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Home My WebLink About33-Parks and Recreation ~ clf1 OF SAN BERNARDI~ - REQUM FOR COUNCIL AC~N From: ANNIE F. RAMOS, DIRECTOR Subject: RESOLUTION AUTHORIZING THE DIRECTOR OF PARKS, RECREATION AND COMMUNITY SERVICES Depl: PARKS, RECREATION & COMMUNITY SERVICES DEPARTMENT TO APPLY FOR AND ACCEPT CON- TINUED FUNDING OF THE SENIOR COMPANION Date MARCH 29, 1989 PROGRAM THROUGH ACTI ON FOR FY 89/90 IN THE AMOUNT OF $?Ol.941. Synopsis of Previous Council action: · ...11'2f .March 21, 1988 - Resolution 88-88 to renew SCP Program for 1988/89 funding was approvld. October 3, 1988 - Resolution 88-387 for additional Federal Funding in the amount of $26,341 was approved bringing the total grant to $201,941 for FY 1988/89. Adopt Resolution I ::D m (') :.: d ",. . -< , I .. ~ t:1 X ~ X :$: -- 0 .. "'l N ..... ..... Recommended motion: c2 ] /'/ . 'UI"j - . ~~~/ Signature Conteet penon: Tom Boggs Phone: 5032 Staff Report, Proposed Application Supporting detl ,ueched: and Resol ution Ward: Amount: $38,723 Source: (ACCT. NO.) 001-381-53030 Special Projects City cash match requirement for salaries (ACCT. DESCRIPTION) and volunteer expenses. Finance: d~./ _~/~ fUNDING REQUIREMENTS: Council Notes: ~::2 o.+r oF SAN.BERNARD'~ - REQUEQ- FOR COUNCIL.AC~N RESOLUTION AUTHORIZING THE DIRECTOR OF PARKS, RECREATION AND COMMUNITY SERVICES STAFF REPORT DEPARTMENT TO APPLY FOR AND ACCEPT CON- TINUED FUNDING OF THE SENIOR COMPANION PROGRAM THROUGH ACTION FOR FY 89/90 IN THE AMOUNT OF $201,941. fhe Senior Companion Program is one in which low income seniors serve as companions for frail elderly or disabled to help them remain in their own homes or return to their own homes, thus avoiding institutionalization. The Senior Compani.ons are volunteers who, because they are low income, receive an untaxed stipend of $2.20 per hour plus help with lunch and transportation. This enables low income seniors to serve as volunteers, thereby keeping them active and in their own homes as well as the clients they serve. The city will provide a total local match of $57,819 which will include salaries for full and part time employees and expenses for volunteers. This match is funded through the General Fund budget for administrative services, in-kind city contributions such as office space, utilities, custodial, recognition, accounting, etc., and contributions from the community for meals, services and donations. This program has been renewed annually since FY 1974-75 and currently has 61companions who are providing 200 clients with over 5000 hours of service each month. March 29, 1989 '..,0204 ... ., . - -- --." - ~ '- RESOLUTION NO. 2 . RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE DIRECTOR OF PARKS, RECREATION AND COMMUNITY SERVICES DEPARTMENT TO MAKE APPLICATION FOR 3 AND ACCEPT A GRANT FROM "ACTION" IN THE AMOUNT OF $201,941 FOR THE SENIOR COMPANION PROGRAM FOR THE PERIOD JULY 1, 1989 THROUGH JUNE 30, 1990. 4 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN 5 BERNARDINO AS FOLLOWS: 6 SECTION 1. The Director of Parks, Recreation and Community Services 7 Department of the City of San Bernardino is hereby authorized and directed 8 to submit an. application to, and accept on behalf of the City a grant from, 9 "ACTION" in the amount of $201,941 for the Senior Companion Program for the 10 period July 1, 1989 through June 3D, 1990. II I HEREBY CERTIFY that the foregoing resolution was duly adopted by the 12 Mayor and Common Council of the City of San Bernardino at a 13 meetin9 thereof, held on the day of , 1989, by the 14 following vote, to wit: 15 AYES: Council Members 16 17 NAYS: 18 ABSENT: 19 20 City Clerk 21 22 The foregoing resolution is hereby approved this . day of 23 , 1989. 24 25 Mayor of the City of San Bernardino 26 Approved as to form and legal content: 27 28 /) ,:::/uftuj ',. I ..- ,.) - FEDERAL ASSISTANCE ~LI e. NUMBER 3. STATE e. NUMBER ANT'S APPLI. APPLI. CATION I. TYPE o NOTICE OF INTENT CATION 95-600072 !DENT!- OF !DENTI. b. DATE FIER b. DATE SUBMISSION (OPTIONAL) FIER rra. _III do." NOTE TO BE ASSIGNED fIN' ,""".1. du' ,IIa,lap o PREAPPLlCA TlON 1989-3-24 ASSIGNEl> 8\' STAn: 19 pI"OINio/,. IX APPLICATION ... ....w BIo,,1 4. LEGAL APPLlCANTIRECIPIENT 5. EMPLOYER IDENTIFICATION NUMBER lEIN' .. Applicant Name : City of San Bernardino b. Organization Unit : Parks. Recreation & Comm. Svs. Dept. 6. e. NUMBER c. StreetIP.O. Box . : 300 North "D" Street PRO. ~ GRAM d.Ci., : San Bernardinoe.Coun~ San Bernardino r. State : CA g. ZIP Code. 92418 IFrom CFVAI MULTIPLE' I ~ h. Contad penon 'N....,. Betty Lewison b. TITLE " . frifpA",.,./to"o.' : (714) 384-5100 SCP i 7 TJTI.E OF APPLICANT'S PROJECT rose _ion IV of thi. ronn to provide e aumme"Y 6. TYPE OF APPL1CANTIREC1P1ENT ~ . deacription of the project.! A........ G-Speria' P'urpa- 0iItnf'I B-I",*,*~ H-Community Artion ~IK) I C-SuoUt... 1_....hrrEducat~]lnltllutll'" Sen{or Companion Program Orpniaa.tioo .J-1ndil.nTri~' C D-Count~. K--Ol.twrfSprcifrl U E-Cjt~. --....- E r-Sr:hool Di_riel [j] Enur appropriaJr ",nt" 1 9. AREA OF PROJECT IMPACT (No"," o(dlin. _1lIin. Ifatft:, dr.1 10. ESTIMATED NO. OF 11. TYPE OF ASSISTANCE ~. PERSONS BENEFITING A-Buic Gfwrt D-lnllW'ant'l' [ill Inland Empire B-&tpple_n...l Onnt E-()Uw.r E 300 C-Loan E'*'opprofP"i4trWfrmA! I 12. PROPOSED FUNDING 13. CONGRESSIONAL DISTRICT OF: 14. TYPE OF APPLICATION A-Nto... C-R"'ision E-- AVff"l'I'''~lIV'' .. FEDERAL . 201;941.00 e. APPLICANT b. PROJECT B--&ene...l I)......(;onllnu.t10n .[jj] E"'rr.,,pruprwfr' ktl.. b. APPLICANT 'U.432.00 36 36 17. TYPE OF CHANGE (For 14. or 14" e. STATE -0- .00 15. PROJECT START 16. PROJECT A-lnerePt DollaR F-Ol.IlI!'r rSpHlt-} DATE DURATION ~DKrnw Dollars d. LOCAL 7.387.00 r_ -'II fIa:, c-~ Duration D-~ Duration e. OTHER -0- .00 1989-7-1 12J101lth. &-Cancellation r. Total . 259.760.00 18. DATE DUE .W~C' ,Q 89".:ro-T" do.. =~ I I I I A y. """'. 19. FEDERAL AGENCY TO RECEIVE REQUEST ACTION 20. EXISTING FEDERAl- .. ORGANIZATIONAL llNIT (IF APPROPRIATE) I b. ADMINISTRATIVE CONTACT (IF KNOWN) GRANT IDENT NO Los Angeles Office Lowell Brinson 4~"-QDI7 c. ADDRESS 21. REMARKS ADDEIl Federal Bldg. Room 14218. 11000 Wilshire Blvd., DYe. []I No Los An2eles. CA 90024 ~ 22. TotM....tl1lIY~..._behef'.data e. YES, THIS NOTICE OF JNTENTIPREAPPLICATlON/APPLICATlON WAS MADE A V An.ABtF THE in&JUt~tioMpplicat.ionanotrue TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: ~ APPLICANT pd~tM~t"'bwndul)' DATE ~ ""KI..u1l au&boriMd by the pemirll '*'>' ~tbe. THAT. plicut ..... 1M applicPt 'IIi1l alIIIpIy rib \heat&ached___iftbe_.._iI . . .......... b. NO, PROGRAM IS NOT COVERED BY E.O. 12372 0 OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 0 "23 . TYPED NAME AND TITLE b./Z. "7 D . ! CERTJFYING 'Annie F. Ramos. Director REPRE- SENTATIVE Parks. Recreation & Comm. Svs. Dept. - '- ~ -- 24. APPLICA. r_ montll ...~ 25. FEDERAL APPLICATION IDENT: NO. 126. FEDERAL" G IDENTIFICATION TlON .. I~ 27. ArnON TAKEN 28. FUNDING rror IftOIIth do) 30. YN.' _lUll dw. = a. AWAJlDED 29. ArnON DATE. 19 81~TING,. ::::! b. JlE.IEC'mD :J c. JlE'J1JRNED FOR e. FEDERAL . .00 31. CONTACT FOR ADDmONAL ::rT . y..." ,""""I> da. AMENDMENT INFORMA nON t'NontI' and kkphoM numMr! .~G IQ ,.. 8 .. B.ETURNED FOR b. 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Ie!: I .0 0 0 0 0 t 0 0 0 0 0 I I Z CIIl ~ ~ ~ ~ I . .. .. . ! 0 0 ~ ... \Jl 1,;-' I 00 00 ! ~ 0 I ... . . ~ ~ . . . ..... ..... ~ ~ It;; ..... . VI \Jl i VI 00 I 00 \Jl VI ~. i VI \Jl ... ... I . . g . . 0 0 ~ 0 0 0 0 0 0 ; 0 0 0 0 ~ I .. ,e .. .. .. .. N ... ~ ... VI \Jl \Jl ... ... ! ~ 0 t ... ... ! .... . . . 0. . . ..... I ~ ~ ~ 00 ~ ..... 00 \Jl 00 t ;; ... 00 N ~ '" '" '" N . . . 2 . . 0 g 0 0 0 0 0 0 0 0 0 0 - - '- ""~ "-' <...'" .IIMY.. -...-. , "J .__I......'IAY_ 'M' 1-IUDGIY'LAN . t. ...UllftllIlUI'PClIlf ........ ~ A. ellMfIl "l'IIOIIINlL ell .. 0' .., III ... J IllPlllUl IWrIIII . ,.". TeIII ....... .......- -lIllfZ .....' OIl ... 'hIo ....., ...... c:. ".,__ W "1_" r.!' . Director 128.938. 100.. , 28.938. 125.690. , 3.248. , Clerk/Typist 14.867. 70% 10.407. -0- 10.407. Coordinator of Volunteers 15.600. 50% 7.800. -0- 7.800. Accountant 30.000. 20% 6.000. -0- 6.000. . 1VI'AL "IlIONNIL ,...NIII 189.405. .. I 53 145. I 25.690. 127.455. II I. flllNGl.NE'1fI 9.976. 3.uuu. '~: C. "'GRANTEEITAP'LOCALTRAYlL 825. 425. C. 01 GRANTEE ITA" UlNG DllTANCE TRAVEL 500. 'UU. -u- D. ......NT .. -.rUB 250. 100. 150. f. CONTMCTUAL IERVICE Go CJntER: Postage" 200. 200. -0- c-.....mutMcItiolw. l"none 720. 462. 258. PriIlIilll 500. 300. 200. ..... Mainentance & -Utilities 5.359. -u- '.35!1. K. INDIRECT COI1I 1VI'AL VOLUNTEEII IUI'PClIlf IllPINIEI 71.501. 30.677. 40.824. -0- .. ....-nlll IXPINIII A. "lIIClNNlL 1...11III ....... 140.104. 140.104 -0- LIIII'I AlII. - .. ......,..... M_ ...... LedIinI M. I- I. fRINGE 'ENUITI - 20.862 16.800. -0- 4.Ub~. fICA - ........ 250. 250. -0- 0Nr. Reco2DitioD 1.400. 610. 790. Phvsical" EXams 2.135. -u- ~.lD. c.~ 23.508 13.'UU. 1O.UUll. I Ill" ENT L '''''UD .. f. ~IERVlCE Go OTHIR . 1VI'AL VOLUNTEIII 1"'11III 188.259.00 171.264.00 12.933.00 4.062.00 'tOTAL CllSTI 1259.760.00 I 201.941.00 '53.757.00 14.062.00 .. flllCIIIfAOI 10ft 78% 21% 21 .. "'UNTII" IfIIENGftl. .....~ VeI_., ..........: ,...... 15.921 2N....15.921 101I....15.921 .......15.921 ........._,.,...- -= 61 ~_._ ""11.1(1111) '-". ., VOLUNTEER SUPPORT EXPENSES A."" Grantee Personnel Expenses Salaries and fringe benefits are based on grantee's salary schedules established by resolution of the Mayor and CODDIlon Council. 1. Project Director (100% time) $13.9125 per hr x 80hrs x 26 pay periods $28.938.00 $25,690.00 $ 3.248.00 2. Clerk/Typist (70% time) $7.15 per hr x 80hrs x 26 pay periods x 70% -0- 10.407.00 -~ r' r"......, V ~ SENIOR COMPANION PROGRAM '- . BUDGET JUSTIFICATION Grant # 436-9017 July 1. 1989 thru June 30, 1990 1. FEDERAL 3. Coordinator of volunteers (50% time) $7.50 per hr x 80hrs x 26 pay periods x 50% 4. Accountant (20% time) $14.42 per hr x "80hrs x 26 pay periods x 20% -0- -0- -0- NON-FEDERAL EXCESS NON-FED. " -0- -0- 7,800.00 -0- 6,000.00 -0- TOTAL PERSONNEL EXPENSES $25.690.00 $27.455.00 B. FrinKe Benefits 1. Project Director: $28.938.00 x 22% 2. Clerk Typist: $10.407.00 x 22% 3. Coordinator of Volunteers: U.I.: $7.800.00 x.25% - $20.00 W.C.: $7.800.00 x .08% - $6.00 4. Accountant: $6.000.00 x 22% 3.000.00 -0- -0- -0- 3,366.00 2.290.00 -0- -0- 26.00 1,320.00 -0- -0- TOTAL FRINGE BENEFITS -0- $ 3,000.00 $ 7,002.00 C. Grantee Staff - Local Travel: The Project Director will travel an average of 150 mi. per month x 12 mos. @ 25~ per mi. - 450.00 The Coordinator of Volunteers will travel an average of 125 mi. per month x 12 mos. @ 25~ per mi.- $375.00 425.00 -0- Di Grantees Staff - Long Distance Travel The Project Director will attend one ACTION Training Conference: 1 R.T. airfare @ $200.00 3 days @ $100.00 per diem - $390.00 (Includes room. meals and other related expenses.) 500.00 25.00 -0- 375.00 -0- -0- -0- -<,.~, ......, "..-.... - - "..# EXCESS VOLUNTEER SUPPORT EXPENSES (Continued) FEDERAL NON-FEDERAL NON-FED. E. Supplies Consumable desk-top supplies are estimated to cost $250.00 $ 100.00 $ 150.00 -0- G. Other: 1. Postage Postage costs are estimated at $200.00 200.00 -0- -0- 2. Telephone Phone costs are estimated at $600.00 per mo x 12 - $720.00 462;00 258.00 -0. 3. Printina and Photocopying Based on actual cost: 834 pages @5C x12 mo. - $500.00 300.00 200.00 -0- 4. Space (Maintenance & Utilities) SCP is housed in the City's Senior Citizens Center and utilizes 1.032 sq. ft. of space. which is 8% of the total building space of 13.000 sq. ft. Custodial Service - $35.988.00 t Utility Costs - 31.000.00 " $66.988.00 $66.988.00 x 8% - $5.359.00 -0- 5.359.00 -0- TOTAL VOLUNTEER SUPPORT EXPENSES $30.677 .00 $40.824.00 -0- - ~ . "" ""'" "-' ~~ -' EXCESS 2. VOLUNTEER EXPENSES FEDERAL NON-FEDERAL NON-FEDERAL A. PERSONNEL EXPENSES Stipends: 61 volunteers x 1044 hrs. @ $2.20 per hr. $140,104.00 -0- -0- B. Fringe Benefits: 1. Meals 61 volunteers x 228 working days @ $1.50 per day 16,800.00 -0- 4,062.00 2. Insurance Accident: 61 volunteers x $1.10 - $67.00 P.L.: Minimum premium - $45.00 Excess Auto: 50 vol. @ $2.75 . $138.00 250.00 -0- -0- 3. Recognition 61 volunteers @ $10.00, plus sponsor and community donations for additional meal costs, door prizes, decorations, etc. in the amount of $790.00 610.00 790.00 -0- 4. Physical Exams 61 volunteers @ $35.00 -0- 2,135.00 -0- C. Travel 50 volunteers will drive their own vehicles and are limited to $35.00 per month - 50 x 12 x $35.00 13,500.00 7,500.00 -o- Il volunteers use public trans- portation @ $1.00 per day x 228 working days - 11 x $1.00 x 228 days -0- 2,508.00 -0.. TOTAL VOLUNTEER EXPENSES $171,264.00 $12,933.00 $4,062.00 TOTAL VOLUNTEER SUPPORT EXPENSES 30,677.00 40,824.00 -0- TOTAL BUDGET $201,941.00 $53,757.00 $4,062.00 ~ ,~'.... n..n o III 0 II n 0 ... 1:>'''' III ~ 10<..... .....010 o ....Ill 10 C " 10 0 Ill" ... " .. .. 0 .......... .. Ill"'< Ol " 0 " Cb..... " C .0 ..... 10 CO" III 10 .. ... .. 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E ::c .. o .. 0 0 ~ ~ a '" \"~ a ~ Ol'I:l .... 00 :s .. -jO :s ..... ... .. ... tI:_ > ...n'l:l ; .. :4;:: :!1 ... ... :rOO 0 . ol -l ;; .....oo ... :;: :s 0 ... ..... :00 ...".. 0 '" - o 'I:l II z " .. .. 0 ;.. ... ... Z .. .. . " 0 "l " .. < ~ .....< :: :s .. .. "C GO ... .. ..... .... '" .. 0 ,.. :: ...." ~ ....... .. is ... :r .. 0 i f: I~ .0 >' t:r 31 z c: .. '< > '< '" III ~ .. , " ....... c.., 3 E; "" i...... ;! ..Ill c: 9 0 ~ .. ~ III III ::s ",~Q. ~ - Z III :: .. il a ... C/l . .. . '''' - ...... w ,.. a ~ a 1<Xl ~ '< 0 g -. '''' "'. III - ... : - l'. s;. I '" I Ci , ,<., l!~> ~ ;- ~ 1- :::;i"C :-. ~ > l:g a .. ... xir" 10 >a:ll ~a€ S&,,,, ~ I zif~ ~ "'3> e ia~ '2.c "" , ",~II: a..."ll ~ot: ii a '" .-<':C ~ . II: 1 il'S ;a ,....... '- '''"''-- -' ...,,/ .... . ~ ... "ll > C'l l"l - . - - - - - c ~ ~ ~ San Bernardino Senior Companion Program Volunteer Stations I. Adult Day Health Care Center - 6 2. Casa Bernardine Retirement Home - 3 3. Department of Public Social Services (S.B. County) - 7 4.. Family Services Agency - 3 5. Mental Health Association - 2 6. National In-Home Health Care - 3 7. Pacific Park Convalescent Hospital - 4 8. St. Bernardine's Medical Center Home Health Care - 1 9. S.B. County Hospital Social Services (New) - 1 10. S.B. County Housing Authority - 1 11. Senior Home and Health Care - 2 12. Senior Services Center Outreach Program - 7 13. Shea Convalescent Hospital - 4 14. Sierra Vista Sanitarium - 2 15. Veteran's Hospital Case Management Program - 4 16. Visiting Nurses Association, Pomona-West End - 5 17. Weatside Drop-In Center - 6 ",r' .~ . ....~ - ._"",,- M E M 0 RAN 0 U M 0 FUN 0 E R S TAN DIN G Between . CITY OF SAN BERNARDINO' SENIOR COMPANION PROGRAM SENIOR CITIZENS SERVICE CENTER 600 West Fifth Street San Bernardino, CA 92410 (714) 384-5100 AND NAME Sf ADDRESS 7 ~ () E. ...;- S'G c:... Svs; D ;rt... Cj'~4" PHONE 38"1~7?5"C;:>_ :3'6' 7 -~ I If , i i I I I I .1 I 1. The sponsor will: a. Recruit, interview, select and enroll volunteers in the project. b. Provide orientation to volunteer station staff prior to placement of .volun- teers, and at other times as the needs arise. c. Refer volunteers to volunteer station for placement.. d. Designate a staff person to serve as liaison with volunteer station. e. Furnish adequate accident and liability insurance coverages as required by the program. f. Retain full responsibility for the management and fiscal control of the project. g. In cooperation with the program Advisory Council, arrange for a volunteer's. appeals procedure to resolve problems arising between the volunteer, the sta- tion and/or the sponsor. h. Ass i 9n I Senior. Companions to serve ~ adul ts '!.etween the hours of ~.oo A I:l and' 5'00 PM' on the ol1owing days of the week: Monday hru Fr,day . . i. Specify activities to be performed by the volunteer under the direction of the program staff, in cooperation with the volunteer station. j. Approve individual written plans of care for each client. 2. The volunteer station will: a. Designate IJrM; M_J_Ik.<::<r to serve as Ha150n with the sponsor. ~ b. Integrate Senior Companions into individual written care plans that address .the social and health needs of each client. c. Where appropriate, assure adequate health and safety provisions for the pro- tection of volunteers. d. Collect and validate appropriate volunteer reports for submission to the sponsor. THIS MEMORANDUM MAY BE AMENDED AT ANY TIME BY THE PARTIES INVOLVED. SIGNATURE FOR VOLUNTEER STATION {~ dMo~, fr<JW TITlE SN'J~ ~~ DATE 5l-!p.tf~. SIGNATUR~ FOR SENIOR COMPANION PROGRA~C-"h,:-j, L.. J .~. .~~ TITlE .. LJ'- L .........-...L LC- '- (J ~....L~i~ATE c9/;;l.. <..../1)7 MEMORANDUM UPDATED SIGNATURE FOR VOLUNTEER STATION 1 ITLE ... "".. . , "- ~,.'..... " "- " e. In consultation with the sponsor, make investigations and reports regarding accidents and injuries involving volunteers. The volunteer. station is not liable for accidents involving the volunteers. Assist the program staff in the coordination of volunteer assignments, orien- tation, in'-service training and other pre-gram related activities. Select and provide ~ adults tt be served by the volunteers. Designate service space for use by volunteers in their activities. (This depends on the nature of the volunteer station.) Provide the following meal arrangements f~r volunteers chargeable to "sn- federal support at $2.00 each day. (This depends on the nature of the volun- teer station.) rvA- f. g. h. f. j. Provide the following transportation arra' ~,ements for volunteers chargeable to non-federal support at $2AOO a day. (This depends on the nature of the volunteer station.) rv k. Obtain a written agreement from person(s) to be served or from persons legally responsible for the adult to be served by the volunteer in a private home. (The document authorizes volunteer service in the home, and requests specified volunteer activities.) - I DATE SIGNATURE FOR SENIOR COMPANION PROGRAM lITlE DATE ~ ........... ,;'.!\,I,l (rnlFlCPf "-" J/ii. j.~ l,~.) . *', ""__:..-_ .J'_ "" . . _.. 1 .1:- ~\ Q. 1 (j f-; NAM[ "'''-10 ADD~l ~.~ Of AGE N(. 'I' 703 7~"-<'3I'l rN~'lJr,l.t.;( ( (" [1"";,6.t.:~ 1Hf CII'A cn.,rAtiIrS It;C <'l{, S rEYH'; S1 Rf ET A L f X V t 2 i 314 AGENcY CDOE 10 ~343 CIGNA CCRPO~ATIr'l P n !I('x 14 Cr:Ll'~,~IA ,",J2104~ -onl4 POLICy NUMB[R Gl H04(1~b POller lV~'( NAME AND MAILING .JODRESS OF INSURED 5Et,!LJR CC'IrAt 1('1. p~JG ICtSt,511 bOO ~: 5TH 5T SA~ 8E~'1AqDINO CA 92410 DAV P POLICY PE~100 flNCEPTION) July 1, 199B TO I(XPtRATIONl July I, I9F9 I --J -- i 1. OAVP P!:fSO'lAL LIAFILITY ------------------------------------------------------------------------------- , . ---------------------------------------.-------------------------------------- VOL'Jr;Tf cf S !t:)U~t'KE Sf'!vICE PCL ICY ('ECLtRtTlof.S This pelley, subject to all its terms, condlticns, and limitations. is continued In force for a further ofrlod of Twelve 1121 months and shel I explr. on July 1, 198<;,12:01 a.m.. Standard Tl",e at tl'e place Dr places cesl9n,ted In said policy. ------------------------------------------------------------------------------ PEPSONAL LIABILITY - LIMIT OF LIABILITY Fersonal Injury Liability or Prooe rty ')""'2ge Lla~ III ty Dr Sl,OOO.OOO each occurrfnce 13,000,000 annu~' eQcreQPtf ~(lt., cv:-,.~fr,~~ PRE~IUM cnrpUTATION ESTIMATED NUMBER OF vOLUNTEfRS PEP YEAR R~TE PER VOLUNTEER PEP YEAR OR PAPT THEREOF ADVANCE PRFMIUt' ----------------------- ------------------------ 54 As per the records of the insured organization .40 1 4~ .00 MINIrur PRE~IU"': 1 45.00 ------------------------------------------------------------------------------ 513 BAL TI~(11E, "It Cr'lM 15% SICf399/MHC:C LO 4787 ~ GL-181b CASA51-3 SC2 .. ~::-:-~>:<:>/ N \.. ,.'-.,. I , ..-~ (A~th;;T~d-S(9~;t~;;)-----.------ HAR~Y F CUSTIS AI.' SIGN.AluRE OF AUTHORIZED REPRESEN1A111/[ ."..'''"- '-' ~ ! ! r t. !, l (; I ~ 1 r : ~~ t. T I '''".~.... .I ; '; \ 1 ~ ~A.W A'~~ A[lli~,[ ss o~ AG[ ,..c', 71:' 7'1'--'-'1(1 Ilt~~.lt~.;""~~1 r (''''1/.'.' \\: ~ ~-. lHf (IrA Cf''1rat.J[ SIt.': {l f SHY ''r'~ ~ TO r :: ~ tol E'X 'J I- 2 i ?II !t AGENCY COOE Ie ~;4: CJGH. cr-~ror^lIr'~ P ') 'If X 14 C(;LlIM~]f. r:>,104' _n (.) . f . -, - ;:l~. JC: POlICY NUMBE.P. .;tYi'3~(,c.j POliCY Tvf'! I NAME AND MAILING ADDRESS OJ" IN5URE 0 t s ;"' t, r (I ~ C t .~ r A" f ! r .~ i IUSA',ll l b0(' ~ ~ no s ~ r s~t. E:EF'JA~r Jt ') CA ( ~ vo POllCV PERIOD <lNCHTIONJ July 1. ll,ot 1(l IlXJ'f~A'lnNI J u I vI" 1 <.~, (. n410 I. ~,vr YS 5~'r lJ/QILJTY ----------------------------------------------------------------------------..-- EXC<SS ~l"r~,nJLf LlAPJLllY ----------------------------------------------------------------------------.. In cons ICleratlon of payment of the total premium Indiceted. th. rollcv designated herein is rene~ed by the Company for the periOd stated. subject to all the terms thereof. and enClorse~ents thereto and additional orovlslon 01 the reverse hereof. 'I . ' Numb~r of Volunteers ~ate Per Volunteer S Renewal Pre~lum S Itl 2.75 112.75 ~J~I'U~ PRErI~~: S 5~.00 ----------------------------------------------------------------------------- 513 ~AL TI"'C~f. ~r COCE 6670 10[\ HTF CJ,.'1 1~7. CASA~I-4 SC2 , , ~ /"". C'---... /' / . . ._._,,,._,~/ ......".:/.) - ---------~~--------------------- l~,uthorized 5lgr;,turel HI.UY F Cl'STIS Il~ I SIGNATURE Of AUTHORIZED REPRESENTATIVE - "'''. ........ ....'" " P, ~~ ,.;~". 'I~: !TT~': ~_. .. ,"; ~ ~.~;. '~l';"; ..;:'\.:I~S I:'-JC ~ I ","11 1.~.. , ,..s........ct ._.:_(_, .....0 ..Gt..... .,~.. ......ACe-'... It.....Ct!. C::::....::...~f ".Su~""Cl '-l.."..,,[....[...-......c ,:.'f" ~~ .,-:." l !.r<>v'{_rs. ,r.;c .,..(_," ....... :.::..!o..\......"...:-.c..,...,!......~.:~ ME/'IORHIOUII D.\ iE : January, 1989 TC: Project Directors f'..8,M: Laurie S. Coleman. National Accounts lIanagef RE: Ol~e; ~~erlcan Volunteer Insurance Renewal ~e are pleased to enclose ycur July 1. 1988 t~ July 1. 1989 Volunteer Insurance Renewal Certificates. Ple~se remember that the Accident coverage Is continuous until cancelled; therefore you will not receive a renewal certificate for this coverage. Ycur Invoice wll I serve as evi~ence that this coverage has been renewed. I would like to take thIs o~portunlty to once a~aln thank you for your contInued participation In the Volunteer Insurance Seivlce ?rogra:n. LSC/pm I.. ;('_ '" ;"''''0'' Sf~[[' T[L.C."C"C ,,703' ,,,.)CO ....t::.......c"',,, "PO...... ~~),..."...J ,......10,). "'..-0'" '!'t..C.90~I.J