HomeMy WebLinkAbout1994-052
I
RESOLUTION NO. 94-52
2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY
3 OF SAN BERNARDINO AUTHORIZING AND DIRECTING THE EXECUTION
OF A COMMUNITY DEVELOPMENT BLOCK GRANT FUNDING
4 AGREEMENT BETWEEN THE CITY OF SAN BERNARDINO AND THE
COUNTY OF SAN BERNARDINO FOR THE YMCA YOUTH TEEN CENTER
5 PROJECT.
6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
7 THE CITY OF SAN BERNARDINO AS FOLLOWS:
8 Section 1.
9
(a)
The Mayor of the City of San Bernardino is hereby authorized
10 and directed to execute, on behalf of the City, an agreement for Community
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12
Development Block Grant funding with County of San Bernardino. which agreement is
attached hereto as Exhibit "1", and is incorporated herein by referenced as though fully
13
14 set forth at length. The agreement provides for the granting of Community
15 Development Block Grant funds in the following amount $60.000.
16 Section 2.
17
(a)
The Authorizations to execute the above referenced agreement is
18
rescinded if the parties to the agreement shall fail to execute it within sixty (60) days
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RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF A CDBG FUNDING AGREEMENT BETWEEN THE CITY
2 AND THE COUNTY OF SAN BERNARDINO FOR THE YMCA YOUTH TEEN
3 CENTER PROJECT.
4 I HEREBY CERTIFY that the foregoing resolution was duly adopted by the
5 Mayor and Common Council of the City of San Bernardino at a reuular
6 meeting thereof, held on the 7th day of
7 to wit:
8
COUNCILMEMBERS
9
10 NEGRETE
II CURLIN
,
12 HERNANDEZ
13 OBERHELMAN
14 DEVLIN
15
POPE-LUDLAM
16
17 MILLER
18
19
20
21
22
23
24
March , 1994, by the following vote,
AYES NAYS ABSTAIN ABSENT
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(~(o { I... ( J (D f.", /^ ^I<? ^
City Clerk
The foregoing resolution is hereby approved this ~day of March ,1994.
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Tom Minor, ayor
City of San Bernardino
Approved as to
form and legal content:
25 JAMES F. PENMAN
City Attorney
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SAN BERNARDINO COUNTY
DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
MAINTENANCE AND OPERATION AGREEMENT
WITH CITY OF SAN BERNARDINO AND YMCA OF SAN BERNARDINO VALLEY, INC.
This Agreement is made and entered into this day of ,
19 , by and between San Bernardino County, hereinafter referred to as "COUNTY", and
theCity of San Bernardino, hereinafter referred to as "CITY", and the Young Men's
Christian Association of San Bernardino Valley, hereinafter referred to as "YMCA".
WHEREAS, COUNTY has entered into a contract with the United states of America
through its Department of Housing and Urban Development (HUD) to execute COUNTY
Community Development Block Grant (CDBG) Program under the Housing and Community
Development Act of 1974, as amended, hereinafter referred to as the "ACT"; and,
WHEREAS, COUNTY Department of Economic and Community Development, hereinafter
referred to as "EeD", is authorized to act on behalf of COUNTY in administering
COUNTY CDSG program; and,
WHEREAS, CITY Development Department, hereinafter referred to as "COD", is
authorized to act on behalf of CITY in administering CITY CDBG program; and,
WHEREAS, YMCA has requested financial assistance from COUNTY and CITY for the
design and construction of renovations to two rooms totalling approximately three
thousand six hundred (3,600) square feet; and,
WHEREAS, COUNTY has determined that YMCA is eligible to receive federal
assistance under Title I of the Act; and,
WHEREAS, COUNTY has allocated up to forty thousand dollars ($40,000) for the
renovation improvements; and,
WHEREAS, CITY has obligated sixty thousand dollars ($60, OOD) for the renovation
improvements; and,
WHEREAS, COUNTY, CITY and YMCA recognize the public benefit in providing a teen
center and its related programs to the youth from low-and moderate-income households
in the City of San Bernardino and the unincorporated areas of the Fifth Supervisorial
District; and
WHEREAS, title to the property is vested with YMCA; and
WHEREAS, YMCA currently maintains and operates said teen center program at the
sole expense of YMCA; and
WHEREAS, COUNTY, CITY and YMCA desire to have CITY manage and direct the
construction of IMPROVEMENTS.
NOW, THEREFORE, in consideration of the mutual covenants herein set forth
and the mutual benefits to be derived therefrom, the parties agree as follows:
1. PURPOSE OF AGREEMENT
This Agreement is made for the purpose of the renovation to, and provides for,
the maintenance and operation of the YMCA Teen Center located at 216 West
Sixth Street, San Bernardino, California, hereinafter referred to as
"FACILITY" .
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2. SCOPE OF PROJECT
The renovation improvements, hereinafter referred to as "IMPROVEMENTS", shall
consist of the remodeling of two FACILITY rooms into a 3,600 square feet teen
center. The teen center will contain a multi-purpose recreation games room,
a lounge area and teen center offices. Additional improvements may be
included only after written agreement between YMCA, COUNTY, and CITY.
YMCA shall maintain and operate the teen center for expanding its teen
recreation program within the San Bernardino area. This program will provide
youth development services to youth from low-and moderate-income households.
YMCA Teen Center programs shall be designed to encourage primary participation
by youth from qualifying census tracts.
Unless as specified otherwise, ECD shall have the authority to represent
COUNTY regarding the terms and conditions of this Agreement, and COO shall
have the authority to represent CITY regarding the terms and conditions of
this Agreement.
3. TIME OF PERFORMANCE
This Agreement shall be effective as of the date the last of the parties
hereto execute this Agreement and the maintenance and operation period as
specified in Section 6, MAINTENANCE AND OPERATION.
4. FUNDING
COUNTY shall provide CDSG funds in an amount not to exceed forty thousand
dollars ($40,000) for the purpose of constructing IMPROVEMENTS. CITY shall
provide CDSG funds in an amount not to exceed sixty thousand dollars ($60,000)
for the purpose of design and construction of IMPROVEMENTS. Within thirty
(30) working days upon written demand by CITY, COUNTY shall pay appropriate
costs associated with completion of IMPROVEMENTS. Appropriate invoiced
documents shall be included in said written demand by CITY. YMCA shall have
the sole responsibility for obtaining additional funds necessary to design and
construct FACILITY. This condition however, does not preclude COUNTY and CITY
from providing additional funding at their sole discretion.
5. CONSTRUCTION MANAGEMENT
COUNTY, CITY and YMCA agree to utilize CITY to provide construction management
and inspection services necessary for IMPROVEMENTS in a manner convenient and
acceptable to YMCA. CITY will be responsible for compliance with the Oavis-
Bacon Act, including the review of original payrolls, and other related acts
associated with the CDBG program
6. MAINTENANCE AND OPERATION
YMCA shall have sole responsibility for the maintenance and operation of
FACILITY at the sole expense of YMCA for a period of not less than twenty (20)
years beginning upon the date of completion of IMPROVEMENTS. CITY shall
notify COUNTY and YMCA in writing of said date of completion of IMPROVEMENTS.
FACILITY shall be maintained and operated at all times for the purpose of
providing youth development services as identified in Section 2, SCOPE OF
PROJECT, and in accordance with federal, state and local laws, regulations and
safety standards.
7. ON-SITE INSPECTION
COUNTY, CITY, their officers, agents, employees, persons under contract with
COUNTY or CITY and representatives of HUD, will have the privilege and right
to on-site inspection of the FACILITY for the duration of this Agreement.
YMCA will require that its employees or agents furnish any information, that
in the judgement of COUNTY, CITY, and HUD rep~esentatives, may be relevant to
a question of compliance with contractual conditions, HUD directives, or the
effectiveness, legality, and achievements of the program.
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8.
AFFIRMATIVE ACTION AND CONTRACT COMPLIANCE
YMCA shall make every effort to ensure that all projects funded wholly or in
part by CDBG funds shall provide equal employment and career advancement
opportunities for minorities and women. In addition, YMCA shall make every
effort to employ residents of the area and shall keep a record of the
positions that have been created directly as a result of this Agreement.
COUNTY and CITY have a goal of 15 percent (15%) minority business enterprise
(MBE) and 5 percent (5%) women business enterprise (WBE) participation for all
Agreements. YMCA and CITY agrees to comply with the provisions of the
Affirmative Action Compliance Program of COUNTY and CITY and rules and
regulations adopted pursuant thereto. YMCA shall comply with Executive
Orders 11246, 11375, 11625, 12138, 12432, 12250, Title VII of the Civil Rights
Act of 1964, the California Fair Employment Practice Act, California Public
Contracts Code 2000 and COUNTY M/WBE Policy No. 11-15, and other applicable
federal, state, and local laws, regulations and policies relating to equal
employment and contracting opportunities, including laws and regulations
hereafter enacted.
9. COMPLIANCE WITH LAWS
All parties agree to be bound by applicable federal, state and local laws,
ordinances, regulations and directives as they pertain to the performance of
this Agreement. This Agreement is subject to and incorporates the terms of
the ACT; 24 Code of Federal Regulations, Part 570, Chapter V and; U.S. Office
of Management and Budget Circular A-8?
10. BENEFICIARY QUALIFICATION.
Beneficiaries qualifying on the basis of income shall have an annual income
equal to or less than the u.s. Department of Housing and Urban Development
(HUD) Section 8 (of the United States Housing Act of 1937) Income Limits. HUD
Section 8 Income Limits for the Riverside-San Bernardino PMSA, define the
maximum family income for low-and moderate-income households. YMCA is
responsible for obtaining from COUNTY and CITY the said current applicable HUD
Section 8 Income Limits for each year of the Agreement term identified in
Paragraph 3, Time of Performance. Under CDBG regulations, the following
clientele categories are presumed to be low-and moderate-income persons and
can qualify for service regardless of income: Abused Children; Battered
Spouses; Elderly Persons (60 and older); Handicapped Persons; Homeless
Persons; Illiterate Persons; Migrant Farm Workers. YMCA shall document the
limited clientele status or the household income of all beneficiaries,
utilizing copies of the "Beneficiary Qualification Statement", Exhibit 2 of 3.
YMCA shall retain these forms for three years (3) after conclusion of this
Agreement.
11. PROGRAM REPORTING.
YMCA agrees to prepare and submit financial, program progress, evaluations,
and other reports as required by HUD or COUNTY directives. YMCA shall
maintain such property, personnel, financial and other records and accounts as
are considered necessary by HUD or COUNTY. All YMCA records, with the
exception of confidential client information, shall be made available to
representatives of County and the appropriate Federal agencies. YMCA is
required to submit data necessary to complete the Annual Grantee Performance
Report in accordance with HUD regulations in the format and at the time
designated by COUNTY Director of ECD or his designee. YMCA shall submit a
completed Direct Benefit Activities form, Exhibit 3 of 3, on an annual basis
for each year of this Agreement.
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12. HOLD HARMLESS
Each party shall indemnify and hold the other party, its officers, agents,
volunteers and employees, harmless from and against any loss, liability,
claim, or damage that may arise or result from its activities and those of its
officers, agents, volunteers and employees; and each party shall, at its own
cost, expense and risk, defend any legal proceedings that may be brought
against the other party, its officers, agents, and employees, on any
liability, claim or demand and satisfy any judgement that may be rendered
against any of them arising or resulting from its activities and those of its
officers, agents, and employees without waiving its right for subsequent 50\
reimbursement of expenditures. CITY shall assume liability for all and any
direct expense incurred in providing services pursuant to this Contract and
shall assume any and all responsibilities for loss or damage resulting from
negligence, injury, illness, or disease arising out of the provision of
services. CITY, however, is obligated to promptly notify COUNTY in writing of
the occurrence of any such loss or damage.
YMCA shall indemnify and hold harmless COUNTY and CITY against any liability,
claims, losses, demands, and actions incurred by COUNTY and CITY as a result
of a determination by HUD or its successor or any other applicable agency of
the Federal government that activities undertaken by or under the direction
and control of YMCA and COUNTY pursuant to YMCA request or on behalf of YMCA,
under the terms of this Agreement, fail to comply with any laws, regulations
or policies applicable thereto or that any funds billed by and disbursed to
YMCA under this Agreement were improperly expended.
13.
INSURANCE
I n order
HARMLESS,
maintain
insurance
limits as
REOUIREMENTS
to accomplish the indemnification provided in Section 12, HOLD
but without limiting the indemnification, YMCA shall secure and
throughout the term of this Agreement the following types of
issued by companies acceptable to COUNTY and CITY Risk Managers with
shown:
Workers' Compensation - A program of Worker's Compensation insurance or
a state-approved Self Insurance Program in an amount and form to meet
all applicable requirements of the Labor Code of the State of
California, including Employer's Liability with $250,000 limits,
covering all persons providing services on behalf of YMCA and all risks
to such persons under this Agreement.
Comprehensive General and Automobile Liabilitv Insurance - This coverage
to include contractual coverage and automobile liability coverage for
owned, hired, and non-owned vehicles. The policy shall have combined
single limits for bodily injury and property damage of not less than one
million dollars ($1,000,000).
Errors and Omissions Liabilitv Insurance - Combined single limits of one
million dollars ($1,000,000) for bodily injury and property damage; or,
Professional Liabilitv - Professional liability insurance with limits of
at least one million dollars ($1,000,000) per claim and in the
aggregate.
Additional Named Insured All policies, except for the Workers'
Compensation coverage and Errors and Omissions or Professional
Liability, shall contain additional endorsements naming COUNTY and CITY
employees, agents, volunteers, and officers as additional named insured
with respect to liabilities arising out of the performance of services
hereunder. For Professional Liability coverage COUNTY and CITY shall be
named as a designated person referencing this Agreement's Number on the
policy.
Waiver of Subroqation Riqhts - YMCA shall require the carriers of the
above required coverage to waive all rights of subrogation against
COUNTY and CITY, their officers, volunteers, employees, contractors and
subcontractors.
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Policies primarv and Non-Contributorv - All policies required above are
to be primary and non-contributory with any insurance or self-insurance
programs carried or administered by COUNTY and CITY.
Proof of Coveraae - YMCA shall immediately furnish certificates of
insurance to ECD evidencing the insurance coverage above required prior
to the commencement of performance of services hereunder. These
certificates shall provide that such insurance shall not be terminated
or expire without thirty (30) days written notice to COUNTY and CITY.
Within sixty (60) days of the commencement of this Agreement YMCA shall
furnish certified copies of the policies and endorsements. YMCA shall
complete and submit Agreement Exhibit 1 of 3, Insurance Inventory, along
with the above required insurance documents.
14. INSURANCE REVIEW
The above insurance requirements are subject to periodic review by COUNTY and
CITY. COUNTY Risk Manager is authorized, but not required, to reduce or waive
any of the above insurance requirements whenever the Risk Managers determine
that any of the above insurance is not available, is unreasonably priced, or
is not needed to protect the interests of COUNTY and CITY. In addition, if
the Risk Managers determine that heretofore unreasonably priced or unavailable
types of insurance coverage or coverage limits become reasonably priced or
available, the Risk Managers are authorized, but not required, to change the
above insurance requirements to require additional types of insurance coverage
or higher coverage limits, provided that any such change is reasonable in
light of past claims against COUNTY and CITY, inflation, or any other item
reasonably related to COUNTY and CITY risk.
Any such reduction or waiver for the entire term of this Agreement and any
change requiring additional types of insurance coverage or higher coverage
limits must be made by amendment to this Agreement. YMCA agrees to execute
any such amendment within thirty (30) days of receipt.
15. ADDITIONAL INSURANCE REOUIREMENTS
YMCA shall, at its sole expense, obtain and deliver to COUNTY and CITY for
their approval, certification(s) or policy(s) of standard fire insurance with
extended coverage and vandalism and malicious mischief endorsements for the
full replacement value of FACILITY. In the event of any damage or destruction
to FACILITY covered by the insurance, YMCA shall use the entire insurance
proceeds to restore FACILITY. The insurance required under this section shall
be maintained by YMCA at its sole expense for the term of this Agreement.
Said insurance shall contain endorsements providing that the insurance company
issuing the insurance will not cancel or reduce the insurance coverage without
thirty (30) days prior written notice to COUNTY and CITY. YMCA shall inform
COUNTY and CITY in writing of any change, expiration or renewal of said
insurance within thirty (30) days of the effective date of change.
16. RELIGIOUS PROSELYTIZING OR POLITICAL ACTIVITIES
YMCA agrees that it will not perform or permit any religious proselytizing or
political activities in connection with the performance of this Agreement.
Funds under this Agreement will be used exclusively for performance of the
work required under this Agreement and no funds made available under this
Agreement shall be used to promote any religious or political activities.
The teen center, however, may be used on an incidental basis to hold political
meetings, candidate forums, or voter registration campaigns, provided that all
parties and organizations have access to the facility on an equal basis, and
are assessed equal rent or use charges, if any.
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17.
DISCRIMINATION
No person shall, on the grounds of race, sex, creed, color, religion, or
national origin, be excluded from participating in, be refused the benefits
of, or otherwise be subjected to discrimination in any activities, programs,
or employment by YMCA.
18. ASSIGNMENT AND SUBLETTING
YMCA shall not assign, subordinate, or sue for financing, this Agreement or
any interest therein, unless COUNTY and CITY have previously given their
written consente Provided, however, that any approved assignment shall be
subject to all the terms, covenants, and conditions of the Agreement. If
YMCA attempts to effect any unauthorized assignment, or transfer occurs by
operation of law, or this Agreement or any interest therein is subjected to
garnishment or sale under any execution of any suit or proceeding brought
against or by YMCA, or if YMCA is adjudged bankrupt or insolvent by any court
or upon YMCA making an assignment for the benefit of creditors, COUNTY and
CITY may, at their option, forthwith terminate this Agreement upon written
notice thereof to YMCA, and thereupon, no one but COUNTY and CITY shall have
any further rights hereunder.
19. HYPOTHECATION OF REAL PROPERTY
During the term of this Agreement, neither YMCA, nor its successors, shall
cause to be placed or permit to be placed any encumbrance or lien on the real
property covered under this Agreement, or shall sell, transfer, mortgage or
hypothecate FACILITY without the written authorization of COUNTY and CITY.
Notwithstanding Section 20, VIOLATION OF AGREEMENT, and any other provisions
herein, YMCA shall reimburse COUNTY and CITY for the fair market value of
FACILITY less any portion thereof attributable to expenditures of non-CDBG
funds for FACILITY, should YMCA sell, hypothecate, mortgage or encumber
FACILITY without the written authorization of COUNTY and CITY during the term
of this Agreement.
20. VIOLATION OF AGREEMENT
In the event that YMCA violates any of the terms and conditions of this
Agreement, COUNTY and CITY shall give written notice of violation and demand
for correction. If, within thirty (30) days from receipt of written notice,
YMCA has not corrected the violation or shown acceptable cause, COUNTY and
CITY has the right to terminate this Agreement. It is agreed that in the
event of a termination due to a violation of this Agreement by YMCA, YMCA
shall pay to COUNTY within ten (10) days of receipt of Notice of Termination,
the sum of forty thousand dollars ($40,000) and YMCA shall pay to CITY within
ten (10) days of receipt of Notice of Termination, the sum of sixty thousand
dollars ($60,000). Said sum is agreed to represent a reasonable endeavor by
both parties hereto, to be a fair compensation for the foreseeable losses that
might result from such a breach or default. Penalties and damages covered
under separate agreements with COUNTY and CITY for teen center programs shall
be in addition to that contained herein. Such termination shall not excuse
YMCA from reimbursement provisions in Section 20, HYPOTHECATION OF REAL
PROPERTY.
21. TERMINATION BY COUNTY
Notwithstanding Section 21, VIOLATION OF AGREEMENT, COUNTY and CITY may
immediately terminate this Agreement upon the termination, suspension,
discontinuation or substantial reduction in coaG funding of the Agreement
activity or the reprogramming of said funds as deemed necessary by COUNTY and
CITY, or for the convenience of COUNTY or CITY.
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22. REVERSION OF ASSETS
All real property acquired or improved in whole or in part with CDBG funds in
excess of $25,000 under this Agreement must continue in the use that provides
the service benefits and national objectives for which it was funded until
five years after expiration of this Agreement as set forth in 24 CPR 470, or
such longer period of time as determined by COUNTY OR CITY; or it must be
disposed of in a manner resulting in a reimbursement to COUNTY or CITY in the
amount of the current fair market value of the property less any portion
thereof attributable to expenditures of non-CDBG funds for the acquisition of,
or improvement to, the property.
23. AMENDMENTS: VARIATIONS
This writing with attachments, embodies the whole of this Agreement of the
parties hereto. There are no oral agreements not contained herein. Except as
herein provided, addition or variation of the terms of this Agreement shall
not be valid unless made in the form of a written amendment to this Agreement
formally approved and executed by the parties.
24. INVALrD CONDITIONS
If anyone or more of the terms, provisions, sections, promises, covenants or
conditions of this Agreement shall to any extent be judged invalid,
unenforceable, void or voidable for any reason whatsoever, by a court of
competent jurisdiction, each and all of the remaining terms, provisions,
sections, promises, covenants and conditions of the Agreement shall not be
affected thereby, and shall be valid and enforceable to the fullest extent
permitted by law.
25. BINDING INTEREST
This Agreement shall be binding on the parties, successors in interest, heirs
and assigns.
26. NOTICES
All notices shall be served in writing.
following addresses:
The notices shall be sent to the
COUNTY
CITY
County of San Bernardino
Department of Economic and
Community Development
474 West Fifth Street
San Bernardino, CA 92415-0040
City of San Bernardino
Economic Development Agency
Community Development Department
2Dl North "E" Street, Ste. 301
San Bernardino, CA 92401
YMCA
YMCA of San Bernardino Valley
216 West Sixth Street
San Bernardino, CA 92401
27. EASEMENTS. TRUSTS AND WARRANTIES
A. It is expressly understood and agreed that this Agreement and all rights
and privileges hereunder granted are subject to all easements and
rights-of-way now existing in, to, under or over the said premises for
any purpose whatsoever.
B. In the event that this Agreement or any provision thereof shall be
declared null and void by a court of competent jurisdiction, COUNTY,
CITY or any of their respective officers, agents or employees, or
members of COUNTY Board of Supervisors and CITY Common Council shall not
be liable to YMCA or to any person holding under or through him for any
losses or damages of any nature whatsoever suffered or claimed to be
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suffered by YMCA or such person by reason of such determination.
C. YMCA assumes all risks incident to the use and management of said
premises in its present condition or in any condition thereof which may
prevail during the term of this Agreement.
D. Any major changes required by a competent government jurisdiction to the
Agreement which are beyond the control of YMCA will make the Agreement
terms subject to renegotiation.
E.
It is expressly understood and
any way nor for any purpose,
venturer with YMCA.
agreed that COUNTY and CITY do not, in
become partners of YMCA, or a joint
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IN WITNESS WHEREOF, the parties have caused this Agreement to be executed as
of the day and year first written above.
COUNTY OF SAN BERNARDINO
CITY OF SAN BERNARDINO
By:
Chairman, Board of Supervisors
":t/J1
By: ~.' 1ft4'\.
/ Mayor
Date: 3,\~\~'t
\
Date:
EARLENE SPROAT
Clerk of the Board of Supervisors
of the County of San Bernardino
APPROVED AS TO FORM AND
LEGAL CONTENT
By: /J.AAA"1~
J/ ~;V:~y
Dated: r:t:6...l c/, /f'fi'
. ,
SIGNED AND CERTIFIED THAT A COPY OF
THIS DOCUMENT HAS BEEN DELIVERED TO
THE CHAIRMAN OF THE BOARD
By:
6LC-/"-.L-C> C~'C4L-t i7r
lerk
By:
Date:
Date:
APPROVED AS TO LEGAL FORM
YMCA OF SAN BERNARDINO VALLEY, INC.
ALAN K. MARKS
COUNTY COUNSEL
BY:~Sl~
Date: FEm 1994
Date: ji.- ~?~ 9'~
, I
By:
Legal Counsel
NONE
Date:
AGMTS/94YMCASB.M&O
1/lO/94/LP/bjj
1/19/94/LP/bjj
1/24/94/LP/bjj
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EXHIBIT --1-- of--1--
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Pro;ect/Activitv Title:
Case Number: 350-19502/1108
Fifth District: Teen Center Remodel - San Bernardino YMCA
Name/Address of Contractor Aoencv:
Date of Issue:
YMCA of San Bernardino Valley, Inc.
216 W. Sixth Street
San Bernardino, CA 92401
----X- Original:
Amendment #_
INSURANCE INVENTORY
PRIMARY INSURANCE POLICY
Name of Contractor's Insurance Company
Effective Dates of Policy
Claims Made Policy / /
Limits of Liability
Deductibles:
Per Occurrence Policy / /
Per Occurrence
Annual Aggregate
Additional Insured Endorsement Attached
Certified Copy of Policy Attached
Certificate of Insurance Attached
Yes
Yes
Yes
No
No
No
EXCESS/UMBRELLA POLICY
Name of Contractor's Insurance Company
Effective Dates
Limits of Liability
Underlying Coverage limits
Name of Underlying Company
Additional Insured Endorsement Attached
Certified Policy (copy of) Attached
Certificate of Insurance Attached
Yes
Yes
No
No
No
Yes
gA
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EXHIBIT --1-- of ~
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Proiect/Activitv Title:
Case Number: 350-19502/1108
Fifth District: Teen Center Remodel - San Bernardino YMCA
Name/Address of Contractor Aaencv:
Date of Issue:
YMCA of San Bernardino Valley, Inc.
216 W. Sixth Street
San Bernardino, CA 92401
---X... Original:
Amendment #_____
BENEFICIARY OUALIFICATION 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 be completed and signed by person (legal guardian> requesting to receive
benefits from the described project/activity.
Please answer each of the following questions.
1. 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. How many persons are in your
household?
2.
For this question a list of the 1993-94 VERY LOW and LOW
below. Please calculate the combined oross annual
household from all sources of income.
income categories are presented
income of all persons in your
State, yes or no, if your combined gross annual household income is equal to or less than
the VERY LOW amount for the number of persons in your household.
state, yes or no, if your combined gross annual household income is equal to or less than
the LOW amount for the number of persons in your household.
VERY LOW
LOW
1
$14,400
$23,000
Number
2
$16,450
$26,300
of Persons in Your Household
345
$18,500 $20,550 $22,200
$29,600 $32,900 $35,500
6
$23,850
$38,150
7
$25,500
$40,750
8+
$27,150
$43,400
3.
Do you identify yourself as:
White Black ___Hispanic
American Indian
Asian
Other
4. Please state, yes or no, if you are a female Head of Household?
5. Please describe the condition that would qualify you as being considered in one of the
following categories: low- and moderate-income household, abused child, battered spouse,
elderly person, homeless person, disabled person, illiterate person ,or migrant farm
worker.
ACKNOWLEDGEMENT AND DISCLAIMER
I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME ANO HOUSEHOLD STATEMENTS MADE ON THIS FORM ARE
TRUE.
NAME:
DATE:
ADDRESS:
PHONE NO:
SIGNATURE:
The information you provide on this form is for Community Development Block Grant (CDBG)
program purposes only and will be kept confidential.
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EXHIBIT --1-- of--1--
COUNTY OF SAN BERNARDINO DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
Proiect/Activltv Title:
Case Number: 350-19502/1108
Fifth District: Teen Center Remodel - San Bernardino YMCA
Name/Address of Contractor Aqency:
Date of Issue:
YMCA of San Bernardino Valley, Inc.
216 W. Sixth Street
San Bernardino, CA 92401
~ Original:
Amendment #_
DIRECT BENEFIT
Number of Households or Persons
Directly Assisted
Low and Moderate Income
Low Income
White, Not Hispanic Origin
Black, Not Hispanic Origin
American Indian/Alaskan Native
Hispanic
Asian Pacific Islander
Households (H) or Persons (P)
(P or H)
Female Headed Households
Households or Persons (total)
Reporting Office
Contact Person
throuah
Reporting Period
Signature
( )
Telephone Number
10
9"
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STATE OF CALIFORNIA
COUNTY OF SAN BERNARDINO
CITY OF SAN BERNARDINO
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I,~C~ ~ {\ \ 'i\:9'L- . City Clerk of the City of San Bernardino, DO
HEREBY CER Y that the foregomg and attached copy of Mayor and Common CouncIl of
the City of San Bernardino Resolution No.C\'-\ 5:J. is a full, true and correct copy of that
now on file in this office.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the official seal of
the Mayor and Common Council of the City of San Bernardino this ~ \-"\\. day of
""'~"'~~ . 1994.
Q~~~ 0~~'\,
City lerk
City of San Bernardino
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