Family Services Association-2022-01 INDEPENDENT CONTRACTOR AGREEMENT
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FOR FISCAL YEAR 2021-2022
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4 THIS AGREEMENT is made and entered into as of this 11 th day of January 2022, by an
between the City of Grand Terrace, a municipal corporation (hereinafter "City") and
5 Family Services Association (hereinafter "FSA"), a California non-profit Corporation.
6 RECITALS
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WHEREAS, City participates in the federally funded Community Development Bloc
8 Grant (CDBG) program as a cooperative city in the County Consortium, and receive
9 annual CDBG funding through the County of San Bernardino, hereinafter referred to as
County.
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WHEREAS, the City submitted an application for CDBG funds for fiscal year 2021-202
11 to fund a Senior Center Coordinator provided by FSA to meet the City's goal to allow
12 seniors to have a safe and healthy place to continue to be nourished and stay active
within their community. The position(s) would be responsible for the daily operation of the
13 Center, including opening and closing the Center, scheduling of classes, educational
14 counseling, coordinating with the Senior transportation bus driver, coordinating with
vendors for programs, and also working with the senior board members.
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WHEREAS, FSA and the City entered into an agreement, approved by the City Council
16 on June 27, 2017, for FSA to provide the Senior Services Coordinator.
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WHEREAS, FSA has expressed an interest in providing a senior nutrition meal program
18 for low-and-moderate income seniors in the City of Grand Terrace.
19 WHEREAS, FSA desires to participate in the CDBG program and represents to City that
20 it is qualified by reason of experience, preparation, organization, staffing, and facilities t
provide a senior nutrition meal program.
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WHEREAS, MAY 4, 2021, the County Board of Supervisors approved the 2021-22
22 Action Plan; and, as part of that plan allocated THIRTY NINE THOUSAND THREE
HUNDRED AND TWENTY NINE DOLLARS ($39,329) in CDBG funds to the City to fun
23 a senior services employee to staff the Grand Terrace Senior Center and TEN
THOUSAND DOLLARS ($10,000.00) for the administration and provision of a "Senio
24 Congregate and Mobile Meal Program", in accordance with Exhibits "A and B'
25 incorporated herein.
01247.0005/758202.2 1
WHEREAS, on October 20, 2021 the City agreed to accept, but has not yet received,
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Community Development Block Grant funding from the County of San Bernardino
2 ("County") in the amount of FORTY NINE THOUSAND THREE HUNDRED AN
3 TWENTY NINE DOLLARS ($49,329) for the purpose of contracting with FSA for the time
period of July 1, 2021 to June 30, 2022 and for the provision of a "Senior Center
4 Coordinator" and "Senior Congregate and Mobile Meal Program", in accordance with
5 Exhibits "A" and "B", incorporated herein.
6 WHEREAS, FSA has been performing the services described in Exhibit "A" and "B'
between July 1, 2021, and January 11, 2022, in the amount of$13,890.52.
WHEREAS, FSA will complete performance of the services described in Exhibits "A" an
8 "B", which is incorporated herein by this Agreement, for the time period of July 1, 2021 t
9 June 30, 2022.
io WHEREAS, in order for the City to receive reimbursement in the amount of FORTY NINE
11 THOUSAND THREE HUNDRED AND TWENTY NINE DOLLARS ($49,329) of CDB
funds, as described above, from the County of San Bernardino, the County requires City
12 to submit an Agreement between the City and FSA to the County.
13 WHEREAS, the parties enter into this agreement to allow City to comply with the County'
14 CDBG funding requirements.
15 NOW THEREFORE, in consideration of the mutual promises contained herein, the City
of Grand Terrace and FSA hereby agree as follows:
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AGREEMENT
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18 Section 1: Services.
19 A. With respect to services performed in accordance with Exhibit "A" and "B'
(including all staffing costs, mileage, equipment, for FSA to administer an
20 provide the "Senior Congregate and Mobile Meal Program" and to provid
21 "Senior Center Coordinator" services), incorporated herein, ("Services")and
rendered from July 1, 2021, to January 11, 2022, City agrees to pa
22 $13,890.52 to FSA, provided that FSA complies with all the requirements o
23 this Agreement, including, but not limited to, this Section 1. By accepting
payment from City pursuant to this Section 1(B), (1) FSA represents and
24 warrants that all Services rendered between July 1, 2022, and January 11,
25 2022, have been rendered in compliance with this Agreement and (2) FSA
01247.0005/7582(hereby releases and forever discharges City and its elected and appointed
officials, officers, employees and agents from any and all claims, demands,
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actions, causes of action, obligations, costs, expenses, penalties, interest,
2 attorneys' fees, damages, losses and liabilities of whatsoever nature,
3 character or kind, whether known or unknown, suspected or unsuspected,
matured or contingent, which are or could have been the attributed to the
4 Services performed by FSA between July 1, 2021, and January 11, 2022,
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including, but not limited to, any claim by FSA against City for payment for
such Services performed between July 1, 2021, and January 11, 2022,.
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B. For Services performed by FSA after January 11, 2022, and subject to an
limitations set forth in this Agreement, City agrees to pay FSA for Service
8 in an amount not to exceed $35,438.48.
C. For all Services performed by FSA pursuant to this Agreement from July 1,
2022, to January 11, 2022, and Services performed from January 11, 2022
10 to June 30, 2022, City and FSA mutually agree that payment of FSA for
11 performance of the Services shall be in the maximum amount of FORTY
NINE THOUSAND THREE HUNDRED AND TWENTY NINE DOLLAR
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($49,329) in Community Development Block Grant ("CDBG") fund
13 reimbursed to the City from the County related to the Services as describe
by Exhibit "A" and "B", incorporated herein.
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15 D. Prior to City's payment to FSA for any Services performed by FSA for which
FSA is seeking payment, FSA shall deliver receipts for all eligible
16 expenditures to the City. Expenditure reports shall be documented with
17 "audit ready" supportive evidence of each expenditure and proof o
payment. Payments shall be limited to the total approved, proper)
18 documented expenditures. All payment requests must be submitted n
19 later than 30 days after the expiration of this Agreement. Requests receive
after said 30-day period shall be considered non-compliant and not eligibl
20 for payment under the terms of this Agreement. FSA shall submit a fina
21 request for payment for the program year no later than July 31, 2022. An
balance remaining on this project after that date will be reprogrammed
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E. FSA shall further submit to the City a completed County of San Bernardin
23 Department of Economic and Community Development Monthly Program
24 Progress and Direct Benefit Report and a completed Beneficiary
Qualification Statement, attached herein as Exhibit C reflecting program
25 01297.0005/7582 d2 aacttivity for the term wherein Services were performed.
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Section 2. Independent Contractor. It is the express intention an
1 understanding of the parties hereto that FSA will act as an independent contractor
2 and not an employee or agent of City. Nothing in this Agreement shall b
3 interpreted or construed as creating or establishing a relationship of employer o
employee between FSA and City. Both parties acknowledge that FSA is not an
4 employee for State tax, Federal tax, or any other purpose.
5 Section 3. Term. Unless earlier terminated in accordance with this Agreement,
6 the term of this Agreement shall commence January 11, 2022 and ending Jun
30, 2022.
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Section 4. Termination. City shall have the right to terminate this Agreement,
8 with or without cause, upon twenty (20) days prior written notice to FSA. City shall
9 have no liability for any claims or damages resulting to FSA as a result of an
exercise by City of its right to terminate this Agreement. FSA shall have the right
10 to terminate this Agreement, with or without cause, upon sixty (60) days prior
11 written notice to City.
12 Section 5. Compliance with Laws and Regulations. FSA shall comply with al
13 applicable federal, state and local laws, regulations and ordinances. By executing
this Agreement, FSA hereby certifies that it will adhere to and comply with the
14 following as they may be applicable to a subrecipient of funds granted pursuant t
15 the Housing and Community Development Act of 1974, as amended (the "Act'):
16 A. The Housing and Community Development Act of 1974, as amended, and
the regulations issued thereto;
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B. Section 3 of the Housing and Urban Development Act of 1968, as amended;
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C. Executive Order 11246, as amended by Executive Orders 11375 and
19 12086, and implementing regulations at 41 CFR Chapter 60;
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D. Executive Order 11063, as amended by Executive Order 12259, and
21 implementing regulations at 24 CFR Part 107;
22 E. Section 504 of the Rehabilitation Act of 1973 (PL 93-112), as amended, an
23 implementing regulations;
24 F. The Age Discrimination Act of 1975 (PL 94-135), as amended, an
implementing regulations;
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01247.0005/758202.2 4
G. The relocation requirements of Title II and the acquisition requirements o
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Title III of the Uniform Relocation Assistance and Real Property Acquisition
2 Policies Act of 1970, and the implementing regulations at 24 CFR Part 42;
3 H. The labor standard requirements as set forth in 24 CFR Part 570, Subpart
4 K and I-IUD regulations issued to implement such requirements;
5 I. Executive Order 11988 relating to the evaluation of flood hazards and
Executive Order 11288 relating to the prevention, control and abatement o
6 water pollution;
7 J. The flood insurance purchase requirements of Section 102(a) of the Flood
8 Disaster Protection Act of 1973 (PL 93-234);
9 K. The regulations, policies, guidelines and requirements of 24 CFR Part 85
to
"Common Rule," OMB Circular Nos. A-87, A-21, A-110, A-122 and A-13
as they relate to the acceptance and use of federal funds under the
11 federally-assigned program;
12 L. Title VI of the Civil Rights Act of 1964 (PL 88-352) and implementing
13 regulations issued at 24 CFR Part I;
14 M. Title Vill of the Civil Rights Act of 1968 (PL-90-284) as amended; and
15 N. The lead based paint requirements of 24 CFR Part 35 issued pursuant t
the Lead-based Paint Poisoning Prevention Act (42 USC 4801, et seq.);
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17 O. Uniform Administration Requirements pursuant to 24 CFR 570.502.
18 P. The FSA shall carry out its activity pursuant to this Agreement in compliance
with all federal laws and regulations described in Subpart K of Title 24 0
19 the Code of Federal Regulations, except that:
20 1. FSA does not assume the City's or County's environments
21 responsibilities described at §570.604; and
22 2. FSA does not assume the City's or County's responsibility for
initiating the review process under the provisions of 24 CFR Pmt 52.
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24 Q. All Uniform Administrative Requirements pursuant to 24 CFR 570.502.
25 Section 6. Federal Requirements. FSA shall comply with the provisions o
01247.oothe-Act,oncE any amendments thereto and the federal regulations and guideline
now or hereafter enacted pursuant to the Act. More particularly, FSA is to comp)
1 with those regulations found in 24 CFR 570, Part 84 and Part 85. FSA is to comp)
2 with OMB Circular Nos. A-110, A-87. A-122, and A-133 as applicable, as the
3 relate to the acceptance and use of federal funds under this Agreement.
4 Section 7. Program Income. FSA, who is a subrecipient as defined in Section
570.500 (c), shall not retain any program income as defined in Section 570.500 0
5 Title 24 of the Federal Code of Regulations.
h Section 8. Insurance. Without limiting or diminishing FSA'S obligations t
defend, indemnify, or hold the City harmless, FSA shall procure and maintain o
cause to be maintained, at its sole cost and expense, the following insurance
8 coverage's during the term of the Agreement.
A. Workers' Compensation:
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If FSA has employees as defined by the State of California, FSA shall
11 maintain statutory Workers' Compensation Insurance (Coverage A) as prescribed
12 by the laws of the State of California. Policy shall include Employers' Liability
(Coverage B) including Occupational Disease with limits not less than $1,000,00
13 per person per accident. The policy shall be endorsed to waive subrogation in favor
14 of THE CITY OF GRAND TERRACE and the GRAND TERRACE SENIOR
CENTER.
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01247.0005/758202.2 6
B. Commercial General Liability:
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2 Commercial General Liability insurance coverage, including but not limited
to, premises liability, contractual liability, products and completed operation
3 liability, personal and advertising injury, and cross liability coverage, covering
Q claims which may arise from or out of FSA'S performance of its obligation
hereunder. Policy shall name the CITY OF GRAND TERRACE, GRAN
TERRACE SENIOR CENTER, their respective Agencies, Districts, Special
r,
Districts, and Department, their respective directors, officers, employees, elected
or appointed officials, agents or representatives as Additional Insureds. Policy'
limit of liability shall not be less than $1,000,000 per occurrence combined single
limit. If such insurance contains a general aggregate limit, it shall apply separate)
to this agreement or be no less than two (2) times the occurrence limit.
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C. Vehicle Liability:
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11 If vehicles or mobile equipment are used in the performance of the
obligations under this Agreement, then FSA shall maintain liability insurance for al
12 owned, non-owned or hired vehicles so use in any amount not less than
13 $1,000,000 per occurrence combined single limit. If such insurance contains a
general aggregate limit, it shall apply separately to this agreement or be no less
14 than two (2) times the occurrence limit. Policy shall name the CITY OF GRAN
15 TERRACE, GRAND TERRACE SENIOR CENTER, their respective Agencies,
Districts, Special Districts, and Departments, their respective directors, officers,
16 employees, elected or appointed officials, agents or representatives as Additional
17 Insureds.
18 D. General Insurance Provisions —All Lines:
19 1. Any insurance carrier providing insurance coverage hereunder shall
be admitted to the State of California and have a A M BEST rating o
20 not less than A: VIII (A:S) unless such requirements are waived, in
21 writing, by the City Attorney. If the City Attorney waives a requiremen
for a particular insurer such waiver is only valid for that specific
z2 insurer and only for one policy term.
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2. FSA shall cause FSA'S insurance carrier(s) to furnish the City with
24 either 1) a properly executed original Certificate(s) of Insurance and
25 certified original copies of Endorsements effecting coverage a
01247.0005/758202.2 7 required herein, and 2) if requested to do so orally or in writing by the
1 City, provide original Certified copies of policies including all
Endorsements and all attachments thereto, showing such insurance
2 is in full force and effect. Further, said Certificate(s) and policies o
3 insurance shall contain the covenant of the insurance carriers(s)tha
thirty (30) days written notice shall be given to the City prior to an
4 material modification, cancellation, expiration or reduction in
5 coverage of such insurance. In the event of a material modification,
cancellation, expiration, or reduction in coverage, this Agreemen
6 shall terminate forthwith, unless the City receives, prior to such
7 effective date, another properly executed original Certificate o
Insurance and original copies of endorsements or certified original
8 policies, including all endorsements and attachments thereto
9 evidencing coverage's set forth herein and the insurance required
herein is in full force and effect. FSA shall not commence operation
10 until the City has been furnished original Certificate(s) of Insurance
11 and certified original copies of endorsements and if requested,
certified original policies of insurance including all endorsements an
12 any and all other attachments as required in this Section. A
13 individual authorized by the insurance carrier to do so on its behalf
shall sign the original endorsements for each policy and the
14 Certificate of Insurance.
15 3. If, during the term of this Agreement or any extension thereof, there
16 is a material change in the Services; or, there is a material change i
17 the equipment to be used in the performance of the Services which
will add additional exposures (such as the use of) aircraft, watercraft,
18 cranes, etc.); or, the term of this Agreement, including an
19 extensions thereof, exceeds five (5) years the City reserves the righ
to adjust the types of insurance required under this Agreement and
20 the monetary limits of liability for the insurance coverage's current)
21 required herein, if; in the City Attorney's reasonable judgment, the
amount or type of insurance carried by the sponsor has become
22 inadequate.
23 4. FSA shall pass down the insurance obligations contained herein t
24 all tiers of subcontractors working under this Agreement.
25 5. The insurance requirements contained in this Agreement may b
01247.0005/758202.2 8 met with a program(s) of self-insurance acceptable to the City.
6. FSA agrees to notify City of any claim by a third party of any incident
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or event that may give rise to claim arising from the performance o
2 this Agreement.
3 Section 9. HUD Indemnity. FSA shall defend, indemnify, and hold harmless
4 the County of San Bernardino and City, their respective elected and appointed
officials, officers, employees and agents against any liability, claims, losses,
5 demands, and actions incurred by the County of San Bernardino and City as
6 result of the determination by HUD or its successor that activities undertaken b
FSA under the program(s) (including, but not limited to, FSA's performance of an
7 Services prior to or after the date of this Agreement) fail to comply with any laws,
8 regulations or policies applicable thereto or that any funds billed by and disbursed
to FSA under this Agreement were improperly expended. This indemnity shall
9 survive and extend beyond the term or termination of this Agreement.
10 Section 10. Indemnity. FSA shall defend, indemnify, and hold harmless the
11 County of San Bernardino and the City, their respective elected and appointed
officials, officers, employees and agents from and against any and all actions,
12 damages, losses, causes of action and liability imposed or claimed relating to the
13 injury or death of any person or damage to any property, including attorney's fees,
14 costs, and other legal expenses, arising directly or indirectly from any act o
omission of FSA in performing Services hereunder (including, but not limited to,
15 FSA's performance of Services prior to or after the date of this Agreement). This
16 indemnity shall survive and extend beyond the term or termination of this
Agreement.
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Section 11. Prohibition Against Conflicts of Interest.
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A. FSA and its assigns, employees, agents, consultants, officers and elected
19 and appointed officials shall become familiar with and shall comply with the
20 CDBG regulations prohibiting conflicts of interest contained in 24 CF
570.611, by this reference incorporated herein.
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B. FSA understands and agrees that no waiver or exception can be granted t
z2 the prohibition against conflict of interest except upon written approval HUD
23 pursuant to 24 CFR 570.611(d). Any request by FSA for any exception shall
24 first be reviewed by City to determine whether such request is appropriate
for submission to HUD.
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01247.0005/758202.2 9
C. Prior to any funding under this Agreement, FSA shall provide City with a lis
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of all employees, agents, consultants, officers and elected and appointed
2 officials who are in a position to participate in a decision-making process,
3 exercise any functions or responsibilities, or gain inside information with
respect to the CDBG activities funded under this Agreement. FSA shall also
4 promptly disclose to City any potential conflict, including even the
5 appearance of conflict, that may arise with respect to the CDBG activities
funded under this agreement.
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D. Any violation of this section shall be deemed a breach of this Agreement
7 and shall be ground for immediate termination by the City.
8 Section 12. Religious Activities. Under federal regulations, CDBG assistance
9 may not be used for inherently religious activities or provided to primarily religious
entities for any activities including secular activities. FSA shall adhere to the
10 restrictions set forth in 24 CFR 570.2000), by this reference is incorporated herein.
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Section 13, Lobbying. FSA certifies to the best of it knowledge and belief, that:
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A. No federally appropriated funds have been paid or will be paid, by or on
13 behalf of the undersigned, to any person for influencing or attempting t
14 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
15 in connection with the awarding of any federal contract, the making of an
16 federal grant, the making of any federal loan, the entering into of an
cooperative agreement, and the extension, continuation, renewal,
17 amendment, or modification of any federal contract, grant, loan, o
18 cooperative agreement.
19 B. If any funds other than federally appropriated funds have been paid or will
be paid to any person for influencing or attempting to influence an officer to
20 employee of any agency, a member of Congress, an officer or employee o
21 Congress, or an employee of a member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned
22 shall complete and submit Standard Form-LLL, "Disclosure Form to Reporl
23 Lobbying," in accordance with it instructions.
24 C. The undersigned shall require that the language of this certification b
25 included in the award document for all subawards at all tier (including
01247.0005/758290cp9tracts, subgrants, and contracts under grants, loans, and
cooperative agreements)and that all subrecipients shall certify and disclose
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accordingly. This certification is a material representation of fact upon which
2 reliance was placed when this transaction was made or entered into.
3 Section 14. Entire Agreement/Modification. This Agreement represents the
4 entire Agreement of the parties hereto as to the matters contained herein. An
modification of this Agreement will be effective only if it is in writing and signed b
S the parties hereto.
6 Section 15. Assignment. This Agreement shall not be assigned without the prior
7 written consent of City. Any assignment, or attempted assignment, without such
prior consent, shall be null and void and, at the option of City, result in the
8 immediate termination of this Agreement.
9 Section 16, Attorney's Fees and Governing Law. In the event any action i
10 commenced to enforce or interpret the terms or conditions of the Agreement the
prevailing party shall, in addition to any costs or other relief, be entitled to recover
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its reasonable attorney's fees. This Agreement and any dispute arising hereunder
12 shall be governed by and interpreted in accordance with the laws of the State o
13 California. This Agreement shall be construed as a whole according to its fair
language and common meaning to achieve the objectives and purposed of the
14 parties hereto, and the rule of construction to the effect that ambiguities are to be
15
resolved against the drafting party shall not be employed in interpreting this
Agreement, all parties having been represented by counsel in the negotiation an
16 preparation hereof.
17 Section 17. Jurisdiction and Venue. Any action at law or in equity arising
18 under this Agreement or brought by a party hereto for the purpose of enforcing,
construing or determining the validity of any provision of this Agreement shall b
19 filed in a court of competent jurisdiction in the County of San Bernardino, State o
20 California, and the parties hereto waive all provisions of law providing for the filing,
removal or change of venue to any other court or jurisdiction.
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Section 18. Program Reporting. FSA agrees to prepare and submit financial,
22 program progress, and other reports as required by HUD or the County of San
23 Bernardino and/or City accounts as are considered necessary by HUD or the
24 County of San Bernardino and/or City to assure proper accounting for all Contract
funds. All FSA records, with the exception of confidential client information, shall
25 be made available to representatives of the County of San Bernardino and/or City
01247.0005/758202.2 11
1 and the appropriate federal agencies. FSA is required to submit data necessary t
complete the Annual Grantee Performance Report in accordance with HUD
2 regulations in the format and at the time designated by the City's Community
3 Development Director or his/her designee. By the 30th of each month, FSA shal
submit a completed "Monthly Program Progress Report." FSA shall also provide
the Monthly Direct Benefit Report and Beneficiary Qualification Statement
information included as Exhibit "C", as necessary for completion of the Annual
Grantee Performance Report.
Section 19. Applicability of Agreement. In consideration of the intent of the
parties to memorialize the parties understanding of the terms of their agreement,
8 all uses of the present tense shall be interpreted to apply to the term of the
Agreement. With the exceptions of Sections 9, 10, 11, and any other section o
9 this Agreement expressly stating otherwise, which obligations shall not terminate,
10 the terms and conditions of this Agreement shall only apply during the term of this
Agreement.
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Section 20. Waiver. Failure by a party to insist upon the strict performance o
12 any of the provisions of this Agreement by the other party, or the failure by a part
13 to exercise its rights upon the default of the other party, shall not constitute a waive
14 of such party's right to insist and demand strict compliance by the other party with
the terms of this Agreement thereafter.
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Section 21. Severability. Each section and provision of this Agreement i
16 severable from each other provision, and if any provision or part thereof is declare
17 invalid, the remaining provisions shall nevertheless remain in full force and effect.
18 Section 22. Counterparts. This Agreement may be signed by the different
parties hereto in counterparts, each of which shall be an original but all of which
19 together shall constitute one and the same agreement.
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01247.0005/758202.2 12
CITY OF GRAND TERRACE
Konrad Bolowich Date
4 City Manager
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6 FAMILY SERVICES ASSOCIATION
7
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9 Cheryl- arie Hansberger, Date
CEO
to
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12 APPROVED AS TO FORM:
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/-�-
15 Adrian R. Guerra
City Attorney
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17 AT ST:
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20 Debra L. Thomas
City Clerk
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01247.0005/758202.2 13
EXHIBIT A
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SENIOR CONGREGATE AND MOBILE MEAL PROGRAM
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3 SERVICES:
For program year 2021-2022 the City of Grand Terrace will contract with Family
4 Services Association (FSA) to provide, Senior Congregate and Mobile Meal Program
and a Senior Services Coordinator. The Senior Congregate and Mobile Meal Program
5 will serve congregate meals, to low-and moderate-income seniors and home delivered
meals to seniors who are homebound by reason of illness, incapacity, disability, and
6 lack of transportation, residing in the City of Grand Terrace. Approximately 145 seniors
will have increase access to nutritional meals programs. The Senior Services
Coordinator will manage the Senior programs at the Grand Terrace Senior Center,
which include, but are not limited to: social activities, educational classes, exercise
8 classes, arts & crafts classes, health insurance counseling, home energy assistance,
9 fresh produce program, health screenings, game nights, karaoke and transportation.
The Senior Services Coordinator will serve approximately 175 low-and moderate-
10 income seniors in the City of Grand Terrace.
11 UNITS OF SERVICE:
Units of Service shall be reported on Monthly Program Progress/Direct Benefit Report,
12 Exhibit 4, Part 1, monthly. Each senior attending a Senior Service Program activity, one
meal counts as an activity, provided by the Family Service Association, shall count as 1
13 unit of service.
14 TIME OF PERFORMANCE: July 1, 2021 through June 30, 2022
15 PROGRAM PARTICIPANT PERFORMANCE STANDARDS:
16 CDB Activity: Senior Congregate and Mobile Meal Program and Senior Service
Coordinator Program Activities.
17
Measurable Outcome: Approximately 145 seniors will have increased access to
18 nutritional meal programs. Approximately 175 seniors from the Grand Terrace Area will
receive Coordinate Senior Center Services.
19
In addition to units of service, the City of Grand Terrace will report unduplicated client
20 counts on the Monthly Program Progress/Direct Benefit Report, Exhibit 4, Part II.
21 OPERATIONS:
22 The FSA Senior Congregate Meal Program and the Coordinated Senior Services will be
operated at the Grand Terrace Senior Center, located at 22627 Grand Terrace Rd.,
23 Grand Terrace, the FSA Mobile Meal Program will operate as meals delivered to home
bound seniors that reside in the City of Grand Terrace. The FSA administration office is
24 located at 21250 Box Springs Rd., Suite 212, Moreno Valley, CA 92557.
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01247.0005/758202.2 14
EXHIBIT B
1
2 CONSOLIDATED PLAN
19 GRAN21 PS-034
3 Grand Terrace:Senior Center Coordinator Services
City of Grand Terrace
Address Public Service Needs of Low-Income and Special Needs Populations
Increase the Capacity of Public Services for Low-Income and Special Needs Populations
Prior Year. Current Year.FY 2021-22: Total:
5287 $41.%l 542,248
Expanding Public Scn'ICC-Family Services Association will provide staff to provide classes.activities.
counseling,transportation and associated coordination,including administrative tasks at the Grand Terrace Senior
Center.The total project budget is S 42.248.539,329 will be used by the City of Grand Terrace to implement the
8 pmject 52.919 will be used to support Activity Delivery Costs incurred by San Bernardino County.
9 r 6/30/2022
10 193 people
11 t Grand Terrace Senior Center
Classes,activities,counseling.transportation and associated coordination
12 Funding is subject to change based on final HUD allocation.
13
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Annual Action Plan
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15 OMB CD trol No 2506-01171ev.0913 012 0 2 1i
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01247.0005/758202.2 15
EXHIBIT C
MONTHLY PROGRAM PROGRESS AND DIRECT BENEFIT REPORT AND
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BENEFICIARY QUALIFICATION STATEMENT
3
COUNTY OF SAN BERNAROINO COMMUNITY DEVELOPMENT AND HOUSING
Project/Activity Title: PROJECT/CASE NUMBER
Grand Terrace:Family Service Association-Senior GTE R-21-1-05A/2992
Meals and Coordinator Services
Name/Address of Contract Aoenav- Date of Issue:
Family Services Association X Original Beginning 7/1/2021
21M Box Springs Rd.,Suite,212,Moreno Valley,CA Amendment No.:
92557
BENEFICIARY QUALIFICATION STATEMENT
This form has the purpose of providing information needed to qualify the use of federal Community Development
Block Grant(CDBG)funds for the project/activity described above. This statement must he completed and signed by
the person(or legal guardian of the person)requesting to receive benefits from the described project/activity Only
one statement per person,per fiscal year Is required(Fiscal Year begins July 1 and ends June 30).
1 I Please answer each of the following questions.
1 1 1. This question helps you determine the size of your household, for this question a household is a group of related or
unrelated persons occupying the same house with at least one member being the head of the household. Renters,
roomers,or borders cannot be included as household members.
12 How many persons are in your household?
13
2. This question asks if you are from a low-and moderate-income household. For this question,a list of the
EXTREMELY LOW-INCOME,VERY LOW-INCOME and LOW-INCOME categories*are presented below. Please add up the
1 combined eross annual income of all persons in your household from all sources of income. In the blanks provided,
write(yes)or(no)If your combined gross annual Income is equal to or less than the,EXTREMELY LOW-INCOME,
1. VERY LOW-INCOME,or LOW4NC01ME amount for the number of persons in your household.
~•(sine
EXTREMELY LOW-INCOME
I
VERY LOW-INCOME _
17 LOW-INCOME
18 Number of Persons in Your Household
1 2 3 4 S 6 7 8
19 EXTREMELY LOW-INCOME 16,600 19,000 21,960 26,5W 31,040 35,S80 40,120 44.6bo
LIMIT(S)
20 'ERY LOW-INCOME LIMIT IS 27,6So 31,6W 35,550 39.500 42,700 4S,850 49,000 52,150
21 COW-INCOMELIMEEM 44,250 50,600 56,900 63,200 68,300 73,350 78AW 83,4SO
•Taken from FY 2021 Income Lrmlfc Summary: Atroa:J/wvwludawr,pafperrat7darayrls�tf12C2U2011wmma�Y.odn
22
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Exhiblt 3(a)Page 1 of 2
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247.0005/758202.2 16
I COUNTY OF SAN BERNARDINO COMMUNITY DEVELOPMENT AND HOUSING
ProieeUActivlty TBIe. PROJECT/CASE NUMBER:
2 Grand Terrace:Family Service Association- GTER-21-1-OSA/2992
Senior Meals and Coordinator Services
3 Name/Address of Contract Aaencv. Date of Issue
Family Services Association X Origiral Beginning 7/1/2021
e 21250 Box Springs Rd.,Suite,212,Moreno Valley,CA 92557 Amendment No.:
5 3.Pledse indicate how you identify yourself by checking only one of the following choices:
Hispanic Non-Hispanic
White a 71
Black/African American n a
American Indian/Alaskan Native EJ
b Asian 71 El
9 Native Hawaiian/Other Pacific Islander a E]
American Indian/Alaskan Native&White O o
10 Asian&White a
11 Black/African American&White
American Indian/Alaskan Native&Black/African American
12 Balance/Other a 71
13 4, Please check whether you belong to a female Headed Household: OYES 71NO
S. Please describe the condition that would qualify you as being considered in one of the following
14 presumed low•and moderate-income categories:abused child,battered spouse,elderly person,homeless
perwn,disabled adult,illiterate person,or migrant farm worker:
15 (Description)
lc
17 ACKNOWLEDGMENT AND DISCLAIMER
18 1 CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSEHOLD STATFMFNTS
MADE ON THIS FORM ARE TRUE.
19 NAME: ?All :
20 ADDRESS: CITY21 : 7G
SIGNATURE: PHONE
The information you provide on this form is for Community Development Block Grant(CDBG)program
22 purposes only and will be kept confidential.
23 Exhibit 3(a)Page 2 of 2
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01247.0005/758202.2 17
1
COUNTY OF SAN BERNARDINO COMMUNITY DEVELOPMENT AND HOUSING
i
ProiecU Actrvdv Title. PROJECT/CASE NUMBER;
Grand Terrace:Family Service Association-Senior Meals and G7ER-21-1-05A/2992
Coordinator Services
NamelAddress of Contract Aaencv. Date of Issue
4 Family Services Association X Original Beginning 7/1/2021
21250 Box Springs Rd.,Suite,212,Moreno Valley,CA 92557 _Amendment No,
5 MONTHLY PROGRAM PROGRESS AND DIRECT BENEFIT REPORT For the Month of ,20
PART l: MONTHLY PROGRAM PROGRESS REPORT
r A.Units of Service Provided and Description
In the spare provided under each type of service Isted below,summarite what your program has accornpished during ttw month.Include is uation,
nutnti r of persons served,servlcesA*Aefits provided,and a description of the clients served.Also report the number of'Units of Service"
provided,as defined in the Prolect/Artivity Deimpoon(Esbriblt 1 of the agreementl.Attach additional pKcs if needed.
8 Type of Service: Anticipated Units of Service
1. Coordinated Senior Services Program activities: Goal/Mo.: 161 Actual/Mo.:
Each senior participating in an actMty counts a one unit
9 of sarvinr
2.Senior Meals Provided at the Senior Center Goa1/Mo,: 331 Actual/Mo-
10 :
Each senior receiving a meal counts a one unit of service.
3. Senior Meals Delivered to Home Bound Seniors GoaVMo.: 166 ActuaVMo.:
I 1 Each senior receivi•rx a meal counts a ase unit of sersece.
B. Monthly Beneficiary Count (may include individual persons or households previously counted during this
12 grant/program year)Total number of twrieficiaries{clients/participants)served this month(choose 1 category only):
Number of Persons OR Number of Households
13
PART If:DIRECT BENEFIT REPORT
Direct Benefit Statistics 1Unduolicated first•tlme client counts since start of contract taken from Beneficiary
14 Qualification Statement forms)
Enter the number of first-time program beneficiaries directly assistedthi5 month(check one box)
15 Count only as: El Individual Persons or El Households (Use Heed of Ilousehosdl
Extremely Low-Income: + Very Low-income: + Low-Income
1 c :All Beneficiaries:
Non Noes
1 ;
Racial Identity Categorle, Hispanic Hispanic Hispanic hispann
(a) (b) (c) (dl
White American Indian/Alaskan Native&White_
1 Black/African American Asian&White _
American Indian/Alaskan Native Black/African American&White _
19 Asian Amer.Indian/Alaskan Native&African Amer _
Native Hawaiian/Other Pacific islander Balance/Other
20
Total of Rachl liderstityCategories.Add columns(a)gb)+(c)+(d)from abnvr.Match to"All Beneficiaries'total above:
Female Headed Households
21 Signed: I rtle Date:
22 Printed Name: Telephone No./Ext:
Exhibit 4 Page 1 of 1
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01247.0005/758202.2 18
COUNTY OF SAN BERNARDINO COMMUNITY DEVELOPMENT AND HOUSING
2
Praecy A;IL l T _ PRO)EC1/CASE NUMBER:
Grand Terrace:Family Service Association- GIER-21-1-OW2992
3 Senior Meals and Coordinator Services
Name/Address of Contract Aoenr-.v' Date of Issue
n Family Services Association X Original Beginning 1/112021
21250 Box Springs Rd.Suite.212,Moreno _Arnen.dment No
Valley,CA 92557
CERTIFICATION OF CDBG FUNDED NEW OR EXPANDED SERVICE
The Crty of Grand Terrace certifies that the public service project described in these Attachments A&8 and
associated Exhibits is either:
aA New Public Service
A new public service is defined as a new service to your community which has not been previously
funded through city funds,
OR
XI An Expanded Service
9 An expanded public service is defined as a quantifiable increase in the level of an existing service
which has been provided by the grantee or another entity on its behalf through State or local
10 government funds in the 12 months preceding the CDBG contract year.
Describe the expansion of the public service:
11 MX This expanded public service will result in an increase of 5 persons per service above the
Level which has been previously provided by or on behalf of the City of Grand Terrace.
12
OR
13 Q This expanded public service will Increase the scope of the service by adding(describe
added or expanded activities)to a public service which has been previously provided by
14 or on behalf of the City of Grand Terrace
The City of Grand Terrace certifies that the implementing organization:
15 M Is a unit of local government(Incorporated city,township,County department or district,community services
distrct,school district,etc.),at a private non-profit entity incorporated in the State of California with"active"
status;and,
MX is conferred tax-exempt status by the Internal Revenue Service,pursuant to Sedan 501(c H3)of the internal
17
Revenue Code:and,
is no suspended or debarred from participating in federally funded contracts and sub awards.
18 Is registered In the System for Awards management(SAM).
19 SIGNATURE: Sj ��� i�( � DATE: �iJ rC)A
20 NAME- •, �''Jt'{'o A `�t�1ClS TI'TL.E: r it[ �r "'t Nnth rS Gr,,4
i(yic�3
21
EliMbit S Pop i of 1
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1247.0005/758202.2 19