, 2024,Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for seven (7) Huntington Beach households. These seven additional households do not include the four(4) Huntington Beach households that are carried over from 2022-2023. Staffing costs are tied to providing housing services, including the search and eligibility process for families. Mercy House will submit a monthly Grantee Performance Report(GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: HS Supervisor: $4,519 HS Case Manager: $27,378 Administrative Costs: $3,103 TOTAL MERCY HOUSE BUDGET: $35,000 4 .r 1 • • 164/ ' / , ® DATE(MM1bbIYYYY) AR o CERTIFICATE OF LIABILITY INSURANCE 5/3/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Melissa Ignells Burnham WGB Insurance Solutions PHONE FAX CA Insurance License OF69771 (A/c.No.exI):714-505-7000 (Arc.No1:714-573-1770 15901 Red Hilt Avenue ADDRESS: melissa.ignells@wgblb.com Tustin CA 92780 INSURER(S)AFFORDING COVERAGE NAIC4 INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED MERCY-1 INSURER B:Berkshire Hathaway Homestate Insurance Company 20044 Mercy House Living Centers, Inc. PO Box 1905 INSURER C: Santa Ana CA 92702 INSURERD: INSURER B: INSURER F: COVERAGES CERTIFICATE NUMBER:816091050 REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WWI) POLICY NUMBER (MMIDDIYYYY) IMMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY PHPK2548587 5/2/2023 5/2/2024 EACH OCCURRENCE $1,000,000 AMA RETED CLAIMS-MADE X OCCUR PREMISESO(E occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY I 1 JECl LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: S. A AUTOMOBILE LIABILITY PHPK2548587 5/2/2023 5/2/2024 C(Ea OMBNEDaccident)SINGLE LIMIT $1,000,000 • X ANY AUTO BODILY INJURY(Per person) $ -- OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY f Per accident) $ A X UMBRELLALIAB X OCCUR PHUB861838 5/2/2023 5/2/2024 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$inprIA $ B WORKERS COMPENSATION MEWC441404 2/8/2023 2/8/2024 X H- AND EMPLOYERS'LIABILITY I ' STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE Y HIA E.L EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED7 • (Mandatory In NH) E.LDISEASE-EAEMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability PHPK2548587 5/2/2023 5/2/2024 PerCccurrence/Agg $1000000/32000000 A D&O!EPLI PHSD1793227 5/2/2023 5/2/2024 Each Policy Period 3,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Abuse/Molestation- Policy Number:PHPK2548587;Carrier:Philadelphia Indemnity;Limits:Each Abusive Conduct$1,000,000!Aggregate$2,000,000 Umbrella Liability Schedule of Underlying:General Liability Policy:PHPK2548587;Auto Liability Policy:PHPK2548587;Professional Liability Policy: PHPK2548587 Certificate holder is named as additional insured on the General Liability per attached PI-GLD-HS(10/11)as regtArmb Int Allitifiet FtttgiMto the terms and conditions of the policy. Waiver of Subrogation applies to the General Liability per attached CG24040509 See Attached... B CERTIFICATE HOLDER CANCELLATION MI AEI-E.GAMS CITY ATTORNEY SHOULD ANY OF THE ABOVg(IBARItIBOLttaltalt _IdD BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Beach 2000 Main St AUTHORIZE'•EPRESENTATIVE Huntington Beach CA 92646 I 001988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ;•rn"r: ,;i•.' :Ir;,;,., r t,,.,r r AGENCY CUSTOMER ID: MERCY-1 LOC#: A ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Burnham WGB Insurance Solutions Mercy House Living Centers,Inc. PO Box 1905 POLICY NUMBER Santa Ana CA 92702 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder Vesting:The City of Huntington Beach,its agents,officers,employees and volunteers Primary and Non-Contributory applies on the General Liability per attached endorsement • • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PHPK2548587 PI-GL-005(07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 05/02/2023 Name of Person or Organization(Additional Insured): City of Huntington Beach, Its officers, elected or appointed officials, employees, agents and volunteers SECTION II—WHO IS AN INSURED is amended to include as an additional Insured the person(s)or organization(s)shown in the endorsement Schedule, but only with respect to liability for"bodily injury," "property damage"or"personal and advertising injury"arising out of or relating to your negligence in the performance of"your work"for such person(s)or organization(s)that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured),except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible Insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance,as described in SECTION III—LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. POLICY NUMBER: PHPK2548587 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract Information required to complete this Schedule, If not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 02 C (Ed. 9.14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the applicable manual premium otherwise due on such remuneration subject to a policy maximum charge for all such waivers of 5% of total manual premium. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Person/Organization: City of Huntington Beach, its agents, officers,employees, and volunteers Job Description: Grant Requirement Waiver Premium: 350.00 Payroll Subject Class State to Waiver 8804 CA 1.00 • This endorsement changes the policy to which it is attached and is effective on the,date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 02/08/2023 PolicyNo.:MEWC441404 Endorsement No.: Insured: Premium$ Insurance Company.Berkshire Hathaway Homestate Ins Co Countersigned by WC 99 04 02 C (Ed. 9-14) Policy No. PHPK2548587 Pl-GLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following Is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 • Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own,Rent,or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Ball Bonds $5,000 5 Supplementary Payment--Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured--Managers,Landlords,or Lessors of Premises Included 7 Additional Insured--Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners,Lessees,or Contractors Included 9 Additional Insured--State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Duties in the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 • Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—Includes Mental Anguish Included 11 Personal and Advertising Injury--includes Abuse of Process, included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a.is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage"resulting.from the use of • reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability • SECTION I—COVERAGES,COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I.-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2)Is deleted In its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long;and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This Insurance is excess over any other valid and collectible insurance available to the insured whether primary,excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) LIABILITY,Subsection 2. Exclusions, Paragraph j. Damage to Property, Item(1)is deleted in its entirety and replaced with the following: (1) Property you own,rent,or occupy, including any costs or expenses incurred by you,or any other person,organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, . the word"fire"is changed to"fire, lightning, explosion, smoke,or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions; Is deleted In its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire,lightning,explosion,smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described In SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you,or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS,Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire,lightning, explosion,smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,Subsection 4.Other Insurance,Paragraph b.Excess Insurance,(1)(a)(il) is deleted in Its entirety and replaced by the following: That is Insurance for fire, lightning, explosion,smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company Pl-GLD-HS(10/11) a. $1,000,000;or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire,lightning,explosion,smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, • is amended as follows: 1. Paragraph 1.Insuring Agreement is amended to Include the following: We will pay those sums that the Insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation,"or"civil proceeding" seeking these damages. However,we will have no duty to defend the insured against any"suit" seeking damages,"investigation,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful, or Deliberate Violations • Any willful, intentional,or deliberate"violation(s)"by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigation" means an examination of an actual or alleged"violation(s)"by HHS. However, "investigation"does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III-LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS,Subsection 1. Insuring Agreement,a.(3)(b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2.Exclusions, Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person Injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows: 1.b.is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these. 1.d.is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or"suit",including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an"employee"in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing"suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B Is amended to include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client," up to a$10,000 limit per occurrence and$10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers,"employees","managers",directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or In collusion with other persons. The following,when used on this coverage,are defined as follows: a. "Client"means an individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions;and (c) Who you have the right to direct and control while performing services for you;or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph(1)above,who is on leave;or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor,commission merchant, consignee,independent contractor or representative of the same general character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving In a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1, If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company PI-GLD-HS(10/11) Coverage Part,Paragraph 3.a.is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. • b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of Its limits of insurance. d. Funding Source--Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option,any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GL.D-HS(10/11) organization is an insured only with respect to liability for"bodily injury,""property damage"or • "personal and advertising injury"caused, in whole or In part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair,construction, erection,or removal of advertising • signs, awnings, canopies,cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings,sidewalk vaults,street banners or decorations and similar exposures; (b) The construction,erection, or removal of elevators;or (c) The ownership, maintenance,or use of any elevators covered by this insurance. i. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distributed or sold In the regular course of the vendor's business,subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily Injury"or"property damage"for which the vendor Is obligated to pay damages by reason of the assumption of liability in a contractor agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging,except when unpacked solely for the purpose of inspection, demonstration, testing,or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to make such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation,servicing or repair operations,except such operations performed at the vendor's premises In connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) (g) Products which, after distribution or sale by you,.have been labeled or relabeled or used as a container;part or Ingredient of any other thing or substance by or for the vendor;or • • (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for Its own acts or omissions or those of Its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs(d)or(f);or (ii) Such Inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in • connection with the distribution or sale of the products. (2) This insurance does not apply to any Insured person or organization,from whom you have acquired such products,or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization Is an additional insured for"bodily injury,""property damage"or"personal and advertising Injury"but only for liability arising out of the negligence of the named insured.The limits of Insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1. Owners,Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising Injury"caused,in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the Insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work,including materials, parts or equipment furnished in connection with such work,on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf .for which the state or political subdivision has issued a permit,and is required by • contract. (2) This Insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality;or (b) "Bodily injury"or"property damage"included within the"products-completed operations hazard." M. Duties In the Event of Occurrence,Claim or Suit SECTION IV.—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2.Is amended as follows: a.is amended to include: This condition applies only when the"occurrence"or offense is known to: (1) You,if you are an individual; (2) A partner, If you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b.is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,6. Representations Is amended to Include the following: It is agreed that,based on our reliance on your representations as to existing hazards,if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Recovery Against Others To Us is deleted in Its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the Insured will bring"suit"or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss,provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Is amended to Include the following: If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the • revision Is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS,Paragraph 3.is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily Injury,sickness or disease sustained by a person, and Includes mental anguish resulting from any of these; and b. Except for mental anguish, Includes death resulting from the foregoing(item a.above)at any time. R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part,the definition of"personal and advertising injury" is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. is deleted In its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race,color, religion,sex,age or national origin, except when: a. Done intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured;or (2) Any executive officer,director, stockholder, partner or member of the Insured; b. Directly or indirectly related to the employment,former or prospective employment, termination of employment,or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) c. Directly or Indirectly related to the sale, rental, lease or sublease or prospective sales,rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured;or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation,court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company • THIRD AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS THIRD AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the 1st day of July, 2Q23, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2021, as amended by the First and Second Amendments, dated July 1, 2022 and November 1, 2022 (collectively, the "Original Agreement"); WHEREAS, on May 2, 2023, by Resolution No. 2023-19, the Huntington Beach City Council approved the FY 2023-2024 Annual Action Plan, which allocated $183,00Q of Community Development Block Grant (CDBG) funds for administrative costs and housing services for the City's Tenant Based Rental Assistance (TBRA) Program, of which $21,071 will be allocated to Mercy House; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 2. SUBRECIPIENT GRANT AMOUNT AND SCOPE OF SERVICES. Shall be amended as follows: a. The City has allocated Federal 2023-2024 CDBG funds in the amount of Twenty One Thousand Seventy One Dollars ($21,071) to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget (Attachement 1). 2. 3. TIME OF PERFORMANCE. Shall be amended as follows: a. The services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Grant Agreement may begin on July 1, 2023 and shall end on June 30, 2024. 1 23-12957/311705 3. 5. LEVELS OF PERFORMANCE. Shall be amended as follows: a. The Subrecipient agrees to provide the levels of program service as described in the Amended Scope of Services and Budget (Attachment 1). 4. 6. Budget. Shall be amended as follows: The budget detailed in the Scope of Services and Budget (Attachment 1) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City. 5. 7. PROJECT SCHEDULE/MILESTONES. Shall be amended as follows: Services of the Subrecipient shall start no sooner than on the first day of July 2023 and end on the thirtieth day of June 2024. Every effort shall be made by the Subrecipient to expend the allocated funds in their entirety by June 3Q, 2024. If the Subrecipient does not expend all funds by June 30, 2024, the City may reallocate the funds not yet drawn to another eligible CDBG Project. 6. 8. COMPENSATION AND METHOD OF PAYMENT. Shall be amended as follows: The City shall reimburse the Subrecipient with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1, 2023 and ending June 30, 2024. The City shall not provide any payments/reimbursements in advance of actual expenditures by the Subrecipient. Funding is contingent upon the City receiving Community Development Block Grant funds from HUD. The Subrecipient shall submit to the City a monthly "Payment Request" within fifteen (15) calendar days after the end of the first month with the final report for 2023/2024 fiscal year delivered by July 15, 2024. The reimbursement requests shall include documentation to verify that the expenditure of funds is consistent with the project description/definition as approved. Prior to reimbursing the Subrecipient, the City will verify that the Subrecipient has met all applicable regulations for the project. Payroll records, receipts, paid invoices including an itemized statement of all costs are samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. All other sections of the Original Agreement, as amended, shall remain in full force and effect. 2 23-12957/311705 IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. SUBRECIPIENT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By: Larry Haynes Print name Director/Chief ITS: (circle one) Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: Patti Long Print name City Attorney U , ITS: (circle one) Chairman/President/Vice President Date COUNTERPART RECEIVE AND FILE: City Clerk Date 3 23-12957/311705 IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. SUBRECIPIENT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By: Print name Director/Chief ITS: (circle one) Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: Print name City Attorney ITS: (circle one) Chairman/President/Vice President Date COUNTERPART RECEIVE AND FILE: q‘)kin‘d.Ad City Clerk Date 3 23-12957/311705 ATTACHMENT 1 FY 2023-24 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2023 and June 30, 2024, Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for four (4) Huntington Beach households. Staffing costs are tied to providing housing services, including the search and eligibility process for families. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: HS Supervisor: $2,173 HS Case Manager: $13,689 Administrative Costs: $5,209 TOTAL: $21,071 4 23-12957/311705 ,---"1 ® A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `ORL7 5/3/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Melissa Ignelis Burnham WGB Insurance Solutions PHONE FAx CA Insurance License 0F69771 (AiC.No.Ex*714-505-7000 (Arc,No):714-573-1770 AI 15901 Red Hill Avenue ADDREss: melissa.igneiis@wgbib.com Tustin CA 92780 INSURER(S)AFFORDINGCOVERAGE NAIC If INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED MERCY-1 INSURERB:Berkshire Hathaway Homestate Insurance Company 20044 Mercy House Living Centers, Inc. PO Box 1905 INSURER C: Santa Ana CA 92702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:816091050 REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVO_ POLICY NUMBER IMMIOD/YYYY) IMM/DD/WYY), A X COMMERCIAL GENERAL LIABILITY PHPK2548587 5/2/2023 5/2/2024 EACH OCCURRENCE $1,000,000 . DAMAGE TO CIAiMS-MADE X OCCUR PREMISES(EaENTED occurrence) $100,000 • MED EXP(My one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY 0 PRO LOC PRODUCTS-COMP/OPAGG $2,000,000 S JECHT OTHER: A AUTOMOBILE LIABILITY PHPK2548587 5/2l2023 5/2/2024 COMBINED SINGLE LIMIT S 1.000,000 (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) S , OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED X NON•OWNEO PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) S A X UMBRELLALIAB X OCCUR PHUB861838 5/2/2023 5/2/2024 EACH OCCURRENCE 54,000,000 EXCESSUAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTIONS i n, no $ B WORKERS COMPENSATION MEWC441404 2/8/2023 2/8/2024 X STkTUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y N/A E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 I(yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 A Professional Liability PHPK2548587 6/2/2023 5/2/2024 Per OccurrencelAggg $1000000/$2000000 A D&OIEPLI PHSD1793227 5/2/2023 5/2/2024 Each Poilcy Polled 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Abuse/Molestation- Policy Number:PHPK2548587;Carrier.Philadelphia Indemnity;Limits:Each Abusive Conduct$1,000,000!Aggregate$2,000,000 Umbrella Liability Schedule of Underlying:General Liability Policy:PHPK2548587;Auto Liability Policy:PHPK2548587;Professional Liability Policy: PHPK2548587 Certificate holder Is named as additional insured on the General Liability per attached Pi-GLD-HS(10/11)as regyimb me to a€14 pMto the terms and conditions of the policy. Waiver of Subrogation applies to the General Liability per attached CG24040509 , See Attached... By: CERTIFICATE HOLDER CANCELLATION `MI AEL E.GATES CITY AT t uRNEY rr SHOULD ANY OF THE ABOVE Qg({B bCibiEaTi CLidD BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Beach 2000 Main St AUTHORIZE'-EPRESENTATWE Huntington Beach CA 92646 1 _ D 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD V!!--:.,•i,''(,, I;'j i 7;•'1,'i.;;•;:::iU AGENCY CUSTOMER ID: MERCY-1 LOC#: AW RD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Burnham WGB Insurance Solutions Mercy House Living Centers,Inc, PO Box 1905 POLICY NUMBER Santa Ma CA 92702 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder Vesting:The City of Huntington Beach,its agents,officers,employees and volunteers Primary and Non-Contributory applies on the General Liability per attached endorsement ACORD 101 (2008/01) 402008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PHPK2548587 PI-GL-005(07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE " • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART • SCHEDULE Effective Date: 05/02/2023 Name of Person or Organization(Additional Insured): City of Huntington Beach, Its officers, elected or appointed officials, employees, agents and volunteers • SECTION II—WHO IS AN INSURED is amended to Include as an additional insured the person(s)or organization(s)shown in the endorsement Schedule,but only with respect to liability for"bodily injury," "property damage"or"personal and advertising injury"arising out of or relating to your negligence in the performance of"your work"for such person(s)or organization(s)that occurs on or after the effective date shown in the endorsement Schedule. This Insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured),except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available 10 the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III-LIMITS OF INSURANCE. All other terms, conditions,and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. POLICY NUMBER: FHPK2548587 • COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required $y Written Contract Information required to complete this Schedule,if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. • CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 02 C (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the applicable manual premium otherwise due on such remuneration subject to a policy maximum charge for all such waivers of 5% of total manual premium. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Person/Organization: City of Huntington Beach, its agents, officers, employees, and volunteers Job Description: Grant Requirement Waiver Premium: 350.00 Payroll Subject Class State to Waiver 8804 CA 1.00 This endorsement changes the policy to which it is attached and is effective on the.date issued unless otherwise stated. (The information below Is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 02/08/2023 PolicyNo.:MEWC441404 Endorsement No.: Insured: Premium$ Insurance Company.Berkshire Hathaway Homestate Ins Co Countersigned by WC 99 04 02 C (Ed. 9-14) Policy No. PHPK2548587 PI-GLD-HS(1 0/1 1) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply In the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own,Rent,or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of.Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included , 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers,Landlords,or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners,Lessees,or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) Duties in the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others.To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advertising Injury—Includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions, Paragraph a. Is deleted In its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage"resulting-from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability • SECTION I—COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent,either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary,excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company PI-GLD-HS(10/11) LIABILITY,Subsection 2. Exclusions, Paragraph j. Damage to Property,Item(1) is deleted in its entirety and replaced with the following: (1) Property you own, rent,or occupy, Including any costs or expenses incurred by you, or any other person, organization or entity,for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client,up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, . the word"fire"is changed to"fire, lightning,explosion,smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning,explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of Insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6, is deleted In Its entirety and replaced by the following: Subject to Paragraph 5.above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you, or in the case of damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., Is deleted in its entirety and replaced by the following: A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by tire,lightning, explosion,smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance,(1) (a) (li) is deleted in its entirety and replaced by the following: That Is insurance for fire, lightning,explosion,smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company PI-GLD-HS (10/11) a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire, lightning,explosion,smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA • SECTION I—COVERAGES,COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, • is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation,"or"civil proceeding" seeking these damages. However,we will have no duty to defend the insured against any"suit" • seeking damages,"investigation,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful,or Deliberate Violations • Any willful, intentional,or deliberate"violation(s)"by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to Include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigation"means an examination of an actual or alleged"violation(s)"by HHS. However, "investigation"does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of insurance Services Office, Inc.,with its permission. ©2011 Philadelphia indemnity Insurance Company PI-GLD-HS(10/11) • G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III-LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement,a. (3)(b)is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I--COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. Supplementary Payments SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows: 1.b. Is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these. 1.d.is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or"suit",Including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following Is added: We will pay, on your behalf, defense costs incurred by an"employee"in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing"suits. Page 5 of 12 Includes copyrighted material of insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to Include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other • loss to keys entrusted to you by your"client," up to a$10,000 limit per occurrence and$10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners,members, officers, "employees","managers", directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or In collusion with other persons. The following,when used on this coverage,are defined as follows: a. "Client"means an Individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above,who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you, (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor,commission merchant,consignee,Independent contractor or representative of the same general character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional lnsureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. ©2011 Philadelphia Indemnity Insurance.Company PI-GLD-HS(10/11) • Coverage Part,Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following Is also an Insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician • or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However,coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named insured's option,any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises;or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 includes copyrighted material of Insurance Services Office, Inc.,with its permission. 2011 Philadelphia Indemnity Insurance Company PI-GL.D-HS(10/11) organization is an insured only with respect to liability for"bodily injury,*"property damage"or • "personal and advertising injury"caused, In whole or in part, by your maintenance,operation • or use of equipment leased to you by such person or organization. A person's or organization's status as an additional Insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits--Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or . political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair,construction, erection,or removal of advertising • signs,awnings,canopies,cellar entrances,coal holes, driveways, manholes, marquees,hoist away openings, sidewalk vaults,street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators;or (c) The ownership, maintenance,or use of any elevators covered by this insurance. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distributed or sold In the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing,or the substitution of parts under Instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such Inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration,installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company PI-GLD-HS(10/11) (g) Products which,after distribution or sale by you,.have been labeled or relabeled or used as a container;part or ingredient of any other thing or substance by or for the vendor;or • • (h) 'Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (I) The exceptions contained in Sub-paragraphs(d)or(f);or (ii) Such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in • connection with the distribution or sale of the products, (2) This Insurance does not apply to any insured person or organization, from whom you have acquired such products,or any ingredient, part or container, entering into, accompanying or containing. J. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract--Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily Injury,""property damage"or"personal and advertising injury"but only for liability arising out of the negligence of the named insured.The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1. Owners,Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf .for which the state or political subdivision has issued a permit,and is required by • contract. (2) This insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) "Bodily injury"or"property damage"included within the"products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV.—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a.is amended to include: This condition applies only when the"occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner,if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b.is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that,based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part,we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Recovery Against Others To Us Is deleted in its entirety and replaced by the following: if the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the Insured will bring "suit"or transfer those rights to us and help us enforce them. • Therefore, the Insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following:. If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person,and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing(Item a.above)at any time. R. Personal and Advertising injury—Abuse of Process, Discrimination ' If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part,the definition of"personal and advertising injury"is amended as follows: 1. SECTION V—DEFINITIONS,Paragraph 14.b.is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race,color, religion, sex,age or national origin, except when: a. Done intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director,stockholder, partner or member of the insured; b. Directly or indirectly related to the employment,former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) • c. Directly or Indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured;or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation,court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity insurance Company SECOND AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS SECOND AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the /Sf day of llJav . , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement, as amended by the First Amendment, dated July 1, 2021 (collectively, the "Original Agreement"); WHEREAS, on November 1, 2022, by Resolution No. 2022-61, the Huntington Beach City Council approved Substantial Amendment No. Three to the 2020-2024 Consolidated Plan, which, in part, adjusted performance goals for HUD-funded programs; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 5. LEVELS OF PERFORMANCE. Shall be amended as follows: The Subrecipient agrees to provide the levels of program service as described in the Amended Scope of Services and Budget (Attachment 1). All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. [SIGNATURE PAGE FOLLOWS] 1 22-12119/295497 CONSULTANT CITY OF HUNTINGTON BEACH, a MERCY H S municipal corporation of the State of California By: Larry Haynes Director of Community Development Print name APPROVED AS TO FORM: ITS: (circle one) Chairman/President/1 Vice President AND City Attorney W,{,J By: RECEIVE AND FILE: Patti Long Print name City Clerk ITS: (circle one) Chairman/President/ Vice President Date COUNTERPART 2 22-12119/295497 CONSULTANT CITY OF HUNTINGTON BEACH, a MERCY HOUSE municipal corporation of the State of California By: A a. Director of Community Development Print name APPROVED TO FORM: ITS: (circle one) Chairman/President/ Vice President AND City Attorney Kw By: CEIVE AND FILE: ini4.44) Print name qdle City Clerk ITS: (circle one) Chairman/President/ Vice President JI;I23 Date COUNTERPART 2 22-12119/295497 ATTACHMENT 1 FY 2022-23 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan(HUD 5-year plan),which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for 15 Huntington Beach households. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment,Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Housing Stability Specialist: $27,500 Leasing Agent: $3,247 Housing Intervention Supervisor: $3,764 Benefits and Insurance: $13,089 Program Supplies: $600 Mileage: $1,800 Administrative Costs: $2,500 Total Mercy House Budget: $52,500 3 22-12119/295497 FIRST AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS FIRST AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the day of J it/ , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECEIPIENT previously entered into that certain Subrecipient Agreement, dated July 1, 2021,the"Original Agreement"; WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $105,000 of Community Development Block Grant(CDBG)funds for administrative costs for Tenant Based Rental Assistance (TBRA) Program, of which $52,500 will be allocated to Mercy House; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 2. SUBRECIPIENT GRANT AMOUNT AND SCOPE OF WORK. Shall be amended as follows: The City has allocated Federal 2022-2023 CDBG funds in the amount of Fifty-Two Thousand, Five Hundred Dollars ($52,500)to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget(Attachment 1). 2. 3. TIME OF PERFORMANCE. Shall be amended as follows: The Services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Grant Agreement may begin on July 1, 2022 and shall end on June 30, 2023. 3. 6. BUDGET. Shall be amended as follows: The budget as proposed in the Subrecipient Grant application(Attachment 1) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City prior to this agreement. 22-115641287153 All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By:_---- /--- - Larry Haynes Print name Director of Community Development ITS: (circle one) Chairma President Nice President(Pursuant I o HBMC 3.03.100) AND APPROVED AS TO FORM: By: Patti Long Print name City Attorney ITS: (circle one) Chairman/President ice President EIVE AND FILE: City Clerk /01,3/22 Date 2 ATTACHMENT 1 FY 2022-23 SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for 25 Huntington Beach households. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Housing Stability Specialist: $27,500 Leasing Agent: $3,247 Housing Intervention Supervisor: $3,764 Benefits and Insurance: $13,089 Program Supplies: $600 Mileage: $1,800 Administrative Costs: $2,500 Total Mercy House Budget: $52,500 E(MMIODNYYY) A� CERTIFICATE OF LIABILITY INSURANCE FDATsr10 oz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CON A Melissa I nelis Burnham WGB Insurance Solutions PHONE 714-505 7000 F°� 714-573-1770 CA Insurance License OF69771 EMAIL 15901 Red Hill Avenue DES& mignellsigwgbib.com Tustin CA 92780 INSURERS AFFORDING COVERAGE NAICM wsuRERA:Philadelphia Indemnity 18058 INSURED MERCY-1 Mercy House Living Centers, Inc. INSURERS:Berkshire Hathaway Homestate PO Box 1905 INSURER C: Santa Ana CA 92702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER,1988953953 REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INT R TYPE OF INSURANCE So ADDL SUER POLICY NUMBER POLICY EFF PMUCY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2409067 512/2022 6/1/2023 EACH OCCURRENCE $1000000 CLAIMS-MADE a OCCUR PREMISES We occurrence $100,000 MED EXP(Any one arson $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY 0 JEST LOC PRODUCTS-COMP/OP AGO $2,000.000 OTHER: $ A AUTOMOBILE LIABILITY PHPK2409057 5=022 5/2/2023 COMBINED SINGLE LI TWe poddent) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per acdden0 $ X HIRED X NON-OWNED PROPERTY DAMAGE $ IAUTOS ONLY AUTOS ONLY TO FORM PPROVEq A $ A X UM13RELLALIAB X OCCUR PHUBS12980 /2022 5/2/2023 EACH OCCURRENCE $4,000,000 EXCESS LIAS CLAIMS-MADE 8 AGGREGATE $4,000,000 DED X RETENTION$ MICHAEL .GATFS $ B WORKERS COMPENSATION MEWC338374 G-0fj&gA 2/8/2023 X AND EMPLOYERS'LIABILITY YIN CM Of:HUNTI s7R E ERH- ANYPROPRETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $1,000 000 OFFICER/MEMBER EXCLUDED'/ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It alas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000,000 A Professional Liability PHPK2409057 6/2f2022 5/2/2023 Per Ocnrnerlce/A $1000600/S2000000 A D60IEPLI PHSDI680830 12/17/2021 512/2023 Each Polley Period 3.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Abuse/Molestation- Policy Number.PHPK2409057;Carrier:Philadelphia Indemnity;Limits:Each Abusive Conduct$1,000,000/Aggregate$2,000,000 Umbrella Liability Schedule of Underlying:General Liability Policy:PHPK2409057;Auto Liability Policy:PHPK2409057:Professional Liability Policy: PHPK2409057 Certificate holder is named as additional Insured on the General Liability per attached PI-GLD-HS(10/11)as required by written contract subject to the terms and conditions of the policy. Waiver of Subrogation applies to the General Liability per attached CG24040509 Certificate Holder Vesting:The City of Huntington 8each,Its agents,officers,employees and volunteers CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Beach 2000 Main St AUTHORIZE EPRESENTATIVE Huntington Beach CA 92646 m 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD RISW Mrat JJN2tf'22PM,104 AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE (Program No. B-21-MC06-0506) FOR PROGRAM YEAR 2021/2022 COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG)FUNDS THIS AGREEMENT is made and entered into on the 11 of July, 2021 by and between the CITY OF HUNTINGTON BEACH a municipal corporation, hereinafter referred to as "City," and MERCY HOUSE,hereinafter referred to as "Subrecipient." RECITALS WHEREAS, the City has applied for and received funds from the United States Government under Title I of the Housing and Community Development Act of 1974, Public Law 93-393, and WHEREAS, the City wishes to engage the Subrecipient to assist the City in utiliAng such funds;and WHEREAS, the City has environmental clearance to release the funds for this project; NOW,THEREFORE, in consideration of these recitals, and the mutual covenants contained herein,City and Subrecipient agree as follows: 1) National Objective The Subrecipient certifies that the activities carried out with funds provided under this Agreement will meet the CDBG program's National Objective of benefit to low/moderate income persons as defined in 24 CFR Part 570.208. The Subrecipient shall adhere to the terms of the City's CDBG Application and Subrecipient Agreement and with assurances and agreements made by the City to the United States Department of Housing and Urban Development. 2) Subrecipient Grant Amount and Scope of Services The City has allocated Federal 2021-2022 CDBG furtds in the amount of Fifty- Two, Five Hundred Dollars ($52,500) to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget (Attachment 1). 3) Time of Performance The services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Grant Agreement may begin on July 1, 1 G Cs1ru,1 I W. 2021 and shall end on June 30, 2022. 4) Personnel Assigned Subrecipient personnel assigned to carry out the Scope of Services shall, if required by the standards of their profession, maintain all licenses and permits necessary to remain in compliance with State and Federal requirements governing the profession. The City shall be notified of all personnel assigned to carry out the Scope of Services and shall be notified if there is a change in personnel. 5) Levels of Performance The Subrecipient agrees to provide the levels of program service as described in the Scope of Services and Budget(Attachment 1). 6) Budget The budget as proposed in the Subrecipient Grant application (Attachment 2) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City prior to this agreement. In addition, the City may request a more detailed budget breakdown than originally proposed and the Subrecipient shall provide such supplementary budget information in a timely fashion in the form and content prescribed by the City. Both the City and Subrecipient must approve any amendments to the budget in writing. 7) Proiect Schedule/Milestones Services of the Subrecipient shall start no sooner than on the first day of July 2021 and end on the thirtieth day of June 2022. Every effort shall be made by the Subrecipient to expend the allocated funds in their entirety by June 30, 2022. if the Subrecipient does not expend all funds by June 30, 2022, the City may reallocate the funds not yet drawn to another eligible CDBG projects. 8) Compensation and Method of Payment The City shall reimburse the Subrecipient with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1, 2021 and ending June 30, 2022. The City shall not provide any payments/reimbursements in advance of actual expenditures by the Subrecipient. Funding is contingent upon the City receiving Community Development Block Grant funds from HUD. The Subrecipient shall submit to the City a monthly "Payment Request" within fifteen (15) calendar days after the end of the first month with the final report for 2021/2022 fiscal year delivered by July 15, 2022. The reimbursement requests shall include documentation to verify that the expenditure of funds is consistent 2 consistent with the project description/definition as approved. Prior to reimbursing the Subrecipient, the City will verify that the Subrecipient has met all applicable regulations for the project. Payroll records, receipts, paid invoices including an itemized statement of all costs arc samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report (Section 11) is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. i 9) Program Income The Subrecipient shall report to the City any interest or other income earned as a direct result of the use of Federal CDBG funds for the program outlined within this agreement. All reported program income may be retained by the Subrecipient for services in connection with providing housing, utilities, funds for medications, computer training and food to the homeless or those who are at risk of homelessness. All provisions of this Agreement shall apply to these activities. The program income, retained by the Subrecipient, must be expended before additional funds are requested from the City. Any program income on hand when the Agreement expires or received after the Agreement's expiration shall be paid to the City. The requirements are set forth in the Code of Federal Regulations, Title 24, Section 570.504(c). 10) Record Keeping Requirements The Subrecipient shall, at minimum, maintain the following records and reports to assist the City in complying with its record keeping requirements. a) Documentation of the income level, ethnicity, age of persons and/or households participating in or benefiting from the Subrecipient's program; b) Documentation of the number of persons and/or households participating in or benefiting from the Subrecipient's program; c) Documentation of all CDBG funds received from the City; d) Documentation of expenses as identified in the monthly report and reimbursement requests; e) Documentation of how and when a determination was made as to the eligibility status of persons assisted, and f) Any such other related records as the City shall require. The Subrecipient shall maintain separate accounting records for the Federal CDBG funds provided by the City. The City, Federal Grantor Agency, Comptroller General of the United States, or any of their duly authorized representatives shall have access to all books, documents, papers and records maintained by the Subrecipient which directly pertain to the above project for the purpose of audit,examination, excerpts and transcriptions. 3 11) Reporting Requirements The Subrecipient shall submit "Monthly Accomplishment Reports" within fifteen (15) calendar days of the end of the month. The final monthly report is due no later than July 15, 2022. Monthly reports shall be provided by the Subrecipient to the City indicating the number of persons assisted, income and ethnicity of persons assisted, how/what assistance was provided, and a description of how and when determination of eligibility status was made for persons assisted. The report must include sufficient information to assist the City in monitoring the j Subrecipient's performance. The Subrecipient must demonstrate satisfactory performance prior to reimbursement for expenditures. 12) Public Access to Program Records The Subrecipient shall furnish and cause each of its own subrecipients or subcontractors to furnish all information and reports required hereunder and will permit access to its books, records and accounts by the City, HUD or its agent, or other authorized Federal officials for purposes of investigation to ascertain compliance with the rules, regulations and provisions stated herein. 13) Records Retention Unless otherwise notified by the City, the Subrecipient shall retain all financial records, supporting documents and statistical reports related to the project identified under this Agreement until September 30, 2027. All records subject to an audit finding must be retained for five (5) years from the date the finding is made or until the finding has been cleared by appropriate officials and the Subrecipient has been given official written notice. 14) Grant Closeout Procedures The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during this close-out period shall include, but are not limited to: making final payments, disposing of program assets (including the return of all unused materials, equipment, unspent cash advances, program income balances, and accounts receivable to the City), and determining the custodianship of records. Notwithstanding the foregoing, the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over CDBG funds, including program income. 15) Uniform Administrative and Program Management Standards The Subrecipient shall comply with applicable Uniform Administrative Requirements as described in Section 570.502 of the federal regulations for the CDBG Program. The Federal requirements are incorporated herein by reference. 16) Use and Reversion of Assets Upon expiration of this Agreement, the Subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. The Subrecipient shall be required to use any real property under the Subrecipient's control that was acquired or improved 4 in whole or in part with CDBG funds in excess of$25,000 as follows: a) Used to meet one of the National Objectives in 24 CPR, Section 570.208 until five(5) years after expiration of this Agreement; or, b) Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property less any portion of the value attributable to expenditure of non-CDBG funds for acquisition or improvement to the property, Reimbursement is not required after the period of time specified in paragraph (a) of this section. 17) Real Property The use and disposition of real property and equipment under this Agreement shall be in compliance with the requirements of 24 CPR Part 84 and 24 CPR 570.502, 570.503, and 570.504, as applicable, which include but are not limited to the following: The Subrecipient shall transfer to the City any CDBG funds on hand and any accounts receivable attributable to the use of funds under this Agreement at the time of expiration, cancellation, or termination. Real property under the Subrecipient's control that was acquired or improved, in whole or in part, with funds under this Agreement in excess of$25,000 shall be used to meet one of the CDBG National Objectives pursuant to 24 CPR 580.208 until five (5) years after expiration of this Agreement [or such longer period of time as the City deems appropriate]. If the Subrecipient fails to use CDBG- assisted real property in a manner that meets a CDBG National Objective for the prescribed period of time, the Subrecipient shall pay the City an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property. Such payment shall constitute program income to the City. The Subrecipient may retain real property acquired or improved under this Agreement after the expiration of the five-year period [or such longer period of time as the City deems appropriate]. In all cases in which equipment acquired, in whole or in part, with funds under this Agreement, is sold, the proceeds shall be program income) prorated to reflect the extent to that funds received under this Agreement were used to acquire the equipment). Equipment not needed by the Subrecipient for activities under this Agreement shall be (a) transferred to the City for the CDBG program or (b) retained after compensating the City [an amount equal to the current fair market value of the equipment less the percentage of non-CDBG funds used to acquire the equipment]. 18) Other Program Requirements Reserved. 5 19) Suspension and"termination In accordance with Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations, this Agreement may be suspended or terminated if the Subrecipient fails to comply with any term(s) of the award and/or the award is terminated for convenience. Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations are incorporated herein by reference as provisions of the Agreement. 20) Compliance with Laws and Regulations The Subrecipient agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants (CDBG) including subpart K (Attachment 3), except that: a) The Subrecipient will not assume the City's environmental responsibilities as described on Section 570.604; and b) The Subrecipient will not assume the City's responsibility for initiating the review process required under the provisions of 24 CFR Part 52. The Subrecipient also agrees to comply with all other applicable Federal, state and local laws, regulations, and policies governing the funds provided under this contract, including those regulations and requirements outlined in Attachment 2 of this subrecipient Agreement insofar as they are applicable to the performance of this contract. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 21) Antidiscrimination/Affirmative Action & Equal Employment Opportunity The Subrecipient shall comply with all State and Federal laws regarding nondiscrimination in the provision of services and the equal opportunity employment of personnel. 22) Financial Management Accounting Standards. The Subrecipient agrees to comply with 24 CPR 84.21-28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. Cost Principles. The Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organizations,"or A- 21, "Cost Principles for Educational Institutions," as applicable. These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 23) Audit Requirement If the Subrecipient shall receive more than $300,000 in total federal funds in one fiscal year from the City of Huntington Beach and/or any other city or agency, the Subrecipient is required to submit a Single Audit Report. As required by the Federal Single Audit Act, the Subrecipient shall be required to submit to the City, 6 a comprehensive financial audit prepared by an independent, neutral third party auditor. The audit shall cover financial operations of the Subrecipient for the period beginning July 1, 2021 and ending June 30, 2022 and is due not later than one year after expiration of this Agreement. 24) Religious and Lobbying Activities Religious Activities. The Subrecipient agrees that funds provided under this contract will not be utilized for religious activities or to promote religious interests. Religious entities may use CDBG funds for secular activities only in accordance with the Federal regulations specified in 24 CFR 570.2006), such as worship, religious instruction, or proselytization. Lobbying. The Subrecipient hereby certifies that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement; (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with this Federal contract, grant loan, or cooperative agreement, it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and (3) It will require that the language of paragraph (d) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly: Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure. 25) Budget Modifications If the Subrecipient desires to modify the use of the CDBG funds following approval of this agreement, a written request must be submitted to the City for review. No change in use of the CDBG funds will permitted without prior written approval by the City, subject to the provisions of the City's adopted Citizen 7 Participation Plan. 26) Performance Monitoring The City will monitor the performance of the Subrecipient against goals and performance standards required herein. Substandard performance as determined by the City will constitute non-compliance with this Agreement. If action to correct such suhstandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, contract suspension or termination procedures will be initiated. i i 27) Conflict of Interest The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 570.611, which include (but are not limited to) the following: 1) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. 2) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. 3) No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. 28) Procurement Standards and Methods 1) Compliance. The Subrecipient shall comply with current City policy concerning the purchase of equipment and shall maintain inventory records of all non-expendable personal property as defined by such policy as may be procured with funds provided herein. All program assets (unexpended program income, property, equipment, etc.), shall revert to the City upon termination of this Agreement. 2) OMB Standards. Unless specified otherwise within this agreement, the Subrecipient shall procure all materials, property, or services in accordance 8 with the requirements of 24 CFR 84.40-48. 3) Travel. The Subrecipient shall obtain written approval from the City for any travel outside the metropolitan area with funds provided under this agreement. 29) Environmental Issues 1) Air and Water. The Subrecipient agrees to comply with the following requirements insofar as they apply to the performance of this Agreement: a) Clean Air Act,42 U.S.C., 7401, et.req.; b) Federal Water Pollution Control Act, as amended, 33 U.S.C., 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder; c) Environmental Protection Agency (EPA) regulations pursuant to 40 CFR Park 50, as amended. 2) Flood Disaster Protection. In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4001), the Subrecipient shall assure that for activities located in an area identified by the Federal Emergency Management Agency (FEMA) as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes (including rehabilitation). 3) Lead-Based Paint. The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this Agreement shall be subject to HUD Lead-Base Paint Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to all CDBG-assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead-based paint. Such notification shall point out the hazards of lead-based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead-based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead-based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied to a property, paint testing, risk assessment, treatment and/or abatement may be conducted. 4) Historic Preservation. The Subrecipient agrees to comply with the Historic Preservation requirements set forth in the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36 CFR Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic Properties, insofar as they apply to the performance of this agreement. In general, this requires concurrence from the State Historic 9 Preservation Officer for all rehabilitation and demolition of historic properties that arc fifty years old or older or that are included on a Federal, state, or local historic property list. i 30) Notices Communication and details concerning this contract shall be directed to the following contract representatives: City: Subrecipient: Community Development/NF.D Mercy House Ann: Steve Holtz, Deputy Director Attn: Larry Haynes 2000 Main Street, 5'h Floor P.O. Box 1905 Huntington Beach,CA 92648 Santa Ana, CA 92702 Phone: (714) 374-1626 31) Independent Contractor Nothing contained in this Agreement is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. The Subrecipient shall at all times remain an "independent contractor" with respect to the services to be performed under this Agreement. The City shall be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the Subrecipient is an independent contractor. 32) Insurance General Liability. In addition to the workers' compensation and employer's liability insurance and Subrecipient's covenant to indemnify City, Subrecipient shall obtain and furnish to City, a policy of general public liability insurance, including motor vehicle coverage covering the program / project. This policy shall indemnify Subrecipient, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the program, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for the program / project. This policy shall name City, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the program / project shall be deemed excess coverage and that Subrecipient's insurance shall be primary. Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a "deductible" or any other similar form of limitation on the required coverage. 10 Workers Compensation and-Employers' Liability. Pursuant to California Labor Code Section 1861, Subrecipient acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; Subrecipient covenants that it will comply with such provisions prior to commencing performance of the work hereunder. Subrecipient shall maintain workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. Subrecipient shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Subrecipient shall furnish to City a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and Subrecipient shall similarly require all subcontractors to waive subrogation. Certificate of Insurance. Prior to commencing performance of the work hereunder, Subrecipient shall furnish to City certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverages as required by this Agreement; the certificates shall: I. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 3. promise to provide that such policies will not be canceled or modified without thirty (30) days' prior written notice of City. Subrecipient shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by City. The requirement for carrying the foregoing insurance coverages shall not derogate from the provisions for indemnification of City by Subrecipient under the Agreement. City or its representative shall at all times have the right to demand the original or a copy of all the policies of insurance. Subrecipient shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required. Subrecipient shall provide a separate copy of the additional insured endorsement to each of Subrecipient's insurance policies, naming City, its officers, elected and appointed officials, employees, agents and volunteers as Additional Insureds, to the City Attorney for approval prior to any payment hereunder. 33) Hold Harmless and Indemnity Agreement Subrecipient hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Subrecipient's employees and damage to Subrecipient's property, arising directly or indirectly out of the obligations or operations herein undertaken by Subrecipient, caused in whole or in part by any negligent act or omission of the Subrecipient, any I subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Subrecipient will conduct all defense at its sole cost and expense and City shall approve selection of Subrecipient's counsel. City shall be reimbursed for all costs and attorney's fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Subrecipient. 34) Scverability If any provision of this Agreement is held invalid, the remainder of the j Agreement shall not be affected thereby and all other parts of this Agreement shall nevertheless be in full force and effect. 35) Assignment of Agreement The Subrecipient shall not assign this Agreement or any monies due thereunder without the prior written consent of the City. 36) Successors and Assigns Subject to the provisions of the Subrecipient Agreement Paragraph 16, "Hold Harmless and Indemnity Agreement," all terms, conditions, and provisions hereof shall inure to and shall bind each of the parties hereto, and each of their respective heirs, executors, administrators, successors, and assigns. 37) Section Headings and Subheadings The section headings and subheadings contained in this Agreement are included for convenience only and shall not limit or otherwise affect the terms of this Agreement. 38) Waiver The City's failure to act with respect to a breach by the Subrecipient does not waive its right to act with respect to subsequent or similar breaches. The failure of the City to exercise or enforce any right or provision shall not constitute a waiver of such right or provision. 39) Authority to Execute this Agreement The person or persons executing this Agreement on behalf of Subrecipient warrants and represents that he/she has the authority to execute this Agreement on behalf of the Subrecipient and has the authority to bind Subrecipient to the performance of its obligations hereunder. 40) Entire Agreement This agreement constitutes the entire agreement between the City and the Subrecipient for the use of funds received under this Agreement and it supersedes all prior or contemporaneous communications and proposals, whether electronic, 12 oral, or written between the City and the Subrecipient with respect to this Agreement. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by and through their authorized officers on Jules_,2021. MERCY HOUSE CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California By: LarryLHaynes Director of Community Development print nome ITS: (circle one) Chairm residen icc APPROVED AS TO FORM: President '} AND U �_ /1 City Attorney By: / / Pat -Low ng print name ITS: (circle one) Secret hief Financial Officer/Asst. Secretary-Treasure COUNTERPART 13 oral, or written between the City and the Subrecipient with respect to this Agreement. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by and through their authorized officers on July 1 2021. MERCY HOUSE CITY OF HUNTINGTON BEACH, a municipal Icorporation of the State of California By: V1r� Director of Community Development SlY� print name ITS: (circle one) Chairrnan/PresidentfVice APPROVED AS TO FORM: President ((II AND City Attorney By: print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary - Treasurer COUNTERPART l3 MERCY HOUSE ATTACHMENT 1 SCOPE OF SERVICES AND BUDGET 14 ATTACHMENT FY 2021-22 SCOPE OF SERVICES AND BUDGET MERCY HOUSE i i A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2021 and June 30, 2022, Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for 25 undupllcated Huntington Beach households. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 151^ of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described In Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Housing Stability Specialist: $27,500 Leasing Agent: $3,247 Housing Intervention Supervisor: $3,764 Benefits and Insurance: $13,089 Program Supplies: $600 Mileage: $1,800 Administrative Costs: $2,500 Total Mercy House Budget: $52,500 i MERCY HOUSE ATTACHMENT SUMMARY OF CDGB LEGAL REQUIREMENTS 15 ATTACHMENT SUMMARY OF LEGAL REQUIREMENTS In addition to the requirements set forth in other provisions of the Subrecipient Agreement, Subrecipient("Participant")shall comply,and shall cause all participant personnel to comply,with the following regulations and requirements insofar as they are applicable with the performance of the Subrecipient Agreement.' 1. Equal Opportunity and Nondiscrimination. a. Title VI of the Civil Rights Act of 1964, as amended, including Public Law 88-352 implemented in 24 C.F.R. Part 1. This law provides in part that no person shall, on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. In regard to the sale or lease of the Site, Participant shall cause or require a covenant running with the land to be inserted in the deed and leases prohibiting discrimination under this Title, and providing that City and the United States are beneficiaries of and entitled to enforce such covenants. Participant shall enforce such covenant and shall not itself so discriminate. b. Fair Housing Act, Title Vlll of the Civil Rights Act of 1968, as amended, including Public Law 90-234. The Fair I lousing Act provides in part that there shall be no discrimination in housing practices on the basis of race, color, religion, sex, and national origin. The Fair Housing Act was amended in 1988 to provide protections from discrimination in any aspect of the sale or rental of housing for families with children and persons with disabilities. The Fair Housing Act also establishes requirements for the design and construction of new rental or for-sale multi-family housing to ensure a minimum level of accessibility for persons with disabilities. C. Section 109 of Title I of the Housing and Community Development Act of 1974, as amended, including 42 U.S.C. 5301 el. seq.,42 U.S.C. 6101 et. seq., and 29 U.S.C. 794. This law provides in part that no person on the grounds of race, color, national origin, sex, or religion shall be excluded from participation in,be denied the benefits of,or otherwise be subject to discrimination under any activity funded in whole or part with funds under this Title. d. Section 104(b) of Title I of the Housing and Community Development Act of 1974, as amended, including 42 U.S.C. 5301 el. seq. This law provides in part that any grant under Section 106 shall be made only if the grantee certifies to the satisfaction of the Secretary of IIUD that the grantee will, among other things, affirmatively further fair housing. This exhibit is a list and summary of some of the applicable legal requirements and is not a complete list of all participant requirements. The description set forth next to a statute or regulation is a summary of certain provisions in the statute or regulation and is in no way intended to be a complete description or summary of the statute or regulation. In the event of any conflict between this summary and the requirements imposed by applicable laws, regulations,and requirements,the applicable laws, regulations, and requirements shall apply. ATTACHMENT2 iwe 2020 -1- C. Executive Order 11246, as amended. This order includes a requirement that grantees and subrecipients and their contractors and subcontractors not discriminate against any employee or applicant for employment because of race, color,religion, sex,or national origin. f. Executive Order 11063,as amended,including 24 C.F.R. Part 107. This order and its implementing regulations include requirements that all actions necessary be taken to prevent discrimination because of race, color, religion, sex, or national origin in the use, occupancy, sale, leasing, rental, or other disposition of property assisted with Federal loans, advances, grants, or contributions. g. Section 504 of the Rehabilitation Act of 1973, as amended. This Act specifies in part that no otherwise qualified individual shall solely by reason of his or her disability or handicap be excluded from participation (including employment), denied program benefits, or subjected to discrimination under any program or activity receiving Federal assistance. Participant must ensure that its programs are accessible to and usable by persons with disabilities. h. The Americans with Disabilities Act (ADA) of 19941, as amended. "this Act prohibits discrimination on the basis of disability in employment by state and local governments and in places of public accommodation and commercial facilities. The ADA also requires that facilities that are newly constricted or altered, by, on behalf of, or for use of a public entity, be designed and constructed in a manner that makes the facility readily accessible to and usable by persons with disabilities. The Act defines the range of conditions that qualify as disabilities and the reasonable accommodations that must be made to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for persons with disabilities. i. The Age Discrimination Act of 1975, as amended. This law provides in part that no person shall be excluded from participation in, be denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal assistance. j. EEO/AA Statement. Participant shall, in all solicitations or advertisements for employees placed by or on behalf of Participant, state that it is an Equal Opportunity or Affirmative Action employer. k. Minority/Women Business Enterprise. Participant will use its best efforts to afford small businesses and minority and womcn-owned business enterprises the maximum practicable opportunity to participate in the performance of the Agreement. As used in the Agreement, the term "small business"means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women-owned business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition,"minority group members" are Afro-Americans, Spanish-speaking, Spanish-surnamed or Spanish-heritage Americans,Asian- Americans, and American Indians. Participant may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. ATTACHMENT2 J.2020 -2- 2. Environmental. a. Air and Water. Participant shall comply with the following regulations insofar as they apply to the performance of the Agreement: Clean Air Act,42 U.S.C. 7401, et seq.; Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308,and all regulations and guidelines issued thereunder; and the U.S. Environmental Protection City regulations pursuant to 40 C.F.R. Part 50, as amended. b. Flood Disaster Protection Act of 1973. Participant shall assure that for I activities located in an area identified by FEMA as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained. C. Lead-Based Paint. Participant shall comply with the Lead-Based Paint Regulations referenced in 24 C.F.R. § 570.608, including 24 C.F.R. Part 35, et. al. d. Historic Preservation. Participant shall comply with the historic preservation requirements set forth in the National Historic Preservation Act of 1966,as amended (16 U.S.C. 470) and the procedures set forth in 36 C.F.R. Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic Properties and related laws and Executive Orders, insofar as they apply to the performance of the Agreement. In general, this requires concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a federal, state, or local historic property list. C. Limitation on Activities Pending Clearance. In accordance with 24 C.F.R. § 58.22 entitled "Limitations on activities pending clearance, "neither a recipient nor any participant in the development process, including public or private nonprofit or for-profit entities, or any of their contractors, may commit HUD assistance under a program listed in 24 C.F.R. § 58,l(b) on an activity or project until HUD or the state has approved the recipient's Request for Release of Funds (RROF) and the related certifications have been approved. Neither a recipient nor any participant in the development process may commit non-HUD fiords or undertake an activity or project that would have an adverse environmental impact or limit the choice of reasonable alternatives. Upon completion of environmental review or receipt of environmental clearance, City shall notify Participant. HUD funds shall not be utilized before this requirement is satisfied. The environmental review or violation of the provisions may result in approval, modification of cancellation of the City Grant. If a project or activity is exempt under 24 C.F.R. § 58.34, or is categorically excluded (except in extraordinary circumstances) under 24 C.P.R. § 58.35(b), no RROF is required and the recipient may undertake the activity immediately after the City has documented its determination that each activity or project is exempt and meets the conditions specified for such exemption under this section by issuing a Notice to Proceed. 3. Uniform Administrative Requirements. The uniform administrative requirements described in 24 C.F.R. § 570.502. 4. Other Program Requirements. Participant shall carry out each activity under the Agreement in accordance with all applicable federal laws and regulations described in Subpart K ATTACHMENT 2 J.2020 -3- of 24 C.F.R. § 570 except for City's environmental responsibilities under 24 C.F.R. § 570.604 and City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52. 5. Reversion of Assets. Upon the expiration of the Funding Period or sooner termination of the Agreement, Participant shall transfer to City (a) any and all CDBG Funds, (b)any accounts receivable attributable to the use of CDBG Funds. In all cases in which equipment acquired, in whole or in part, with funds under the Agreement is sold,the proceeds shall be program income(prorated to reflect the extent to that funds received under the Agreement were used to acquire the equipment). Equipment not needed by Participant for activities wider the Agreement shall at the election of City either be (a) transferred to City for the CDBG program, or (b) retained by Participant after compensating City an amount equal to the current fair market value of the equipment less the percentage of non-CDBG Funds used to acquire the equipment. 6. Relocation. City shall not be responsible for relocating any occupants from the Site in connection with the Program or Project. If required, Participant shall have the sole and exclusive responsibility for providing relocation assistance and paying all relocation costs required to comply with all applicable federal and state laws, rules, and regulations, including the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. § 4601 of seg., as amended, and implementing regulations, and I-IUD Handbook 1378. Participant shall indemnify, defend, and hold City harmless from and against any claims, liabilities, damages, or losses made against it by tenants or occupants of the Site, including without limitation claims for relocation assistance,inverse condemnation,and claims otherwise arising from any act or omission of Participant pursuant to the provision of relocation assistance. 7. Allowable Costs and Audits. Participant shall comply with and administer the Project and Program in accordance with the requirements of The Office of Management and Budget (OMB)"Super Circular' 2 CFR Part 200, which includes the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for federal awards, as applicable. 8. Records and Reports. Participant shall provide to City and shall cause each of its contractors, subcontractors and subrecipienls to provide to City all records and reports relating to the Project and Program that may be reasonably requested by City in order to enable it to perform its record keeping and reporting obligations pursuant to the CDBG Requirements, including but not limited to those described in the Agreement and 24 C.F.R. § 570.506. 9. Religious Organizations. If Participant is a religious organization as defined by the CDBG Requirements, Participant shall comply with all conditions prescribed by HUD for the use of CDBG Funds by religious organizations, including the First Amendment of the United States Constitution regarding church/state principles and the applicable constitutional prohibitions set forth in 24 C.F.K. § 570.2000). 10. Conflict of Interest. Participant will comply with 24 C.F.R. § 570.611 regarding the avoidance of conflict of interest,which provisions include(but are not limited to)the following: i. Participant shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. ATTACF WENT 2 hme 2020 -4- ii. No employee, officer or agent of the Participant shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. iii. No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family tics, during their tenure or for a period of one(1) year thereafter. For purposes of this paragraph, a"covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the Grantee, the Participant, or any designated public agency. 11. Political Activity (24 C.F.R. § 570.207(a)(3)). Participant is prohibited from using CDBG Funds to finance the use of facilities or equipment for political purposes or to engage in other partisan political activities, such as sponsoring candidate forums, distributing brochures, voter transportation, or voter registration. 12. Anti-Lobbying Certification. By its execution of the Agreement, Participant hereby certifies that: i. No Federal appropriated funds have been paid or will be paid, by or on behalf of it,to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress, an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. ii. if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,it will complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying," in accordance with its instructions. iii. It will require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. This certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than ATTACHMENT2 June 2020 -5- $100,000 for each such failure. At the request of City, Participant shall execute a separate document that contains the certifications set forth above. 13. Drug-Free Workplace Requirements. Participant shall comply with and be subject to the requirements of the federal drug-free workplace requirements, which include the following actions be taken: i. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition. ii. Establishing an ongoing drug-free awareness program to inform employees about: (a) the dangers of drug abuse in the work place; (b) the grantee's policy of maintaining a drug-free workplace; (c) any available drug counseling, rehabilitation, and employee assistance programs; and (d) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. iii. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph(i). iv. Notifying the employee in the statement required by paragraph(i) that, as a condition of employment under the grant, the employee will: (a) abide by the terms of the statement; and (b)notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five(5)calendar days after such conviction. V. Notifying the agency in writing, within ten (10) calendar days after receiving notice under sub-paragraph (iv)(b) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant. vi. Taking one of the following actions, within thirty (30) calendar days of receiving notice under subparagraph (iv)(b), with respect to any employee who is so convicted: (a) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (b) 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. vii. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (i), (ii), (iii), (iv), (v), and (vi). ATTACHMENT 1.2020 -6- 14. Procurement. Participant will comply with the procurement standards under 2 C.F.R. §§ 200.317-200.326. Participant shall comply with all existing and future City policies concerning the purchase of equipment. 15. Labor Provisions. a. Section 3 of the Housing and Community Development Act of 1968. Participant shall comply with and cause its contractors and subcontractors to comply with the requirements of Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. § 1701u), the HUD regulations issued pursuant thereto at 24 C.F.R, Part 135, and any applicable rules and orders of HUD issued thereunder. The Section 3 clause, set forth in 24 C.F.R § 135.38 provides: i. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. § 170lu (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low-and very low-income persons, particularly persons who are recipients of HUI) assistance for housing. ii. The parties to this contract agree to comply with HUD's regulations in 24 C.F.R. Part 135, which implement Section.3. As evidenced by their execution of this contract, the parties to this contract certify that they arc under no contractual or other impediment that would prevent them from complying with the Part 135 regulations. iii. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause; and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions,the qualifications for each;and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. iv. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 C.F.R. Part 135, and agrees to take appropriate action,as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 C.F.R. Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 C.F.R. Part 135. V. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 C.F.R. ATTACHMENT June 2020 -7- Pan 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 C.F.R. Part 135. vi. Noncompliance with HUD's regulations in 24 C.P.R. Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. Participant shall abide by the Section 3 clause set forth above and will also cause this Section 3 clause to be inserted in all contracts relating to the construction of the Project. b. Labor Standards. Participant shall comply with the provisions of 24 C.F.R. 570.603 and related requirements. Participant shall include in all applicable construction contracts the provisions of federal law imposing labor standards on federally assisted contracts. Participant shall comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended (40 U.S.C. 3141 through 3148), the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq. and implementing regulations), the Copeland Anti-Kick Back Act (40 U.S.C. 276c and 18 U.S.C. 874 et seq.), the implementing regulations of the U.S. Department of Labor including 29 C.F.R. Parts 1, 3, 5, 6 and 7, and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of the Agreement. Participant shall maintain documentation that demonstrates compliance with these provisions and such documentation shall be made available to City and HUD for review upon request. Participant shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. C. HUD Form 4010. Participant shall comply and cause Participant Personnel to comply with the provisions of HUD Form 4010 attached hereto. HUD Form 4010 must be included in the bid packet and construction contract and subcontracts for the Project. ATTACHMENT 2 J.ft 2020 -8- Federal Labor Standards Provisions U.S.Department of Housing and Urban Development Office of Labor Relations Applicability (1) The work to be perlofmad by the classification The Project or Program to which the construction work requested is not performed by a classllicallon in the wage covereo by this contract Pertains is being assisted by the determination; and United States of America and the following Federal Labor (2) The classification Is utilized In the area by the Standards Provisions are included In this Contract construction industry;and pursuant to the provisions applicable to such Federal (3) The oroposed wage rate. Including any bona fide assistance. [rings benefits, bears a reasonable relationship to the A. 1. (1) Minimum Wages. All laliurafs and mechanics wage rates contained in the wage 0elermin3tton. employed Or working upon the site of the work, will be paid (b) 11 the contractor and the laborers and mechanics to be unconditionally and not less often than once a week, and employed In the classification (if known), or their without subsequent deduction or rebate an any account representatives, and HUD or Its designee agree an the (except such payroll deductions as are permitted by classification and wage fate (Including the amount regulations issued by the Secretary of Labor under the designated for fringe benefits where ap Droonato), a report Copeland Act (29 CFR Part 3), the full amount of wages of the action taken shall no sent by HUD or its designee to and bona fide fringe benefits (of cash equivalents thereof) the Administrator of the Wage and Hour Division, due at Ilene of payment computed at rates not less than Employment Standards Administration, U.S. Department of those contained In the wage determination of the Labor, Washington, D.C. 20210. The Administrator, or an Secretary of Labor which is altacnea hereto and made a authorized representative, will approve, modify, or Dan hereof, regardless of any contractual relationship disapprove every additional classification action within 30 which may be alleged to exist between the conlraclof and days of receipt and so advise HUD or its designee or will such laborers and mechanics. Contributions made or notify HUD or its designee within the 30-day period that costs reasonably anticipated for bona fide fringe benefits addilionai time 15 necessary. (Approved by the Office of under Section I(b)(2)of the Davis-Bacon Act on behalf of Management and Budget under OMB control numbel 1215- laborers or mechanics are considered wages paid to such 0140.) laborers or mechanics, subject to the provisions of 29 CFR (cl In the event The contractor, No laborers or mechanics 5.5(ap7)(Iv); also, regular contributions made of costs to to employed in the he la orers o Or tnics incurred for more than a weekly period (but not less often representatives,bemployed and HUD t Its designee do not agree on eir than quarterly) under plans. funds, or Dlogfam5, which the proposed classification and wage rate (including the Cover [no particular weekly Denod, are deemed to be amount designated for fringe bonellls, Where appropriate), constructively made or incurred during such weekly period. HUD of Its designee shall refer the questions, Including Such laborers and mechanics shall be paid the appropriate me views of all interested parties and the recommendation wage rate and fringe benefits on the wage determination of HUD or its designee, to the Administrator for for the classification of work actually performed. without determination. The Administrator, or an authorized regard to 0111. except as provided In 29 CFR 5.51ap4). representative,will issue a determination within 30 days o1 Laborers or mechanics performing work In more than one receipt and so advise HUD or Its designee Or will notify classification may be compensated at the rate specified for HUD or Its designee within the 30-day period Ihm each C133siflCati00 for the time actually worked therein: additional time Is necessary. (Approved by the Office of Provided, Thai the employers payroll records accurately Managemenl and Budget under OMB Control Number set forth the time spent in each classification in which 1215-0140.) work Is perforated. The wage determination(including any additional classification and wage rates conformed under fill The wage fora (Including fringe benefits wnew 29 CFR 5.5(agU(li) and the Davis-Bacon poster (WH- appropriate) determined pursuant to subparagraphs 1321)shall be posted at all times by the contractor and Its (1)110 b) or (c) of this paragraph, shall be paid to all subcomlaClprs at the site of Ine work in a prominent and workers performing work In the Classification under this accessible, oiace where it can be easily seen by the contract from the first day on which work is performed In workers, the Classificallon. (ill (a) Any class of laborers or mechanics which Is not till) Whenever the minimum wage rate prescribed in the listed In the wage determination and which Is to be contract for a class of laborers or mechanics Includes a employed under the contract shall be classified in fringe benefit which Is not expressed as an hourly tale, the conformance with the wage determination. HUD shall contractor shall either pay the benefit as stated In the apo(ave an additional classification and wage rate and wage determination or shall pay another bona fide (rings fringe benefits therefor only when the following criteria benefit Ot an hourly cash equivalent thereof. have been met: IN) If the contractor does not make payments to a trustee Or other third person, the contractor may consider as part arm I Previous editions are obsolete Page I of 5 rel.Handbook 1144.1 ATTACFI.MENI'2 -9- nr the wages of any tallorer of mechanic the amount of an': ronimb Oftaled in writing fo the laborers or Inecnanlcs Cids reationiol'y anaUpaled bi pf nvlCnng hOOJ Illy hinge dI1P Qed. aid records which StIOA• the Costs dntllq,M4l Of ber,en:s under a plan or tiograrl. �IovlOed That Ina the actual cost (howled if, Convicting SUM benefits. Secretary at Lahof has IDund, upon the wwan leanest if CQruraclol3 employing apprew;Ce'i of ❑alnees under the eonliaciof, :het Ina ap DllCahle smndatd9 C! Me Ga'+le approved orn rams that mainlam 'wrtan evidence of In(- Bacon ACT have i:i en nlel. The 50cretary of Labor may regli:aUon of bruin iceshlO programs and ceraf --atlon of require the colwatic! to set aside IC a facility atcour.; trainee programs. toe registration Of Ina ap Dfent4Ps and aSSES for Me meeting Of obligations under the plan br flambe), ally Ina itufos anC wage rites orestrioee in the orogam (ApCuO•NC by :he UOIco of Management and JDpl1(ahle otograms. iAoproved by Me Olfke of Fuca under )RIB Control Number 1215-Ct40 1 'danagemem ado Budge: tindef DIAS Cori N(Imbos 2. Withholding. HUD or its designee shall up`in :s own Ql1 -014C and t215 0017.) action of boon wnhen request of ,an authorized In) (a) The Contractor shall submit:really for e,lcn wgek representative of the Depal:men; of Lai%or Snnhold or in :which any contract 'Mork if eerlfAmed d Copy Of ail i cause to be withhold from the contractor under This payrolls to HUD or ITS designee it the agency if a party IQ Contraet or any other Feeefal contract woe :he same prime the cowrdcl but if the agen Cy rs not such a Carey, the contactor, or an-; clher Federally-aaslsted ConVat: contractor pill submit the payrolls to the a"11C.lnt suhfect t0 Dams-Bacon' prevailing :age requirements. Sponsor, of owner, as Ina case may be, for Ila0sml3s:an:o •xMch Is held fly the same prima Contractor ao much of me HUD of its Cesignee. The hayloft submitted shall set out accrued pa''/Vents of ,advances as may to consiou red actinic Pry .and completely all of the mtormalion IaqulreC necessary :o pay lanorers and mechanics, inOueing to ne maintained under 29 CFR 5 Sla)(3)tii 4,,cabt that lull apoi trainees and helperi employed by lee social security humiliate Ono nnOte addresses mall no; he COntacto, of a^•y SUD w'COnIlJctof me lull amount of wages included on eei ly Ifonspllltlli instead Ina pJYfdlls 9dal :equlred by:tie contract In the even[ of !allure to o0'/ any Owl} need to Include Bra imLviduafly Identifying funnier bar laborer or mechanic. Including any apprentice, Ira nee or each em Dloyye (e.g_ me last four rllgcs of Ina employee s helpel. employed or working on The site of the work. all or social security nurn1w). The oequir" 'weekly payroll oar; 01 the wages required by the contract, HUD Or ins Information may be su0mltled In any form desired. designee may, alien wflllen notice to ine contractor Dollonal Fofni 'NF-3a7 Is available flat this purpose from sponsor, applicant, or Owner. !a" such action as may uO the 'Wage and Hour DIv41on Web site at neCefsafy to Cause the susoonslon of .any further Iflrp'I/www.act cokyPssrmnd/formsylyn347+dclr darn, or Its payment. advance, or guarantee of funds until such successor site. The prime Contractor Is reioonsible for violations have ceased HUD of Its designee may. after the submission of copies of payrolls by JII subcontractors, winter, notice to the contractor. disburse such amounts Contractors and subcontractors snail ramirtaln Ine lull withheld for and on account of the contractor or sacral Saturn,, number and current address of each subcontractor to !he ref DOC[IVO employees t0 whom :hOy Covered 'worker. and shall provide Morn upon request to are due The Comptroller General snail make such HUD or Its designee if the agency is a Davy to the disbursements Ili the Case of direct Davis-Bacon Act contract. put II The agency Is not such a party. the contracts contractor out submit the payrolls to the noplicanl 3. (I) Payrolls atilt basic records. Payrolls aria hash sponsor,or owner. as :tie Case may be, for :ransmissuan to le(ords relating :hefe(n mall be malmained by :f.e HUD(if Its designee, Ina COntraCtOi.Or too'yagC and Hour CoordUof during the Course of Ina work preserved for a Division of the DePillmeld of Labor for Dar Doses of an Canna of three years ihe(farlet for all laboar3 and mvesbg,ahon of lurid of Compliance wun prevailing wage Mechanics wofhnig ai the site of the work, Such records re Cugements. I:Is not a violation of this suboofagrJon for that ConlOin ine name address. .and social security J Dunne contractor to require a Subcontractor to provide rummer DI each such worker his or her correct JCdiess e5 and social security humors IQ the rnmb classification. hourly rates Of wages paid !Including fates contractor for its own records w'nnoul weekly submission of contributions or costs anticipawo (or bona fide hinge :o HUD Or its designee (Approved by my Quite of nefefts or Cash eourvalents thereof of the:yDgs descrlb9d •Management and Budge: under CUB Control Number in 3ec:lon IIUI('_IIEI of the Da•ns-Macon .Ails, daily and 1215.0149.1 ,liekly nuntoer of hours 'w'of'<ea, deductions moat' and (b) Each payroll subnutled shall tit accompanied by i actual wages paid Wheilevef the ,eCiei Jiy of Labor has -Statement Of Compliance.' signed by the colua<tor or fount under 20 CFR 55 tan 111w) that the wages of cnly subcontractor or ins or net agent 'Afro Days or Sb Defvl9e5 laborer of mechanic mcluce the amount of any coils the payment of the petsmn emcloyed under the contract reasonably anticipated Ill plorrdinq benefits under a clan and shall Con.fy the follordnq: or program eescrilaC in .Section i(h)(2)IB) of The Da'+is- (1) That the payroll for the payroll catcall contains the Eaton Act. the cmuaclof Shan mam;ain records ::inch information required to be wadded under 29 CFR 5 5 snob: That the Commitment to provide such beretils Is (al(31(u). the appflapnate IntOrmabon is bound malna inee enforceJhle. Ina( the plan or 000gam Is nninclall'/ undel 29 CFR 5 51a)(31fl), and that such infornlabon a responsible. and that lire pan or progrant his been correct and Complete, remous edbops are bso'e:e Icahn I. - / i Page 2N5 rt Flinolsaok lytd,l AITACI EMENT 2 -10- (2) That each laborer or mechanic lin Cluding each helper, Is nor registered or otherwise employed as staled above, apprentice, and trainee) employed on the contract during shall be paid not less than the applicable wage rate on the the payroll period has been paid the full weekly wages wage determination for the classification of work actually earned. Without rebels. either directly or Indirectly. and performed. In addition. any apprentice performing work on that no deductions have been made either directly or the lob Site in excess of the ratio permitted under the Indirectly From (no full wages earned, other than registered program shall be paid not less Iran the permissible deductions as set forth In 29 CFR Part 3: aoplicable wage rate on the wage tierermination for the (3) That each laborer or mechanic has been paid not less work actually performed. Where a contractor Is performing than the applicable wage rates and fringe benefits or cash construction on a project In a locality other than that In equivalents for the classification of work performed, as which Its program Is registered, the ratios and wage rates specified in the applicable wage determination (expressed in percentages Of ins Journeyman's nobly incorporated Into the contract. rate) Specified In the Contractor's or subcontractor S registers($ program shall he observed. Every apprentice Icl The weekly sunmission of a properly executed certification Set lorth on the reverse tide of Optional Form registmust hB pall el not rase than the rate level cried In the W H-347 shall satisfy the requirement for submission of the expressed program for the aODrho four teme Of progress, hourly rate 'Statement of Compliance' required by subparagraph expressed as a percentage of the journeymen hourly rate A 3(Iry(b) specified in the paidapp firing wage determination. .AUprenll cal sna0 be Daltl fringe benefits In accordance (d) The falsification of any of the above certifications may with ;its provisions of the apprenticeship program. 11 the Subject the Conuaclof or subcontractor to Civil Or criminal appromicesho program does not specify fringe benefits, prosecution under Section 1001 of Title 19 and Section apprentices Must be paid the full amount of fringe benefits 231 of Title 31 of the United States Code. II3100 on the wage determination for the appllCable Illi) The contractor or 6ubconlra Cl01 shall make the Classification. It the Administrator determines that a records required under subparagraph A.3.0) available for different practice prevails for the applicable apprentice inspection, copying, of transcription by authorized classification, fringes shall be paid in accordance with that representatives of HUD Or Its designee or the Department determination. In the event the Office of Apprenticeship of Labor, and shall permit such representatives to Training, Employer and Labor Services, or a Stale interview employees during working hours on the job. It ApDrenllceshlp Agency recognized by the Office, the contractor or subcontractor fails to submit the required withdraws approval of an apprenticeship program, the records or to make rem available. HUD or its designee contractor will no longer be Permitted t0 utilize may, after written notice to the contractor, sponsor, apprentices at less than the applicable predetermined rate applicant or owner, take such action as may be necessary lot the work performed until an acceptable program is to cause the suspension of any further payment, advance, approved. or guarantee of funds. Furthermore, failure to submit the pry Trainees. Except as provided in 29 CFR 5.16. required records upon request or to make such records trainees will not be permitted to work al less than the available may be grounds for debarment action pursuant to predetermined rate for the work performed unless they are 29 CFR SA2. employed pursuant ',to and Individually registered In a 4. Apprentices and Trainees. program which has received prior approval, evidenced by (1) Apprentices. Apprentices will be permitted to work at formal certification by the U.S. Department of Labor, less than the predetermined rate for the work they Employment and Training Administration. The ratio of performed when they are employed pursuant to and trainees to journeymen on the jot site shall not be greater individually registered in a bona Ilde apprenticeship than permitted under me plan approved by the Diagram registered with the U.S. Department of Labor. Employment and Training Adremistrbon. Every trainee Employment and T(alning Administration, Office 01 must be Pala at not less than the rate specified in the Apprenticeship Training, Employer and Labor SONICOS. of approved program for the trainee's level of progress, Writ a Stale Apprenticeship Agency recognized by the expressed as a percentage or the journeyman hourly rate Office, or if a person is employed In his or net first g0 specified in Ine applicable wage determination. Trainees days of probationary employment as an apprentice in such shall be paid Fringe benefits In accordance with the an apprenticeship Program, who is not Individually provisions of the trainee program. 11 the trainee program registered in the program, but who has been certified by dose not mention fringe benefits, trainees shall be paid the Office of Apprenticeship Training, Employer and Labor the full amount of fringe benefits listed on its wage Services of a State Apprenticeship Agency (where determination unIOSS the .Administrator of the Wage and appropriate)to ber eligible for probationary employment as Hour Division determines that there is an apprenticeship an apprentice. The allowable ratio of apprentices to program associated with the corresponding Journeyman journeymen on the job site in any craft classification shall wage tale on the wage determination which provides for not be greater than the ratio permitted to the contractor as loss than full fringe henefils for apprentices. Any to the entire work force under the registered program. Any employee listed on the payroll at a trainee rate who is not worker listed on a payroll at an apprentice wage rate, who registered and Participating in a training plan approved by Previous edoons are obsoleui farm ( ) Page 3a(5 ,at HarxPDok 1344.1 ATT'ACHNIENI'2 -11- the Employment and Training Administration shall be paid awarded HUD contracts or participate in HUD programs not less than the applicable wage fate on the wage pufsuaml to 24 CFR Part 24. determination for the work actually performed. In addition. 411) NO part Of this contract shall be subcontracted to any any trainee performing wolk on the lob site in excess of person or firm Inellglble for awpid of a Government the fold permitted under the registered program small be contract by virtue of Section 3(a) Of the Doves-Bacon Act cold not less than the applicable wage rate on the wage or 29 CFR 5.12fa)(1) of to be awarded HUD contracts or determination for the work actually performed. In the participate in HUD programs pursuant to 24 CFR Part 24. event the Employment and Training Administration withdraws approval of a training program, the contractor In t The penalty for making f0150 statements Is Additionally, will no longer be pefmhied to utilize tfainees at loss than In lime U.S. Cl Code, Code, 19 U.S.C. , Titl Additionally, the applicable predetermined vale lot the work performed U.S. Criminal Code, Section 1 transactions'. 0, Title 18. U.S.C_ until an acceptable voofam is approved. 'Federal neveHousr, t , theAdmi UfpOGOtration 01 . . .cOonY. provides In pari'. 'Whoever, IOt the purpose Or . . . IOfIUOOGipq in any ' (III) Equal employment opportunity. The utilization Of way the action of such Admmistratlon.._. makes, utlers of apprentices,trainees and journeymen under 29 CFR Part 5 publishes any statement knowing the same to be false..... shall be In conformity with the equal employment shall be fined not more than S5,000 of Imprisoned not opportunity requirements of Executive Older 11246. as more than two years,or boln.- amended, and 29 CFR Part 30. 11, Complaints, Proceedings, or Testimony by 5. Compliance with Copeland Act requirements. The Employees. No laborer or mechanic to whom the 'wage, contractor shall comply with the requirements of 29 CFR q salary, of other labor sldmdortls provl5lo ns of this Contract Part 3 which are Incorporated by reference In this contract are applicable shot] be discharged or In any otner manner 0. Subcontracts. The contractor or subcontractor will discriminated against by the Contractor Or any insert In any subcontracts the clauses contained In 9ubcontf9clor "Cause such employee has then any subparagraphs 1 through 11 In this paragrapn A and such complaint or Instituted or caused to be Instituted any Other clauses as HUD of its designee may by appropriate proceeding Of has testified or Is about to testily In any Instructions require. and a Copy Of the applicable proceeding under of relating to the labor slandards prevailing wage decision, and also a clause requiring Ine applicable under this Contract to his employer. subcontractors to Include these clauses In any lower tier B. Contract Work Hours and Safety standards Act. The subcontracts. The prime contractor shall be responsible pmwslom of this Dafagraph B are applicable where me allot]"Or the for the compliance by any subcontractor or lower tier cmme contract exceeds S100.000. As used In this pmagfaph, the subcontractor with all the contract clauses In this Ilifins'labdten'arp'merlunks'Inclutle watcmmenand guards. paragraph. (1) Overtime requirements. NO Contrafa Or subcommictor 7. Contract termination; debarment. A breach Of the curaractin9 far any on of tat commuct work which may require or contract clauses in 29 CFR 5.5 may be grounds for Inrt4ve the emmyrrient Of fabc.ers a Mechanics slag require a termination of the contract and for debarment as a permit any such laborer a mechanic In any w r"k In which the contractor and a subcontractor as provided in 29 CFR individual is employed on such work to work in excess of 40 hotas In 5.12. such workweek teo59 such tat" a memarvc receives 9. Compliance with Davis-9YCM1 and Related Act Requirements. conversation at a rate M less than ore and one-half limes the La4C All rulings and interpretations of the Davis-Bacon and rate of pay W all hours waked in excess 0( 40 hogs in such Related Acts contained In 29 CFR Parts 1, 3, and 5 are workweek. herein incorporated by reference In this contract (21 Violation; liability lot unpaid wages; liquidated 9. Disputes concerning labor standards. Disputes damages. In the event of any violation of the clause set arising out of the labor standards provisions of this forth In subpofagfapm (1)of this paragraph, the contractor contract shall not be subject to the general disputes and any subcontractor responsible therefor shall le liable Clause of this contract. Such disputes shall le resolved In for the unpaid wages. In addition, such contractor and accordance with the pfotedures Of the Department Of subcontractor shall be liable to the United Slates (in the Labor sal forth in 29 CFR Parts 5, 6, and 7. Disputes case of work done under contract for the District 01 within the meaning Of this clause Include disputes between Columbia or a territory, to such District or to such the contractor (Or any of its subcontractors) and HUD of territory), for liquidated damages. Such liquidated Its designee, the U.S Department of Labor, of the damages shall be computed with respect to each InOivduOl employees Or their representatives. laborer or Mechanic, Including watchmen and guards, 10. pit Certification of Eligibility. By entering Into this employed In violation of the clause set forth In contract the contractor certifies that nallner it (nor he or subparagraph(1)Of this paragraph, In the sum of$10 fa each shel not any person or Ilrm who has an interest in the ca!entlar day on which such Individual was required Or pemYtteit Io contractor's firm is a person of firm Ineligible to be work In excess acne standard workweek of 40 hours without payment awarded Government contracts by virtue Of Section 3(2) of of the ovagnle wages requited by the Clause Set forth In sun the Davis-Bacon Act of 29 CFR 5.12(a)(7) or to be paragraph(1)of this paragraph, ewau5 edOlale are o0soreto 1 ) Page 4 of 5 hit.Handbook 7244.1 ATTACHMENT 2 -12- (1) Wlthholdlno for unpaid wages and liquidated damages. HUD or Its designee shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable an account Of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contract. or any other Federally-asslsled contract subject to the Contract 'Work Hours and Safely Standards Act Lvhlcn Is held by the some prime contractor such sums as may be determined to be necessary to satisfy any hahllilles of such contractor or subcontractor for unpaid wages and liquidated damages as provided In the clause eel forth In subparagraph (2)of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set IOrth In subparagraph (Il through (4) of cols paragraph and also a clause requiring the subcontractors to Include these clauses In any lower tier subcontracts. The prime contractor shall he responsible for compliance by any subcontractor or lower tier subcontractor with the Clauses set lo(lh In subparagraphs (1) through t4) of this paragraph. C. Health and Solely. The provisions of this paragraph C are applicable where Ibe an aunt of the pinta contract exceeds S1g0.000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health and safety as deterrmined under construction safely and health standards promulgated by the Secretary of Labor by regulation. (2) The Contractor shall comply with all regulations Issued by the Secretary of Labor pursuant to Title 29 Part 1926 and failure to comply may result in imposition of sanctions pursuant to the Contract Work Hours and Satety Standards Act. (Puhlit Law 91-54. 63 Stat 96). 40 USC 3701 et sea. (3) The contractor shall Include the provisions of this Paragraph lO every subcontract so that such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Prevtc us editions are Obsolete form HUDA01 0( ) Page 5 of 5 ref.Handbook 1344.1 ATCACHMENI. 2 -13- Ne✓ MERCY-2 OP 10:SO .4`oJRo CERTIFICATE OF LIABILITY INSURANCE wO5t2412021 05f2df2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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(Sj AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: 11 the coDlficalo holder Is an ADDITIONAL INSURED, the policy(loa) must be ondorsod. It SUBROGATION IS WAIVED,subject to the forms and conditions of the policy,certain pcllclas may require on ondarsomant. A Stateroom on thla conlllceto does not confar rights to the certificate holder In llw of such ondersoment a). PrtooucER "'T r Ste hanlo Dufour Dufour Insurance Services,LLL MAIN 5611 Llttlor Oruro (Imo. E1,.714.369-2998 II,AjrC „ .714-860-6767 Huntington Beach,CA 92849 LIWYC .Stophanta@dutourinsairanco.com SlopheNo Dufour RORR NSIIRERIS)AFFORONO COVERAGE NNC, INSURER A,Philadelphia lndomn[!X 1805E INsuRFo ercy ouse Iv ng Comers wwuxo:NOVA CasualtyCompany 42552 P.O.Box 1905 Santa Ana,CA 92702 n.tuRFNe:AAIS Insurance Company 013034 wrortmo Toklo Marino Speelalty Ins wWREA E: Nau 0.EgF• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED DELOW HAVE BEEN ISSUED TO PIE INSURE13 NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM ON CONUf110N OF ANY CONTRACT OR OTHER UOUAWENT%1TI1 RESPECT TO VauCH THIS CERTIFICATE MAY BE ISSUED OR WAY PERTAIN, THE MSUHANCE AFI'ORDCO BY THE POLICIES OESCRIOED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEFR REDUCED BY PAID CLAIMS. TYPR OF wayMNG4 Y N pot EFFTFO7Ac P IlWia OENF'RAL UAealry CAVIOCCUMENCE 1 1,000, A X cOMAIEAWLCFrrFnAL Lweuir X X PNPK2268697 0510212021 0610212022 OUAAGETORU7TE PREusEB lE.xan.nul_ 1 100,000 _ CLAIMS.MACE OX 0('.Ctw MEn E%P An m. Fant 1 10,0 A % .ro`f?LI111illlty_ PHPK2266697 06)OV2021 05102)20I2 PERsa+u.aAwmtsRr 1 1,000,0 A X I Sex AbusefMlseand PHPK2266697 06)0712021 06)02f2022 GEW.A AGen9wre 4 2,000,00 GENL AGDAEGAIE UMIr APPLIES PER: PRCOUCTS•COUPAIP AGO I 2,00D,00 x ) Llx: Ded,•50 I i AuioJAT tEI.0 UYV COMSIMED 5 hDILL LIW I1,000,00 ANANYAtno X X HPK2264697 05102JZ021 OS10712022 wacwty INArny"Pw.m) S A11 OMNeu X UYae1XA Lu AUTOS Aurcf WXYINAtY(PwGo*w4 I wu0wlos X Alrrx� eO Qwl : 1 Comp/Coll Red. 4 50 X uMORa1LA LMa X OCCLIR FACN OCCIIASIEACE I 5,000, A seen LAAD ,C;AMa+uce X X MUS765396 051OV2021 OSID212022 AwRewiE % 5,000, .D x wi 1000o Mo>oFRadOMPEN,ATtow Nb x SIAM i„. N .w A EaFLO TY yERr wau B Ar,PROPer:rpwINFRA:xr IA tNeulrvE YIN x F7• K•10000041A5 OLOB120I1 OL L.OBI2023 E. EAGII ACCYfENi s 1,000,0 OFFx:F `w-. FAEMAMOcoa lMM,tIwNy b NMI E.L.DISEASE•EA S 1,000,0 A wNO.Mda IM DPERATTONS F_t.D6FASF.-POT ICY IIMIi I 1,000,0D C Cybur Llablif y X X RPS AXIS P-077142121 0112912021 01129)2022 Per Occ 1.000.00 A D&OO EPU X X PHS01592211 12/17/2020 IV17/2021 Aggregate 1.000,00 eESCRa IWN OP OPtWIiW„f I LOCAIgNi I VXIeCLtlI(AeAra ACbiO ICI,Aealb.w 0.wNA.Isla.a.,lr mo,.N+..�M nRWM) The City of Huntingqton Bosch, its agents, officers, ettploysas and volunteers ere nomad as Additional inaurod as roapocta tha operation of Netted Inourud APPROVED AS TO FORM attached ondoroaeo ea nt. This ineuranco io priry and noncontributory. Blonkot waiver of Subrogation apppplios on liability and workoro carry limes. 10 day rotico of oanoallation. r By:.—�.R MICHAEL E.GATES CITY ATTORNEY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Huntington Beath THE EXPIRATION DATE rHEAEOF, NOTICE WILL BE DELIVERED IN 2000 Main Street ACCORDANCE VIITN THE POLICY PROVISIONS. Huntington Beach,CA 92648 AUYNOAREOAEPREIENunve �1FiY1r+tiC��Cf� 01888-2010 ACORD CORPORATION. All rights rosomed. ACORD 25(20101051 The ACORD narrm and logo are registered marks of ACORD r I NOTEPAD Mercy Houw Uving Centers MERCY-2 PAGE 2 INSMEWa MME OP ID:SD o.0 06124/202/ i {I I I i I POLICY NUMBER: PHPK2266697 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 of Huntington Beach Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organizatlon(s) shown In the Schedule, but only Section III—Limits Of Insurance: with respect to liability for'bodily injury", "property If coverage provided to the additional Insured is damage" or 'personal and advertising Injury" required by a contract or agreement, the most we caused, in whole or In part, by your acts or will pay on behalf of the additional insured Is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1• Required by the contract or agreement;or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown In the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 0 Insurance Services Office, Inc.,2012 Page 8 of 26 FOURTH AMENDMENT TO HOME SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS FOURTH AMENDMENT TO HOME SUBRECIPIENT AGREEMENT between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into,to be effective the 1st day of July, 2023, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2022, as amended by the First, Second, and Third Amendments, dated July 1, 2022,November 1, 2022, and July 1, 2023 (collectively,the "Original Agreement"); WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $296,642 of HOME funds to the SUBRECIPIENT for rental assistance for the CITY's Tenant Based Rental Assistance(TBRA) Program; WHEREAS, CITY and SUBRECIPIENT desire to amend the Agreement to provide that $115,000 of the $296,642 allocated in the FY 2022-2023 Annual Action Plan as outlined in the Original Agreement, as amended,be allocated to the TBRA program for tenant based rental assistance for the 2023-2024 program year. Now,therefore, it is mutually agreed, by and between the parties as follows: 1. 1.1 SCOPE OF SERVICES. Shall be amended as follows: During the entire Term(defined below,as amended)of this Agreement, SUBRECIPIENT shall administer the CITY's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively,the"Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, SUBRECIPIENT shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. SUBRECIPIENT shall further take all reasonable actions necessary.to enable,.,, CITY to comply with CITY's obligations under the HOME Program relatingto the TBRA Program. The SUBRECIPIENT.shall perform the Services set forth in the Article 1 in furtherance of the TBRA Program. (a) Levels of Performance. The SUBRECIPIENT agrees to provide the levels of , program service as described in the Scope of Work and Budget (Attachment 1). 23-13250/315722 -1- 2. 2.1 TERM. Shall be amended as follows: Services of the SUBRECIPIENT under this Agreement shall start on July 1, 2023 and end on the earlier to occur of (i) June 30, 2024 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) (as amended) has been disbursed to SUBRECIPIENT and expended by SUBRECIPIENT to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the SUBRECIPIENT remains in control of HOME Funds or other HOME assets, including program income. 3. 3.2(a) Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed One Hundred Fifteen Thousand Dollars ($115,000). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of SUBRECIPIENT and Director. All other sections of the Original Agreement,as amended, shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Fourth Amendment to be executed by their respective officers duly authorized as of the date first written above. SUBRECIPIENT, CITY OF HUNTINGTON BEACH, MERCY O SE A municipal corporation of the State of California N A-1 N C 1 Di ect of Community Development Print Name (Pursuant To HBMC 3.03.100) ITS: (circle one) Chairman/President/ Vice President APPROVE ORM: air By. Ci Attorney - . � CEIVE &FILE: Print Name e0l-tallga444)ITS: (circle one) Chairman/President/ dVSAft, Vice President City Clerk Date 23-13250/315722 -2- ATTACHMENT 1 FY2023-24 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at-risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2023 and June 30, 2024, Mercy House will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to seven (7) additional Huntington Beach households in accordance with the TBRA Guidelines. These seven additional households do not include the four(4) Huntington Beach households that are carried over from FY 2022-2023. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this Agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Rental Assistance: $115,000 Total Mercy House Budget: $115,000 23-13250/315722 -3- THIRD AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS THIRD AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH, a municipal corporation 9f the State of California, hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the 1st day of July, 2023, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2021, as amended by the First and Second Amendments, dated July 1, 2022 and November 1, 2022 (collectively, the "Original Agreement"); WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $275,000 of HOME funds to the Subrecipient for rental assistance for the City's Tenant Based Rental Assistance (TBRA) Program; WHEREAS, City and Subrecipient desire to amend the Agreement to provide that $36,229 of the $275,000 allocated in the FY 2022-2Q23 Annual Action Plan as outlined in the Original Agreement, as amended, be allocated to the TBRA program for rental assistance for the 2Q23-2024 program year. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 1.1 SCOPE OF SERVICES. Shall be amended as follows: During the entire Term (defined below, as amended) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively, the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in the Article 1 in furtherance of the TBRA Program. 23-12957/31171 Q -1- (a) Levels of Performance. The Subrecipient p9rees to provide the levels of program service es described in the Amended Scope of Work and Budget (Attachment 1). 2. 2.1 TERM. Shall be amended as follows: Services of the Subrecipient under this Agreement shall start on July 1, 2Q23 and end on the earlier to occur of (i) June 3Q, 2924 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) (as amended) hes been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control 9f HOME Funds or other HOME assets, including program income. 3. 3.2(a) Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Thirty Six Thousand Two Hundred Twenty Nine Dollars ($36,229). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and Director. All other sections of the Original Agreement, as amended, shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 23-12957/311710 -2- IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By: Larry Haynes Print name Director/Chief ITS: (circle one) Chairman/Presldent/Vice President (Pursuant To HBMC 3,03.100) AND APPROVED AS TO FORM: By: Patti Long Print name City Attorney / ITS: (circle one) Chairman/President/Vice President Date COUNTERPART RECEIVE AND FILE: City Clerk Date 23-12957/311710 -3- IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By: Print name Director/Chief ITS: (circle one) Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: Print name City Attorney litv ITS: (circle one) Chairman/President/Vice President Date COUNTERPART RECEIVE AND FILE: ( 441f1,- edbelZ141444) City Clerk . 3/23 Date 23-12957/311710 -3- ATTACHMENT 1 FY 2023-24 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk 9f homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2Q23 and June 3Q, 2024, Mercy House will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to four (4) Huntington Beach households in accordance with the TBRA Guidelines. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Rental Assistance: $36,229 Total Mercy House Budget: $36,229 23-12957/311710 -4- SECOND AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS SECOND AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California,hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECEIPIENT" is made and entered into, to be effective the /5' day of Alai _ , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement, as amended by the First Amendment, dated July 1, 2021 (collectively, the "Original Agreement"); WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $296,642 of HOME funds for Housing Services for Tenant Based Rental Assistance (TBRA) Program; WHEREAS, on November 1, 2022, by Resolution No. 2022-61, the Huntington Beach City Council approved Substantial Amendment No. Three to the 2020-2024 Consolidated Plan, which, in part, adjusted performance goals for HUD-funded programs; WHEREAS, City and Subrecipient desire to amend the Original Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 1.1 SCOPE OF SERVICES. Shall be amended as follows: During the entire Term (defined below, as amended) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively,the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in the Article 1 in furtherance of the TBRA Program. (a) Levels of Performance. The Subrecipeient agrees to provide the levels of program service as described in the Scope of Work and Budget (Attachment 1). 22-12119/295496 -1- 2. 2.1 TERM. Shall be amended as follows: Services of the Subrecipient under this Agreement shall start on July 1, 2022 and end on the earlier to occur of(i) June 30, 2023 or (ii)the date the full amount of HOME Funds available under Section 3.2(a) (as amended) has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets,including program income. 3. 3.2(a)Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Ninety Six Thousand Six Hundred Forty Two Dollars ($296,642). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and Director. All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT CITY OF HUNTINGTON BEACH, a MERCY HOU E municipal corporation of the State of California By: Larry Haynes Director of Community Development Print name APPROVED AS TO FORM: ITS: (circle one) Chairman/President/ Vice President AND City Attorney By: RECEIVE AND FILE: Patti Long Print name City Clerk - •s- Chairman/President/ Vice President Date 22-12119/295496 -2- COUNTERPART 2. 2.1 TERM. Shall be amended as follows: Services of the Subrecipient under this Agreement shall start on July 1, 2022 and end on the earlier to occur of(i) June 30, 2023 or(ii) the date the full amount of HOME Funds available under Section 3.2(a) (as amended) has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets,including program income. 3. 3.2(a) Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Ninety Six Thousand Six Hundred Forty Two Dollars ($296,642). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and Director. All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT CITY OF HUNTINGTON BEACH, a MERCY HOUSE municipal corporation of the State of California By: ' Dototoime Director of Community Development Print name APPROVED AS FORM: ITS: (circle one) Chairman/President/ Vice President AND City Attorney tttoU By: CEIVE AND FILE: Print name (#141t, 9.4i211714140 City Clerk ITS: (circle one) Chairman/President/ Vice President 4/23 Date 22-12119/295496 COUNTERPART ATTACHMENT A FY 2022-23 AMENDED SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan(HUD 5-year plan),which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Mercy House will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to 15 Huntington Beach households in accordance with the TBRA Guidelines. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment,Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $199,442 Security Deposit Subsidy: $64,800 Utility Deposit Subsidy: $4,050 HQS Inspections: $18,900 Income Eligibility: $9,450 Total Mercy House Budget: $296,642 22-12119/295496 -3- FIRST AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE FOR TENANT BASED RENTAL ASSISTANCE THIS FIRST AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California,hereinafter referred to as "CITY" and MERCY HOUSE, hereinafter referred to as "SUBRECEIPIENT" is made and entered into,to be effective the�day of.��`J 2022, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement,dated July 1, 2021,the"Original Agreement"; WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan,which allocated $296,642 of HOME funds for Housing Services for Tenant Based Rental Assistance(TBRA)Program; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now,therefore,it is mutually agreed,by and between the parties as follows: 1. 2.1 TERM. Shall be amended as follows: (a) Services of the Subrecipient under this Agreement shall start on July 1, 2022 and end on the earlier to occur of(i) June 30, 2023 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. All other sections of this Agreement, as amended shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 22-11564/287152 -1- IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, MERCY HOUSE a municipal cooperation of the State of California By. Larry Haynes , ,y Print name Director of Community Development ITS: (circle one) Chairma President Nice President (Pursuant I o HBMC 3.03.100) AND APPROVED AS TO FORM: By: Patti Long Print name City Attorney i.(.(J ITS: (circle one) Chairman/President Vice Presidm7l RECEIVE AND FILLE: 4q4ftL" Ii62440'4j City Clerk 1013/z 2 Date 22-11564/287152 -2- EXHIBIT A FY 2022-23 SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Mercy House will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to 25 Huntington Beach households in accordance with the TBRA Guidelines. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $199,442 Security Deposit Subsidy: $64,800 Utility Deposit Subsidy: $4,050 HQS Inspections: $18,900 Income Eligibility: $9,450 Total Mercy House Budget: $296,642 HOME SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE (Tenant Based Rental Assistance) This HOME SUBRECIPIENT AGREEMENT (Tenant Based Rental Assistance) ("Agreement') is made and entered into as of July 1. 2021 ("Effective Date') by and between the CITY OF HUNTINGTON BEACH, a municipal corporation and charter city ("City'), and MERCY HOUSE,a California nonprofit public benefit corporation ("Subrecipient"). RECITALS A. City is a California municipal corporation and charter city under the laws of the State of California. B. City has applied for and received funds ("HOME Funds') from the United States Department of Housing and Urban Development ("HUD") pursuant to the HOME Investment Partnerships Act and HOME Investment Partnerships Program, 42 U.S.C. §12701, et seq., and the implementing regulations set forth in 24 CFR § 92.1, et seq. (together, "HOME Program') for the purposes of strengthening public-private partnerships to provide more affordable housing, and particularly to provide decent, safe, sanitary, and affordable housing for very low income and low income citizens of Huntington Beach in accordance with the HOME Program. As used herein, the HOME Program includes the HUD Final Rule set forth at 78 FR 142, adopted July 24, 2013, which adopts substantial amendments to the HOME Program regulations set forth at 24 CFR Part 92. C. City is currently implementing a coordinated one-year strategy and program to provide financial assistance to eligible extremely low, very low and low income families and households to enable such households to secure housing available at an affordable housing cost in the City. D. City has developed a Tenant Based Rental Assistance Program to assist households in the City, who are homeless or at imminent risk of homelessness, preference given to veterans and seniors, to enable such households to transition into permanent, supportive housing. E. City wishes to engage the Subrecipient to assist the City in utilizing HOME Funds to provide tenant based rental assistance, security deposits and utility assistance to veteran and senior residents of the City, in accordance with the terms and provision set forth in this Agreement. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: I Afpvzof ► G C? rXeA l rvk /Aip>.n l IC11, ARTICLE 1 SCOPE OF SERVICES 1.1 Scope of Services. During the entire Term (defined below) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively, the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in this Article 1 in furtherance of the TBRA Program. 1.2 Marketing and Outreach; Application Process. (a) Marketing and Outreach. Subrecipient shall undertake affirmative marketing and outreach activities to find prospective Eligible Households interested in the TBRA Program, all in accordance with HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. Subrecipient shall describe its marketing and outreach efforts in monthly progress reports submitted to the City under this Agreement, as described in Exhibit B. (b) Waiting List. Subrecipient shall maintain a waiting list of prospective Eligible Households. The waiting list shall be prioritized first based on the most urgent need as set forth in the TBRA Program Operating Guidelines, prospective Eligible Households of equally urgent need will be helped on a first come-first served basis, based on the date and time of referral or initial direct contact with the Subrecipient. (c) Intake Process. Upon being contacted by a prospective Eligible Household recruited through Subrecipent's affirmative marketing and outreach efforts, Subrecipient shall initially meet with such prospective Eligible Household to fill out an Initial Qualification Document in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, including an income calculation based on two months of source documentation (bank account statements, pay stubs, etc.) to prequalify such prospective Eligible Household. Subrecipient shall then meet with prequalified Eligible Households to determine and verify their qualifications and eligibility for assistance under the TBRA Program, provide such prequalified Eligible Households with the TBRA Program application and other documentation described below, assist prospective Eligible Households with the completion of the application and gross income calculation worksheet and qualify Eligible Households for the TBRA Program. Subrecipient shall provide every prequalified Eligible Household with all of the following documentation. 2 (i) TBRA Application in the form attached to the TBRA Program Operating Guidelines in Exhibit A, or as otherwise approved in writing by the Deputy Director of Business Development on behalf of the City ("Deputy Director"). The TBRA Application shall solicit information regarding each applicant household's income and assets, household size and composition (number of children and adults), names of household members, Housing Unit (defined below) size and location preferences, specific needs and considerations, and a race/ethnicity survey. Examples of acceptable documental to confirm recent residency include: • Copy of previous lease • Copy of previous utility bill • Written confirmation of residency from a previous landlord, or proof of residency in transitional living facility • Copy of school records confirming previous residency Examples of proof of strong ties to the Community include: • Current residency of an immediate family member — mother, father, sibling, child, or grandparent • Proof that the individual and/or their dependent(s) attended K- 12 school in Huntington Beach • Proof that the individual and/or their dependents(s) attended K- 12 school in Huntington Beach (ii) Declaration of Homelessness Status or Declaration of At-Risk of Homelessness States, as appropriate, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iii) Rental Assistance Contracts for the Landlord and the Eligible Household, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iv) Household Budget Worksheet in the form attached to this Agreement as Exhibit D. (v) Lead-Based Hazard Information Pamphlet "Protect Your Family from Lead in Your Home" attached to this Agreement as Exhibit E. (d) Guidance for Eligible Households. Subrecipient shall meet with prospective Eligible Households throughout the application process and shall continue to meet with and counsel each Eligible Household regarding the TBRA Program, the Eligible Household's responsibilities as participants of the TBRA Program, and the goals and objectives of the TBRA Program. 3 1.3 Determination of Eligibility. Subrecipient shall qualify all Eligible Households in accordance with the selection criteria described in this Section. Further, for all Eligible Households Subrecipient shall implement the selection criteria and policies in compliance with the City's Consolidated Plan and the City's housing needs and priorities. (a) Eligible Household. As used in this Agreement, "Eligible Household" refers to extremely low income households that are (i) currently residents in the City of Huntington Beach; and (ii) currently homeless or at risk of homelessness. G) As used in this Agreement `homeless" is defined at 24 CFR 91, 582 and 583, as defined by HUD. (ii) For purposes of determining eligibility for the TBRA Program, a prospective Eligible Household's (or for continuing compliance, a participating Eligible Household's) gross annual income shall be determined in accordance with 24 CFR 5.609, with the allowable exclusions from income established at 24 CPR 5.611. For purposes of this Agreement, annual income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be received prospectively during the 12-month period following the date of application and before any deductions are taken (and for a participating household, income anticipated for the 12 months following verification described in §1.3(b)(ii) below.) When collecting income verification documentation, Subrecipient may also consider any likely changes in income. (iii) For purposes of this Agreement and the TBRA Program, income limits for extremely-low, very-low and low income households are established annually by HUD for the Orange County income limit area. (b) Income Verification. (i) Initial Verification. To determine if TBRA Program applicants (collectively, "Applicants") are income-eligible, Subrecipient must verify each Applicant's household income using source documentation such as wage statements, interest statements, unemployment compensation statements, bank account statements and other documentation types approved by HUD. Once an initial income verification is completed, the Subrecipient is not required to re- examine the Eligible Household's income unless six months has elapsed before assistance is provided. (ii) Annual Eligibility Verification. Subrecipient shall annually re- certify income and re-qualify each Eligible Household, including examination of source documentation. Household income must be no 4 greater than 80 percent of AMi to remain eligible for assistance. For households found no longer eligible, assistance must be terminated following a 30-day notification period. (c) Verification of Eligibility. Subrecipient shall collect and examine source documentation submitted by the Applicant to verify the identity of the members of the Eligible Household. Subrecipient shall make a determination that the Eligible Household is currently experiencing homelessness or is at imminent risk of homelessness, as defined 24 CFR 91, 582 and 583, based on caseworker observations and certification and Applicant certification. I (d) Notice of Eligibility Determination. Subrecipient shall provide written or documented verbal notice to each Applicant stating whether such Applicant was determined to be eligible for assistance under the TBRA Program. Applicants determined to be ineligible for TBRA Program assistance shall have an opportunity to appeal the determination to the Subrecipient's Executive Director. If the issue is not resolved, the case will be referred to the Deputy Director. The definition of"homelessness" 24 CPR 91, 582 and 583 is applicable to this Agreement. 1.4 Selection of Housing Units. (a) Housing Unit Selection. Subrecipient shall assist Eligible Households with finding and selecting an appropriate housing unit (each a "Housing Unit") that meets federal housing quality standards ("HQS") or such other standards as may be made applicable to the TBRA Program by HOME Program statutes and/or regulations, specifically including Uniform Physical Condition Standards (UPCS), and that satisfies the requirements of the TBRA Program, HOME Program and this Agreement. Eligible Households shall also be entitled to find a Housing Unit for themselves, subject to compliance with the requirements of the TBRA Program, HOME Program and this Agreement; however, the parties anticipate that in most cases, Subrecipient shall be responsible for locating and qualifying an appropriate Housing Unit for occupancy by each Eligible Household. Subrecipient may refer Eligible Households to appropriate Housing Units but may not require an Eligible Household to select a particular Housing Unit. Subsidy Payments shall only be provided in connection with the rental of a qualified Housing Unit located in the City, unless Subrecipient documents reason for selecting housing outside the city. Subsidy Payments under this Agreement are portable within the City. Subrecipient's obligations under this Section 1.4 apply to each Housing Unit to be occupied by an Eligible Household receiving Subsidy Payments hereunder. (b) Housing Unit Size; Occupancy Standards. Housing unit selection shall comply with the following "Occupancy Standards" for the applicable Eligible Household: No more than two persons per bedroom plus one may occupy the Housing Unit. Thus, no more than three persons may occupy a one-bedroom 5 Housing Unit, no more than five persons may occupy a two-bedroom Housing Unit; no more than seven persons may occupy a three-bedroom Housing Unit; no more than nine persons may occupy a four-bedroom Housing Unit. (c) Property Inspection. Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual (or more often) verification process, Subrecipient shall cause a certified HQS inspector to inspect each Housing Unit occupied or to be occupied by an Eligible Household to ensure the Housing Unit complies with HQS as set forth in the HOME Program, including without limitation 24 CFR 92.251, as well as all applicable state and local codes and ordinances, including zoning ordinances. Subrecipient shall provide the City with documentation of each HQS inspector's certification. Each HQS inspection shall include all of the following: (i) Verification of the age of the Housing Unit (on Rent Reasonableness Form attached to the TBRA Program Operating Guidelines in Exhibit A; (ii) Complete HQS Inspection Checklist in the form attached to the TBRA Program Operating Guidelines in Exhibit A, including a rating for the Housing Unit of Pass, Pass with Comment, or Fail; (iii) Lead-based hazard assessment, dissemination of lead-based hazard information pamphlet and disclosure form and lead-based hazard reduction activities, if required by the HOME Program or applicable federal, state and/or local laws; (iv) Adequate opportunity for the Landlord (defined below) to correct any deficiencies indicated in the HQS Inspection Form to bring the Housing Unit into compliance with HQS requirements; (v) Verification that occupancy by the Eligible Household will comply with the Occupancy Standards set forth in Section 1.4(b); and (vi) Certification of rent reasonableness regarding the rent being charged for the Housing Unit based on comparable non-assisted Housing Units in the same area. Subrecipient shall perform the rent reasonableness review as approved by the City. City may elect to perform the rent reasonableness reviews on behalf of Subrecipient by providing written notice to Subrecipient. The rent charged under the written lease agreement for the Housing Unit shall conform to the Rent Reasonableness Standard pursuant to the TBRA Program Operating Guidelines in Exhibit A, which is based on local market conditions. The contract rent for Housing Units that are restricted to an affordable rent by agreement with the City or by regulation or ordinance, or otherwise, shall be likewise restricted to such affordable rent in accordance with the contractual, statutory or regulatory restrictions 6 governing the permitted rents for such Housing Units and the Rental Assistance Subsidy Payment shall be limited and calculated accordingly, as described in Section 1.5(a), below. (d) Coordination with Landlords. (i) Landlord Guidance. Subrecipient shall provide guidance to the property owners, property owners' representatives, or property management companies hired by property owners (each a "Landlord" and collectively referred to as "Landlords") participating in the TBRA Program regarding the TBRA Program requirements and procedures that impact Landlords. (ii) Landlord Agreement. Subrecipient shall enter into a Landlord Agreement with each participating property owner/Landlord in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A. The Landlord Agreement will establish the Subsidy Payments to be made by Subrecipient on behalf of the Eligible Household as well as the Eligible Household's initial share of the contract rent. The Landlord Agreement shall further establish the terms and conditions under which the Subsidy Payments shall be paid to the Landlord for the applicable Housing Unit, including applicable HOME Program requirements. The Landlord Agreement shall have an initial term of 6-12 months, subject to extensions approved by Subrecipient and City (as applicable) pursuant to the TBRA Program Operating Guidelines. (iii) Tenant Protection Agreement. Subrecipient shall require each Landlord to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit owned and/or managed by such Landlord, which lease agreement shall include a Tenant Protection Agreement in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, or an updated form of Tenant Protection Agreement as may be prepared and provided by the City to the Subrecipient, and then by Subrecipient to Landlord. The Tenant Protection Agreement shall be executed in connection with the lease agreement between the Landlord and Eligible Household. The Tenant Protection Agreement will prohibit the inclusion of prohibited lease terms listed at 24 CFR 92.253; Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401; and prohibit discrimination by the landlord against the Eligible Household. The Subrecipient will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. If the Landlord's form of rental agreement is not acceptable, Subrecipient shall require the Landlord and Eligible Household to enter into a lease agreement 7 that complies with state law, HOME requirements, and City requirements. 1.5 Subsidy Payments. Subrecipient shall make rent payments and security deposit payments, as applicable (collectively, the "Subsidy Payments"), to Landlords, on behalf of Eligible Households. Subsidy payments must be provided in accordance to the Subrecipient's TBRA Program Operating Guidelines. Eligible Households are not expected to repay Subsidy Payments received pursuant to the TBRA Program. Except as may be permitted by the HOME Program, Subrecipient' s sole remedy in the event of noncompliance or breach by an Eligible Household shall be non-renewal of assistance under the TBRA Program. (a) Rental Assistance Calculation. Subrecipient shall calculate the "Rental Assistance" payments to be paid on behalf of each Eligible Household under this Agreement. The maximum amount of monthly assistance that the Subrecipient may pay on behalf of a family is the difference between the rent standard for the unit size and 30 percent of the household's monthly adjusted income. (b) Payment Standards. Subrecipient must use the payment standards as set forth in the Rent Reasonableness Standards attached to the TBRA Program Operating Guidelines in Exhibit A. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach. Payment standards are established by bedroom size. (c) Utility Allowance. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the Eligible Households entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the Eligible Household is directly responsible for payment of utility services, the Eligible Household's initial share of monthly rent will be determined by subtracting a utility allowance from 30 percent of the Eligible Household's gross monthly income. The Subrecipient must use the County of Orange's Housing Authority's Utility Allowance Schedule attached to the TBRA Program Operating Guidelines in Exhibit A. (d) Term. The Subrecipient will provide rental assistance for an initial term of 6- 12 months, which can be extended in 6-12 month intervals, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Subrecipient and shall be based on continued program compliance and ongoing need. The Subrecipient will evaluate ongoing need. (e) Security Deposit Assistance. Subrecipient may provide security deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit 8 refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease- (f) Utility Deposit Assistance. Subrecipient may provide utility deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. 1.6 Administrative Cost Reimbursements. The City will reimburse the Subrecipient for allowable costs incurred in administering the TBRA Program, which are associated with the determination of income eligibility, pursuant to 24 CFR 92. 203, and property inspections under HQS, codified per 24 CFR 982. 401. Administrative costs incurred in administering the TBRA Program that are ineligible under the HOME Program will be reimbursed from a non-HOME Program funding source, or Community Development Block Grant (CDBG) Funds. The administrative costs to be reimbursed from the CDBG Funds include Intake Assessments, Housing Search, Case Management, Self—Sufficiency and related services and overhead. 1.7 Termination of Assistance and Returning Eligible Households. (a) Termination of Rental Assistance. Subrecipient may terminate assistance under the TBRA Program for any of the following reasons: (i) Eligible Household is evicted from the Housing Unit based on behavioral issues or unlawful activity; (ii) Eligible Household has violated TBRA participant agreement. (iii) Eligible Household will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based Programs. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must be terminated. 1.8 Returning Eligible Households. As needed, Eligible Households may be allowed to return to the program for rental assistance. A determination to allow re-entry shall be based on the following criteria: (i) Eligible Households must have left the program in good standing. To be in good standing, Eligible Households must have been engaged in their case management plan, voluntarily left the program (not in lieu of termination) or have been released because their household income 9 exceeded eligibility limits. In general, Eligible Households will not be allowed to re-enter the program if' they were terminated for non- compliance. (ii) At the discretion of the Subrecipient, a request for re-admission from a prospective Eligible Household previously terminated due to non- compliance may be considered when compelling reasons exist. In such cases, re-admission will require concurrence from the City. i (iii) Eligible Households may return so long as the previous rental assistance did not exceed 24 months. Cumulatively, Eligible Households may not receive rental advice for more than a cumulative period of 24 months unless such assistance is permitted by the HOME Program and approved by the City. 1.9 Additional Requirements. (a) Self-Sufficiency Program. Subrecipient shall request each Eligible Household receiving Subsidy Payments from the Subrecipient to participate in Housing Stabilization Case Management administered by Subrecipient and in accordance with the Case Management and Self Sufficiency Program Policies and Procedures attached to the TBRA Program Operating Guidelines in Exhibit A. Failure of an Eligible Household that is already receiving Subsidy Payments to participate in the Self-Sufficiency Program shall not be grounds for termination of the Subsidy Payments, but may be grounds for non-renewal of Subsidy Payments upon expiration of the subsidy term. (b) No Fees. Subrecipient may not charge fees to any Eligible Household for the Services, Subsidy Payments, Case Management or other services or assistance to be provided to Eligible Households under this Agreement. 1.10 Schedule of Performance. Subrecipient shall use its best efforts to perform the Services in accordance with the following schedule: (a) Affirmative marketing and outreach activities required by this Agreement shall commence immediately upon execution of this Agreement. (b) Subrecipient shall qualify Eligible Households, conduct HQS inspections, approve Housing Units, and move Eligible Households into approved Housing Units in accordance with the following milestone schedule: (i) Subrecipient shall process intake paperwork for and verify eligibility for TBRA Program assistance (`Enroll") for not fewer than three (3) Eligible Households within three (3) months following execution of this Agreement. As program income becomes available and/or additional HOME Funds are contributed to the TBRA Program, Subrecipient shall use diligent efforts to Enroll additional Eligible 10 Households within not more than three (3) months following written notice from the City that such additional funds are expected to become available. (ii) Subrecipient shall assist each Enrolled Eligible Household in finding an appropriate Housing Unit and shall conduct an HQS inspection of such Housing Unit, all within two (2) months following Enrollment of such Eligible Household. I (iii) Subrecipient shall commence providing Subsidiary Payments on behalf of each Eligible Household and shall assist each Eligible Household to move into an HQS-inspected and approved Housing Unit, all within three (3) months following Enrollment/Intake of such Eligible Household. (c) Subrecipient shall request each Eligible Household to commence participation in the self-sufficiency program immediately upon Enrollment of such Eligible Household, whether or not such Eligible Household has yet moved into a Housing Unit and received the benefit of Subsidy Payments hereunder. 1.11 City Oversight and Approval Rights. City shall have the right, by written notice to Subrecipient at any time during the Term of this Agreement, to require City review of any of the Services to be performed or pre-approval of service tools and procedures by Subrecipient hereunder, including for example income determinations, qualification of applicants as " Eligible Households," qualification of Housing Units, determination of reasonable rents, etc., to ensure compliance with the TBRA Program, the HOME Program, or other applicable requirements. ARTICLE 2 TERM 2.1 Term. Services of the Subrecipient under this Agreement shall start on July 1, 2021 and end on the earlier to occur of(i) June 30, 2022 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. ARTICLE 3 BUDGET AND PAYMENTS 3.1 Budget. Subrecipient has submitted a budget to City for approval (`Budget'), which sets forth the estimated timing and use of the HOME Funds contributed by the City pursuant to this Agreement. The Budget is attached hereto as outlined in the Scope of Services and Budget in Exhibit A. Any amendments to an approved Budget for the 11 Services must be approved by the City's Director or his authorized designee. In the event this Agreement is extended past the initial Term or any additional moneys will be contributed to the TBRA Program by City pursuant to this Agreement, Subrecipicnt shall prepare and submit to the Deputy Director for approval an updated Budget for such additional moneys. Subrecipicnt shalt prepare a Budget, for approval by Deputy Director, for each year during which this Agreement remains in effect. The City may require a more detailed line item breakdown of the Budget than the one contained herein, and the Subrecipient shall provide such supplementary information about the Budget in a timely fashion in the form and content prescribed by the City. 3.2 Reimbursement of Subsidy Payments. City shall reimburse Subrecipient for Subsidy Payment actually disbursed to or on behalf of Eligible Households pursuant to this Agreement and in accordance with line items on the approved Budget or as otherwise approved by the City's Deputy Director. City shall have no obligation to reimburse Subrecipient for ineligible administrative costs or expenses incurred by Subrecipient to manage or implement the TBRA Program or this Agreement, for the cost of social or supportive services provided to Eligible Households hereunder, or for any other costs or expenses incurred by Subrecipicnt in connection with its activities under this Agreement. City's payment obligations hereunder shall be limited to the actual amount of Subsidy Payments disbursed by Subrecipient and eligible administrative costs in accordance with the terms of this Agreement and the approved Budget. Payments may be contingent upon certification of the Subrecipient's financial management system in accordance with the standards specified in 24 CFR 84.21. (a) Amount of Payments. It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Seventy-Five thousand Dollars ($275,000.00). The dollar amounts stated in the immediately preceeding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and the Director. (b) Requests for Payments. To receive each payment under this Agreement, Subrecipient shall submit to the City a written reimbursement request or invoice in a form approved by City, along with such supporting documentation as may be requested by the City to verify Subrecipient's performance of the Services for which the payment is requested. Reimbursement requests shall be submitted no more frequently than one time per month. Payments will be adjusted by the City in accordance with fund advances, if any, balances available in Subrecipient accounts. In addition, the City reserves the right to liquidate funds available under this Agreement for costs incurred by the City on behalf of the Subrecipient. 3.3 Payments Subject to Availability of HOME Funds. City's obligation to provide payments to Subrecipicnt hereunder is subject to City's receipt of HOME Funds from HUD pursuant to the HOME Program. 12 3.4 Accounting. Subrecipient shall, upon request, provide City with an accounting report, in form and content reasonably satisfactory to City, of any funds disbursed by City pursuant to Section 3.2. i 3.5 Program Income. City and Subrecipient acknowledge and agree that the design of TBRA Program does not anticipate the receipt of"Program Income," as defined in 24 CFR 92.2, by the Subrecipient. Notwithstanding, in the event that any Program Income is received by the Subrecipient, Subrecipient will promptly remit same to the City. ARTICLE 4 INSURANCE AND INDEMNIFICATION 4.1 Insurance. Without limiting City's right to indemnification, Subrecipient shall secure prior to commencing the performance of any Services under this Agreement, and maintain during the Term of this Agreement, insurance coverage as set forth in this Section. (a) Required Insurance. Subrecipient shall secure and maintain the following coverage: jib Workers' Compensation Insurance as required by California statutes; (ii) Commercial General Liability Insurance, or Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, Broad-Form Property Damage, Independent Contractor's Liability and Fire Damage Legal Liability, in the amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single limit,written on an occurrence form; and (iii) Comprehensive Automobile Liability coverage, including — as applicable — owned, non-owned and hire autos, in an amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single-limit, written on an occurrence form. The Deputy Director, with the consent of City's Risk Manager is hereby authorized to modify the requirements set forth above in the event he or she determines that a modification, whether an increase or decrease, is in the City's best interest. (b) Required Clauses in Policies. Each insurance policy required by this Agreement shall contain the following clauses: "This insurance shall not be canceled or allowed to lapse without at least ten (10) day's prior written notice given to the City Clerk of the City of Huntington Beach, 2000 Main Street, Huntington Beach, CA 92648." 13 "It is agreed that any insurance maintained by the City of Huntington Beach shall apply in excess of and not contribute with insurance provided by this policy." Each insurance policy required by this Agreement, excepting policies for workers' compensation, shall contain the following clause: "The City of Huntington Beach, its officials, agents, employees, representative, and volunteers are added as additional insureds as respects operations and activities of, or on behalf of the named insured, performed under contract with the City of Huntington Beach. Subrecipient hereby agrees to waive subrogation which any insurer of the Subrecipient may acquire from the Subrecipient by virtue of the payment of any loss. If requested by City, Subrecipient agrees to obtain and deliver to City any endorsement from Subrecipient's general liability and automobile insurance insurer to effect his waiver of subrogation. (c) Property Insurance. Subrecipient shall further comply with the insurance requirements of 24 CFT 94.31. (d) Required Certificates and Endorsements. Prior to commencement of any Services under this Agreement, the Subrecipient shall deliver to City ( i) insurance certificates confirming the existence of the insurance required by this Agreement, and including the applicable clauses referenced above, and ( ii) endorsements to the above -required policies, which add to these policies the applicable clauses referenced above. Such endorsements shall be signed by an authorized representative of the insurance company and shall include the signator's company affiliation and title. Should it be deemed necessary by City, it shall be the Subrecipient's responsibility to see that City receives documentation, acceptable to City, which sustains that the individual signing such endorsements is indeed authorized to do so by the insurance company. Also, City reserves the right at any time to demand, and to receive within a reasonable time period, certified copies of any insurance policies required under this Agreement, including endorsements effecting the coverage required by these specifications. (c) Remedies for Defaults Re: Insurance. In addition to any other remedies City may have if the Subrecipient fails to provide or maintain any insurance policies or policy endorsements to the extent and within the time herein required, City may, at its sole option: (i) Obtain such insurance and deduct and retain the amount of the premium for such insurance from any sums due under the Agreement; 14 (ii) Order the Subrecipient to stop work under this Agreement and/ or withhold any payment( s) which become due to the Subrecipient hereunder until the Subrecipient demonstrates compliance with the requirements hereof; or (iii) Terminate this Agreement. i Exercise of any of the above remedies, however, is an alternative to other remedies City may have and is not the exclusive remedy for the Subrecipient's failure to maintain insurance or secure appropriate endorsements. Nothing herein contained shall be construed as limiting in any way the extent to which the Subrecipient may be held responsible for payment of damages to persons or property resulting from the Subrecipient's or its subcontractor's performance of the Services covered under this Agreement. 4.2 Indemnification. (a) As respects acts, errors or omissions in the performance of Services under this Agreement, the Subrecipient agrees to defend, indemnify and hold harmless City, its officers, agents, employees, representatives and volunteers from and against any and all claims, demands, defense costs, liability or consequential damages of any kind or nature arising directly out of the Subrecipient's negligent acts, errors or omissions in the performance of Services under the terms of this Agreement. (b) As respects all acts or omissions which do not arise directly out of the performance of Services, including but not limited to those acts or omissions normally covered by general and automobile liability insurance, Subrecipient agrees to indemnify, defend (at City's option), and hold harmless City, its officers, agents, employees, representatives, and volunteers from and against any and all claims, demands, defense costs, liability, or consequential damages of any kind or nature arising out of or in connection with Subrecipient's performance or failure to perform, under this Agreement; excepting those which arise out of the sole negligence of City. ARTICLE 5 ADMINISTRATIVE REQUIREMENTS 5.1 Financial Management. (a) Accounting Standards. Subrecipient agrees to comply with 24 CFR 84.21 through 84.28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. 15 (b) Cost Principles. Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organization." These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 5.2 Documentation, Recordkeeping, Reporting and Monitoring. Subrecipient shall maintain documents and records, prepare and submit reports, and permit City to monitor Subrecipient's activities all in accordance with the requirements set forth in Exhibit B and applicable laws and regulations. All requirements set forth in such Exhibit B are incorporated herein as if set forth in full in this Agreement. 5.3 Use and Reversion of Assets. The use and disposition of property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFT 92.504, as applicable. The Subrecipient shall transfer to the City any HOME Funds on hand and any accounts receivable attributable to the use of HOME Funds under this Agreement at the time of the earliest to occur of expiration, cancellation, or termination. 5.4 Ownership of Documents. All documents and materials, both tangible and intangible, furnished by or through the City to Subrecipient pursuant to this Agreement are and shall remain the property of City and shall be returned to City upon the earliest to occur of expiration, cancellation, or termination of this Agreement. All documents and materials prepared by Subrecipient under or related to this Agreement shall become the property of City at the time of payment to Subrecipient of all fees, if any, for their preparation, and shall be delivered to City by Subrecipient at the request of City, and in any event upon the earliest to occur of expiration, cancellation, or termination of this Agreement. 5.5 Record Retention. All TBRA Program records shall be maintained by the Subrecipient for a minimum of five (5) years beyond the final payment under this Agreement. Notwithstanding, if there are litigation, claims, audits, negotiations or other actions that involve any of the records cited and that have commenced before the expiration of the retention periods outlined, such records must be retained until completion of the actions and resolution of all issues, or the expiration of the retention period, whichever occurs later. ARTICLE 6 PERSONNEL& PARTICIPANT CONDITIONS 6.1 Civil Rights. (a) Compliance. The Subrecipient agrees to comply with the Huntington Beach Municipal Code, Government Code Section 4450, et seq., the Unruh Civil Rights Act, Civil Code Section 51, et seq., Title VI of the Civil Rights Act of 1964, as amended, Title Vill of the Civil Rights Act of 1968 as amended, Section 104(b) and Section 109 of Title 1 of the Housing and Community 16 Development Act of 1974, as amended, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Executive Order 11063, and Executive Order 11246 as amended by Executive Orders 11375, 11478, 12107 and 12086. (b) Nondiscrimination. The Subrecipient agrees to comply with (1) the requirements of 24 CFR Part 5, subpart A, which relate to nondiscrimination and equal opportunity; (2) the nondiscrimination requirements of Section 282 of the HOME Investment Partnerships Act, 42 U.S.C. Section 12701, et seq. (c) Section 504. The Subrecipient agrees to comply with all federal regulations issued pursuant to compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination against the individuals with disabilities or handicaps in any federally assisted program. 6.2 Affirmative Action. (a) Executive Order 11246. The Subrecipient agrees that it shall be committed to carry out pursuant to the City's specifications an Affirmative Action Program in keeping with the principles as provided in President's Executive Order 11246 of September 24, 1966. (b) Women- and Minority-Owned Businesses (W/MBE). The Subrecipient will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance of this Agreement. As used in this Agreement, the term "small business" means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish surnamed or Spanish-heritage Americans, Asian-Americans, and American Indians. The Subrecipient may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. (c) Equal Employment Opportunity and Affirmative Action (EEO/AA) Statement. The Subrecipient will, in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient, state that it is an Equal Opportunity or Affirmative Action employer. (d) Subcontract Provisions. The Subrecipient will include the provisions of Sections 6.1, Civil Rights, and 6.2, Affirmative Action, in every subcontract or purchase order, specifically or by reference, so that such provisions will be binding upon each of its own sub-subrecipients or subcontractors. 17 6.3 Employment Restrictions. (a) Prohibited Activity. The Subrecipient is prohibited from using HOME Funds provided herein or personnel employed in the administration of the program for: political activities; inherently religious activities; lobbying; political patronage; and nepotism activities. (b) Labor Standard, The Subrecipient agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) and all other applicable federal, state and local laws and regulations pertaining to labor standards insofar as and when those acts apply to the performance of this Agreement. The Subrecipicnt agrees to comply with the Copeland Anti-Kick Back Act (18 U.S.C. 874 et seq.) and the implementing regulations thereto issued by the U.S. Department of Labor at 29 CFR Part 5. The Subrecipient shall maintain documentation that demonstrates compliance with applicable hour and wage requirements. (c) Prevailing Wage. The Subrecipient agrees that, to the extent applicable, all contractors engaged under contracts for construction, renovation or repair work financed in whole or in part with assistance provided under this Agreement shall comply with the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7 and California Labor Code Section 1720, et seq. governing the payment of wages and ratio of apprentices and trainees to journey workers. The Subrecipicnt shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. (d) Section 3 Clause. The Subrecipient agrees, to the extent applicable, to comply with Section 3 of the HUD Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR 135. 6.4 Conduct. (a) Assignment. The Subrecipient shall not assign or transfer any interest in this Agreement without the prior written consent of the City thereto; provided, however, that claims for money due or to become due to the Subrecipient from the City under this Agreement may be assigned to a bank, trust company, or other financial institution without such approval. Notice of any such assignment or transfer shall be fumished promptly to the City. (b) Subcontracts. (i) Approvals. The Subrecipient shall not enter into any subcontracts with any entity, agency or individual in the performance of this Agreement 18 without the written consent of the City prior to the execution of such agreement. (ii) Monitoring. The Subrecipient will monitor all subcontracted services on a regular basis to assure contract compliance. Results of monitoring efforts shall be summarized in written reports and supported with documented evidence of follow-up actions taken to correct areas of noncompliance. (iii) Content. The Subrecipient shall cause all of the provisions of this Agreement in its entirety to be included in and made a part of any subcontract executed in the performance of this Agreement. (iv) Selection Process. The Subrecipient shall undertake to insure that all subcontracts let in the performance of this Agreement shall be awarded on a fair and open competition basis in accordance with applicable procurement requirements. Executed copies of all subcontracts shall be forwarded to the City along with documentation concerning the selection process. (c) Hatch Act. The Subrecipient agrees that no funds provided, nor personnel employed under this Agreement, shall be in any way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of Title V of the U.S.C. (d) Conflict of Interest. The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 92.356, which include (but are not limited to) the following: (i) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers. employees or agents engaged in the award and administration of contracts supported by HOME Funds. (ii) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by HOME Funds if a conflict of interest, real or apparent, would be involved. (iii) No covered persons who exercise or have exercised any functions or responsibilities with respect to HOME-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the HOME-assisted activity, or with respect to the proceeds from the HOME-assisted activity, either for themselves or those with whom they have business or 19 immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person' includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. (e) Lobbying. The Subrecipient hereby certifies that: I (i) No federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement; (ii) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and (iii) it will require that the language of paragraph (iv) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly. (f) Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352 Title 31, US.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than S10,000 and not more than S100,000 for each such failure. (g) Religious Activities. The Subrecipient agrees that funds provided under this Agreement will not be utilized for inherently religious activities such as worship, religious instniction, or prose lytization. (h) Drug-Free Workplace. The Subrecipient agrees to maintain a drug-free workplace per the requirements of 2 CFR part 2429. 20 (i) Debarred or Suspended Entities. By signing this Agreement, Subrecipient certifies that it is not presently listed by any federal agency as debarred, suspended, or proposed for debarment from any federal contract activity. If during the term of this Agreement this information changes, Subrecipient shall notify City without delay. Such notice shall contain all relevant particulars of any debarment, suspension, or proposed debarment. Further, in carrying out its responsibilities hereunder, Subrecipient will not employ, contract with, or otherwise make use of subcontractors, service providers, consultants, or any other party that is debarred, suspended, or proposed for debarment from any federal contract activity. (j) VAWA Regulations. The City and Subrecipient both acknowledge and agree that each are subject to the requirements of 24 CFR 92.359 and 24 CFR 5, Subpart L. which implements provisions of the Violence Against Women Reauthorization Act of 2013 (VAWA). Subrecipient also agrees to follow and implement the applicable VAWA requirements contained in the City's Program Guidelines and the City's Emergency Transfer Plan, as required by 24 CFR 92.359(g), for all applicants to the 'rBRA Program, and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover, the Subrecipient agrees that all leases that are approved by the Subrecipient shall contain the City's required VAWA lease term/addendum, as described in 24 CFR 92.359(e) and the City's TBRA Program (Exhibit A). ARTICLE 7 GENERAL CONDITIONS 7.1 General Compliance. The Subrecipient agrees to comply with the requirements of the HOME Program in the administration and implementation of the TBRA Program and this Agreement. The Subrecipient shall carry out each activity in compliance with all regulations described in subpar H of 24 CFR Part 92, except that the Subrecipient does not assume the City's responsibilities for environmental review under 24 CPR 92.352 and the intergovernmental review process described in 24 CFR 92.357 does not apply to the Subrecipient. The Subrecipient also agrees to comply with all other applicable federal, state and local laws, regulations, and policies governing the funds provided under this Agreement. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 7.2 Familiarity with Services;Qualified Personnel. (a) By executing this Agreement, Subrecipient represents and warrants that Subrecipient (i) has thoroughly investigated and considered the Services to be performed, (ii) has carefully considered how the Services should be performed, and (iii) fully understands the requirements, difficulties and restrictions attending the performance of the Services under this Agreement. (b) Subrecipient represents that Subrecipient has or will secure and maintain, at 21 Subrecipient's sole cost and expense, all qualified and licensed personnel required to perform the Services. Staff and any additional personnel hired by Subrecipient shall be employees of Subrecipient. Such personnel shall not be deemed to be employees of City or to have any contractual relationship with City. Such Personnel shall be authorized or permitted under state and local law to perform the Services. 7.3 Independent Contractor. In performing under this Agreement, Subrecipient is and shall at all times be acting and performing as an independent contractor to City, performing its duties in accordance with its own judgment. City shall neither have nor exercise any control or direction over the methods by which Subrecipient performs its work and function nor shall City have the right to interfere with such freedom or action or prescribe rules or otherwise control or direct the manner in which such services are performed. The sole interest of the City in the Services performed by the Subrecipient is that such Services he performed in a legal competent, efficient and satisfactory manner. Nothing contained herein shall cause the relationship between the parties to this Agreement to be that of employer and employee. Subrecipient shall not have the authority to obligate City to any contract, obligation, or undertaking whatsoever and shall make no representation, either oral or in writing. 7.4 Subrecipient Representative. Subrecipient hereby designates Nancy Gonzalez, OC Housinp Solutions Regional Director for the TBRA Program ("Subrecipient's Representative"), Subrecipient's Representative shall supervise and direct the Services, using his or her best skill and attention, and shall be responsible for all means, methods, techniques, sequences and procedures and for the satisfactory coordination of all portions of the Services under this Agreement. 7.5 Nepotism. Subrecipient shall not hire or permit the hiring of any person to fill a position funded through this Agreement if a member of the person's immediate family is employed in an administrative capacity by City's HOME Program or any department of the City which is administering the HOME Program. For the purposes of this section, the term "immediate family' means spouse, child, mother, father brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisory or management responsibilities, including serving on the governing body of City. 7.6 Hold Harmless. The Subrecipient shall indemnify, hold harmless, and defend the City and their elected officials, officers, employees and agents and shall pay for expenses incurred by the City for any and all claims, actions, suits, charges and judgments whatsoever related in any mariner to or that arise out of the Subrecipient's performance or nonperformance of the Services or subject matter called for in this Agreement. 7.7 City Recognition. The Subrecipient shall insure recognition of the role of the City in providing Services through this Agreement. All activities, facilities and items utilized pursuant to this Agreement shall be prominently labeled as to funding source. 22 7.8 Notices. Any approval, disapproval, demand, document or other notice ("Notice") which any party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (6) delivery by reputable document delivery service such as Federal Express that provides a receipt showing date and time of delivery, (iii) facsimile transmission, or (vi) mailing in the United States mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below, or at any other address as that party may later designate by Notice. Service shall be deemed conclusively made at the time of service if personally served; upon confirmation of receipt if sent by facsimile transmission; the next business if sent by overnight courier and receipt is confirmed by the signature of an agent or employee of the party served; the next business day after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by express mail; and three (3) days after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by certified mail. Subrecipient: Larry Haynes Executive Director Mcrcy House PO Box 1905 Santa Ana, CA_92702 City: City Clerk City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 With copies to: Steve Holtz, Deputy Director Community Development/NED 2000 Main Street Huntington Beach, CA 92648 Such addresses may be changed by Notice to the other party(ies) given in the same manner as provided above. 7.9 Amendment and Waiver. This Agreement may be amended, modified, or supplemented only by a writing executed by each of the parties. Any party may in writing waive any provision of this Agreement to the extent such provision is for the benefit of the waiving party. No action taken pursuant to this Agreement, including any investigation by or on behalf of any party, shall be deemed to constitute a waiver by that party or its or any other party's compliance with any representations or warranties or with any provision of this Agreement. 23 7.10 Entire Agreement, This Agreement, including all Exhibits attached hereto, embodies the entire agreement and understanding between the parties pertaining to the subject matter of this Agreement and supersedes all prior agreements, understandings, negotiations, representations, and discussions, whether verbal or written, of the parties pertaining to the subject matter. In the event of a conflict between this Agreement, on one hand, and any Exhibit attached hereto, on the other hand, the provisions of this Agreement shall control; provided, if it is possible to comply with the requirements of this Agreement and the Exhibits, the parties shall do so. The following Exhibits are attached to this Agreement and incorporated herein: Exhibit A Scope of Services and Budget and TBRA Program Operating Guidelines Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Exhibit C Gross Income Calculation Form Exhibit D Household Budget Worksheet Exhibit E Lead-Based Hazard Information Pamphlet"Protect Your Family from Lead in your Home" 7.11 Governing Law. The validity, construction, and performance of this Agreement shall be governed by the laws of the State of California. 7.12 Non-Liability of Members, Officials and Employees of City. No member, official or employee of City shall be personally liable to Subrecipient, or any successor in interest, in the event of any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or on any obligation under the terms of this Agreement. Subrecipient hereby waives and releases any claim Subrecipient may have against the member, officials or employees of City with respect to any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or any obligations under the terms of this Agreement. Subrecipient makes such release with the full knowledge of Civil Code Section 1542 and hereby waives any and all rights thereunder to the extent of this release, if such Section 1542 is applicable. Section 1542 of the Civil Code provides as follows: "A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR FIER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR." 24 ARTICLE 8 ENFORCEMENT; TERMINATION 8.1 Events of Default. (a) For purposes of this Agreement, the word "Default" shall mean the failure of Subrecipient to perform any of Subrecipient's duties or obligations or the breach by Subrecipient of any of the terms and conditions set forth in this Agreement; any failure by Subrecipient to comply with any of the rules, regulations or provisions referred to herein, or such statutes, regulations, executive orders, and HUD guidelines, policies or directives as may become applicable at any time; any ineffective or improper use of funds provided under this Agreement; or submission by the Subrecipient to the City reports that are incorrect or incomplete in any material respect. in addition, Subrecipient shall be deemed to be in Default upon Subrecipient's (i) application for, consent to, or suffering of, the appointment of a receiver, trustee or liquidator for all or a substantial portion of its assets, (ii) making a general assignment for the benefit of creditors, (iii) being adjudged bankrupt, (iv) filing a voluntary petition or suffering an involuntary petition under any bankruptcy, arrangement, reorganization or insolvency law (unless in the case of an involuntary petition, the same is dismissed within thirty (30) days of such tiling), or (v) suffering or permitting to continue unstayed and in effect for fifteen (15) consecutive days any attachment, levy, execution or seizure of all or a substantial portion of Subrecipient's assets or of Subrecipient' s interests hereunder. (b) City shall not be deemed to be in Default in the performance of any obligation required to be performed by City hereunder unless and until City has failed to perform such obligation for a period of thirty (30) days after receipt of written notice from Subrecipient specifying in reasonable detail the nature and extent of any such failure; provided, however, that if the nature of City's obligation is such that more than thirty (30) days are required for its performance, then City shall not be deemed to be in Default if City shall commence to cure such performance within such thirty (30) day period and thereafter diligently prosecute the same to completion. 8.2 Institution of Legal Actions. In addition to any other rights and remedies, and subject to the restrictions otherwise set forth in this Agreement, either party may institute an action at law or in equity to seek the specific performance of the terms of this Agreement, to cure, correct or remedy any Default, to recover damages for any Default or to obtain any other remedy consistent with the purpose of this Agreement. Such legal actions must be instituted in the Superior Court of the County of California, State of California or in the United States District Court for the Central District of California. 8.3 Acceptance of Service of Process. In the event that any legal action is commenced 25 by the Subrecipient against City, service of process on City shall be made by personal service upon the City Clerk or in such other manner as may be provided by law. In the event that any legal action is commenced by City against the Subrecipient, service of process on the Subrecipient shall be made by personal service upon Subrecipient's Representative or in such other manner as may be provided by law. 8.4 Rights and Remedies Are Cumulative. Except as otherwise expressly stated in this Agreement, the rights and remedies of the parties are cumulative, and the exercise by either party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different times, of any other rights or remedies for the same Default or any other Default by the other party. 8.5 Inaction Not a Waiver of Default. Any failures or delays by either party in asserting any of its rights and remedies as to any Default shall not operate as a waiver of any Default or of any such rights or remedies, or deprive either such party of its right to institute and maintain any actions or proceedings which it may deem necessary to protect, assert or enforce any such rights or remedies. 8.6 Attorney's Fees. City and Subrecipient agree that in the event of litigation to enforce this Agreement or terms, provisions and conditions contained herein, to terminate this Agreement, or to collect damages for a Default hereunder, the prevailing party shall not be entitled to costs and expenses, including reasonable attomey's fees, incurred in connection with such litigation, such that each party shall be responsible for their costs and attorneys' fees. 8.7 Termination. (a) Termination for Cause. In accordance with 24 CFR 85.43, the City may suspend or terminate this Agreement in the event of a Default by the Subrecipient under this Agreement. Subrecipient may suspend or terminate this Agreement if City fails to make payments to Subrecipient as required herein. (b) Termination for Convenience. In accordance with 24 CFR 85.44, this Agreement may also be terminated for convenience by either the City or the Subrecipient, in whole or in part, by setting forth the reasons for such termination, the date the termination will be effective, and, in the case of partial termination, the portion to be terminated. However, if in the case of a partial termination, the City determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the City may terminate the award in its entirety. 26 IN WITNESS WHEREOF, the parties have executed this HOME Subrecipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. SUBRECIPIENT: CfI'Y: MERCY HOUSE, CITY OF HUNTINGTON BEACH, a California nonptofit corporation a municipal corporation and charter city By: `� ;� By: Lam/ Haynes City Manager print nwne ITS:Executive Director ATTEST: AND By: � City Clerk By: Jul Patti Long APPROVED AS TO FORM: print name 1TS: circle ate Secretary/ By: � hiefFinancial0tee sst. Secretary—Treasurer Tz, City Attorney INITIATED AND APPROVED: By: Director of Community Development REVIEWED AND APPROVED: By: Assistant City Manager COUNTERPART 27 IN WITNESS WHEREOF, the parties have executed this HOME Subrecipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. SUBRECIPIENT: CITY: MERCY HOUSE, CITY OF HUNTINGTON BEACH, a California nonprofit corporation a municipal corporation and charter city By: By: I i�- -,e"-' City Manager print name ITS: Executive Director ATTEST: AND By: �Lf. City Clerk By: APPROVED AS TOr FOP M: print name I t 1 1 ITS: (circle one) Secretary/ By: .�--_a— Chief Financial OfHcer/Asst. Secretary—Treasurer 7z, City homey INITIIIATED AN"PP D: By: V� Director of Community Development REVIEWED AND APPROVED: By: Assistant City Mana er COUNTERPART 27 i Exhibit A Scope of Services and Budget Program Guidelines/Operating Procedures EXHIBIT A FY 2021-22 SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2021 and June 30, 2022, Mercy House will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) Inspections and Income eligibility reviews to 25 unduplicated Huntington Beach households in accordance with the TBRA Guidelines. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15t° of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly Invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $188,900 Security Deposit Subsidy: $60,000 Utility Deposit Subsidy: $3,600 HQS Inspections: $15,000 Income Eligibility: $7,500 Total Mercy House Budget: $275,000 EXHIBIT A CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM PROGRAM GUIDELINES/OPERATING PROCEDURES j (July 2021) I. INTRODUCTION I Utilizing HOME Investment Partnership Program (HOME) funding, the City of Huntington Beach (City) has elected to assist certain eligible low income persons and families through funding by the Housing and Urban Development Department(HUD) by establishing a Tenant Based Rental Assistance Program (TBRA) that follows all of the requirements set forth in the HOME Program under Section 24, Part 92, of the Code of Federal Regulations (24 CFR 92). By partnering with local Service Providers, the Program will enable the City to meet the needs of participating tenant households by providing monthly rental assistance for up to 24 months (subject to funding availability.) IL TENANT SELECTION POLICY A. Current Residents of the City of Huntington Beach and Persons with Strong Ties to the City This program is designed to help current residents of the City and those with strong ties to the City. Priority shall be given to residents from the Huntington Beach Police Department, Huntington Beach Homeless Task Force, OC211 and other housing providers. Due to the nature of the population served by the Program, it may not be possible to obtain traditional proof of residency documentation such as utility bills. The following documentation can be accepted to establish that an applicant household qualifies for the Huntington Beach live/work preference: • Documentation from a Huntington Beach school that the children in the household have been enrolled in and attending the school for at least the last 90 days from the time of admission into the Program. • Documentation from a partner agency, such as the Huntington Beach Police Department, evidencing that the family is known to be homeless in Huntington Beach. • Proof that the applicant's last place of stable residency was in the City of Huntington Beach. Verification from a landlord is acceptable. 1 • Proof that an adult member of the household is working or has been recently hired to work in Huntington Beach. B. Currently Homeless or At-Risk of Homelessness • At-Risk of Homelessness refers to a household that is at imminent risk of being evicted due to an economic hardship in paying rent or staying current with rent. (Category 2 of HUD Homeless Definition) I • Homelessness refers to a household who meets the HUD Homeless Definition at 24 CRF 91, 582 and 583: Category 1 (literally homeless) and Category 4 (fleeing/attempting to flee violence and living in a place described in Category 1). C. Intake Process As part of the intake process, the Service Provider will meet with the prospective Eligible Household to conduct a needs assessment and complete an Initial Qualifications Form (Appendix A). If the Program has reached maximum capacity, the Service Provider shall review the applicant to assess if other services may be offered while the applicant is waiting for a slot to open in the Program. As part of the intake process, the Service Provider shall also request and/or assist the prospective Eligible Household with the completion of the following documents: • TBRA Application (Appendix B) • Declaration of Homeless Status or Declaration of At-Risk of Homelessness Status (Appendix C) D. Income Eligible Households • To receive supportive services as well as rental assistance under the HOME Program, the Applicant's total household income must be at or below 60% of the Orange County area median income (AM 1). However, once the Applicant is part of the Program, the household income can increase up to 80% of the AMI before a notice of termination must be given from the Program. • Income limits for low-income households are established annually for the HOME Program by HUD for the Orange County income limit area. • Gross Annual Income shall be determined in accordance with 24 CFR 5.609,with the allowable exclusions from income established at 24 CFR 5.611. • Gross Annual Income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be 2 received prospectively during the 12-month period following the date of application and before any deductions are taken. • Applicants must verify eligibility for assistance under the Program through the review of income source documents. As outlined in the revised HOME rules published in July 2013, applicants must provide evidence of income for the two (2) most recent months. Acceptable source documents include wage statements, check stubs, entitlement verification from another government agency and bank statements. The definition of income for the purposes of the Program is located at 24 CFR Part 5 (often referred to as the Section 8 definition). In cases where no evidence of income (third-party verification) is available, applicants may self- report their income. In such cases, a written explanation must be provided as to why third-party verification or documentation was unavailable. • Likely changes in income may be considered when collecting income verification documentation. • Initial income verifications are valid for six months. If admission to the Program takes longer than 6 months, income verifications must be updated and reevaluated. After initial verification, income recertification shall be conducted every six months. Income verifications will be used for two purposes: • To determine eligibility for services. A determination of eligibility will be completed as part of the admissions process and thereafter annually. • Income information will be used to establish the household's initial contribution toward rent, which shall be set at 30% of the household income. The household's initial contribution will remain unchanged for at least six months. E. Eligibility Verification • Applicants will be re-qualified, including examination of source documentation, every six months or at the end of the lease term, whichever occurs earlier. • If an applicant has fluctuating income, and/or a change of household size or composition and/or fails to participate in all the policies of the program, the applicant may be requested to provide verification(s) more often, as reasonably necessary to confirm continued qualification and eligibility for the Program. Applicants will be given written notice stating whether the Eligible Household was determined to be eligible for continued assistance under the Program. 3 F. Waiting List Once the Program has reached maximum enrollment, a waiting list of prospective Eligible Households will be maintained. This list will be prioritized as follows: • Clients who have been assessed for TBRA eligibility, completed intake process, and are ready for housing placement. Ready for housing placement means that the household has found a housing unit that meets TBRA requirements. • Clients who have been assessed for TBRA eligibility, completed intake process, and are searching for housing. • Clients who have been assessed for TBRA eligibility and pending intake. • Priority ranking will be given for Homeless Category 1 (24 CRF 91, 582 and 583), literally homeless participants from the streets or other locations not meant for human habitation,emergency shelters,or safe havens. G. Outreach and Collaboration with the City If funds are available to assist more City residents,the Service Provider is responsible for marketing and outreach activities to find prospective Eligible Households interested in the Program. Examples of outreach activities include conducting community presentations, contacting school districts, community based organizations and faith-based groups, and participating in community events to educate on TBRA resources available. Ill. SELECTION OF HOUSING UNITS A. Housing Unit Selection Eligible Households may elect to rent any Housing Unit in the City so long as the unit meets federal Housing Quality Standards (HQS) (Appendix D) orsuch other standards as may be made applicable to the Program by HOME Program statues and/or regulations, specifically including Uniform Physical Condition Standards (UPCS) and passes a rent reasonableness test. If an appropriate Housing Unit cannot be located within the City boundaries, a Housing Unit can be located outside of the City boundaries. B. Occupancy Standards The number of persons in each Eligible Household will determine the required unit type. Each household must comply with the two per bedroom plus one occupancy standard. The following table provides the occupancy standards by unit type: 4 Number UnitType Household One-bedroom Unit Up to 3 Persons Two-bedroom Unit Up to S Persons Three-bedroom Unit Up to 7 Persons Four-bedroom Unit Up to 9 Persons C. Property Inspections Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual verification process, a certified HQS inspector must inspect each Housing Unit to ensure the unit complies with HQS as set forth in the HOME Program (24 CFR 92.251), as well as all applicable state and local codes and ordinances, including zoning ordinances. Each HQS inspection will include the following: • Verification of the age of the Housing Unit (on Rent Reasonableness Form) Appendix E; • Completed HQS Inspection Form (HUD-52580); • Lead-based paint hazard assessment, dissemination of lead-based paint information pamphlet and disclosure form and lead-based paint reduction activities, if required; • Adequate opportunity for landlord to correctany deficiencies indicated in the HQS Inspection form to bring the Housing Unit into compliance; and • Verification that occupancy by the Eligible Household will comply with occupancy standards. D. Housing Unit Rent Reasonableness Rental assistance paid on behalf of the Eligible Household must be in compliance with federal Rent Reasonableness requirements that mandate rents paid by or on behalf of assisted households be similar to rents paid by non-assisted households. Rent Reasonableness reviews will be performed by the service providers. The factors listed below shall be considered when determining rent comparability: • Location and age; • Unit size including the number of rooms and square footage or rooms; • The type of unit including construction type (e.g., single family, duplexes, garden, low-rise, high-rise); 5 • The quality of the unit,which includes the building construction,maintenance and improvements; and • Amenities, services and utilities included in the rent. i The Service Provider will follow both the rent reasonableness regulations established for the Housing Choice Voucher (HCV) program at 24 CFR 982.507 to evaluate rents. In the event that a rent request does not meet rent reasonableness requirements, the Service Provider shall attempt to negotiate a lower rent with the property owner. If the owner is not willing to accept a lower rent, the household must be instructed to search for another unit. Under no circumstances shall rent exceed the sum approved through the rent reasonableness review. Additionally, the assisted household is not allowed to make up any difference in the rent offer. E. Coordination with Landlords The Service Provider will meet with and provide guidance to landlords participating in the Program regarding the requirements and procedures that impact landlords. Landlord Agreement (Appendix F) • The Service Provider will enter into a Landlord Agreement with each participating landlord or property owner. The Landlord Agreement will establish the security deposit assistance payment and the initial rental assistance payments to be paid on behalf of the household. The Agreement will also establish the participating household's initial share of the contract rent.The Agreement will also require the landlord to provide the Service Provider with notice of a lease termination, and reaffirm the tenant protections included in the Tenant Protection Agreement. • This contract will have an initial term of 6 months unless otherwise agreed between the Service Provider, tenant and the City. Lease Addendum for Tenant Protection (Appendix G) • The landlord will be required to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit. • The lease agreement will include a Tenant Protection Agreement that will be executed in connection with the lease between the landlord and the Eligible Household. • The Tenant Protection Agreement will include the following elements: • Prohibit the inclusion of the following provisions in the lease, as required by 24 CFR 92.253: • (1) Agreement to be sued; 6 • (2) Treatment of property; (3) Excusing owner from responsibility; • (4) Waiver of notice; I • (S) Waiver of legal proceedings; • (6) Waiver of a jury trial; (7) Waiver of right to appeal court decision; (8) Tenant chargeable with cost of legal actions regardless of outcome•, and (9) Mandatory supportive services. • Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401. • Prohibit discrimination by the landlord against the Eligible Household. • The Service Provider will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. Prior to signing the lease, the Service Provider must provide the City with the tenant's application, income eligibility documentation, IDIS form and lease terms for approval of acceptance into the program. If the City does not respond within two business days, the tenant is deemed approved. IV. Payment Standards, Rent Calculation,Term and Subsidy Reductions As authorized by HOME TBRA regulations, the Program will rely on a traditional rental assistance calculation. The model allows for the rent subsidy determination based on 30% of household income. A. Rent Assistance Calculation A rental assistance calculation will be completed for each Eligible Household. The calculation will determine each household's Program subsidy and share of the rent. The maximum amount of monthly assistance is the difference between the rent standard for the unit size and 30% of the household's monthly adjusted income. Each household's maximum rent subsidy will vary since the calculation involves the use of individualized factors such as the household's actual income and family size. 7 The initial household contribution to rent will remain unchanged for at least six months. Minimum tenant contribution to rent under the Program is set at $S0.00. This minimum is used if the maximum subsidy calculation would result in the household paying less than $50.00 towards the monthly rent (e.g. if 30% of the household's monthly adjusted income is less than $50.00). B. Rent Payment Rent Reasonableness The Program must use the Rent Reasonableness Standard (Appendix E) to calculate monthly rental assistance. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach as well as those in surrounding Orange County cities. Payment standards are established by bedroom size. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the household's entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the household is directly responsible for payment of utility services, the household's initial share will be determined by subtracting a utility allowance from 30% of the household's income. The Orange County Housing Authority utility allowance schedule (Appendix 1) shall determine the household's utility allowance. In these cases, the household's share of the rent is equal to 30% of the household's monthly adjusted income minus the applicable monthly utility allowance. Each household is responsible for paying their rent share directly to the landlord each month. If a selected Housing Unit is subject to contractual, statutory and/or regulatory affordability restriction, the monthly rental assistance payments will not exceed the difference between the required affordable rent amount for the Housing Unit and 30% of the Eligible Household's monthly adjusted income. i. Participant Agreement(Appendix H) The Service Provider will enter into a Participant Agreement with each participating client household. The Participant Agreement will establish the Eligible Household's responsibilities towards rent payments. The Agreement will establish the participating household's initial share of the contract rent, which will be adjusted every 6 months. li. Term Rental assistance will be for an initial term of 6 months, which can be extended every 6-12 months, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Service Provider and shall be based on continued Program compliance and ongoing need. 8 The Service Provider will utilize the Gap Analysis and Income Re-Evaluation to assess ongoing need and adjust household's share of rent as appropriate. Households with income above 80%AMI will be notified about income eligibility limits. I Ill. Subsidy Reductions The participant's household income will be reevaluated every six months. If the household income has changed since the previous evaluation, the participant's monthly rent responsibility will be adjusted accordingly. V. Security Deposits Security deposit assistance is available to Eligible Households. Such assistance shall be the lesser of: • Two months approved rent for the Housing Unit; or • The standard security deposit required by the landlord for non-subsidized tenants. Security deposit assistance provided to participating households will be in the form of a grant. As such, the landlord can provide a security deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by the tenant and landlord, as provided for in the lease. V1. Utility Deposits Utility deposit assistance is available to Eligible Households. Utility deposit assistance provided to participating households will be in the form of a grant. As such, the utility provider can provide a utility deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a utility deposit shall be settled by the tenant and the utility provider. The Utility deposit subsidies cannot be used as a stand-alone activity. The assistance must be utilized with rental subsidy, security deposit subsidy, or both. The Orange County Housing Authority will annually establish the utility allowances for each year. (Appendix H) 9 V11. Annual Recertification, Termination of Assistance and Returning Households A. Annual Recertification Recertification of income and Program eligibility will every 6 months. The Service Provider will gather source documentation for participating households to determine annual income. Annual income must be calculated in accordance with 24 CFR Part 5. If the total household income is above 80%AM1, rental assistance must be terminated following a 30 day notification period. B. Termination of Rental Assistance Assistance can be terminated for the following reasons: • Eviction from the assisted rental unit based on behavioral issues and/or unlawful activity. ■ The family will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based program. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must terminate. • Failure to meet significant goals in the participants Self-Sufficiency Program as outlined on page 11, Case Management. C. Returning Participant Households As needed, participants may be allowed to return to the Program for either support services, rental assistance or both. A determination to allow re-entry shall be based on the following criteria: • Participants must have left the Program in good standing. To be in good standing, participants must have been engaged in their case management plan, voluntarily left the program (not in-lieu of termination) or have been released because their household income exceeded eligible limits. In general, participants will not be allowed to re-enter the Program if they were terminated for non-compliance. • A request for readmission from a non-compliant household may be considered when compelling reasons exist. In such cases, re-admission will require concurrence from the City. • The Participant's previous rental assistance did not exceed 24 months. Cumulatively, participants will only be allowed to receive rental assistance for a maximum of 24 months. 10 Self Sufficiency Program Subrecipient will request each Eligible Household receiving rental assistance payments to participate in a Self-Sufficiency Program administered by Subrecipient. The Case Management and Self-Sufficiency Program Policies and Procedures are outlined in Appendix J. The Self-Sufficiency Program provides participating households with intense case management,which is designed to assist participants move to self-sufficiency within a 12 to 24-month period. Income recertifications will be completed annually for participating households. If the participating household's income exceeds the low (80%AM]) income limits,Subrecipient must terminate the rental assistance. Listed below are some of the Self-Sufficiency Case Management Services offered by Subrecipient: D. Case Management The Subrecipient Case Management model maximizes client success by developing individualized service plans and addressing clients' specific needs in securing permanent housing and self-sufficiency. Clients will meet with their Case Manger on a minimum of a monthly basis to update goals, monitor progress, and ensure long- term housing stability. Self-sufficiency groups are also held weekly to assist with financial management, job development, life skills, personal empowerment, and accessing other resources needed to gain housing stability. E. Individualized Housing and Service Plan Participants meet with their Case Manager at intake and monthly to review their Goal Worksheet and Individualized Service Plan to help establish and identify participant goals and plans for housing, education, employment, financial (including budgeting and credit repair), legal, and other housing stabilization and relocation resources needed. F. Housing Search and Placement Subrecipient advocates assists clients with comprehensive housing search and placement into affordable permanent housing. Subrecipient has established close partnerships with permanent housing agencies, including affordable housing providers, apartment associations, and private landlords/owners. G. Financial Management/ Credit Repair Subrecipient assists program participants with credit repair, financial literacy, and job placement and retention. Assistance will also be provided to access mainstream financial benefits including social security, veteran's benefits, CaIWORKs, disability, unemployment, and other public assistance. 11 H. Employment Assistance Obtaining self-sufficiency is a critical goal for families served by Subrecipient. Subrecipient Case Managers work with clients to identify interests, life experiences and talents that lend themselves to employment. Housing Advocates also: • Help clients develop resumes, complete job application and prepare for interviews; Obtain educational scholarships through AmeriCorps and other sources to increase leadership skills and/or further their education; • Provide transportation solutions to job interviews and job-related activities; and • Provide job placement in career-level jobs and job retention assistance. i I. Transportation Subrecipient provides support services at Community Service Center and Satellite sites in Huntington Beach conveniently accessible via public transportation routes or via home visits as needed. Subrecipient provides assistance with transportation via bus passes and accessing mainstream resources available for transportation through CalWORKS and disability access. Subrecipient also maintains agreements with local taxi companies to provide emergency transportation assistance and works closely with the Huntington Beach Police Department to assist transport participants in crisis situations. J. Behavioral Health Subrecipient provides an array of individual and group counseling programs on-site and works closely with other mental health providers to address behavioral health needs of participants. VIII. RIGHT TO AN INFORMAL HEARING PROCEDURE Participating Tenant Households have the right to be heard by an impartial official, without prejudice. Program participants may appeal a proposed Program action that may have an adverse effect upon them by submitting a written Request for Hearing to the City of Huntington Beach, which include the Participating Tenant Household's objection, name and relationship of all potential parties, list of documents to be presented, current address and telephone number. Appeals must be filed within seven (7) calendar days of notification of proposed Program action. The informal hearing will be scheduled as soon as possible. The informal hearing shall be conducted in English. Notice of Informal Hearing will be issued at least ten days prior to the Hearing appointment. The Participating Tenant Household may bring person(s) to testify and/or documents at their expense. Participating Tenant Households may review pertinent file documentation so long as such documentation does not infringe on any other parry's rights. 12 IX. CITY REQUIREMENTS A. Monthly Meetings and Reports Each month,the City will meet with each Service Provider via teleconference. At least 24 hours prior to the meeting, the Service Provider will provide an updated tenant chart. The City and Service Provider will discuss all tenants, potential applicants and other issues impacting the operations of the Program. B. Monthly Summaries At the end of each month, the Service Provider will submit a summary of services provided. The summary shall include the number of new, continuing and existing households served in the quarter, any staffing changes, any billing issues, any outreach efforts and other issues impacting the administration of the Program., The Quarterly Summary is due within 45 days after the end of the quarter. C. Billing Requirements Service Providers shall submit their invoices no later than 20 days after the end of a service month. The invoices shall include a City coversheet for each household, a general ledger of all current clients, an updated IDIS form, if necessary, proof of all reimbursable costs, including rent checks, security deposits and staff time and any written communication with the City discussing exceptions or unusual circumstances regarding a household. Timely submission of invoices is required for City finance and budget purposes. D. The City maintains the ability to make changes to the Operating Guidelines as City, State and Federal laws, ordinances and policies change. The City shall provide written notice to the Service Provider when a substantive change is made to the guidelines. IX. COMFORMANCE WITH HOME LAWS, RULES AND REGULATIONS The Program Guidelines/Operating Procedures must conform to all HOME laws, rules and regulations. To the extent Congress or the federal government makes changes to the laws, rules and regulations, particularly due to an exigent circumstance, the City has the discretion to modify these guidelines/procedures to align with federal laws, rules and regulations. At the time of the adoption of these Operating Guidelines, HUD has issued waivers and suspensions of HOME regulations due to COVID 19. The changes to the HOME regulations shall be in effect until December 31, 2020 unless otherwise modified by HUD. (Appendix K.) 13 As applicable, the City and Service Providers shall both implement the requirements regulations of the Violence Against Women Reauthorization Act of 2013 (VAWA) per the provisions outlined in 24 CFR 92.359 and 24 CFR 5, Subpart L. Service Providers shall also implement the applicable VAWA requirements related to the City's Emergency Transfer Plan,as required by 24 CFR 92.359(g) and included as Appendix K, for all applicants to the TBRA Program, and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover, all leases that are approved by the Service Providers shall contain the City's required VAWA lease term/addendum per 24 CFR 92.359(e), and included as Appendix L. I 14 i Exhibit A - Appendix A i Sample TBRA Application (Pre-Application) SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Pre-Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: Alternate Phone: i I HOUSEHOLD COMPOSITION (List the Head of Household and all other members who will be living in th o 't. Give the relationship of each family member to the head.) Member's Full Name Relationship Birthdate Age ey Scu;doSecurity No. to w Race of Head of Household (Check One��tion I• fiance (This information is being collected to assur I'anwlt;.fair housing and equal opportunity rules.) ❑ White ❑ B1 ❑ Asian/Pacific Islander ❑ Native American/ a"1`s`'ha ative ❑ Hispanic Preference Information.' You ma ali a reference for housing assistance if any of the following circumstances, an be verifie or yoo r amily. Please check any that apply to you. ❑ Are you cu , ntly ome ' or li Ing in substandard housing? If yes, pleas xple" . ❑ Have yonbeen are you about to be) displaced from your housing? If y p ea " ex p in: What is the tota!an uaI income of all household members? (Include wages, salaries and tips; other income sushas alimony, child support; and Social Security, AFDC or other benefits) S APPLICATION CERTIFICATION: I/we understand that the above information is being collected to determine if I/we are eligible to receive rental assistance. Itwe authorize the [Program Administrator)to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date 1 Note: These are examples only. Insert the appropriate local preferences. Exhibit A - Appendix B i Sample TBRA Application (Full-Application) SAMPLE TBRA APPLICATIONS APPLICATION FOR RENTAL ASSISTANCE (Full Application Version) APPLICANT NAME: Current Address: City, State, Zip Code: Home Phone: Alternate Phone: HOUSEHOLD COMPOSITION (List the Head of Household and all other members who will be living in the unit. Give the relationship of each family member to the head.) Member's Full Name Relationship Birthdate Age Sex Social Security No. Race of Head of Household (Check One) - Optional (This information is being collected to assure compliance with fair housing and equal opportunity rules.) ❑ White ❑ Black ❑ Asian/Pacific Islander ❑ Native American/Alaskan Native ❑ Hispanic Preference Information.' You may qualify for a preference for housing assistance if any of the following circumstances can be verified for your family. Please check any that apply to you. ❑ Are you currently homeless or living in substandard housing? If yes, please explain: ❑ Have you been (or are you about to be) displaced from your housing? If yes, please explain: 2 Note: These are examples only. Insert the appropriate local preferences. INCOME INFORMATION What is the total annual income of all household members? (Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits) Member's Full Source of Income Annual Payment Basis Name Amount (weekly, monthly, etc.) ASSET INFORMATION List the type and source of any family assets. Provide both the current cash value and the estimated annual income from the asset. Member's Full Name Type and Source of Asset Cash Value Annual (e.g.bank accounts, investments) of Asset Income from Asset EXPENSE INFORMATION ❑ Yes ❑ No Does your household have un-reimbursed medical expenses in excess of 3 percent of annual income? ❑ Yes ❑ No Does your household pay child care expenses for children under the age of 13 that enable a family member to work or go to school? ❑ Yes ❑ No Does your household pay care expenses for the care of a family member with disabilities that enable a family member to work? APPLICATION CERTIFICATION: I/we understand that the above information is being collected to determine if I/we are eligible to receive rental assistance. I/we authorize the [Program Administrator] to verify all information provided on this application. Head of Household Signature Date Spouse Signature Date i i Exhibit A - Appendix C Declaration of Homelessness DECLARATION OF HOMELESSNESS STATUS Applicant Name: ❑ I certify, under penalty of perjury,that following information is true and complete: Applicant Signature: Date: 'T=Third Parry I O=Observation/S=Self-certification Attach Third Party verification documentation and Intake Observation statements behind this forth Verif cation Type T/O/5'/Notes Situation 1 LJ An individual or family who lacks a fixed, regular, and adequate nighttime residence,meaning - Check one of the following , 71 An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park,abandoned building, bus or train station,airport,or camping ground.(T-not required for emergency shelter or street outreach) An individual or familyliving in a supervised publicly or nvatel operated shelter designated to ovide 9� P P ty P Y P 9 W temporary living arrangements(including congregate shelters,transitional housing,and hotels and motels paid for b charitable or anizations orb federal stale or local government r rams for low-income individuals An individual who is exiting an institution where he or she resided for 90 days or less AND who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution.(O-not allowed) Verification Type T/0/5-/Notes Situation 2 tWw An individual or family who will imminently lose their primary nighttime residence,provided that: WLNW.st0 „ The primary nighttime residence will be lost within 14 days of the date of application for homeless assistance AND No subsequent residence has been Identified AND The individual or family lacks the resources or support nehvorks, e.g., family,friends,faith-based or other social networks, needed to obtain other permanent housing Verification Type T/O/S•/Notes Situation 3 LJ Unaccompanied youth under 25 years of age,or families with children and youth,who do not otherwise quality as homeless under this definition but who qualifies as"homeless"under another federal statute AND(Only T Is allowed have not had a lease,ownership interest,or occupancy agreement in permanent housing at any time during the 60 days immediately preceding the date of application for homeless assistance AND O is not allowed) have experienced persistent instability as measured by two moves or more during the 60-day period immediately preceding the date of applying for homeless assistance AND O is not allowed) can be expected to continue in such status for an extended period of time because of chronic disabilities,chronic physical health or mental health conditions,substance addiction, histories of domestic violence or childhood abuse (including neglect),the presence of a child or youth with a disability,OR two or more barriers to employment, which include the lack of a high school degree or General Education Development(GED), illiteracy, low English proficiency,a history of incarceration or detention for criminal activity,and a history of unstable employment: (5 Is not allowed O is not allowed for bafflers to employment) Safety should never be put at risk in order to obtain documentation under this situation. If the provider is a DV Verification Type provider sell-certification sufficient. For non-DV providers,if there is no threat of safety supporting verification T/o/5•/Notes should be provided. Situation 4- ME��`�r�' Any individual or family who Is fleeing, or is attempting to flee,domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual's or family's primary nighttime residence or has made the Individual or lamily afraid to return to their primary nighttime residence AND has Ln other residence AND lacks the resources or support networks, e.g., family, friends, faith-based or other social networks, to obtain other permanent housing DECLARATION OF HOMELESSNESS STATUS (continued) Applicant Name: Staff Certification I understand that third-party verification is the preferred method of certifying homelessness or risk for homelessness for an individual who is applying for assistance. I understand self declaration is only permitted when I have attempted to but cannot obtain third party verification. Describe in detail efforts made for Third Party verification and attach documentation behind this form(email, phone logs, etc...J I Staff Signature: Date: I Exhibit A - Appendix D HQS Inspection Checklist Inspection Checklist U.S.DBpa Tent of Housing OMB Approval No.2577-0169 and Urtan Developmant (Fxp.07/3112022) Housing Choice Voucher Program Office of Public and Indian Housing Public reporting burden for this collection o(ntormmlon is estimated to average 0.50 hours per response,including the time for reviewing Instructions, searching existing data sources,gathering and maintaining the data needed,and completing and roviewing the collection of Information.This agency may not conduct or sponsor,and a person Is not requl ed to respond to,a collection of Information unless that collection displays a valid OMB control number. Assurances of confidentiality are not provided under this collection. This collection of information is authorized under Section 8 of the U.S.Housing Act of 1937(42 U.S.C. 14371).This Information is used to determine II a unit meets the housing quality standards of the section 8 rental assistance program. Privacy Act Statement.The Department of Housing and Urban Development(HUD)is authorized to collect the Information required on this form by Section 8 of the U.S.Housing Act of 1B37(42 U.S.C. 14370.Collection of the name and address of both family and the owner is mandatory.The information is usetl to determine it a unit meets the housing quality standards of the Section a rental assistance program.HUD may disclose this information to Federal,State and local agencles when relevant to civil,criminal,or regulatory Investigations and prosecutions.It will not be otherwise disclosed or released outside of HUD,except as permitted or required by law.Failure to provide any of the information may result In delay or rejection of family participation. Nome of Famly Tenant ID Number Date or Retiuest anamedryyyy) Inspector Nel9hborhood(Ceneu3 Tract Data of lnspetion(mMddyyyyy) Type of Inspection Data al Loot InipecUon(mMdaryyyy) p11A Intel Special ❑ Relnspection A. General Information Inspected Unit Year earnu.rcted&M) Kouarfing Type(mark ac appeopisan till A cos(Including Sbael,city.County,Slate,Zip) Q Single Family Detached Duplex or Two Family Row House or Town House Low Rise 3,4 Sterling, Including Garden Apartment Number of CNldrm In Family Unaer 0 High Rise;5 or More Sbrles Q Manufactured Home Owner Congregate Name of Ow.Qr or Agent Autroffae l to Lease Unt Inspected Phone Number 0 Cooperative 0 Independent Group Residence Address of Owner or Agent 0 Single Room Occupancy C3 Shared Housing (] Other B. Summary Decision On Unit To be completed alter form has been filled out rF a55ms Number of Bedroo for Purposes Number of Sleeping Rooms ail of the FMR of Payment Standard conclusive Inspection Checklist ion Yes No In- Final Approval No. I.Living Room Pass Fell IConic Comment Date(mm/ddlyyyy) 1.1 Living Room Present 1.2 Elechicity 1.3 Electrical Hazards 1.4 Security 1.5 Window Condition 1.6 Ceiling Condition 1.7 Wall Condition 1.8 Floor Condition Previous eellons are obsolete Page t of 8 form HUD-52580(712019) Room Codas:1=Bedroom or Any Omer Room Used for Sleeping(regardless or type of room); 2=Dining Room or Dining Area; 3=Second Living Room,Family Room,Den,Playroom,TV Room:4=Entrance Flans,Corridors,Halls,Staircases;5=Additional Bathroom;6=Other It— 1. Living Room (Continued) yes No In. Final Approve] No. Pu Fell conc. Commons Dare movtltl 1'9 Lead-Based Paint Not Applicable Are all painted surfaces free of deteriorated paint? If not,do deteriorated surfaces exceed two square feet per room and/or Is more than 10%of a component? 2. Kitchen 2.1 Kitchen Area Present 2.2 Electricity ' 2.3 Electrical Hazards I 2.4 Security 2.5 Waldow Condition 2.6 Ceiling Condition 2.7 Wall Condition 2.8 Floor Condition 2-9 Lead-Based Paint Not Applicable Are all pointed surfaces free of deteriorated paint? If mX do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? 2.10 Stove or Range with Oven 2.11 Refrigerator 2.12 Sink 2.13 Space for Storage,Preparation,and Serving of Food 3. Bathroom 3.1 Bathroom Present 3.2 Electricity 3.3 Electrical Hazards 3.4 Security 3.5 Window Condition 3.6 Ceiling Condition 3.7 Well Condition 3.8 Floor Condition 3.9 Lead-Based Paint Nor Applicable Are all painted surfaces free of deteriorated paint? If not, do deteriorated surfaces exceed two square feet per room and/or Is more than 104%of a component? 3.10 Flush Toilet In Enclosed Room in Unit 3.11 Fixed Wash Basin or Lavatory In Unit 3.12 Tub or Showerm Unit 3.13 Ventilation Previous eddoru am obsololo Page 2 of 8 form HUD-52580 (7/2019) Item�4.Other Roams Used For Living and Halls Yea 1 No In. Fin.1 Approval Pese Feil Lanc.i CUmmeat Date(mmlddryyW) 4.1 Room Code'and (Clole One) (Circle One) Room Location El RI IvVCentera.ea Fmn/Center/Rear Flow Level 4.2 Electrkl /Illumination 4.3 Electrical Hazards I _ 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition I __ 4.8 Floor Condition _ 4.9 Lead-Based Paint ❑ Not Applicable Ala all painted surfaces free of deteriorated I paint? If not,do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? 4,10 Smoke Detectors 4.1 Room Code'and (CLcle One) (Circle One) Room Location ❑ Rlght/Cantert-eft Frwv/Cenler/Rear _Floor Level 4.2 ElectricityAlluminaWn 4.3 Electrical Hazards 4.4 Security _ 4.5 Window Condition 4.6 Ceiling Condition 4.7 Well Condition 4.8 Floor Condition _ 4.9 Lead-Based Paint I ❑ Nol Apptioable Are all painted surfaces free of deteriorated paint? If not,do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? 4.10 Smoke Detectors 4.1 Room Code'and (Curie One) (Coda One) Roam Location RightlCantar/Left Front/Center/Rear _Floor Level 4.2 ElectricityAlluminatbn 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4,6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead-Based Paint ❑ ;Notgpfximble Are all painted surfaces free of deteriorated paint? If not. do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? Previous editurs are obsolete Page 3 of 8 form HUD-52580(7/2019) ,am 4.Other Rooms Used For Living and Halls Yes uo In- Final Approval Na. pea+ Fall eons. cammam oats(mmlddlyyyy) 4.1 Room Code (Ckde One) (Circle One) and Room Location Rlght/Cemeole8 Front/CenterlRear Floor Level 4.2 ElectdcityAllumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead-Based Paint Not Applicable Are all painted surfaces free of deteriorated Paint? If not,do deteriorated surfaces exceed two square feet per room and/or Is more than 10%of a component? 4.10 Smoke Detectors 4.1 Room Code'and (Circle One) (Circle One) Room Location RlghtrCenleni-eft FrontlCenterlRear _Floor Level 4.2 Efectricityllllumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead-Based Paint Not Applicable Are all painted surfaces free of deteriorated Paint? If not,do deteriorated surfaces exceed two square feet per room and/or is more than 10%of a component? 4.10 Smoke Detectors 5. All Secondary Rooms (Rooms not used for living) 5.1 None Go to Part 6 5.2 Security 5.3 Electrical Hazards 5.4 Other Potentially Hazardous Features In these Rooms Previous edl8ons am obsolete Page 4 of 8 form HUD-5258a (712019) Item 6. Building Exterior Yes No Im I Flntl App &! No. Z Fall anc. Commmr aVImMaNyyyy) 6.1 Condition at oun a ion 6.2 Condition of Stairs, Ralls,and Porches 6.3 Condition of RooliGutters I 6.4 Condition of Exterior Surfaces 6.5 Condition of Chimney 6.6 Lead Paint: Exterior Surfaces Not Appikatxe Are all painted surfaces free of deteriorated paint? If not,do deteriorated surfaces exceed 20 square feet of total exterior surface area"? 6.7 Manufactured Home:Tie Downs 7. Heating and Plumbing 7.1 Adequacy of Heating Eauipment 7.2 Safety of Heating Equipment 7.3 Ventilatlon/Cooling 7.4 Water Heater 7.5 Approvable Water Supply 7.6 Plumbing 7.7 Sewer Connection 8.General Health and Safety 8.1 Access to Unit 8.2 Fire Exits 8.3 Evidence of Infestation 8 4 Garbage and Debris 8.5 Refuse Disposal 8,6 Interior Stairs and Commom Halls 8,7 Other Interior Hazards 8.8 Elevators 8.9 Interior Air Quality 8.10 Site and Neighborhood Conditions 8.11 Lead-Based Paint:Owner's Certification Not Applicable If the owner is required to correct any lead-based paint hazards at the property Including deteriorated paint or other hazards identified by a visual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that the work has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must be received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice. Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HOS lead-based paint requirements have been met and no re-inspection by the HOS Inspector is required. Previous editions are otoolete Page 5 of a forth HUD-52580(7/2018) C.Special Amenities(Optional) This Section is for optimal use of the HA.It is designed to cefect additional Information about otner positive features of the unit that may be present. Aahough the features listed below are not included In the Housing Quality Standards,the tenant and HA may Wish to take them Into considerstion in decisions about renting the unit and the reasonableness of the rent CrietkAist any positive features found in relaticn to the unit. 11. Llvina Room 4.Bath I High quality floors or wall coverings I Special feature shower head —II Working fireplace or stove Bakorry, Built-In heat lamp patio, deck, porch Special windows Large minors J or doors Glass door on showedtub Exceptional size relative to needs of family ] Separate dressing room J Other:(Spedy) Double sink or special lavatory Exceptional sae relative to needs of family Other:(Specify) I 2. Kitchen Dishwasher Separate freezer —Garbage disposal — Eating counter/breakfast nook Pantry or abundant shelving or cabinets Double evenyeeff cleaning oven,microwave S.Overall Characteristics Double sink Stonn windows and doors — High quality cabinets Other forms of"etherization(e.g.,Insulation,weather Abundant counter-tap space J stripping)Screen doom or windows Modem appliance(s) Goad upkeep of grounds(Le.,site cleanliness,landscaping, Exceptional size relative to needs of family condition or lawn) Other.(Specify) —Garage or parking facilities Driveway —Large yard —Good maintenance of building exterior Other.(Specify) 3.Other Rooms Used for Living H(( High quality scorn or wall m enngs {(�— Working freplara a slove Balcony, patio,dear, porch Special wndo 6. Disabled Accessibility a doors Exceptional size relative to reeds of fandly Unit is accessible to a particular disability. ❑ Yes No Other.(Specfy) Disability Previte editions ale obsolete Page 6 of 8 tam HUD-52580(7r2019) 1. Does the owner make repairs whenn asked?Yes No r-1 2. How many people live there? 3. How much money do you pay to the owner/agent for rent?$ 4. Do you pay for anything else? (specify) 5. Who owns the range and refrigerator? (insert O=Owner or T= Tenant) Range Refrigerator_Microwave❑ 6. Is there anything else you want to tell us?(specify)Yes❑ No❑ i i Prewar editions are obsolete Page 7 of 8 form HUD-52580(M019) E.Inspection Summary/Comments(Opilonal) Prodde a summa cescripton of each Rem which resulted in a ratin oI'FaT ur"Pass with Comments.' Tenets ID N..E Inspector On1e d Inspection(mmNdt Y )Address of Inspected Unit ype of Inspeclbn Indal Speca Relnspectbn Rem Numicer Reason br'Feil"or"Pass with Comments"Rating I Continued on additional page Yes No Previous edltln are obsolete Page 8of8 form HUD-325 (4f2015 ref Hand ( 7520,t i i i Exhibit A - Appendix E Rent Reasonableness Checklist RENT REASONABLENESS CHECKLIST AND CERTIFICATION Proposed Unit Unit#1 Unit #2 Unit#3 Address Number of Bedrooms Square Feet Type of Unit/Construction Housing Condition AW , Location/Accessibility Amenities Unit: N Site: ,. Neighborhood: Age in Years at Utilities (type) � } Unit Rent VA Utility Allowance Gross Rent Handicap Accessible? � CERTIFICAT O A �Go liance Eandard Proposed a"nh c6 tent + Utility Allowance = Proposed Gross Rent Approved ren es not exceed applicable Payment Standard of 3 a. B. Rent Reasonableness Based upon a comparison with rents for comparable units, I have determined that the proposed rent for the unit [ ]is [ ] is not reasonable. Name: Signature: Dale: i I Exhibit A - Appendix F Lease Contract HOME RENTAL ASSISTANCE CONTRACT LANDLORD NAME &ADDRESS UNIT NO. &ADDRESS TENANT NAME Telephone No. This HOME Rental Assistance Contract("Contract') is entered into between the"City of Anytown, Department of "(program administrator) and the Landlord identified above. This Contract applies only to the Tenant family and the dwelling unit identified above. 1. TERM OF THE CONTRACT j The term of this Contract shall begin on and end no later than .2 The Contract automatically terminates on the last day of the term of the Leas . 2. SECURITY DEPOSITS A. The(program administrator)will pay a security deposit to the Landlord in el . ougt- $ The Landlord will hold this security dep 3ikduring the period t €p"a t occupies the dwelling unit under the Lease. The Landlord shall carr ty with stale and loca Paws regarding interest payments on security deposits. B. After the Tenant has moved from the dwellio yy d,they dlord m A o state and local law, use the security deposit, including allyf erest on h'1deposii as rement for rent or any other amounts payable by the Tenan`ti'��,.der the L_ sre. The Landlord will give the Tenant a written list of all items charged aga�s the s'ecc FIt de osit and the amount of each item. After deducting the amount used as reinlu. emenlLandlord, the Landlord shall promptly refund the full amount of the balance to thei a ei t/progr _ administralorj. C. The Landlord shall immedj tely notify (p v m adrmi"nistrator)when the Tenant has moved from the Contract unit. wr_ 3. RENT AND AMOUNTS PAYA9- Y�TEN i.AND(program administrator) A. Initial Rent. anit total mo I`I ent payable to the Landlord for the first twelve months of this Contract is$ B. Rent Adjustmen -Wi lessItjla _4 days'notice to the Tenant and the (program a mitllstr tor), th o ^^[ r may propose a reasonable adjustment to be effective no earlier than the tfimoh h of this ontract. The proposed rent may be rejected by either the Tenant or the A(program dmi istraiorl. The Tenant may reject the proposed rent by providing the Landlord Insert the first day of the term of the Lease. z The maximum allowable length of a HOME Coupon Contract is two years. 7 Modify the paragraph based on PJ policy. Insert the number of days notice the owner must provide of a rent increase. At least 60 days Is recommended to enable the program administrator 30 days to review the rent and still enable the landlord to give the tenant 30 days notice. HOME Rental Assistance Contract(Page Two) with 30 days'written notice of intent to vacate. If the program administrator rejects the proposed rent, the program administrator must give both the Tenant and the Landlord 30 days' notice of intent to terminate the Contract. C. Tenant Share of the Rent. Initially, and until such time as both the Landlord and the Tenant are notified by the(program administrator), the Tenant's share of the rent shall be $ I D. Program Administrator Share of the Rent. Initially, and until such time as.oth the Landlord and Tenant are notified by the(program administrator), the(program admin a es) share of the rent shall be $ Neither the (program administrataTffir)or HUD assumes any obligation for the Tenant's rent, or for payment of any claim by the - 5r er agai e i e Tenant. The (program administrator's)obligation is limited to making rentaIt ment ehalf of the j Tenant in accordance with this Contract. E. Payment Conditions. The right of the owner to receive payments under t ontr dbe subject to compliance with all of the provisions of the Cb1ttract. The Landlo7 s 9 be paid under this Contract on or about the first day of the mon b'%(which the paymen[' due. The Landlord agrees that the endorsement on the c ec haIQi nclusive ev��idd nce that the Landlord received the full amount due for the `nthd shaW afi""-ffon that: 1. the Contract unit is in decent, safe aanitary c n Ilion, andit$he Landlord is providing the services, maintenance and utilitte reed t ���r,ry he Lease. 2. the Contract unit is leased to a occuu i chbyttEl�Tenant named above in this Contract. 3. the Landlord has not receive a dl noc a any payments as rent for the Contract unit other than those identified to lv onto 4. to the best of the Landlord's it c d` n s.used solely as the Tenant's principal place of residence. F. Overpayments. If the (p[o ra adminis or) determines that the Landlord is not entitled to any payments received, in a dIflo f her Kemedies,the (program administrator)may deduct the amount of a overpaymeQ m an}1�atpounts due the Landlord, including the amounts due under any of ntal Assistanav Coupon Contract. 4. HOUSING QUALI , ST O"ND'LANDLORD-PROVIDED SERVICES A. e1�'Lr'andlord agrk maintain and operate the Contract unit and related facilities to provide ecent; safe and sa tary housing in accordance with 24 CFR Section 882.109, including all of he servicesa. aintence and utilities agreed to in the Lease. Bfji program' inistrator) shall have the right to inspect the Contract unit and related facilities at lea� nnually, and at such other times as may be necessary to assure that the unit is in decent t�''''sa e, and sanitary condition, and that required maintenance, services and utilities are saegr� C. If the (program administrator) determines that the Landlord Is not meeting these obligations,the program administrator shall have the right, even if the Tenant continues in occupancy,to terminate payment of the (program administrator's) share of the rent and/or terminate the Contract. 5. TERMINATION OF TENANCY The Landlord may evict the Tenant following applicable state and local laws. The Landlord must give the Tenant at least 30 days'written notice of the termination and notify the (program administrator)in writing when eviction proceedings are begun. This may be done by providing the (program administrator)with a copy of the required notice to the tenant. HOME Rental Assistance Contract(Page Three) 6. FAIR HOUSING REQUIREMENTS A. Nondiscrimination. The Landlord shall not, In the provision of services or in any other manner, discriminate against any person on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status. The obligation of the Landlord to comply with Fair Housing Requirements insures to the benefit of the United States of America, the Department of Housing and Urban Development, and the (program administrator), any of which shall be entitled to involve any of the remedies available by law to redress any bregq4 or to compel compliance by the Landlord. �> I B. Cooperation in Quality Opportunity Compliance Reviews. The Lao d shall cattt� ly with the (program administrator)and with HUD in conducting compliance �v �vs and��cTnplaint investigations pursuant to all applicable civil rights statutes, Executi .Otd �and all WOW rules and regulations. - I 7. (Program administrator)AND HUD ACCESS TO LAND&P D RECORDS _ A. The Landlord shall provide any information pertine L o th tract whic the(program administrator) or HUD may reasonably requirea- B. The Landlord shall permit the(program strator)� UD, or:vnY of their authorized representatives, to have access to the pre jges andefbr the purposes of audit and examination,to have access to an !books, doc me is, papers, and records of the Landlord to the extent necessary to determin ¢d lion cw this Contract. 8. RIGHTS OF (Program administrator) IF AN ORD.-BREACHES THE CONTRACT A. Any of the fallowing sh III s tute a br ch o e Contract: (1) If the Landlord has viic,as an e li a i n under this Contract: or (2) If the Land and has demons ra d any intention to violate any obligation under this Contract, or (3) If the Landlo, ha ommitted any fraud or made any false statement in connection with the (RNd , or a , mmitted fraud or made any false statement in connection with any L Fe eral'housin ssistance program. 8;..The P„�[Ajy�rigfii nd�- edies under the Contract include recovery of overpayments, `-;ate mI"`ation or re uction of payments, and termination of the Contract. If the (program a ministrator) ermines that a breach has occurred, the program administrator may exercise any n its rig _ - r remedies under the Contract. The (program administrator) shall notify the Laneford+fri}wn�ng of such determination, including a brief statement of the reasons for the determination. The notice by the PHA to the landlord may require the Landlord to take corrective action by a time prescribed in the notice- C. Any remedies employed by the(program administrator) in accordance with this Contract shall be effective as provided in a written notice by the (program administrator)to the Landlord. The (program administrator's)exercise or non-exercise of any remedy shall not constitute a waiver of the right to exercise that or any other right or remedy at any time. HOME Rental Assistance Contract(Page Four) 9. PHA RELATION TO THIRD PARTIES A. The(program administrator)does not assume any responsibility for, or liability to, any person injured as a result of the Landlord's action or failure to act in connection with the implementation of this Contract, or as a result of any other action or failure to act by the Landlord. B. The Landlord is not the agent of the (program administrator)and this Conuvlgt does not create or affect any relationship between the(program administrator) and any a er to the Landlord, or any suppliers, employees, contractors or subcontractors used by _ andlord 'n connection with this Contract. C. Nothing in this Contract shall be construed as creating any right of t ,;! as or a third p2i y (other than HUD)to enforce any provision of this Contract or to asses a aim agai s'F�LID, the(program administrator) or the Landlord under this Contract. 10. CONFLICT OF INTEREST PROVISIONS , e A. No employee of the(program administrator) arm totes po or in does decisions with respect to the Rental Assistance Program no pub`I official o mber of a governing body or state of local legislator who exercise _u3 nclions or°[ sponsiblliff with respect to the program shall have any direct or indirect`lilt �est durirj his persos tenure, or for one year thereafter, in this contract or in an �p oceed n i be a its arising from the Contract or to any benefits which may arise from R. 11. TRANSFER OF THE CONTRACT ,k., a The Landlord shall not transfet�eOY form his Co t ct without the prior written consent of the (program administrator). Tf1e{p og admi-strato shall give its consent to a transfer if the transferee agrees in writing (in` +o�cr�to the (program administrator)) to comply with all terms and condilio s of this Co ' 12. ENTIRE AGREEM NT�'41 PRE ON A. This Contract cant i tt j en i agreement between the Landlord and the program drfi—t_ stlalor. No li rages in this Contract shall be made except in writing signed by both the fan'a'or and the gram administrator). Bra The Cant etp h II be aterpreled and implemented in accordance with HUD requirements. HOME Rental Assistance Contract(Page Five) 13. WARRANTY OF LEGAL CAPACITY AND CONDITION OF UNIT A. The Landlord warrants the unit is in decent, safe, and sanitary condition as defined in 24 CFR Section 882.109, and that the Landlord has the legal right to lease the dwelling unit covered by this Contract during the Contract term. B. The party, if any, executing this Contract on behalf of the Landlord hereby warrants that authorization has been given by the Landlord to execute it on behalf of th C ndiord. Landlord Name (Type or Print): (Program administrator prese t8 ive (Type of Print): (Signature/Date) (Signature/Date) WARNING: 18 U.S.C. 1001 provides, among other things_that ver knowingly a'nd willingly makes or uses a document or writing containing any false, fictdlotls�o raudUl'At.�t statements or entries, in any matter within the jurisdiction of any department or age y of�e niled i'a es, ah be fined not more than $10,000, or imprisoned for not more than fiv ° ears,or bor, LANDLORD'S CHECK TO BE MAILED TO SS O aF... NAME(S) _ ADDRESS SIGNPAttJOE OF OWNER DATE 1 SIGNATURE OF OWNER DATE r 1 i i i Exhibit A - Appendix G Lease Addendum LEASE ADDENDUM TENANT LANDLORD UNIT NO. &ADDRESS This lease addendum adds the following paragraphs to the Lease between the Tenant and Landlord referred to above. A. Purpose of the Addendum. The lease for the abover. renceq unit s being amended to include the provisions of this a e dum b E`ause the Tenant has been approved to receive rental assista ce u, er the [program administrator's] HOME Rental Assistance Prog Under the Rental Assistance Program, the [program administratoa ill a monthly payments to the Landlord on beh`]f of the Tenant. The Lease has been signed by the paftie .on t onditio t the [program administrator] and Landt�w ljN0 r e a HOME Rental Assistance Contract. T i ease sZ'iii 11 tcge effective unless the Contract has been ex cc��uted ol the L ndlord and the [program administrator], ffectiveYt day of the term of the Lease. ' YG B. Conflict with Ot eer Provisf ns a_„She Le se. In case of any conflict between the proms do of thi�s�dd°e�dum and other sections of the Lease, the provisrois Ad endu` shall prevail. C. Terms cfithe Leasse terms all begin on and shall continu ntil- ) the Lejepkis terminated by the Landlord in accord cRwit Ip-,ble state and local Tenant/Landlord laws; (2) the Leaser,,��ss,,,,te, natedl'y the Tenant in accordance with the Lease M y mutua`,Pa�`ggrreement during the term of the Lease; or(3) termination be HOME Rental Assistance Program Contract by the [ m c m dTi, 'strator]. D' ental istance Payment. Each month the [program �l ad ' i tor]will make a rental assistance payment to the Landlord ialf of the Tenant. This payment shall be credited by the Landlord toward the monthly rent payable by the Tenant. The balance of the monthly rent shall be paid by the Tenant. E. Security Deposit (1) The(Tenant/[program administrator]) has deposited $ with the Landlord as a Security Deposit. The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits. (2) After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local laws, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the (Tenant/[program administrator]). Vi�ee,, F. Utilities and Appliances. The utilities and appliances IisCep"in Column 1 are provided by the Landlord and included"0.� rent. The utilities and appliances listed in Column 2 below are.ft Clnclude l the rent and are paid separately by the Tenant. UTILITY/APPLIANCE Included In Re t Tenant Paid Garbage Collection , Water/SewerAV r' Heating Fuel(specify) Lights, electric Cooking Fuel(specify) Other(specify) T- Refrigeralo _ Stove/Range T G. House hod'Me tiers.Fl� ehold members authorized to live in this unit are Ifs ed be h enant may not permit other persons to join tie Housed hout n tifying the[program administrator] and ob ining t ek andlord's permission. Household members: H. Hou g Aua i Standards. The Landlord shall maintain the elling unit, common areas, equipment, facilities and appliances in decent, sa e, and sanitary condition (as determined by Section 8 He sin uality Standards). I. Termination of Tenancy. The Landlord may evict the Tenant following applicable state and local laws. The landlord must provide the Tenant with at least 30 days' written notice of the termination. The Landlord must notify the [program administrator] in writing when eviction proceedings are begun. This may be done by providing the [program administrator]with a copy of the required notice to the Tenant. J. Prohibited Lease Provision. Any provision of the Lease which falls within the classifications below shall not apply and not be enforced by the Landlord. (1) Confession of Judgment. Consent by the Tenant to be sued, to admit guilt, or to a judgment in favor of the landlord in a lawsuit brought in connection with the Lease. (2) Treatment of Property. Agreement by the Tenant that the Landlord may take or hold the Tenant's property, or may sell such property without notice to the Tenant and a court decision on the rights of the parties. (3) Excusing the Landlord from Responsibility. Agreeme� by the Tenant not to hold the Landlord or Landlord's agen�legally responsible for any action or failure to act, whethe'nien6a"al or negligent. (4) Waiver of Legal Notice. Agreement by the Tenant he Landlord may institute a lawsuit withoub(�Otice to the Tenant 5 Waiver of Court Proceedln s for EvictionL� th O g �Algreement by th ' Tenant that the Landlord may evicMh In (i)L ithout instituting a civil court proceedl 'gs in ich ijX}f as the �. .ci opportunity to present a d 2a" e, o» p efore at i ion by the court on the rights of the partle (6) Waiver of Jury Trial A"U onzatl 0 the Landlord to waive the Tenant's right to a trial i,R�l (7) Waiver o/Right to App ,Co r-t-.o Authorization to the Landlord to the the Teri nt' T .�t to appeal a court decision or waive the a ant ri ht to' to o'tQlevent a judgment from being put into effectp `t s (6) Te ges 1-� ith osnant Chart/ I Legal Actions Regardless o/ Out�imeaoMhe Lawsuii Agreement by the Tenant to pay la erjs fe�"es oho erlegal costs whenever the Landlord decides to sue 'y�het or4ig1heTenantwins. JrTe�a discrin Ia"on. The Landlord shall not discriminate against the ntin__thexovision of services, or in any other manner, on the s'QQ__arace, color, creed, religion, sex, handicap, national gn, orfa4niliai status. TENAN SIGNATURES LANDLORD SIGNATURES By: LANDLORD NAME: (Type or Print Name of Tenant Representative) By: (Signature/Date) (Type or Print Name of Landlord Representative) By: (Type or Print Name of Tenant Representative) (Signature/Date) (Signature/Date) i i Exhibit A - Appendix H Participant Agreement PARTICIPANT CONTRACT Service Provider's TBRA Program aims to provide homeless individuals with short-term rental subsidies,accompanied by intensive services, in order to rapidly transition homeless individuals into housing and prevent them from remaining homeless. At the same time,these services are designed to support individuals in achieving housing independence and realizing their full potential. I/We met with the Housing Stability Specialist and have elected to: Participate in the TBRA program Not Participate in the TBRA program Now that I have been accepted into the program, I understand that in order to remain eligible for services, I agree to j comply with the following Next Step Participant rules/guide lines: • I understand that 1 am responsible for managing all additional living expenses(i.e.utilities,sewage,water, garbage,food,etc.....)above and beyond what is paid for by my sub .7 �zz • 1 agree to schedule and meet with my Housing Stability Specialist as deteihed neces3ary but no less than one time per month with all meetings being at my housing location unless otherwiseagreed upon. I agree that if there is a conflict with the schedule, it is my responsibility to colifact.the Housing Stabdity.,Specialist lo,address/re- schedule the meeting. • 1 agree that there will be a mutual respect between myff6Qhg Stability:Specialist and myself. diiii • 1 am aware that the Housing Stability Specialist�mey completc:y housing i�nspectiondunng the home visits. ly • I agree to take initiative and cooperate in"to a Self Sufficiency Plan wlthmy Housing Stability Specialist that identifies and seeks to resolve bat?iers to pemi$nent housing including,but not limited to; u15 � O gaining or IRCrCLSmg,employment/in come a_llvin WagC Through job training/basic education o address debt issues,, o team or improve money management skulls o increase knowledge of hous'ingoptions and opportunities in the community. • 1 agree to complete and follow a budget andsa4inss plan. • 1 agree to provide'documentation as neede&by�my Housing Stability Specialist to provide proof of employment/mcome,'employment search applying, attendance records at job trainings,G.E.D.classes, proof of debt payments,etc.....during scheduled_imeetings. • I agree to notify,my Housing Stabilization'Case Manager of any lease violations or concerns. • I agree not to sublet or have anyone not already approved by the lease agreement to stay at the rental property for an extended period of I170G. - My signature below indicates,that Yunderstand what is expected of me by the TBRA Program and that in order to continue to be eligible for paiticipation in the program I must follow these rules guidelines. In addition 1 will be an active participant in my Self Sufficiency Plan. Participant Name Participant Signature Date Participant Name Participant Signature Date Housing Stability Specialist Signature Date [Type here] t i Exhibit A - Appendix I Utility Allowance OCCommunity Resources 2021 Utility Allowance Schedule The following utility allowances will be used by the Orange County Housing Authority for administration of the Housing Choice Voucher Program effective December 1, 2020. I .'��- �'�� �°��"' ��'�}Gas•-� _ .-��� - ��� I Cooking 3 4 6 7 9 11 Heating 16 18 21 22 25 27 Water Heating 9 10 14 20 26 31 Natural Gas Base Charcle 1 3 Oil gii%-v Basic 30 35 49 65 82 100 Cooking 6 7 12 17 21 25 Heating 19 22 25 28 30 35 Water Heating 17 22 31 37 44 51 Air Conditioninq 9 10 17 23 30 38 Water 45 49 71 104 138 171 Sewer 9 9 11 13 16 18 Trash 17 Refri erator 9 Stove 7 OC HOUSING AUTHORITY 1501 E. ST. ANDREW PLACE, FIPST FLOOR, SANFA ANA, CA 92705 1 P40NE (714) 480-2700 FAX (714) 480-2945 i Exhibit A - Appendix J Case Management and Self-Sufficiency Program Policies and Procedures i I I MERCYAHOUSE Case Management Guidelines and Written Standards HOME TBRA PROGRAM i Table of Contents I. Introduction............................................................................................................................................3 A. Program Overview......................... B. Housing First Policies........................................................................................................................3 II. Housing Search and Move-In...........................................................................................................4 A. Housing History and Search Plan................................................................................................4 i B. Participant Agreement..................................................................................................................4 C. Move-In.............................................................................................................................................5 III. Housing Stability...................................................................................................................................6 ' A. Case Management.......................................................................................................................6 Housing stability case management .........................................................................................6 Individualized Housing Stabilization Plans.................................................................................6 Housing Barriers Assessment..........................................................................................................7 Strengths Assessment Tool.............................................................................................................7 ExitPlanning Tool..............................................................................................................................7 B. Supportive Services.........................................................................................................................s ReferralProcedures.........................................................................................................................9 C. Length of Assistance/Recertification........................................................................................9 IV. Program Exit.......................................................................................................................................11 Involuntary Termination Policy...................................................................................................11 Voluntary Termination Process...................................................................................................12 Termination Appeal Process.......................................................................................................13 HMISExit............................................................................................................................................14 V. Grievance Procedure .....................................................................................................................14 Section 504 Grievance Procedure...........................................................................................is 2 I. Introduction A. Program Overview The HOME TBRA Program is targeted to homeless families and individuals. The goal of the program is to provide homeless households temporary financial assistance, housing relocation and stabilization services and provide resources that will enable them to maintain their housing once assistance has been expended. The program may provide; temporary financial assistance which may include deposit assistance and rental assistance, housing relocation and stabilization services, referrals to community resources, agency partners, and mainstream benefits to help households maintain stability. During their time in the program, households will work closely with a Housing Stability Specialist (HSS)to; secure housing and set housing stabilization goals. The HOME TBRA Program assistance is not intended to provide long-term support or to provide all supportive service needs that affect housing stability. The program instead is part of a plan made in partnership with the family and other community resources, agency partners, and mainstream benefits to help households regain stability. B. Housing First Policies Housing First is a program model designed for individuals and families who have complex service needs and are often turned away from homeless assistance programs. In applying Housing First principles to our HOME TBRA programs, Mercy House incorporates the following care elements to our program: • Program participant eligibility promotes the acceptance of individuals and families regardless of their sobriety status, employment status or participation in services. • Individuals and families may not be rejected from the program on the basis of poor credit or financial history, poor or lack of rental history, or behaviors that indicate lack of "housing readiness". • While not a Mercy House policy or prohibition, program participants with criminal convictions may be subject to landlord and property management requirements and terms of tenancy. • Mercy House accepts referrals from the Orange County Coordinated Entry System, which may include individuals and families residing in shelters, street outreach. drop-in centers, and other types of crisis responses systems that are frequented by vulnerable people experiencing homelessness. 3 • Supportive and stabilization services are offered to all program participants, but not made mandatory as a condition of tenancy. There is an emphasis on engagement and problem-solving goals to help overcome and troubleshoot barriers to acquiring/re-acquiring and maintaining permanent housing. • Use of alcohol or drugs (without other lease violations) is not considered reason for eviction or program termination. Nonetheless, program participants are subject to landlord and property management requirements and terms of lease. II. Housing Search and Move-In A. Housing History and Search Plan As soon as a participant is enrolled, the HSS will work with the participant to identify: housing history, barriers, housing preferences, affordability and goals. The initial housing search plan lists only those things that are needed to develop and conduct a successful housing search. The HSS and/or Leasing Agent may also provide them with leads on affordable housing options and properties with landlords that are agreeable to working with the program. The clients search plan may include: • Helping participants to complete application paper work and submit to leasing agents • Assisting participates with preparing to make personal contact with landlords (including dress, cleanliness, and presentation) when applying for housing. • Assisting participants to follow up with landlords, and/or a Mercy House Leasing Agent once a unit is identified to ensure paperwork needed to secure the unit and move in is complete. During this time, most of the focus of the case management relationship is on the housing search. However, participants may need other supports as well, including assistance gaining income, handling health or mental health issues, or other needs. B. Participant Agreement The client must sign a participation agreement that demonstrates their willingness to participate in case management and other terms including: • Provide accurate and honest information to the HSS or other agency staff. • Meet with their HSS at intervals established in their housing and service plan. • Work collaboratively with their HSS to establish a housing and service plan and take necessary steps to achieve the goals outlined in the 4 plan. • Provide current proof of income for subsidy recertification meetings. • Pay their portion of the rent on time every month and immediately advise their HSS if I have any trouble doing so. • Provide any documentation required by their HSS as it pertains to their services plan, rent or income (i.e. attendance record for job training, proof of debt payments, etc.) • Notify their HSS of any changes in income. • Sign a release of information so that their HSS can collaborate with any other service providers that they are working with. • Have a written lease for their apartment with a legitimate landlord. They may not sublet their unit or have anyone not already approved staying there for an extended period of time without the program approval. They must comply with all the requirements of their lease. C. Move-In Once the participant has located a unit and the unit has been approved by Mercy House the HSS, accompanied by a leasing Agent whenever possible, will schedule a move in appointment with the client at the apartment complex. At the Move In appointment the following will take place: • The HSS will read through the terms of the lease agreement with the client. The client may also opt to read through the documents on their own if they so desire and ask any questions to gain greater clarity. • When needed the client will be given guidance on how to access local resources in the area including public transportation, food banks and grocery stores as well as other local amenities to fit their needs. • The client may be provided with furniture and/or a welcome basket upon move in. • The client will be introduced to the property manager and made sure that they have contact information for the property manager, HSS for any and all ongoing needs. 5 III. Housing Stability A. Case Management The HOME TBRA case management philosophy is to provide the support necessary to help the household to retain housing once it is secured and to secure resources and make connections in the community that can help to sustain them after the program is over. The program is intended to be compassionate, individualized and Housing First oriented. Services are voluntary and participant may not be required to participate in specific services or to fulfil other service or compliance expectations (such as entering treatment) to be assisted. Nonetheless, to achieve the income levels or other supports needed to sustain housing, participants are expected to be actively engaged in whatever self-determined goals they have set in their housing stability plan. In order to monitor progress in the goal of housing stability, acceptance into the program requires that participants meet with a case manager not less than once per month while they are receiving assistance. Housing stability case management includes: • Co-developing a housing stability plan with the participant and a crisis plan. • Using the VI-SPDAT to inform case management needs and goals, especially for behavioral health and primary health issues. • Assisting the participant to increase income through employment, benefits or a combination of the two, as needed to sustain housing. • Supporting the participant to develop tenancy skills and addressing issues that may arise once in housing, including tenancy challenges and isolation. • Supporting the development of money management skills • Making referrals to, and working with the client to secure, a range of supportive services that the participant may need or want in the community,which may include: o Material supports for basic needs such as furniture, food and clothing o Vocational or employment services o Health and mental health care o Substance abuse treatment or recovery services, if needed o Legal services Individualized Housing Stabilization Plans The Housing Stability Specialist will gather information from the client about past housing experiences or instability, health, education, employment, family history, substance use, history of domestic violence, personal aspirations and skills, law enforcement history, and goals. From this information, the Housing Stability Specialist will work with client, utilizing a strength-based approach, to determine the goals of the Individualized Housing Stabilization Plan. Individualized Housing Stabilization Plans reflect the goals of the individual served. Including the client in the process of developing the Individualized Housing Stabilization 6 Plan creates a higher level of commitment from the client and allows them to visualize their goals in a tangible plan. Together a date will be determined for each goal to be met, or for steps to be taken toward completion of the goals. The Housing Stability Specialist will track the progress of the goals and goals will be updated as needed. The plan may identify a number of areas in which the client needs additional support including housing stabilization, financial, employment, credit counseling, life skills, sobriety, physical and mental health and others. The Housing Stability Specialist will provide resources and referrals to providers and others who can provide support for client to meet the goals. Once the goal is completed, they may set further related goals. i Ongoing meetings will take place as clients stabilize and meet their goals. Clients will be encouraged to continue setting goals, personal and aspirational as well as those that ore more imperative to ensure housing stability. Housing Barriers Assessment The VI-SPDAT provides us with valuable information on self-disclosed components of the client's history. Such elements include: mental health, wellness and cognitive thinking, physical health and wellness, medication, substance abuse history, experiences of abuse and/or trauma, risk of harm to self or others, involvement in high risk and/or exploitive situations, interaction with emergency services, legal involvement, managing tenancy, personal administration and money management, social relationships and networks, self-care and daily living skills, meaningful daily activities, and history of housing & homelessness. At entry we also engage clients in a dialogue about the reasons why they became homeless and what they believe they need in order to get back into stable housing. Strengths Assessment Tool A Strengths Assessment Tool enables us to identify each individual client's resources and motivations to create a path to housing and housing stabilization around them. These strengths often include resiliency, determination, resolve and desire to provide a safe environment for their children. Exit Planning Tool When HOME TBRA assistance is near completion it is important that clients begin to see themselves as capable agents in being able to support the stability of their housing on their own using the tools and resources we have provided them as a guide. To this extent we work with clients to develop an exit planning strategy that identifies their support networks, resources they can turn to, solutions to problems that may arise, steps they need to take to remain a good tenant and goals that they still may be working 7 toward. This exit planning tool helps to support a high rote of housing retention and reduction in homeless recidivism. B. Supportive Services Supportive services designed to meet the needs of the program participants are made available., In order to monitor progress in the goal of housing stability, acceptance into the program requires that participants meet with a case manager not less than once per month while they are receiving assistance. These meetings will be used to assist participants in obtaining appropriate supportive services, as well as connect them to other federal, state, local and private benefits and services for which they may be eligible. Program participants will work closely with a HSS to set housing stabilization goals and create a plan to maintain housing. Other supportive services provided to the client directly by Mercy House may include: • Housing search and counseling, which can include landlord mediation, credit counseling and payment of rental application fees • Life skills training such as budgeting, money management, household management, and other skills that may never have been learned or have been lost • Resources for Counseling • Benefits advocacy • Transportation assistance • Utility payments/deposits • Furniture • Food such as meals or groceries for program participants Mercy House may also provide referrals through partner agencies that Include: • Education services including consumer education, health education, substance abuse prevention, literacy, ESL and GED (can include the costs of tutoring, books, supplies, and instructional materials) • Employment assistance and job training • Legal services • Outpatient mental health services • Outpatient health services • Outpatient substance abuse treatment services • Other needs as presented by the program participant • Child Care Services • Housing subsidy programs such as voucher programs, VASH, EFSP, and PSH (as needed) 8 Referral Procedures A client's need for additional supportive services will be addressed in case management sessions. Mercy House Housing Stability Specialists are trained on resources that are available in the community and have access to electronic and other resource guides. Once a need is identified, the HSS will provide the client with a list of resource referrals, primary contact information and any other important information related to accessing the service. Clients with a lower level of acuity may opt to access the resource on their own. Clients with a higher level of acuity may be provided additional support to access the resource including arranging appointments and transportation to the service site. Bus passes and/or gas cards may be provided to client households as resources are available. The HSS may request these from the Program Manager. All bus posses and gift cards will be kept in a locked safe in a locked office or closet at all times when not in use. Mercy House staff members will not be permitted to transport guests under any circumstances in their personal vehicles. Once a HSS has provided a client with a resource referral they will include this referral in their case management meeting notes. At the subsequent case management session, the HSS will inquire as to the success of the resource connection. Here they will address and problem solve any remaining challenges that may hinder the client's ability to access the resource and provide additional support where and as needed. If the resource referral was successful, the HSS will note this in both the case notes. C. Length of Assistance/Recertification The program is intended to be based on a progressive engagement model in which support is offered for a short period and only extended as necessary. Financial assistance may be extended to up to 24 months, if the household is determined to need continued assistance at recertification intervals (every 6 months). Continued assistance may be determined by need, eligibility, funding regulation and funding availability, Any participant who receives more than six (6) months of assistance needs to be formally reassessed and recertified for continued assistance. This is distinguished from the more frequent check-ins and meetings with the client, which should occur at least monthly and as needed, and are recorded in case notes. To continue to receive assistance, a program participant's recertification must demonstrate eligibility based on: 1. Lack of resources and support networks. The program participant's household must continue to lack sufficient resources and support networks to retain housing without program assistance. 9 2. Need. The case manager will determine the amount and type of assistance that the individual or family will need to (re)gain stability in permanent housing. 3. Income. The program participant household's annual income must be less than or equal to 80%of Area Median Income (AMID Considerations for whether to continue assistance may be flexible but should focus on whether the participant has the means and capacity to be reasonably expected to retain their housing. Participant choice should also be considered. Other considerations may include the following: Indicators for closure Indicators for continuation sit Fh' +r. ae-£rr+f � �s "Yy, a t'vyi5�- Rip INCOM Income from all sources Is suI1Ic entin `� ,Cannot paytrent•ForanexGmonth ortwo' a „ acovey ent z ven If very/tlgh No In ome sourres avetlabl� `'g 4 tS House g,ssubsidyse ed3� h t , a t s zxt � � � -'3mn''°�SL`�, �. � � ��2S�e�cl�ln�com�or�ubs�ldy,approach inpracess, goals achlevetl � �",•-. q t.�,t� that needs mare time.. Recentincomecnsls_GLa LEASE In compliance -Currently In violation of lease or serious complaints • Landlord satisfied _ •Landlordaccepted client only if longer-term - support provided �.n. f �w� .ere; ' `� ^'E s ^�''� ya�,a �S:fis�' '•ss? LINKSar� �: Oth pro„ graams/res u�rcte a e�nI -No other tesour_ces �etwllling/aable ta azsts� s connecEtatandlll�p[ovideneeded_ y asks-fs_tance; ram`_ CHOICE Program participant wants to Program participant wants(and needs)additional complete services and exit assistance (adapted from materials from AbtAuodates) Even if there has been little change in income, at the recertification the program may increase the client's portion of the rent. The client should be reminded that the program is short term and they may be required to pick up the full rent once assistance as ended. Once the recertification is completed, the participant should be notified whether they will continue to receive case management and/or financial assistance or not. 10 IV. Program Exit A client will be exited from the program once their financial assistance has been completed. Clients who remain in permanent housing and may need continued support or resource referrals may at any time reach out to their HSS and/or another Mercy House staff member for on-going support. I Continued program assistance may be ended if a participant is inactive for an extended period, unable (or unwilling) to be reached, or consistently unwilling to make efforts consistent with the housing stability plan. Before any steps are taken to terminate a participant from the program, reasonable efforts will be made to offer additional assistance, including determining whether a different staff person should be assigned to the participant, and whether referral to another program is more suited for the participant. Efforts to address the issues should be documented and any recommendation for termination must be brought to a supervisor or to a team meeting. Whenever possible, termination from a program is limited to extenuating and severe circumstances. Housing assistance may be terminated if the program participant no longer meets certification qualification or if the participant violates program requirements. Between the time that a person is enrolled and before moving into housing, a participant may become inactive if they do not connect with provider for a month. After 30 days of inactive status, a client should be terminated from the program. If a participant is determined to be in continued or grave violation of the program rules, or has endangered staff or other tenants, a written Notice of Termination of Assistance will be provided containing a clear statement of the reasons for termination, the date on which the termination will become effective, and the grievance process. Involuntary Termination Policy t. Participants are to be given copies of both Program Agreement, grievance policy and this Termination Policy before participation begins. Participants shall acknowledge receipt of both documents in writing at program intake. 2. If at any time during the course of participation a Participant is not meeting their obligations to a standard lease contract or is in violation of program rules, the following shall apply: (a) The participant shall be given a verbal warning that they are out of compliance with either the lease or program rules. (If the issue remains unresolved after a verbal warning, go to (b)) 11 (b) The participant shall receive a written notice of program violation containing a reasonable period of time given to correct the issue. Generally 30 days. i. The participant shall work with their Housing Stabilization Case Manager to develop a written plan of action to correct the issue. The Participant shall retain a copy of the plan, and a copy shall be maintained in the Participant's file. ii. If at the end of the designated time period the issue has been corrected, the program violation is resolved. If the issue remains unresolved, go to (c). (c) If the participant does not follow the written plan of action, or the violation is not resolved by the date listed on the Program Violation, the program may, at its discretion, move to terminate the participant from the program. I. Participants shall be given written notice of termination written in clear, easy to understand language,with a proposed date of termination. This date should not be fewer than 30 days from the date of notification. • The Housing Stabilization Case Manager shall make notice to the landlord that financial assistance to the participant will terminate on the date the given to the tenant. ii. This notice shall come from the Housing Stabilization Case Manager. iii. The notice shall list the specific violations that prompted the termination and the attempts at resolution offered by program staff. iv. The notice must contain contact information for appeal. Reference Termination Appeal Process. 3. Involuntary termination must be reserved for the most serious of cases. Voluntary Termination Process If a participant is voluntarily terminated from the program, e.g., reached the maximum length of stay, or no longer requires support services and has identified other suitable housing. The following applies; (a) Participants shall be given written notice of termination written in clear, easy to understand language, with a proposed date of termination. This date should not be fewer than 30 days from the date of notification. i. The Program manager shall make notice to the landlord that financial assistance 10 the participant will terminate on the date the given to the tenant. (b) This notice shall come from the Housing Stabilization Case Manager (c) The notice shall list the specific circumstances that prompted the termination decision and the option for participant appeal. (d) The notice must contain contact information for the appeal. Reference Termination Appeal Process. 12 Termination Appeal Process A termination appeal policy and procedures has been established as a means to resolve certain complaints regarding termination from a Mercy House program. The Termination Appeal Procedure provides a method by which a program participant can have his or her termination from a program reviewed by a neutral person(s) other than the person who made or approved the termination decision. Step 1: • The first step in the Termination Appeal Procedure is a review by the Program Manager of the decision to terminate. • A program participant who desires to challenge the termination must submit a request for review of the termination to the Program Manager by completing Part 1 of the Termination Appeal Form provided by Mercy House. Part 1 of the Termination Appeal Form must be fully completed and signed and must state every reason why the program participant contests the termination and must specify the relief sought by the program participant. • The Termination Appeal Form must be delivered to the Program Manager and postmarked within fourteen (14) calendar days of the date the program participant received written notification of termination unless mutually extended. • The Termination Appeal Form may be obtained from any program staff member. Step 2: • The Program Manager, will investigate the circumstances surrounding the termination and may meet with the program participant, if it is deemed necessary, to discuss and/or attempt to resolve the program participant's complaint. • Program participant can appeal their termination verbally or in writing. • After investigating, the Program Manager will answer the program participant's complaint on Part 2 of the Termination Appeal Form. • The answer will be hand delivered or postmarked no later than fourteen (14) business days after the receipt of Part 1 of the Termination Appeal Form. • If mailed, the answer will be sent by certified mail, return receipt requested, to the address designated by the program participant on the Termination Appeal Form. Step 3: • In the event that the program participant is not satisfied with the results of the review of the Program Manager, the program participant may elect to request that his/her case be arbitrated by an Appeals Committee that will include the Program Director, Associate Director and/or the Executive Director and a Member of the Board of Directors. • A program participant who desires to challenge the review of the Program Manager and request arbitration by the Appeals Committee must submit a 13 request to the Program Director by completing the Part 3- "Appeals Committee Arbitration Request Form". The form must be delivered or postmarked no later than fourteen (14) business days after the receipt of Part 2 Appeal Decision. Step 4: • At the meeting, the claimant will begin by stating his/her case to the Appeals Committee. There the program participant will have the opportunity to present written or oral evidence or testimony in their defense. • The Appeals Committee may also request additional information from additional parties involved including testimony from the program staff member issuing the original termination. • The Appeals Committee will review all documentation and testimony and make a decision regarding any misconduct or need for repeal of action. • A written decision of the Termination Appeal will be provided no later than three (3) business days after the Appeals Committee Meeting, HMIS Exit Upon completion of the program (both subsidy and services), or upon termination prior to completion as described above, all the participant should be exited from the program in HMIS. At this time all information including income, address, housing status, and any changes in other conditions such as disabilities are recorded and updated. The Exit Form is an HMIS-provided form. A printed copy of the form(s) should be kept in the participant file and oll data entered into HMIS. V. Grievance Procedure A client can file a grievance to dispute an action or inaction and to address any client/staff conflict within 48 hours. Staff will make every effort to conduct an investigation and make a decision within 10 days. The grievance procedure does not suspend the rules or consequences established in the Program Rules. Clients have the right to file a grievance without fear of harmful repercussions from staff. All grievances need to be documented on a Grievance Form and submitted to the Program Director. Contact information for Directors is provided on the Grievance Form. Grievances should include the names of all parties involved, a detailed account of the nature of the problem and requested action to be taken. Grievance forms may be obtained from any staff member. 14 Program Directors will make every effort to resolve the conflict or concern with the client and or staff involved. If they are unable to do so they will submit the grievance to the Associate Director. The Associate Director will review grievances submitted and investigate the complaint. The Associate Director will acquire all documentation and interview involved parties as necessary. If the Associate Director feels that there is not enough information to determine if the matter was handled in an unfair manner a formal meeting will be called. At the meeting, the claimant will begin by stating his/her case to a Committee that will include the Associate Director, the Executive Director or their proxy. If necessary the Executive Staff may request a board member to sit on the committee as well. The committee may also request additional information from additional parties involved. The Committee will review all documentation and testimony and make a decision regarding any misconduct or need for repeal of action. If the complaint involves the Executive Staff a board member will take their place on the committee. Program participants also have the right to file a grievance with the Housing Division or HUD following procedures listed on httr)s://www.hud.gov/program offices/fair housing eaual oop/online-complaint. Section 504 Grievance Procedure It is the policy of Mercy House Living Centers not to discriminate on the basis of disability. Mercy House Living Centers has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and the regulations implementing the Act. Section 504 prohibits discrimination on the basis of disability in any program or activity receiving federal financial assistance. The law and regulations may be examined in the office of the Section 504 Coordinator. Any person who believes she or he has been subjected to discrimination on the basis of disability may file a grievance under this procedure. It is against the law for Mercy House Living Centers to retaliate against anyone who files a grievance or cooperates in the investigation of a grievance. Step one: Any person with a disability, and/or a representative of this person, may discuss a complaint and seek resolution of the complaint with the responsible employee or employees, or the employee's designee,within thirty (30) days of the date the person with the grievance becomes aware or reasonably should have been aware of the alleged discriminatory action. If the issue is not resolved within ten (10) working days following this discussion, the grievant may elect to move the grievance to Step 2. 15 Step 2: Grievances must be submitted to the Section 504 Coordinator within sixty (60) of the date the person filing the grievance becomes aware or reasonably should have been aware of the alleged discriminatory action. A complaint shall be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. Upon request, the complaint may be made using alternative formats. The Section 504 Coordinator, or her/his designee, shall conduct an investigation of the complaint. This investigation may be informal, but it must be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 504 Coordinator will maintain the files and records of Mercy House Living centers relating to such grievances. The Section 504 Coordinator will issue a written decision on the grievance no later than 30 working days after its filing. Upon request, the Section 504 Coordinator may issue a decision using alternative formats, although written documentation of all decisions shall be maintained by the Section 504 Coordinator. The person filing the grievance may appeal the decision of the Section 504 Coordinator by writing to the Board of Directors of Mercy House Living Centers within 15 days of receiving the Section 504 Coordinator's decision. The Board of Directors of Mercy House Living Centers shall issue a written decision in response to the appeal no later than 30 days after its filing. The availability and use of this grievance procedure does not prevent a person from filing a complaint of discrimination on the basis of disability with the U.S. Department of Housing and Urban Development's Office of Fair Housing & Equal Opportunity or other appropriate federal agency. Mercy House Living Centers will make appropriate arrangements to ensure that disabled persons are provided reasonable accommodations, if needed, to participate in this grievance process. Such arrangements may include, but are not limited to, providing interpreters for the deaf, providing taped cassettes of material for the blind, or assuring a barrier-free location for the proceedings. The Section 504 Coordinator will be responsible for such arrangements, in addition to, when requested, providing a list of organizations representing persons with disabilities. For further information about this policy, contact: The Mercy House Chief Operations Officer who has been designated as the Section 504 Patti Long, pottil@mercyhouse.net, (714) 836-7188 x 104. 16 I Exhibit A - Appendix K Addendum to Operating Procedures for the Tenant Based Rental Assistance Program ADDENDUM TO OPERATING PROCEDURES FOR TENANT BASED RENTAL ASSISTANCE PROGRAMS On April 10, 2020, the Housing and Urban Development Department, HUD, issued two memoranda, April 10, 2020 Memorandum — Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic and April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA) for Emergency and Short-term Assistance in Response to COVID-19 Pandemic. The memoranda prioritized the immediate housing needs of those impacted by COVID- 19 and the prevention of the spread of COVID-19 and to achieve such ends, j provided for numerous waivers and suspensions in current federal regulations and policies. The City's Community Development Department applied for and was granted the waivers and suspensions on April 22, 2020. The following waivers and suspensions, among others, were granted and impact the administration of the HOME Tenant Rental Based Assistance Program (TBRA) which provides rental assistance to low income individuals and families in Huntington Beach. April 10, 2020 Memorandum—Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic • HOME Program - 10% Administration and Planning Cap • HOME Program — Income Documentation • HOME Program — On-Site Inspections of HOME-assisted Rental Housing • HOME Program - Annual Inspection of Units Occupied by Recipients of HOME Tenant-Based Rental Assistance (TBRA) April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA)for Emergency and Short-term Assistance in Response to COVID-19 Pandemic • HOME Program —Consolidated Plan-HOME Certification, Analysis of Local Market Conditions, and Citizen Participation • HOME Program —Tenant Selection and Targeted Assistance • HOME Program - Eligible Tenant-based Rental Assistance Costs and Maximum TBRA Subsidy • HOME Program - Term of Rental Assistance Contract • HOME Program — Tenant Protections-Lease • HOME Program — Housing Quality Standards • HOME Program — Annual Inspection of Units Occupied by Recipients of HOME TBRA • HOME Program - Income Determinations HUD will be issuing further guidance on the waivers and suspensions. The City will adopt these guidelines within the program's operating procedures to ensure low income residents of Huntington Beach will be afforded maximum access to this program. The City will be required to provide written documentation of the changes to operating procedures and work closely with the service providers to ensure compliance of the modified regulations during the pandemic and its aftermath. i i I Exhibit A - Appendix L Emergency Transfer Plan and VAWA Lease Addendum CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM EMERGENCY TRANSFER PLAN Emergency Transfers i The City of Huntington Beach ("City") is concerned about the safety of its residents, and such concern extends to residents who are victims of domestic violence, dating violence, sexual assault, or stalking. In accordance with the Violence Against Women Act (VAWA), the City allows residents who are victims of domestic violence, dating violence, sexual assault, or stalking to request an emergency transfer from the resident's current unit to another unit. Despite the name of this law,VAWA protection is available to all victims of domestic violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity,or sexual orientation. The ability to request a transfer is available to all individuals as housing providers cannot discriminate on the basis of any protected characteristic,including race, color,national origin,religion,sex,familial status, disability,or age.United States Department of Housing and Urban Development(HUD)assisted and HUD- insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation, gender identity, or marital status. The ability of the City to honor such request for residents currently receiving assistance, however, may depend upon a preliminary determination that the resident is or has been a victim of domestic violence, dating violence, sexual assault,or stalking, and on whether the City has another dwelling unit that is available and is safe to offer the resident for temporary or more permanent occupancy. This plan identifies residents who are: 1. eligible for an emergency transfer; 2. the documentation needed to request an emergency transfer; 3. confidentiality protections; 4. how an emergency transfer may occur•, and 5. guidance to residents on safety and security. The City's plan is based on a model emergency transfer plan published by HUD, the Federal agency that provides funding to the City for its Tenant Based Rental Assistance (TBRA)Program and that oversees that the City is in compliance with VAWA. Eligibility for Emergency Transfers A resident who is a victim of domestic violence, dating violence, sexual assault,or stalking, as provided in HUD's regulations at 24 CFR part 5, subpart L is eligible for an emergency transfer, if: the resident reasonably believes that there is a threat of imminent harm from further violence if the resident remains within the same unit. If the resident is a victim of sexual assault, the resident may also be eligible to transfer if the sexual assault occurred on the premises within the 90-calendar-day period preceding a request for an emergency transfer. • A resident requesting an emergency transfer must expressly request the transfer in accordance with the procedures described in this plan. • Residents who are not in good standing may still request an emergency transfer if they meet the eligibility requirements in this section. According to HUD's regulation 24 CFR part 5, subpart L a victim includes the following: i Domestic violence includes felony or misdemeanor crimes of violence committed by a current or I former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies, or by any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws of the jurisdiction. Dating violence means violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors: The length of the relationship The type of relationship The frequency of interaction between the persons involved in the relationship Sexual assault means any nonconsensual sexual act proscribed by federal, tribal, or state law, including when the victim lacks the capacity to consent. Stalking means to engage in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress. Emergency Transfer Request Documentation To request an emergency transfer, the resident shall notify the TBRA case managers and complete a "VAWA Transfer Request" form.The completed form will be received by the TBRA service providers/case managers. The City working with the TBRA service providers/case managers will provide reasonable accommodations to this policy for individuals with disabilities. The resident's written request for an emergency transfer should include either: 1. A statement expressing that the resident reasonably believes that there is a threat of imminent harm from further violence if the resident were to remain in the same dwelling unit assisted under the TBRA's program; OR 2. A statement that the resident was a sexual assault victim and that the sexual assault occurred on the premises during the 90-calendar-day period preceding the residents request for an emergency transfer; AND I 3. Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking and alternate documentation form must be completed. (Refer to Form HUD-5382) i Confidentiality The TBRA Program service providers will keep confidential any information that the resident submits in requesting an emergency transfer, and information about the emergency transfer, unless the resident gives the TBRA Program service providers written permission to release the information on a time limited basis, or disclosure of the information is required by law or required for use in an eviction proceeding or hearing regarding termination of assistance from the covered program.This includes keeping confidential the new location of the dwelling unit of the tenant, if one is provided,from the person(s) that committed an act(s) of domestic violence, dating violence, sexual assault, or stalking against the resident. NOTE: See the Notice of Occupancy Rights under the Violence Against Women Act For All Tenants for more information about City's and TBRA service providers' responsibility to maintain the confidentiality of information related to incidents of domestic violence, dating violence,sexual assault, or stalking, Emergency Transfer Timing and Availability The City and its TBRA service provider partners cannot guarantee that a transfer request will be approved or how long it will take to process a transfer request.The City and its TBRA service provider partners will, however, act as quickly as possible to move a resident who is a victim of domestic violence, dating violence,sexual assault,or stalking to another unit,subject to availability and safety of a unit. If a resident reasonably believes a proposed transfer would not be safe, the resident may request a transfer to a different unit. If a unit is available, the transferred resident must agree to abide by the terms and conditions that govern occupancy in the unit to which the resident has been transferred.The City and its TBRA service provider partners cannot transfer a resident to a particular unit if the resident has not or cannot establish eligibility for that unit. If the City and its TBRA service provider partners have no safe and available units for which a resident who needs an emergency is eligible, City and its TBRA service provider partners will identify other housing providers who may have safe and available units to which the resident could move. At the resident's request, City and its TBRA service provider partners will also assist residents in contacting the local organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking. Safety and Security of Residents Pending processing of the transfer and the actual transfer, if it is approved and occurs, the resident is urged to take all reasonable precautions to be safe. National Resources: Residents who are or have been victims of domestic violence are encouraged to contact the National Domestic Violence Hotline at 1.800-799-7233, or a local domestic violence shelter, for assistance in creating a safety plan. For persons with hearing impairments, that hotline can be accessed by calling 1- 800-7873224(Try). i Residents who have been victims of sexual assault may call the Rape, Abuse & Incest National Network's National Sexual Assault Hotline at 800-656-HOPE,or visit the online hotline at https://www.rainn.orF/ i Residents who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/ourprograms/stalking-resource- center VIOLENCE, DATING VIOLENCE U.S. Department of Housing OMB Approval No.2502.0204 OR STALKING and Urban Development Exp.6/30rz017 Office of Housing LEASE ADDENDUM VIOLENCE AGAINST WOMEN AND JUSTICE DEPARTMENT REAUTHORIZATION Act'of 2013 TENANT LANDLORD UNIT NO. &ADDRESS This lease addendum adds the following paragraphs to the Lease between the above referenced Tenant and Landlord. Purpose of the Addendum The lease for the above referenced unit is being amended to include the provisions of the Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA). Conflicts with Other Provisions of the Lease In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. Term of the Lease Addendum The effective date of this Lease Addendum is This Lease Addendum shall continue to be in effect until the Lease is terminated. VAWA Protections 1. The Landlord may not consider incidents of domestic violence, dating violence or stalking as serious or repeated violations of the lease or other"good cause" for termination of assistance, tenancy or occupancy rights of the victim of abuse. 2. The Landlord may not consider criminal activity directly relating to abuse, engaged in by a member of a tenant's household or any guest or other person under the tenant's control, cause for termination of assistance, tenancy, or occupancy rights i f the tenant or an immediate member of the tenant's family is the victim or threatened victim of that abuse. 3. The Landlord may request in writing that the victim, or a family member on the victim's behalf, certify that the individual is a victim of abuse and that the Certification of Domestic Violence, Dating Violence or Stalking, Form HUD-91066, or other documentation as noted on the certification form, be completed and submitted within 14 business days, or an agreed upon extension date, to receive protection under the VAWA. Failure to provide the certification or other supporting documentation within the specified timeframe may result in eviction. Tenant Date Landlord Date Form HUD-91067 (9/2008) i I I Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements I Mercy House (Subrecipient) shall comply with the requirements set forth in this document at all times during the term of the HOME Subrecipient Agreement(Agreement) between the City of Huntington Beach (City)and Subrecipient, to which this document is attached. I. Documentation and Recordkeeping A. Records to be Maintained Subrecipient shall maintain all records required by the federal regulations specified in 24 CFR 92.508(a)(3),which are pertinent to the Services to be funded under the Agreement. Records shall be maintained for each prospective participant,each Eligible Household and each Housing Unit inspected and/or occupied by an Eligible Household pursuant to the Agreement. Such records shall include but are not limited to: • Records providing a full description of each activity undertaken. • Records required to determine the eligibility of activities for use of HOME funds. • Records(including property inspection reports) demonstrating that each Housing Unit occupied by an Eligible Household meets the property standards of 24 CFR 92.251(d) and 24 CFR 982.401 upon occupancy and at the time of each annual inspection. • Records demonstrating compliance with the property standards and financial reviews and actions pursuant to 24 CFR 492.504(d). • Records demonstrating that each Eligible Household is income eligible in accordance with 24 CFR 92.203, including all TBRA applications,eligibility determinations and documentation regarding any appeals of eligibility determinations. • Records demonstrating that Subrecipient is in compliance with the City's written tenant selection policies and criteria of 24 CFR 92.209(c), including any targeting provisions of 24 CFR 92.209(h),and calculation of each Subsidy Payment. • Records demonstrating that each rental agreement for an Eligible Household receiving Subsidy Payments complies with the tenant and participant protections of 24 CFR 92.253. Records documenting compliance with Subrecipients marketing and outreach obligations under the Agreement, including compliance with the fair housing and equal opportunity components of the HOME program and HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan,when adopted. Records documenting compliance with the lead-based hazards requirements under the Agreement, the HOME Program,and 24 CFR Part 35, subparts A, B,J, K, M and R. • Financial records as required by 24 CFR 492.508(a)(5) and 24 CFR§92.222. • Records documenting the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program, specifically including 24 CFR 92.218 through 24 CFR 92.222. B. Retention The Subrecipient shall retain all financial records, supporting documents, statistical records, and all other records pertinent to the Agreement for a period of five years after the period of Subsidy Payments terminates. Notwithstanding the above, if there are litigation matters,claims, audits, negotiations or other actions that involve any of the records cited and that have started before the expiration of the five-year period, then all pertinent records must be retained until completion of the actions and resolution of all issues,or the expiration of the five-year period,whichever occurs later. C. Client Data The Subrecipient shall maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to, client name, address, income level or other basis for determining eligibility,and description of service provided. Such information shall be made available to City monitors or their designees for review upon request. D. Disclosure The Subrecipient understands that client information collected under this Agreement is private and the use or disclosure of such information, when not directly connected with the administration of the City's or Subrecipient's responsibilities with respect to Services provided under this Agreement, is prohibited unless written consent is obtained from such person receiving services and, in case of a minor, that of a responsible parent/guardian. E. Close Outs The Subrecipient's obligation to the City shall not end until all close-out requirements are completed, Activities during the close-out period shall include, but are not limited to: making final payments, disposing of program assets(including the return of all unused materials, equipment, unspent cash advances, program income balances, and accounts receivable to the City),and determining the custodianship of records. Notwithstanding the foregoing, the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over HOME funds, including program income. F. Audits and Inspections All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the City, HUD and the Comptroller General of the United States or any of their authorized representatives, at any time during normal business hours, as often as deemed necessary,to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of the Agreement and may result in the withholding of future payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current City policy concerning Subrecipient audits and OMB Circular A-122. Il. Monthly Progress Reports Subrecipient shall submit Monthly progress reports to the City in a form approved or directed by the City,which shall include all of the following information regarding Subrecipient's activities during the prior quarter: • The number of TBRA applications received, processed,approved and disapproved. • The number of Housing Units inspected,approved and disapproved and a description of any corrective work performed by Landlords to comply with HQS. • The number of Eligible Households assisted, including specific information regarding the number of and ages of all household members, income categories, types and amounts of assistance provided to each Eligible Household,and remaining terms of assistance expected to be provided to such households. • Description of each Eligible Household's participation in required self-sufficiency program and other optional social and supportive Services provided or otherwise made available to each Eligible Household. Budget reconciliation information, Including year-to-date expenditures and remaining balance available for Subsidy Payments in accordance with the Budget and the Agreement. • Number of additional Eligible Households Subrecipient expects to qualify and assist within the following three-month period. • Updated schedule of performance of the Services under the Agreement, including a schedule for qualifying and assisting additional Eligible Households as permitted by the Budget. • Information regarding any complaints receipted from Applicants or Eligible Households and any correspondence received from community members or organizations or other nonprofit organizations regarding the Program or specific activities or individuals involved in the Program. • Documentation of the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program,specifically including 24 CFR 92.218 through 24 CFR 92.222. Ill. Performance Monitoring A. Monthly Reports Subrecipient shall provide progress reports on a Monthly basis during the first quarter of the Term of the Agreement in order for the City to review Subrecipient's activities and progress under the Agreement and to ensure that the Program is progressing smoothly. B. City Oversight and Review City will monitor the performance of the Subrecipient against the goals and performance standards set forth in the Agreement. From time to time, City shall be entitled to audit and review Subrecipient's performance of the Services in accordance with the terms of the Agreement and compliance with the HOME Program. Substandard performance as determined by the City will constitute noncompliance with the Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, termination procedures will be initiated in accordance with Section 8.3 of the Agreement. I I i Exhibit C I Gross Income Calculation Form INCOME QUALIFICATION - COMPUTING ANNUAL INCOME 1. Head of Household Name: 2. D.O.B.: Date: Assets Current Case Actual Value of Income from Family Member Asset Description Assets Assets 50.00 $0.00 $0.00 $0.00 $0.001 $0.00 $0.001 $0.00 3. Net Case Value of Assets................................................................ 4.Total Actual Income from Assets............................................................................. 5. If line 3 is greater than$5,000.00, multiply line by 2%(Passbook Rate)and i enter results here; otherwise, leave blank. ANTICIPATED ANNUAL INCOME Family a. b. Benefits/ c. Public d. Other e. Asset Members Wagers/Salaries Pensions Assistance Income Income Enter the greater of lines 4 or 5 above in e. 6.Totals: 7. Enter total of Items from Sa.Through 5e.This is the Annual Income................ $0.00 Head of Household Sign Name: Date: For Office Use Only N of HH members $ Income of household Income limit 0-30% $28,250 $32,300 $36,350 $40,350 $43,600 $46,850 $50,050 $53,300 30-50% $47,100 $53,800 $60,550 $67,250 $72,650 $78,050 $83,400 $88,800 50-80% $75,3 0 T86,050 96,800 $107,550 $116,200 $124,800 $133,400 $142,000 I, verify to the best of my knowledge, based on the documenation that the above client has provided to me that the above information meets the income eligibility and does not exceed the HUD income limits. Case Manager Sign Name: Date: ,I Exhibit D Household Budget Worksheet GAP ANALYIS OF ASSISTANCE Applicant's Name: INCOME Income(See Computing Part 5 Annual Income) ,Wn5A t�0_'.➢Q Groceries Income Eligible to be Excluded from the Amount Above Personal Supplies WE- 11 ClothingCleaning/laundry Education/Lessons Or00 Dining/Eating Out blo0 Salon/Barber �'si.._;,s;0_00 ay.Sr"�s. .e Pet Food ,`(Total INCOME. ^ Storage La' ¢OE00 EXPENSES " I • Videos/DVOs Rent ':3a 0100 music ,Do rental Insurance -ir 0!00 Games 0?00 Electricity '_ 3`yaOl00 Rentals Ge5/011 a ;:' .OT00 Movies/Theater Lam" a01.00 Water/Sewer/Trash ' ,"> 70100 Concerts/Plays �m ,�0100 Phone � DO Book I 0!000 j Cable/Satellite t "K--, 0100 Hobbles g 'go-rob. Internet -''0(00 Film/Photos -_;'"0100 Fumishings/Appliances 5-'a`m x000 Sports 00 Lawn/Garden i R d O utoor Recreation x0i00 Maintenance/Supplies =00 Toys/Gadgets Improvements ;?`;',�-',s''-`; .0!00 Vacation/Travel Other tom, "s0 00 Other f��-,�--- coo TatiatJIE"SRT/i1NMEN7& WA WE •. Vehicle Payments Sr'gws'�.,;'„y,,0100 Emergency FundD!00 Auto Insurance `K- �*"1.,0i00 Transfer to Savings - oT __x r ss s�:e.ao.ao Fuel 0{00 Retirement(401k,IRA) -'"�-; "=0100 Bus/Taxl/Traln Fare LO!� Investments L�. y 'a0!OD Repairs A ,rK-a!00 Education z0'DO Registration/License 't "'ADO Other '��,'i-i ,�y0:00 other t rFS%r':bOb To`` SAVING t �c "���=r ��' ,' 'tdf�GT�N6FORl'Wf_ION� - .r • Student Loan ✓ D:00 Health Insurance ;3 g0!00 Other Loan Doctor/Dentist 9!001 Credit Cards Medicine/Drugs `WxO?00 Alimony/Child Support Health Club Dues ,-i0r00 Federal Taxes *00 Life Insurance s�?'`"r�1 .0'00 State/Local Taxes +i�. �i0E00 Veterinarian/Pet Care other - MOO Other SUBSCRIPTIONS Bank Fees -iy r? 0!00 m Newspaper 0`'.am0_00 Postage Magazines Other Dues/Memberships Othere_-y000 Other Do "' TSkSiCMISBECNaNE0t15j ,_ df>!. `"yTotaCS085C�tIPSTOH -, , Total.Expenses _ Emergency Solutions Grant ANALYIS OF ASSISTANCE (continued) E5G Applicant Name: MONTHLY ANALYSIS AT ENTRYIN OF GROSS I INCOME Total Monthly Income '$g ;fi Total Monthly Expenses Monthly Rent cost 000 Housing Relocation and Stabilization Expenses Divided by Monthly Gross income ? SQ'00 Funds available/(Funds Needed) Equals JIhIVL01 If there are funds available no assistance Is needed 4 x 100(%of income to rent) ist month&Deposit assistance cannot exceed Schedule of Assistance - Security Deposit I Ist Month- y� 2nd Month xIX 3rd Month. ;; Total Assistance i Exhibit E Lead-Based Hazard Information Pamphlet "Protect Your Family from Lead in your Home" f Protect Your _ Family From Lead in Your f. Home .t • .. A United States EPA Prtttectio Agency Protection Agency United States -� N`_ r•�, ,, r Consumer Product Safety Commission United States Department of Housing II�II�II and Urban Development December 2012 Are You Planning to Buy or Rent a Home Built Before 1978? Did you know that many homes built before 1978 have lead-based paint? Lead from paint,chips,and dust can pose serious health hazards. Read this entire brochure to learn: • How lead gets into the body • About health effects of lead • What you can do to protect your family • Where to go for more information Before renting or buying a pre-1978 home or apartment,federal law requires: • Sellers must disclose known information on lead-based paint or lead- based paint hazards before selling a house. • Real estate sales contracts must include a specific warning statement about lead-based paint.Buyers have up to 10 days to check for lead. • Landlords must disclose known information on lead-based paint and lead-based paint hazards before leases take effect. Leases must include a specific warning statement about lead-based paint. If undertaking renovations, repairs,or painting(RRP) projects in your pre-1978 home or apartment: Read EPA's pamphlet, The Lead-Safe Certified Guide to Renovate Right, to learn about the lead-safe work practices that contractors are required to follow when working in your home(see page 12). ;�1 I Simple Steps to Protect Your Family from Lead Hazards If you think your home has lead-based paint: Don't try to remove lead-based paint yourself. Always keep painted surfaces in good condition to minimize deterioration. Get your home checked for lead hazards.Find a certified inspector or risk assessor at epa.gov/lead. • Talk to your landlord about fixing surfaces with peeling or chipping paint. • Regularly clean floors,window sills,and other surfaces. • Take precautions to avoid exposure to lead dust when remodeling. • When renovating,repairing,or painting,hire only EPA-or state- approved Lead-Safe certified renovation firms. • Before buying, renting,or renovating your home have it checked for lead-based paint. • Consult your health care provider about testing your children for lead.Your pediatrician can check for lead with a simple blood test. • Wash children's hands,bottles,pacifiers,and toys often. • Make sure children eat healthy,low-fat foods high in iron, calcium,and vitamin C. • Remove shoes or wipe soil off shoes before entering your house. 1 i Lead Gets into the Body in Many Ways Adults and children can get lead into their bodies If they: Breathe in lead dust(especially during activities such as renovations, repairs,or painting that disturb painted surfaces). Swallow lead dust that has settled on food,food preparation surfaces, and other places. Eat paint chips or soil that contains lead. Lead is especially dangerous to children under the age of 6. • At this age,children's brains and nervous systems are more sensitive to the damaging effects of lead. • Children's growing bodies absorb more lead. t ;1 • Babies and young children often put their hands 1 _ and other objects in their mouths.These objects can have lead dust on them. Women of childbearing age should know that lead is dangerous to a developing fetus. i • Women with a high lead level in their system before or during pregnancy risk exposing the fetus to lead through the placenta during fetal development. 2 Health Effects of Lead Lead affects the body in many ways. It is important to know that even exposure to low levels of lead can severely harm children. In children,exposure to lead can cause: a,,,nN.•,.M. ,. Nervous system and kidney damage Ro°^ Learning disabilities,attention deficit disorder,and decreased intelligence va.e Speech,language,and behavior problems Poor muscle coordination Decreased muscle and bone growth Hearing damage asn„n � While low-lead exposure is most common, mN• exposure to high amounts of lead can have devastating effects on children, including seizures,unconsciousness,and,in some cases,death. Although children are especially susceptible to lead exposure,lead can be dangerous for adults,too. In adults,exposure to lead can cause: • Harm to a developing fetus • Increased chance of high blood pressure during pregnancy • Fertility problems(in men and women) • High blood pressure • Digestive problems • Nerve disorders • Memory and concentration problems • Muscle and Joint pain 3 Check Your Family for Lead I j Get your children and home tested if you think your home has lead. Children's blood lead levels tend to increase rapidly from 6 to 12 months of age,and tend to peak at 18 to 24 months of age. Consult your doctor for advice on testing your children.A simple blood test can detect lead.Blood lead tests are usually recommended for: • Children at ages 1 and 2 • Children or other family members who have been exposed to high levels of lead • Children who should be tested under your state or local health screening plan Your doctor can explain what the test results mean and if more testing will be needed. 4 i Where Lead-Based Paint Is Found In general,the older your home or childcare facility,the more likely it has lead-based paint.' Many homes,including private,federally assisted,federally owned housing,and childcare facilities built before 1978 have lead-based paint.In 1978,the federal government banned consumer uses of lead- containing paint? Learn how to determine if paint is lead-based paint on page 7. Lead can be found: • In homes and childcare facilities in the city,country,or suburbs, • In private and public single-family homes and apartments, • On surfaces Inside and outside of the house,and • In soil around a home.(Soil can pick up lead from exterior paint or other sources,such as past use of leaded gas in cars.) Learn more about where lead is found at epa.gov/lead. 'Lead-based paint'is currently defined by the federal government as paint with lead levels greater than or equal to 1.0 milligram per square centimeter(mg/cm),or more than 0.5%by weight. ' 'Lead-containing palnt"is currently defined by the federal government as lead in new dried paint in excess of 90 parts per million(ppm)by weight. 5 Identifying Lead-Based Paint and Lead-Based Paint Hazards Deteriorating lead-based paint(peeling,chipping,chalking, cracking,or damaged paint) is a hazard and needs immediate attention.Lead-based paint may also be a hazard when found on surfaces that children can chew or that get a lot of wear and tear,such as: • On windows and window sills • Doors and door frames • Stairs,railings, banisters,and porches Lead-based paint is usually not a hazard if it is in good condition and if it Is not on an impact or friction surface like a window. Lead dust can form when lead-based paint is scraped,sanded,or heated. Lead dust also forms when painted surfaces containing lead bump or rub together.Lead paint chips and dust can get on surfaces and objects that people touch.Settled lead dust can reenter the air when the home is vacuumed or swept,or when people walk through it.EPA currently defines the following levels of lead in dust as hazardous: 40 micrograms per square foot(pg/ft')and higher for floors, including carpeted floors 250 pg/ft'and higher for interior windowsills Lead in soil can be a hazard when children play in bare soil or when people bring soil into the house on their shoes.EPA currently defines the following levels of lead In soil as hazardous: • 400 parts per million (ppm)and higher in play areas of bare soil • 1,200 ppm (average)and higher in bare soil in the remainder of the yard Remember,lead from paint chips—which you can see—and lead dust—which you may not be able to see—both can be hazards. The only way to find out if paint,dust,or soil lead hazards exist is to test for them.The next page describes how to do this. 6 i Checking Your Home for Lead You can get your home tested for lead in several different ways: A lead-based paint Inspection tells you if your home has lead- based paint and where it is located.It won't tell you whether your home currently has lead hazards.A trained and certified testing professional,called a lead-based paint inspector,will conduct a paint inspection r� using methods,such as: • Portable x-ray Fluorescence (XRF) machine �A , • Lab tests of paint samples A risk assessment tells you If your home currently has any lead hazards from lead in paint,dust,or soil.It also tells you what actions to take to address any hazards.A trained and certified testing professional, called a risk assessor,will: • Sample paint that Is deteriorated on doors,windows,Floors,stairs, and walls • Sample dust near painted surfaces and sampling bare soil in the yard • Get lab tests of paint,dust,and soil samples A combination inspection and risk assessment tells you if your home has any lead-based paint and if your home has any lead hazards,and where both are located. Be sure to read the report provided to you after your inspection or risk assessment is completed,and ask questions about anything you do not understand. 7 Checking Your Home for Lead, continued i In preparing for renovation, repair,or painting work in a pre-1978 home,Lead-Safe Certified renovators (see page 12) may: • Take paint chip samples to determine if lead-based paint Is present in the area planned for renovation and send them to an EPA-recognized lead lab for analysis. In housing receiving federal assistance,the person collecting these samples must be a certified lead-based paint inspector or risk assessor • Use EPA-recognized tests kits to determine If lead-based paint is absent(but not In housing receiving federal assistance) • Presume that lead-based paint Is present and use lead-safe work practices There are state and federal programs in place to ensure that testing is done safely, reliably, and effectively.Contact your state or local agency for more information,visit epa.gov/lead,or call 1-800-424-LEAD (5323)for a list of contacts in your area' ' Hearing-or soeech challenged individuals may access this number through TTY by calling the Federal Relay Service at 1-800-877-8399. 8 i What You Can Do Now to Protect Your Family I If you suspect that your house has lead-based paint hazards,you can take some immediate steps to reduce your family's risk: If you rent,notify your landlord of peeling or chipping paint. Keep painted surfaces clean and free of dust.Clean floors,window frames,window sills,and other surfaces weekly.Use a mop or sponge with warm water and a general all-purpose cleaner.(Remember: never mix ammonia and bleach products together because they can form a dangerous gas.) Carefully clean up paint chips Immediately without creating dust. Thoroughly rinse sponges and mop heads often during cleaning of dirty or dusty areas,and again afterward. Wash your hands and your children's hands often,especially before they eat and before nap time and bed time. Keep play areas clean.Wash bottles, pacifiers,toys,and stuffed animals regularly. Keep children from chewing window sills or other painted surfaces,or eating soil. When renovating,repairing,or painting,hire only EPA- or state- approved Lead-Safe Certified renovation firms (see page 12). Clean or remove shoes before entering your home to avoid tracking in lead from soil. Make sure children eat nutritious,low-fat meals high in iron,and calcium, such as spinach and dairy products.Children with good diets absorb less lead. 9 Reducing Lead Hazards Disturbing lead-based paint or -A 6 I_ I removing lead improperly can _;. 3 .� Increase the hazard to your family by F§ spreading even more lead dust around the house. - O • In addition to day-to-day cleaning and good nutrition,you can -_ temporarily reduce lead-based paint - hazards by taking actions,such as i r repairing damaged painted surfaces and planting grass to cover lead- contaminated soil.These actions are not permanent solutions and will need ongoing attention. • You can minimize exposure to lead when renovating,repairing,or painting, by hiring an EPA-or state- certified renovator who is trained in the use of lead-safe work practices.If you are a do-it-yourselfer,learn how to use lead-safe work practices in your home. • To remove lead hazards permanently,you should hire a certified lead abatement contractor.Abatement(or permanent hazard elimination) methods include removing,sealing,or enclosing lead-based paint with special materials.Just painting over the hazard with regular paint is not permanent control. Always use a certified contractor who Is trained to address lead hazards safely. Hire a Lead-Safe Certified firm (see pagel 2)to perform renovation, repair,or painting (RRP) projects that disturb painted surfaces. To correct lead hazards permanently,hire a certified lead abatement professional.This will ensure your contractor knows how to work safely and has the proper equipment to clean up thoroughly. Certified contractors will employ qualified workers and follow strict safety rules as set by their state or by the federal government. 10 Reducing Lead Hazards, continued If your home has had lead abatement work done or if the housing is receiving federal assistance,once the work is completed,dust cleanup activities must be conducted until clearance testing indicates that lead dust levels are below the following levels: • 40 micrograms per square foot(Ng/ft')for floors,including carpeted floors i • 250 pg/ft'for interior windows sills • 400 pg/ft'for window troughs For help in locating certified lead abatement professionals in your area, call your state or local agency(see pages 14 and 15),or visit epa.gov/lead,or call 1.800-424-LEAD. 11 Renovating, Remodeling, or Repairing (RRP) a Home with Lead-Based Paint i If you hire a contractor to conduct renovation,repair,or painting (RRP)projects in your pre-1978 home or childcare facility(such as pre-school and kindergarten),your contractor must: • Be a Lead-Safe Certified firm approved by EPA or an EPA-authorized state program 4 • Use qualified trained individuals(Lead-Safe Certified renovators) who follow specific lead-safe work practices to prevent lead contamination • Provide a copyof EPA's lead hazard information document, The Lead-Safe Certified Guide to Renovate Right RRP contractors working in pre-1978 homes and childcare facilities must follow lead-safe work practices that: Contain the work area.The area must be contained so that dust and debris do not escape from the work area.Warning signs must be put up,and plastic or other impermeable material and tape must be used. Avoid renovation methods that generate large amounts of lead-contaminated dust.Some methods generate so much lead- contaminated dust that their use is prohibited.They are: Open-Flame burning or torching Sanding,grinding, planing,needle gunning,or blasting with power tools and equipment not equipped with a shroud and HEPA vacuum attachment and Using a heat gun at temperatures greater than i 700°F Clean up thoroughly.The work area should be cleaned up daily. When all the work is done,the area must be cleaned up using special cleaning methods. Dispose of waste properly.Collect and seal waste in a heavy duty bag or sheeting.When transported,ensure that waste is contained to prevent release of dust and debris. To learn more about EPA's requirements for RRP projects visit epa.gov/getleadsafe,or read The Lead-Safe Certified Guide to 12 Renovate Right. Other Sources of Lead While paint,dust,and soil are the most common sources of lead, other lead sources also exist: • Drinking water.Your home might have plumbing with lead or lead solder.You cannot see,smell,or taste lead,and boiling your water will not get rid of lead.If you think your plumbing might contain lead: • Use only cold water for drinking and cooking. • Run water for 15 to 30 seconds before drinking it, especially if you have not used your water for a few hours. Call your local health department or water supplier to find out about testing your water,or visit epa.gov/lead for EPA's lead in drinking water information. • Lead smelters or other industries that release lead into the air. • Yourjob.If you work with lead,you could bring It home on your body or clothes.Shower and change clothes before coming home.Launder your work clothes separately from the rest of your family's clothes. • Hobbies that use lead,such as making pottery or stained glass, or refinishing furniture.Call your local health department for Information about hobbies that may use lead. • Old toys and furniture may have been painted with lead-containing paint.Older toys and other children's products may have parts that contain lead.' • Food and liquids cooked or stored in lead crystal or lead-glazed pottery or porcelain may contain lead. Folk remedies,such as"greta"and "azarcon"used to treat an upset stomach. ' In 1978,the federal government banned toys,other children's products,and furniture with lead containing paint(16 CFR 1303).In 2008,the federal government banned lead in most children's products.The federal government currently bans lead in excess of 100 ppm by weight in most children's products(76 FR 44463). 13 For More Information The National Lead Information Center Learn how to protect children from lead poisoning and get other information about lead hazards on the Web at epa.gov/lead and hud.gov/lead,or call 1-800-424-LEAD(5323). EPA's Safe Drinking Water Hotline For information about lead in drinking water,call 1-800-426-4791,or visit epa.gov/lead for information about lead in drinking water. Consumer Product Safety Commission (CPSC)Hotline For information on lead In toys and other consumer products,or to report an unsafe consumer product or a product-related injury,call 1-800-638-2772,or visit CPSC's website at cpsc.gov or saferproducts.gov. State and Local Health and Environmental Agencies Some states,tribes,and cities have their own rules related to lead- based paint.Check with your local agency to see which laws apply to you.Most agencies can also provide information on finding a lead abatement firm in your area,and on possible sources of financial aid for reducing lead hazards.Receive up-to-date address and phone information for your state or local contacts on the Web at epa.gov/lead, or contact the National Lead Information Center at 1-800-424-LEAD. Hearing-or speech-challenged individuals may access any of the phone numbers in this brochure through TTY by calling the toll- free Federal Relay Service at 1-800-877-8339. 14 U. S. Environmental Protection Agency (EPA) Regional Offices The mission of EPA is to protect human health and the environment. Your Regional EPA Office can provide further information regarding regulations and lead protection programs. Region 1(Connecticut,Massachusetts.Maine, Region 6(Arkansas,Louisiana,New Mexico, New Hampshire,Rhode Island,Vermont) Oklahoma,Texas,and 66 Tribes) Regional Lead Contact Regional Lead Contact U.S.EPA Region 1 1445 Ross Avenue,12th Floor Suite 1100(CPT)One Congress Street Dallas,TX 75202-2733 Boston,MA 02114-2023 (214)665-2704 (617)918-1524 Region 7(Iowa,Kansas.Missouri,Nebraska) Region 2(New Jersey,New York,Puerto Rico, Regional Lead Contact Virgin Islands) U.S.EPA Region 7 Regional Lead Contact 11201 Renner Blvd. U.S.EPA Region 2 W WPD/TOPE 2890 Woodbridge Avenue Lenexa,KS 66219 Building 205,Mail Stop 225 (800)223-0425 Edison,NJ 08837-3679 (732)321-6671 Region 8(Colorado,Montana.North Dakota,South Dakota,Utah,Wyoming) Region 3(Delaware,Maryland,Pennsylvania, Regional Lead Contact Virginia,OC,West Virginia) U.S.EPA Region 8 Regional Lead Contact 1595 Wynkoop St. U.S.EPA Region 3 Denver,CO 80202 1650 Arch Street (303)312-6966 Philadelphia,PA 19103 (215)814-2088 Region 9(Arizona,California,Hawaii, Nevada) Region 4(Alabama,Florida,Georgia, Regional Lead Contact Kentucky,Mississippi,North Carolina,South U.S.EPA Region 9(CMD-4-2) Carollna,Tennessee) 75 Hawthorne Street Regional Lead Contact San Francisco,CA 94105 US.EPA Region 4 (415)947-4280 AFC Tower,12th Floor,Air,Pesticides&Toxics 61 Forsyth Street,SW Region 10(Alaska,Idaho,Oregon, Atlanta,GA 30303 Washington) (404)562-8998 Regional Lead Contact Region 5(Illinois,Indiana,Michigan, U.S.EPA Region 10 Minnesota,Ohio,Wisconsin) Solid Waste&Toxics Unit(WCM-128) 1200 Sixth Avenue,Suite 900 Regional Lead Contact Seattle,WA 98101 U.S.EPA Region 5(OT-BJ) (206)553.1200 77 West Jackson Boulevard Chicago,IL 60604-3666 (312)886-7836 15 Consumer Product Safety Commission (CPSC) I The CPSC protects the public against unreasonable risk of injury from consumer products through education,safety standards activities,and enforcement.Contact CPSC for further information regarding consumer product safety and regulations. CPSC 4330 East West Highway Bethesda, MD 20814-4421 1-800-638-2772 cpsc.gov or saferproducts.gov U. S. Department of Housing and Urban Development (HUD) HUD's mission is to create strong,sustainable,inclusive communities and quality affordable homes for all.Contact HUD's Office of Healthy Homes and Lead Hazard Control for further information regarding the Lead Safe Housing Rule which protects families in pre-1978 assisted housing and the lead hazard control and research grant programs. HUD 451 Seventh Street, SW, Room 8236 Washington, DC 20410-3000 (202)402-7698 hud.gov/offices/lead/ This document Is In the public domain.It may be produced by an Individual or organization without permission.Information provided In this booklet is based upon<urrent scientific and technical understanding of the Issues presented and Is re0active of the Judscilalonal boundaries established by the statues governing the co-authodrsg agenclet.Fallowing the advice given will not necessa rify provide complete protection in all situations or against all health hazards that can be caused by lead exposure. US EPA Washington DC 204W EPAJa7.K.12.001 U.S.CPSC Bethesda MD 20914 December 2012 U 5.HUD Washington DC 2oa 10 16 i IMPORTANT! Lead From Paint, Dust, and Soil in and Around Your Home Can Be Dangerous if Not Managed Properly Children under 6 years old are most at risk for lead poisoning in your home. • Lead exposure can harm young children,babies, and fetuses even before they are born. • Homes, schools, and child care facilities built before 1978 are likely to contain lead-based paint. • Even children who seem healthy may have dangerous levels of lead in their bodies. Disturbing surfaces with lead-based paint or removing lead-based paint improperly can increase the danger to your family. People can get lead into their bodies by breathing or j swallowing lead dust, or by eating soil or paint chips containing lead. People have many options for reducing lead hazards. j Generally, lead-based paint that is in good condition is not a hazard (see page 10). j THIRD AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FQR TENANT BASED RENTAL ASSISTANCE THIS THIRD AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the 1st day of July, 2023, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2021, as amended by the First and Second Amendments, dated July 1,2022 and November 1, 2022 (collectively, the "Original Agreement"); WHEREAS,on May 15,2023,by Resolution No.2023-19,the Huntington Beach City Council approved the FY 2023-2024 Annual Action Plan, which allocated $1$3,000 of Community Development Block Grant(CDBG)funds for administrative costs for Tenant Based Rental Assistance (TBRA) Programs, of which$65,556 will be allocated to Families Forward; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed,by and between the parties as follows: 1. SUBRECIPIENT GRANT AMOUNT AND SCOPE OF SERVICES. Shall be amended as follows: a. The City has allocated Federal 2023-2024 CDBG funds in the amount of Sixty Five Thousand Five Hundred Fifty Six Dollars ($65,556) to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget (Attachment 1). 2. TIME OF PERFORMANCE. Shall be amended as follows: a. The services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Grant Agreement may begin on July 1, 2023 and shall end on June 30, 2024. 3. LEVELS OF PERFORMANCE. Shall be amended as follows: a. The Subrecipient agrees to provide the levels of program service as described in the Amended Scope of Services and Budget(Attachment 1). 23-12957/311699 4. BUDGET. Shall be amended as follows: The budget detailed in the Scope of Services and Budget(Attachment 1) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City. 5. PROJECT SCHEDULE/MILESTONES. Shall be amended as follows: Services of the Subrecipient shall start no sooner than on the first day of July 2023 and end on the thirtieth day of June 2024. Every effort shall be made by the Subrecipient to expend the allocated funds in their entirety by June 30, 2024. If the Subrecipient does not expend all funds by June 20, 2Q24, the City may reallocate the funds not yet drawn to another eligible CDBG Project. 6. COMPENSATION AND METHOD OF PAYMENT. Shall be amended as follows: The City shall reimburse the Subrecipient with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1, 2Q23 and ending June 30, 2024. The City shall not provide any payments/reimbursements in advance of actual expenditures by the Subrecipient. Funding is contingent upon the City receiving Community Development Block Grant funds from HUD. The Subrecipient shall submit to the City a monthly"Payment Request"within fifteen(15) calendar days after the end of the first month with the final report for 2023/2024 fiscal year delivered by July 15, 2024. The reimbursement requests shall include documentation to verify that the expenditure of funds is consistent with the project description/definition as approved. Prior to reimbursing the Subrecipient,the City will verify that the Subrecipient has met all applicable regulations for the project. Payroll records, receipts, paid invoices including an itemized statement of all costs are samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. All other sections of this Agreement, as amended, shall remain in full force and effect. IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. [SIGNATURE PAGE FOLLOWS] SUBRECIPIENT, CITY OF HUNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California By:'S. OViLtL,Y1201 0 M otok A jvm tl i mfAse ?tint name Director/Chief ITS: (circle one Chairman/PresidentNice President (Pursuant To HBMC 3.03.100 MO AND APPROVED AS TO FORM: By:A10(4 fcSo -6441-r"*".Ka r.i'n 4_ard Print nam City Attorney / ITS: (circle one hairma resident/Vice President Date COUNTERPART RECEIVE AND FILE: City Clerk Date SUBRECIPIENT, CITY OF HUNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California By: Print name Director/Chief ITS: (circle one) Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: Print name City Attorney ate ITS: (circle one) Chairman/President/Vice President Date COUNTERPART RECEIVE AND FILE: 10401, 9ASellUd,41-4) City Clerk V/11/23 Date ATTACHMENT 1 FY 2023-24 AMENDED SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2023 and June 30, 2024, Families Forward will: 1. Administer the Tenant Based Rental Assistance Program for 15 Huntington Beach households. Staffing costs are tied to the search and eligibility process for families. Families Forward will submit a monthly Grantee Performance Report(GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Case Manager: $39,752 Data&Compliance: $11,073 Benefits and Insurance: $8,5 51 AdminCosts: $6,180 Total Families Forward Budget: $65,556 FAMIFOR-01 LBOSSHART A ci- CERTIFICATE OF LIABILITY INSURANCE DATE A E(MMI Y)023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0M10410 co TACT NAME: ArmstronglRobitaiilelRiegle Business and Insurance Solutions PHONE FAX 1600 Quail St,Suite#100 (Arc,No,Eat):(949)381-7700 (Arc,No):(949)861-9429 Newport Beach,CA 92660 At i SS:arrinfo@aleragroup.com INSURERIS)AFFORDING COVERAGE NAIC N INSURER A:Marketing INSURED INSURER Philadelphia Indemnity Ins Co 18058 Families Forward INSURER C:Corti pWest Insurance Company 12177 8 Thomas INSURER D: Irvine,CA 92618 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)..IMM/OD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK2575266 7/112023 7/1/2024 DAMAGE G RENTED 100,000 X X PREMISES(Ea occurrencel $ MED EXP(Any one person) $ 20,000 PERSONAL 8.ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY !N i X LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: SEXUAL ABUSE $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 fEaaccident) X ANY AUTO PHPK2575266 7/1/2023 711/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED IA{URTEOS ONLY _ AUTOS �N� BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY (Per acEciident)AMAGE $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 X EXCESS LIAB CLAIMS-MADE PHUB872228 7/1/2023 7/1/2024 AGGREGATE $ 7,000,000 DED X RETENTIONS 10,000 $ C WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y!N X CWWCP10004229302 7/1/2023 7/1/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ FILERR/MEMBER EXCLUDED? f N/A 1,000,000 ( andatory In ) E.L.DISEASE-EA EMPLOYEES Eyes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E,L DISEASE-POLICY LIMIT $ A Professional(E&O) PHPK2575266 7/1/2023 7/1/2024 Occurrence/Aggregate 1,000,000 A Abuse/Molestation PHPK2575266 7/1/2023 7/1/2024 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) The City of Huntington Beach,Its officers,elected or appointed officials,employees,agents and volunteers aX (p�c tlq.pal dyed on the General Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General L a I I y pe tt cYf� CC C(1 MICHAEL E.GATES CITY ATTORNEY CITY OF HUNTINGTON BEACH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cityof Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE 'dam CompYrb,i ACORD 25(2016/03) Oc 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2575266 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Organization(s): The City of Huntington Beach, its officers, elected or appointed officials employees, agents and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the Insurance afforded to these include as an additional insured the persons) or additional insureds, the following is added to • organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" "personal personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law;and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 ©Insurance Services Office, Inc.,2012 Pagel6 of 20 Policy Number; PHPK2575266 COMMERCIAL GENERAL LIABILITY CG20010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be$500. Schedule Person or Organization Description Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective 0710112023 Policy No. CW WCP 100042293 02 Endorsement No. Insured FAMILIES FORWARD,INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 99 03 13 C (Ed.7-09) SECOND AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR TENANT BASED RENTAL ASSISTANCE THIS SECOND AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the day of 1t)yj. , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement, as amended by the First Amendment, dated July 1, 2021 (collectively, the "Original Agreement"); WHEREAS, on November 1, 2022, by Resolution No. 2022-61, the Huntington Beach City Council approved Substantial Amendment No. Three to the 2020-2024 Consolidated Plan, which, in part, adjusted performance goals for HUD-funded programs; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 5. LEVELS OF PERFORMANCE. Shall be amended as follows: The Subrecipient agrees to provide the levels of program service as described in the Amended Scope of Services and Budget(Attachment 1). All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. [SIGNATURE PAGE FOLLOWS] 1 22-1 2 1 1 9/295499 CONSULTANT CITY OF HUNTINGTON BEACH, a FAMILIES FORWARD municipal corporation of the State of California By: U(Y)ed,AAI,A(\.(2Ait-k.— M A-MA t)IJ OA V-0 tSE Director of Community Development Print name APPROVED AS TO FORM: ITS: (circle one) Cha' 'resident/ Vice President otT) AND City Attorney edlc\--)By. " RECEIVE AND FILE: jot{1-n ?:2&/S6h Print name City Clerk • ITS: (circle one) Chairma "'residen Vice President Date • CO TE ART 2 22-12119/295499 CONSULTANT CITY OF HUNTINGTON BEACH, a FAMILIES FORWARD municipal corporation of the State of California By: um,12„ Director of Community Development Print name APPROVED AS T RM: ITS: (circle one) Chairman/President/ Vice President AND City Attorney V By: GENE AND FILE: ( triffi,. Wall/Q.40 Print name City Clerk ITS: (circle one) Chairman/President/ Vice President / //2i/.Z3 Date COUNTE . ART 2 22-12119/295499 ATTACHMENT 1 FY 2022-23 AMENDED SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan(HUD 5-year plan),which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Families Forward will: 1. Administer the Tenant Based Rental Assistance Program for 15 Huntington Beach households. Families Forward will submit a monthly Grantee Performance Report(GPR)on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment,Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Case Manager: $37,864 Data & Compliance: $3,706 Benefits and Insurance: $5,680 Administrative Costs: $5,250 Total Families Forward Budget: $52,500 3 22-12119/295499 FIRST AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR TENANT BASED RENTAL ASSISTANCE THIS FIRST AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California, hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECIPIENT" is made and entered into, to be effective the day of�u l� , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECEIPIENT previously entered into that certain Subrecipient Agreement, dated July 1, 2021, the "Original Agreement"; WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $105,000 of Community Development Block Grant(CDBG)funds for administrative costs for Tenant Based Rental Assistance (TBRA) Program, of which $52,500 will be allocated to Families Forward; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 2. SUBRECIPIENT GRANT AMOUNT AND SCOPE OF WORK. Shall be amended as follows: The City has allocated Federal 2022-2023 CDBG funds in the amount of Fifty-Two Thousand, Five Hundred Dollars ($52,500) to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget (Attachment 1). 2. 3. TIME OF PERFORMANCE. Shall be amended as follows: The Services described above are generally provided on a weekly basis to eligible persons. Reimbursable activities per this Grant Agreement may begin on July 1, 2022 and shall end on June 30, 2023. 3. 6. BUDGET. Shall be amended as follows: The budget as proposed in the Subrecipient Grant application (Attachment 1) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City prior to this agreement. All other sections of this Agreement, as amended shall remain in full force and effect. IN WITNESS WHEREOF, the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California By: V��r �✓+—� Print name Director of Community Development ITS: (circle one)Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: 1c5 Print name ty Attorney TAV ITS: (circle one)E�President[Vice President RECEIVE AND FILE: City Clerk 0�1►A1 gwa'�' ate 2 ATTACHMENT 1 FY 2022-23 SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Families Forward will: 1. Administer the Tenant Based Rental Assistance Program for 25 Huntington Beach households. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Case Manager: $37,864 Data & Compliance: $3,706 Benefits and Insurance: $5,680 Administrative Costs: $5,250 Total Families Forward Budget: $52,500 1 FAMIFOR-01 LOOSSHAR ACORo" CERTIFICATE OF LIABILITY INSURANCE DAT/30/2DrYYYY) srsorzoz2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER License#OM10410 co TACT ArmstrongJRobitaille/Riegle Business and Insurance Solutions pNCNNo,Ex1):(949)381.7700 (AAIc, ;( 1500 Quail St,Suite#100 949)861-9429 Newport Beach,CA 92660 5a%ss.arrinfo@aleragroup.com INSURERISI AFFORDING COVERAGE NAIC N INSURERA:Philadelphia Indemnity Ins Co 18068 INSURED INSURERS:Com West Insurance Company 12177 Families Forward INSURER C: 8 Thomas INSURER D: Irvine,CA 92618 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTRD D /DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE OCCUR X PHPK2433529 7/112022 711l2023 DAMAGE TO RENTED AI 100,000 MEDEXP(Anyoneperson) 20,000 PERSONAL&ADV INJURY 1,000,000 GEULAGGREGATE LIMITAPPLIES PEP: GENERAL AGGREGATE 3,000,000 POLICY❑j£CT FRILOC PRODUCTS-COMP/OP AGG 3,000,000 OTHER: SEXUAL ABUSE 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ix ANY AUTO PHPK2433529 7/112022 7/1/2023 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLYM AUTOS BODILY BOODILY INJURY Peraccldend $ AUT OS ONLY AE OS Se Y PPe�a dent AMAGE $ $ A URETENTION$ AR X OCCUR 7,000 000 EACH OCCURRENCE S � X CLAIMS-MADE PHUB821656 7/1/2022 7/1/2023 AGGREGATE $ 7,000,000 10,000 B WORKERS COMPENSATION X PER OTH- ANo EMPLOYERS'LIABILITY Y/ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N CWWCP10004229301 7/112022 711/2023 E.L.EACH ACCIDENT $ OFFICERm4EMBE{�EXCLUDED? N I A {Mandatory In NFi) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If Yyes descnbeurltler 1,000,000 OES�RIPTI N F OPERATIONS below E.L.DISEASE.POLICY LIMIT $ A Professional(E&O) PHPK2433529 7/1/2022 7J7l2023 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Huntington Beach,its officers,elected or appointed officials,employees,agents and volunteers are named as additional insured on the General Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General Liability per attached form. A ROVED AS TO F9RNf1 MI _AEL E.GATES CITY ATTORNEY CERTIFICATE HOLDER CA CE� A UNTINGTON 13FACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y g ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE tM 9 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2433529 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Organization(s):The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A, Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1• Required by the contract or agreement;or or 2. Available under the applicable Limits of Insurance shown in the Declarations; 2. In connection with your premises owned by or rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 0 Insurance Services Office, Inc.,2012 Policy Number: PHPK2433529 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY -- OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 ©insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number:PHPK2293752 PI-CA-004 10/14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following is added to SECTION IV-BUSINESS AUTO CONDITIONS, B.General Conditions,5. Other Insurance: The insurance provided by this policy for any additional insured endorsement attached to this policy is primary when primary coverage Is required In a written contract. In addition,we will not seek contribution from any insurer when insurance on a non-contributing basis is required in a written contract for any additional insured endorsement attached to this policy. For coverage to apply,the written contract must have been executed prior to the occurrence of"loss." This endorsement supersedes anything to the contrary. Page 1 of 1 ©2014 Philadelphia Consolidated Holding Corp. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be S 500 Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. Person or Organization Job Description This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise staled. (The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2021 Policy No.WCV 5505161 Endorsement No. 000 Insured FAMILIES FORWARD, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC 99 03 13 C (Ed. 7-09) Policy Number: PHPK2293752 PI-GLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own,Rent,or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers, Landlords,or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners, Lessees,or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLO-HS(10/11) Duties in the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advertising Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a.is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A.BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b.Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client,up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g.(2)is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own,Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) LIABILITY,Subsection 2.Exclusions, Paragraph j. Damage to Property, Item(1) is deleted in its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you,or any other person, organization or entity,for repair, replacement,enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word"fire"is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning, explosion,smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5, above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you,or in the case of damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion,smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance, (1)(a)(ii)is deleted in its entirety and replaced by the following: That is insurance for fire, lightning,explosion, smoke,or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10l11) a. $1,000,000;or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire, lightning, explosion, smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation,"or"civil proceeding" seeking these damages. However,we will have no duty to defend the insured against any"suit' seeking damages,"investigation,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful,or Deliberate Violations Any willful, intentional, or deliberate"violation(s)"by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding" means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigation" means an examination of an actual or alleged"violation(s)"by HHS. However, "Investigation"does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4of12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III -LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3)(b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows: 1. b.is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an"employee"in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing"suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client,"up to a$10,000 limit per occurrence and$10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers,"employees","managers", directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client'for any purpose commit,whether acting alone or in collusion with other persons. The following,when used on this coverage, are defined as follows: a. "Client"means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above,who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor,commission merchant, consignee, independent contractor or representative of the same general character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional insureds SECTION 11—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 02011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators,but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own,maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers,Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises ]eased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for"bodily injury,""property damage"or "personal and advertising injury"caused, in whole or in part, by your maintenance,operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires, h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair,construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances,coal holes, driveways, manholes, marquees, hoist away openings,sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators;or (c) The ownership, maintenance, or use of any elevators covered by this insurance. 1. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distributed or sold in the regular course of the vendor's business,subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GILD-HS(10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (1) The exceptions contained in Sub-paragraphs(d)or(f);or (ii) Such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization,from whom you have acquired such products,or any ingredient, part or container,entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury,""property damage"or"personal and advertising injury"but only for liability arising out of the negligence of the named insured.The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1. Owners,Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions;or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) "Bodily injury"or"property damage"Included within the"products-completed operations hazard." M. Duties in the Event of Occurrence,Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the'occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b, is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership;or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,6.Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part,we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Recovery Against Others To Us is deleted in Its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the insured will bring"suit"or transfer those rights to us and help us enforce them. Therefore,the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury"means: a. Bodily injury, sickness or disease sustained by a person, and Includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing(Item a.above) at any time. R. Personal and Advertising Injury Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part,the definition of"personal and advertising injury" is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b, is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. Is amended by adding the following: Discrimination based on race,color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured;or (2) Any executive officer,director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment,former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation,court decision or administrative ruling, The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company I AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD (Program No. B-21-MC06-0506) FOR PROGRAM YEAR 2021/2022 COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG) FUNDS THIS AGREEMENT is made and entered into on the I' of July, 2021 by and between the CITY OF HUNTINGTON BEACH a municipal corporation, hereinafter referred to as "City," and FAMILIES FORWARD, hereinafter referred to as "Subrecipient." RECITALS WHEREAS, the City has applied for and received funds from the United States Government under Title I of the I lousing and Community Development Act of 1974, Public Law 93-383; and WHEREAS, the City wishes to engage the Subrecipient to assist the City in utilizing such funds; and WHEREAS, the City has environmental clearance to release the funds for this project; NOW, THEREFORE, in consideration of these recitals, and the mutual covenants contained herein. City and Subrecipient agree as follows: 1) National Obiective The Subrecipient certifies that the activities carried out with funds provided under this Agreement will meet the CDBG program's National Objective of benefit to low/moderate income persons as defined in 24 CFR Part 570.208. The Subrecipient shall adhere to the terms of the City's CDBG Application and Subrecipient Agreement and with assurances and agreements made by the City to the United States Department of Housing and Urban Development. 2) Subrecipient Grant Amount and Scope of Services The City has allocated Federal 2021-2022 CDBG funds in the amount of Fifty- Two, Five Hundred Dollars ($52,500) to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget (Attachment 1). 3) Time of Performance The services described above are generally provided on a weekly basis to eligible 1 Ct1V nC+ rn 7A-V" I (qrl"t zoo. persons. Reimbursable activities per this Grant Agreement may begin on July 1, 2021 and shall end on June 30,2022. 4) Personnel Assigned Subrecipient personnel assigned to carry out the Scope of Services shall, if required by the standards of their profession, maintain all licenses and permits necessary to remain in compliance with State and Federal requirements governing the profession. The City shall be notified of all personnel assigned to carry out the Scope of Services and shall be notified if there is a change in personnel. 5) Levels of Performance The Subrecipient agrees to provide the levels of program service as described in the Scope of Services and Budget(Attachment 1). 6) Budget The budget as proposed in the Subrecipient Grant application (Attachment 2) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City prior to this agreement. In addition, the City may request a more detailed budget breakdown than originally proposed and the Subrecipient shall provide such supplementary budget information in a timely fashion in the form and content prescribed by the City. Both the City and Subrecipient must approve any amendments to the budget in writing. 7) Project Schedule/Milestones Services of the Subrecipient shall start no sooner than on the first day of July 2021 and end on the thirtieth day of June 2022. Every effort shall be made by the Subrecipient to expend the allocated funds in their entirety by June 30, 2022. If the Subrecipient does not expend all funds by June 30, 2022, the City may reallocate the funds not yet drawn to another eligible CDBG projects. 8) Compensation and Method of Payment The City shall reimburse the Subrecipient with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1,2021 and ending June 30, 2022. The City shall not provide any payments/reimbursements in advance of actual expenditures by the Subrecipient. Funding is contingent upon the City receiving Community Development Block Grant funds from HUD. The Subrecipient shall submit to the City a monthly "Payment Request' within fifteen (15) calendar days after the end of the first month with the final report for 2021/2022 fiscal year delivered by July 15, 2022. The reimbursement requests 2 shall include documentation to verify that the expenditure of funds is consistent with the project description/definition as approved. Prior to reimbursing the Subrecipient, the City will verify that the Subrecipient has met all applicable regulations for the project. Payroll records, receipts, paid invoices including an itemized statement of all costs are samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report (Section 11) is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. 9) Program Income The Subrecipient shall report to the City any interest or other income earned as a direct result of the use of Federal CDBG funds for the program outlined within this agreement. All reported program income may be retained by the Subrecipient for services in connection with providing housing, utilities, funds for medications, computer training and food to the homeless or those who are at risk of homelessness. All provisions of this Agreement shall apply to these activities. The program income, retained by the Subrecipient, must be expended before additional funds are requested from the City. Any program income on hand when the Agreement expires or received after the Agreement's expiration shall be paid to the City. The requirements are set forth in the Code of Federal Regulations, Tide 24, Section 570.504(c). 10) Record Keeping Requirements The Subrecipient shall, at minimum, maintain the following records and reports to assist the City in complying with its record keeping requirements. a) Documentation of the income level, ethnicity, age of persons and/or households participating in or benefiting from the Subrecipient's program; b) Documentation of the number of persons and/or households participating in or benefiting from the Subrecipient's program; c) Documentation of all CDBG funds received from the City; d) Documentation of expenses as identified in the monthly report and reimbursement requests; e) Documentation of how and when a determination was made as to the eligibility status of persons assisted, and f) Any such other related records as the City shall require. The Subrecipient shall maintain separate accounting records for the Federal CDBG funds provided by the City. The City, Federal Grantor Agency, Comptroller General of the United States, or any of their duly authorized representatives shall have access to all books, documents, papers and records maintained by the Subrecipient which directly pertain to the above project for the 3 purpose of audit, examination,excerpts and transcriptions. 11) Reporting Requirements The Subrecipient shall submit "Monthly Accomplishment Reports" within fifteen (15) calendar days of the end of the month. The final monthly report is due no later than July 15, 2022. Monthly reports shall be provided by the Subrecipient to the City indicating the number of persons assisted, income and ethnicity of persons assisted, how/what assistance: was provided, and a description of how and when determination of eligibility status was made for persons assisted. The report must include sufficient information to assist the City in monitoring the Subrecipient's performance. The Subrecipient must demonstrate satisfactory performance prior to reimbursement for expenditures. 12) Public Access to Program Records The Subrecipient shall furnish and cause each of its own subrecipients or subcontractors to furnish all information and reports required hereunder and will permit access to its books, records and accounts by the City, HUD or its agent, or other authorized Federal officials for purposes of investigation to ascertain compliance with the rules, regulations and provisions stated herein. 13) Records Retention Unless otherwise notified by the City, the Subrecipient shall retain all financial records, supporting documents and statistical reports related to the project identified under this Agreement until September 30, 2027. All records subject to an audit finding must be retained for five (5) years from the date the finding is made or until the finding has been cleared by appropriate officials and the Subrecipient has been given official written notice. 14) Grant Closeout Procedures The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during this close-out period shall include, but are not limited to: making final payments, disposing of program assets (including the return of all unused materials, equipment, unspent cash advances, program income balances, and accounts receivable to the City), and determining the custodianship of records. Notwithstanding the foregoing, the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over CDBG funds, including program income. 15) Uniform Administrative and Program Management Standards The Subrecipient shall comply with applicable Uniform Administrative Requirements as described in Section 570.502 of the federal regulations for the CDBG Program. The Federal requirements are incorporated herein by reference. 16) Use and Reversion of Assets Upon expiration of this Agreement, the Subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. The Subrecipient shall be required to use 4 any real property under the Subrecipient's control that was acquired or improved in whole or in pan with CDBG funds in excess of$25,000 as follows: a) Used to meet one of the National Objectives in 24 CFR, Section 570.208 until five (5) years after expiration of this Agreement; or, b) Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property less any portion of the value attributable to expenditure of non-CDBG funds for acquisition or improvement to the property, Reimbursement is not required after the period of time specified in paragraph (a) of this section. 17) Real Property The use and disposition of real property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFR 570.502, 570.503, and 570,504, as applicable, which include but are not limited to the following: The Subrecipient shall transfer to the City any CDBG funds on hand and any accounts receivable attributable to the use of funds under this Agreement at the time of expiration, cancellation, or termination. Real property under the Subrecipient's control that was acquired or improved, in whole or in part, with funds under this Agreement in excess of$25,000 shall be used to meet one of the CDBG National Objectives pursuant to 24 CFR 580.208 until five (5) years after expiration of this Agreement [or such longer period of time as the City deems appropriate]. If the Subrecipient fails to use CDBG- assisted real property in a manner that meets a CDBG National Objective for the prescribed period of time, the Subrecipient shall pay the City an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property. Such payment shall constitute program income to the City. The Subrecipient may retain real property acquired or improved under this Agreement after the expiration of the five-year period [or such longer period of time as the City deems appropriate]. In all cases in which equipment acquired, in whole or in part, with funds under this Agreement, is sold, the proceeds shall be program income) prorated to reflect the extent to that funds received under this Agreement were used to acquire the equipment). Equipment not needed by the Subrecipient for activities under this Agreement shall be (a) transferred to the City for the CDBG program or (b) retained after compensating the City [an amount equal to the current fair market value of the equipment less the percentage of non-CDBG funds used to acquire the equipment]. 18) Other Program Requirements Reserved. 5 19) Suspension and Termination In accordance with Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations, this Agreement may be suspended or terminated if the Subrecipient fails to comply with any term(s) of the award and/or the award is terminated for convenience. Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations are incorporated herein by reference as provisions of the Agreement. 20) Compliance with Laws and Regulations The Subrecipient agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants (CDBG) including subpart K (Attachment 3), except that: a) The Subrecipient will not assume the City's environmental responsibilities as described on Section 570.604; and b) The Subrecipient will not assume the City's responsibility for initiating the review process required under the provisions of 24 CFR Part 52. The Subrecipient also agrees to comply with all other applicable Federal, state and local laws, regulations, and policies governing the funds provided under this contract, including those regulations and requirements outlined in Attachment 2 of this Subrecipient Agreement insofar as they are applicable to the performance of this contract. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 21) Antidiscrimination/Affirmative Action & Equal Employment Opportunity The Subrecipient shall comply with all State and Federal laws regarding nondiscrimination in the provision of services and the equal opportunity employment of personnel. 22) Financial Management Accounting Standards. The Subrecipient agrees to comply with 24 CFR 84.21-28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. Cost Principles. The Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organizations,"or A- 21, "Cost Principles for Educational Institutions," as applicable. These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 23) Audit Requirement If the Subrecipient shall receive more than $300,000 in total federal funds in one fiscal year from the City of Huntington Beach and/or any other city or agency, the Subrecipient is required to submit a Single Audit Report. As required by the 6 Federal Single Audit Act, the Subrecipient shall be required to submit to the City, a comprehensive financial audit prepared by an independent, neutral third party auditor. The audit shall cover financial operations of the Subrecipient for the period beginning July 1, 2021 and ending June 30, 2022 and is due not later than one year after expiration of this Agreement. 24) Religious and Lobbying Activities Religious Activities. The Subrecipient agrees that funds provided under this contract will not be utilized for religious activities or to promote religious interests. Religious entities may use CDBG funds for secular activities only in accordance with the Federal regulations specified in 24 CFR 570.2000), such as worship, religious instruction, or proselytization. Lobbying. The Subrecipient hereby certifies that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement; (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with this Federal contract, grant loan, or cooperative agreement, it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and (3) It will require that the language of paragraph (d) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly: Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 25) Budget Modifications If the Subrecipient desires to modify the use of the CDBG funds following approval of this agreement, a written request must be submitted to the City for review. No change in use of the CDBG funds will permitted without prior written 7 approval by the City, subject to the provisions of the City's adopted Citizen Participation Plan. 26) Performance Monitorine The City will monitor the performance of the Subrecipient against goals and performance standards required herein. Substandard performance as determined by the City will constitute non-compliance with this Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, contract suspension or termination procedures will be initiated. 27) Conflict of Interest The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 570.611, which include (but are not limited to) the following: I) The Subrecipient shall maintain a written code or standards of conduct that shall govem the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. 2) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. 3) No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. 28) Procurement Standards and Methods I) Compliance. The Subrecipient shall comply with current City policy concerning the purchase of equipment and shall maintain inventory records of all non-expendable personal property as defined by such policy as may be procured with funds provided herein. All program assets (unexpended program income, property, equipment, etc.), shall revert to the City upon. termination of this Agreement. 2) OMB Standards. Unless specified otherwise within this agreement, the 8 Subrecipient shall procure all materials, property, or services in accordance with the requirements of 24 CFR 84.40-48. 3) Travel. The Subrecipient shall obtain written approval from the City for any travel outside the metropolitan area with funds provided under this agreement. 29) Environmental Issues 1) Air and Water. The Subrecipient agrees to comply with the following requirements insofar as they apply to the performance of this Agreement: a) Clean Air Act,42 U.S.C., 7401, et seq.; b) Federal Water Pollution Control Act, as amended, 33 U.S.C., 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder; c) Environmental Protection Agency (EPA) regulations pursuant to 40 CFR Park 50, as amended. 2) Flood Disaster Protection. In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4001), the Subrecipient shall assure that for activities located in an area identified by the Federal Emergency Management Agency (FEMA) as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes(including rehabilitation). 3) Lead-Based Paint. The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this Agreement shall be subject to MUD Lead-Base Paint Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to all CDBG-assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead-based paint. Such notification shall point out the hazards of lead-based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead-based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead-based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied to a property, paint testing, risk assessment, treatment and/or abatement may be conducted. 4) Historic Preservation. The Subrecipient agrees to comply with the Historic Preservation requirements set forth in the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36 CFR Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic Properties, insofar as they apply to the performance of this 9 agreement. In general, this requires concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a Federal, state, or local historic property list. 30) Notices Communication and details concerning this contract shall be directed to the following contract representatives: City: Subrecipient: Community Development/NED Families Forward Attn: Steve Holtz, Deputy Director Madelynn Hirneise, Project Manager 2000 Main Street, 51h Floor 8 Thomas Huntington Beach, CA 92648 Irvine, CA 92618 Phone: (714) 374-1626 31) Independent Contractor Nothing contained in this Agreement is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. The Subrecipient shall at all times remain an "independent contractor" with respect to the services to be performed under this Agreement. The City shall be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the Subrecipient is an independent contractor. 32) Insurance General Liability. In addition to the workers' compensation and employer's liability insurance and Subrecipient's covenant to indemnify City, Subrecipient shall obtain and furnish to City; a policy of general public liability insurance, including motor vehicle coverage covering the program / project. This policy shall indemnify Subrecipient, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the program, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000) per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for the program / project. This policy shall name City, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the program / project shall be deemed excess coverage and that Subrecipient's insurance shall be primary. 10 Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a "deductible" or any other similar form of limitation on the required coverage. Workers Compensation and-Employers' Liability. Pursuant to California Labor Code Section 1861, Subrecipient acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; Subrecipient covenants that it will comply with such provisions prior to commencing performance of the work hereunder. Subrecipient shall maintain workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. Subrecipient shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Subrecipient shall furnish to City a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and Subrecipient shall similarly require all subcontractors to waive subrogation. Certificate of insurance. Prior to commencing performance of the work hereunder, Subrecipient shall fumish to City certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverages as required by this Agreement; the certificates shall: l. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 3. promise to provide that such policies will not be canceled or modified without thirty (30) days' prior written notice of City. Subrecipient shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by City. The requirement for carrying the foregoing insurance coverages shall not derogate from the provisions for indemnification of City by Subrecipient under the Agreement. City or its representative shall at all times have the right to demand the original or a copy of all the policies of insurance. Subrecipient shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required. Subrecipient shall provide a separate copy of the additional insured endorsement to each of Subrecipient's insurance policies, naming City, its officers, elected and appointed officials, employees, agents and volunteers as Additional Insureds, to the City Attorney for approval prior to any payment hereunder. 33) Hold Harmless and Indemnity Agreement Subrecipient hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses, judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Subrecipient's 11 employees and damage to Subrecipient's property, arising directly or indirectly out of the obligations or operations herein undertaken by Subrecipient, caused in whole or in part by any negligent act or omission of the Subrecipient, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Subrecipient will conduct all defense at its sole cost and expense and City shall approve selection of Subrecipient's counsel. City shall be reimbursed for all costs and attorney's fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Subrecipient. 34) Severability If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be affected thereby and all other parts of this Agreement shall nevertheless be in full force and effect. 35) Assignment of Agreement The Subrecipient shall not assign this Agreement or any monies due thereunder without the prior written consent of the City. 36) Successors and Assigns Subject to the provisions of the Subrecipient Agreement Paragraph 16, "Hold Harmless and Indemnity Agreement," all terms, conditions, and provisions hereof shall inure to and shall bind each of the parties hereto, and each of their respective heirs, executors, administrators, successors, and assigns. 37) Section Headings and Subheadings The section headings and subheadings contained in this Agreement arc included for convenience only and shall not limit or otherwise affect the terms of this Agreement. 38) Waiver The City's failure to act with respect to a breach by the Subrecipient does not waive its right to act with respect to subsequent or similar breaches. The failure of the City to exercise or enforce any right or provision shall not constitute a waiver of such right or provision. 39) Authority to Execute this Agreement The person or persons executing this Agreement on behalf of Subrecipient warrants and represents that he/she has the authority to execute this Agreement on behalf of the Subrecipient and has the authority to bind Subrecipient to the performance of its obligations hereunder. 12 40) Entire Agreement This agreement constitutes the entire agreement between the City and the Subrecipient for the use of funds received under this Agreement and it supersedes j all prior or contemporaneous communications and proposals, whether electronic, oral, or written between the City and the Subrecipient with respect to this Agreement. I IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by and through their authorized officers on July 1 ,2021. i FAMILIES FORWARD CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California By: S 1 L t)Cti. Michele Silva,Chief Advancement Officer Director of Community Development print name ITS: (circle one) Chairman/PresidentNice APPROVED AS TO FORM: President n D AND City Attorney Elimbc Childs,Saaetary print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary -Treasurer COUNTERPART 13 40) Entire Agreement This agreement constitutes the entire agreement between the City and the Subrecipient for the use of funds received under this Agreement and it supersedes all prior or contemporaneous communications and proposals, whether electronic, oral, or written between the City and the Subrecipient with respect to this Agreement. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by and through their authorized officers on July 1 , 2021. i FAMILIES FORWARD CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California By: t �0 D== Director of Community bevelopmentt* print name ITS: (circle one) Chaitman/PresidentNice APPROVED AS TO FORM: President AND M City Attorney By: print none ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary - Treasurer COUNTERPART 13 i FAMILIES FORWARD ATTACHMENT SCOPE OF SERVICES AND BUDGET 14 ATTACHMENT 1 FY 2021-22 SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2021 and June 30, 2022, Families Forward will: 1. Administer the Tenant Based Rental Assistance Program for 22 unduplicated Huntington Beach households. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15t' of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Case Manager: $27,000 Data & Compliance: $10,000 Director of Programs: $5,000 Benefits and Insurance: $4,200 Administrative Costs: $6,300 Total Families Forward Budget: $52,SOO FAMILIES FORWARD ATTACHMENT 2 SUMMARY OF CDGB LEGAL REQUIREMENTS IS ATTACHMENT SUMMARY OF LEGAL REQUIREMENTS In addition to the requirements set forth in other provisions of the Subrecipient Agreement, Subrecipient("Participant")shall comply,and shall cause all participant personnel to comply,with the following regulations and requirements insofar as they are applicable with the performance of the Subrecipient Agreement.1 1. Equal Opportunity and Nondiscrimination. a. Title VI of the Civil Rights Act of 1964, as amended, including Public Law 88-352 implemented in 24 C.F.R. Part 1. This law provides in part that no person shall,on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. In regard to the sale or lease of the Site, Participant shall cause or require a covenant running with the land to be inserted in the deed and leases prohibiting discrimination under this Title, and providing that City and the United States are beneficiaries of and entitled to enforce such covenants. Participant shall enforce such covenant and shall not itself so discriminate. b. Fair Housing Act, Title VIII of the Civil Rights Act of 1968, as amended, including Public Law 90-234. The Fair Housing Act provides in part that there shall be no discrimination in housing practices on the basis of race, color, religion, sex, and national origin. The Fair Housing Act was amended in 1988 to provide protections from discrimination in any aspect of the sale or rental of housing for families with children and persons with disabilities. The Fair Housing Act also establishes requirements for the design and construction of new rental or for-sale multi-family housing to ensure a minimum level of' accessibility for persons with disabilities. C. Section 109 of Title I of the Housing and Community Development Act of 1974, as amended, including 42 U.S.C. 5301 et. seq., 42 U.S.C. 6101 et. seq., and 29 U.S.C. 794. This law provides in part that no person on the grounds of race, color, national origin, sex, or religion shall be excluded from participation in,be denied the benefits of,or otherwise be subject to discrimination under any activity funded in whole or part with funds under this Title. d. Section 104(b) of Title I of the Housing and Community Development Act of 1974, as amended, including 42 U.S.C. 5301 et. seq. This law provides in part that any grant under Section 106 shall be made only if the grantee certifies to the satisfaction of the Secretary of HUD that the grantee will, among other things, affirmatively further fair housing. This exhibit is a list and summary of some of the applicable legal requirements and is not a complete list of all participant requirements. The description set forth next to a statute or regulation is a summary of certain provisions in the statute or regulation and is in no way intended to be a complete description or summary of the statute or regulation. In the event of any conflict between this summary and the requirements imposed by applicable laws, regulations,and requirements,the applicable laws, regulations, and requirements shall apply. ATTACHMENT2 3 2020 -1- C. Executive Order 11246, as amended. This order includes a requirement that grantees and subrecipients and their contractors and subcontractors not discriminate against any employee or applicant for employment because of race, color,religion, sex, or national origin. f. Executive Order 11063,as amended,including 24 C.F.R. Part 107. This order and its implementing regulations include requirements that all actions necessary be taken to prevent discrimination because of race, color, religion, sex, or national origin in the use, occupancy, sale, leasing, rental, or other disposition of property assisted with Federal loans, advances, grants, or contributions. g. Section 504 of the Rehabilitation Act of 1973, as amended. This Act specifies in part that no otherwise qualified individual shall solely by reason of his or her disability or handicap be excluded from participation (including employment), denied program benefits, or subjected to discrimination tinder any program or activity receiving Federal assistance. Participant must ensure that its programs are accessible to and usable by persons with disabilities. h. The Americans with Disabilities Act(ADA) of 1990, as amended. This Act prohibits discrimination on the basis of disability in employment by state and local governments and in places of public accommodation and commercial facilities. The ADA also requires that facilities that are newly constructed or altered, by,on behalf of, or for use of a public entity, be designed and constructed in a manner that makes the facility readily accessible to and usable by persons with disabilities. The Act defines the range of conditions that qualify as disabilities and the reasonable accommodations that must be made to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for persons with disabilities. i. The Age Discrimination Act of 1975, as amended. This law provides in part that no person shall be excluded from participation in, be denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal assistance. j. EEO/AA Statement. Participant shall, in all solicitations or advertisements for employees placed by or on behalf of Participant, state that it is an Equal Opportunity or Affirmative Action employer. k. Minority/Women Business Enterprise. Participant will use its best efforts to afford small businesses and minority and women-owned business enterprises the maximum practicable opportunity to participate in the performance of the Agreement. As used in the Agreement, the term "small business" means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women-owned business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish-surnamed or Spanish-heritage Americans,Asian- Americans, and American Indians. Participant may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. ATI'ACHMENT 2 June 2020 -2- 2. Environmental. a. Air and Water. Participant shall comply with the following regulations insofar as they apply to the performance of the Agreement: Clean Air Act,42 U.S.C. 7401,et seq.; Federal Rater Pollution Control Act, as amended, 33 U.S.C. 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308,and all regulations and guidelines issued thereunder; and the U.S. Environmental Protection City regulations pursuant to 40 C.F.R. Part 50,as amended. b. Flood Disaster Protection Act of 1973. Participant shall assure that for activities located in an area identified by FEMA as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained. C. Lead-Based Paint. Participant shall comply with the Lead-Based Paint Regulations referenced in 24 C.F.R. § 570.608, including 24 C.F.R. Part 35, et. al. d. Historic Preservation. Participant shall comply with the historic preservation requirements set forth in the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36 C.F.R. Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historie Properties and related laws and Executive Orders, insofar as they apply to the performance of the Agreement. In general, this requires concurrence from the State historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a federal, state, or local historic property list. e. Limitation on Activities Pending Clearance. In accordance with 24 C.F.R. § 58.22 entitled "Limitations on activities pending clearance, "neither a recipient nor any participant in the development process, including public or private nonprofit or for-profit entities, or any of their contractors, may commit HUD assistance under a program listed in 24 C.F.R. § 58.1(b) on an activity or project until HUD or the state has approved the recipient's Request for Release of Funds (RROF) and the related certifications have been approved. Neither a recipient nor any participant in the development process may commit non-HUD funds or undertake an activity or project that would have an adverse environmental impact or limit the choice of reasonable alternatives. Upon completion of environmental review or receipt of environmental clearance, City shall notify Participant. HUD funds shall not be utilized before this requirement is satisfied. The environmental review or violation of the provisions may result in approval, modification of cancellation of the City Grant. If a project or activity is exempt under 24 C.F.R. § 58.34, or is categorically excluded (except in extraordinary circumstances) under 24 C.F.R. § 58.35(b), no RROF is required and the recipient may undertake the activity immediately after the City has documented its determination that each activity or project is exempt and meets the conditions specified for such exemption under this section by issuing a Notice to Proceed. 3. Uniform Administrative Requirements. The uniform administrative requirements described in 24 C.F.K. § 570.502. 4. Other Program Requirements. Participant shall carry out each activity under the Agreement in accordance with all applicable federal laws and regulations described in Subpart K ATTACHMENT 2 h..2020 -3- of 24 C.F.R. § 570 except for City's environmental responsibilities under 24 C.F.R. § 570.604 and City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52. 5. Reversion of Assets. Upon the expiration of the Funding Period or sooner termination of the Agreement, Participant shall transfer to City (a) any and all CDBG Funds, (b) any accounts receivable attributable to the use of CDBG Funds. In all cases in which equipment acquired,in whole or in part, with funds under the Agreement is sold,the proceeds shall be program income(prorated to reflect the extent to that funds received under the Agreement were used to acquire the equipment). Equipment not needed by Participant for activities under the Agreement shall at the election of City either be (a) transferred to City for the CDBG program, or (b) retained by Participant after compensating City an amount equal to the current fair market value of the equipment less the percentage of non-CDBG Funds used to acquire the equipment. 6. Relocation. City shall not be responsible for relocating any occupants from the Site in connection with the Program or Project. If required, Participant shall have the sole and exclusive responsibility for providing relocation assistance and paying all relocation costs required to comply with all applicable federal and state laws, rules, and regulations, including the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. § 4601 et seq., as amended, and implementing regulations, and HUD Handbook 1378. Participant shall indemnify, defend, and hold City harmless from and against any claims, liabilities, damages, or losses made against it by tenants or occupants of the Site, including without limitation claims for relocation assistance, inverse condemnation,and claims otherwise arising from any act or omission of Participant pursuant to the provision of relocation assistance. 7. Allowable Costs and Audits. Participant shall comply with and administer the Project and Program in accordance with the requirements of The Office of Management and Budget (OMB)"Super Circular" 2 CFR Part 200, which includes the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for federal awards, as applicable. 8. Records and Reports. Participant shall provide to City and shall cause each of its contractors, subcontractors and subrecipients to provide to City all records and reports relating to the Project and Program that may be reasonably requested by City in order to enable it to perform its record keeping and reporting obligations pursuant to the CDBG Requirements, including but not limited to those described in the Agreement and 24 C.F.R. § 570.506. 9. Religious Organizations. If Participant is a religious organization as defined by the CDBG Requirements, Participant shall comply with all conditions prescribed by HUD for the use of CDBG Funds by religious organizations, including the First Amendment of the United States Constitution regarding church/state principles and the applicable constitutional prohibitions set forth in 24 C.F.R. § 570.2000). 10. Conflict of Interest. Participant will comply with 24 C.F.R. § 570.611 regarding the avoidance of conflict of interest,which provisions include(but are not limited to)the following: i. Participant shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. ATTACI IMENT 2 line 2020 -4- ii. No employee, officer or agent of the Participant shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. iii. No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one(1)year thereafter. For purposes of this paragraph, a"covered person' includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the Grantee, the Participant, or any designated public agency. 11. Political Activity (24 C.F.R. § 570.207(a)(3)). Participant is prohibited from using CDBG Funds to finance the use of facilities or equipment for political purposes or to engage in other partisan political activities, such as sponsoring candidate forums, distributing brochures, voter transportation, or voter registration. 12. Anti-Lobbying Certification. By its execution of the Agreement, Participant hereby certifies that: i. No Federal appropriated funds have been paid or will be paid, by or on behalf of it,to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. ii. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying," in accordance with its instructions. iii. It will require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. This certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than ATTACHMENT 2 tune 2020 -5- $100,000 for each such failure. At the request of City, Participant shall execute a separate document that contains the certifications set forth above. 13. Drug-Free Workplace Requirements. Participant shall comply with and be subject to the requirements of the federal drug-free workplace requirements, which include the following actions be taken: i. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition. ii. Establishing an ongoing drug-free awareness program to inform employees about: (a) the dangers of drug abuse in the work place; (b) the grantee's policy of maintaining a drug-free workplace; (c) any available drug counseling, rehabilitation, and employee assistance programs; and (d) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. iii. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (i). iv. Notifying the employee in the statement required by paragraph(i) that, as a condition of employment under the grant, the employee will: (a)abide by the terms of the statement; and (b) notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five (5)calendar days after such conviction. V. Notifying the agency in writing, within ten (10) calendar days after receiving notice under sub-paragraph (iv)(b) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant. vi. Taking one of the following actions, within thirty (30) calendar days of receiving notice under subparagraph (iv)(b), with respect to any employee who is so convicted: (a) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (b) 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. vii. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (i), (ii), (iii), (iv), (v), and (vi). ATTACHMENT 2 tune 200 -6- 14. Procurement. Participant will comply with the procurement standards under 2 C.F.R. §§ 200.317-200.326. Participant shall comply with all existing and future City policies concerning the purchase of equipment. 15. Labor Provisions. a. Section 3 of the Housing and Community Development Act of 1968. Participant shall comply with and cause its contractors and subcontractors to comply with the requirements of Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. § 1701u), the HUD regulations issued pursuant thereto at 24 C.F.R, Part 135, and any applicable rules and orders of HUD issued thereunder. The Section 3 clause, set forth in 24 C.F.R § 135.38 provides: i. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. § 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by I-IUD assistance or HUD-assisted projects covered by Section 3, shall,to the greatest extent feasible, be directed to low-and very low-income persons, particularly persons who are recipients of HUD assistance for housing. ii. The parties to this contract agree to comply with HUD's regulations in 24 C.F.R. Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations. iii. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause,and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions,the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. iv. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 C.F.R. Part 135,and agrees to take appropriate action,as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 C.F.R. Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 C.F.R. Part 135. V. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 C.F.R. ATTACHMBNT2 Jum 2020 -7- Part 135 require employment opportunities to be directed,were not filled to circumvent the contractor's obligations under 24 C.F.R. Part 135. vi. Noncompliance with I IUD's regulations in 24 C.F.R. Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future I-IUD assisted contracts. Participant shall abide by the Section 3 clause set forth above and will also cause this Section 3 clause to be inserted in all contracts relating to the construction of the Project. b. Labor Standards. Participant shall comply with the provisions of 24 C.F.R. 570.603 and related requirements. Participant shall include in all applicable construction contracts the provisions of federal law imposing labor standards on federally assisted contracts. Participant shall comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended (40 U.S.C. 3141 through 3148), the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq. and implementing regulations), the Copeland Anti-Kick Back Act (40 U.S.C. 276c and 18 U.S.C. 874 et seq.), the implementing regulations of the U.S. Department of labor including 29 C.F.R. Parts 1, 3, 5, 6 and 7, and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of the Agreement. Participant shall maintain documentation that demonstrates compliance with these provisions and such documentation shall be made available to City and HUD for review upon request. Participant shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. C. HUD Form 4010. Participant shall comply and cause Participant Personnel to comply with the provisions of HUD Form 4010 attached hereto. HUD Form 4010 must be included in the bid packet and construction contract and subcontracts for the Project. ATTACHMENT 2 June 2020 -8- Federal Labor Standards Provisions U.S.Department of Housing and Urban Development Office of Labor Relations Applicability (1) The work to be performed by the classification The Project or Program to which the construction work requested Is not performed by a classification in the wage Covered by this COMI'3 l pertains is being assisted by the determination; and United Stales of America and the following Federal Labor 121 The classification Is utilized In the area by the Standards Provisions are Included In this Contract construction Industry:and pursuant to the provisions applicable to such Federal (31 The proposed wage rate. Including any bona tide assistance. fringe benefits. bears a reasonable relallonshlp to the A. 1. 11) Minimum Wages. All laborers and mechanics wage rates contained In the wage determination. employed of working upon the site of the work,will be paid to) If the contractor and the laborers and mechanics to be unconditionally and not less often than once a week, and employee In the classification (if known). or their without subsequent deduction of rebate On any account representatives, and HUD or Its designee agree on the (except such payroll deductions as are Permitted by classification and wage rare (Including the amount regulations issued by the Secretary of Labor under the designated for fringe benefits where appiopdale), a report Copeland Act (20 CFR Pan 3). the full amount of wages of the action taken shall be sent by HUD or Its designee to and bona fide fringe benellls (or cash equivalents Iherrefl the Administrator of the Wage and Hour Division, due at lime of payment computed at rates not less than Employment Standards Administration. U.S. Department of those contained In the wage determination of the Labor, Washington. D.C. 20210. The Administrator, or an Secretary of Labor WNCII is attached hereto and made a authorized representative, will approve, modify, of part hereof, regardless of any contractual relationship disapprove every additional classification action within 30 which may he alleged lc exist between ins contractor and days of receipt and so advise HUD or its designee or will such laborers and mechanics. Contributions made or notify HUD or Its designee within the 30-day period that costs reasonably anticipated for bona fide fringe benefits additional lima is necessary. (Approved by the Office 01 under Section I(b)(2) of the Davis-Bacon Act on behalf of Management and Budget under OMB control number 1215- laborers or mechanics are considered wages paid to such 0140.) laborers of mechanics. subject to the provisions of 29 CFR 5.5(al(1)hv): also, regular contributions made or costs (c) In the event the contractor, the laborers ct mechanics their Incurred for more than a weekly period lbut not less often to tie employed in ilia classification Or eon than quarterly) under Plans. funds• or programs, which representatives,c and HUD orits designee do not agree on cover the particular weekly period, are deemed fo b0 ilia PfOp06ed classification and Wage rate (including the . constructively made or incurred during such weakly period. amount designated for fringe benefits, where appropriate), HUD or Its designee shall reler the questions, including Such laborers and mechanics shall be paid the appropriate the views of a0 interested parties and the recommendation wage rate and fringe benefits on the wage determination of HUD or Its designee, to the Administrator for for the classification of work actually performed, without determination. The Administrator. or an authorized regard to skill, except as provided in 29 CFR 5.5(a)(4), representative. caul issue a determination within 30 days of Laborers or mechanics performing walk In more than one receipt and so advise HUD Or Its designee or will notify classification may be compensated at the rate specllled for HUD or Its designee within the 30-day period rat each C12551fiCallon lot the time actually worked therein: additional lime Is necessary. (Approved by the Office o1 Provided, That the employer's payroll records accurately Management and Budget under OMB Control Number set forth the time spent in each classification In which 1215-0140.) work is performed. The wage determination(including any (d) The wage rate (including fringe benefits where additional classification and wage rates conformed under 29 CFR 5.5(a)(1)(il) and the Davo-Bacon poster (WH- appropriate) determined pursuant to subparagraphs 1321)shall 6e posted at all times by the contractor and Its (1)(IU(b) m (c) of this paragraph, shall be paid to all subcontractors at the site Of the work In a prominent and workers Performing work In the classification under Ih15 accessible, place where It can be easily seen by the contract front the first day on which work Is performed In VfOrker9. the Classlh ibe. (II) (a) Any class of laborers Or mechanics which is not fill) Whenever the minimum wage rate prescribed In the 119Ietl In the wage determination and which If to be contract for a class of laborers or mechanics Includes a employed under the termincontrag shall he classified to in fringe benefit Which Is not expressed as an hourly fate,the conformance with the wage determination. HUD shall wagecontr determination mall Bonet pay the benefit as stated I(t the approve an additional classification and wage rate and wage delerntlnatlon Or shall pay another Uow IIOe range fringe benefits therefor only when the following criteria pano0t or an nourly cash equivalent thereof. have been met: fiv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part am ( ) Presiaus adtiom are obsaate Page 1 of 5 fal.Handbook 1344.1 ATTACFiMENI.2 -9- of Ine wages of any laborer or mechaiuC The amount of an7 communicated in writing 10 the lanorers or mecnanlcs casts raisonably anticipated be Providing Rana flab fringe affected. and records v;hi(h shop;flie casts anticipated Of Aenuhis under a Clan or otogram. li OYlded That Ine ih9 IM31 Cost Incurred in Providing SU(n. )enoflls. Setr4lary o! Labor has found, upon The widen request of Con;racwts emploging anprenuces of ❑alneeS under the Contractor, I11a1 Ine ap011Cabte stannalds of The Davis- JOPrOved [Warrants his Maintain wditen ovioente of Inc Baran Act have peon nlm. The Secretary Or W1101 may registration Of ,icprewce"ID progfams and Ce!!i1fCollon at require she contractor to set "d or In a sepalate account :I.11nee crogf,anbs, !be 1eglSbabon 01 the nppfenlices Dnn assets for the mae;mg of obligations under the plan or trainees. and The silos alto wage rates DfescrWoU In the Drogfam IAporoved by the om(e or Management and aopikable wogl:mis. IAD(S led by the Office al Budget under OMS Control Number 1215.0;40 1 -Annagenient and Burl unde: OMB :ontlo' Nuoul:ors 2. Wllhholding. HUD of d5 designee shall upon Its own 1215 0I40 and 121!-0C17 ) aeon of uoon wfih2n request of an auihdtlzen Ifs) (a) Tne ccntfacto: shall submit tweehly ter Pion weO rsDr"sSntJ;i:P of :lie Department of Labor •.itnholu CI to whicil an, contract Wofk Is perlolmed a CCD'y Or all cause to Ito MThheld hone The Contra Cl O• under this o.lyfalls :P HUD of Its designee it the agen C'y Is a party to Contract at any otndr Fede6al formic'wdp the same crime the contract. hul if the agene; i5 not such a party. the Contractor. of any other Fedefllly-asslsted contract contractor :ill submit the pa'/rolls :0 the lopliclr.t SuIlleG :a Days Bacon Ofevading ;rape regWfenleniS. sponsor,or Cones, as Ine Case may IR. for ira[snllosion to whi(h Is held by the same prime contractor so much or Ine HUD of Its designee. The payrolls SuleniRed $hall set out acvruea payments or advances as may he considered accurately and compieteiy all 01 one r mmolion Ieaunel necess4r; :o nay laborers ilia mechanics. Including 10 ale maintained under 29 CFR 5 51 O)lii errept that lull apwenllee5 trainees and helpers, employed by the social security numbers and name addresses snill not he contractor ar any subConita Ctor the lull amount DI Wages mCludea on welLly Ir insm InI ills. Instead the p3yrolle shall requited by :re contract In Ine event of failure to Day any only need t0 Include an indlvidu3il'y IdemQymg number lot woolen or mechanic. Including ally applenboe. trainee or each am Dloyea le.g., ine last tau, digits of the employee's helpef. employed or Wofkmg On The site OI the work, all or social security number). The requited Weekly pa'/roll can o1 the 'wages required by the Contract. HUD or Its information Play be submitted In any term desired, designee may, after written notice to the contractor. Optional Form 'NHJ47 is available for !Ns purpose front s Don S01, applicant, or owner, lake sucn actlon as may he the 'Wage and Hour Division Web site it necessary to cause Ine susoenslon of .any further nr'D"//WWW act C09yes8/Y4Q/IOrm3Pwn]<7:nsfr nfm or its payment. advance. or guarantee of lunds until such sucuesor site. The puma contractor Is responsible lot violations have ceased HUD or Its designee may. after the subnusslon of Copies or payrolls by.all subcontractors, Written notice to AS contractor. disburse Such amoUms Contractors and subcontractors shall maintain the full withheld for and on account of the conlracior or social security number and current address of oacn subcontractor to ine respective employees to whom :hey Covered viorker, and shall provide them upon request to are due Tne Comptroller General shall make such HUD of Its designee If the agency Is a party to the dlsbursemsi in the case of dnett Davrs-BaCon AC: Contract. but II the agency Is not such J Party. the contracts :onira Clm will sunren :he payrolls to the applicant 3. Ill Payrolls and bosh recoils. Payrolls ,and 10SIC sponsor,of owner, as ine Case may be. lot transmission:o reCord9 !Sloping :msto Shall he mannalned toy the HUD or its designee. Tne contfa(Iof.of Ine.':age and HdUt Counfattor during the Course of the WUfk oresefved far ,h Division of ine Department at L1o01 $or Dernoses of .in 0ermq of three years Netealler for all Iarurers antl Investigation Ot audit 0! compliance 'wain oravalling W'agc nie<hintce '.Working in :he sale of The 'N[tk Such records fequitemonis. is is not a vloUlion of this fuboafag(aph far snail contain the flame ad Ofess, .and social secUrhy a Crime Conifaclor io require as sul)comfacior to provide ounlbel of each sutn :-,ulker gas no her Correct addresses pod social security nunlnefs 10 the Orinle rli;sib(atioc, hourly rates at 'wages paid (including fates CONf3001 to( IS evrn IeCafde. Wnnnut Wecoldy Submission of contributions of costs anticipated for Pend fide hinge :o HUD of Its. designee (AOproved by the Office of banelgs or cash equivalents thereof of the :70eS desc(Ihed IAanagement find Budget under O'AB Control NUmher nI ie CtlOn lib)(2)(BI (4 the Dint-1Ucoll Alt). daily and 1215-dIJS.i ar9ekly number of hours wort%ed. deductions made and Ili) Each oayfoll suhnutted Shall be nCcompanled by a .actual wages paw Wnenever ine Secretary of Labor his 'Statement 01 Conlpllan(e, sighed a; the contractor or round under 29 CFR 5 5 (alftluvl that the wages of any sunconlrac:or or nis of nor agent who Days or supo,Ases laoofer of mechanic incluoe the alnoAni Of any Costs the oayment of the persons ampwyed under the Contract •easonauly aniccited on o1Ondnug I;en P!d; tinder a plan and shall(entry the following: or program oescnlbeo In Section hb)4290) of the Davis- (1) Trial the payroll for the payroll period Contains the Ba(Do Act. :he Contractor Shall nm,ruail, records which information required to be provided under 2;• CFR 5 . irOW that the COInfubmen; to provide such hPnefili IS 401(31 n), the ap DrODrla:e Infornixon is tieing nlllnl Jlned eniorcealue. that the Plan Or Program Is financially under 29 CFR 5 5(a)(31h), and ihal sm.h information is rescoPsrble and :hat the Title of Drd13-An h05 Assn Correct and complete. leNrN5 Sol 110ns are o0l5oWP !cml HIJO.4010 1001120ft Page 2 of 5 tea H.uaalsock 1-'4=.1 ATTAC14MENT2 -10- (2) That each laborer or mechanic (including each helper, Is not registered or otherwise employed as stated above, apprentice, and trainee) employed on the contract during shall be paid not lees than the appllcallle wage rate on the the payroll period has often paid the full weekly wages wage determination for the classification of work actually earned, without rebate. either directly or Indirectly. and performed. In addition, any apprentice performing work on that no deductions have been made either directly or Ina job site in excess of the ratio permitted under the indirectly front the full wages earned, other Ivan registered program shall be paid nor less than the permissible deductions as set form In 29 CFR Part l; applicable wage rate on The wage determination for the (3) That each laborer or mechanic has been paid not less work actually performed. Where a Contractor Is perforating than the applicable wage rates ana fringe benefits or cash construction on a protect in a locality other than that in equivalents for the classification of work performed, as which Its program Is registered, the ratios and wage rates specified in the applicable wage determination (expressed in percentages of the journeyman's hourly incorporated Into the contract. rate) specified In the call 3 or subcontractor's registered program shall he observed. Every apprentice (cl The weekly submission of a properly executed must be paid at rot less than the rate specifed In the Certification set forth on the reverse side of Optional Form registered program for the apprentices level of progress, WH-347 shall satisfy the requirement for submission of the expressed as a percentage at the journeymen hourly fat Statement at Compliance' required by subparagraph specified in the applicable wage determinallon. A.3.Ib)(b). Apprentices small be paid fringe benefits In accordance (it) The falsification of any of Ina above certifications may with Itle provisions of Ins apprenticeship program. If the Subject the contractor or subcontractor to civil or criminal apprenticeship program does not specify fringe benefits, prosecution under Section 1001 of Title 18 and Section apprentices must be Pala the lull amount of fringe benefits 231 of Title 31 of the United Slates Code. Ilsted on the wage determination for the applicable (1fl) The contractor or subcontractor shall make the classification. If the Administrator determines that a records required under subparagraph A.3.(I) avallahlo for different practice prevails for the applicable apprentice Inspection, copying, of transcription by authorized classification, fringes shag be paid in accordance with that representatives of HUD or Its designee or the Department determination. In the event the office of Apprenticeship of Labor, and shall permit ouch representatives to Training. Employer and Labor Service$, at a State interview employees during working hours on the lab. If Apprenticeship Agency recognized by the Office, the contractor of subcontractor lolls to submit the required withdraws approval of an apotenticeship program, the records or to make them available, HUD or its designee contractor will no longer be permitted 10 utilize may, alter written notice to the contractor, sponsor. apprentices at less than the applicable predetermined rate applicant of owner, lake such action as may be necessary for the work oerfofined until an acceptable program is to cause the suspension of any further payment, advance, approved. of guarantee of funds. Furthermore, failure to submit the (1l) Trainees. Except as provided In 29 CFR 5,16, required records upon request or to make such records trainees will not be permitted to work at less than The available may be grounds for debarrelent action pursuant to predelefmmed rate for the work Performed unless they are 29 CFR 5,12. employed pursuant %to and Individually registered in a 4. Apprentices and Trainees. program which has received prior 3pPfOV31, evidenced by II) Apprentices. Apprentices will be permitted to work at formal certification by the U.S. Department of Labor, less than the predetermined rate for the work they Employment and Training Administration. The ratio of performed when they are employed pursuant io and trainees to journeymen on the lob Silo shall not be gfeatef than permitted under the plan approved by The individuallyually registered In a Uona Ilde aDDrenticesniP program registered with the U.S. Department of Labor, Employment and Training AdmtNSits lion. Every trainee Employment and Training Administration, Office of must be paid at not less than The rate specified In the Apprenticeship Training, Emoloysr and Labor Services, or approved program for (he trainee's level of progress, With a State Apprenticeship Agency recognized by the expressed as a percentage of lne Journeyman hourly rate Office, of if a person Is employed In his at her first 90 specified In the applicable wage determination. Trainees days of Probationary employment as an apprentice In such shall be paid fringe benefits in accordance with the an apprenticeship program, who is not Individually provisions of the trainee progom. II the trainee Program registered In the program, but who has been certified by does not mention fringe benefits, trainees shall he paid the Office of Apprenticeship Training. Employer and Labor the full amount of fringe benefits listed on the wage Services or a State Apprenticesnlo Agency (where determination unless the Administrator of the Wage and appropriate)to be eligible fpr Probationary em Dloymenl as Hour Division determines that there Is an apprenticeship an apprentice. The allowable ratio of apprentices to program associated with the corresponding Journeyman journeymen on the job site In any craft classification snail wage rate on the wage determlnaTldn whicn provides for not he greater than the ratio permitted to the contractor as less than run fringe benefits for apprentices. Any to the entire work force under the registered program. Any employee listed on the payroll at a trainee Palo who Is o0l worker listed on a payroll at an apprentice wage rate, who registered and participating In a training plan approved by Previous editions are obsolete form HUD4010 IMMIX) Page 3 of 5 ref.Para lgcA 1344.1 ATTACHMENT2 -11- the Employment and Training Administration shall be paid awarded HUD contracts or participate In HUD programs not less than the applicable 'wage rate on the wage pursuant to 24 CFR Part 24. determination for the work actually performed. In addition. Jill No part of this contract shall be subcontracted to any any trainee performing work on the lob site in excess of person or firm Ineligible for award of a Government the ratio permitted under the legislated program shall be Contract by virtue Of Section 3(a) of the 03v13-62ton Act DOW not less than the applicable wage rate on the wage or 29 CFR 5.12(a)(1) or to be awarded HUD contracts of determination for the work actually performed. In the participate in HUD programs pursuant to 2e CFR Part 24. event the Employment and Training Administration (ill) The penally rot making false statements Is prescribed withdraws approval of a training program, the contractor in the U.S. Criminal Code, 18 U.S.C. 1001, Additionally, will no longer be permitted to utilize trainees at lass than U.S. Criminal Cade, Section 1 01 0, Title IB. U.S.C..unlit ann ins applicable predetermined rate for Ins work performed 'Federal Housing Administration transactions', provides in accepeptablo program Is approved. part: "Nhaever, for the purpose of . . . Influencing in any (fill Equal employment opportunity. The utilization of way the action Of such Administration. .., makes, utters or apprentices,trainees and journeymen under 29 CFR Part 5 publishes any statement knowing the $ante to be false. ... shall be In conformity with the equal employment shall be firma not more than $5.000 or Imprisoned not opportunity requirements of Executive Order 112e6. as more than two years,of boln.- amended, and 29 CFR Part 30. 1t. Complaints, Proceedings, or Testimony by 5. Compliance with Copeland Act requirements. The Employees. No laborer or mechanic to whom the wage, contractor shall comply with the requirements of 29 CFR salary,or other labor standards provisions of this Contract Part 3 which are Incorporated by reference In this contract are applicable Shall be discharged Or In any other manner 6. Subcontracts. The contractor or subcontractor will discriminated against by the Contractor or any Insert in any subcontracts the clauses contained In subcontractor because such employee has filed any subparagraphs 1 through 11 in this paragraph A and such complaint or Instituted or caused 10 be Instituted any other clauses as HUD or its designee may by appropriate proceeding or has testified or Is about to testify In any instructions require, and a Copy of the applicable proceeding under or relating to Ins labor standards prevailing wage declslOn, and also a clause requiring the applicable under this Contract to his employer. subcontractors to Include these clauses In any lower tier B. Contract Work (burs and Safety Standards Act. Tire subcontracts. The prime contractor shall be responsible pmnsions of this paragraph B are applicable where the amount of hie for the compliance by any subcontractor or lower tier prime contract exceeds $100,000. As used In Jim 03ifWaph, the subcontractor with all the contract clauses In MIS lemt9'lytaers'and Mechanici Include watchmen and guards. paragraph. (1) Overtime requirements. No contractor a sWeonlractor 7. Contract termination; debarment. A breach of the contracNq for arty can of the contract Work which may require or contract clauses in 29 CFR 5.5 may be grounds for involve " employment of Iabpen or mechanics shall require or termination of the contract and for debarment as a petard any Such laborer a mechanic N any workweek in which the contractor and a subcontractor as provided in 29 CFR indwldul is emp4ned on Such Wpm to work In excess of 40 hous In 5.12. such Workweek unless such tatwrer or merchant receives a. Compliance with Davis-Bacon and Related Act Requirements. comfxvsalion at a rate not less man one and one-IUM lilies the basic All rulings and Interpretations 0f the Davis-Bacon and rate of Ply fa all hours waked In excess of 40 harts w such Related Acts contained in 29 CFR Parts 1. S. and 5 are Workweek. herein Incorporated by reference In this contract (2) Violation; liability rot unpaid wages; liquidated 9. Disputes concerning labor Standards. Disputes damages. In the event of any violation of the clause set arising out of the labor Standards provisions of this form in suhparagraph if)of this paragraph. the contractor contract shall not be subject to the general disputes and any subcontractor responsible therefor Sind be liable clause of this contract. Such disputes shall be resolved In for the unpaid wages. In a0dltion, such contractor and accordance with the procedures of the Department of subcontractor shall be liable to the United Stales (In the Labor set forth In 29 CFR Parts 5, 6, and 7. Disputes case of work done under contract for the District of within the meaning of this clause Include disputes between Columbia Or a territory, to such District of to such the contractor (or any of Its subcontractors) and HUD of military), rot liquidated damages. Such liquidated its designee, the U.S. Department of Labor, or the damages shall be computed with respect to each Individual employees or(heir representatives. laborer of mechanic. Including watchmen and guards, 10. (1) Certification of Eligibility. By entering Into this employed In violation of the clause set forth In contract the contractor certifies that neither it Inor he Or subparagraph (1)of tins paragraph, In gw Such of$10 for each she) nor any person or firm who has an interest in the calendar day an Mich such individual was required a permlged to contractor's firm Is a person of firm Ineligible to be work In excess Of the standard Workweek of 40 hours Without Dayniam awarded Government contracts by virtue of Section 3(a)of Of gee Overtime wages required by the Clause set forth In sub the Oavil-Baton Act or 29 CFR 5.12(2)(1) or to be paragraph(1)of this paragraph. Previous 060"are Obsolete form HUD4010(OV200131 Page a of 5 ref.Handbook 1344.1 A17ACHMFNT 2 -12- 13) Withholding for unpaid wages and liquidated damages. HUD or its designee shall upon Its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor of subcontractor under any such contract or any other Federal contract With the same prime contract, or any other Federally-asalsted contract Subject to the Contract Work Hours and Safety Standards Act which Is held by the same prime contractor such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided In the clause set forth In subparagraph(2)of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert In any subcontracts the clauses set forth In subparagraph (1) through (4)of this paragraph and also a clause requiring the subcontractors to Include these clauses in any lower tier subcontracts. The prime contractor snail be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in subparagraphs (1) through (4) of this Paragraph. C. Health and Safely. The provisions of this paragraph C are appllcade where the amount of the prime contact exceeds$160,6gd. 11) No laborer or mechanic shall be required to work in surroundings of under working Conditions which are unsanitary. hazardous, or dangerous to his health and safely as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The Contractor shall comply with all regulations Issued by the Secretary of Labor pursuant to Tulle 29 Part 1926 and failure to comply may result In Imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act. (Public Law 91-54. 63 Slat 96). 40 USC 3701 at sea. 13) The contractor small include the provisions of this paragraph In every Subcontract So that such provisions will be binding on each subcontractor. The Contractor shall take such action with respect to any subcontractor as the Secfelary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions Previous M Obsolete form HU04010( ) Page 5 of 5 mt.Handbook 1344.1 ATTAC IM ENT 2 -13- ----- FAMIFOR-01 RTONG a►coRa CERTIFICATE OF LIABILITY INSURANCE DATEIMMJDDAT Y) e110/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder Is an ADDITIONAL INSURED,the policy(los)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,contain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of auch andorsoment(s). I'n00VCER License N OMI0410 MET Armslrung/Robitallle/Rlegle Business and Insurance Solutions %IDNE FAX 949 487-6161 830 Roosevelt Sulto 200 aC It Eu:(949)381-7700 ac,Ne:( ) Irvino,CA 926110 .arrlrl(o aleragroup.corn INSURcit(S)AFFORDINOCOVERAGE NAIC0 L--g A:Phlladoiphia indomnity ins Co 18068 INSURED INSu ERa:CDmpWest Insurance Company 12177 Families Forward IN{yRER C, 8 Thomas INSURER D: Irvine,CA 92618 - '--- "— INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' 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 CONTRACTOR 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,..LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS._ INSH ryPE OFINSURJWCE i SUUHI POLICY NUMBER POIJCYEFF I POLICY CAP LIMITS A I X I COMMERCIAL GENERAL UABILITY EACHOCCURRENCE 5 1'000.000 CLAIMS MADE X occlm PHPK2293752 711I2021 7I112022 DAMAGE TO RENTED 100,000 X PREMISES.1Eo acwertrsoJ—5 MI D CXP n4/grpn)__{ 20,000 P' NALSAUVINJUKY 5 1,000.000 UE114 AOfiHEGAIE LIAaT APPLIE61•EH� NENAL(1c:00EriAIE— S_.___ 000.000 POLICY U vn U Loc PRODUCTS-CCUPQP AGG, s 3.000,000 OTHER. SEXUALABUSE 1,000.000 A IC aBIINNEE�DeSINGLE BmT S 1,000,000 (EaAUTOMOBILE ll4aILITV ` X ANy AmO _ PHPK2293752 7/112021 7/112022 BODLY INJURY pNrl>.)_ $ OWNED SCHEDULED AUgT�O�S GNI.Y _ ANVpTNOS�yr�EU paROULY INNRY I'm eaJn n' S X AUTOS ONLY X AUI M) !Ij Parma nl MADE A _ UMBRELLA LIAB X OCCW EACH OCCURRENCE 5 7,000,000 X EXCESS LUB CWMSLAUE PHUB774654 71112021 7/1/2022 AGORr, ATF 7,000,000 DF.O I X I RETENTIONS 10'000 B WORRERScOMPENSATION PER pT14 AM EMPLOYERS'LIABILITY YIN x STATUTE__LER_ ApN�Y��PR�RO/PMR�IEdTgOERIUPART NERIEXECUINE I—I WCV560516100 71112021 711/2022 1,000,000 K.Fgld F NH IxcwosoT LI NIA .EL.FI,C)t_2c_GI4.NT -{ 11000,000 F.L.DISEASE-F FMPI.OYF 5 Ilyym dI F 1.000.000 OE P O OPF. TIOVS b4M E.L.CIS F.- TCYONIT PTION S A Professional(E&O) PHPK2293762 71112021 71112022 Occurrence 1.000,000 DESORPTIONOFOPERAIWNs ILOCAMNSIVEHICLES fACORD 101,Ad=a nalRemake S<Mdeh,may GolUcMdItmanquceMnwlmdl The City of Huntington Beach,Its oflicers,elected or appointed officials,employees,agents and volunteers are named as additional Insured on the General Liability per attached farm,as required by written contract.Primary and Non-Contributory applies to the General Liability per attached form. APPROVED AS TO FORM By. _�'�__.= — MICHAEL E.GA ` CERTIFICATE HOLDER CANCELLATION CITY ATTORNEY GI#OF'Mt/NI IN BEG'fO1T- ACTT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Clty of Huntington Bosch ACCORDANCE WITH TEXPIRATION HE POLICY PROATE VISIONSCE WILL BE DELIVERED INAC Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORUEDREPRESENTATNE '4um gc,.r*A-, ACORD 26(2016103) IB 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: PHPK2293752 PI-GLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply In the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following Is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page p Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1.000.000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments-Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments-Bail Bonds $5,000 5 Supplementary Payment-Loss of Earnings S1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement-Janitorial Services Client Coverage $10,000 limit 6 Additional Insured-N&My Acquired Time Period Amended 6 Additional Insured-Medical Directors and Administrators Included 7 Additional Insured-Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured-Broadened Named Insured Included 7 Additional Insured-Funding Source Included 7 Additional Insured-Home Care Providers Included 7 Additional Insured-Managers, Landlords, or Lessors of Premises Included 7 Additional Insured- Lessor of Leased Equipment Included 7 Additional Insured-Grantor of Permits Included 8 Additional insured-Vendor Included 8 Additional Insured-Franchisor Included 9 Additional Insured-When Required by Contract Included 9 Additional Insured-Owners,Lessees,or Contractors Included 9 Additional Insured-State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10111) i Duties in the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 I Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury-Includes Mental Anguish Included 11 Personal and Advertising Injury-Includes Abuse of Process, Induced 11 Discrimination A. Extended Property Damage SECTION I-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury 'Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to*bodily injury'or"property damage' resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I-COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to$50.000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance Is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I-COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) LIABILITY, Subsection 2. Exclusions, Paragraph J. Damage to Property, Item (1)is deleted in its entirety and replaced with the following: (1) Property you own, rent,or occupy, including any costs or expenses incurred by you,or any other person,organization or entity,for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word"fire'is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in Its entirety and replaced by the following; Exclusions c.through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract` 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance, (1)(a) (if) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company i PI-GLD-HS (10/11) i j a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire, lightning, explosion, smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1, Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)'of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any'suit," or"civil proceeding" seeking these damages. However, we will have no duty to defend the insured against any*suit' seeking damages,*investigation,' or'civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional, Willful, or Deliberate Violations Any willful, intentional, or deliberate'violation(s)"by any insured. b. Criminal Acts Any"violation"which results In any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V— DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services (HHS) arising out of"violations." b. "Investlgation' means an examination of an actual or alleged"violation(s)'by HHS. However, 'investigation"does not Include a Compliance Review. c. "Violation'means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4of12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 02011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Pan. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement,a. (3)(b) is deleted In its entirely and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGE A AND B are amended as follows: 1. b. is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these. 1.d.is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the Investigation or defense of the claim or"suit", including actual loss of earnings up to $1.000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND 8 the following is added: We will pay, on your behalf, defense costs incurred by an"employee' in a criminal proceeding occurring In the course of employment. The most we will pay for any'employee"who is alleged to be directly Involved in a criminal proceeding is$25,000 regardless of the numbers of'employees,"claims or'suits"brought or persons or organizations making claims or bringing'suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company I PI-GLD-HS (10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the'clients' premises due to theft or other loss to keys entrusted to you by your'client,' up to a$10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, 'employees','managers',directors, trustees, authorized representatives or any one to whom you entrust the keys of a"client'for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client"means an individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While In your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1) above,who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. 0 2011 Philadelphia Indemnily Insurance Company PI-GLD-HS(10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist In the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees'are also insureds for"bodily Injury'to a co- .employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers —At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence'which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required In Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for'bodily injury,""property damage'or 'personal and advertising injury'caused, in whole or in part, by your maintenance,operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit In connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. I. Vendors—Only with respect to'bodily injury" or"property damage'arising out of"your products' which are distributed or sold in the regular course of the vendors business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations,except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily Injury'or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d)or(f); or (II) Such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. J. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury, "property damage"or"personal and advertising injury'but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury;"'property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations.for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any stale or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the slate or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury,"'property damage'or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) 'Bodily injury"or"property damage"included within the"products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the'occurrence"or offense is known to: (1) You, if you are an individual, (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or'suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It Is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. Al our request,the insured will bring "suit"or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your stale. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: 'Bodily injury' means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and h. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. R. Personal and Advertising injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of'personal and advertising injury' is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. Is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company i PI-GLD-HS (10/11) i c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. i Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company Policy Number: PHPK2293752 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 4D Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: PHPK2293752 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Organizatlon(s): The city of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers Information required to complete this Schedule If not shown above will be shown in the Declarations. A. Section II — Who Is An Insured Is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury', "property If coverage provided to the additional insured is damage' or "personal and advertising injury' required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of Insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement;or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 ®Insurance Services Office, Inc., 2012 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ S00 Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. Person or Organization Job Description This endorsement changes the policy to which It is attached and Is effective on the dole Issued unless otherwise stated. (Tito Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2.021 Policy No.WCV 5505161 Endorsement No. 000 Insured FAMTLTES FORWARD, 1NC. Insurance Company COMPWEST INSURANCE COMPANY Countorsigned by WC 99 03 13 C (Ed. 7.09) Policy Number: PHPK2293752 PI-CA-004 10114 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following is added to SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, S. Otherinsurance: The insurance provided by this policy for any additional insured endorsement attached to this policy Is primary when primary coverage is required in a written contract. In addition,we will not seek contribution from any insurer when insurance on a non-contributing basis is required In a written contract for any additional insured endorsement attached to this policy. For coverage to apply,the written contract must have been executed prior to the occurrence of"loss." This endorsement supersedes anything to the contrary. Page 1 of 1 (02014 Philadelphia Consolidated Holding Corp. THIRD AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR TENANT BASED RENTAL ASSISTANCE THIS SECOND AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California, hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECEIPIENT" is made and entered into, to be effective the 1st day of July, 2023, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement on July 1, 2Q21, as amended by the First and Second Amendments, dated July 1, 2Q22 and November 1, 2Q22 (collectively, the "Original Agreement"); WHEREAS, on May 15, 2023, by Resolution No. 2023-19, the Huntington Beach City Council approved the FY 2023-2024 Annual Action Plan, which allocated $200,000 of HOME funds for Housing Services for Tenant Based Rental Assistance (TBRA) Program; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 1.1 SCOPE OF SERVICES. Shall be amended as follows: During the entire Term (defined below, as amended) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively, the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in the Article 1 in furtherance of the TBRA Program. (a) Levels of Performance. The Subrecipeient agrees to provide the levels of program service as described in the Scope of Work and Budget (Attachment 1). 23-12957/311700 -1- 2. 2.1 TERM. Shall be amended as follows: Services of the Subrecipient under this Agreement shall start on July 1, 2023 and end on the earlier to occur of (i) June 30, 2024 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) (as amended) has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. 3. 3.2(a) Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Thousand Dollars ($2QQ,000). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and Director. All other sections of the Original Agreement, as amended shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 23-12957/311700 -2- IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HIJNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California By: .Arnak,A--AlUi2A-C) WokeAtril tYh c, int name Director/Chief ITS: (circle one)Chairman/President/Vice President (Pursuant T9 HBMC 3.03.1QQ) AND APPROVED AS TO FORM: By 6),A a J ( kY;k\ : c(s-6 V- Print name City Attorney Uuj ITS: (circle on airma President/Vice President Date COUNTERPART RECEIVE AND FILE: City Clerk Date 23-12957/311700 -3- IN WITNESS WHEREOF, the parties have caused this Third Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California By: , ' n Print name Director/Chief ITS: (circle one) Chairman/President/Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: By: Print name City Attorney ti,,� ,V ITS: (circle one) Chairman/President/Vice President V Date COUNTERPART RECEIVE AND FILE: 10401., 944/1,14,144d City Clerk Date 23-12957/311700 -3- ATTACHMENT 1 FY 2023-24 AMENDED SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2023 and June 30, 2024, Families Forward will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to 15 Huntington Beach households in accordance with the TBRA Guidelines. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. 13. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $140,000 Security Deposit Subsidy: 45,000 Utility Deposit Subsidy: 0 HQS: 7,500 Income Eligibility: 7,500 Total Families Forward Budget $200,000 23-12957/311700 -4- r „.-----', FAMIFOR-01 LBOSSHART h.,-Rry CERTIFICATE OF LIABILITY INSURANCE DATE(MM2DDIYYYY) 7/11/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0M10410 CONTACT NAME: ArmstronglRobltaille/Riegle Business and Insurance Solutions PHONE FAX 1500 Quail St,Suite#100 (A/c,No,Ext):(949)381-7700 lac,Ne):(949)861-9429 Newport Beach,CA 92660 Mass:arrinfo@aleragroup.com INSURERIS)AFFORDING COVERAGE NAIC t/ _INSURER A:Marketing INSURED INSURER B:Philadelphia Indemnity Ins Co 18058 Families Forward INSURER c:CompWest Insurance Company 12177 8 Thomas INSURER 0: Irvine,CA 92618 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER /YPOLICY EFF POLICY EXP LIMITS LTR INSD WVA (MM/DDYYYL IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X 1 OCCUR PHPK2575266 7/1/2023 7/1/2024 PREMI ES(RENTED 100,000 X X PREMISES(Ea occurrencel $ MED EXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY j8T X LOG PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER SEXUAL ABUSE 1,000,000 $ A AUTOMOBILE LIABILITY //E ac cideentSINGLE LIMIT $ 1,000,000 X ANY AUTO PHPK2575266 7/1/2023 7/1/2024 BODILY INJURY(Per person) $ AAUTO�SONLY SCHEDULED AUTOS BODILY INJURY(Per accident) $ DAMAGE X AUTOS ONLY X AUT06 OILY (PerR accident) $ S B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 X EXCESS LIAB CLAIMS-MADE PHUB872228 7/1/2023 7/1/2024 AGGREGATE $ 7,000,000 DED X RETENTIONS 10,000 $ C WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY YIN x CWWCP10004229302 7/1/2023 7/1/2024 1,000,000 ANYFF PROPRIETOR/PARTNER/EXECUTIVEEL.EACH ACCIDENT $ ?alendER/M IM NH)EXCLUDED? N N/A 1,000,000 E.L DISEASE-EA EMPLOYEE $ It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ A Professional(E&O) PHPK2575266 7/1/2023 7/1/2024 Occurrence/Aggregate 1,006,000 A Abuse/Molestation PHPK2575266 7/1/2023 7/1/2024 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The City of Huntington Beach,Its officers,elected or appointed officials,employees,agents and volunteers am g� lq } yL9d on the General Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General Lia I I y pe tt d''}}@@FlFlff�� CCC(i MICHAEL E, GATES CITY ATTORNEY CITY COP HUNTINGTON BEACH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE I _ ,4> ►19- ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2575266 COMMERCIAL GENERAL LIABILITY CG20260413 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 Organization(s): The City of Huntington Beach, its officers, elected or appointed officials employees, agents and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the Insurance afforded to these include as an additional insured the persons) or additional insureds, the following is added to • organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: . 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 0413 ©Insurance Services Office, Inc., 2012 Pagel6of 20 Policy Number; PHPK2575266 COMMERCIAL GENERAL LIABILITY CG20010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional Insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and • CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 r 'WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 031.3 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $500. Schedule Person or Organization Description Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2023 Policy No. CW WCP 100042293 02 Endorsement No. Insured FAMILIES FORWARD,INC. Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 99 0313 C (Ed.7-09) SECOND AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR TENANT BASED RENTAL ASSISTANCE THIS SECOND AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California,hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECEIPIENT" is made and entered into, to be effective the 'if day of Net,. , 2022, as follows: RECITALS WHEREAS, CITY and SUBRECIPIENT previously entered into that certain Subrecipient Agreement, as amended by the First Amendment, dated July 1, 2021 (collectively, the "Original Agreement"); WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $302,755 of HOME funds for Housing Services for Tenant Based Rental Assistance (TBRA) Program; WHEREAS, on November 1, 2022, by Resolution No. 2022-61, the Huntington Beach City Council approved Substantial Amendment No. Three to the 2020-2024 Consolidated Plan, which, in part, adjusted performance goals for HUD-funded programs; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 1.1 SCOPE OF SERVICES. Shall be amended as follows: During the entire Term (defined below, as amended) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article 1 (collectively,the"Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in the Article 1 in furtherance of the TBRA Program. (a) Levels of Performance. The Subrecipeient agrees to provide the levels of program service as described in the Scope of Work and Budget (Attachment 1). 22-12119/295498 -1- 2. 2.1 TERM. Shall be amended as follows: Services of the Subrecipient under this Agreement shall start on July 1, 2022 and end on the earlier to occur of(i) June 30, 2023 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) (as amended) has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. 3. 3.2(a) Amount of Payments. Shall be amended as follows: It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Three Hundred Two Thousand Seven Hundred Fifty Five Dollars ($302,755). The dollar amounts stated in the immediately preceding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and Director. All other sections of this Agreement, as amended shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 22-12119/295498 -2- IN WITNESS WHEREOF, the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT CITY OF HUNTINGTON BEACH, a FAMILIES FORWARD municipal corporation of the State of California By: U\(\(\i lot pciouy 1 O E Director of Community Development Print name APPROVED AS TO FORM: ITS: (circle one) Chairman/President/ Vice President l " AND City Attorney 11,47 By: RECEIVE AND FILE: f6t. Px_cc/S a fr. Print name City Clerk ITS: (circle one) Chairma siden Vice President Date COUNTERPART 22-12119/295498 -3- IN WITNESS WHEREOF, the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT CITY OF HUNTINGTON BEACH, a FAMILIES FORWARD municipal corporation of the State of California By: ()AAA Director of Community Development Print name APPROVED AS 0 ORM: ITS: (circle one) Chairman/President/ "role Vice President i� AND City Attorney IAA/ By: ' CEIVE AND FILE: 6101,14i. Print name Cit'y Clerk ITS: (circle one) Chairman/President/ p Vice President /2/2.3 Date COUNTERPART 22-12119/295498 -3- ATTACHMENT A FY 2022-23 AMENDED SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan(HUD 5-year plan),which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Families Forward will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to 15 Huntington Beach households in accordance with the TBRA Guidelines. Families Forward will submit a monthly Grantee Performance Report(GPR)on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment,Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $217,755 Security Deposit Subsidy: $70,000 Utility Deposit Subsidy: $0 HQS Inspections: $7,500 Income Eligibility: $7,500 Total Families Forward Budget: $302,755 22-12119/295498 -4- FIRST AMENDMENT TO HOME SUBRECIPENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD FOR TENANT BASED RENTAL ASSISTANCE THIS FIRST AMENDMENT TO HOME SUBRECIPENT AGREEMENT between the CITY OF HUNTINGTON BEACH,a municipal corporation of the State of California,hereinafter referred to as "CITY" and FAMILIES FORWARD, hereinafter referred to as "SUBRECEIPIENT" is made and entered into, to be effective the i sr day of 1 /y , 2022, as follows: --� RECITALS WHEREAS, CITY and SUBRECEIPIENT previously entered into that certain Subrecipient Agreement, dated July 1, 2021, the "Original Agreement"; WHEREAS, on April 19, 2022, by Resolution No. 2022-16, the Huntington Beach City Council approved the FY 2022-2023 Annual Action Plan, which allocated $302,755 of HOME funds for Housing Services for Tenant Based Rental Assistance (TBRA) Program; WHEREAS, City and Subrecipient desire to amend the Agreement as provided herein. Now, therefore, it is mutually agreed, by and between the parties as follows: 1. 2.1 TERM. Shall be amended as follows: (a) Services of the Subrecipient under this Agreement shall start on July 1, 2022 and end on the earlier to occur of(i) June 30, 2023 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. All other sections of this Agreement, as amended shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] 22-11565/287096 -1- IN WITNESS WHEREOF,the parties have caused this Second Amendment to be executed by their respective officers duly authorized as of the date first written above. CONSULTANT, CITY OF HUNTINGTON BEACH, FAMILIES FORWARD a municipal cooperation of the State of California t\-kc�- Yl YA Print name k Director of Community Development ITS: (circle one) Chairman/ reside D /Vice President (Pursuant To HBMC 3.03.100) AND APPROVED AS TO FORM: RV fD D - -* - - ity ttorney kw Print nam�hairman/ ITS: (circle one) resident/ RECEIVE AND FILE: Vice President City Clerk gl\u\��a. Date 22-11565/287096 -2- EXHIBIT A FY 2022-23 SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2022 and June 30, 2023, Families Forward will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and income eligibility reviews to 25 Huntington Beach households in accordance with the TBRA Guidelines. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $217,755 Security Deposit Subsidy: $70,000 Utility Deposit Subsidy: $0 HQS Inspections: $7,500 Income Eligibility: $7,500 Total Families Forward Budget: $302,755 FAMIFOR-01 LIBOSSHAR ACORar" CERTIFICATE OF LIABILITY INSURANCE DAT130/2D22 `-�- sr3arzo22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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 holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lied of such endorsement(s). PRODUCER License#OM10410 CO TACT Arm strong/RobitaiilelRiegle Business and Insurance Solutions PHONE O Ne,Exl; 949 381-7700 �No;(949)861-9429 1500 Quail St,Suite#100 -Ma1L Newport Beach,CA 92660 E D .arrinfo@aleragroup.com INSUR5R(SI AFFORDING COVERAGE NAIC N INSURER A:Philadelphia Indemnit Ins Co 18058 INSURED INSURER B:COm West Insurance Com an 12177 Families Forward INSURER C: 8 Thomas INSURER D: Irvine,CA 92618 ENSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRTYPE OF INSURANCE ADD SUER POLICY NUMBER POLICY EFF POLICY EXP aL LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE f_x_j OCCUR X PHPK2433529 7/1/2022 7/1/2023 DAMAGE TO RENTED S 100,000 MED EXP(Any one PersonI 20,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PEP: GENERAL AGGREGATE 3,000,000 POLICY jRa FX LOC PRODUCTS-COMP/OP AGG 3,000,000 OTHER: SEXUAL ABUSE 1,000,000 A AUTOMOBILE LIABILITY CO aBINED SINGLE LIMIT $ 1,000,000 Ix ANY AUTO PHPK2433529 7/1/2022 7/1/2023 BODILY INJURY Per person) S OWNED SCHEDULED AUTOS ONLYM AUTOS y� o BODILY INJURY Per accident S ALIT OS ONLY AUTOS ONLY (RD,P FQ AMAGE $ S A UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 7,000,000 X EXCESSLIAB CLAIMS-MADE PHUBB21656 7/112022 7/112023 AGGREGATE $ 7,000,000 DED X RETENTIONS 10,006 S B WORKERS COMPENSATION X I PERTUTE OTH- AND EMPLOYERS'LIABILITY CWWCP10004229301 7/1/2022 7/1/2023 1,000,000 OFFICERI RIETO /PAXRTNER/EUDE ECUTIVE Ya N!A E.L.EACH ACCIDENT $ (Mandatory InNH) E.L.DISEASE-EA EMPLOYE S 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional(E&O) PHPK2433529 7/112022 711/2023 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Huntington Beach,Its officers,elected or appointed officials,employees,agents and volunteers are named as additional insured on the General Liability per attached form,as required by written contract.Primary and Non-Contributory applies to the General Liability per attached form. A ROVED AS TO F9R By: MI AEL E.GATES CITY ATTORNEY CERTIFICATE HOLDER CANCE�LA WUNTINGTON 13EACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Huntington Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y g ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Ursula Luna-Reynosa 2000 Main Street Huntington Beach,CA 92648 AUTHORIZED REPRESENTATIVE M 9C"I&j ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2433529 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Organization(s):The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; 2. Available under the applicable Limits of or Insurance shown in the Declarations; 2. In connection with your premises owned by or rented to you. whichever Is less. . However: This endorsement shall not increase the applicable Limits of Insurance shown in the 1. The insurance afforded to such additional Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 0 Insurance Services Office, Inc.,2012 Policy Number: PHPK2433529 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY -- OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number:PHPK2293752 PI-CA-00410/14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following is added to SECTION IV-BUSINESS AUTO CONDITIONS, B.General Conditlons,5. Other Insurance: The insurance provided by this policy for any additional insured endorsement attached to this policy is primary when primary coverage Is required in a written contract. In addition,we will not seek contribution from any insurer when insurance on a non-contributing basis is required in a written contract for any additional insured endorsement attached to this policy. For coverage to apply,the written contract must have been executed prior to the occurrence of'loss." This endorsement supersedes anything to the contrary. Page 1 of 1 ©2014 Philadelphia Consolidated Holding Corp. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work.under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ 500 Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. Person or Organization Job Description This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise staled. (The Information below is required only when this endorsement Is issued subsequent to preparation of the policy,) Endorsement Effective 07/01/2021 PolicyNo.WCV 5505161 Endorsement No. 000 Insured FAMILIES FORWARD, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by WC 99 03 13 C (Ed. 7-09) Policy Number: PHPK2293752 PI-GLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $60,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own,Rent,or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment--Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers, Landlords,or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners, Lessees,or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia indemnity Insurance Company PI-GLD-HS(10/11) Duties in the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advertising Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a.is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g.(2)is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own,Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company I PI-GLD-HS(10/11) LIABILITY,Subsection 2. Exclusions, Paragraph j. Damage to Property, Item(1) is deleted in its entirety and replaced with the following: (1) Property you own, rent,or occupy, including any costs or expenses incurred by you,or any other person, organization or entity,for repair, replacement,enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word"fire"is changed to"fire,lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning, explosion,smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you,or in the case of damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion,smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance, (1) (a)(0)is deleted in its entirety and replaced by the following: That is insurance for fire, lightning,explosion, smoke,or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company . i PI-GLD-HS(10/11) a. $1,000,000;or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire, lightning, explosion, smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation,"or"civil proceeding" seeking these damages. However,we will have no duty to defend the insured against any"suit' seeking damages,"investigation,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful,or Deliberate Violations Any willful, intentional, or deliberate"violation(s)"by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigatjon" means an examination of an actual or alleged"violation(s)"by HHS. However, "investigation"does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company i PI-GLD-HS(10111) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period if COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III -LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION t—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3)(b)is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident, H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS,Subsection 2. Exclusions, Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows: 1. b.is deleted in its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an"employee"in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing"suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission, 0 2011 Philadelphia Indemnity Insurance Company PI-GI-D-HS (10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client,"up to a$10,000 limit per occurrence and$10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers,"employees","managers", directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or in collusion with other persons. The following,when used on this coverage, are defined as follows: a. "Client"means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above,who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor,commission merchant, consignee, independent contractor or representative of the same general character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company I PI-GLD-HS(10111) j i Coverage Part, Paragraph 3.a, is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However,coverage does not apply to any organization or subsidiary not named In the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own, maintain or control while you lease or occupy these premises, This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for"bodily injury,""property damage" or "personal and advertising injury"caused, in whole or in part, by your maintenance,operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires, h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence,maintenance, repair,construction, erection,or removal of advertising signs, awnings, canopies, cellar entrances,coal holes, driveways, manholes, marquees, hoist away openings,sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators;or (c) The ownership, maintenance, or use of any elevators covered by this insurance. 1. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distributed or sold in the regular course of the vendor's business,subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to make such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8of12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which,after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (1) The exceptions contained in Sub-paragraphs(d)or(f);or (ii) Such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization,from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k, As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury,""property damage"or"personal and advertising injury"but only for liability arising out of the negligence of the named insured.The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1. Owners,Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions;or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) "Bodily injury"or"property damage" Included within the"products-completed operations hazard." M. Duties in the Event of Occurrence,Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2.is amended as follows: a. is amended to include: This condition applies only when the"occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership;or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,8.Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part,we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GID-HS(10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the insured will bring"suit"or transfer those rights to us and help us enforce them. Therefore,the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing(item a.above) at any time. R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part,the definition of"personal and advertising injury" is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race,color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured;or (2) Any executive officer,director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment,former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law,public policy, legislation,court decision or administrative ruling, The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission, ©2011 Philadelphia Indemnity Insurance Company I HOME SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND FAMILIES FORWARD (Tenant Based Rental Assistance) This HOME SUBRECIPIENT AGREEMENT (Tenant Based Rental Assistance) ("Agreement") is made and entered into as of July 1,2021 ("Effective Date") by and between the CITY OF HUNTINGTON BEACH, a municipal corporation and charter city ("City"), and FAMILIES FORWARD, a California nonprofit public benefit corporation ("Subrecipient"). RECITALS A. City is a California municipal corporation and charter city under the laws of the State of California. B. City has applied for and received funds ("HOME Funds") from the United States Department of Housing and Urban Development ("HUD") pursuant to the HOME Investment Partnerships Act and HOME Investment Partnerships Program, 42 U.S.C. §12701, et seq., and the implementing regulations set forth in 24 CFR § 92.1, et seq. (together, "HOME Program' for the purposes of strengthening public-private partnerships to provide more affordable housing, and particularly to provide decent, safe, sanitary, and affordable housing for very low income and low income citizens of Huntington Beach in accordance with the HOME Program. As used herein, the HOME Program includes the HUD Final Rule set forth at 78 FR 142, adopted July 24, 2013, which adopts substantial amendments to the HOME Program regulations set forth at 24 CFR Part 92. C. City is currently implementing a coordinated one-year strategy and program to provide financial assistance to eligible extremely low, very low and low income families and households to enable such households to secure housing available at an affordable housing cost in the City. D. City has developed a Tenant Based Rental Assistance Program to assist households in the City, who are homeless or at imminent risk of homelessness, preference given to veterans and seniors, to enable such households to transition into permanent, supportive housing. E. City wishes to engage the Subrecipient to assist the City in utilizing HOME Funds to provide tenant based rental assistance, security deposits and utility assistance to veteran and senior residents of the City, in accordance with the terms and provision set forth in this Agreement. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: 1 l4q01'ZoZ1 . ARTICLE 1 SCOPE OF SERVICES 1.1 Scope of Services. During the entire Term (defined below) of this Agreement, Subrecipient shall administer the City's HOME-funded Tenant Based Rental Assistance Program ("TBRA Program"), all in accordance with this Article I (collectively, the "Services") and the Scope of Services and TBRA Program Operating Guidelines attached hereto as Exhibit A. In connection with the Services, j Subrecipient shall comply with all requirements of the HOME Program, this Agreement and all applicable federal, state and local laws and regulations. Subrecipient shall further take all reasonable actions necessary to enable City to comply with City's obligations under the HOME Program relating to the TBRA Program. The Subrecipient shall perform the Services set forth in this Article 1 in furtherance of the TBRA Program, 1.2 Marketing and Outreach; Application Process. (a) Marketing and Outreach. Subrecipient shall undertake affirmative marketing and outreach activities to find prospective Eligible Households interested in the TBRA Program, all in accordance with HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. Subrecipient shall describe its marketing and outreach efforts in monthly progress reports submitted to the City under this Agreement, as described in Exhibit B. (b) Waiting List. Subrecipient shall maintain a waiting list of prospective Eligible Households. The waiting list shall be prioritized first based on the most urgent need as set forth in the TBRA Program Operating Guidelines, prospective Eligible Households of equally urgent need will be helped on a first come-first served basis, based on the date and time of referral or initial direct contact with the Subrecipient. (c) Intake Process. Upon being contacted by a prospective Eligible Household recruited through Subrecipent's affirmative marketing and outreach efforts, subrecipicnt shall initially meet with such prospective Eligible Household to fill out an Initial Qualification Document in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, including an income calculation based on two months of source documentation (bank account statements, pay stubs, etc.) to prequalify such prospective Eligible Household. Subrecipient shall then meet with prequalified Eligible Households to determine and verify their qualifications and eligibility for assistance under the TBRA Program, provide such prequalified Eligible Households with the TBRA Program application and other documentation described below, assist prospective Eligible Households with the completion of the application and gross income calculation worksheet and qualify Eligible Households for the 2 TBRA Program. Subrecipient shall provide every prequalified Eligible Household with all of the following documentation. (i) TBRA Application in the form attached to the TBRA Program Operating Guidelines in Exhibit A, or as otherwise approved in writing by the Deputy Director of Business Development on behalf of the City ("Deputy Director"). The TBRA Application shall solicit information regarding each applicant household's income and assets, household j size and composition (number of children and adults), names of household members, Housing Unit (defined below) size and location preferences, specific needs and considerations, and a race/ethnicity survey. Examples of acceptable documental to confirm recent residency include: • Copy of previous lease • Copy of previous utility bill • Written confirmation of residency from a previous landlord, or proof of residency in transitional living facility • Copy of school records confirming previous residency Examples of proof of strong ties to the Community include: • Current residency of an immediate family member — mother, father, sibling, child, or grandparent • Proof that the individual and/or their dependent(s) attended K- 12 school in Huntington Beach • Proof that the individual and/or their dependents(s) attended K- 12 school in Huntington Beach (ii) Declaration of Homelessness Status or Declaration of At-Risk of Homelessness States, as appropriate, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iii) Rental Assistance Contracts for the Landlord and the Eligible Household, in the forms attached to the TBRA Program Operating Guidelines in Exhibit A. (iv) Household Budget Worksheet in the form attached to this Agreement as Exhibit D. (v) Lead-Based Hazard Information Pamphlet "Protect Your Family from Lead in Your Home" attached to this Agreement as Exhibit E. (d) Guidance for Eligible Households. Subrecipient shall meet with prospective Eligible Households throughout the application process and shall continue to meet with and counsel each Eligible Household regarding the TBRA Program, 3 the Eligible Household's responsibilities as participants of the TBRA Program, and the goals and objectives of the"rBRA Program. 1.3 Determination of Eligibility. Subrecipient shall qualify all Eligible Households in accordance with the selection criteria described in this Section. Further, for all j Eligible Households Subrecipient shall implement the selection criteria and policies in compliance with the City's Consolidated Plan and the City's housing needs and priorities. (a) Eligible Household. As used in this Agreement, "Eligible Household" refers ! to extremely low income households that are (i) currently residents in the City of Huntington Beach; and (ii) currently homeless or at risk of homelessness. (i) As used in this Agreement "homeless" is defined at 24 CFR 91, 582 and 583, as defined by HUD. (ii) For purposes of determining eligibility for the TBRA Program, a prospective Eligible Household's (or for continuing compliance, a participating Eligible Household's) gross annual income shall be determined in accordance with 24 CFR 5.609, with the allowable exclusions from income established at 24 CFR 5.611. For purposes of this Agreement, annual income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be received prospectively during the 12-month period following the date of application and before any deductions are taken (and for a participating household, income anticipated for the 12 months following verification described in §1.3(b)(ii) below.) When collecting income verification doctunentation, Subrecipient may also consider any likely changes in income. (iii) For purposes of this Agreement and the TBRA Program, income limits for extremely-low, very-low and low income households are established annually by HUD for the Orange County income limit area. (b) Income Verification. (i) Initial Verification. To determine if TBRA Program applicants (collectively, "Applicants") are income-eligible, Subrecipient must verify each Applicant's household income using source documentation such as wage statements, interest statements, unemployment compensation statements, bank account statements and other documentation types approved by HUD. Once an initial income verification is completed, the Subrecipient is not required to re- examine the Eligible Household's income unless six months has elapsed before assistance is provided. 4 (ii) Annual Eligibility Verification. Subrecipient shall annually re- certify income and re-qualify each Eligible Household, including examination of source documentation. Household income must be no greater than 80 percent of AM] to remain eligible for assistance. For households found no longer eligible, assistance must be terminated following a 30-day notification period. (c) Verification of Eligibility. Subrecipient shall collect and examine source documentation submitted by the Applicant to verify the identity of the members of the Eligible Household. Subrecipient shall make a determination that the Eligible Household is currently experiencing homelessness or is at imminent risk of homelessness, as defined 24 CFR 91, 582 and 583, based on caseworker observations and certification and Applicant certification. (d) Notice of Eligibility Determination. Subrecipient shall provide written or documented verbal notice to each Applicant stating whether such Applicant was determined to be eligible for assistance under the TBRA Program. Applicants determined to be ineligible for TBRA Program assistance shall have an opportunity to appeal the determination to the Subrecipient's Executive Director. If the issue is not resolved, the case will be referred to the Deputy Director. The definition of"homelessness" 24 CFR 91, 582 and 583 is applicable to this Agreement. 1.4 Selection of Housing Units. (a) Housing Unit Selection. Subrecipient shall assist Eligible Households with finding and selecting an appropriate housing unit (each a"Housing Unit") that meets federal housing quality standards ("HQS") or such other standards as may be made applicable to the TBRA Program by HOME Program statutes and/or regulations, specifically including Uniform Physical Condition Standards (UPCS), and that satisfies the requirements of the TBRA Program, HOME Program and this Agreement. Eligible Households shall also be entitled to find a Housing Unit for themselves, subject to compliance with the requirements of the TBRA Program, HOME Program and this Agreement; however, the parties anticipate that in most cases, Subrecipient shall be responsible for locating and qualifying an appropriate Housing Unit for occupancy by each Eligible Household. Subrecipient may refer Eligible Households to appropriate Housing Units but may not require an Eligible Household to select a particular Housing Unit. Subsidy Payments shall only be provided in connection with the rental of a qualified Housing Unit located in the City, unless Subrecipient documents reason for selecting housing outside the city. Subsidy Payments under this Agreement are portable within the City. Subrecipient's obligations under this Section 1.4 apply to each Housing Unit to be occupied by an Eligible Household receiving Subsidy Payments hereunder. 5 (b) Housing Unit Size; Occupancy Standards. Housing unit selection shall comply with the following "Occupancy Standards" for the applicable Eligible Household: No more than two persons per bedroom plus one may occupy the Housing Unit. Thus, no more than three persons may occupy a one-bedroom Housing Unit, no more than five persons may occupy a two-bedroom Housing Unit; no more than seven persons may occupy a three-bedroom Housing Unit; no more than nine persons may occupy a four-bedroom Housing Unit. (c) Property Inspection. Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual (or more often) verification process, Subrecipient shall cause a certified HQS inspector to inspect each Housing Unit occupied or to be occupied by an Eligible Household to ensure the Housing Unit complies with HQS as set forth in the HOME Program, including without limitation 24 CFR 92.251, as well as all applicable state and local codes and ordinances, including zoning ordinances. Subrecipient shall provide the City with documentation of each HQS inspector's certification. Each HQS inspection shall include all of the following: (i) Verification of the age of the Housing Unit (on Rent Reasonableness Form attached to the TBRA Program Operating Guidelines in Exhibit A; (ii) Complete HQS Inspection Checklist in the form attached to the TBRA Program Operating Guidelines in Exhibit A, including a rating for the Housing Unit of Pass, Pass with Comment, or Fail; (iii) Lead-based hazard assessment, dissemination of Icad-based hazard information pamphlet and disclosure form and lead-based hazard reduction activities, if required by the HOME Program or applicable federal, state and/or local laws; (iv) Adequate opportunity for the Landlord (defined below) to correct any deficiencies indicated in the HQS Inspection Form to bring the Housing Unit into compliance with HQS requirements; (v) Verification that occupancy by the Eligible Household will comply with the Occupancy Standards set forth in Section 1.4(b); and (vi) Certification of rent reasonableness regarding the rent being charged for the Housing Unit based on comparable non-assisted Housing Units in the same area. Subrecipient shall perform the rent reasonableness review as approved by the City. City may elect to perform the rent reasonableness reviews on behalf of Subrecipient by providing written notice to Subrecipient. The rent charged under the written lease agreement for the Housing Unit shall conform to the Rent Reasonableness Standard pursuant to the TBRA Program Operating Guidelines in Exhibit A, which is based on local market conditions. 6 The contract rent for Housing Units that are restricted to an affordable rent by agreement with the City or by regulation or ordinance, or otherwise, shall be likewise restricted to such affordable rent in accordance with the contractual, statutory or regulatory restrictions governing the permitted rents for such Housing Units and the Rental Assistance Subsidy Payment shall be limited and calculated accordingly, as described in Section 1.5(a), below. (d) Coordination with Landlords. i (i) Landlord Guidance. Subrecipient shall provide guidance to the property owners, property owners' representatives, or property management companies hired by property owners (each a "Landlord" and collectively referred to as "Landlords") participating in the TBRA Program regarding the TBRA Program requirements and procedures that impact Landlords. (ii) Landlord Agreement. Subrecipient shall enter into a Landlord Agreement with each participating property owner/Landlord in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A. The Landlord Agreement will establish the Subsidy Payments to be made by Subrecipient on behalf of the Eligible Household as well as the Eligible Household's initial share of the contract rent. The Landlord Agreement shall further establish the terms and conditions under which the Subsidy Payments shall be paid to the Landlord for the applicable Housing Unit, including applicable HOME Program requirements. The Landlord Agreement shall have an initial term of 6-12 months, subject to extensions approved by Subrecipient and City (as applicable) pursuant to the TBRA Program Operating Guidelines. (iii) Tenant Protection Agreement. Subrecipient shall require each Landlord to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit owned and/or managed by such Landlord, which lease agreement shall include a Tenant Protection Agreement in substantially the form attached to the TBRA Program Operating Guidelines in Exhibit A, or an updated form of Tenant Protection Agreement as may be prepared and provided by the City to the Subrecipient, and then by Subrecipient to Landlord. The Tenant Protection Agreement shall be executed in connection with the lease agreement between the Landlord and Eligible Household. The Tenant Protection Agreement will prohibit the inclusion of prohibited lease terms listed at 24 CFR 92.253; Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS, as established at 24 CFR 982.401; and prohibit discrimination by the landlord against the Eligible Household. The Subrecipient wilt review the lease agreement to confirm its compliance 7 with state law and all HOME Program requirements. If the Landlord's form of rental agreement is not acceptable, Subrecipient shall require the Landlord and Eligible Household to enter into a lease agreement that complies with state law, HOME requirements, and City requirements. 1.5 Subsidy Payments. Subrecipient shall make rent payments and security deposit payments, as applicable (collectively, the "Subsidy Payments"), to Landlords, on behalf of Eligible Households. Subsidy payments must be provided in accordance to the Subrecipient's TBRA Program Operating Guidelines. Eligible Households are not expected to repay Subsidy Payments received pursuant to the TBRA Program. Except as may be permitted by the HOME Program, Subrecipient' s sole remedy in the event of noncompliance or breach by an Eligible Household shall be non-renewal of assistance under the TBRA Program. (a) Rental Assistance Calculation. Subrecipient shall calculate the "Rental Assistance" payments to be paid on behalf of each Eligible Household under this Agreement. The maximum amount of monthly assistance that the Subrecipient may pay on behalf of a family is the difference between the rent standard for the unit size and 30 percent of the household's monthly adjusted income. (b) Payment Standards. Subrecipient must use the payment standards as set forth in the Rent Reasonableness Standards attached to the TBRA Pmgram Operating Guidelines in Exhibit A. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach. Payment standards are established by bedroom size. (c) Utility Allowance. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the Eligible Households entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the Eligible Household is directly responsible for payment of utility services, the Eligible Household's initial share of monthly rent will be determined by subtracting a utility allowance from 30 percent of the Eligible Household's gross monthly income. The Subrecipient must use the County of Orange's Housing Authority's Utility Allowance Schedule attached to the TBRA Program Operating Guidelines in Exhibit A. (d) Term. The Subrecipient will provide rental assistance for an initial term of 6- 12 months, which can be extended in 6-12 month intervals, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Subrecipient and shall be based on continued program compliance and ongoing need. The Subrecipient will evaluate ongoing need. (e) Security Deposit Assistance. Subrecipient may provide security deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall 8 provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. (f) Utility Deposit Assistance. Subrecipient may provide utility deposit assistance to each Eligible Household. It is anticipated that Subrecipient shall provide Security Deposit Assistance to each Eligible Household in an amount no greater than two months' rent. The lease agreement must provide that the security deposit is refundable in accordance with state law. Security deposit refunds shall be provided by the Landlord directly to the Eligible Household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by Eligible Household and landlord, as provided for in the lease. 1.6 Administrative Cost Reimbursements. The City will reimburse the Subrecipient for allowable costs incurred in administering the TBRA Program, which are associated with the determination of income eligibility, pursuant to 24 CFR 92. 203, and property inspections under HQS, codified per 24 CFR 982. 401. Administrative costs incurred in administering the TBRA Program that are ineligible under the HOME Program will be reimbursed from a non-HOME Program funding source, or Community Development Block Grant (CDBG) Funds. The administrative costs to be reimbursed from the CDBG Funds include Intake Assessments, Housing Search, Case Management, Self—Sufficiency and related services and overhead. 1.7 Termination of Assistance and Returning Eligible Households. (a) Termination of Rental Assistance. Subrecipient may terminate assistance under the TBRA Program for any of the following reasons: (i) Eligible Household is evicted from the Housing Unit based on behavioral issues or unlawful activity; (ii) Eligible Household has violated TBRA participant agreement. (iii) Eligible Household will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based Programs. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must be terminated. 1.8 Returning Eligible Households. As needed, Eligible Households may be allowed to return to the program for rental assistance. A determination to allow re-entry shall be based on the following criteria: 9 (i) Eligible Households must have left the program in good standing. To be in good standing, Eligible Households must have been engaged in their case management plan, voluntarily left the program (not in lieu of termination) or have been released because their household income exceeded eligibility limits. In general, Eligible Households will not be allowed to re-enter the program if they were terminated for non- compliance. (ii) At the discretion of the Subrecipient, a request for re-admission from a prospective Eligible Household previously terminated due to non- compliance may be considered when compelling reasons exist. In such cases, re-admission will require concurrence from the City. (iii) Eligible Households may return so long as the previous rental assistance did not exceed 24 months. Cumulatively, Eligible Households may not receive rental advice for more than a cumulative period of 24 months unless such assistance is permitted by the HOME Program and approved by the City. 1.9 Additional Requirements. (a) Self-Sufficiency Program. Subrecipient shall request each Eligible Household receiving Subsidy Payments from the Subrecipient to participate in Housing Stabilization Case Management administered by Subrecipient and in accordance with the Case Management and Self Sufficiency Program Policies and Procedures attached to the TBRA Program Operating Guidelines in Exhibit A. Failure of an Eligible Household that is already receiving Subsidy Payments to participate in the Self-Sufficiency Program shall not be grounds for termination of the Subsidy Payments, but may be grounds for non-renewal of Subsidy Payments upon expiration of the subsidy term. (b) No Fees. Subrecipient may not charge fees to any Eligible Household for the Services, Subsidy Payments, Case Management or other services or assistance to be provided to Eligible Households under this Agreement. 1.10 Schedule of Performance. Subrecipient shall use its best efforts to perform the Services in accordance with the following schedule: (a) Affirmative marketing and outreach activities required by this Agreement shall commence immediately upon execution of this Agreement. (b) Subrecipient shall qualify Eligible Households, conduct HQS inspections, approve Housing Units, and move Eligible Households into approved Housing Units in accordance with the following milestone schedule: (i) Subrecipient shall process intake paperwork for and verify eligibility for TBRA Program assistance ("Enroll`) for not fewer than three (3) 10 Eligible Households within three (3) months following execution of this Agreement. As program income becomes available and/or additional HOME Funds are contributed to the TBRA Program, Subrecipient shall use diligent efforts to Enroll additional Eligible Households within not more than three (3) months following written notice from the City that such additional funds are expected to become available. (ii) Subrecipient shall assist each Enrolled Eligible Household in finding an appropriate Housing Unit and shall conduct an HQS inspection of such Housing Unit, all within two (2) months following Enrollment of such Eligible Household. (iii) Subrecipient shall commence providing Subsidiary Payments on behalf of each Eligible Household and shall assist each Eligible Household to move into an I-IQS-inspected and approved Housing Unit, all within three (3) months following Enrollment/Intake of such Eligible Household. (c) Subrecipient shall request each Eligible Household to commence participation in the self-sufficiency program immediately upon Enrollment of such Eligible Household, whether or not such Eligible Household has yet moved into a Housing Unit and received the benefit of Subsidy Payments hereunder. 1.11 City Oversight and Approval Rights. City shall have the right; by written notice to Subrecipient at any time during the Term of this Agreement, to require City review of any of the Services to be performed or pre-approval of service tools and procedures by Subrecipient hereunder, including for example income determinations, qualification of applicants as " Eligible Households," qualification of Housing Units, determination of reasonable rents, etc., to ensure compliance with the TBRA Program, the HOME Program, or other applicable requirements. ARTICLE 2 TERM 2.1 Term. Services of the Subrecipient under this Agreement shall start on July 1, 2021 and end on the earlier to occur of(i) June 30, 2022 or (ii) the date the full amount of HOME Funds available under Section 3.2(a) below has been disbursed to Subrecipient and expended by Subrecipient to provide Subsidy Payments pursuant to this Agreement ("Term"), unless this Agreement is earlier terminated pursuant to Section 8.3. The Term of this Agreement and the provisions herein shall be further extended to cover any additional time period during which the Subrecipient remains in control of HOME Funds or other HOME assets, including program income. ARTICLE 3 BUDGET AND PAYMENTS 11 3.1 Budget. Subrecipient has submitted a budget to City for approval ("Budget"), which sets forth the estimated timing and use of the HOME, Funds contributed by the City pursuant to this Agreement. The Budget is attached hereto as outlined in the Scope of Services and Budget in Exhibit A. Any amendments to an approved Budget for the Services must be approved by the City's Director or his authorized designee. in the event this Agreement is extended past the initial Term or any additional moneys will be contributed to the TBRA Program by City pursuant to this Agreement, Subrecipient shall prepare and submit to the Deputy Director for approval an updated Budget for such additional moneys. Subrecipient shall prepare a Budget, for approval by Deputy Director, for each year during which this Agreement remains in effect. The City may require a more detailed line item breakdown of the Budget than the one contained herein, and the Subrecipient shall provide such supplementary information about the Budget in a timely fashion in the form and content prescribed by the City. 3.2 Reimbursement of Subsidy Payments. City shall reimburse Subrecipient for Subsidy Payment actually disbursed to or on behalf of Eligible Households pursuant to this Agreement and in accordance with line items on the approved Budget or as otherwise approved by the City's Deputy Director. City shall have no obligation to reimburse Subrecipient for ineligible administrative costs or expenses incurred by Subrecipient to manage or implement the TBRA Program or this Agreement, for the cost of social or supportive services provided to Eligible Households hereunder, or for any other costs or expenses incurred by Subrecipient in connection with its activities under this Agreement. City's payment obligations hereunder shall be limited to the actual amount of Subsidy Payments disbursed by Subrecipient and eligible administrative costs in accordance with the terms of this Agreement and the approved Budget. Payments may be contingent upon certification of the Subrecipient's financial management system in accordance with the standards specified in 24 CFR 84.21. (a) Amount of Payments. It is expressly agreed and understood that the total amount of HOME Program funds to be paid by the City under this Agreement shall not exceed Two Hundred Eighty One Thousand, Four Hundred Ten Dollars ($281,410.00). The dollar amounts stated in the immediately preceeding sentences may be increased by written amendment of this Agreement, signed by an authorized representative of Subrecipient and the Director. (b) Requests for Payments. To receive each payment under this Agreement, Subrecipient shall submit to the City a written reimbursement request or invoice in a form approved by City, along with such supporting documentation as may be requested by the City to verify Subrecipient's performance of the Services for which the payment is requested. Reimbursement requests shall be submitted no more frequently than one time per month. Payments will be adjusted by the City in accordance with fund advances, if any, balances available in Subrecipient accounts. In addition, the City reserves the right to liquidate funds available under this Agreement for costs incurred by the City on behalf of the Subrecipient. 12 3.3 Payments Subject to Availability of HOME Funds. City's obligation to provide payments to Subrecipient hereunder is subject to City's receipt of HOME Funds from HUD pursuant to the HOME Program. 3.4 Accounting. Subrecipient shall, upon request, provide City with an accounting report, in form and content reasonably satisfactory to City, of any funds disbursed by City pursuant to Section 3.2. 3.5 Program Income. City and Subrecipient acknowledge and agree that the design of TBRA Program does not anticipate the receipt of"Program Income," as defined in 24 CFR 92.2, by the Subrecipient. Notwithstanding, in the event that any Program Income is received by the Subrecipient, Subrecipient will promptly remit same to the City. ARTICLE 4 INSURANCE AND INDEMNIFICATION 4.1 Insurance. Without limiting City's right to indemnification, Subrecipient shall secure prior to commencing the performance of any Services under this Agreement, and maintain during the Term of this Agreement, insurance coverage as set forth in this Section. (a) Required Insurance. Subrecipient shall secure and maintain the following coverage: u Workers' Compensation Insurance as required by California statutes; (ii) Commercial General Liability Insurance, or Commercial General Liability Insurance, including coverage for Premises and Operations, Contractual Liability, Personal Injury Liability, Products/Completed Operations Liability, Broad-Form Property Damage, Independent Contractor's Liability and Fire Damage Legal Liability, in the amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single limit, written on an occurrence form; and (iii) Comprehensive Automobile Liability coverage, including — as applicable — owned, non-owned and hire autos, in an amount of not less than One Million Dollars ($1,000,000.00) per occurrence, combined single-limit, written on an occurrence form. The Deputy Director, with the consent of City's Risk Manager is hereby authorized to modify the requirements set forth above in the event he or she determines that a modification, whether an increase or decrease, is in the City's best interest. 13 (b) Required Clauses in Policies. Each insurance policy required by this Agreement shall contain the following clauses: "This insurance shall not be canceled or allowed to lapse without at least ten (10) day's prior written notice given to the City Clerk of the City of Huntington Beach, 2000 Main Street, Huntington Beach, CA 92648." "it is agreed that any insurance maintained by the City of Huntington Beach shall apply in excess of and not contribute with insurance provided by this policy." Each insurance policy required by this Agreement, excepting policies for workers' compensation, shall contain the following clause: "The City of Huntington Beach, its officials, agents, employees, representative, and volunteers are added as additional insureds as respects operations and activities of, or on behalf of the named insured, performed under contract with the City of Huntington Beach. Subrecipient hereby agrees to waive subrogation which any insurer of the Subrecipient may acquire from the Subrecipient by virtue of the payment of any loss. If requested by City, Subrecipient agrees to obtain and deliver to City any endorsement from Subrecipient's general liability and automobile insurance insurer to effect his waiver of subrogation. (c) Property Insurance. Subrecipient shall further comply with the insurance requirements of 24 CH F 94.31. (d) Required Certificates and Endorsements. Prior to commencement of any Services under this Agreement, the Subrecipient shall deliver to City ( i) insurance certificates confirming the existence of the insurance required by this Agreement, and including the applicable clauses referenced above, and ( ii) endorsements to the above -required policies, which add to these policies the applicable clauses referenced above. Such endorsements shall be signed by an authorized representative of the insurance company and shall include the signator's company affiliation and title. Should it be deemed necessary by City, it shall be the Subrecipient's responsibility to see that City receives documentation, acceptable to City, which sustains that the individual signing such endorsements is indeed authorized to do so by the insurance company. Also, City reserves the right at any time to demand, and to receive within a reasonable time period, certified copies of any insurance policies required under this Agreement, including endorsements effecting the coverage required by these specifications. (e) Remedies for Defaults Re: Insurance. In addition to any other remedies City may have if the Subrecipient fails to provide or maintain any insurance 14 policies or policy endorsements to the extent and within the time herein required, City may,-at its sole option: (i) Obtain such insurance and deduct and retain the amount of the premium for such insurance from any sums due under the Agreement; (ii) Order the Subrecipient to stop work under this Agreement and/ or withhold any payment( s) which become due to the Subrecipient hereunder until the Subrecipient demonstrates compliance with the requirements hereof, or (iii) Terminate this Agreement. Exercise of any of the above remedies, however, is an alternative to other remedies City may have and is not the exclusive remedy for the Subrecipient's failure to maintain insurance or secure appropriate endorsements. Nothing herein contained shall be construed as limiting in any way the extent to which the Subrecipient may be held responsible for payment of damages to persons or property resulting from the Subrecipient's or its subcontractor's performance of the Services covered under this Agreement. 4.2 Indemnification. (a) As respects acts, errors or omissions in the performance of Services under this Agreement, the Subrecipient agrees to defend, indemnify and hold harmless City, its officers, agents, employees, representatives and volunteers from and against any and all claims, demands, defense costs, liability or consequential damages of any kind or nature arising directly out of the Subrecipient's negligent acts, errors or omissions in the performance of Services under the terms of this Agreement. (b) As respects all acts or omissions which do not arise directly out of the performance of Services, including but not limited to those acts or omissions normally covered by general and automobile liability insurance, Subrecipient agrees to indemnify, defend (at City's option), and hold harmless City, its officers, agents, employees, representatives, and volunteers from and against any and all claims, demands, defense costs, liability, or consequential damages of any kind or nature arising out of or in connection with Subrecipient's performance or failure to perform, under this Agreement; excepting those which arise out of the sole negligence of City. ARTICLE 5 ADMINISTRATIVE REQUIREMENTS 15 5.1 Financial Management. (a) Accounting Standards. Subrecipient agrees to comply with 24 CFR 84.21 through 84.28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. (b) Cost Principles. Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organization." These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 5.2 Documentation, Recordkeeping, Reporting and Monitoring. Subrecipient shall maintain documents and records, prepare and submit reports, and permit City to monitor Subrecipient's activities all in accordance with the requirements set forth in Exhibit B and applicable laws and regulations. All requirements set forth in such Exhibit B are incorporated herein as if set forth in full in this Agreement. 5.3 Use and Reversion of Assets. The use and disposition of property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CPT 92.504, as applicable. The Subrecipient shall transfer to the City any HOME Funds on hand and any accounts receivable attributable to the use of HOME Funds under this Agreement at the time of the earliest to occur of expiration, cancellation, or termination. 5.4 Ownership of Documents. All documents and materials, both tangible and intangible, furnished by or through the City to Subrecipient pursuant to this Agreement are and shall remain the property of City and shall be returned to City upon the earliest to occur of expiration, cancellation, or termination of this Agreement. All documents and materials prepared by Subrecipient under or related to this Agreement shall become the property of City at the time of payment to Subrecipient of all fees, if any, for their preparation, and shall be delivered to City by Subrecipient at the request of City, and in any event upon the earliest to occur of expiration, cancellation, or termination of this Agreement. 5.5 Record Retention. All TBRA Program records shall be maintained by the Subrecipient for a minimum of five (5) years beyond the final payment under this Agreement. Notwithstanding, if there are litigation, claims, audits, negotiations or other actions that involve any of the records cited and that have commenced before the expiration of the retention periods outlined, such records must be retained until completion of the actions and resolution of all issues, or the expiration of the retention period,whichever occurs later. ARTICLE 6 PERSONNEL & PARTICIPANT CONDITIONS 6.1 Civil Rights. 16 (a) Compliance. The Subrecipient agrees to comply with the Huntington Beach Municipal Code, Government Code Section 4450, et seq., the Unruh Civil Rights Act, Civil Code Section 51, et seq., Title VI of the Civil Rights Act of 1964, as amended, Title VIII of the Civil Rights Act of 1968 as amended, Section 104(b) and Section 109 of Title 1 of the Housing and Community Development Act of 1974, as amended, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Executive Order 11063, and Executive Order 11246 as amended by Executive Orders 11375, 11478, 12107 and 12086. (b) Nondiscrimination. The Subrecipient agrees to comply with (1) the i requirements of 24 CFR Part 5, subpart A, which relate to nondiscrimination and equal opportunity; (2) the nondiscrimination requirements of Section 282 of the HOME Investment Partnerships Act, 42 U.S.C. Section 12701, et seq. (c) Section 504. The Subrecipient agrees to comply with all federal regulations issued pursuant to compliance with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination against the individuals with disabilities or handicaps in any federally assisted program. 6.2 Affirmative Action. (a) Executive Order 11246, The Subrecipient agrees that it shall be committed to cant' out pursuant to the City's specifications an Affirmative Action Program in keeping with the principles as provided in President's Executive Order 11246 of September 24, 1966. (b) Women- and Minority-Owned Businesses (W/MBE). The Subrecipient will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance of this Agreement. As used in this Agreement, the term "small business" means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish surnamed or Spanish-heritage Americans, Asian-Americans, and American Indians. The Subrecipient may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. (c) Equal Employment Opportunity and Affirmative Action (EEO/AA) Statement. The Subrecipient will, in all solicitations or advertisements for employees placed by or on behalf of the Subrecipient, state that it is an Equal Opportunity or Affirmative Action employer. 17 (d) Subcontract Provisions. The Subrecipient will include the provisions of Sections 6.1, Civil Rights, and 6.2, Affirmative Action, in every subcontract or purchase order, specifically or by reference, so that such provisions will be binding upon each of its own sub-subrecipients or subcontractors. I 6.3 Employment Restrictions. (a) Prohibited Activity. The Subrecipient is prohibited from using HOME Funds provided herein or personnel employed in the administration of the program for: political activities; inherently religious activities; lobbying; political patronage; and nepotism activities. (b) Labor Standard. The Subrecipient agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) and all other applicable federal, state and local laws and regulations pertaining to labor standards insofar as and when those acts apply to the performance of this Agreement. The Subrecipicnt agrees to comply with the Copeland Anti-Kick Back Act (18 U.S.C. 874 et seq.) and the implementing regulations thereto issued by the U.S. Department of Labor at 29 CFR Part 5. The Subrecipient shall maintain documentation that demonstrates compliance with applicable hour and wage requirements. (c) Prevailing Wage. The Subrecipicnt agrees that, to the extent applicable, all contractors engaged under contracts for construction, renovation or repair work financed in whole or in part with assistance provided under this Agreement shall comply with the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7 and California Labor Code Section 1720, et seq. governing the payment of wages and ratio of apprentices and trainees to journey workers. The Subrecipient shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. (d) Section 3 Clause. The Subrecipient agrees, to the extent applicable, to comply with Section 3 of the HUD Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR 135. 6.4 Conduct. (a) Assignment. The Subrecipient shall not assign or transfer any interest in this Agreement without the prior written consent of the City thereto; provided, however, that claims for money due or to become due to the Subrecipient from the City under this Agreement may be assigned to a bank, trust company, or other financial institution without such approval. Notice of anv such assignment or transfer shall be furnished promptly to the City. 18 (b) Subcontracts. (i) Approvals. The Subrecipient shall not enter into any subcontracts with any entity, agency or individual in the performance of this Agreement j without the written consent of the City prior to the execution of such agreement. I (ii) Monitoring. The Subrecipient will monitor all subcontracted services on a regular basis to assure contract compliance. Results of monitoring efforts shall be summarized in written reports and supported with documented evidence of follow-up actions taken to correct areas of noncompliance. (iii) Content. The Subrecipient shall cause all of the provisions of this Agreement in its entirety to be included in and made a part of any subcontract executed in the performance of this Agreement. (iv) Selection Process. The Subrecipient shall undertake to insure that all subcontracts let in the performance of this Agreement shall be awarded on a fair and open competition basis in accordance with applicable procurement requirements. Executed copies of all subcontracts shall be forwarded to the City along with documentation concerning the selection process. (c) Hatch Act. The Subrecipient agrees that no funds provided, nor personnel employed under this Agreement, shall be in any way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of Title V of the U.S.C. (d) Conflict of Interest. The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 92.356, which include (but are not limited to) the following: (i) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers. employees or agents engaged in the award and administration of contracts supported by HOME Funds. (ii) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by HOME Funds if a conflict of interest, real or apparent, would be involved. (iii) No covered persons who exercise or have exercised any functions or responsibilities with respect to HOME-assisted activities, or who are in a position to participate in a decision-making process or gain inside 19 information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the HOME-assisted activity, or with respect to the proceeds from the HOME-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Subrecipient, or any designated public agency. (c) Lobbying. The Subrecipient hereby certifies that: (i) No federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement; (ii) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and (iii) It will require that the language of paragraph (iv) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly. (f) Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352 Title 31, US.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 20 (g) Religious Activities. The Subrecipient agrees that funds provided under this Agreement will not be utilized for inherently religious activities such as worship, religious instruction, or proselytization. (h) Drug-Free Workplace. The Subrecipient agrees to maintain a drug-free workplace per the requirements of 2 CPR part 2429. (i) Debarred or Suspended Entities. By signing this Agreement, Subrecipient certifies that it is not presently listed by any federal agency as debarred, suspended, or proposed for debarment from any federal contract activity. If during the term of this Agreement this information changes, Subrecipient shall notify City without delay. Such notice shall contain all relevant particulars of any debarment, suspension, or proposed debarment. Further, in carrying out its responsibilities hereunder, Subrecipient will not employ, contract with, or otherwise make use of subcontractors, service providers, consultants, or any other party that is debarred, suspended, or proposed for debarment from any federal contract activity. (j) VAWA Regulations. The City and Subrecipient both acknowledge and agree that each are subject to the requirements of 24 CFR 92.359 and 24 CFR 5, Subpart L, which implements provisions of the Violence Against Women Reauthorization Act of 2013 (VAWA). Subrecipient also agrees to follow and implement the applicable VAWA requirements contained in the City's Program Guidelines and the City's Emergency Transfer Plan, as required by 24 CFR 92.359(g), for all applicants to the TBRA Program, and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover, the Subrecipient agrees that all leases that are approved by the Subrecipient shall contain the City's required VAWA lease term/addendum, as described in 24 CFR 92.359(e)and the City's TBRA Program ARTICLE 7 GENERAL CONDITIONS 7.1 General Compliance. The Subrecipient agrees to comply with the requirements of the IIOME Program in the administration and implementation of the TBRA Program and this Agreement. The Subrecipient shall carry out each activity in compliance with all regulations described in subpart I-I of 24 CFR Part 92, except that the Subrecipient does not assume the City's responsibilities for environmental review under 24 CPR 92.352 and the intergovernmental review process described in 24 CFR 92.357 does not apply to the Subrecipient. The Subrecipient also agrees to comply with all other applicable federal, state and local laws, regulations, and policies governing the funds provided under this Agreement. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 7.2 Familiarity with Services;Qualified Personnel. 21 (a) By executing this Agreement, Subrecipient represents and warrants that Subrecipient (i) has thoroughly investigated and considered the Services to be performed, (ii) has carefully considered how the Services should be performed, and (iii) fully understands the requirements, difficulties and restrictions attending the performance of the Services under this Agreement. (b) Subrecipient represents that Subrecipient has or will secure and maintain, at Subrecipient's sole cost and expense, all qualified and licensed personnel required to perform the Services. Staff and any additional personnel hired by Subrecipient shall be employees of Subrecipient. Such personnel shall not be deemed to be employees of City or to have any contractual relationship with City. Such Personnel shall be authorized or permitted under state and local law to perform the Scrvices. 7.3 Independent Contractor. In performing under this Agreement, Subrecipient is and shall at all times be acting and performing as an independent contractor to City, performing its duties in accordance with its owrtjudgmcnt. City shall neither have nor exercise any control or direction over the methods by which Subrecipient performs its work and function nor shall City have the right to interfere with such freedom or action or prescribe rules or otherwise control or direct the manner in which such services are performed. The sole interest of the City in the Services performed by the Subrecipient is that such Services be performed in a legal competent, efficient and satisfactory manner. Nothing contained herein shall cause the relationship between the parties to this Agreement to be that of employer and employee. Subrecipient shall not have the authority to obligate City to any contract, obligation, or undertaking whatsoever and shall make no representation, either oral or in writing. 7.4 Subrecipient Representative. Subrecipient hereby designates Madelynn Himcise as its Project Manager for the TBRA Program ("Subrecipient's Representative"). Subrecipient's Representative shall supervise and direct the Scrvices, using his or her best skill and attention, and shall be responsible for all means, methods, techniques, sequences and procedures and for the satisfactory coordination of all portions of the Services under this Agreement. 7.5 Nepotism. Subrecipient shall not hire or permit the hiring of any person to fill a position funded through this Agreement if a member of the person's immediate family is employed in an administrative capacity by City's HOME Program or any department of the City which is administering the HOME Program. For the purposes of this section, the term "immediate family' means spouse, child, mother, father brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisory or management responsibilities, including serving on the governing body of City. 7.6 Hold Harmless. The Subrecipient shall indemnify, hold harmless, and defend the City and their elected officials, officers, employees and agents and shall pay for expenses incurred by the City for any and all claims, actions, suits, charges and 22 judgments whatsoever related in any manner to or that arise out of the Subrecipient's performance or nonperformance of the Services or subject matter called for in this Agreement. 7.7 City Recognition. The Subrecipient shall insure recognition of the role of the City in providing Services through this Agreement. All activities, facilities and items utilized pursuant to this Agreement shall be prominently labeled as to funding source. I 7.8 Notices. Any approval, disapproval, demand, document or other notice ("Notice") which any party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by reputable document delivery service such as Federal Express that provides a receipt showing date and time of delivery, (iii) facsimile transmission, or (vi) mailing in the United States mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below, or at any other address as that party may later designate by Notice. Service shall be deemed conclusively made at the time of service if personally served; upon confirmation of receipt if sent by facsimile transmission; the next business if sent by overnight courier and receipt is confirmed by the signature of an agent or employee of the party served; the next business day after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by express mail; and three (3) days after deposit in the United States mail, properly addressed and postage prepaid, return receipt requested, if served by certified mail. Subrecipient: Madclynn Himeise Project Manager Families Forward 8 Thomas Irvine, CA, 92618 City: City Clerk City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 With copies to: Steve Holtz, Deputy Director Community Development/NED 2000 Main Street Huntington Beach, CA 92648 Such addresses may be changed by Notice to the other party(ies) given in the same manner as provided above. 23 7.9 Amendment and Waiver. This Agreement may be amended, modified, or supplemented only by a writing executed by each of the parties. Any party may in writing waive any provision of this Agreement to the extent such provision is for the benefit of the waiving party. No action taken pursuant to this Agreement, including any investigation by or on behalf of any party, shall be deemed to constitute a waiver by that party or its or any other party's compliance with any representations or warranties or with any provision of this Agreement. 7.10 Entire Agreement. This Agreement, including all Exhibits attached hereto, embodies the entire agreement and understanding between the parties pertaining to the subject matter of this Agreement and supersedes all prior agreements, understandings, negotiations, representations, and discussions, whether verbal or written, of the parties pertaining to the subject matter. In the event of a conflict between this Agreement, on one hand, and any Exhibit attached hereto, on the other hand, the provisions of this Agreement shall control; provided, if it is possible to comply with the requirements of this Agreement and the Exhibits, the parties shall do so. The following Exhibits are attached to this Agreement and incorporated herein: Exhibit A Scope of Services and Budget and TBRA Program Operating Guidelines Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Exhibit C Gross Income Calculation Form Exhibit D Household Budget Worksheet Exhibit E Lead-Based Hazard Information Painphlet"Protect Your Family from Lead in your Home" 7.11 Governing Law. The validity, construction, and performance of this Agreement shall be governed by the laws of the State of California. 7.12 Non-Liability of Members, Officials and Employees of City. No member, official or employee of City shall be personally liable to Subrecipient, or any successor in interest, in the event of any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or on any obligation under the terms of this Agreement. Subrecipient hereby waives and releases any claim Subrecipient may have against the member, officials or employees of City with respect to any Default or breach by City or for any amount which may become due to Subrecipient or Subrecipient's successors, or any obligations under the terms of this Agreement. Subrecipient makes such release with the full knowledge of Civil Code Section 1542 and hereby waives any and all rights thereunder to the extent of this release, if such Section 1542 is applicable. Section 1542 of the Civil Code provides as follows: 24 "A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT TIME TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR." ARTICLE 8 ENFORCEMENT; TERMINATION 8.1 Events of Default. i (a) For purposes of this Agreement, the word "Default" shall mean the failure of Subrecipient to perform any of Subrecipient's duties or obligations or the breach by Subrecipient of any of the terms and conditions set forth in this Agreement; any failure by Subrecipient to comply with any of the rules, regulations or provisions referred to herein, or such statutes, regulations, executive orders, and HUD guidelines, policies or directives as may become applicable at any time; any ineffective or improper use of funds provided under this Agreement; or submission by the Subrecipient to the City reports that are incorrect or incomplete in any material respect. In addition, Subrecipient shall be deemed to be in Default upon Subrecipient's (i) application for, consent to, or suffering of, the appointment of a receiver, trustee or liquidator for all or a substantial portion of its assets, (ii) making a general assignment for the benefit of creditors, (iii) being adjudged bankrupt, (iv) filing a voluntary petition or suffering an involuntary petition under any bankruptcy, arrangement, reorganization or insolvency law (unless in the case of an involuntary petition, the same is dismissed within thirty (30) days of such filing), or (v) suffering or permitting to continue unstayed and in effect for fifteen (15) consecutive days any attachment, levy, execution or seizure of all or a substantial portion of Subrecipient's assets or of Subrecipient' s interests hereunder. (b) City shall not be deemed to be in Default in the performance of any obligation required to be performed by City hereunder unless and until City has failed to perform such obligation for a period of thirty (30) days after receipt of written notice from Subrecipient specifying in reasonable detail the nature and extent of any such failure; provided, however, that if the nature of City's obligation is such that more than thirty (30) days are required for its performance, then City shall not be deemed to be in Default if City shall commence to cure such performance within such thirty (30) day period and thereafter diligently prosecute the same to completion. 8.2 Institution of Legal Actions. In addition to any other rights and remedies, and subject to the restrictions otherwise set forth in this Agreement, either party may 25 institute an action at law or in equity to seek the specific performance of the terms of this Agreement, to cure, correct or remedy any Default, to recover damages for any Default or to obtain any other remedy consistent with the purpose of this Agreement. Such legal actions must be instituted in the Superior Court of the County of California, State of California or in the United States District Court for the Central District of California. 8.3 Acceptance of Service of Process. In the event that any legal action is commenced by the Subrecipient against City, service of process on City shall be made by personal service upon the City Clerk or in such other manner as may be provided by law. In the event that any legal action is commenced by City against the Subrecipient, service of process on the Subrecipient shall be made by personal service upon Subrecipient's Representative or in such other manner as may be provided by law. 8.4 Rights and Remedies Are Cumulative. Except as otherwise expressly stated in this Agreement, the rights and remedies of the parties are cumulative, and the exercise by either party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different times, of any other rights or remedies for the same Default or any other Default by the other party. 8.5 Inaction Not a Waiver of Default. Any failures or delays by either party in asserting any of its rights and remedies as to any Default shall not operate as a waiver of any Default or of any such rights or remedies, or deprive either such party of its right to institute and maintain any actions or proceedings which it may deem necessary to protect, assert or enforce any such rights or remedies. 8.6 Attorney's Fees. City and Subrecipient agree that in the event of litigation to enforce this Agreement or terms, provisions and conditions contained herein, to terminate this Agreement, or to collect damages for a Default hereunder, the prevailing party shall not be entitled to costs and expenses, including reasonable attorney's fees, incurred in connection with such litigation, such that each party shall be responsible for their costs and attorneys' fees. 8.7 Termination. (a) Termination for Cause. In accordance with 24 CFR 85.43, the City may suspend or terminate this Agreement in the event of a Default by the Subrecipient under this Agreement. Subrecipient may suspend or terminate this Agreement if City fails to make payments to Subrecipient as required herein. (b) Termination for Convenience. In accordance with 24 CFR 85.44, this Agreement may also be terminated for convenience by either the City or the Subrecipient, in whole or in part, by setting forth the reasons for such termination, the date the termination will be effective, and, in the case of partial termination, the portion to be terminated. However, if in the case of a 26 partial termination, the City determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the City may terminate die award in its entirety. 27 IN WITNESS WHEREOF, the parties have executed this HOME Subrecipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. j II SUBRF,CIPIENT: CITY: FAMILIES FORWARD, CITY OF HUNTINGTON BEACH, a California nonprofit corporation a municipal corporation and charter city By: 1 r ��I/��t �(L By: Michele Silva,Chief Advancement Officer City Manager print name ITS: Executive Director ATTEST: w� AND r By: City Clerk By. Elizabcth hilds,Secretary_ _ _ APPROVED AS TO FO print name ITS: (circle one)Secretary/ By: Chief Financial Officer/Asst. Secretary—Treasurer O,CityAttorney INITIATED AND APPROVED: I By: Director of Community Development REVIEWED AND APPROVED: By: Assistant City Manager COUNTERPART 28 IN WITNESS WHEREOF, the parties have executed this HOME Subrecipient Agreement (Tenant Based Rental Assistance) as of the Effective Date, which is the date of the City Council approving this Agreement. I SUBRF.CTPIENT: CITY: FAMILIES FORWARD, CITY OF HUNTINGTON BEACH, ! a California nonprofit corporation a municipal corporation and charter city CL By: By: City Manager print name ITS: Executive Director ATTEST: /—i.,-ell AND By: City Clerk By: APPROVED AS TO Z- � print name - ITS: (circle one) Secretary/ By: I l Chief Financial Officer/Asst. Secretary—Treasurer City Attorney NT>�TECDCv By: Director of Community Development S4� REVIEWED AND APPROVED: By I-- -- Assistant City Manager COUNTERPART 28 i I i Exhibit A Scope of Services and Budget Program Guidelines/Operating Procedures EXHIBIT A FY 2021-22 SCOPE OF SERVICES AND BUDGET FAMILIES FORWARD A. SCOPE OF SERVICES I Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2021 and June 30, 2022, Families Forward will: 1. Provide rental assistance subsidies, security deposit subsidies, utility deposit subsidies, Housing Quality Standards (HQS) inspections and Income eligibility reviews to 25 unduplicated Huntington Beach households in accordance with the TBRA Guldelines. Families Forward will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 1511' of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Families Forward will be reimbursed on a monthly basis in accordance with the following annual project budget: Tenant Based Rental Assistance Subsidy: $185,910 Security Deposit Subsidy: $80,000 Utility Deposit Subsidy: $0 HQS Inspections: $7,500 Income Eligibility: $8,000 Total Families Forward Budget: $281,410 I EXHIBIT A CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM PROGRAM GUIDELINES/OPERATING PROCEDURES (July 2021) 1. INTRODUCTION Utilizing HOME Investment Partnership Program (HOME) funding, the City of Huntington Beach (City) has elected to assist certain eligible low income persons and families through funding by the Housing and Urban Development Department(HUD) by establishing a Tenant Based Rental Assistance Program (TBRA) that follows all of the requirements set forth in the HOME Program under Section 24, Part 92, of the Code of Federal Regulations (24 CFR 92). By partnering with local Service Providers, the Program will enable the City to meet the needs of participating tenant households by providing monthly rental assistance for up to 24 months (subject to funding availability.) 11. TENANT SELECTION POLICY A. Current Residents of the City of Huntington Beach and Persons with Strong Ties to the City This program is designed to help current residents of the City and those with strong ties to the City. Priority shall be given to residents from the Huntington Beach Police Department, Huntington Beach Homeless Task Force, OC211 and other housing providers. Due to the nature of the population served by the Program, it may not be possible to obtain traditional proof of residency documentation such as utility bills. The following documentation can be accepted to establish that an applicant household qualifies for the Huntington Beach live/work preference: • Documentation from a Huntington Beach school that the children in the household have been enrolled in and attending the school for at least the last 90 days from the time of admission into the Program. • Documentation from a partner agency, such as the Huntington Beach Police Department, evidencing that the family is known to be homeless in Huntington Beach. • Proof that the applicant's last place of stable residency was in the City of Huntington Beach. Verification from a landlord is acceptable. 1 • Proof that an adult member of the household is working or has been recently hired to work in Huntington Beach. B. Currently Homeless or At-Risk of Homelessness • At-Risk of Homelessness refers to a household that is at imminent risk of being evicted due to an economic hardship in paying rent or staying current with rent. (Category 2 of HUD Homeless Definition) • Homelessness refers to a household who meets the HUD Homeless Definition at 24 CRF 91, 582 and 583: Category 1 (literally homeless) and Category 4 (fleeing/attempting to flee violence and living in a place described in Category 1). C. Intake Process As part of the intake process, the Service Provider will meet with the prospective Eligible Household to conduct a needs assessment and complete an Initial Qualifications Form (Appendix A). If the Program has reached maximum capacity, the Service Provider shall review the applicant to assess if other services may be offered while the applicant is waiting for a slot to open in the Program. As part of the intake process, the Service Provider shall also request and/or assist the prospective Eligible Household with the completion of the following documents: • TBRA Application (Appendix B) • Declaration of Homeless Status or Declaration of At-Risk of Homelessness Status (Appendix C) D. Income Eligible Households • To receive supportive services as well as rental assistance under the HOME Program, the Applicant's total household income must be at or below 60% of the Orange County area median income (AMI). However,once the Applicant is part of the Program, the household income can increase up to 80% of the AMI before a notice of termination must be given from the Program. • Income limits for low-income households are established annually for the HOME Program by HUD for the Orange County income limit area. • Gross Annual Income shall be determined in accordance with 24 CFR 5.609,with the allowable exclusions from income established at 24 CFR 5.611. • Gross Annual Income means the gross amount of income from all sources, including assets, for all adult household members that is anticipated to be 2 received prospectively during the 12-month period following the date of application and before any deductions are taken. • Applicants must verify eligibility for assistance under the Program through the review of income source documents. As outlined in the revised HOME rules published in July 2013, applicants must provide evidence of income for the two (2) most recent months. Acceptable source documents include wage statements, check stubs, entitlement verification from another government agency and bank i statements. The definition of income for the purposes of the Program is located at 24 CFR Part 5 (often referred to as the Section 8 definition). In cases where no evidence of income (third-party verification) is available, applicants may self- report their income. In such cases, a written explanation must be provided as to why third-party verification or documentation was unavailable. • Likely changes in income may be considered when collecting income verification documentation. • Initial income verifications are valid for six months. If admission to the Program takes longer than 6 months, income verifications must be updated and reevaluated. After initial verification, income recertification shall be conducted every six months. • Income verifications will be used for two purposes: • To determine eligibility for services. A determination of eligibility will be completed as part of the admissions process and thereafter annually. • Income information will be used to establish the household's initial contribution toward rent, which shall be set at 30% of the household income. The household's initial contribution will remain unchanged for at least six months. E. Eligibility Verification • Applicants will be re-qualified, including examination of source documentation, every six months or at the end of the lease term,whichever occurs earlier. • if an applicant has fluctuating income, and/or a change of household size or composition and/or fails to participate in all the policies of the program, the applicant may be requested to provide verification(s) more often, as reasonably necessary to confirm continued qualification and eligibility for the Program. • Applicants will be given written notice stating whether the Eligible Household was determined to be eligible for continued assistance under the Program. 3 F. Waiting List Once the Program has reached maximum enrollment, a waiting list of prospective Eligible Households will be maintained. This list will be prioritized as follows: • Clients who have been assessed for TBRA eligibility, completed intake process, and are ready for housing placement. Ready for housing placement means that the household has found a housing unit that meets TBRA requirements. • Clients who have been assessed for TBRA eligibility, completed intake process, and are searching for housing. • Clients who have been assessed for TBRA eligibility and pending intake. • Priority ranking will be given for Homeless Category 1 (24 CRF 91, 582 and 583), literally homeless participants from the streets or other locations not meant for human habitation, emergency shelters, or safe havens. G. Outreach and Collaboration with the City If funds are available to assist more City residents,the Service Provider is responsible for marketing and outreach activities to find prospective Eligible Households interested in the Program. Examples of outreach activities include conducting community presentations, contacting school districts, community based organizations and faith-based groups, and participating in community events to educate on TBRA resources available. III. SELECTION OF HOUSING UNITS A. Housing Unit Selection Eligible Households may elect to rent any Housing Unit in the City so long as the unit meets federal Housing Quality Standards (HQS) (Appendix D)or such other standards as may be made applicable to the Program by HOME Program statues and/or regulations, specifically including Uniform Physical Condition Standards (UPCS) and passes a rent reasonableness test. If an appropriate Housing Unit cannot be located within the City boundaries, a Housing Unit can be located outside of the City boundaries. B. Occupancy Standards The number of persons in each Eligible Household will determine the required unit type. Each household must comply with the two per bedroom plus one occupancy standard. The following table provides the occupancy standards by unit type: 4 Number III UnitType Household One-bedroom Unit Up to 3 Persons Two-bedroom Unit Up to S Persons Three-bedroom Unit Up to 7 Persons Four-bedroom Unit Up to 9 Persons C. Property Inspections I Prior to occupancy of any Housing Unit by an Eligible Household, and again during the annual verification process, a certified HQS inspector must inspect each Housing Unit to ensure the unit complies with HQS as set forth in the HOME Program (24 CFR 92.251), as well as all applicable state and local codes and ordinances, including zoning ordinances. Each HQS inspection will include the following: • Verification of the age of the Housing Unit (on Rent Reasonableness Form) Appendix E; • Completed HQS Inspection Form (HUD-52580); • Lead-based paint hazard assessment, dissemination of lead-based paint information pamphlet and disclosure form and lead-based paint reduction activities, if required; • Adequate opportunity for landlord to correct any deficiencies indicated in the HQS Inspection form to bring the Housing Unit into compliance; and • Verification that occupancy by the Eligible Household will comply with occupancy standards. D. Housing Unit Rent Reasonableness Rental assistance paid on behalf of the Eligible Household must be in compliance with federal Rent Reasonableness requirements that mandate rents paid by or on behalf of assisted households be similar to rents paid by non-assisted households. Rent Reasonableness reviews will be performed by the service providers. The factors listed below shall be considered when determining rent comparability: • Location and age; • Unit size including the number of rooms and square footage or rooms; • The type of unit including construction type (e.g.,single family, duplexes, garden, low-rise, high-rise); 5 Exhibit A - Appendix G Lease Addendum Families Forward Huntington Beach Tenant Base Rental Assistance Program i (Clients Name) has been approved to receive rental assistance under the Huntington Beach Tenant Based Rental Assistance Program. Under the Tenant Bases Rental Assistance Program, Families Forward will make monthly payments to the landlord on behalf of the tenant. The term of the lease shall begin on and shall continue until: (1)the Lease is terminated by i the Landlord in accordance with applicable state and local Tenant/Landlord laws; (2)the Lease is terminated by the Tenant in accordance with the Lease or by mutual agreement during the term of the Lease; or(3) termination of the Tenant Base Rental Assistance Program Contract by Families Forward. Each month Families Forward will provide a rental assistance payment to Landlord on behalf of the Tenant. This payment shall be credited by the landlord towards the monthly rent payable by the Tenant.The balance of the monthly rent shall be paid by the Tenant. Families Forward has assisted Tenant with a Security Deposit of$ that has been provided to the landlord.The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the lease.The Landlord shall comply with state and local laws regarding interest payments on security deposits. After Tenant has moved from the dwelling unit,the Landlord may, subject to state and local laws, use the security deposit including any interest on the deposit,as reimbursement for rent or any other amounts payable by the tenant under the Lease.The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item.After deducting the amount used as reimbursement to the Landlord,the Landlord shall promptly refund the full amount of the balance to the Tenant. The utilities and appliances listed in Column A. (Included in Rent)are provided by the Landlord and included in the rent.The utilities and appliance listed in Column B. (Tenant Paid) below are not included in the rent and are paid separately by the Tenant. ( UTILITY/APPLIANCE A ---- B. ! Included in Rent Tenant Paid Garbage Collection Water/Sewer Heating Fuel (specify) Lights,electric Cooking Fuel (specify) Other Specify Refrigerator Stove/ Range Household members authorized to live in this unit are listed below.The Tenant may not permit other persons to Join the Household without notifying Families Forward and obtaining the Landlord's permission. Household members: The Landlord agrees to maintain the dwelling unit, common areas equipment, facilities and appliances in decent,safe and sanitary condition. The Landlord may evict the Tenant following applicable state and local laws.The landlord must provide the Tenant with at least 30 days'written notice of the termination.The Landlord must notify Families Forward when eviction proceedings are begun.This may be done by providing Families Forward with a copy of the required notice to the Tenant. Any provision of the Lease which falls within the classification below shall not apply and not be enforced by the Landlord. (1) Confession of Judgment. Concept by the Tenant to be sued, to admit guilt, or to a judgment in favor of the landlord In a lawsuit brought in connection with the Lease. t (2) Treatment of Property.Agreement by the Tenant that the Landlord may take or hold the Tenant's property or may sell such property without notice to the Tenant and a court decision on the rights of the parties. (3)Excusing the Landlord from Responsibility.Agreement by the Tenant not to hold the Landlord or Landlord's agent legally responsible for any action or failure to act,whether intentional or negligent. (4) Waiver of Legal Notice.Agreement by the Tenant that the Landlord may institute a lawsuit without notice to the Tenant. (5) Wavier of Court Proceedings for Eviction.Agreement by the Tenant that the Landlord may evict the Tenant Family(1)without instituting a civil court proceeding in which the Family has the opportunity to present a defense, or(!I) before a decision by the court on the rights of the parties. (6) Wavier cfluryTroll.Authorization to the Landlord to wave the Tenants right to a trial by jury. (7) Wavier of Right to Appeal Court Decisions.Authorization to the Landlord to waive the Tenant's right to appeal a court decision or waive the Tenant's to sue prevent a judgement from being put into effect. (8) Tenant Chargeable with Cost of Legal Actions Regardless of Outcome of Lawsuit. Agreement by the Tenant to pay lawyer's fees or other legal costs whenever the Landlord decides to sure,whether or not the Tenant wins. The Landlord shall not discriminate against the Tenant In the provision of services, or in any other manner, on the grounds of age, race, color,creed, religion,sex, handicap, national origin,or familial status. --Tenant Signature Landlord Signatures iPrint Print Name: Print Name: Signature/Date: Signature/Date: Print Name: Print Name: Signature/Date: — _ ____ Signature/Date: • The quality of the unit,which includes the building construction, maintenance and improvements; and • Amenities, services and utilities included in the rent The Service Provider will follow both the rent reasonableness regulations established for the Housing Choice Voucher (HCV) program at 24 CFR 982.507 to evaluate rents. In the event that a rent request does not meet rent reasonableness requirements, the Service Provider shall attempt to negotiate a lower rent with the property owner. If the owner is not willing to accept a lower rent, the household must be instructed to search for another unit. Under no circumstances shall rent exceed the sum approved through the rent reasonableness review. Additionally, the assisted household is not allowed to make up any difference in the rent offer. E. Coordination with Landlords The Service Provider will meet with and provide guidance to landlords participating in the Program regarding the requirements and procedures that impact landlords. Landlord Agreement (Appendix F) • The Service Provider will enter into a Landlord Agreement with each participating landlord or property owner. The Landlord Agreement will establish the security deposit assistance payment and the initial rental assistance payments to be paid on behalf of the household. The Agreement will also establish the participating household's initial share of the contract rent. The Agreement will also require the landlord to provide the Service Provider with notice of a lease termination, and reaffirm the tenant protections included in the Tenant Protection Agreement. • This contract will have an initial term of 6 months unless otherwise agreed between the Service Provider, tenant and the City. Lease Addendum for Tenant Protection (Appendix G) • The landlord will be required to enter into a lease agreement with a term of 12 months with any Eligible Household occupying a Housing Unit. • The lease agreement will include a Tenant Protection Agreement that will be executed in connection with the lease between the landlord and the Eligible Household. • The Tenant Protection Agreement will include the following elements: • Prohibit the inclusion of the following provisions in the lease, as required by 24 CFR 92.253: • (1)Agreement to be sued; 6 • (2) Treatment of property; (3) Excusing owner from responsibility; • (4) Waiver of notice; j (5) Waiver of legal proceedings; (6) Waiver of a jury trial; ■ (7) Waiver of right to appeal court decision; (8) Tenant chargeable with cost of legal actions regardless of outcome; and (9) Mandatory supportive services. • Confirm the landlord's obligation to maintain the Housing Unit in accordance with HQS,as established at 24 CFR 982.401. • Prohibit discrimination by the landlord against the Eligible Household. • The Service Provider will review the lease agreement to confirm its compliance with state law and all HOME Program requirements. Prior to signing the lease, the Service Provider must provide the City with the tenant's application, income eligibility documentation, IDIS form and lease terms for approval of acceptance into the program. If the City does not respond within two business days,the tenant is deemed approved. IV. Payment Standards, Rent Calculation,Term and Subsidy Reductions As authorized by HOME TBRA regulations, the Program will rely on a traditional rental assistance calculation. The model allows for the rent subsidy determination based on 30% of household income. A. Rent Assistance Calculation A rental assistance calculation will be completed for each Eligible Household. The calculation will determine each household's Program subsidy and share of the rent. The maximum amount of monthly assistance is the difference between the rent standard for the unit size and 30%of the household's monthly adjusted income. Each household's maximum rent subsidy will vary since the calculation involves the use of individualized factors such as the household's actual income and family size. 7 The initial household contribution to rent will remain unchanged for at least six months. Minimum tenant contribution to rent under the Program is set at $50.00. This minimum is used if the maximum subsidy calculation would result in the household paying less than $50.00 towards the monthly rent (e.g. if 30% of the household's monthly adjusted income is less than $50.00). B. Rent Payment Rent Reasonableness The Program must use the Rent Reasonableness Standard (Appendix E) to calculate monthly rental assistance. The payment standards represent the cost of rent and utilities for moderately priced units in Huntington Beach as well as those in surrounding Orange County cities. Payment standards are established by bedroom size. When utilities are included in the cost of renting a unit, that is, the owner assumes responsibility for payment for all utility services, the household's entire share of the housing costs will go directly to the owner. When the cost of utilities is not part of the rent, that is, the household is directly responsible for payment of utility services, the household's initial share will be determined by subtracting a utility allowance from 30% of the household's income. The Orange County Housing Authority utility allowance schedule (Appendix 1) shall determine the household's utility allowance. In these cases, the household's share of the rent is equal to 30% of the household's monthly adjusted income minus the applicable monthly utility allowance. Each household is responsible for paying their rent share directly to the landlord each month. If a selected Housing Unit is subject to contractual, statutory and/or regulatory affordability restriction, the monthly rental assistance payments will not exceed the difference between the required affordable rent amount for the Housing Unit and 30% of the Eligible Household's monthly adjusted income. I. Participant Agreement (Appendix H) The Service Provider will enter into a Participant Agreement with each participating client household. The Participant Agreement will establish the Eligible Household's responsibilities towards rent payments. The Agreement will establish the participating household's initial share of the contract rent, which will be adjusted every 6 months. II. Term Rental assistance will be for an initial term of 6 months,which can be extended every 6-12 months, for a cumulative term of up to 24 months. Extensions will be granted at the discretion of the Service Provider and shall be based on continued Program compliance and ongoing need. 8 The Service Provider will utilize the Gap Analysis and Income Re-Evaluation to assess ongoing need and adjust household's share of rent as appropriate. Households with income above 80% AMI will be notified about income eligibility limits. Ili. Subsidy Reductions The participant's household income will be reevaluated every six months. If the household income has changed since the previous evaluation, the participant's i monthly rent responsibility will be adjusted accordingly. V. Security Deposits Security deposit assistance is available to Eligible Households. Such assistance shall be the lesser of: • Two months approved rent for the Housing Unit; or • The standard security deposit required by the landlord for non-subsidized tenants. Security deposit assistance provided to participating households will be in the form of a grant. As such, the landlord can provide a security deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a security deposit shall be settled by the tenant and landlord, as provided for in the lease. Vl. Utility Deposits Utility deposit assistance is available to Eligible Households. Utility deposit assistance provided to participating households will be in the form of a grant. As such, the utility provider can provide a utility deposit refund directly to the household. Any disputes involving the return, or lack thereof, of a utility deposit shall be settled by the tenant and the utility provider. The Utility deposit subsidies cannot be used as a stand-alone activity. The assistance must be utilized with rental subsidy, security deposit subsidy, or both. The Orange County Housing Authority will annually establish the utility allowances for each year. (Appendix I) 9 V11. Annual Recertification, Termination of Assistance and Returning Households A. Annual Recertification Recertification of income and Program eligibility will every 6 months. The Service Provider will gather source documentation for participating households to determine annual income. Annual income must be calculated in accordance with 24 CFR Part 5. If the total household income is above 80%AM1, rental assistance must be terminated following a 30 day notification period. B. Termination of Rental Assistance Assistance can be terminated for the following reasons: • Eviction from the assisted rental unit based on behavioral issues and/or unlawful activity. • The family will be assisted by another rental assistance program such as the Section 8 Tenant-Based or Project-Based program. Participation in any other rental assistance program is considered a duplicative subsidy therefore all HOME funded rental assistance must terminate. • Failure to meet significant goals in the participants Self-Sufficiency Program as outlined on page 11, Case Management. C. Returning Participant Households As needed, participants may be allowed to return to the Program for either support services, rental assistance or both. A determination to allow re-entry shall be based on the following criteria: • Participants must have left the Program in good standing. To be in good standing, participants must have been engaged in their case management plan, voluntarily left the program (not in-lieu of termination) or have been released because their household income exceeded eligible limits. In general, participants will not be allowed to re-enter the Program if they were terminated for non-compliance. • A request for readmission from a non-compliant household may be considered when compelling reasons exist. In such cases, re-admission will require concurrence from the City. • The Participant's previous rental assistance did not exceed 24 months. Cumulatively, participants will only be allowed to receive rental assistance for a maximum of 24 months. 10 Self Sufficiency Program Subrecipient will request each Eligible Household receiving rental assistance payments to participate in a Self-Sufficiency Program administered by Subrecipient. The Case Management and Self-Sufficiency Program Policies and Procedures are outlined in Appendix j. The Self-Sufficiency Program provides participating households with intense case management, which is designed to assist participants move to self-sufficiency within a 12 to 24-month period. Income recertifications will be completed annually for participating households. If the participating household's income exceeds the low (80% AM]) income limits, Subrecipient must terminate the rental assistance. Listed below are some of the Self-Sufficiency Case Management Services offered by Subrecipient: D. Case Management The Subrecipient Case Management model maximizes client success by developing individualized service plans and addressing clients' specific needs in securing permanent housing and self-sufficiency. Clients will meet with their Case Manger on a minimum of a monthly basis to update goals, monitor progress, and ensure long- term housing stability. Self-sufficiency groups are also held weekly to assist with financial management, job development, life skills, personal empowerment, and accessing other resources needed to gain housing stability. E. Individualized Housing and Service Plan Participants meet with their Case Manager at intake and monthly to review their Goal Worksheet and Individualized Service Plan to help establish and identify participant goals and plans for housing, education, employment, financial (including budgeting and credit repair), legal, and other housing stabilization and relocation resources needed. F. Housing Search and Placement Subrecipient advocates assists clients with comprehensive housing search and placement into affordable permanent housing. Subrecipient has established close partnerships with permanent housing agencies, including affordable housing providers, apartment associations,and private landlords/owners. G. Financial Management / Credit Repair Subrecipient assists program participants with credit repair, financial literacy, and job placement and retention. Assistance will also be provided to access mainstream financial benefits including social security, veteran's benefits, CaIWORKs, disability, unemployment, and other public assistance. 11 H. Employment Assistance Obtaining self-sufficiency is a critical goal for families served by Subrecipient. Subrecipient Case Managers work with clients to identify interests, life experiences and talents that lend themselves to employment. Housing Advocates also: • Help clients develop resumes,complete job application and prepare for interviews; i • Obtain educational scholarships through AmeriCorps and other sources to increase leadership skills and/or further their education; • Provide transportation solutions to job interviews and job-related activities; and • Provide job placement in career-level jobs and job retention assistance. I. Transportation Subrecipient provides support services at Community Service Center and Satellite sites in Huntington Beach conveniently accessible via public transportation routes or via home visits as needed. Subrecipient provides assistance with transportation via bus passes and accessing mainstream resources available for transportation through CaIWORKs and disability access. Subrecipient also maintains agreements with local taxi companies to provide emergency transportation assistance and works closely with the Huntington Beach Police Department to assisttransport participants in crisis situations. J. Behavioral Health Subrecipient provides an array of individual and group counseling programs on-site and works closely with other mental health providers to address behavioral health needs of participants. VIII. RIGHT TO AN INFORMAL HEARING PROCEDURE Participating Tenant Households have the right to be heard by an impartial official, without prejudice. Program participants may appeal a proposed Program action that may have an adverse effect upon them by submitting a written Request for Hearing to the City of Huntington Beach, which include the Participating Tenant Household's objection, name and relationship of all potential parties, list of documents to be presented, current address and telephone number. Appeals must be filed within seven (7) calendar days of notification of proposed Program action. The informal hearing will be scheduled as soon as possible. The informal hearing shall be conducted in English. Notice of Informal Hearing will be issued at least ten days prior to the Hearing appointment. The Participating Tenant Household may bring person(s) to testify and/or documents at their expense. Participating Tenant Households may review pertinent file documentation so long as such documentation does not infringe on any other party's rights. 12 IX. CITY REQUIREMENTS A. Monthly Meetings and Reports Each month,the City will meet with each Service Provider via teleconference. At least 24 hours prior to the meeting, the Service Provider will provide an updated tenant chart. The City and Service Provider will discuss all tenants, potential applicants and other issues impacting the operations of the Program. B. Monthly Summaries At the end of each month, the Service Provider will submit a summary of services provided. The summary shall include the number of new, continuing and existing households served in the quarter, any staffing changes, any billing issues, any outreach efforts and other issues impacting the administration of the Program., The Quarterly Summary is due within 45 days after the end of the quarter. C. Billing Requirements Service Providers shall submit their invoices no later than 20 days after the end of a service month. The invoices shall include a City coversheet for each household, a general ledger of all current clients, an updated IDIS form, if necessary, proof of all reimbursable costs, including rent checks, security deposits and staff time and any written communication with the City discussing exceptions or unusual circumstances regarding a household. Timely submission of invoices is required for City finance and budget purposes. D. The City maintains the ability to make changes to the Operating Guidelines as City, State and Federal laws, ordinances and policies change. The City shall provide written notice to the Service Provider when a substantive change is made to the guidelines. IX. COMFORMANCE WITH HOME LAWS, RULES AND REGULATIONS The Program Guidelines/Operating Procedures must conform to all HOME laws,rules and regulations. To the extent Congress or the federal government makes changes to the laws, rules and regulations, particularly due to an exigent circumstance, the City has the discretion to modify these guidelines/procedures to align with federal laws, rules and regulations. At the time of the adoption of these Operating Guidelines, HUD has issued waivers and suspensions of HOME regulations due to COVID 19. The changes to the HOME regulations shall be in effect until December 31, 2020 unless otherwise modified by HUD. (Appendix K.] 13 As applicable, the City and Service Providers shall both implement the requirements regulations of the Violence Against Women Reauthorization Act of 2013 (VAWA) per the provisions outlined in 24 CFR 92.359 and 24 CFR 5, Subpart L. Service Providers shall also implement the applicable VAWA requirements related to the City's Emergency Transfer Plan,as required by 24 CFR 92.359(g) and included as Appendix K, for all applicants to the TBRA Program,and all TBRA recipients for the period that tenant based rental assistance is provided. Moreover,all leases that are approved by the Service Providers shall contain the City's required VAWA lease term/addendum per 24 CFR 92.359(e),and included as Appendix L. i 14 I I Exhibit A - Appendix A i Sample TBRA Application (Pre-Application) Family Solutions Collaborative Initial Triage Form Interview: Over the phone ❑ In Person ❑ Date: Referred by: Completed by: Agency: 1. Services Requested: O Basic Nerds ❑Case Management O Counseling O Housing ❑ Life Skills O Medical O Workforce/Job training ❑ Other (please specify) i 2. General Information: (I urill ask you some questions to collect some basic information as the first step of the process) zLast`. . Dfeahillty `Veteran Race r * � Ethniclty 1` = Advlt's Ptill Name DOB' Gendei Reltttitia 4, Status' Statue � . i.. t to.ROH (Y/NI:` 8eebelow Hbpaaie -Aoa-s.; :•: (Head of Household) (Other Adult) (Other Adult) 'Native Hawaiian or other Pacific Islander, Black or African American,While,American Indian or Alaska Native, Asian, Client refused, client doesn't know. Primary Phone 8: Alternate q: Email: Last Permanent address: Zip Code: Primary Language: OC Resident?Y_N_How Long in have you been in OC? What city do you currently reside in? 3. Do you require immediate medical attention? 4. Do you feel safe where you sleep? OY OY ON ❑ N S. Is anyone in the family currently pregnant? 6. Do you have access to food? O Y How far along? O Y ON ON 7.At Risk- Diversion Intervention 8. where Did You Sleep Last Nisht? Rental .................................................I.......... ❑ Monthly Rent? Car/Street/Park...................I............I............ ❑ Eviction notice?Date Received: 3-day notice to pay or quit?Date Received: ❑ Shelter........................................................... Living with family/friends ..................""""""""" ElWhich Shelter? Exit date Other f )...................................... ❑ Transitional Housing....................................... ❑ How long can you stay in your current living situation? af ❑ Motel (name) .................................................. 01-7 Days ❑ 8-14 days ❑ 15+ Days Who is currently paying for your motel stay? What Resources do you need to stay there longer? Circle one: Self/Social Services/Agency/Other Garage/Shed.................................................. ❑ What is the reason you cannot stay in your current Other ❑ housing situation longer? 9. What caused your current situation? 10. How much time have you spent in your current situation? 11. Where will you stay tonight? 12. Do you currently have a voucher or subsidy to help you pay rent each month (either current or new)? 0 Yes (Please specify: When does it expire? 0 No 13. Children Schoov Distri Full'. of -oustodY. Child iFull N 7, ID Gender --o-r Child.care Program, --r Custody? .tod ' ' Y or N Y or N Y or N y or N Yor N 14. Employment N Length of any E w e* e ki 106 Applicant Y or N $ Other Adult Y or N $ Other Adult Y or N $ 15. Other Income CaIWORKs/Cash aid: $ Cal Fresh: Child/Spousal Support: $ Disability/SSI: $ Other Income (Specify): $ Unemployment: $ 16. Do you have any pets? Y N— What kind? —How many? — Registered as a Service Animal (trained to assist)? 17. Do you have a vehicle? Y N— 18. To beat assist YOU, your information may need to be shared with other agencies within the Family Solutions Collaborative. Do you give us permission to share your information to assist In securing resources? Y—N— To be completed by Agency/ Family Service Navigator: Resources Provided: We appreciate you taking the time to complete the Triage Form.This information will be passed to the Family Service Navigator, from the Family Solutions Collaborative,who will be calling you back within the next 1 to 2 business days. i Exhibit A - Appendix B Sample TBRA Application (Full-Application) OC HMIS: PROJECT INTAKE FORM — CoCIESG CLIENTPROFILE SOCIAL SECURITY NUMBER(SSN) :- ;I I QUALITY OF:SSN ❑ Full SSN reported ci SSN Pe orted Aproximate or partial ❑Client doesn't know ❑Client refused ❑Data not collected CLIENT'S NAME NIA Last First ❑ i Middle ❑ Suffix ❑ QUALITY OF NAME ❑ Full name ❑Partial,street name,or code ❑Client doesn't know ❑Client refused ❑Data not collected reported name reported DATE.OFBIRTH ;ty Age: Month Day Year QUALITY OF SSN ❑Full DOB reported ❑ Approximate or ❑Client doesn't know E.Client refused ❑Data not collected partial DOB re rted LiFemale 0 Trans Female(MTF or Male to Female) El Client doesn't know GENDER ❑Male ❑Trans Male(FTM or Female to Male) ❑Client refused ❑ Data not collected ❑White ❑American Indian or Alaska Native FODala doesn't know RACE ❑Black or African American ❑Native Hawaiian or Other Pacific Islander refused 0 Asian not collected ❑Non-Hispanic 0 Client doesn't know ETHNICITY ❑Hispanic ❑Client refused ❑Data not collected CI No ❑Client doesn't know VETERAN STATUS ❑Yes 0 Client refused ❑Data not collected RELATIONSHIP TO HEAD OF HOUSEHOLD ❑Self(head of household) El❑Head of household's child Head of houslation s other relation member ❑ Head of household's spouse or partner ❑Other:non-relation member LAST KNOWN PERMANENT ADDRESS What is the address of the place you last lived for 90 days or morel Not including emergency shelters or transitional housing) Address County Unit Type Unit Number ZIP Code city State 1 Revised 4/23/18 OC HMIS: PROJECT INTAKE FORM — CoC/ESG PROJECT ENROLLMENT PROJECT NAME PROJECT START DATE HOUSING MOVE-IN DATE (For PSH, PH with no disability requirement,and RRH, T-7 Prqeds:Record the date a client or household moves, in to a permanent housing unit) LIVING SITUATION for project types otherthon Street Outreach, Emergency Shelter, or Safe Haven hidh HOMELESS SITUATION o Place not meant for human habitation (3 Safe Haven o Emergency shelter,including hotel or motel paid for with D Interim Housing emergency shelter voucher INSTITUTIONAL SITUATION n Foster care home or foster care group home I o Long-term care facility or nursing home C.Hospital or other residential non-psychiatric medical facility 0 Psychiatric hospital or other psychiatric facility C,Jail,prison or juvenile detention facility o Substance abuse treatment facility or detox center TRANSITIONAL AND PERMANENT HOUSING SITUATION o Hotel or motel paid for without emergency shelter voucher 0 Rental by client,with other housing subsidy(including RRH) 0 Owned by client,no ongoing housing subsidy 0 Residential project or halfway house with no homeless criteria o Owned by client,with ongoing housing subsidy u Staying or living in a family members mom,apartment,or u Permanent housing(other than RRH)for formerly homeless house persons ci Staying or living in a friend's room,apartment or house c Rental by client, no ongoing housing subsidy u Transitional housing for homeless persons 0 Rental by client,with VASH housing subsidy o Client doesn't know 0 Rental by client,with GPD TIP subsidy u Client refused o Data not collected Ciididth7of Sta;y,I h:Peliw LM figftiafl&C(Duratldffidf Prior LW1r42"Sitd6tioh)_'.% 0 One night or less 0 One month or more,but less than 90 days 0 Client doesn't know 0 Two to six nights 0 90 days or more, but less than one year n Client refused 0 One week or more,but less than one month D One year or longer 0 Data not collected If Client's Type of Residence is any of the Homeless Situotion options: '-A(0I,eoiIdfiW_I �MO*W Ntrof Ves lie che t, 2ZQ_ , ihe, IV, 1 ;btu - D One time 0 Three times 0 Client doesn't know U Two times 0 Four or more times 0 Client refused 0 Data not collected ear s­' W F�-Jotahriumberi'of'montti§homeless ESLdfSR Kthei� iit thrii j�e o 0 One month(this time is the first month) ri Six Months U Eleven Months U Two Months 0 Seven Months 0 Twelve Months 0 Three Months 0 Eight Months 0 More than 12 months ri Four Months 0 Nine Months E.Client doesn't know D Five Months 0 Ten Months o Client refused C,Data not collected 2 Revised 4/23/18 OC HMIS: PROJECT INTAKE FORM — CoC1ESG If Client's Type of Residence Is any of the Institutional Situation options: Lengtfi.df Stay,Lessthan 90 days7 r,T ? �� y r� (Indicate d the stay!n the rnstdutlonal seihng th'ey,6ved m immediately pnorto protect entry was o No a Yes If Client's Type of Residence is any of the Transitional and Permanent Housing Situation options: rLength bt StayLess than 7,n(gtits7 ��ga y (Indicate i the stay ip the hansitionai orpe a-At.houusiinngsethng theyG%ed m immediafely pnor ❑No ❑Yes to ioed:enf ,ivas:lessfhan,Tril-Ms .a.n . 'a ,r ...; W If'Length of Stay Less than 90 dayi Is YES—OR—If'Length of Stay Less than 7 nights is YES On the night bWefore stayed.ont s reets,,ES of.Sife Heaen v ? (On fhe nIg ti6?Idreahe lleM�stay ofless than 90 daysrma nlnshtuha al setdng, octess U�art7 0 No o Yes nights in;a transr6oneUpermanenEhou'stng setthig were they on the stfeets mien:Emergency Shelte`rvor.m:a Safe; ave7l c �z ! „FT + tip n s Ff �s If'On the night before—stayed on streets, ES,or Safe Heaven' is YES A *klinateiDate,Homede3sness`;Sfartedi A"roinmatErdcf*14,If6hieless sft6&U6r 6e fan) ! I Number,'of times the cfienYhas.been en tfie streets,In�ES,ar Save�Heaven in'tlie past three yearsJncludmg todayr�-�� i,Re`aesS Of Where!the Sta�ed`last ni'hf s•'" x�4-.,.a`_ r._i Y�.,?'3; 0 One time n Three times o Client doesn't know ❑Two times ❑Four or more times ❑Client refused o Data not collected JdtaVKdfiiberbfmonths`hortielessoatheiitreets.fniES`-orSH1K,the�astithree ears .i4 a G s 0 One month(this time is the first month) ❑Six Months 0 Eleven Months 0 Two Months 0 Seven Months 0 Twelve Months ❑Three Months ❑Eight Months ❑More than 12 months ❑Four Months ❑Nine Months a Client doesn't know ❑Five Months 0 Ten Months o Client refused ❑Data not collected DISABLING CONDITIONSAND BARRIERS Do you have a disabling condition? No 0 Client doesn't know ❑Client refused a Yes ❑Data not collected Do you have a physical disability? ❑No ❑Client doesn't know 0 Client refused ❑Yes 0 Data not collected If yes for Physical Disability, ❑No 0 Client doesn't know Expected to be of.long-continued and Indefinite duration and 0 Client refused substantially Impairs ability to live Independently?. ❑Yes ❑Data not collected 3 Revised 4/23/18 OC HMIS: PROJECT INTAKE FORM — CoC/ESG Do you have a developmental disability? it No ❑Client doesn't know D Client refused ❑Yes D Data not collected If yes for Developmental Disability, ❑No ❑Client doesn't know Expected to be of long-continued,and indefinite duration: ❑Client refused and substantially Impairs ability to live Independently?_ ❑Yes n Data not collected Do you have a chronic health condition? it No D Client doesn't know ❑Client refused ❑Yes D Data not collected Il yes.for Chronic Health Condition, ❑No ❑Client doesn't know Expected.to be of long-continued and indefinite duration and D Client refused substantially Impairs ability to live independently? ❑Yes D Data not collected Have you been diagnosed with AIDS or have you tested positive for HIV? D No ❑Client doesn't know D Client refused ❑Yes D Data not collected If yes for tested'positive forH1V/AIDS,. ❑No ❑Client doesn't know Expected to be of long-continued.and Indefinite duration and n Client refused substantially.linpaire ability toilve independently? D Yes D Data not collected Do you have a mental healthproblem? ❑No D Client doesn't know D Client refused ❑Yes D Data not collected If yes for Mental Heath Problem, ❑No D Client doesn't know Expected to.be of long-continued and Indefinite duration and . D Client refused substantial) Im airs ability to live Independently? C.Yes Y . P ty ❑Data not collected Do you have a substance abuseproblem? ri No ❑Client doesn't know ❑Alcohol Abuse D Client refused ❑Drug Abuse ❑Data not collected Both Alcohol and Drug If you have any Substance Abuse Problem, ❑No ❑Client doesn't know Expected to be of long-continued and Indefinite duration and ❑Client refused substantially Impairs ability to live Independently? D Yes ❑Data not collected Are you a survivor of domestic or Intimate partner violence? D No D Client doesn't know D Client refused ❑Yes D Data not collected If Yes for survivor of domestic or intimate partner violence When did this experlence D Within the past three months D Client doesn't know occur? 0 Three to six months ago(excluding six months exactly) D Client refused D From six to twelve months ago(excluding one year exactly) ❑Data not collected ❑More than a year ago ❑No ❑Client doesn't know Are you currently fleeing? Cl Yes ❑Client refused D Data not collected 4 Revised 4/23/18 OC HMIS: PROJECT INTAKE FORM — CoC/ESG CASH INCOME FOR INDIVIDUAL Income from Any Source 0 No ❑Client doesn't know ❑Client refused 0 Yes ❑Data not collected IF"YES"TO INCOME FROM ANY SOURCE—INDICATE ALL SOURCES THAT APPLY' Income Source Check all that apply) Monthly Amount ❑Earned Income 0 Unemployment Insurance 0 Worker's Compensation ❑Private Disability Insurance ❑VA Service-Connected Disability Compensation ❑Social Security Disability Income SSDI 0 Supplemental Security Income SSI 0 Retirement Income from Social Security ❑VA Non-Service-Connected Disability Pension ❑Pension or retirement income from a former job 0 Temporary Assistance for Needy Families ANF 0 General Assistance GA 0 Alimony or other spousal support ❑Child Support 0 Other Cash Income(Specify: NON-CASH BENEFITS Receiving Non-Cash Benefits? 0 No ❑Client doesn't know 0 Client refused ❑Yes 0 Data not collected IF"YES"TO RECEIVING NON-CASH BENEFITS-INDICATE'ALL SOURCES THAT APPLY 0 Supplemental Nutrition Assistance Program SNAP 0 TAN F Transportation Services 0 Special Supplemental Nutrition Program for Women, ❑Other TANF-funded services Infants, and Children WIC ❑Other Non-Cash Benefits 0 TANF Childcare Services (Specify Source): HEALTH INSURANCE Covered by Health Insurance? 0 No 0 Client doesn't know Client refused ❑Yes ❑Data not collected IF "YES"TO COVERED BY HEALTH INSURANCE-INDICATE ALL SOURCES THAT APPLY 0 MEDICAID 0 Insurance Obtained through COBRA 0 MEDICARE 0 Private Pay Health Insurance ❑Stale Children's Health Insurance Program 0 Slate Health Insurance for Adults ❑Veteran's Administration A Medical Services ❑Indian Health Services Program ❑Employer-provided Health Insurance ❑Other Health Insurance (Specify Source): 5 Revised 4/23/18 OC HMIS: PROJECT INTAKE FORM — CoC1ESG I certify that the information above Is correct to the best of my knovdedge. Client Signature Date I Agency Staff Signature Date DO NOT ANSWER QUESTIONS BELOW—DATA ENTRY PERSONNEL ONLY(Optional): Date entered into HY11S: I I aQitestlon ;z ,, ` ti t_rka .M- Answerti3Comments' Was the hard copy Intake form ❑No completely filled out correctly? ❑Yes Staff Name(verifying completion of Data Entry): 6 Revised 4/23/18 i i i Exhibit A - Appendix C Declaration of Homelessness FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Families Forward Housing Program Homeless Certification Applicant Name: O Household without dependent children (complete one form for each adult in the household) O Household with dependent children (complete one form for household) Number of persons in the household: This is to certify that the above named individual or household is currently homeless based on the check mark, other indicated information, and signature indicating their current living situation. Check only one and complete only that section Living Situation: place not meant for human habitation (e.g., cars, parks, abandoned buildings, streets/sidewalks) O The person(s) named above is/are currently living in (or, if currently in hospital or other institution, was living in immediately prior to hospital/institution admission) a public or private place not designed for, or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus station, airport, or camp ground. Description of current living situation: Living Situation: Emergency Shelter O The person(s) named above is/are currently living in) a supervised publicly or privately operated shelter or, if currently in a motel where a charitable or government/state agency is paying for the stay. Emergency Shelter Program Name: Living Situation: Transitional Housing O The person(s) named above is/are currently living in a transitional housing program for persons who are homeless. The persons(s) named above is/are graduating from or timing out of the transitional housing program: Transitional Housing Program Name: Families Forward FAMILIES FORWARD DIGNITY - EMPOWERMENT HOPE I, have provided Families Forward with V party (Client's Name) verification of current housing situation (see attached document). i i OR I, certify that the housing information provided (Case manager Name) is accurate by visually inspecting the client's vehicle on (Date) Applicant Name (printed): Date: Applicant Name (signed): Date: Applicant Name(printed): Date: Applicant Name (signed): Date: Case Manager(printed): Date: Case Manager(signed): Date: Families Forward i Exhibit A - Appendix D i HQS Inspection Checklist Exhibit G Minimum Standards for Permanent Housing Instructions:Place a check mark In the correct column to indicate whether the property is approved or deficient with respect to each standard. The property must meet all standards in order to be approved. A copy of this checklist should be placed in the client file. Approved Deficient Standard (24 CFR part 576.403(c)) 1. Structure and materials:The structure is structurally sound to protect the residents from the elements and not pose any threat to the health and safety of the residents. 2. Space and security: Each resident is provided adequate space and security for themselves and their belongings. Each resident is provided an acceptable place to sleep. 3. Interior air quality: Each room or space has a natural or mechanical means of ventilation. The interior air Is free of pollutants at a level that might threaten or harm the health of residents. 4. Water Supply:The water supply Is free from contamination. 5. Sanitary Facilities: Residents have access to sufficient sanitary facilities that are In proper operating condition, are private,and are adequate for personal cleanliness and the disposal of human waste. 6. Thermal environment:The housing has any necessary heating/cooling facilities in proper operating condition. 7. Illumination and electricity:The structure has adequate natural or artificial illumination to permit normal indoor activities and support health and safety.There are sufficient electrical sources to permit the safe use of electrical appliances in the structure. 8. Food preparation:All food preparation areas contain suitable space and equipment to store, prepare, and serve food in a safe and sanitary manner. 9. Sanitary condition:The housing Is maintained in sanitary condition. 10. Fire safety: a. There is a second means of exiting the building In the event of fire or other emergency. b. The unit includes at least one battery-operated or hard-wired smoke detector, in proper working condition, on each occupied level of the unit. Smoke detectors are located,to the extent practicable, in a hallway adjacent to a bedroom. c. If the unit is occupied by hearing-impaired persons,smoke detectors have an alarm system designed for hearing-impaired persons in each bedroom occupied by a hearing-impaired person. d. The public areas are equipped with a sufficient number, but not less than one for each area,of battery-operated or hard-wired smoke detectors. Public areas Include, but are not limited to, laundry rooms, day care centers, hallways,stairwells, and other common areas. 11. Meets additional reci lent/subrecipient standards (if any). Exhibit G CERTIFICATION STATEMENT I certify that I have evaluated the property located at the address below to the best of my ability and find the following: ❑ Property meets all of the above standards. ❑ Property does not meet all of the above standards. COMMENTS: Program Participant Name: Street Address: Apartment: City: State: Zip: Evaluator Signature: Date of review: Evaluator Name (Printed): Approving Official Signature(if applicable): Date: Approving Official Name(if applicable): Exhibit G RENT REASONABLENESS CHECKLIST AND CERTIFICATION Proposed Unit UNIT## UNIT#2 UNITrr3 ADDRESS NUMBER OF BEDROOMS I SQUARE FEET TYPE OF UNIT/CONSTRUCTION ROUSING CONDITION LOCATION ACCESSIBILITY AMENITIES UNIT: SITE: NEIGHBORHOOD: AGE IN YEARS UTILITIES(TYPE) UNIT RENT HANDICAP ACCESSIBLE? CERTIFICATION: A. COMPLIANCE WITH PAYMENT STANDARD PROPOSED CONTRACT RENT + UTILITY ALLOWANCE = PROPOSED GROSS RENT APPROVED RENT DOES NOT EXCEED APPLICABLE PAYMENT STANDARD OF S B. RENT REASONABLENESS Based upon a comparison with rents for comparable units, I have determined that the prop2sed rent for the unit is f I is not reasonable. NAMF: SIGNATURE. DATE i Exhibit A - Appendix E Rent Reasonableness Checklist RENT REASONABLENESS CHECKLIST AND CERTIFICATION Proposed Unit Unit#1 Unit#2 Unit#3 Address Number of Bedrooms i Square Feet Type of Unit/Construction Housing Condition Location/ Accessibility Amenities Unit: Site: Neighborhood: Age in Years Utilities(type) Unit Rent Handicap Accessible? CERTIFICATION: A. Compliance with Payment Standard Proposed Contract Rent + Utility Allowance = Proposed Gross Rent Approved rent does not exceed applicable Payment Standard of S B. Rent Reasonableness Based upon a comparison with rents for comparable units, I have determined that the proposed rent for the unit [ ]is [ ] is not reasonable. Name: Signature: Date: i I Exhibit A - Appendix F Lease Contract FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Date: To:(Community name,landlord) Address: On Behalf of:(Client name) Families Forward is pleased to inform(Client name)has been approved for housing assistance as of the date of this letter.The primary focus of the Families Forward Housing Program is to help families become self-sufficient. Families Forward will provide supportive services during their tie of assistance.Services that are provided by Families Forward include the following:case management, financial literacy,budgeting,food pantry,home orien- tations,home inspections, holiday programs,career coaching and counseling.Families forward can also assist with rental subsidies that will allow the family to adjust to their new housing commitment. Families Forward will make timely payments to(Community name,landlord)in accordance with the Schedule of Rent Payment attached. Families Forward will make financial assistance payments to(Community name,land- lord),on behalf of the client,using a corporate check.The payments will be mailed or hand delivered by Families Forward staff to the address designated on the lease. Copies of notices given to client during tenancy shall be provided to Families Forward.If tenant is given a notice to vacate unit,or any complaint used under state or local law to commence an eviction action against(Client name),(Community name,landlord)shall also provide a copy of said notice to Families Forward. i Move-in date: Payment Due Date:_/_f Monthly Rent;$ Grace Period Late Payment fee:$ The amounts reflected on the schedule of payment may represent the entire or partial amount of rent for each month. (Client Name)shall be responsible for any balance due.In addition,any late fees or penalties Incurred are the sole re- sponsibility of(Client Name).By accepting payment you agree to all the terms to the terms noted above. Thank you, 8 Thomas•Irvine,CA 92618•(949)552-2727•www.familles-forward.org•TAX 100 33-0086043 i Exhibit A - Appendix H Participant Agreement FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Families Forward Housing Program Contract Families Forward provides a Housing Program for families who are without housing and who do not have the financial resources to provide housing for themselves. No distinction is made regarding admittance based on race, religion, age, sex or ethnic origin. 1. The rent is due on or before the first of each month. 2. Tenant is to provide a copy of rent payment receipt by the 3' of each month. 3. Each tenant will receive support in maintaining a monthly budget. Monthly meetings will be scheduled to verify income, expenses and collect pay stubs in order to complete the monthly budget. 4. Tenant is to maintain communication with the Case Manager with regards to progress, problems, change in employment status or other concerns. & Families Forward Staff are mandated reporters, which are professionals, required by law to report any reasonable suspicion of abuse or neglect inflicted on children and/or dependent adults. Any investigations will be conducted by law enforcement, county agency and/or the child welfare department to determine if abuse or neglect has occurred. 6. Tenant is responsible for keeping the property clean and well maintained at all times. 7. Tenant will allow for home Inspections to be completed on the property by the Housing Resource Specialist and Case Manager. The family may or may not be present at the time of the inspection. These home inspections will be done twice a month and Housing Resource Specialist will inform family of the predesignated days of the month during Home Orientation. B. Tenant has access to a Housing Resource Specialist and may complete a Tenant Screening. Tenant can have regular check-ins until housing is identified. These meetings will include discussions on housing options in Orange County, current market rates by area, and barriers and strategies to circumvent these issues. 9. Families Forward reserves the right to terminate housing assistance in the event the tenant violates regulations outlined in the lease and/or rental agreement. 10, It is a violation of the agreement to allow anyone not stated on the lease to assume residence in the tenant's property. it. Families Forward Staff will assist the tenant as appropriate to achieve self-sufficiency. Applicant Date Case Manager Date Applicant Date Families Forward I Exhibit A - Appendix I Utility Allowance IdICCommunity Resources 2021 Utility Allowance Schedule The following utility allowances will be used by the Orange County Housing Authority for administration of the Housing Choice Voucher Program effective December 1, 2020. i a;Gas�:. .�z... Cooking 3 4 6 7 9 11 Heating 16 18 21 22 25 27 Water Heating 9 10 14 20 26 31 Natural Gas Base Charge 3 MOM— ME M Basic 30 35 49 65 82 100 Cooking 6 7 12 17 21 25 Heating 19 22 25 28 30 35 Water Heating 17 22 31 37 44 51 v i Y r =� x �Ot r3 Q ��m" aBS-- c&: s , - _' fiery, �ME— �.. Air Conditionin 9 10 17 23 30 38 Water 45 49 71 104 138 171 Sewer 9 9 11 13 16 18 Trash 17 Refrigerator 9 Stove 7 OC HOUSING AUTHORITY 1501 E. ST. ANOREW PLACE, FIRST FLOOR, SANTA ANA, CA 92705 1 PHONE (7141 480-2700 FAX (714) 480-2945 i Exhibit A - Appendix J Case Management and Self-Sufficiency Program Policies and Procedures FAMILIES FORWARD DIGNITY • EMPOWERMENT - HOPE Families Forward Intake Process The Housing Intake Coordinator (HIC) oversees the intake process for all Literally Homeless families that complete a Request for Services (RFS) form. The HIC will call back all literally homeless families between 24-48 hours after submission of the RFS i - Literally Homeless Definition l An individual or family who lacks a fixed, regular, and adequate nighttime residence, which includes a primary nighttime residence of: o Place not designed for or ordinarily used as a regular sleeping accommodation (including a car, park, abandoned building, bus/train station, airport, or camping ground) o A supervised publicly or privately operated shelter designated to provide temporary living arrangements (including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs) o Or an individual is considered homeless if she or he is being discharged from an institution where she or she has been a resident for 90 days or less and the person resided in a shelter (not transitional housing) or place not meant for human habitation immediately prior to entering that institution Families in need call Families Forward and speak to a volunteer that collect basic information and complete a Request for Services (RFS) Form (see attached PSF form) The HIC will review the RFS to determine who meets the criteria for assistance. - The family must be literally homeless - There must be at least one minor aged child in the household and the parent(s) must have at least 50% custody of their child(ren) Those that meet the criteria will receive a call from the HIC to verify the information on the RFS, explain the Intake and Coordinated Entry process. HIC will then schedule an appointment to complete the Vulnerability Index- Service Prioritization Decision Assistance Tool (VI-SPDAT) see following page for copy of VI-SPDAT. The VI-SPDAT tool is utilized by the entire Continuum of Care to prioritize homeless persons seeking help. An accurate score is calculated from the VI-SPDAT, which ensures that the most vulnerable persons are receiving immediate service without bias. FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Score ranges and housing interventlon: - 0-3 No Housing Intervention - 4-8 Rapid Re-Housing - 9+ Permanent Supportive Housing (chronically homeless and disabled) or Orange County Housing Authority Voucher Program (NOT chronically homeless and/or disabled) See below for an outline of a typical phone call with a client. Phone call: Hello, this is the Housing Intake Coordinator calling from Families Forward. The reason for my call is to review the information on your Request For Services form received on (date). Do you have 20-30 minutes to review this information with me? The H/C may ask the following questions based on the information on the PFS. - Has anything changed since you last called? - Adult(s): Is your name ? What is your date of birth? Do you have any other adults in the household i.e. adult child, grandparent, aunt, uncle? - Employment/Income: It says here that you are working at (company) for (time) and are making per month. Is this correct? Partner's employment status? If collecting Cashaid/Calworks/SSI, how j long/how much? - Current living situation: It says here that you are currently staying in In the city of . Is that still accurate? Where did you sleep last night? If so, how long? How long have you been looking for housing? Is your current environment safe? - Children: What are the ages of your children? Are there any children that are not living with you now, that may live with you when you find permanent housing? - Program history: Are you currently working with any other program(s)? If so, can you provide a program letter of verification? Have you completed a VI-SPDAT with that or any other agency? Explain what a VI-SPDAT is. - Plan: Have you reached out to an emergency shelter? Have you reached out to an agency or Social Services for access to a motel voucher? DO you want or need any additional resources to bridge the time before you are matched? FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE HIC will give a brief overview of the intake process• - Families Forward does offer a Rapid Re-Housing program that helps families identify permanent housing and offers rental subsidles for I families to help them get back on their feet. This is a short term , assistance program and is 1-3 months long, - Along with rental assistance, we provide supportive services through case management such as budgeting assistance (as you are required to maintain a monthly budget), career coaching, food pantry, counseling, and referrals to resources within the community as needed by the family. - In addition, we conduct monthly home inspections to make sure your apartment is clean and safe. Families Forward, along with other agencies that offer Rapid Re- Housing assistance, participate in Coordinated Entry System (CES). As part of CES, all agencies must submit the information from the VI- SPDAT. CES oversees this process for Orange County. The information is gathered by CES and families are placed on a prioritization list based on the needs and preferences of the family. From that list, families are matched to an agency depending on their availability. Since CES oversees the matching process, your family may or may not be matched to Families Forward, All families are matched to an agency that offers a Rapid Re-Housing program. Once a family is matched, that agency will call you with next steps. A typical timeframe to be matched can take a few days to a few weeks. HIC will ask the family to bring in documentation to verify their current housing status. If the family is in: o An emergency shelter, client must bring in a program letter on letterhead from the agency o A motel, then client must bring an award letter from the Social Services and/or program letter on letterhead from the agency or church o A place not meant for human habitation, such as a car, the HIC will personally inspect the car The next step in the intake process is to schedule a 1st meeting to complete the VI-SPDAT. All the adults must be present for the VI- SPDAT. This meeting is approximately an hour long. 15t Meeting: The meeting will take place in the office of the HIC. During this meeting, the HIC will meet one on one with the client and have him complete the following documents: FAMILIES FORWARD DIGNITY • 'EMPOWERMENT • HOPE - VI-SPDAT - HMIS Consent Form Homelessness Certification o Client to sign Homelessness Certification and provide supporting homeless documentation from agency, emergency shelter, church and/or social service agency j o If client is stating the family is sleeping in their car, HIC will complete a car inspection in the FF parking lot. HIC will sign Homelessness Certification verifying homelessness - VA Form 10-5345 for Veteran clients HIC will proceed with the questions on the VI-SPDAT. Upon completion, HIC will allow time for any follow-up questions from the family. VI-SPDAT submissions to CES: HIC will submit all VI-SPDAT assessments, HMIS Consent Forms and Homelessness Certifications no later than 12PM every Friday to CES. VI- SPDAT assessments are submitted via a CES google doc link. The other supporting documents are encrypted and password protected, then sent to CES via email. A family that does not have all the required documentation to submit to CES is not considered "document ready" and will not be matched to an agency until they complete the above mentioned forms. Along with the VI-SPDAT submissions, HIC will notify CES every Friday of any Families Forward housing opportunities via google doc. Families Forward bases these housing opportunities on the caseload capacity of the Case Managers. Matches to Families Forward: Every week, the HIC will receive matches from CES based on the housing opportunities submitted from the previous week. This information is sent via email with a secured attachment, password protected, of personal client information. HIC will call client within 24-48 hours for introduction of program and next steps to complete the program enrollment process. FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE The HIC will meet with the Housing Program Manager to discuss Case Manager (CM) and grant assignment for the weekly matches. HIC will provide the client contact information to the CM. For families that have been matched to Families Forward and CM is unable to connect with them after 3 attempts with 3 different forms of communication (i.e. text, phone call, email), those families will be returned to CES. HIC will check in with the CM on a weekly basis to gather this information. I I Coordinated Entry Intake for Families Basic Information: la.Street Outreach Team or In-Reach Site: Sb. Interviewer's Name: 1c.Survey Date: Id, Survey Time: j le.Survey Location (City): 3.Will you be completing the full assessment? ❑ Yes(CE Intake, VI-SPDAT and Housing Preference Survey) Go to Intake for Head of Household ❑ No(Name Only) Go to By Name Only Head of Household—Client Identification 1. First Name: 3. Last Name: 2. Middle Name: 2a.Suffix: 2b.Alias: 4. Date of Birth: / / S.Social Security Number(last 4 digits): ❑ Full DOB reported ❑ Approximate or partial SSN reported ❑ Approximate or partial 008 ❑ Client Doesn't Know Cl Client Doesn't Know ❑ Client Refused ❑ Client Refused ❑ Data not Collected ❑ Data not Collected Contact Information—Do you have a number and/or email where I can follow up with you or leave a message? 6. Main Phone 8:( ) - ext. ❑ Message/VM okay Contact Preference 6a. Alternate Phone 9: ( ) ext. ❑ MessageNM okay ❑ Phone 7. Email: @ ❑ Tex ❑ Email Head of Household-Demographics 8. Gender: 9. Do you have a disability? 10. Have you e7Know ❑ Male (Physical, Developmental, Mental U.S.Armed For ❑ Female Health, Chronic Health Condition, ❑ Yes—> pleas ❑ Transgender Female to Male HIV/AIDS,and/or Substance Use release of I ❑ Transgender Male to Female Disorder.) ❑ No ❑ Client Doesn't Know ❑ Yes ❑ Client Does❑ Client Refused ❑ No ❑ Client Refus ❑ Data not Collected ❑ Client Doesn't Know ❑ Data not Collected ❑ Other: ❑ Client Refused ❑ Data not Collected 11. Education Level—What Is the highest degree or level of school you have completed? If currently enrolled, highest degree received. ❑ No Schooling Completed ❑ 11"Grade ❑ 4-years College Degree ❑ Nursery School to 41 Grade ❑ 121h Grade, no diploma ❑ Graduate School ❑ 5 h or 6`h Grade ❑ High School Diploma ❑ Client Doesn't Know ❑ 7rh or 8th Grade ❑ GED ❑ Client Refused ❑ 91hGrade ❑ Post-Secondary School ❑ Da ta not Collected 0 101h Grade • • •�•■yy�� L +� • pI �lryn.Y11RY� S.l �� Y t 1 f � j \ t i -V'1.t i. .Y rt�Y i � 1 � �C1 �ls�ripp '� {5 w4'!a� 2:x�•L �"qr Yv,,y'4�� .fu �»t k ,,ins �+b ti'?i..�v� r. .S.!'b4.G.£F l_ L ;. r 7� i � .�; S; xI�• � PS .f`� A:•h' 1�aZ'r Fay �5az Yr,ry-� ■ ■ �;j(^f�J,�# `i"�-?+y��'���5�,���114'l",�����..:'�'�"r�h !k ' "�,r�a�l ,>J't�E3�1Z�'1.�.��;i•Jbtst��'•',dar'��`! '' .;_ I� 3a �"r' �'�t'at, 1 �F'it 3+ +rrr, Ott o•��4itt ii'��+e .iri^'at 4.,� ��-�S F-7.1 . i � '�W_..ia,�...l,.e..d>..cL♦;:L_.x.a..aW'��d.� _ Y._� a,.T.� ..fi��?.:.f.,L,a� :...uf.�.X� � a...i�.�."-; .. J1rL. ,'f ��•�y_L•iG•€ f°�� �,J,1:(7?S�t•'�`c°��1 {��A�J4� ���� .�1 c i aims c ". ,��+, "y rr� � . r, tA�#'7.T uai'a..a._Nt...'r•>'zey- 'ivl..,..Y-•L e.vL�,-r-. �•.`�.��� ti r� ' rfr-�,.•.i:1.:.-.PFa6.....: �J Te. .S31 ■ YI (�P1�g1 '!"��C��sl pogll�i • h�i�7l4�� r �5'lutlsvi°y 11(L.y�'T�r • 7� e l r r f n n f 1._.. .b.'Y_•iflf'. '-Q�i�,Jai;�':`.r�l�X�a��a�,in ��:3�IJ�"�` °�"�a.1Fl^�'��*f��ik?J�1�C;1s�d1C fi,r� "Yr�": .�` ..�.t .,",•:�- Client Name: 9. Does anybody force or trick you or anyone In your family to do things that ❑Yes ❑ No ❑ Refused you do not want to do? 10. Do you or anyone In your family ever do things that may be considered risky like exchange sex for money,run drugs for someone, have unprotected sex with someone you don't know, share a needle,or 1, anything like that? 21. Is there any person,past landlord, business, bookie, dealer,or government ❑Yes ❑ No ❑ Refused group like the IRS, that thinks you or anyone In your family owe them money?? 12. Do you or anyone In your family get any money from the government,a ❑Yes ❑ No ❑ Refused pension, an Inheritance,working under the table, a regular Job, or anything like that? 13. Does everyone In your family have planned activities, other than Just ❑Yes ❑ No ❑ Refused surviving that make them feel ha y and fulfllled? M-XMW0jT9W,MQ�qW_ 14. Is everyone in your family currently able to take care of basic needs like. ❑Yes ❑ No ❑ Refused bathing, changing clothes, using a restroom,getting food and clean water, and other things like that? 15. Is your family's current homelessness In any way caused by a relationship ❑Yes ❑ No ❑ Refused that broke down,an unhealthy or abusive relationship, or because family or friends caused you to become evicted? WEt ES ` 16, Has ycur family ever had to leave an apartment, shelter program or other ❑Yes ❑ No ❑ Refused place you were staying because of the physical health of you or anyone in your family? 17, Do you or anyone in your family have any chronic health Issues with your ❑Yes ❑ No ❑ Refused liver, kidreys,stomach, lungs or heart? 18. If there was space available In a program that specifically assists people ❑Yes ❑ No ❑ Refused that live with HIV or AIDS,would that be of interest to you or anyone in your family? 19. Does anyone in your family have any physical disabilities that would limit ❑Yes ❑ No ❑ Refused the type of housing you could assess,or would make it hard for you to live Independently because you'd need help? 20.When someone in your family is sick or not feeling well, does your family ❑Yes ❑ No ❑ Refused avoid getting medical help? 21. IF THE HOUSEHOLD INCLUDES A FEMALE: Is any member of the family ❑ Yes ❑ No ❑ ,Refused currently pregnant? 22. Has drinking or drug use by you or anyone in your family led your family ❑Yes ❑ No ❑ Refused to being kicked out of an apartment or program where you were staying In the past? Client Name: 23.Will drinking or drug use make It difficult for your family to stay housed or ❑Yes ❑ No ❑ Refused afford your housing? 24. Has your family ever had trouble maintaining your housing, or being kicked out of an apartment, shelter program or other place you were staying, or because of: a. A mental health issue or concern? ❑Yes ❑ No ❑ Refused b. A past head Injury? ❑Yes ❑ No ❑ Refused c. A learning disability,developmental disability,or other Impairment? ❑Yes ❑ No ❑ Refused 25. Do you or anyone In your family have any mental health or brain Issues ❑Yes ❑ No ❑ Refused that would make It hard for your family to live Independently because hel would be needed? /7 IF THE FAMILY SCORED 1 EACH FOR PHYSICAL HEALTH,SUBSTANCE USE, ❑Yes ❑ No ❑ N/A or AND MENTAL HEALTH:Does any single member of your household have a Refused medical condition, mental health concern, and experience with problematic substance use? 26.Are there any medications that a doctor said you or anyone In your family ❑Yes ❑ No ❑ Refused should be taking that,for whatever reason,they a re not taking? 27. Are there any medications like painkillers that you or anyone In your family ❑Yes ❑ No ❑ Refused don't take the way the doctor prescribed or where they sell the medication? 28. YES or NO: Has your current period of homelessness been caused by an ❑Yes ❑ No ❑ Refused experience of emotional, physical, psychological,sexual,or other type of abuse,or by any other trauma you have experienced? ME E MOMMa E 29. What best describes this household? ❑ Single Parent ❑ Two Parent KNOW l C "1 4�El,V - 30. How many children under the age of 18 are currently with you? ❑ Refused 31. How many children under the age of 18 are not currently with your family, but you have reason to believe they will be joining you when you get housed? ❑ Refused 32. Please provide a list of children's names and ages: First Name Last Name ■ n�'�1 {�j'� aYFrY�'11K q ` rc t T n it. )•. 9�1h 2rya tiQP L��l'.6 r`•.Y41.a,4.U.1 �,y�, �X! 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C• ;.>c�f .y r. -r i:.,r •t �17., �f"`tr�Y,S-'�"LN.'�l�-x 'y^ ixf,�cl. .at Sn'_ tl._. 1 � ^) .W,�. ..wt�cv_�.,..trS L..`.o:�1,,....,-In�•za.l.!-;.t 7...�"st... . h.•.�.s�.i,.�c..Ye l..... w..-C. .y.ti 71 • • - rL�� �m������.ii�r+•#I1A� >i����ad�..�U.Le.s��A�✓�_ a�'t5���-..rt 3�. Y r5 fY Yxt.- 1- ��7''�1Kr "'2vt�C�^a:�L`-- �1•c atq`• ° �c �.'il• .1 3 (�Yk �} ;ice, r,,Tc. rf >?,((''��5{1yy s•//>;��f{ty.' 1 .G.: .u:i vY. :..II_ic`'4l'�IN h Z:�S:.�l•'h: .if:.. .F�i k,.. ,r .-F.S..s�Y3?1..A�f:i[rt•1��1inl �� Client Name: slbling(s) with things like getting ready for school, helping with homework, making them dinner,bathing them,or anything like that? ^1 'S Scoring Summary Subtotal Results Page Total A Score Recommendations Page Total B 0-3 No housing Intervention Page Total C 4-8 Assessment for Rapid Rehousing PageTotalD 9+ Assessment for Permanent Supportive Housing Page Total E Grand Total I I i I Housing Preference Survey-PSH Client Name: 1. What elty wlthln the County of Orange,do you live In? 2. Which of the following communities would 3. Which of 4. Which of S. Where are you be your FIRST choice for housing? the the NOT willing to ❑ Anywhere within Orange County(wherever I following following accept housing? am most likely to be placed Into housing the communitie communitle ❑ North quickest) -j Skip to 6 s would be s would be ❑ South ❑ North ❑ East your your THIRD ❑ East ❑ South ❑ West SECOND choice for ❑ West choice for housing? housing? ❑ North ❑ North ❑ South ❑ South ❑ East ❑ East ❑ West ❑ West ❑ Not ❑ Not Applicable Applicable 6. Do you have any ties to the Civic Center? 7. Haw many adults, including yourself,will be living in ❑ Yes the unit? ❑ No ❑ 1 ❑ 2 ❑ 3 ❑ 4+ 7a. If one or more adults In addition to you will 8. Are all adults In the household authorized to work In be living In the unit,please list each adult and the U.S.? his/her relation to you. ❑ Yes, all adults are authorized to work in the U.S. ❑ Not Applicable ❑ Some adults, but not all adults are authorized to work Name: in the U.S. Relation: 17 No adult Is authorized to work in the U.S. Name: Relation: 9. if you were able to locate housing,do you 10. What Is your household's monthly Income?Include have money saved up for move-in or the Income of all adults(18 years of age and older)who housing? will be living with you. ❑ Yes $ . ❑ No 11. Have you ever been evicted or received 11a. If yes to eviction,do any of the following notice to leave from housing or abandoned a situatlans apply to you? unit, of which your name was on the lease? ❑ Evicted due to fraud. ❑ Yes,evicted. ❑ Evicted due to unit damage ❑ Yes,received notice to leave. ❑ Owe money to property manager ❑ Yes,abandoned a unit. ❑ Not Applicable ❑ No ❑ Client Refused ❑ Client Doesn't Know ❑ Client Refused Client Name: Additional Adults in the Household—Total#: ❑ No additional adults In the household. 1.Flrst Name: 3. last Name: 2a. Middle Name: 2b.Suffix: 2c.Alias: 4, Date of Birth:_/_ / S.Social Security Number: _ ❑ Full DOB reported ❑ Full SSN reported ❑ Approximate or partial DOB ❑ Approximate or partial SSN reported ❑ Client Doesn't Know ❑ Client Doesn't Know ❑ Client Refused ❑ Cl lent Refused ❑ Data not Collected ❑ Data not Collected 8. Gender: 9. Do you have a disability? 10. Have you ever served in the ❑ Male (Physical, Developmental, Mental U.S.Armed Forces? ❑ Female Health,Chronic Health Condition, ❑ Yes 4 please administer VA ❑ Transgender Female to Male HIV/AIDS,and/or Substance Use release of Information ❑ Transgender Male to Female Disorder) ❑ No ❑ Other: ❑ Yes ❑ Client Doesn't Know ❑ Client Doesn't Know ❑ No ❑ Cllent Refused ❑ Client Refused ❑ Client Doesn't Know ❑ Data not Collected ❑ Data not Collected ❑ Client Refused ❑ Data not Collected 11. Education Level—What Is the highest level of education you've completed? ❑ No Schooling Completed ❑ 111h Grade ❑ 4-years College Degree ❑ Nursery School to 4 h Grade ❑ 12'h Grade, no diploma ❑ Graduate School ❑ 51'or 6th Grade ❑ High School Diploma ❑ Client Doesn't Know ❑ 71h or 8"Grade ❑ GED ❑ Client Refused ❑ 91hGrade ❑ Post-Secondary School ❑ Data not Collected ❑ 100 Grade 12. Which category best describes your race? (Check All that 13.Which category best describes your Apply): ethnlclty? ❑ Asian ❑ Client Doesn't Know ❑ Non-Hispanic ❑ Black or African American ❑ Client Refused ❑ Hispanic ❑ Native Hawaiian/Other Pacific ❑ Data not Collected ❑ Client Doesn't Know Islander ❑ Client Refused ❑ American Indian/Alaska Native ❑ Data not Collected ❑ White i i Client Name: 12.Which category best describes your race? (Check all that 13.Which category best describes your Apply): ethnicity? ❑ Asian ❑ Client Doesn't Know ❑ Non-Hlspanlc ❑ Black or African American ❑ Client Refused ❑ Hispanic ❑ Native Hawaiian/Other Pacific ❑ Data not Collected ❑ Client Doesn't Know Islander ❑ Client Refused ❑ American Indian/Alaska Native ❑ Data not Collected ❑ White Location Information—On a regular day,where is it easiest to find you and your family? 14.On a regular day,where Is it easiest to find you? 14a. Intersection: ❑ Street ❑ Vehlcle ❑ Abandoned building ❑ Bus/train/subway station/airport ❑ Drop in Center 14b.Landmark: ❑ Day Services Center ❑ Soup Kitchen ❑ Emergency Shelter ❑ Transitional Housing 14c.City: ❑ Permanent Housing ❑ Clinic/Hospital—Health ❑ Cllnlc/Hospital—Mental Health 14d.Zip Code: ❑ Clinic/Hospital—Substance Abuse ❑ Jail, prison,or Juvenile detention facility ❑ Family or friend's room, apartment, condo,or house ❑ Faster care or group home ❑ Other(specify): Housing Preference Survey—PSH Client Name: 12. Have you ever been evicted from a 13. Have you ever 14. If yes,please describe all felonies Public Housing Authority(PHA) units? been convicted for which you have been ❑ Yes of a felony? convicted? ❑ No ❑ Yes ❑ Not Applicable ❑ No ❑ Client Refused ❑ Client Refused ❑ Not Applicable 15. Have you ever been convicted of.....7 16.Are you a registered sex offender? ❑ Felonies considered violent ❑ Yes ❑ Manufacturing or producing methamphetamine ❑ No ❑ Arson ❑ Client Doesn't Know ❑ Not Applicable ❑ Client Refused ❑ Client Refused 17.Are you currently on probation or parole? ❑ No ❑ Probation ❑ Both ❑ Parole 18.To the best of your knowledge,do you (or anyone In your 0 Yes ❑ Client ❑ Client family)have any active warrants? ❑ No Doesn't Refused Know 19.Are you (or anyone in your family) receiving 19a.If yes,what agency provides those supportive supportive services that can/will follow you services? into permanent housing? ❑ Yes ❑ Not Applicable ❑ No ❑ Client Refused 20.Are you linked to a Care Coordinator/Case Manager/Mental Health Program/ ❑ Yes Behavloral Health Clinic? ❑ No ❑ Client Doesn't Know ❑ Client Refused 21. Do you have a pet or companion/service 21a.If yes, what type of pet? animal? ❑ Dog ❑ Pet ❑ Cat ❑ Companion Animal ❑ Other: ❑ Service Animal 21b.If yes,how many? ❑ Not Applicable ❑ 1 ❑ Client Refused ❑ 2 ❑ 3 ❑ 4t i ❑ N/A I Housing Preference Survey— PSH Client Name: 22. Do you require or request a ground floor 23. Do you require or request parking unit? accommodations? ❑ Yes, due to physical disability ❑ Yes,for vehicle ❑ Yes, due to preference ❑ Yes, for RV/Trailer ❑ No ❑ No ❑ Client Refused ❑ Client Refused 24.Are you open to shared housing? 25. Have you been In shared housing? ❑ Yes ❑ Yes ❑ No ❑ No 25a. If so, how was your experience? 26.Are you Interested in..? ❑ 1 ❑ Sheiter Plus Care ❑ 2 ❑ STAY, housing program for youth ❑ 3 ❑ 4 ❑ 5 27.Are there other requirements or request NOTES: around permanent housing that we need to be aware of? CountyService Planning Areas forgrange North South East West • Anaheim Allso Viejo Laguna Niguel • Costa Mesa . Cypress Atwood • Balboa . Laguna Wood • El Modena . Fountain Valley • Brea Capistrano Lake Forest • Irvine . Huntington Beach • Buena Park Beach Mission Male • Lemon Heights Los Alamitos • Fullerton . Corona del Rancho Mission Newport Beach . Midway City • Garden Grove Mar Viejo • Orange • Seal Beach • La Habra Dana Point Rancho Santa . Santa Ana • Sunset Beach • La Palma Ladera Ranch Margarita • Tustin • Westminster • Placentia . Laguna Beach . San Clemente . Villa Park • Stanton Laguna Hills San Juan Capistrano • Ycrba Linda I FAMILIES FORWARD DIGNITY • EMPOWERMENT - HOPE Enrollment Process: • Once CM receives match, CM will call client within 24-48 hours to schedule appointment for Packet Review and Tenant Screening with CM and HRS • Appointment takes approximately 2 hours to complete • CM to send calendar and google doc Invite to HRS for date and time of appointment o Client to bring the required family documents: • Proof of Income (one month's worth; last 3 paystubs) • Birth certificates • ID's for adults • Social security cards • Immunization records for children 0-5 or school enrollment verification for children 5+ • Medical cards • Current pay stubs or any other income source • Bank statements • Car registration and insurance • Custody/court documentation (If applicable) • Disability forms (If applicable) • Include Dara Entry Clerk to calendar invite (availability to attend appointment based on DEC capacity) o DEC will make copies of all family documents during appointment • Begin Enrollment Process (Packet Review and Tenant Screening): o CM to start meeting with review of homeless certification from CES • CM to gather current documentation from client • CM to provide Homeless Certification form for client to sign and date, as well as provide the homeless documentation from agency, emergency shelter, church and/or social service agency • If client is stating the family is sleeping in their vehicle, CM will complete a vehicle inspection in the FF parking lot. CM will sign Homelessness Certification verifying homelessness FAMILIES FORWARD DIGNITY - EMPOWERMENT • HOPE o Once the documentation is collected, CM will proceed with the Packet Review o For any family that does not re-certify and/or cannot provide the above information, will be sent back to CES • CM to update HIC with this information • HIC will send update to CES on a weekly basis o CM will gather all family documents and hand over to DEC o HRS will conduct Tenant Screening in which housing history and credit report will be reviewed o For packet review, CM will fill out an enrollment packet for each member of the household • CM to use this time to ask about family and homeless history • CM will also review and verify income documentation provided by client. Adults earning any form of income must sign the Self Declaration of Income and provide any of the following forms of verification that are applicable: • Last 3 paystubs for earned income • If paystubs are not available, then an offer letter as it relates to a new job, that has not yet started, can be submitted • An award letter on letterhead for Cashaid, Disability and/or SSI • Court paperwork as it relates to child support or alimony • If the above mentioned documents are unavailable and CM has done their due diligence in trying to obtain documents (as noted in emails and/or case notes) CM will use the Self Declaration of Income as proof of income for the family o CM will plug in this information into the Income Calculation Worksheet to determine if family meets income guideline requirements o Based on the information, circle the income bracket the family falls under on the annual HUD guidelines document • CDBG participants must fall under extremely low to low-income bracket I o Once packets are completed, CM will explain and obtain client(s) signature on all program documents during appointment FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE • Complete Enrollment Process o CM will submit the completed HMIS packets and family documents to DEC to enter information in both HMIS and Client Track Systems o CM will receive client information from Data Entry Clerk (DEC) after client information is entered into both Client Track and HMIS systems • DEC will provide information to CM within 24 hours • CM will pull an HMIS report and Background Check on all adults in the household • Note: o What program is the family entering (Interim Transitional Housing- I- TH or Rapid Re-housing)? • All I-TH clients are required to complete a drug screen prior to program entry as part of a needs assessment and not as a determinant of program entry • CM provides a referral to all of the adults in the household to complete a drug screening at a predesignated location • Clients must complete the Packet Review and Tenant Screening in order to complete enrollment into the housing program • Active vs Pending Clients o Once the enrollment process is completed, CM will maintain a caseload consisting of both Active and Pending clients • Active clients- homeless families that are currently in Interim I Transitional Housing or Rapid Re-Housing Programs • Pending clients- homeless families that have been matched to Families Forward and have completed the enrollment process, but have yet to identify permanent housing • CM and HRS must check in weekly with family until housing is identified • Family will be sent back to CES for non-compliance with program rules or ceases communication with CM FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Family Move in Process Interim Transitional Housing: • Prior to all move-ins, the client must be given a drug screening referral and submit for a background check o Review results with Housing Program Manager • CM sends Interim move-In request to Housing Resource Specialist (HRS) via google doc and calendar invite to schedule date and time • Property Coordinator will meet with the family to review lease agreement o The family's rent amount will be calculated using the Rental Formula form with the included chart below I ?ier .` Rent Monthly Household lncorne' 0 $100 Below$850 1 $200 $851- $1500 2 $300 $1501 -$2500 3 $500 Above$2501 o Rent will not exceed 30% of client's gross Income as stated in • Proof of income • Client self-declaration of Income • Or signed intake form o A $500 deposit is required for move-in into Interim housing o During this time CM can prepare food/toiletry bags for family • CM will lead second half of lease signing meeting: o CM will go over program expectations/guidelines/agreements • During this meeting CM will go over the following documents: o Termination of assistance process of policy o Termination of.housing assistance process of appeals o Transitional housing application process o Misconduct act o Exhibit A o Program contract o Rent Amendment o Community cares forms I • Give copies of documents to client • Give client directions and address to Interim Transitional Housing unit o Families Forward staff will go in pairs to escort the family to the unit o Family will follow you in their own vehicle to the home o Prior approval is needed if CM plans on having the family in their personal vehicle • Take family on a tour of the home • Before leaving the home let family know you will be in contact with them in the next 2 days to make their first family meeting appointment I i I FAMILIES FORWARD DIGNITY • EMPOWERMENT - HOPE Rapid Re-Housing: • Client and/or landlord to send over W9 and copy of unsigned lease/move-in statement to CM • CM to evaluate/create Schedule of Rent Payment (SORP) • CM to submit check request to accounting with copy of unsigned lease/move- In, W9 and SORP o Check requests are process every Wednesday • Only emergency check requests will be processed outside of that time frame o Check requests that are over $1000 need two signatures from a Director and/or Manager o Check requests that are under $1000 need only one signature from a Director and/or Manager • Request copy of signed lease as soon as its available from client or landlord o Get this from apartment community or client o Save signed lease copy in the "G Drive" • Apartment community will be sent copies of below documents by CM: o Communication disclosure o Program contract o Apartment Inspection o SORP • Set up 11t family meeting • Set up home orientation with Housing Resource Specialist o Client Is responsible for setting up this appointment o CM is responsible for giving client contact Information for Housing Resource Specialist i i FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Family Meetings Preparation for Initial family meeting • Meet with Housing Program Manager to review all current family barriers o This information with will be used to develop a CTI plan • The following information will be included in clients CTI plan o Name of adults in household o Date the CTI plan was created o Phase 1 • Assessment of the family and their support network, decide on areas of focus, begin connecting to appropriate resources o Phase 2 • Evaluate progress with areas of focus and connections to those areas o Phase 3 • Finalize all connections made to areas of focus, • Family will have identified continuous support, program end o Areas of Focus • CM and client will collaborate on the areas of focus • Areas of focus are goals with action steps listed for each phase • 6 areas of focus include: counseling and psychiatric treatment, career coaching, substance abuse treatment, housing crisis prevention & management, and family intervention o Recertification/Extension • If a client requests or CM feels the need to extend the time in the program, the CM will present recommendations and progress for the family to the housing committee during the case management meeting at least a month prior to exit Initial family meeting I During the initial family meeting the following items will be reviewed with ! the family j o Client Handbook • Review the Client Handbook with the family • The purpose of the client handbook is to allow for the family to have an organized tangible place to keep all documents that they receive and to have a place to keep track of all appointments. j o CTI Plan i • Make note of any goals family would like to add to their CTI plan i I FAMILIES FORWARD I DIGNITY • EMPOWERMENT HOPE • Explain to the family the program expectations and importance of regular communication with CM • Cell phone (call or text) • Office direct line • Email o Review Schedule of Rent Payment (SORP) with family • During this time CM will inform the family of projected program end date and what the family is financially responsible for towards monthly rent and/or utility payments o If there are missing documents be sure to have those documents present for completion during this initial meeting • This includes missing supporting documents and missing information or signatures o Food Pantry Form • Review with family the food pantry policy • Make family aware that they can access food once a week All forms must be filled out and submitted by 9am Monday morning for pick up Tuesday through Thursday • Inform family to communicate with CM on any special requests that are not regularly available in the food pantry • Diapers in larger sizes • Food allergies • In some cases gift cards may be made available to purchase such items o If gift card is provided to client CM will make a copy of gift card and have client sign and date the copy • Copy is then filed in CM section of client file Family meeting • CM is required to meet with family in person at least once a month o Depending on family need, program length and barriers CM may need to meet with family weekly c CM will maintain communication with family outside of the scheduled monthly family meeting as needed • During monthly meeting CM will review family progress with initially established areas of focus • CM is responsible for addressing any new barriers presented at family meeting or via various methods of communication • Family will provide CM with: o Monthly budget o Current paystubs FAMILIES FORWARD i DIGNITY • EMPOWERMENT - HOPE o Rent if appropriate (Interim Transitional Housing Families) • Money in cash cannot be accepted offsite o Utility payments (Interim Transitional Housing Families) • Utility payments are due two weeks after CM provides family with copy of utility bills • Utility payments are rounded to the nearest dollar amount and family is notified of the total amount due o Any other verification documents that CM has requested i FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Services for Families Housing Family Services Food Pantry for Housing Clients • Families in the housing program will have access to the pantry weekly • They will submit a request form by Monday 9 am j • The family will then pick up the food anytime between 9-Spm Tuesday, Wednesday, Thursday • The family can request up to 10 categories on list and the quantity of each item as needed for that week • Volunteers in the pantry will fill the order and store on an assigned rack with the family's last name and quantity of bags(total) o From time to time, the case manager may need to fulfill the request if there is a late or last minute request • Families in the housing program go directly to the food pantry for pickup and do not need to check in at the front desk Food Pantry for the Public • Families Forward offers access to the food pantry to qualifying families once a month (every 30 days) that are not in the Housing Program • Families must reside in the following cities to qualify: o Irvine, Newport Beach, Tustin, Lake Forest, Mission Viejo, Aliso Viejo, Laguna Hills, Laguna Niguel, Rancho Santa Margarita, Dana Point and all other South Orange County cities. • Families need to fill out a registration form, provide photo ID, proof of residency, and proof of income; documents will be updated annually • An appointment must be made in order to pick up food • Families will check in with the front desk before going to the food pantry if they need to update and documents. Child Care • There are certain grants that can assist with child care costs o Check with HPM for approval • They may be referred to Children's Home Society or the Department of Education for subsidized childcare programs Gift Cards • Gifts cards can be issued to families in emergency situations • There are gift cards for gas, groceries, target(clothes/shoes for kids) • There are $800 allocated to each family for emergencies such as car repairs, field trip cost for kids, or gift cards (some examples) o This an example of when check requests are submitted and a check is given to a family once the request is approved t i FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE • If a gift card is given, the case manager must write the amount of the card and the date given to the client on a ledger • CM to enter the gift card information in both the Client Track and HMIS systems • A copy must be made of the gift card which the family will sign and date. This copy will be added to their hard file Career Services • After the family meeting and a CTI plan is created the case manager may refer individuals from the family to a career coach • The CM will give the contact information for career coaches to the client The Career Coach will assist those that are unemployed or under employed and evaluate their work history and earning potential • Once an appointment is set up career will have a one on one appointment with the client; assignments will be given and this will continue on for the I duration of the program • The Career Coach will: o Construct a new resume for client o Target the resume to fit each job description o Assist clients in obtaining professional clothing o Teach client to upload resume to various career sites o Give tips on how to interview for a job • There are a series of workshops lead by the Career Coaches, which are free to bath the housing families and the public Community Cares ' • Families who do not have access to medical services can be linked to a provider • In many medical emergency situations families can be linked to services through the Prevention Program Manager o The Prevention Program Manager (PPM) will contact a doctor from her list of providers who will see a patient free of charge • The Community Resources Coordinator (CRC)can also assist families with enrollment to insurance(Covered California) , medical services, and food stamps • The PPM and CRC also put together a Community Resource Fair that is open to the public o This is an annual event hosted by Families Forward o Over 50 service providers in the OC offer free health screenings, legal advice, financial counseling, workshops and kid's activities o It is located at Irvine Valley Community College o Everyone is welcome with NO need to enroll FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Counseling Services • Families that are enrolled in the housing program are eligible for counseling if they chose to participate o Some counselors can meet with minor-aged children of the family o Meetings are set by appointment and meet at least once a week while they are in the program Community Counselina Center • Families Forward also has a Community Counseling Center available to the public o These services are offered to families with minor-aged kids o Families will call and make an appointment between Monday - Thursday from 9am-5pm o There is a fee that is based on a sliding scale Community Resources Transportation Services • Families that do not have access to a car are eligible for transportation services through the JARC, which is offered by Jewish Federation and Family Services • Through JARC an adult family member can make an appointment for a ride to and from an interview or any employment related meeting or appointment o A case manager will give the family member a referral to complete o It is then faxed over to Jewish Federation and Family Services for documentation • The family is also given ride vouchers; the family member is responsible to make the appointment for a ride ahead of time Vision Services • When a family member from the program has poor vison, they can be referred through our Gift of Sight program for glasses or contacts • This is a service free of charge to that individual • There are multiple locations for this service, but there may be a wait list In order to proceed a: o Letter must be faxed o Appointment made • Copy of letter given to client Emergency Hotel Stay • When a family is matched to the program, but there is an issue in finding immediate housing for them at that moment, the family can be placed at a motel in the meantime until housing is ready for move-in FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE • Families.Forward partners with the motel Keys Inn in Tustin, CA • If it is deemed necessary then a family will be referred by the case manager to the Keys Inn for a pre-determined time and paid for by Families Forward • The information will be faxed to the Keys Inn before the family's arrival and can check in with motel staff Seasonal Programs • Families Forward puts together seasonal programs to assist families • There are 4 programs that are offered every year: o Community Resource Fair- an annual event that brings over 50 service providers for free health screenings, legal advice, financial counseling, workshops and kid's activities to families o Back to School Backpacks- Backpacks are given for free to kids K-12 j before the school year starts. Families who previously received backpacks within the past year will receive refill supplies j o Thanksgiving- Baskets of food that are needed to prepare a Thanksgiving meal are given to the families; the food given out is based on a lottery which will depend on the donations received o Adopt-a-family-Holiday Gift Program- Donors give gifts to an assigned family based on a lottery; families must sign up for this program in October of each year t Furniture • Families Forward receives various types of donated furniture • These donations are mainly used to furnish the homes for transitional housing • Some families that move into Rapid Re-Housing move in with no furniture at all • A request can be made to the Property Manager to see if there are extra donations to accommodate the family's housing needs o An email is sent to the property coordinator with furniture and/or household item request form attached o The Property Manager will confirm if the request can be filled If it can be filled then the furniture will be brought to Families Forward and the family can arrange for pickup • Depending on availability, Families Forward has a partnership with Two Men and a Truck, a moving company that offers moving services pro-bono to families in the Rapid Re-Housing program o CM to submit a request no later than Tuesday of the week they want to utilize the service • Include Name, phone number, address, pickup time and list of items i FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE File Management Creating New Family File • Before creating the file make sure all HMIS enrollment forms and program documents provided are completely filled out and up to date o Note all areas where information is missing to request from client during the next in person meeting • Case manager will use the P-Touch to create the following labels o Client name • Last Name, First Name • If there are two adults in the family only add the Head of Household to label o Tab I- Personal o Tab ll- Financial o Tab III- Rapid Rehousing o Tab IV- Interim o Tab V- Case Management o Tab VI- Program • Use HP File Index as a guide for proper placement of documents within file Maintaining Record Keeping • It is required for the following documents to be filled/collected regularly: o Budgets o Paystubs o Home inspection forms o Gift card verifications o Rent receipts • Copies of receipts for Rapid Re-housing clients will be filed under Tab V- Housing • Rent receipts for Interim Housing will be kept by the Operations Associate • HRS will provide CM with a monthly ledger or what has or has not been paid by the client o Food pantry lists o Correspondence with client • Pertinent information that Would affect their housing program • Change in child support income letter, court letters, cash aide award letters, etc. • Data Entry Clerk will perform audit on any new files on a weekly basis o Any corrections will be flagged with an attached explanation as needed HOUSING PROGRAM FILE INDEX CLIENT TRACK ID: HMIS ID: TH/IH_RRH_Grant Tab I—Personal Tab II-Financial ❑ ❑ HP File Index ❑ ❑ Income calculation worksheet ❑ ❑ Homeless Certification ❑ ❑ Entry Income Verification o ❑ V party verification of homelessness o o Income Guidelines. ❑ ❑ FF Motel Reservation forms(If applicable) o ❑ HMIS Enrollment Forms Divider ❑ o CFC Client Forms(only If client is CFC funded) o ❑ Current Income Verification , ❑ ❑ HMIS Consent Form o ❑ Monthly Budgets to ❑ Self-Declaration of Income Divider ❑ ❑ Self-Declaration of Financial Resources r.. ❑ HMI5 Report(if applicable) o ❑ Bank Statements-3 months ❑ ❑ Request for Services Form o o CES Referral ❑ ❑ Picture ID ❑ to Social Security Card ❑ e Immunization Card(0-5 years) ❑ c School Enrollment Verification(5+years) ❑ o Birth Certificates-all house hold members ❑ o Medical Insurance Cards ❑ ❑ Court/Custody Documentation (If applicable) ❑ ❑ Disability Documentation(if applicable) ❑ r Exit Documents - HMIS forms,CFC survey(If applicable) Tab III—Rapid Rehousing Tab IV—Interim ❑ Schedule of Rent Payments ❑ ❑ Current Lease Agreement ci ❑ Lease ❑ ❑ Residential Rent o ❑ Check Requests ❑ ❑ Exhibit A ❑ o Rent Receipts ❑ ❑ Rental Formula ❑ ❑ Key Exchange Agreement o ❑ Drug Test ❑ ❑ Rapid Re-Housing Needs Assessment ❑ ❑ Misconduct Act ❑ ❑ ESG Lead Screening Worksheet •❑ n Housing Inspection Forms(If applicable) o ❑ Rent Reasonableness Checklist and Certification o ❑ 30-Day Notice/Extension ❑ ❑ Minimum Standards for Permanent Housing o o Security Deposit Return ❑ in Housing Inspection Forms(If applicable) Tab V—Case Management Tab VI-Program ❑ CTI Plan Both Programs o ❑ Client Email Correspondence o o Program Offer Letter ❑ ❑ Crisis Documentation(If applicable) ❑ ❑ Termination of Assistance Policy ❑ u Signed gift card copies(If applicable) ❑ ❑ Termination of Housing Process of Appeals ❑ ❑ Filled food pantry forms(If applicable) ❑ o Communication Disclosure • o Program Contract ❑ ❑ Grievance Polity ❑ ❑ Consent to Exchange Information o in Consent for Services ❑ ❑ Tenant Screening Form(If applicable) ❑ ❑ Credit Report ❑ o Background Check Disclosure o ❑ Printed background check ❑ o Employment Agreement(If applicable) CASE,MANAGER NAME: FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Case Management Best Practices ❑ Meet at least once a month in person D Review CTI plan o Discuss family progress towards areas of focus o Discuss barriers (new or existing) Refer family to appropriate resources o For "pending" clients, discuss progress on housing search and employment status if unemployed ❑ Collect previous months budget o During monthly meeting review client's budget in detail o Refer family to Financial Literacy if needed ❑ Collect rent receipt o For RRH By the 3rd of the month o For TH/INT on or before the 15C of the month ❑ Send out utility bills (TH/INT) o Collect utility bill payment o 2 weeks from when CM sent out payment o Amount due for utilities: $ ❑ Collect previous months paystubs ❑ Send out check requests for FF rent portion (RRH) o No later than the 3rd Monday of each month i I I i I I I FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Case Management Deadlines Check Requests • Rent Check Request (Rapid Re-Housing) o Rent check requests are due on or before the third Monday of the month • Check Request Deadline o Check requests must be submitted by 11AM every Wednesday • When client makes a request that will result in cutting a check CM must get the expense approved by management team o At this time you may make client aware if the expense was approved or denied • Check requests are completed for the following items o Rent for Rapid Re-Housing families o Childcare assistance o Car repair assistance o Security deposit reimbursement o Any other expenses that have been approved • When completing check requests make sure all fields are included which include: o Urgent request (if applicable) o Date check request is completed o Amount o Check payable to: o Address (of vendor) o CM name (requested by) o Indicate new or repeat vendor • If new vendor a W-9 must be attached to request and saved to the "G" Drive o CM will always mark "return to requester" • CM must always have a copy of the check and check request i to file o Purpose i o Month o Grant o Client name o Current client address o At this point CM will make a copy of the check request o First approval signature ? o Second approval signature (if amount is $1,000 or over) • See sample check request attached • Once check request is complete submit to accounting • When check has been given to CM make a copy of the check o Place check request copy with copy of check in client file Interim Housing Deadlines • CM-Case Manager; HRS-Housing Resource Specialist; FM-Facilities Manager; FA-Facilities Assistant; OA-Operations Associate FAMILIES FORWARD DIGNITY EMPOWERMENT • HOPE WHEN WHAT WHO Move In Family is given all keys (mailbox, home, garage) and . CM, OA Introduced to new home. 3—5 business Once the family has moved in (physically occupying the unit) OA days after the Home Orientation is conducted within 3-5 business move in days. At this time Tenant Education, Move-In Inspection, j and Affordable Housing List is given. First Tuesday Monthly Home Visits are conducted the first Tuesday of FM, OA of every every month for the entire program period month .: 1 week after If family does not pass Home Visit the recheck Is conducted OA, CM if home visit the following Tuesday. Allowing one week for the family to available rectify the problem. During _ If there Is an emergency maintenance problem (affects FM Tenancy habitability—relating to sanitation, water, heat, etc.)family is instructed to call Facilities Manager ' During If there is a non-emergency maintenance problem family Is FM Tenancy instructed to e-mail Facilities Manager. During Facilities Manager will attempt to fix in-house and will FM Tenancy schedule outside service If needed. .: During All maintenance follow up with tenant is conducted by FM Tenancy Facilities Manager in a timely manner. I During When HOA complaints are received pertaining to client,the CM, HRS Tenancy issue Is corrected and follow up is written to HOA.The Template can be found on the G drive—G:\Forms\Program Form s\Transitional Housing Forms\Property Management. During When HOA complaints are received pertaining to HRS Tenancy maintenance/non-client,the issue is corrected and follow up Is written to HOA 30 days Notice to vacate Is given to family and PM team before move out d , - z. FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE 7-14 days Final home visit Is conducted. Move out inspection is CM, CA, FM before move scheduled with client out 7-14 days The Move-Out Inspection is completed with tenant to CM, CA, FM before move discuss potential Security Deposit deductions and move out out checklist.The tenant is to provide CM with furniture request at this time. Any permissible furniture to be taken with tenant will be written on their move out inspection form. ASAP Any exceptions of lease extensions given to client must be CM shared with PM team as soon as possible. Day of Move Key exchanged Is performed at the home face to face on the CM, CA Out family's last day. Walk through should be done by CM at this time. If unit Is not acceptable CM is to work with client to resolve issues. If family Is not ready, key should not be exchanged. I Within 3 days First inspection Is completed to evaluate any damages or FM post move excessive wear and tear to be deducted from Sec. Deposit out Within 21 Security Deposit is returned to family within 21 days of FM, CM, CIA days post move out. Only damage to the unit, cleaning fees and/or move out utility fees may be deducted from the security deposit. 1-2 weeks Home is evaluated for fix-its,furniture replacement and first FM, FA post move clean sweep. Maintenance is scheduled and conducted. out Facilities Manager conducts final Maintenance Walkthrough with Maintenance Checklist for property file—Also leave two light bulbs and one SIV battery per unit. i 1-2 weeks Professional cleaners are scheduled for full cleaning FM post move out 1-2 weeks Painters are scheduled if necessary FM post move out FAMILIES FORWARD DIGNITY EMPOWERMENT HOPE 1-2 weeks Carpet cleaner scheduled FM post move out ASAP Family Profile is given to PM team as soon as available even CM if not finalized Once FP Is Warehouse and home are evaluated to match Family FM, FA received (2-3 Profile. Items are pulled and unit is adjusted to family weeks post profile. One corkboard per child's room is supplied. move out) ASAP If Family Profile changes adjustments to unit are made CM, OA, FM, FA accordingly. ASAP.. Couhselors are notified that the unit is ready to'gc..'. HRS, OA 3 days before Notification to PM team of new family moving in at least 3 CM move in days prior to their move in >3 week post ,. Jf unit sits for a period of time(over two weeks)spiffing is OA Group Visit necessary for dust bulld-up just prior to family moving In' so ASAP Throughout entire process make sure the Whiteboard is OA updated so that all units have the most current Information Family Moves in and the process re-starts) ;. s Data Deadlines • New family data o All families need to be entered into HMIS and Client Track (CT) within three days of receiving case assignment which is the "Match" date from the Coordinated Entry Systems (CES) • Services o All services need to be entered into CT and HMIS within three days of rendered service date • Exiting Families Upon Completion of Program o All families need to be exited from HMIS and CT within 3 days from move-out date • Case Notes o Case notes need to be entered no more than three days after family meeting FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE • Case notes are required for the following: • Entry of the family into housing case note • First family meeting case note • Family meeting case note for each month in the program • Gift card services provided • Emergency with client, family or home (entered immediately) • Information or interaction CM feels important to document • Exit case note i I I i I FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Family Move-Out Process Interim Transitional Housing: Exit Meeting/Phase 3 • CM to schedule exit meeting with client within the last month of their program • During meeting CM and client to review progress on: 0 3 areas of focus o Support systems o If utilizing the Rapid Re-Housing program, review SORP and program expectations • CM to provide client with Exit packets for each member of the household • CM to collect income documentation and budget for the final month Move-out Inspection/Key Exchange • CM to provide client with appropriate notice before expected exit date 0 30 Day Notice given for an extension that is at least 30 days o An Extension of Termination Date form Is given out when an extension is less than 30 days ex: 1 week, 2 weeks • CM sends Interim move-out inspection request to Housing Resource Specialist (HRS) via google doc and calendar invite to schedule date and time o Move-out inspections are conducted 7-14 days before exit date ! o During inspection, HRS will note any repairs that need to be made • If needed, client to submit furniture and household item request to CM o Request can be made before or after move into permanent housing c If needed, CM can connect client to free moving services • CM to submit request to HPM for assistance from Two Men and a Truck • Two Men and a Truck can only accommodate moving request once a week on Wednesdays; request deadline is the Friday before • Two Men and a Truck can only move furniture from Families Forward to the client's home; they cannot move furniture from any other locations • CM to perform key exchange on the day of move out o CM to do a final walk through of the unit prior to key exchange and note any concerns if necessary o If family is not ready to move out, then do not exchange keys with client and consult with HPM • Once family has moved out, Operations Associate will provide security deposit ! form to CM o Any unpaid utility bills and/or damages made to the unit will be deducted from the security deposit o Client cannot use security deposit towards any unpaid rent l o Any monies left over, will be given back to the client in the form of a check FAMILIES FORWARD DIGNITY • EMPOWERMENT - HOPE • CM to submit check request to accounting with security deposit attached • Check can be mailed out or picked up by client • CM to inform client that the process can take up to 21 days Rapid Re-Housing: Exit Meeting/Phase 3 • CM to schedule exit meeting with client within the last month of thelr program • During meeting CM and client to review progress on: o 3 areas of focus o Support systems o Rent expectations for the remainder of lease • CM to provide client with Exit packets for each member of the household • CM to collect income documentation, rent receipt and budget for the final month Data Exit • CM to email Exit Request to Data Entry Clerk (DEC) at least 2 weeks prior to client exit o CM to CC Data Quality Manager and Housing Program Manager in email • CM must provide DEC with completed exit packet o Client must mark each question, sign each packet for each member of the household o CM to review the completed exit packet before submitting to DEC o Incomplete exit forms will be entered as "no exit interview completed" i i i FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Regular Case Manager Meetings Individual Supervision • This meeting takes place weekly with HPM • HPM will send CM a re-occurring individual supervision meeting invite via Outlook • During this meeting CM will type up a list of their caseload with any updates on each family to HPM • This meeting serves as additional accountability and support for CM Case Management: • This meeting takes place every Monday at 3:00pm • All clients that will be presented during this meeting must be submitted the Friday before the meeting to HPM • During this meeting the following will be presented by CM: o New families that have moved into housing, RRH or TH • CM will give brief description of family background, go over areas of focus established for CTI plan, and projected program time frame o Client updates • If there is any new information on active or pending clients that may impact family, program or involvement with other staff members an update will be made during this time • For example, client obtained employment, serious health issues, transportation changes etc o New Pending Clients • HRS will introduce any new pending clients for the week and give a brief description on the family o Famify Exits • If presenting on family exit CM will discuss the areas of focus that were accomplished during the program and those that were not • Management team may have questions in regards to outcomes, such as family destination after program Property Management • This meeting Is conducted monthly on the 3ra Monday of every month at 2:30pm • The Property Management meeting is specifically for Transitional Housing as well as any housing inquiries for furniture requests ! • This monthly meeting is to discuss turn over, vacancies, upcoming exits, unit problems, procedures etc FAMILIES FORWARD DIGNITY • EMPOWERMENT - HOPE Staff Meeting • This meeting is held once a month on the first Monday of the month at 9:00am-10:30am • A staff member from the operations team will email meeting agenda the week prior to meeting. • If you will be in charge of speaking on any particular topic during the meeting your supervisor will let you know In advance Program Committee Meeting • This meeting is held once a month on the 2"J Tuesday of the month at 8:00am-9:00am • A Program staff member will be assigned to email meeting agenda the week prior to meeting. o Each month a different program staff member will be responsible for creating agenda, prepping board room, taking attendance and minutes during meeting, and lastly writing up final draft of minutes and emailing them out to program committee • Agenda items are obtained from Director Housing Programs and Services the week prior to meeting i I I ' I ' i I I I I I 1 i i I i Exhibit A - Appendix K i Addendum to Operating Procedures for the Tenant Based Rental Assistance Program ADDENDUM TO OPERATING PROCEDURES FOR TENTANT BASED RENTAL ASSISTANCE PROGRAMS On April 10, 2020, the Housing and Urban Development Department, HUD, issued two memoranda, April 10, 2020 Memorandum — Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic and April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA) for Emergency and Short-term Assistance in Response to COVID-19 Pandemic. The memoranda prioritized the immediate housing needs of those impacted by COVID- 19 and the prevention of the spread of COVID-19 and to achieve such ends, provided for numerous waivers and suspensions in current federal regulations and policies. The City's Community Development Department applied for and was granted the waivers and suspensions on April 22, 2020. The following waivers and suspensions, among others, were granted and impact the administration of the HOME Tenant Rental Based Assistance Program (TBRA) which provides rental assistance to low income individuals and families in Huntington Beach. April 10, 2020 Memorandum—Availability of Waivers and Suspensions of the HOME Program Requirements in Response to COVID-19 Pandemic • HOME Program - 10% Administration and Planning Cap • HOME Program — Income Documentation • HOME Program — On-Site Inspections of HOME-assisted Rental Housing • HOME Program - Annual Inspection of Units Occupied by Recipients of HOME Tenant-Based Rental Assistance (TBRA) April 10, 2020 Memorandum — Suspensions and Waivers to Facilitate Use of HOME-Assisted Tenant-Based Rental Assistance (TBRA)for Emergency and Short-term Assistance in Response to COVID-19 Pandemic • HOME Program—Consolidated Plan-HOME Certification, Analysis of Local Market Conditions, and Citizen Participation • HOME Program — Tenant Selection and Targeted Assistance • HOME Program - Eligible Tenant-based Rental Assistance Costs and Maximum TBRA Subsidy • HOME Program - Term of Rental Assistance Contract • HOME Program —Tenant Protections-Lease • HOME Program— Housing Quality Standards • HOME Program — Annual Inspection of Units Occupied by Recipients of HOME TBRA • HOME Program - Income Determinations HUD will be issuing further guidance on the waivers and suspensions. The City will adopt these guidelines within the program's operating procedures to ensure low income residents of Huntington Beach will be afforded maximum access to this program. The City will be required to provide written documentation of the changes to operating procedures and work closely with the service providers to ensure compliance of the modified regulations during the pandemic and its aftermath. I i i Exhibit A - Appendix L Emergency Transfer Plan and VAWA Lease Addendum CITY OF HUNTINGTON BEACH TENANT BASED RENTAL ASSISTANCE PROGRAM EMERGENCY TRANSFER PLAN Emergency Transfers i The City of Huntington Beach ("City") is concerned about the safety of its residents, and such concern extends to residents who are victims of domestic violence, dating violence, sexual assault, or stalking. In accordance with the Violence Against Women Act (VAWA), the City allows residents who are victims of domestic violence, dating violence, sexual assault, or stalking to request an emergency transfer from the resident's current unit to another unit. Despite the name of this law,VAWA protection is available to all victims of domestic violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity, or sexual orientation. The ability to request a transfer is available to all individuals as housing providers cannot discriminate on the basis of any protected characteristic, including race,color,national origin,religion,sex,familial status, disability,or age. United States Department of Housing and Urban Development(HUD)assisted and HUD- insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation, gender identity, or marital status. The ability of the City to honor such request for residents currently receiving assistance, however, may depend upon a preliminary determination that the resident is or has been a victim of domestic violence, dating violence, sexual assault,or stalking,and on whether the City has another dwelling unit that is available and is safe to offer the resident for temporary or more permanent occupancy. This plan identifies residents who are: 1. eligible for an emergency transfer; 2.the documentation needed to request an emergency transfer; 3.confidentiality protections; 4. how an emergency transfer may occur; and 5.guidance to residents on safety and security. The City's plan is based on a model emergency transfer plan published by HUD, the Federal agency that provides funding to the City for its Tenant Based Rental Assistance(TBRA) Program and that oversees that the City is in compliance with VAWA. Eligibility for Emergency Transfers A resident who is a victim of domestic violence, dating violence, sexual assault,or stalking, as provided in HUD's regulations at 24 CFR part 5, subpart L is eligible for an emergency transfer, if: the resident reasonably believes that there is a threat of imminent harm from further violence if the resident remains within the same unit. If the resident is a victim of sexual assault, the resident may also be eligible to transfer if the sexual assault occurred on the premises within the 90-calendar•day period preceding a request for an emergency transfer. • A resident requesting an emergency transfer must expressly request the transfer in accordance with the procedures described in this plan. • Residents who are not in good standing may still request an emergency transfer if they meet the eligibility requirements in this section. According to HUD's regulation 24 CFR part 5, subpart L a victim includes the following: I Domestic violence includes felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies, or by any other person against an adult or youth victim who is protected from that person's acts under the domestic or family violence laws of the jurisdiction. Dating violence means violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors: The length of the relationship The type of relationship The frequency of interaction between the persons involved In the relationship Sexual assault means any nonconsensual sexual act proscribed by federal, tribal, or state law, including when the victim lacks the capacity to consent. Stalking means to engage in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress. Emergency Transfer Request Documentation To request an emergency transfer, the resident shall notify the TBRA case managers and complete a "VAWA Transfer Request" form.The completed form will be received by the TBRA service providers/case managers. The City working with the TBRA service providers/case managers will provide reasonable accommodations to this policy for individuals with disabilities. The resident's written request for an emergency transfer should include either: 1. A statement expressing that the resident reasonably believes that there is a threat of imminent harm from further violence if the resident were to remain in the same dwelling unit assisted under the TBRA's program; OR 2. A statement that the resident was a sexual assault victim and that the sexual assault occurred on the premises during the 90-calendar-day period preceding the residents request for an emergency transfer; AND 3. Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking and alternate documentation form must be completed. (Refer to Form HUD-5382) Confidentiality The TBRA Program service providers will keep confidential any information that the resident submits in requesting an emergency transfer, and information about the emergency transfer, unless the resident gives the TBRA Program service providers written permission to release the information on a time limited basis, or disclosure of the information is required by law or required for use in an eviction proceeding or hearing regarding termination of assistance from the covered program.This includes keeping confidential the new location of the dwelling unit of the tenant, if one Is provided, from the person(s)that committed an act(s) of domestic violence, dating violence, sexual assault,or stalking against the resident. NOTE: See the Notice of Occupancy Rights under the Violence Against Women Act For All Tenants for more information about City's and TBRA service providers' responsibility to maintain the confidentiality of information related to incidents of domestic violence, dating violence,sexual assault, or stalking. Emergency Transfer Timing and Availability The City and its TBRA service provider partners cannot guarantee that a transfer request will be approved or how long it will take to process a transfer request.The City and its TBRA service provider partners will, however, act as quickly as possible to move a resident who is a victim of domestic violence, dating violence,sexual assault,or stalking to another unit,subject to availability and safety of a unit. If a resident reasonably believes a proposed transfer would not be safe, the resident may request a transfer to a different unit. If a unit is available, the transferred resident must agree to abide by the terms and conditions that govern occupancy in the unit to which the resident has been transferred.The City and its TBRA service provider partners cannot transfer a resident to a particular unit if the resident has not or cannot establish eligibility for that unit. If the City and its TBRA service provider partners have no safe and available units for which a resident who needs an emergency is eligible, City and its TBRA service provider partners will identify other housing providers who may have safe and available units to which the resident could move. At the resident's request, City and its TBRA service provider partners will also assist residents in contacting the local organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking. Safety and Security of Residents Pending processing of the transfer and the actual transfer, if it is approved and occurs, the resident is urged to take all reasonable precautions to be safe. National Resources: Residents who are or have been victims of domestic violence are encouraged to contact the National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for assistance in creating a safety plan. For persons with hearing impairments, that hotline can be accessed by calling 1- 800-787-3224 (TTY). Residents who have been victims of sexual assault may call the Rape,Abuse & Incest National Network's National Sexual Assault Hotline at 800-656-HOPE, or visit the online hotline at https://www.rainn.org/ Residents who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at httPS://www.victimsofcrime.org/ourprograms/stalking-resource- center VIOLENCE, DATING VIOLENCE U.S. Department of Housing OMB Approval No.2502-0204 OR STALKING and Urban Development rxp.6/3012017 Office of Housing LEASE ADDENDUM VIOLENCE AGAINST WOMEN AND JUSTICE DEPARTMENT REAUTHORIZATION ACT OF 2013 1'ENAN'I' LANDLORD UNIT NO. &ADDRESS This lease addendum adds the following paragraphs to the Lease between the above referenced Tenant and Landlord. Purpose of the Addendum The lease for the above referenced unit is being amended to include the provisions of the Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA). Conflicts with Other Provisions of the Lease In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. Term of the Lease Addendum The effective date of this Lease Addendum is This Lease Addendum shall continue to be in effect until the Lease is terminated. VAWA Protections I. The Landlord may not consider incidents of domestic violence, dating violence or stalking as serious or repeated violations of the lease or other"good cause" for termination of assistance, tenancy or occupancy rights of the victim of abuse. 2. The Landlord may not consider criminal activity directly relating to abuse, engaged in by a member of a tenant's household or any guest or other person under the tenant's control, cause for termination of assistance, tenancy, or occupancy rights if the tenant or an immediate member of the tenant's family is the victim or threatened victim of that abuse. 3. The Landlord may request in writing that the victim, or a family member on the victim's behalf, certify that the individual is a victim of abuse and that the Certification of Domestic Violence, Dating Violence or Stalking, Form HUD-91066, or other documentation as noted on the certification form, be completed and submitted within 14 business days, or an agreed upon extension date, to receive protection under the VAWA. Failure to provide the certification or other supporting documentation within the specified timcframe may result in eviction. Tenant Date Landlord Date Form HUD-91067 (9/2008) I Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Exhibit B Documentation, Recordkeeping, Reporting and Monitoring Requirements Mercy House (Subrecipient)shall comply with the requirements set forth in this document at all times during the term of the HOME Subrecipient Agreement (Agreement) between the City of Huntington Beach (City)and Subrecipient, to which this document is attached. I. Documentation and Recordkeeping A. Records to be Maintained Subrecipient shall maintain all records required by the federal regulations specified in 24 CFR 92.508(a)(3),which are pertinent to the Services to be funded under the Agreement. Records shall be maintained for each prospective participant, each Eligible Household and each Housing Unit inspected and/or occupied by an Eligible Household pursuant to the Agreement. Such records shall include but are not limited to: • Records providing a full description of each activity undertaken. • Records required to determine the eligibility of activities for use of HOME funds. • Records(including property inspection reports)demonstrating that each Housing Unit occupied by an Eligible Household meets the property standards of 24 CFR 92.251(d) and 24 CFR 982.401 upon occupancy and at the time of each annual inspection. • Records demonstrating compliance with the property standards and financial reviews and actions pursuant to 24 CFR§92.504(d). • Records demonstrating that each Eligible Household is income eligible in accordance with 24 CFR 92.203, including all TBRA applications, eligibility determinations and documentation regarding any appeals of eligibility determinations. • Records demonstrating that Subrecipient is in compliance with the City's written tenant selection policies and criteria of 24 CFR 92.209(c), including any targeting provisions of 24 CFR 92.209(h), and calculation of each Subsidy Payment. • Records demonstrating that each rental agreement for an Eligible Household receiving Subsidy Payments complies with the tenant and participant protections of 24 CFR 92.253. • Records documenting compliance with Subrecipients marketing and outreach obligations under the Agreement, including compliance with the fair housing and equal opportunity components of the HOME program and HUD's Affirmative Fair Housing and Marketing regulations and the City's Affirmative Fair Housing Marketing Plan, when adopted. i • Records documenting compliance with the lead-based hazards requirements under the Agreement, the HOME Program, and 24 CFR Part 35, subparts A, B,J, K, M and R. I • Financial records as required by 24 CFR§92.508(a)(5) and 24 CFR §92.222. • Records documenting the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program,specifically including 24 CFR 92.218 through 24 CFR 92.222. B. Retention The Subrecipient shall retain all financial records, supporting documents, statistical records, and all other records pertinent to the Agreement for a period of five years after the period of Subsidy Payments terminates. Notwithstanding the above, if there are litigation matters,claims, audits, negotiations or other actions that involve any of the records cited and that have started before the expiration of the five-year period,then all pertinent records must be retained until completion of the actions and resolution of all issues,or the expiration of the five-year period, whichever occurs later. C. Client Data The Subrecipient shall maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to, client name,address, income level or other basis for determining eligibility, and description of service provided. Such information shall be made available to City monitors or their designees for review upon request. D. Disclosure The Subrecipient understands that client information collected under this Agreement is private and the use or disclosure of such information,when not directly connected with the administration of the City s or Subrecipient's responsibilities with respect to Services provided under this Agreement, is prohibited unless written consent is obtained from such person receiving services and, in case of a minor, that of a responsible parent/guardian. E. Close Outs The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during the close-out period shall include, but are not limited to: making final payments, disposing of program assets (including the return of all unused materials, equipment, unspent cash advances, program income balances, and accounts receivable to the City), and determining the custodianship of records. Notwithstanding the foregoing, the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over HOME funds, Including program income. F. Audits and Inspections All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the City, HUD and the Comptroller General of the United States or any of their authorized representatives, at any time during normal business hours,as often as deemed necessary,to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of the Agreement and may result in the withholding of future payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current City policy concerning Subrecipient audits and OMB Circular A-122. II. Monthly Progress Reports Subrecipient shall submit Monthly progress reports to the City in a form approved or directed by the City, which shall include all of the following information regarding Subrecipient's activities during the prior quarter: • The number of TBRA applications received, processed,approved and disapproved. • The number of Housing Units inspected, approved and disapproved and a description of any corrective work performed by landlords to comply with HQS. • The number of Eligible Households assisted, including specific information regarding the number of and ages of all household members, income categories,types and amounts of assistance provided to each Eligible Household, and remaining terms of assistance expected to be provided to such households. Description of each Eligible Household's participation in required self-sufficiency program and other optional social and supportive Services provided or otherwise made available to each Eligible Household. • Budget reconciliation information, Including year-to-date expenditures and remaining balance available for Subsidy Payments in accordance with the Budget and the Agreement. Number of additional Eligible Households Subrecipient expects to qualify and assist within the following three-month period. • Updated schedule of performance of the Services under the Agreement, including a schedule for qualifying and assisting additional Eligible Households as permitted by the Budget. • Information regarding any complaints receipted from Applicants or Eligible Households and any correspondence received from community members or organizations or other nonprofit organizations regarding the Program or specific activities or individuals involved in the Program. Documentation of the HOME Matching Contributions made by Subrecipient pursuant to the Agreement and the HOME Program, specifically including 24 CFR 92.218 through 24 CFR 92.222. III. Performance Monitoring A. Monthly Reports Subrecipient shall provide progress reports on a Monthly basis during the first quarter of the Term of the Agreement in order for the City to review Subrecipient's activities and progress under the Agreement and to ensure that the Program is progressing smoothly. B. City Oversight and Review City will monitor the performance of the Subrecipient against the goals and performance standards set forth in the Agreement. From time to time,City shall be entitled to audit and review Subrecipient's performance of the Services in accordance with the terms of the Agreement and compliance with the HOME Program. Substandard performance as determined by the City will constitute noncompliance with the Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, termination procedures will be initiated in accordance with Section 8.3 of the Agreement. i Exhibit C Gross income Calculation Form Income Calculation Worksheet • Seml-Monthly pay cycles are usually 15 days a longer from the 1st-15th and the 16th-30tW31st • Semi-Monthly salaried wage stubs will often show 66.66 or 86.67 under the"hours'section ' 61-Weekly pay cycles are usually 14 days and begin on the same day of the week and end on the same day of the week from pay cycle to pay cycle For migrant workers,monthly gross Income Is coputed by averaging the total gross Income received during the previous 12 months and Is NOT recalculated until the next annual certification Sofoct Appropriate Income Pay Cycle for Applicant Household Weekly:(52 pay periods annually) Member Name: I $ + E + S E 1 3 = E Weekly Average $ X 52 pay periods E gross annual Income Member Name: $ + $ + $ _ $ ! 3 - S Weekly Average $ X 52 pay periods S gross annual Income BbWeekly:(26 pay periods annually) Member Name: E + S- + $ _ $ f 3 = $ BI-Weekly Average S X 26 pay periods E gross annual Income Member Name: E + $ + $ _ $ 1 3 = $ 61-Weekly Aveaago $ X 26 pay periods$ gross annual Income Semi-Monthly:(24 pay perolds annually) Member Name: $ + S + Semi-Monthly Avg. $ X 24 pay periods S gross annual Income Member Name: $ + $ + $ _ $ ! J = $ Semi-Manthly Avg. $ X 24 pay periods E gross annual Income Monthly:(12 pay periods annually) Member Name: $ X 12 pay periods S gross annual Income Member Name: $ X 12 pay periods$ gross annual Income Fluctuating:use for seasonal,migrant agricultural,commissions Member Name: $ gross annual Income Member Name: $ gross annual income Total Household Annual Income From All Sources Listed Above: FAMILIES FORWARD DIGNITY - EMPOWERMENT - HOPE Families Forward Housing Program Self-Declaration of Income This is to certify the income status for the applicant. Income Includes but is not limited to: -The full amount of gross income earned before taxes and deductions. -The net Income earned from the operation of a business, i.e., total revenue minus business operating expenses. This also Includes any withdrawals of cash from the business or profession for your personal use. -Monthly interest and dividend income credited to an applicant's bank account and available for use. -The monthly payment amount received from Social Security, annuities, retirement funds, pensions, disability and other similar types of periodic payments. -Any monthly payments in lieu of earnings, such as unemployment, disability compensation, SSI, SSDI, and worker's compensation. -Monthly income from government agencies excluding amounts designated for shelter, and utilities, WIC, food stamps, and childcare. -Alimony, child support & foster care payments received from organizations or from persons not residing in the dwelling. -All basic pay, special day& allowances of a member of the Armed Forces excluding special pay for exposure to hostile fire. I certify that the information below and any other information i have provided in applying for Families Forward Housing Program assistance Is true, accurate and complete. Check only one and complete only that section: o I certify that I currently receive the following income: 0 ource: Amount: Frequency. o Source: Amount: Frequency: o I certify that I do not have any income from any source at this time. Applicant Name (signed): Date: o I certify that I currently receive the following Income: o Source: Amount: Frequency: o Source: Amount: Frequency: o I certify that I do not have any income from any source at this time. Applicant Name (signed): Date: Case Manager(printed): Date: Case Manager(signed): Date: Families Forward FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Families Forward Housing Program Self-Declaration of Financial Resources This is to certify the financial status for the applicant. Do you presently have a checking account? ❑Yes ❑No If No, why not? Do you have a savings account? ❑Yes ❑No If Not, why not? Do you presently have one or more active credit cards? ❑Yes ❑No If Yes, how many? If No, have you ever had a credit card? ❑Yes ❑No Please list ALL of your debts and expenditures (if you need more space, please attach separate sheet) Owed to: Total Amount: Monthl Payments: Balance Due: 1. 1 1 _ 2. _ 3 4, 5. Have your wages been garnished in the last year, or are you at risk of having your wages garnished? ❑Yes ❑No Are you in Bankruptcy now or are in the process of filing for bankruptcy? ❑Yes ❑No Do you owe money to friends or famlly? ❑Yes ❑No If Yes, amount you owe: $ Do you owe money to a previous landlord? ❑Yes ❑No If Yes, amount owed: $ Do you have past due household bills? ❑Yes ❑No If Yes, amount of balance $ Are you carrying a balance on credit cards(s)? ❑Yes ❑No If Yes, amount of balance(s): $ Do you have outstanding student loans? ❑Yes ❑No If Yes, amount of outstanding loan(s): $ Do you have any outstanding medical bills? Families Forward FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE ❑Yes ❑No If Yes, amount of outstanding balance: $ Have your utilities.been disconnected in the past year or as you at risk of.having your utilities disconnected? ❑Yes ❑No Has your car been repossessed in the past year or is at risk of being repossessed? ❑Yes ❑No i Are collection agencies presently contacting your about unsettled claims? ❑Yes ❑No Do you owe support (This includes current child support and child support that Is in arrears)? ❑Yes ONO If Yes, please list amount: Current monthly: In arrears: Are you owed child and/or spousal support? ❑Yes ONO If Yes, please discuss: t certify,that the information above and any other information 1 have provided in applying for Families Forward Housing Program assistance is true, accurate and complete. Applicant Name (printed): Date: Applicant Name (signed): Dale: Applicant Name (printed): Date: Applicant Name (signed): Date: Case Manager(printed): Date: Case Manager(signed): Date: Families Forward FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE Enrollment Process: • Once CM receives match, CM will call client within 24-48 hours to schedule appointment for Packet Review and Tenant Screening with CM and HRS • Appointment takes approximately 2 hours to complete • CM to send calendar and google doc invite to HRS for date and time of appointment o Client to bring the required family documents: • Proof of Income (one month's worth; last 3 paystubs) • Birth certificates • ID's for adults • Social security cards • Immunization records for children 0-5 or school enrollment verification for children 5+ • Medical cards • Current pay stubs or any other income source • Bank statements • Car registration and insurance • Custody/court documentation (If applicable) • Disability forms (If applicable) • Include Dara Entry Clerk to calendar invite (availability to attend appointment based on DEC capacity) o DEC will make copies of all family documents during appointment • Begin Enrollment Process (Packet Review and Tenant Screening): o CM to start meeting with review of homeless certification from CES • CM to gather current documentation from client • CM to provide Homeless Certification form for client to sign and date, as well as provide the homeless documentation from agency, emergency shelter, church and/or social service agency • If client is stating the family is sleeping in their vehicle, CM will complete a vehicle inspection in the FF parking lot. CM will sign Homelessness Certification verifying homelessness FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE e Once the documentation is collected, CM will proceed with the Packet Review o For any family that does not re-certify and/or cannot provide the above information, will be sent back to CES • CM to update HIC with this information • HIC will send update to CES on a weekly basis o CM will gather all family documents and hand over to DEC o HRS will conduct Tenant Screening in which housing history and credit report will be reviewed o For packet review, CM will fill out an enrollment packet for each member of the household • CM to use this time to ask about family and homeless history • CM will also review and verify income documentation provided by client. Adults earning any form of income must sign the Self Declaration of Income and provide any of the following forms of verification that are applicable: • Last 3 paystubs for earned income • If paystubs are not available, then an offer letter as it relates to a new job, that has not yet started, can be submitted • An award letter on letterhead for Cashaid, Disability and/or SSI • Court paperwork as it relates to child support or alimony • If the above mentioned documents are unavailable and CM has done their due diligence in trying to obtain documents (as noted in emails and/or case notes) CM will use the Self Declaration of Income as proof of income for the family o CM will plug in this information into the Income Calculation Worksheet to determine if family meets income guideline requirements o Based on the information, circle the income bracket the family falls under on the annual HUD guidelines document • CDBG participants must fall under extremely low to low-income bracket o Once packets are completed, CM will explain and obtain clients) signature on all program documents during appointment FAMILIES FORWARD DIGNITY • EMPOWERMENT • HOPE • Complete Enrollment Process o CM will submit the completed HMIS packets and family documents to DEC to enter information in both HMIS and Client Track Systems o CM will receive client information from Data Entry Clerk (DEC) after client information is entered into both Client Track and HMIS systems • DEC will provide information to CM within 24 hours • CM will pull an HMIS report and Background Check on all adults in the household • Note: o What program is the family entering (Interim Transitional Housing- I- TH or Rapid Re-housing)? • All I-TH clients are required to complete a drug screen prior to program entry as part of a needs assessment and not as a determinant of program entry • CM provides a referral to all of the adults in the household to complete a drug screening at a predesignated location • Clients must complete the Packet Review and Tenant Screening in order to complete enrollment into the housing program • Active vs Pending Clients o Once the enrollment process is completed, CM will maintain a caseload consisting of both Active and Pending clients • Active clients- homeless families that are currently in Interim Transitional Housing or Rapid Re-Housing Programs • Pending clients- homeless families that have been matched to Families Forward and have completed the enrollment process, but have yet to identify permanent housing • CM and HRS must check in weekly with family until housing is identified • Family will be sent back to CES for non-compliance with program rules or ceases communication with CM i Exhibit D Household Budget Worksheet Monthly Budget Name: Summary Percentage of Income Spent TOTAL MONTHLY INCOME $0 TOTAL MONTHLY EXPENSES Oho $0 TOTAL MONTHLY SAVINGS $20 I CASH BALANCE Checking Account Belcnce: —$20 Monthly Income Monthly Expenses ITEM AMOUNT ITEM AMOUNT Income Source 1 $0.00 Projected Rent $0.00 Income Source 2 $0.00 G?5:0 Projected water $0.00 0?{ CalFresh $0.00 -\i; Projected electric $0.00 CashAid $0.00 U✓=l Gas $0.00 Monthly Savings Cell phone $O.00 ITEM AMOUNT o Internet/Cable %.00 Monthly 5avings $20.00 Groceries $0.00 Outstanding Debts CarPayment $0.00 ITEM AMOUNT Transportation $0.00 Credit Card $0.00 �lt Student Loans $0.00 School So-00 tj Credit Cards $0.00 Personal Loan Saw Child Care $0.00 Other: $0.00 Auto Insurance $0.00 hNaJ Personal Care $0.00 OMiscellaneous $0.00 ® Storage $0.00 Exhibit E Lead-Based Hazard Information Pamphlet "Protect Your Family from Lead in your Home" Exhibit E ESG lead Screening Worksheet About this Tool The ESG Lead Screening Worksheet is intended to guide grantees through the lead-based paint inspection process to ensure compliance with the rule. ESG staff can use this worksheet to document any exemptions that may apply,whether any potential hazards have been Identified, and if safe work practices and clearance are required and used. A copy of the completed worksheet along with any additional documentation should be kept In each program participant's case file. Please seethe ESG Lead-Based Point Requirements Summary for additional Information. INSTRUCTIONS To prevent lead-poisoning In young children, ESG grantees must comply with the Lead-Based Paint Poisoning Prevention Act of 1973 and its applicable regulations found at 24 CFR 35, Parts A, B, M,and R. Under certain circumstances,a visual assessment of the unit is not required. This screening worksheet will help program staff determine whether a unit Is subject to a visual assessment, and If so, how to proceed. A copy of the completed worksheet along with any related documentation should be kept in each program participant's file. Note: ALL pre-1978 properties are subject to the disclosure requirements outlined In 24 CFR 35, Part A, regardless of whether they are exempt from the visual assessment requirements. BASIC INFORMATION Name of Participant: Address: Unit Number: City: State: Zip: Case Manager: PART 1: DETERMINE WHETHER THE UNIT IS SUBJECT TO A VISUAL ASSESSMENT If the answer to one or both of the following questions is'no,'a visual assessment is not triggered for this unit and no further action is required at this time. Place this screening worksheet and related documentation in the program participant's file. If the answer to both of these questions is'yes,'then a visual assessment is triggered for this unit and program staff should continue to Part 2. 1. Was the leased property constructed before 1978? ❑ Yes ❑ No 2. Will a child under the age of six be living in the unit occupied by the household receiving ESG assistance? ❑Yes I ❑ No ESG Lead Screening Worksheet 1 Exhibit E PART 2: DOCUMENT ADDITIONAL EXEMPTIONS If the answer to any of the following questions is'yes,'the property Is exempt from the visual assessment requirement and no further action is needed at this point. Place this screening sheet and supporting documentation for each exemption in the program participant's file. If the answer to all of these questions is'no; then continue to Part 3 to determine whether deteriorated paint is present. 1. Is it a zero-bedroom or SRO-sized unit? ❑ Yes ❑ No 2. Has X-ray or laboratory testing of all painted surfaces by certified personnel been conducted In accordance with HUD regulations and the unit is officially certified to not contain lead-based paint? ❑ Yes ❑ No 3. Has this property had all lead-based paint identified and removed in accordance with HUD regulations? ❑ Yes ❑ No 4. Is the client receiving Federal assistance from another program,where the unit has already undergone (and passed) a visual assessment within the past 12 months(e.g., if the client has a Section 8 voucher and is receiving ESG assistance for a security deposit or arrears)? ❑ Yes (Obtain documentation for the case file.) ❑ No 5. Does the property meet any of the other exemptions described In 24 CFR Part 35.115(a). ❑Yes ❑ No Please describe the exemption and provide appropriate documentation of the exemption. PART 3: DETERMINE THE PRESENCE OF DETERIORATED PAINT To determine whether there are any identified problems with paint surfaces, program staff should conduct a visual assessment prior to providing ESG financial assistance to the unit as outlined in the following training on HUD's website at: htt o://www.hud.gov/offices/lead/tra i n i na/vi sua la ssessme nt/h0010l.htm. If no problems with paint surfaces are identified during the visual assessment,then no further action is required at this time. Place this screening sheet and certification form (Attachment A) in the program participants file. If any problems with paint surfaces are Identified during the visual assessment,then continue to Part 4 to determine whether safe work practices and clearance are required. i I ESG Lead Screening Worksheet 2 Exhibit E 1. Has a visual assessment of the unit been conducted? ❑Yes ❑ No 2. Were any problems with paint surfaces identified in the unit during the visual assessment? ❑ Yes ❑ No(Complete Attachment A—Lead-Based Paint Visual Assessment Certification Form) PART 4: DOCUMENT THE LEVEL OF IDENTIFIED PROBLEMS All deteriorated paint Identified during the visual assessment must be repaired prior to clearing the unit for assistance. However,if the area of paint to be stabilized exceeds the de minimus levels(defined below),the use of lead safe work practices and clearance Is required. If deteriorating paint exists but the area of paint to be stabilized does not exceed these levels,then the paint must be repaired prior to clearing the unit for assistance, but safe work practices and clearance are not required. 1. Does the area of paint to be stabilized exceed any of the de minimus levels below? • 20 square feet on exterior surfaces ❑Yes ❑ No • 2 square feet in any one Interior room or space ❑Yes ❑ No • 10 percent of the total surface area on an interior or exterior component with a small surface area, like window sills, baseboards,and trim ❑ Yes ❑No If any of the above are'yes,'then safe work practices and clearance are required prior to clearing the unit for assistance. PART 5: CONFIRM ALL IDENTIFIED DETERIORATED PAINT HAS BEEN STABILIZED Program staff should work with property owners/managers to ensure that all deteriorated paint identified during the visual assessment has been stabilized. If the area of paint to be stabilized does not exceed the de minimus level, safe work practices and a clearance exam are not required(though safe work practices are always recommended). In these cases,the ESG program staff should confirm that the identified deteriorated paint has been repaired by conducting a follow-up assessment. If the area of paint to be stabilized exceeds the de minimus level,program staff should ensure that the clearance inspection Is conducted by an Independent certified lead professional. A certified lead professional may go by various titles, including a certified paint Inspector, risk assessor,or sampling/clearance technician. Note,the clearance Inspection cannot be conducted by the same firm that is repairing the deteriorated paint. 1. Has a follow-up visual assessment of the unit been conducted? ❑Yes ❑ No 2. Have all identified problems with the paint surfaces been repaired? ❑Yes ❑ No E5G Lead Screening Worksheet 3 Exhibit E ATTACHMENT l: LEAD-BASED PAINT VISUAL ASSESSMENT CERTIFICATION TEMPLATE I, certify the following: • I have completed HUD's online visual assessment training and am a HUD-certified visual assessor. • I conducted a visual assessment at on I No problems with paint surfaces were Identified in the unit or in the building's common areas. (Signature) (Date) Client Name: Case Number: ESG Lead Screening worksheet 5 I Exhibit E 3. Were all identified problems with paint surfaces repaired using safe work practices? ❑Yes ❑ No ❑ Not Applicable—The area of paint to be stabilized did not exceed the de minimus levels. 4. Was a clearance exam conducted by an Independent, certified lead professional? ❑Yes ❑ No ❑ Not Applicable—The area of paint to be stabilized did not exceed the de minimus levels. S. Did the unit pass the clearance exam? ❑Yes ❑ No ❑ Not Applicable—The area of paint to be stabilized did not exceed the de minimus levels. Note:A copy of the clearance report should be placed in the program participant's file. E5G Lead Screening Worksheet 4 i ;..w ti,u tiv y - a � • r c} �1r MA \ e '16f - r �I��, R M1 �Y\w JJ Are You Planning to Buy or Rent a Home Built Before 1978? Did you know that many homes built before 1978 have lead-based paint?Lead from paint,chips,and dust can pose serious health hazards. Read this entire brochure to learn: • How lead gets into the body • About health effects of lead • What you can do to protect your family • Where to go for more Information Before renting or buying a pre-1978 home or apartment,federal law requires: • Sellers must disclose known Information on lead-based paint or lead- based paint hazards before selling a house. • Real estate sales contracts must include a specific warning statement about lead-based paint.Buyers have up to 10 days to check for lead. • Landlords must disclose known Information on lead-based paint and lead-based paint hazards before leases take effect.Leases must include a specific warning statement about lead-based paint. If undertaking renovations,repairs,or painting (RRP)projects In your pre-1978 home or apartment: Read EPNs pamphlet,The Lead-Safe Certified Guide to Renovate Right, to learn about the lead-safe work practices that contractors are required to follow when working In your home(see page 12). rI ` ' Simple Steps to Protect Your Family from Lead Hazards If you think your home has lead-based paint: • Don't try to remove lead-based paint yourself. • Always keep painted surfaces in good condition to minimize deterioration. • Get your home checked for lead hazards.Find a certified Inspector or risk assessor at epa.gov/lead. Talk to your landlord about fixing surfaces with peeling or chipping paint. Regularly clean Floors,window sills,and other surfaces. Take precautions to avoid exposure to lead dust when remodeling. When renovating,repairing,or painting, hire only EPA-or state- approved Lead-Safe certified renovation firms. Before buying,renting,or renovating your home,have it checked for lead-based paint. Consult your health care provider about testing your children for lead.Your pediatrician can check for lead with a simple blood test. Wash children's hands,bottles,pacifiers,and toys often. Make sure children avoid fatty(or high fat)foods and eat nutritious meals high in iron and calcium. Remove shoes or wipe soll off shoes before entering your house. 1 i Lead Gets into the Body in Many Ways i Adults and children can get lead into their bodies if they: i • Breathe in lead dust(especially during activities such as renovations, repairs,or painting that disturb painted surfaces). • Swallow lead dust that has settled on food,food preparation surfaces, and other places. • Eat paint chips or soil that contains lead. Lead is especially dangerous to children under the age of 6. At this age,children's brains and nervous systems are more sensitive to the damaging effects of lead. Children's growing bodies absorb more lead. Babies and young children often put their hands and other objects in their mouths.These objects can have lead dust on them. j . Women of childbearing age should know that lead is dangerous to a developing fetus. • Women with a high lead level In their system before or during pregnancy risk exposing the fetus to lead through the placenta during fetal development, 2 I i Health Effects of Lead Lead affects the body in many ways. It Is Important to know that even exposure to low levels of lead can severely harm children. In children,exposure to lead can cause: Nervous system and kidney damage "e°d Learning disabilities,attention deficit disorder,and decreased Intelligence Wew• • Speech,language,and behavior problems • Poor muscle coordination • Decreased muscle and bone growth • Hearing damage ay..w. While low-lead exposure Is most common, exposure to high amounts of lead can have wwa' devastating effects on children,Including seizures,unconsciousness,and,In some cases,death. Although children are especially susceptible to lead exposure,lead can be dangerous for adults,too. In adults,exposure to lead can cause: • Harm to a developing fetus • Increased chance of high blood pressure during pregnancy • Fertility problems(in men and women) • High blood pressure • Digestive problems • Nerve disorders • Memory and concentration problems 3 Muscle and Joint pain i Check Your Family for Lead Get your children and home tested If youth Ink your home has lead. I Children's blood lead levels tend to Increase rapidly from 6 to 12 months of age,and tend to peak at 18 to 24 months of age. Consult your doctor for advice on testing your children.A simple blood test can detect lead.Blood lead tests are usually recommended for: • Children at ages 1 and 2 • Children or other family members who have been exposed to high levels of lead • Children who should be tested under your state or local health screening plan Your doctor can explain what the test results mean and if more testing will be needed. 4 Where Lead-Based Paint Is Found In general,the older your home or childcare facility,the more likely It has lead-based paint.' Many homes,including private,federally-assisted,federally- owned housing,and childcare facilities built before 1978 have lead-based paint. In 1978,the federal government banned consumer uses of lead-containing paint' Learn how to determine if paint Is lead-based paint on page 7. Lead can be found: • In homes and childcare facilities in the city,country,or suburbs, • In private and public single-family homes and apartments, • On surfaces Inside and outside of the house,and • In soil around a home.(Soil can pick up lead from exterior paint or other sources,such as past use of leaded gas In cars.) Learn more about where lead Is found at epa.gov/lead. ''Lead-based paint"is currently defined by the federal government as paint with lead levels greater than or equal to 1.0 milligram per square centimeter(mg/cm),or more than 0.5%by weight. "Lead-containing paint'Is currently defined by the federal government as lead In new dried paint In excess of 90 parts per million(ppm)by weight. 5 Identifying Lead-Based Paint and Lead-Based Paint Hazards Deteriorating lead-based paint(peeling,chipping,chalking, cracking,or damaged paint)is a hazard and needs Immediate attention.Lead-based paint may also be a hazard when found on surfaces that children can chew or that get a lot of wear and tear,such as: • On windows and window sills • Doors and door frames • Stairs,railings,banisters,and porches Lead-based paint Is usually not a hazard if it is In good condition and If It Is not on an impact or friction surface like a window. Lead dust can form when lead-based paint is scraped,sanded,or heated.Lead dust also forms when painted surfaces containing lead bump or rub together.Lead paint chips and dust can get on surfaces and objects that people touch.Settled lead dust can reenter the air when the home is vacuumed or swept,or when people walk through it.EPA currently defines the following levels of lead in dust as hazardous: • 40 micrograms per square foot(µg/ft')and higher for Floors, including carpeted floors • 250 µg/ft'and higher for interior window sills Lead in soil can be a hazard when children play in bare soil or when people bring soil into the house on their shoes.EPA currently defines the following levels of lead in soil as hazardous: • 400 parts per million (ppm)and higher in play areas of bare soil • 1,200 ppm (average)and higher in bare soil in the remainder of the yard Remember, lead from paint chips—which you can see—and lead dust—which you may not be able to see—both can be hazards. The only way to find out if paint,dust,or soil lead hazards exist is to test for them.The next page describes how to do this. 6 Checking Your Home for Lead i You can get your home tested for lead in several different ways: • A lead-based paint inspection tells you if your home has lead- based paint and where it is located.It won't tell you whether your home currently has lead hazards.A trained and certified testing professional,called a lead-based paint inspector,will conduct a paint Inspection using methods, such as: Portable x-ray fluorescence(XRF) machine Lab tests of paint samples 4.1 pF • A risk assessment tells you if your home currently has any lead hazards from lead in paint,dust,or soil.It also tells you what actions to take to address any hazards.A trained and certified testing professional, called a risk assessor,will: • Sample paint that is deteriorated on doors,windows, Floors,stairs, and walls • Sample dust near painted surfaces and sample bare soil in the yard Get lab tests of paint,dust,and soil samples • A combination inspection and risk assessment tells you if your home has any lead-based paint and If your home has any lead hazards,and where both are located. Be sure to read the report provided to you after your inspection or risk assessment Is completed,and ask questions about anything you do not understand. 7 Checking Your Home for Lead, continued In preparing for renovation,repair,or painting work in a pre-1978 home, Lead-Safe Certified renovators(see page 12) may: • Take paint chip samples to determine if lead-based paint is present in the area planned for renovation and send them to an EPA-recognized lead lab for analysis.In housing receiving federal assistance,the person collecting these samples must be a certified lead-based paint inspector or risk assessor • Use EPA-recognized tests kits to determine if lead-based paint is absent(but not in housing receiving federal assistance) • Presume that lead-based paint is present and use lead-safe work practices There are state and federal programs in place to ensure that testing Is done safely, reliably,and effectively.Contact your state or local agency for more information,visit epa.gov/lead,or call 1.800-424-LEAD (5323)for a list of contacts In your area? i Hearing-or speech-challenged Individuals may access this number through M by calling the Federal Relay Service at 1.800-877-8399. 8 i i What You Can Do Now to Protect Your Family If you suspect that your house has lead-based paint hazards,you can take some immediate steps to reduce your family's risk: • If you rent,notify your landlord of peeling or chipping paint. • Keep painted surfaces clean and free of dust.Clean floors,window i frames,window sills,and other surfaces weekly.Use a mop or sponge with warm water and a general all-purpose cleaner.(Remember: never mix ammonia and bleach products together because they can form a dangerous gas.) • Carefully clean up paint chips immediately without creating dust. • Thoroughly rinse sponges and mop heads often during cleaning of dirty or dusty areas,and again afterward. • Wash your hands and your children's hands often,especially before they eat and before nap time and bed time. • Keep play areas clean.Wash bottles,pacifiers,toys,and stuffed animals regularly. • Keep children from chewing window sills or other painted surfaces,or eating soil. • When renovating,repairing,or painting,hire only EPA-or state- approved Lead-Safe Certified renovation firms(see page 12), • Clean or remove shoes before entering your home to avoid tracking In lead from soil. • Make sure children avoid fatty(or high fat) foods and eat nutritious meals high in iron and calcium.Children with good diets absorb less I lead. I i I 9 I i Reducing Lead Hazards Disturbing lead-based paint or 9 i) removing lead improperly can Increase the hazard to your family by spreading even more lead dust around a the house. - • In addition to day-to-day cleaning and good nutrition,you can temporarily reduce lead-based paint hazards by taking actions,such as r repairing damaged painted surfaces and planting grass to cover lead- contaminated soil.These actions are not permanent solutions and will need ongoing attention. ! • You can minimize exposure to lead when renovating, repairing,or painting by hiring an EPA-or state- certified renovator who is trained in the use of lead-safe work practices.If you are a do-it-yourselfer,learn how to use lead-safe work practices In your home. • To remove lead hazards permanently,you should hire a certified lead abatement contractor.Abatement(or permanent hazard elimination) methods include removing,sealing,or enclosing lead-based paint with special materials.Just painting over the hazard with regular paint is not permanent control. Always use a certified contractor who Is trained to address lead hazards safely. Hire a Lead-Safe Certified firm(see page 12)to perform renovation, repair,or painting (RRP)projects that disturb painted surfaces. To correct lead hazards permanently,hire a certified lead abatement professional.This will ensure your contractor knows how to work safely and has the proper equipment to clean up thoroughly. Certified contractors will employ qualified workers and follow strict safety rules as set by their state or by the federal government. 10 i i I i Reducing Lead Hazards, continued It your home has had lead abatement work done or If the housing is receiving federal assistance,once the work is completed,dust cleanup activities must be conducted until clearance testing indicates that lead dust levels are belowthe following levels: f • 40 micrograms per square foot(µg/ft')for floors,Including carpeted Floors 250 Ng/ft'for interior windows sills • 400 pg/ft'for window troughs For help In locating certified lead abatement professionals in your area, call your state or local agency(see pages 14 and 15), or visit epa.gov/lead,or call 1-800-424-LEAD. 1 ) 11 I Renovating, Remodeling, or Repairing (RRP) a Home with Lead-Based Paint i i If you hire a contractor to conduct renovation,repair,or painting (RRP)projects in your pre-1978 home or childcare facility(such as pre-school and kindergarten),your contractor must: Be a Lead-Safe Certified firm approved by EPA or an EPA-authorized state program A s Use qualified trained individuals(Lead-Safe Certified renovators)who follow specific lead-safe work practices to prevent lead contamination Provide a copy of EPA's lead hazard information document,The Lead-Safe Certified Guide to Renovate Right RRP contractors working in pre-1978 homes and childcare facilities must follow lead-safe work practices that: Contain the work area.The area must be contained so that dust and debris do not escape from the work area.Warning signs must be put up,and plastic or other impermeable material and tape must be used. Avoid renovation methods that generate large amounts of lead-contaminated dust.Some methods generate so much lead- contaminated dust that their use is prohibited.They are: Open-flame burning or torching Sanding,grinding,planing,needle gunning,or blasting with power tools and equipment not equipped with a shroud and HEPA vacuum attachment and Using a heat gun at temperatures greater than 1100°F • Clean up thoroughly.The work area should be cleaned up daily. When all the work is done,the area must be cleaned up using special cleaning methods. • Dispose of waste properly.Collect and seal waste in a heavy duty bag or sheeting.When transported,ensure that waste Is contained to prevent release of dust and debris. To learn more about EPA's requirements for RRP projects visit epa.gov/getleadsafe,or read The Lead-Safe Certified Guide to 12 Renovate Right. i I I Other Sources of Lead While paint,dust,and soil are the most common sources of lead, other lead sources also exist: Drinking water.Your home might have plumbing with lead or lead solder.You cannot see,smell,or taste lead,and boiling your water will not get rid of lead.If you think your plumbing might contain lead: Use only cold water for drinking and cooking. Run water for 15 to 30 seconds before drinking it,especially if you have not used your water for a few hours. Call your local health department or water supplier to find out about testing your water,or visit epa.gov/lead for EPA's lead in drinking water Information. Lead smelters or other industries that release lead Into the air. • Yourjob.If you work with lead,you could bring It home on your body or clothes.Shower and change clothes before coming home.Launder your work clothes separately from the rest of your family's clothes. • Hobbies that use lead,such as making pottery or stained glass, or refinishing furniture.Call your local health department for information about hobbies that may use lead. • Old toys and furniture may have been painted with lead-containing paint.Older toys and other children's products may have parts that contain lead! • Food and liquids cooked or stored in lead crystal or lead-glazed pottery or porcelain may contain lead. • Folk remedies,such as"greta"and"azarcon,"used to treat an upset stomach. i i In 1978,the federal govemment banned toys,other children's products,and furniture l with lead-containing paint(16 CFR 1303).In 2008,the federal government banned lead in most children's products.The federal government currently bans lead In excess of 100 ppm by weight In most children's products(76 FR 44463). 13 For More Information The National Lead Information Center Learn how to protect children from lead poisoning and get other information about lead hazards on the Web at epa.gov/lead and hud.gov/lead,or call 1-800-424-LEAD(5323). EPA's Safe Drinking Water Hotline For information about lead in drinking water,call 1-800.426.4791,or visit epa.gov/lead for information about lead In drinking water. Consumer Product Safety Commission (CPSC)Hotline For information on lead in toys and other consumer products,or to report an unsafe consumer product or a product-related injury,call 1.800-638-2772,or visit CPSC's website at cpsc.gov or saferproducts,gov. State and Local Health and Environmental Agencies Some states,tribes,and cities have their own rules related to lead- based paint.Check with your local agency to see which laws apply to you.Most agencies can also provide Information on finding a lead abatement firm in your area,and on possible sources of financial aid for reducing lead hazards.Receive up-to-date address and phone information for your state or local contacts on the Web at epa.gov/lead, or contact the National Lead Information Center at 1-800-424-LEAD. Hearing-or speech-challenged individuals may access any of the phone numbers In this brochure through TTY by calling the toll- free Federal Relay Service at 1-800-877-8339. 14 i U.S. Environmental Protection Agency (EPA) Regional Offices The mission of EPA Is to protect human health and the environment. Your Regional EPA Office can provide further information regarding regulations and lead protection programs. Region 1(Connecticut.Massachusetts,Maine, Region 6(Arkansas,Louisiana,New Mexico, New Hampshire,Rhode Island,Vermont) Oklahoma.Texas,and 66 Tribes) Regional Lead Contact Regional Lead Contact US.EPA Region 1 U.S.EPA Region 6 5 Post Office Square.Suite 100,DES 05-4 1445 Ross Avenue,12th Floor Boston,MA 02109-3912 Dallas,TX 75202-2733 (888)372.7241 (214)665-2704 Region 2(New Jersey,New York,Puerto Rico, Region 7 Oowa,Kansas,Missouri,Nebraska) Virgin Islands) Regional Lead Contact Regional Lead Contact U.S.EPA Region 7 U.S.EPA Region 2 11201 Renner Blvd. 2890 Woodbridge Avenue VJWPD/TCPE Building 205,Mail Stop 225 Lenexa,KS 66219 Edison,NJ 08637-3,579 (800)223-0425 (732)321-6671 Region 8(Colorado,Montana,North Region 3(Delaware,Maryland,Pennsyhvanla Dakota,South Dakota,Utah,Wyoming) Vlrglnla,DC,West Virginia) Regional Lead Contact Regional Lead Contact US.EPA Region 8 U.S.EPA Region 3 1595 Wynkoop St. 1650 Arch Street Denver,CO 80202 Philadelphia,PA 19103 (303)312-0966 (215)874.2088 Region 9(Arizona,California,Hawall, Region 4(Alabama.Florida,Georgia, Nevada) Kentucky,Mississippi,North Carolina,South Regional Lead Contact Carolina,Tennessee) U.S.EPA Region 9(CMD-4.2) Regional Lead Contact 75 Hawthome Street U.S.EPA Region 4 San Francisco,CA 94105 AFC Tower,12th Floor,Air,Pesticides&Toxlcs (415)947-4280 61 Forsyth Street,SW Atlanta,GA 30303 Region 1 O Waska,Idaho,Oregon, 1404)562-8998 Washington) Region 5(Illinois,Indiana,Michigan, Regional Lead Contact Minnesota.Ohlo,Wisconsin) U.S.EPA Region 10 SoBd Waste&Toxlcs Unit(WCM-128) Regional Lead Contact 1200 Sixth Avenue,Suite 900 U.S.EPA Region 5(OT-8)) Seattle,WA 98101 77 West ladson Boulevard (206)553-1200 Chicago,IL 60604-3666 (312)886-7836 75 I Consumer Product Safety Commission (CPSC) The CPSC protects the public against unreasonable risk of injury from consumer products through education, safety standards activities,and enforcement. Contact CPSC for further information regarding consumer product safety and regulations. CPSC 4330 East West Highway Bethesda, MD 20814-4421 1-800-638-2772 cpsc.gov or saferproducts.gov U. S. Department of Housing and Urban Development (HUD) HUD's mission is to create strong,sustainable, inclusive communities and quality affordable homes for all.Contact HUD's Office of Healthy Homes and Lead Hazard Control for further information regarding the Lead Safe Housing Rule,which protects families in pre-1978 assisted housing, and for the lead hazard control and research grant programs. HUD 451 Seventh Street,SW, Room 8236 Washington, DC 20410-3000 (202)402-7698 hud.gov/offices/lead/ This docuonent is In the public domain.It may be produced by an Individual or organintion without permission.Information p crAced In this booklet Is based upon cunt scientific and technical uMerslanding of the Issues presented and Is reflective of the)udsdlalcnal bounda Has established by the statutes gov ming the co-outhoring agencies.Following the advice given will not necessarily provide complete protection in all altwdons or against all health he cards[het can be caused by lead wosurs. U.S.EPA Washington DC 20460 EPA-747-N-12-001 U.S.CPSC Bethesda MD 2g814 September 2013 HUD Washington DC 20410 16 i IMPORTANT! i Lead From Paint, Dust, and Soil in and Around Your Home Can Be Dangerous if Not Managed Properly • Children under 6 years old are most at risk for lead poisoning In your home. • Lead exposure can harm young children and babies even before they are born. • Homes,schools,and child care facilities built before 1978 are likely to contain lead-based paint. • even children who seem healthy may have dangerous levels of lead in their bodies. • Disturbing surfaces with lead-based paint or removing lead-based paint improperly can Increase the danger to your family. • People can get lead into their bodies by breathing or swallowing lead dust,or by eating soil or paint chips containing lead. • People have many options for reducing lead hazards. Generally,lead-based paint that is in good condition is not a hazard (see page 10). Switzer, Donna From: Switzer, Donna Sent: Thursday, July 22, 2021 10:05 AM To: Esquetini, Allison Subject: FW: TBRA Agreements Attachments: Families Forward CDBG Agmt Final.pdf, Families Forward HOME Agmt Final.pdf, Mercy House CDBG Agmt Final.pdf, Mercy House HOME Agmt Final.pdf From: Bazant, Denise <dbazant@surfcity-hb.org> Sent: Wednesday,July 7, 2021 4:58 PM To: Switzer, Donna <Donna.Switzer@surfcity-hb.org> Subject:TBRA Agreements The City adopted the Federal Community Development Action Plan in April 2021. As a result of the Action Plan, the City entered into agreements with Mercy House and Families Forward to implement the TBRA Program. System ID 544090 Denise Bazant Housing Analyst City of Huntington Beach 714-536-5901 t