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HomeMy WebLinkAbout1992-08-25 - AGENDA REPORTS - SMTE ON AGING (2)CONSENT CALENDAR DATE: AUGUST 25, 1992 AGENDA REPORT City Manager App Item to be press: Raquel Garcia SUBJECT: SANTA CLARITA VALLEY COMMITTEE ON AGING CORPORATION AGREEMENT DEPARTMENT: PARKS AND RECREATION BACKGROUND On May 26, 1992, Council approved the submission of the City's Final Statement and projected use of funds for the Community Development Block Grant program for FY 92-93. The City has recently executed its Grant Agreement with the U.S. Department of Housing and Urban Development for these funds. The Santa Clarita Valley (SCV) Committee on'Aging Corporation was one of the subrecipients approved, by City Council for funding in the amount of $48,000. During the fiscal year 92-93, City CDBG funds will assist the Santa Clarita Valley Committee on Aging to provide housing information and consumer education at the Santa Clarita Valley Senior Center to low and moderate income seniors at risk of.being institutionalized. In FY 91-92, City CDBG funds also assisted the SCV Committee on Aging Corporation in the provision for Health and Wellness services. As part of the City's FY 92-93 budget process, the City allocated $75,000 -from the general fund to continue this facet of the program originally assisted with CDBG dollars. The attached Summary of Contract Service Units and Actual Performance illustrates the increase in service units between contract and actual units in FY 91-92 and provides percentages of change in contract units from FY 91/92 to 92/93. In FY 92-93, the City's CDBG allocation will assist in funding services for -housing information and consumer education program components only. The City's CDBG program does.not fund participants who reside in the unincorporated area outside the City. City staff is concerned about the return on the City's CDBG grant allocation of $48,000. Although the City understands the financial needs of SCV Committee on Aging Corporation for funding, the return on this grant subsidy is very intangible. In keeping a good and supportive working relationship with the SCV Committee on Aging Corporation, staff recommends that the City begin to work with the SCV Committee on Aging Corporation to explore and develop other opportunities for. services which are more tangible and meet the multi -faceted needs of our low and moderate income seniors of our community. City Council to direct staff to execute Agreement between the City and the SCV Committee on Aging Corporation in the amount of $48,000, and begin to work .with the Committee to explore other program services. Agenda Item: I A I I I I I I GNORE ATTACHMENTS Summary of Contract Service Units and Actual Performance Santa Clarita Valley Committee on Aging Corporation Agreement RG:PRCOUNC.sle.170 SCV Committee on Aging Corporation SCV Senior Center Services Program Summary of Contract Service Units and Actual Performance *4,393 contacts represent approximately 98 persons RG:slc.648 91/92 91/92 Proposed X Change in Contract Actual Contract Contract Units Service Units Performance Units 92/93 from 91/92 to 92/93 I. CONSUMER HOUSING INFORMATION a. Housing Info. and Referral 216 390 .200 -7X b. Consumer Education Seminar 100 118 80 -202 c. Comprehensive Assessments 240 941 400 +672 d. Apartment Manager Training (1• time) 20 22 20 N/C e. Community Housing Resource Manual Update 1 1 1 N/C II. HEALTH 6 VELLNESS a. Lectures 480• 911 0 -1002 b. Blood Pressure Checks 600 1090 0 -1002 c. Exercise (Sit -N -B -Fit) 2000 4393* 0 -1002 d. Support Groups 960 1425 0 -1002 e. Health Fair 200 304 0 -100X- f. Flu Shot Clinic 100 179 0 -1002 g. Staff/Peer Counselor Training (sessions) 24 39 0 -1002 *4,393 contacts represent approximately 98 persons RG:slc.648 AGREEMENT BETWEEN THE CITY OF SANTA CLARITA AND SANTA CLARITA VALLEY COMMITTEE ON AGING CORPORATION FOR THE IMPLEMENTATION OF THE SENIOR CENTER SERVICES PROGRAM THIS AGREEMENT is made and entered into in the City of Santa Clarita, California, by and between the CITY OF SANTA CLARITA, hereinafter referred to as "City" and SANTA CLARITA VALLEY COMMITTEE ON AGING CORPORATION, hereinafter referred to as "Subrecipient." RECITALS WHEREAS, the City of Santa Clarita supports the national objective of the Housing and Community Development Act (HCDA) of 1974, as amended, which provides for the development of viable urban communities by providing for decent housing and a suitable living environment and expanding economic opportunities, principally for persons of low and moderate income; and WHEREAS, City has entered into an Agreement with the U.S. Housing and Urban Development Department (HUD) to execute the City's Community Development Block Grant Program (CDBG Agreement) under Title I of the Housing Community Development Act of 1974, as amended, hereinafter called the "Act," and WHEREAS, Subrecipient desires to participate in said program and is qualified by reason of experience, preparation, organization, staffing and facilities to provide services. NOW, THEREFORE, the parties hereto agree as follows: 1. AGREEMENT. ,This Agreement consists of this. Agreement and attachments: Exhibit A, Project Description and Exhibit B, Budget. 1 IVGOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, C 2186-5826 PCN:24142&U WORKERS' COMPENSATION AND/ MPLOYERS' LIABILITY INSURANCE POLICY PENDING RATE CHANGE EN96RSEMENT PolieyNo: PWC -113568-01 A rate change Filing is being considered by �e proper regulatory authority. The filing may result in rates different from the rates shown on the p7the . If it does, we will issue an endorsement to show the new rates and their effective date. If only one state is shown in item 3A9Information Page, this endorsement applies to that state. If more than one state is shown there, this e9dorsement applies only in the state shown in the Schedule. State WC 520 47192) Insured's Copy 2. STATEMENT OF WORK. Subrecipient is to perform all the servicesset forth in the Exhibit A, Project Description, to this Agreement, a copy of which is attached hereto and incorporated herein by this reference. 3. TIME OF PERFORMANCE. Upon execution of this Agreement between the City and Subrecipient, said services are to commence and shall be completed no later than June 30, 1993. 4. AGREEMENT ADMINISTRATION. Hereinafter called "City Project Coordinator," or his designee, shall have full authority to act for City in the administration of this Agreement consistent with the provisions contained herein. 5. COMPENSATION AND METHOD OF PAYMENT. The City will pay Subrecipient an amount not exceeding the sum of forty eight thousand and no/100 dollars ($48,000), which paymen)t shall constitute full and complete compensation for Subrecipient's services under this Agreement. As detailed in Exhibit A, Project Description, and Exhibit B,' Budget of this Agreement. Said compensation will be paid by the City from Community Development Block Grant (CDBG) Funds for Fiscal Year 1992/93. The City. will reimburse Subrecipient for proceeding months expenses incurred for services as described in Exhibit A, Project Description, and Exhibit B, Budget, in an amount not to exceed four thousand eight hundred dollars ($4,800) per month. On or before the 15th day of each calendar month starting with the calendar month of September 1992, the Subrecipient shall submit.to the City a payment invoice and monthly progress report for the Subrecipient's previous months expenses and program activity. Said payment invoice shall give the total monthly expenses owed to Subrecipient, and shall also itemize the same detail conforming to the Exhibit B, Budget, of this Fa Agreement. In order for payment to be processed and expenses reimbursed, invoice and reports shall be submitted with all supporting documentation and shall be satisfactory to the City. The City will issue payment according to the City's established demand warrant schedule and corresponding warrant deadlines; no exceptions will be made. In the event the Subrecipient exceeds allowable monthly allotment of $4,800, a written addendum to the invoice stating the reason will be attached. Payment of additional sums will be subject to City approval and the CDBG Agreement. In accordance with Section 49,,any•funds received by the Subrecipient , and not expended for expenses incurred during the term of this Agreement, shall be promptly returned to the City upon the expiration of the term of this Agreement. Subrecipient-may also be eligible for reimbursement of certain pre -agreement _costs incurred prior to the. execution of this Agreement. Pre -agreement costs are eligible as •specifically allowed under HUD regulations, 24 CFR, Section 570.200(h) and are reimbursable to Subrecipient after the execution of this Agreement. 6. BUDGET SECTION. Expenditures made by the Subrecipient in the. implementation of this Agreement shall be in strict conformity with Exhibit B, Budget, and the U.S. Office of Management and Budget Circulars, A-110 and A-122, which is attached hereto and incorporated herein by this reference. No more than the amount specified may be spent for the separate cost categories. Any modifications. to the budget require prior written approval from the City Project Coordinator and are allowable as specified in Section 29 of this Agreement. 7. COMPLIANCE WITH LAWS. The Subrecipient agrees to comply with all applicable Federal, State and local laws, rules and regulations, E1 ordinances and policies as they pertain to the performance of this Agreement. As a recipient of Federal CDBG Funds through a local government the Subrecipient is subject to adhering to the provisions and regulatory requirements of Title I of the Housing and Community Development Act of 1974 as amended, Federal Regulations 24, Part 570, or common rule to the CDBG entitlement programs,.specifically set forth 24 CFR 570.503, and other program requirements at Sub part K, with the .exception of Subrecipient does not assume the grantee's environmental responsibilities described at Section 570.604 and does 'not assume the grantee's responsibility for initiating the intergovernmental process of Executive Order 123721 described at Section 570.62, 24. CFR Part 85, "Administrative Requirements for Grants. and Cooperative Agreements to State, Local and Federally recognized Indian Tribal Governments", U.S. Office of Management and Budget Circulars (OMB) A-110, "Grants and Agreements with Institutions of Higher Education, Hospitals, and other Non-profit Organizations", OMB Circular A-122 "Cost Principles for Non-profit Organizations", OMB Circular A-133 "Audits of Institutions of Higher Education and Other Non-profit Institutions". 8. RELATIONSHIP OF PARTIES. Subrecipient will be acting in .an independent capacity and not as an agent, employee, partner, joint venturer, or associate of the City. The employees or agents of Subrecipient shall not be deemed or construed to' be the agent or employees of the City for any purpose whatsoever. 9. INSURANCE. Without limiting Subrecipient's indemnification of the City, Subrecipient shall obtain and maintain.at its.own.expense during the term of this Agreement, a program of insurance satisfactory to the City's 4 Risk Manager covering its operations hereunder as specifically defined in Exhibit A, Project Description, of this Agreement. The following minimum insurance limits shall apply: a. Worker's Comnensation. Subrecipient shall carry adequate Worker's Compensation at its sole expense, for its employees as required by California law, in an amount not less than $ 250,000 per occurrence. b. Liability Insurance. During the -entire term of this agreement, Subrecipient agrees to procure and maintain General/Public and Professional public liability insurance at its sole expense to protect against loss from liability imposed by law for damages on account of.bodily injury, including death therefrom, suffered or alleged to be suffered by any person or persons whomsoever, resulting directly or indirectly frpm any act or activities of the City or Subrecipient, its employees or any personacting for the City, or Subrecipient or under its control or direction, and also to protect against loss from liability imposed by law for damages to any property of any person caused directly or indirectly by or from acts or activities of the City, or Subrecipient, or its employees, or any person acting for the City or Subrecipient, or under its control or direction. Such public liability and property damage insurance shall also provide for and protect the City against incurring any legal cost in defending claims for alleged loss. Such public liability and property damage insurance shall also provide for and protect the City against incurring any legal cost in defending claims for alleged loss. Such General, Public and Professional.liability and property damage insurance shall be maintained in full force and effept throughout the term of the Agreement and any extension thereof in the following minimum limits: A combined single limit policy with coverage limits in the amount of $1,000,000 (one million dollars) per occurrence will be considered equivalent tot he.required minimum limits. c. Automotive Insurance. The Subrecipient shall procure and maintain, at its sole expense, throughout the term of this agreement and any extension thereof public liability and property damage 'insurance coverage for automotive equipment with coverage limits of not less than $500,000 (five hundred thousand dollars) combined single limit. All such insurance shall be primary insurance and shall name the City of Santa Clarita as an additional insured. d. Blanket Honesty Bond. Subrecipient shall carry a Blanket Honesty Bond at its sole expense, in. an amount of at least 504 of the contract amount or $25,000 (twenty five thousand dollars) whichever is less. e. Additional Insured. Concurrent with the execution. of this Agreement, Subrecipient shall provide the City with a certificate or certificates of such insurance naming the City as additional insured. f. Property Coverage. Subrecipient shall carry insurance to insure owned real property for replacement cost against fire, and extended coverage including vandalism and malicious mischief. g. Cancellation. All of the aforementioned policies of insurance shall contain a provision rendering the policy not subject to cancellation except upon 30 days written notice to both Subrecipient and City. 10. FAILURE TO PROCURE INSURANCE. Failure on the part of Subrecipient to procure or maintain required insurance shall constitute a material breach of Agreement 'under which City may immediately terminate this Agreement or, at its discretion, procure or renew such insurance and pay 11 any and all premiums in connection therewith, and all monies so paid by City shall be repaid by Subrecipient to City upon demand or City may offset the cost of the premiums against any monies due to Subrecipient from City, 11. INDEMNIFICATION AND HOLD HARMLESS. Subrecipient agrees to indemnify, defend with Council approved City, and holds harmless City, its agents, employees and elected and appointed officers, from and against any and all damages, claims, liabilities, costs, suits or expenses arising out of any act omission of Subrecipient or any agent or employee of Subrecipient or resulting from any condition of property owned- or controlled by the Subrecipient arising from or connected in any way with Subrecipient's operation, or its services hereunder. Subrecipient agrees to reimburse the City for any expenditures, including reasonable attorney fees incurred by the City in defending against claims ultimately determined to be due to negligent acts, errors or omissions of Subrecipient. 12. PROGRAM EVALUATION AND REVIEW. The City will monitor, evaluate and provide guidance to Subrecipient in the performance of this agreement. Authorized representatives of the ,City and HUD shall have the right of access to all activities and facilities operated by the Subrecipient under this agreement. Facilities include all files, financial and performance records and all other documents pertaining to the performance of this Agreement. Activities include attendance of staff, board of directors, advisory committee meetings, interviewing of Subrecipient and Program Participants and observation of ongoing program functions and operations. Subrecipient will ensure the cooperation of its' staff and board members in such efforts. The City Project Coordinator or his/her designee will conduct periodic program progress reviews. These reviews will focus on the extend to which the planned program has been implemented and work 7 measurement goals achieved, effectiveness of program management, impact of the program and accountability to Federal rules, regulations and laws. If any program file review or financial audit determine- observation of a significant finding(s) which would cause a disallowance of an expenditure of an activity or service performed by the'Subrecipient which is deemed ineligible by the review or audit, the Subrecipient would be responsible for reimbursing the City the total cost of the disallowance. 13. EXPENDABLE PERSONAL PROPERTY. Expendable personal property refers to all tangible personal property other than nonexpendable personal property. Upon termination of this Agreement, if. purchased expendable' property has an aggregate value of One Thousand Dollars ($1,000) or more any sale of said property must be preapproved in writing by the City Project Coordinator or his designee. 14. NONEXPENDABLE -PROPERTY. A record shall be maintained for each item of nonexpendable property acquired consistent with the property management standards set forth in 41 Federal Register 146, Attachment N, Circular No A-110. This record shall be provided. tot he City upon each purchase. Nonexpendable property shall include onlytangible personal property. Nonexpendable personal property means tangible personal property having a useful life of more than one year and an acquisition cost of three hundred dollars ($300) or more per unit. Any sale or other use or disposition of nonexpendable property having a unit acquisition cost of one thousand ($1,000) dollars or more must have prior approval of the City and otherwise comply with all applicable laws and regulations including without limitation Circular Ar110. :In case of the Agreement's termination, the City reserves the right to determine the final disposition of said 0 nonexpendable property acquired for this program including funds derived therefrom. Said.disposition may include.the City taking possession of said nonexpendable property. 15. PURCHASE OR LEASE OF NONEXPENDABLE PROPERTY OR EQUIPMENT. Subrecipient shall obtain three (3) written documented bids prior to purchasing or leasing any nonexpendable personal property or equipment as approved in the -Budget, Exhibit B. Bids shall require approval of the City Project Director prior to purchase of lease price of over Three Hundred Dollars ($300) in unit value and having a life expectancy of more than one (1) year shall be properly identified and inventoried and shall be charged at its actual price deducting all cash discounts, rebates, and allowances received by Subrecipient. This inventory shall be provided to the'City upon request, records on non -expendable property acquired with federal funds shall be retained with three (3) years after its final. disposition. 16. ALLOWANCES FOR LEASE OR RENTAL OF VEHICLE AND EQUIPMENT SPACE. The City will approve vehicle/or equipment space requirements necessary for Agreement performances, at costs using prevailing area rates and space allocations. Vehicle lease or rental expenses shall be prorated to reflect only the proportional use attributable to work performed under this Agreement. The City will -not reimburse expenses incurred while performing activities under contract for other agencies. 17. ACCOUNTING. Subrecipient must.establish and maintain on a current basis an adequate accrual accounting system in accordance with generally accepted accounting principles and standards. 18. AFFIRMATIVE ACTION. Subrecipient shall make every effort to ensure that all projects funded wholly or in part by CDBG funds shall 9 provide equal employment and career advancement opportunities for minorities and women. In addition, Subrecipient shall make every effort to employ low and moderate income persons residing within the community for positions that have been created directly or as a result of this program. 19. CHANGES. The City may, from time to time, request changes in the Scope of Services of Subrecipient to be performed hereunder. Such changes, including any increase or decrease in the amount of Subrecipient's compensation, which are agreed upon by and between' the City and Subrecipient shall be incorporated into this Agreement by written amendments. 20. CHANGES IN GRANT ALLOCATION. The City reserves the right to reduce the grant allocation- when the City's fiscal monitoring indicates that Subrecipient's rate of expenditure will result in unspent funds at the end of the program year. Changes in the grant allocation made after Agreement execution will be incorporated into this Agreement by written amendments and may require an amendment to the City's Final Statement. 21. JOINT FUNDING. For programs in which there are sources of funds in addition to those identified in Exhibit B, Budget,Subrecipient shall provide documentation detailing percentages of CDBG and non CDBG allocations as part of the Budget. The City shall not pay for any services paid for by Subrecipient which are funded by other sources and are not within the City limits. All restrictions and/or requirements relative to accounting, budgeting and reporting apply to the total program regardless of funding sources. 22. PROGRAM INCOME. Program Income as defined in 24 CFR 570.500 and 570.504(c) shall be recorded as part of the financial transactions of the 10 U Senior Center program and shall be returned to the City. 23. ASSURANCES. Subrecipient hereby assures and certifies that it has complied with the Act, applicable regulations, policies, guidelines and requirements, OMB, Circular A-110, A-122 and A-133, and that it will comply with all applicable Federal, State and City laws and regulations as they relate to acceptance and use of Federal funds for this Federally assisted program. Furthermore, Subrecipient gives assurances and certifies that it will comply with the provisions of 41 Code of Federal Regulation 60-1.4, 24 CFR 570.502, and 24 Code of Federal Regulations 135.20 each of which are incorporated herein by this reference. Subrecipient further assures and certifies that it will comply with any future amendments for changes to said required assurances and that during the term of this Agreement will maintain current copies of said assurances at the address specified in Section 24 below. 24. NOTICES. All notices shall be served in writing. The Notices to Subrecipient shall be sent to the following address: Program Coordinator, Santa Clarita Valley Committee on Aging Corporation, 22900 Market Street, Santa Clarita, CA 91321. Notices, reports and statements to the .City shall be delivered or sent to City Project Coordinator or his designee at 23920 Valencia Boulevard, Suite 125, Santa Clarita, CA 91355. 25. NON ASSIGNABILITY. The services to be rendered to the public pursuant to this agreement by the Subrecipient or considered to be unique, personal services and the Subrecipient shall not assign, delegate, sub contract, transfer or otherwise substitute its interest or obligations in this Agreement without the prior written consent of the City. 26. TERMINATION AND TERMINATION COSTS. This Agreement may be terminated at any time by either party without cause upon giving thirty 11 0 (30) days written notice. City may immediately terminate this Agreement by written notice upon the termination, suspension, discontinuation or substantial reduction in CDBG funding for the Agreement activity,.or if for any reason the, timely completion of the work.. under this, Agreement is rendered improbable, infeasible or impossible or when both parties agree that the continuation with the program would not produce beneficial results commensurate with the further expenditures of funds. In such event. Subrecipient shall be compensated for all services rendered and all necessarily incurred costs performed in good faith.in accordance with the terms of this Agreement that have not been previously reimbursed, to the date of said termination to the extent CDBG funds are available. In accordance with 24 CFR 85.43, suspension or termination may occur if the subrecipient materially fails to comply with any term of the award and the award may be terminated.for convenience in accordance with 24 CFR 85.44. 27. FISCAL LIMITATIONS. The United States of America through BUD in the future may place programmatic fiscal limitation(s) on CDBG funds not presently anticipated. Accordingly, the City reserves the right to.revise this Agreement in order to take into.account actions affecting BUD program funding. In the event of funding reduction, the.City may reduce the budget of this Agreement as a whole or as a cost category, may limit the rate of Subrecipient's authority to commit and spend funds, or', may restrict Subrecipient's use of both its uncommitted and its unspent funds. Where HUD has directed or requested the City to implement a reduction in funding, in whole or as to cost category, with respect to funding for .this Agreement, City Project Coordinator may act for the City in implementing and effecting such a reduction and in.revising the Agreement for such 22 U purpose. Where City Project Coordinator has reasonable grounds to question the fiscal accountability, financial soundness, or compliance with this Agreement of Subrecipient, City Project Coordinator may act for the City in suspending the operation of this Agreement or up to Thirty (30) days upon three (3) days' written notice to Subrecipient of his intention to so act, pending an audit or other resolution of such questions. In no event, however, shall any revision made by the City affect expenditures and legally binding commitments made by Subrecipient before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable .and. that .such commitments are consistent with HUD cash withdrawal guidelines. 28. USE OF FUNDS FOR ENTERTAINMENT. MEAL, OR GIFTS. Subrecipient certifies and agrees that it will not use funds.provided through this Agreement to pay for entertainment; meals, or gifts. 29. CONFLICT OF INTEREST. The Subrecipient shall maintain a code for standards of conduct that will govern the performance of its officers, employees or agents engaged in the awarding and administration of contracts using Federal funds. No employee, officer or agent shall participate in the selection, award or administration of a contract in which Federal funds are used if a conflict of interest; real or apparent would be involved. 30. PROHIBITION AGAINST DISCRIMINATION AND DENIAL OF BENEFITS. Subrecipient will comply with Title . VIII of the Civil Rights Act of 1968, 42 U.S.C. 3801, amended by Title I of the Housing and Community Development Act of 1974 which prohibits against discrimination, exclusion of participation, or denial of benefits on the grounds of race, creed, color or national origin, familial status or disability. 13 31. BUDGET MODIFICATIONS. City Project Coordinator or his designee may grant budget modifications to this Agreement for the movement of funds within the budget categories identified in Exhibit B, Budget, when such modification: a. Do not exceed $10,000 per budget cost category; b. Are specifically requested by Subrecipient; C. Do not alter the amount of compensation with this Agreement; d. Will not change the project goals or scope of services; e. Are in the best interest of the City and Subrecipient in performing the scope of services, under this Agreement; f. Related to salaries, are in accordance with applicable salary ordinances or laws; and g. City Project Coordinator subject to the restrictions in Sections 27 and 28 may authorize reallocation of Budget line items and other items within the Agreement; Exhibit B, Budget. h. ,Is consistent with the CDBG Agreement. 32. TIME OF' PERFORMANCE MODIFICATIONS. City Project Coordinator may grant time of performance modifications to this Agreement (see Section 3) when such modifications: a. In aggregate do not exceed twelve (12) calendar months and; b. Are specifically requested by Subrecipient in writing. 33. AUDIT EXCEPTIONS BY STATE AND FEDERAL AGENCIES. Subrecipient agrees that in the event the. program established hereunder is subject to audit exceptions by appropriate State and Federal audit agencies, it shall be responsible for complying with such exceptions and paying the U.S. Department of Housing and Urban Development the full amount of City's 14 liability to the funding agency resulting from such audit exceptions. 34. PURCHASE AND INVOICE DEADLINES. Purchase of equipment and supplies must be completed before the last month of the Agreement period and all equipment and supply bills are to be paid before the last month of this period. Invoices for all obligations incurred under this Agreement must be submitted to the City within sixty (60) days from when the indebtedness is incurred or they may be subject to disallowance. Payment invoices which have not been submitted for payment prior to the termination date.of this Agreement, must be forwarded to the City with thirty (30) days after the Agreement termination date or they. may not be honored. Exceptions to the preceding limitations require prior written approval by City Project Coordinator or his/her designee. 35. ACQUISITION OF SUPPLIES AND EQUIPMENT. Following approval by the City for necessary supplies and equipment for Agreement performance, Subrecipient may purchase from a related agency/organization only if: (a) prior authorization is obtained in writing from the City; (b) no more than maximum prices or charges are made and no less than minimum specifications are met as provided in writing by the City; (c) a community related benefit is derived from such Subrecipient related acquisition; and (d) no conflict of interest for private gain accrues to Subrecipient or its employees, agents or officers. 36. AUDITS. Subrecipient program as provided under this agreement will be audited in accordance with City policies .and Federal guidelines as outlined on OMB Circular A-133 and Attachment F of OMB Circular A-110. The City or its authorized representatives shall, at all times, have access for the purpose of audit or inspection to any and all books, documents, papers, 15 records, property, and premises of Subrecipient. Subrecipient's staff will cooperate fully with authorized auditors when they: conduct audits and examinations of program. If indications of misappropriation or misapplication of the fund of this Agreement -cause the City to require a special audit, the cost of the audit will be encumbered and deducted from this Agreement budget. Should the City subsequently determine that the special audit was not warranted, the amount encumbered will be restored to the .Agreement budget. The City Project Coordinator or designee shall request a copy of the Subrecipient's financial audit for activities performed under this Agreement at the expiration of the final phase out period. 37. FINANCIAL PHASE OUT PERIOD. Subrecipient agrees to complete all necessary financial phase out procedures required by the City Project Coordinator within period of not more that forty-five (45) calendar days from the expiration date of this Agreement. This time period will be referred to as the financial phase out period. The City is notliable to provide reimbursement for any expenses or costs associated with this Agreement after the expiration of the financial phase out period. After the expiration of the financial phase out period, .those funds not paid to Subrecipient under this Agreement, if any, may be immediately reprogrammed by City into other eligible activities in the City. 38. PERSONNEL POLICIES. City may. review Subrecipient'spersonnel policies and may make available to Subrecipient personnel policies developed by City. City personnel policies are optional with Subrecipient, unless City verifies 'personnel management problems during the Agreement period, in which instance City's Project Coordinator may require use of City developed personnel practices, including use of City Personnel Policies, as a condition of continued funding of the Agreement. Personnel policies include, but are not limited to, staff size and levels, salaries, supervisory -subordinate ratios, consultant fees, fringe benefits and other related matters. 39. NEPOTISM. Subrecipient shall not hire nor permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by Subrecipient. For the purposes of this section, the term "immediate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, step-parent, and step -child. The term "administrative capacity" means having selection, hiring, supervisory or management responsibilities, including serving on the governing body of Subrecipient. 40. RELIGIOUS AND POLITICAL ACTIVITIES. Subrecipient agrees that funds under this Agreement, will be used exclusively for performance of the services required under this Agreement, and that no funds made available under this Agreement shall be used to promote religious or political activities in connection with the performance of this Agreement. 41. OUTSIDE EMPLOYMENT. In its written personnel policies, Subrecipient shall include the following provisions governing outside employment of its employees: a. Such employment shall not interfere with efficient performance of the employee's dutibs in the program of this Agreement; b. Such employment shall not involve a conflict of interest or an 17 appearance of conflict with the employee's duties in the program of this Agreement; c. Such employment shall not involve the performance of duties which the employee should perform as part.of his employment in the program of this Agreement; and d. Such employment shall not occur during the employee's regular or assigned working hours in the program of this Agreement, unless during the entire day on which such employment occurs, the employee is on vacation, compensatory leave or leave without pay. Subrecipient shall establish effective procedures to enforce these provisions and must provide_ specific procedures regarding outside employment'of its full-time personnel whose duties are not readily confined to a standard work -day or work -week. Personnel includes, but .is not limited to, Executive Directors, neighborhood workers, and other employees whose responsibilities may require them to be available for duty during evenings or on weekends. 42. STAFF- TRAVEL. Subrecipient shall not incur any expenditures for travel outside of Los Angeles County, without prior written approval of City. 43. USE OF FUNDS. All funds approved under this Agreement shall be used solely for costs approved in the program budget for this Agreement. Agreement funds shall not be used as a cash advancement,. to guarantee payments for any non -program obligations, or as loans for non -program activities. Separate financial and program records shall be kept for each funding source. ' 44. RETENTION OF AND ACCESS TO RECORDS. The City, HUD or any other duly authorized representative shall have the right of access to any books, 18 0 documents, papers and records of the Subrecipient which are directly pertinent to the contract for the purpose of making audit or examination, for three years after final payments and all other: pending matters are closed. 45. ATTORNEY FEES. In the event legal proceedings are necessary to enforce the terms, provisions or conditions of this Agreement, the prevailing party in such legal proceeding shall be entitles to recover reasonable attorney fees. 46. REVERSION OF ASSETS. Subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration of ,Agreement and any accounts receivable attributable to the use of CDBG funds. An audit may be required of Subrecipient in accordance with Section 34, Audits of this Agreement. Subrecipient will ensure that any real property under the Subrecipient's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000 is either: 1. Used to meet one of the national objectives until five years after expiration of the Agreement, or for such longer period of time as determined to be appropriate by City; or 2. Disposed of in a manner that results in the Subrecipient being reimbursed in the amount of the current fair market value of the property. less any portion of the .value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property. . 47. EXTENT OF AGREEMENT. This writing constitutes the entire agreement between the City and Subrecipient. There are no oral agreements or amendments between de parties. This Agreement shall not be amended, except in writing, executed by both parties to this Agreement. 19 Executed on this at the City of Santa.Clarita. Donna Grindey City Clerk Approved as to form: Carl Newton City Attorney RG:slc.637 day of . 1992 Jill Rlajic Mayor of Santa.Clarita Committee on Aging Corporation (EXHIBIT A) Project Description Purpose and Benificiarles The purpose of the proposed project is to provide assistance to low and moderate income senior citizens who are at risk of being Institutionalized: and also provide support services that will Increase their chances of remaining in their homes or help them relocate to the least restrictive alternative when living arrangements must be changed: and to assist the elderly and others at risk in accessing services and benefits currently available in the community.and the.Los Angeles area. Content and operation The Santa Clarita Valley Committee on Aging corporation, 22900 Market Street, Santa Clarita, California 91321, Telephone number 805-259-9444, or 805-255-1588 will provide, under the supervision of the City of Santa Clarita: all labor, equipment, supplies administrative support, community outreach and determination of eligibility for program participation and documentation for implementation of a ^senior focal point, services program". The program shall focus on five major components: Housing Information and Referrals, Consumer Education, Comprehensive Assessments, Housing Resource manuals and.Geriatrics Training. These components will promote dignity, understanding and a more supportive environment that allows for accessibility of eligible participants. - An "eligible participant" is defined as a household.consisting of one or more persons who occupy a single family home or apartment where the household income does not exceed the low to moderate income limits established by the United states Department of Housing and Urban Development. At the time eligibility for participation is determined. Applicants may participate in the Program year round. A) Community Outreach A marketing and community networking program is in place and will be enhanced to. provide awareness of the a program throughout the service area. Outreach will help identify and inform potential program participants. Flyers, press releases, newsletters and other similar written materials will be prepared and distributed. B) screening participants Potential participants who make inquiries will be counseled to the extent of services which can be offered or performed, advised of eligibility requirements and of application procedures. The following services will be provided: 1) Housing Information and Referral Consumer Housing Information and Referral services will assist low to moderate income senior citizens; younger adults and disabled persons who are looking for a suitable living environment, or are seeking ways to "age in place" and remain In their existing homes. It is critical that people have access to information that enable them to weigh the advantage and disadvantages, risks and benefits of various housing options that allow them to age in place in the .most appropriate and least restrictive environment. Participants will be enabled to make their own informed decision about housing situations after full consideration of their, options. Housing specialists -will provide pertinent information in a comprehensive, accurate and impartial manner. STAFFING OF TIME CHARGED TO CDBG - - Supportive services Director Health & Wellness'Coordinator Case Worker Home Delivered Meals Assessor/Case Worker Telephone Receptionist I&R/Housing Specialist.(Title V) Volunteer coordinator Volunteers (Peer counselors, office Helpers) Bi -lingual Case worker social Worker 4% 6% 7%. 2% 4.25% 45% 1% 10% 22% 16% 2) Consumer Education Seminars Informational lectures and forums will be provided for the community and in particular for senors and their families. This consumer education will assist in developing. strategies, maximize existing housing resources and access support service; allowing seniors to remain safely at home and becoming an education and informed consumer. Seminar topics might include: Home Safety and Security Improving Landlord -Tenant Relationships Guarding Against cold and Heat Home Weatherization conserving Energy Consumer.Fraud Handyman Program (Home Repairs) _ Supportive Housing Staying in Your Home - Supportive Services Protecting.Your Assets Earthquake Preparedness Fair Housing Act and How it Relates to you STAFFING Supportive Services Director Health a Wellness Coordinator W x OF TIME CHARGED TO CDBC 2% 13% __' 3) Comprehensive Assessments Will be done on those having multiple and complex needs. The assessment would collect information regarding the client to identify the need, determine the necessary supportive service to address that need, and arrange for clients to receive the benefits .of these supportive service. These services include; a) Forms completion - Many seniors are fearful of and overwhelmed by paperwork. A very large percentage of seniors lose out on needed benefits simply because they cannot fill out the necessary paperwork. For instance, the current application for Medi -Cal insurance is 14 pages long and quite intimidating. Trained case workers would assist seniors. and disabled persons through the paperwork maze. This service alone ensures accessibility to benefits for many people who would otherwise lose out. b) Advocacy - Trained staff advocate for the right of older _ persons by action on their behalf. All legal .matters are referred for legal assistance. Advocacy is much like forms completion, the advocates 'help clients work through the bureaucratic maze of such benefits as social security, Medi -Cal, consumer problems, etc. c) Financial and Benefits Counseling - Many seniors are not aware of the variety of benefits that they are entitled to. An extraordinary example of this is : a low income senior.could be eligible for four different rebates or credits that would assist them with their utility bills each year. These credits and rebates can literally be life savers for the individual whose only -income is $650.00 per month. d) Information and Referral - This service is designed to link older persons who need assistance to the appropriate service delivery entit. caseworkers provide information based on clients needs, resources or requests; this I and R is generally community based but can. be county -wide. When referrals are made, appropriate agencies are contacted by the Information Specialist or Case worker to make arrangements and/or appointments. Follow-up and evaluation provides closure on the case- and ensures efficient and positive operations on behalf of the client. STAFFING 3 OF TIME ' CHARGED TO CDBG Supportive Services Director 73 Health & wellness Coordinator 12.63 Case Worker 323 HDM Assessor/Case Worker 28 Telephone Receptionist 4.253 I & R/ Housing Specialist (Title V) 153 Volunteers (Peer Counselors, Office Personnel) 203 Bi -lingual Case Worker 183 Social Worker 163 FA 4) 5) 6) Gerontological Seminar/Training An all day seminar focusing on gerontological issues and how they relate to management will be coordinated by the Santa Clarita Senior Center and will be available to employees and managers of Housing and Urban Development buildings and other housing projects where seniors and disabled people reside. STAFFING % OF TIME IN SERVICE Supportive Services Director 63 Consultant/Facilitator 1003 Housing Manual A guide to Local Housing Resources for Older Persons will be updated each year and distributed to the community. This guide is a comprehensive community resource directory.. The updated manual is an essential component to the CHISS program. The guide is also an -essential training tool for specialists who work in the program. Information must be complete, accurate and up-to-date. The resource guide is informational/descriptive and does not imply any rating or endorsement. The manual will be completed as follows: -data is collected- from available sources in the community, county.and state. - a list is created for those that are currently no available - assistance will be solicited will address unmet housing need —350 copies will be printed STAFFING ,Supportive Servies Director C.H.I.S.S. Editor Administration Executive Director Secretary Statistician Administrative. Director Payroll Clerk Clerk counter Supportive Services Director Activity Coordinator Other Custodian 5 Information and services from existing sources. from the CHISS coalition s in the community 3., OF TIME I CHARGED TO.CDBG 33 1003 83 3.33 83 63 2.53 13 123 53 53 C) D) Procurement of Services Procureme t of employees nof hescontractonot rrovishalld beya persons who are the city and shall conform with the prequirementsproveIn v of adby vance Circular A-110 and Circular A-122. A Minimum bids shall be solicited with the service ag eementree awardedtto the lowest responsible bidder. Copies of all related documentation in the procurement of outside service shall be transmitted to the City. DocUmentatIon of Reports Detailed records will be kept on each client served, .noting name of beneficiary, address, providedcensus tract, type of services hours wor. Employee recordsked and rate of pay, will be maintained, Including on a monthly basis, the . monthl_.contractor will provide performance andy account of reports personnel, travel, space, equipmactual expenditures for ent/supplies, and any other expenditures, and accompanied by any other appropriate .expenditure documentation, as required by the U.S. and Urban Development Department and the City. Housing SANTA CLUITA VALLEY COMMITTEE ON ACINC, CORP. Saute Clarita Valley Senior Center Oraanlsatlos Chart r Advisory _ _ _ _ _ .Etecatite -Council f/irecter Not itloo I Pr Brae Centcel _ Pood Sens. ___ Dleaq Seno D1rKtor - Volunteer Activities Coordinator Coordinator So 7idFi.IL•�1={Ql bl naea DW. X13• _ Bert Psrk L I Coot it Volunteer [itches Food Sena. Aeatetent Sita Mgr. HIM Cooke 12 A 1 Packer/Driver Dlewsher Rorer Supervisor Respite WaIdAMmome Coordinator _Sockel Yorker Supervisor Clerk - Bond Cook RON Vel Verde Respite Orchard Area Yorker _ - .Driver T' 1 Assistant Site Mgr. ' RKeptlonlat ., CFI. Catry Site, Mgr, Custodian Reepito Yorker Volunteer Vol. Peer Driven Camaelora Assistant L I Coot it Volunteer Meal Packers Aeatetent HIM Cooke 12 A 1 Packer/Driver Dlewsher Rorer 11 N 12 Statistician L _ _ _ _ _-I A3delatreCtw Sup L I Dir tot a Servlces Suplutlw Saws. Director _ Secreur) WaIdAMmome Coordinator pgroll Clerk - - Yorker - Telephone ' RKeptlonlat IQeI Assessor Clerk Counter Inters /1 eiltogml ex. Ietepoe • Gee Yorkrr RamasQ Thrift Shop Intern 12 Title V Title V t I i R Receptionist tntern sass Talent" 004 6dlovc SCV COMMITTEE ON AGING CORPORATION 1 SCV SENIOR CENTER SERVICE PROGRAM WORK MEASUREMENTS FY 92-93 WORK MEASUREMENT SERVICES ANNUAL MONTHLY UNIT OF UNITS UNITS MEASUREMENT Housing Information 6 Referral 200 20 Persons Consumer Education Seminars (Lectures — 4/year) 80 -- Persons` Comprehensive Assessments 400 40 Persons Gerontological Seminar (apartment manager training) (one time only) 20 -- Persons Community Housing Resource - Manual 1 -- 1 manual up—date E3 C Santa Clarita Valley Committee on Aging Corporatic Aoency Name TARGET POPULATION I. Complete the items below concerning the 60+ population characteristics of each community in the service area. Use a separate Form A-1 for each community in you service area. SERVICE AREA: . Santa Clarita POPULATION a 5 of Persons 60+ 1 b Ace 60+ CHARACTERISTICS in Service Area In Undup icated.to be Served AI/AN (American Indian/ ) Alaskan Native) , 35 i 1 A/PI (Asian Pacific Islander) I I � 28 3 - B (Black) - 130 I 2_ H (Hispanic) 100 13 W (White) 8778 1296 TOTAL ; 9071 315 LOW INCOME � 2721 � 129 MODERATE I 6350 I 186 NOTE: "Unduplicated" is the number of different persons to be served one time during the contract year. *Note:Demographic data provided by the Area Agency On Aging 9 (EXHIBIT B) CDBG BUDGET 1992/93 CDBG SHARE 2 OF AGENCY TOTAL AMOUNT PERSONNEL & BENEFIT 7 $39956 CONSULTANTS 1 400 TRAVEL & TRAINING 16 1704 SPACE 0 0 CONSUMABLE SUPPLIES 3 848 OTHER 4 5092 . TOTAL 5 $48000 10 EXHIBIT B OTHER TOTAL 5092 1'I Z of Agency Budget (CDBG share) Budget PHONE 7 747 DUES & MEMBERSHIP g 90 OUTSIDE SERVICES 7 540 VOLUNTEER EXPENSES 2 77 LIABILITY INSURANCE 6 966 TAX & LICENSE 6 225 ADVERTISING 4.5 200 PRINTING 25 1767 R & M BUILDING 6 240 AUDIT 5 240 TOTAL 5092 1'I V.11 V1' JA.1le1 LL:1{\Lld COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM PERSO NEL JUSTIFICATION Project Title: Santa Clarita Valley Committee on Aging Corporation Project Number: 10 to Month Budget F-x7x original U 9 Amendment No. From 9-I-92 to 6-30-93 Ad veu c a.Number of Persons b.Position or Title c.Monthly Salary d.Percent of Time on . Undertaking e.Months To Be Employed f.Cost (a x c x d x e) I Executive Director $3667 8 10 , $2978 I Secretary 1127 3.3 10 378 1 Statistician 1170 8 10 950 I Administrative Director 2080 6 10 1267 1 Payroll Clerk 546 2.5 10 191 1 Clerk Counter 217 1 10 22 1 Supportive Services Director 2253 34 10 7779 1 Health & Wellness Coordinator 1941 31.6 10 6228 1 Social Worker 663 32 10 1647 1 Case Worker 1300 39 10 5148 Bi -lingual Case Worker 1320 40 10 3366 I C.H.I.S.S. Manual Editor $ I09 100 10 1276 Sub-totall $31230 12 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM PERSONNEL JUSTIFICATION Project Title: Santa Clarita Valley Committee on Aging Corporation Project Number: 1 10 (ten) Month Budget Original U Amendment No. From 9-1-92 to 6-30-93 66 ...Le a.Number of Persons b.Position or Title c.Monthly Salary d.Percent of, Time on Undertaking e.Months To Be Employed f.Cost (a x c x d x e] Nome Delivered Meal Assessor' $130G 4 10 $ 510 1 Receptionist/ Newsletter 1170 8.5 10 , 1010 I Activity Coordinatoi 1395, 5 10 708 I Volunteer Coordinaoir 784 1 10 80 1 Cnatondian $1313 5 10 $ 584 • i Unpaid Staff (in-ki ) I A R Housing Specialist '• Rlurnioounselors/ eer • Page 2 . ' Page 1 FICA 2389 SUI 634 ,Taxes WORKER^. COMP -1816 MEDICAL INSUREANCE 795 Benefits $ 2892. 31230 3223 2611 TOTAL $ 39956 __....._.. 13 Santa Clarita Valley Comnittee on Aging Corporation Agency Name STAFF DUTY STATEMENT (Complete one -tot each job category) Job Title: EXECUTIVE DIR]]CMR (use same title throughout application) (No. of P)sitions) Hours per week 30 Supervised by Whom (Job Title): MARD of DIRECIDRS - OJh21IT= ON AGING CORP Requirements for Position: 1.. B.A. Degree in social'service, public administration, gerontology or related field and minimum of three years supervisory or managerial experience in an agency. 2. Knowledge of the Aging"Nethork arra community based seryices for the elderly. 3. Ability to Cork effectively with volunteer boards and advisory councils, 4. Ability to develop positive relations with other agencies. 5.. Ability to plan, monitor and evaluate budgets. 6. Ability to motivate arra manage people, 7. Ability to plan, organize and implement programs suitable for fulfillment of the agency's mission. .7013 DUFIFS: _ 1. Responsible for planning and overall administration of the full scope of Programs being Provided by the Santa Clarita Valley Committee on Aging " Corporation. 2. Develops programs andmakes recommendations to the Board that will further the organizations mission, goals and objectives in such a manner that optimum results are achieved in relation to the resources of the agency: 3. Ensures implementation of policies adopted by the Board, and has chief administrative responsibility for the public accountability of the agency. 4. Responsible for the execution of all contracts for service. 5. Prepares agency budgets in concert with the budget/finance committee and is responsible for control once approved. 6. Directs financial operations of the funded progrims.under the direction of the Chief Financial Officer. 7. Supervises and directs the Food Seryor ice Manager, Supptive Service Director, Senior Center activities, and Administrative Director. 8. Provides overall control and direction for the personnel function of the agency, including active participation in or approval of personnel. 9. Evaluates the services being provided by the agency in relation to changing .demographic needs, policies of the Area Agency on Aging and other funding sources, and according to recognized standards for services to the elderly. 14 rage 2 EMW17VE DIRER.'=: a 10. Develops 111. and reccmTends to the Board of Directors programs and services. Maintaining involvement in the Aging Network and Gerontological organizations 12. Recamesds modifications in services where appropriate, 13. Maintains community contact and develop a positive public image of the agency in earm rdty affairs and with funding agencies. 14. Develops an appropriate community information and public relations effort. 15. Maintains effective client relations efforts. 16. Works with the Advisory Council as the agency's primary'advocacy body and in compliance with Area Agency on Aging regulations. 17. Acts as the agency's spokes person, interpreting the agency function and position to other agencies, public officials, the media and general public. 18. Attends all.Board meetings, provides staff support when required, and administers an orientation and training program for the Board, Staff, and the Advisory Council. Js— Job Title: Ccrnnittee on Aai Corporation Agency Name STAFF DUTY STATt MEN (Complete one for each job category) same title of Hours per week 40 Supervised by Whom (Job MUe): _ AnMn4T=AT ,c• p rr m R Requirements for Position: 1. Ability to analyze and organize tasks to be done. 2.File and maintain filing system 3.Type 50 WPM. 4. Take direction. 5. Work with a minimum of supervision. 6. Do minimum amount of volunteer supervision. 7. Work with the elderly. 8. Must be bondable. Job Duties: 1. Works cooperatively with Executive Director, Supportive Services Director, and all Senior Cuter Staff. 2. Reep Pertinent typing and correspondence up to date as required. 3. Keep assigned filing up to date. 4. Assist in supervision of office volunteers as requested. 5. Assist with Executive'Director's scheduling and Cop, Board work flow. 6. Attend staff meetings as required, take notes, type -and distribut to other staff members. 7. Work with the Advisory Council, prepare for monthly meetings, take minutes of meetings, type them and distribute to Council members. 8. Learn and carry out policies and procedures of the Area Agency on Aging and Committee on Aging Corporation. 9. Must be flexible and adaptable. 10. Other minor duties as requested. 11. Order and'malntain all office supplies needed for all program categories. 16 Qa'L-4 t-iarica valley Committee on Aaina «+ Agency. Name +n STAFF DUTY STATEMENT (Complete one for each job category) Job Title: STATISTICIAN (Use same title throughout application (No. of P)sitions) Hours per week 30 Supervised by Whom (Job Moe): anMTt.,ren.nrmn'£ DIRF)CIl�1� ' Requirements for Position: 1. Ability to type 40 wpm and produce statistics and data neatly and accurately. 2. Ability to use 10 key calculator and some knowledge or willingness to -learn word.Processor and Data Base canputer programs. 3. Ability to produce neat, legible reports. 4. Ability to analyze and organize a task with limited.instructions and follow through to completion. 5. Ability to plan work to meet schedules and deadlines.. 6. Ability to work and get along with others - must be flexible and adaptable. 7. Valid Calif. Class III.Driver's License, good driving record and able to meet all insurance requirements. 8. Must be bondable. Job Duties; 1. Record and compile statistics for weekly and monthly repoy-ts on all program .catagories. . 2. Prepare and submit timely monthly reports to all funding sources. 3. Prepare and submit a monthly year-to-date summary report on all ocntract and actual data in all program categories for presentation of services provided. 4. Record and maintain all statistical data'for all previous and present funding Years in an organized system for quick reference. I 5. Design master forms for the development or improvement of record keeping for all program categories. 6- Organize and maintain filing system for all funding year contracts/agreements/ compliance its/insurance policies, etc. 7. Process, record, and maintain participants intakes records and transfer data to 8. Work Accountant for nd sub on call as timely reports to funding sources. 9. Assist with pests of documentation. 10. Coordinate trpe 1m� preparation. I administration work flow to assure accurate and timely oospletior. and submittal. 11. Attend staff meetings and in-service training as required. 12. Other minor duties as requested. 17 Santa Clarita Valley Cr J tt— on Aging Corporation Agency Name STAFF DUTY STATEMErfT (Complete one for each job category) Job Title: ADMINISTRiATIVE DIRDCDQR (Use same title throughout application No. of Positidns) Hours per week _ a0 Supervised by Whom (Job.Titte):' F CCTfM DIRDCvPOR Requirements for Position: 1- AA Degree in accounting with computer training and experience including ' Lotus 1, 21 3. 2- Minimum of three (3) -years experience in.7supervisory accounting position. - 3. Knowledge of government accounting and fund accounting principles. 4. Ability to analyze fiscal problems and procedures, 5- Ability to work with agency management personnel to develop budget, cost control mesures, and unit pricing. 6. Ability to meet insurance requirements. 7. Must be able to follow through tasks .to completion and submit reports on time. 8. Ability to work cooperatively, confidentially arra creatively with agency staff. 9. Must be bondable. Job Duties 1. 2. 3. 4. S. 6. 7. 8. 9. 10. 11. Oringize and implement statistical reporting system. Monitor all reporting procedures. Fullcharge bookkeeping - manual and computer. Process all AAA statistical and financial reports in a timely manner. Prepare CDBG monthly reports, #152, III -B quarterly reports, #151 AAA monthly reports. Preparation of all budgets, revisions, and closeout reports. Works cooperatively with Executive Director, the Chief Financial Officer of the Board of Directors, and the AAA fiscal consultants. Preparation of quarterly payroll tax report and year end DC3 and Federal 940. _ Supervise and instruct administrative staff. Attend staff meetings and training as required. Other duties.as needed. 18 Cc mi on Acing Corporation Agency Name STAFF DUTY STATFiue� (Complete one for each job category) Job Title: PAYROLL CLERK (Use same Me throughout application (No. of Positions) Hours per week 24 Supervised by Whom (Job MUe): nry INISmommIro pnIEC'IM - Requirements for Position: 1. Ability to analyze and organize tasks to be done. - 2. File and maintain filing system. 3. Ability to work on computer: 4. Background in bookkeeping. 5. Work with a minimum amount of supervision. - 6. Must be bondable. Job Duties: 1. Works cooperatively with Administrative Dirdctor, 2. Keep filing up to date. - 3. Prepare weekly time sheets and distribute to supervisors. 4. Enter payroll hours on computer.and payroll checks. S. Enter accounts payable on computer and run•checks. 6. inter other data as needed on canputer. 7. Must be flexible and.adaptable. S. Attend staff meetings as required. 9. Other minor duties as requested. 19 0 nynncy Name STAFF DUTY STA MENT (Complete one for each Job category) Job Title: r•rFax rrxrt�� (Use same We throughout aNp6cation (No. of Positions) Hours per week 10 Supervised by Whom (Job Title): _- arw,rti*rSMATTnm nIgEC= Requirements for Position: 1. Be able to use 10 key touch. 2. Ability to count rtuney accurately: 3. Ability to record money a=mts accurately. 4. Work with a•minimum amount of supervision. 5. Must meet insurance requirements to be bondable' Job Duties; 1. Count Honey in afternoon for about two (2) hours. 2. Should have monies from Sites, IOM, Supportive Services, Exercise, General Accounts, Trips and Tours: 3. Make deposit slips and make sure that sanebody other than deposit to bank. yourself takes C _...._..20 Committee on Aging Corporation Agency Name, STAFF DL7STATEMENT (Complete one for each job category) Job Title: SUPPQRTlyE CII t" v DIi2DCIOR (Use same Inle throughout application) (No. of. Positions) Hours per week 40 Supervised by Whbm (Job Title): Fr-TrrIVE :)R Requirements for Position: 1. Bachelor's Degree in Social Services or Gerontology. 2- Experience in Gerontology. and Social Welfare system 3- Experience in administration and supervision. 4- Experience in implementation of services for the elderly. 5. Ability to interview, counsel, and relate to older people,.and assess their needs, 6. Ability to work well in a nonprofit organization and to relate well with older adults as clients and co-workers. Jod Duties: 1. Analyze job duties, tasks, and performance of all staff and volunteers within the department. ' 2. 'Interviews clients with multiple needs it the Center or at hone to 00114A information necessary to determine the mostappropriate supportive service to meet those needs. (Camprehensive•Assess.ments). . 3.. Interfaces with other comiunity organizations as requested. 4. Works cooperately with the Executive Director, to organize/reorganize a coordinate and effective work plan for all supportive services offered by the Center. 5. Coordinates Case Management. 6. Coordinates and supervises Peer Counseling and In -Home Visits. 7. Coordinates and supervises the Telephone Reassurance program. 8- Coordinates and supervises the C.H.I.S.S. (housing information volunteers). 9. Maintains statistical intake records according to the requirements of Los Anges County Area Agency on Aging and.Santa Clarita Valley Committee on Aging. 10. Supervises data collection from all staff and volunteer members of Supportive Services team. 11. Maintain files and prepares accurate and timely program reports. 12. Reports to the Executive Director. 13. Attends staff meetings and other In -Service training as required. 14. Performs other related duties as required. 21 Committee on Aging Corporation Agency Name STAFF DUTY STATEMENT (Complete one for each job category) Job Trtle: HFALTH AND WELWESS COORDINATOR same Hours per week 77 appmcation) (No. of r Supervised by Whom (Job TNe): —SUPPORTIVE SERVICES DIRE= Requirements for Position: 1. Graduate Degree in social work or equivalent preferred.. 2. Experience in gerontology and social welfare systems. 3. -Ability to interview, counsel, and relate to older people and their families and to assess their needs. 4. Ability to work well in a nonprofit organization and to relate well with older adults as clients and cc -workers: S. Experience in implementation of services for the elderly. 6. Ability to carry out procedures set down by the Area Agency on Aging and. the Santa.Clarita Valley Committee on Aging. Job Duties: .1. Plarh organize, and facilitate support groups. 2. Provides Case Management for elderly clients with multiple needs. 3. Complete comprehensive assessments, develop care plans, authorize and arrange appropriate services, and monitor client's progress. 4. Plans and implements Health and Wellness lectures/:­ * -,rn; 5. Recruits and supervises social work/gerontology intes. 6. Consult with Respite Program as needed. 7. Interfaces with other community organizations as requested. 8. Attends staff meetings and other 'In -Service training as required. 9. Maintains files and prepare accurate and timely reports. 10. Perform related duties as requested. _ 11. Plans, in0wm s, O=rnx edL a leob a . 12. Pxmdas ir&=mtiat & refesal c,bm nmcbd to eld2rly c1lets and their bn1l.ies. 13. PruddEs Cnegiter Carselirg ufiat nom. 22 Santa Clarita Valley COffltfil LPA An O�.�n !';, nn r'On Agency Name 6 - STAFF DUTY STATEMENT (Complete one for each job category) Job Title: Social Worker (Use same title throughout application (No. of Positions) Hours per week 13 (thirteen) Supervised by Whom (Job Title: Supportive Services Director Requirements for Position: 1. Must have a combination of education and 'experience in the human services field. 2. Knowledge of the unique problems and needs of the elderly. 3. Ability to identify and coordinate local resources. 4. Ability to interview, counsel, and relate to older people, and their families and to assess their needs. 5. Ability to work well in a non-profit organization. 6. Ability to maintain current and accurate records. 7. Ability to.organize a -task with limited instruction/direction. 8. Valid California Driver's Lidense,.possession of a reliable transportation vehicle and proof of.cuirent insurance -coverage. Job -Duties: I. Assists in providing. Case Management.to 'eiderly'clients'with multiple needs.-. 2. Complete Comprehensive_'Assessments, develop care plans,>authorize.and arrange appropriate services and monitor clients progress:undei the supervision of the Supportive Services Director. 3.. Make in-home visits and assessments as needed. _ 4. Provide inf6rmation and referrals to appropriate community services. 5. Attend community meetings as required: 6. Attend staff meetings and other in-service training as required. 23 - Committee an Aging corporation Agency Name STAFF STAT MENT(COMPlele one for each job category) Job Title: IM R (Use same title throughout applicatio (No. 01 Positions) Hours Per week 40 Supervised by'WhOm (Job Title): S MTVE gERVICES DnU=M Requirements for Position: I Knowledge of the unique problems and needs . of the elderly. Z. Ability to access the needs of the frail elderly, and develop and implement t care plans to Beet their needs. 3. Ability to identify and coordinate local resources: - 4. Ability to maintain current and accurate records: 5- Ability to work well with others including staff, families. volunteers, client and. 6- Must have a thorough knowledge of supportive services. 7- Must have a combination of education and experience -in the human service field preferred. S. Valid California Driver's License, possession of a reli4ble transportation.. vehicle and proof Of Current insurance coverage. Job Duties: 1 Assists in providing Case Management to el&zly Clients. with'multiple roads. 2: Complete providing assessments, develop care plans, authorize and arrange appropriate services, and monitor clients progress under the. supervision of the Supportive Servioes Director. 3 Maims In-home visits and assessment as needed. 4: Maintains files. and prepares accurate and timely reports. 5. Attends staff meetings and other In_Service tr�L� as required . 6. Perform related duties as required. 24 Job Tale: aanca uarita Valley Cammittee on Aging Corporation. Agency Name STAFF DUTY STATEMENT (Complete one for each job category) same thle howl (No. of Hours per week 35 Supervised by Whom (Job Title): SUPPORTIVE SERVICES DnU=C3R Requirements for Position: 1. Knowledge of the unique problems and needs of the elderly. 2. Ability to access the needs of the frail elderly, -and develop and implement care plans to meet their needs. 3. Ability to identify and coordinate -local resources;. 4. Ability to maintain current and accurate records. 5. Ability to work well with others including staff, volunteers, client and families. 6. Must have a thorough knowledge of supportive services. 7. Must have a combination of education and experience in the human service field -.preferred. 'a. Valid California Driver's License, possession of a reli4ble transportation vehicle and proof of current insurance coverage.. �. Must be able to communicate with clients in Spanish as well as English. Job Duties: 1. Assists in providing Case Management to elderly clients.with'multiple needs. 2. Complete comprehensive assessments, develop care plans, authorize and arrange appropriate services, and monitor clients progress under the - supervision of the supportive Services Director. 3. Makes In -Hare visits.and assessment as needed. 4. Maintains files and prepares accurate and timely reports. 5. Attends staff meetings and other In -Service training as required. 6. Perform related duties as requires. 7. Provide translation when necessary for other staff members and clients: 25 Santa Clarita Valley Committee on Aging Corporation Agency Name STAFF DUTY STATEMENT (Complete one for each job category) Job Title: C.H.I.S.S. Manual Editor (Use same title throughout application (No. of Positions) Hours per week 4 (four) Supervised by Whom (Job Title: Supportive Service Director Requirements for Position: 1. Ability to type 40 wpm and produce neat .and accurate work. - 2. Ability to analyze and organize a task with limited instructions and follow through to completion. 3. Ability to plan and meet schedules and deadlines. 4. Ability to work cooperately with agency staff and others. Job Duties: ' 1. Collects and updates information-on local housing resources as well as-' community resources for.the purpose of.publishing a local housing-resource manual. 2. Assists in the coordination of local C.H.I.S.S. Coalition meetings. 3. -Assists with the coordination'of the annual gerontological'seminar for training apartment managers where seniors-and disables people-res-ide. 4. Attends meetings and In-serve training as required.. = - ' 26 Santa Clarita Valley Committee on Aging Corporation Agency Name STAFF DUTY STATEMENT (Complete one for each job category) Job Trile: Home delivered Meal (HDM) Assessor (Use same title throughout application (No. of Posilirinst Hours per week 40 Supervised by Whom (Job Trtte): -911P n F' SE RVICFS DIRE= Requirements for Position: 1- ExPeriience working with community groups, community social service -agencies. 2. Ability to work well in a nonprofit organization and to relate well with older adults as clients and co-workers. 3. Knowledge of gerontology and social service systems.is desirable. 4. Ability to interview and relate to older people and to assess their needs. 5. Ability to organize information and service referrals into a usable system. 6. Valid CAlifornia Class III Driver's License and meet insurance carriers requests. 7. Must be bondable., Job Duties: 1. Receives written client request for hone'delivered meals from HDM Supervisor. 2: Make telephone contact with client.for intake screen information. 3. Visit client in for assessment of needs to determine eligibility and appropriatness of Home Delivered Meal service and/or other services. 4. Provides paraprofessional counseling where deemmed.neoessary. 5. Identifies senior citizens who are at risk because of absence of other' community services. 6. Calmunicates "at ris)e" seniors to Supportive Services Director. 7. Cooperates with program planning and staff decision making. 8- Maintains familiarity with, and adheres to all policies and procedures of the agency as well as the Area Agency on Aging. 9. Receive and implements instructions from supervisor. 10. Works cooperatively with all staff members to ensure that each client receives the const appropriate available service when needed. 11. Attends staff meetings as required. 12. Other pertinent duties as required. 13. Provides Comprehensive Assesments and Information.& Referral when needed. 27 Santa Clarita Valley Ccrtmittee on Aging Corporation Agency Name STAFF DUTY STAT MENT (Complete one for each job category) Job Title: _ T2FY'FATTQrjT NmJQT Luse same tale throughout application (No. of Positions) Hours per week qp Supervised by Whom (job Title):—Ark'T^TTSTRATIVE nTRFJCIC)R Requirements for PostUon: :. 1.Ability to analyze and organize tasks to be done. 2. Must -have good hearing. 3. Must be personable and be able to represent the agency well. 4. Type 50 -words per minute. 5. Take direction and follow through with tasks. 6. Work with a minimum amount of supervision 7. Do Minim= amount of volunteer supervision. 8. Must be bondable. Job Duties; 1. Reports and receives instructions from Administrative Director. 2. Answers the telephone for the agency, receives and directs walk-in ir44res. 3. Works cooperatively with Social Services and Supportive Services staff.- 4. Takes messages for agency staff. 5. Assists with the preparation of the Might Oak Newsletter.: - 6. Keep pertinent typing up to date as required. 7. Follows through with assigned clerical duties. 8. Assist in supervision of office volunteers as requested. 9. Learn and carries out policies and procedures of the agency. 10. Accepts responsibility for maintaining confidentiality. 11. Must be flexible and adaptable and maintain a pleasant attitude. 12. Attend staff meetings as required. 13. .Other minor duties as requested. 14. Provides Information & Referral when needed and or refers calls to appropriate staff. 28. Job Title: "M"'" valley ommittIng Corpc ee on A ratio Agency Name STAFF DITTY STATEMENT (Complete one for each job category) Hours per week 40 Supervised by Whom (Job TNe): ESC ?rTVE D>RF:CIOR Requirements for Position: I. .Ability.to analyze and organize tasks to be done. 2. Must have good hearing, 3. Must be personable and be able to represent the agency well.: 4. Take direction and follow Uxca gh with tasks. 5.- Work with a minimum amount of supervision. 6. Must be bondable. Job Duties: 1. Organizes and supervises Senior Center activities. 2. Reports and receives instruction from Executive Director. 3. Answers the telephone when receptionist is unavailable, receives arra. directs walk-in inquires, 4. Works cooperatively with Social Services aryl its staff. 5. Keep pertinent typing up to date as events. fired with activities and special 6. Follows through with assigned clerical duties. 7. Learn and carries out policies and procedures of the agency. 8. Accepts responsibility for maintaining confidentiality. 9. Obtain participant intakes whenever possible. . 10. Must be flexible and adaptable acid maintain a.pleasent attitude. 11. Attend staff meetings as required. 12. Schedules activities for Senior Center, makes arrangements for fame of them. 13. Keeps Master Calendar up to date. 14. works with other staff to organize an ad carry through many special events. 15. Keeps in contact with outside gimps who use our facilities and informs staff of inside and outside activities, 16. Makes flyers and pasters for and secretary to be sure events ares activities and parks with publicity Senior Housing of 6am.e published in newspapers. Notifies 17' Works with center service.group in getting materials, organize distribution of items to shut-ins, and preparing for seasonal boutiques as fund raisers for the Center. 18. Other minor duties as requested. 29 Santa Clarita Valley _ Cpm ittee on A4ing Corporation Agency Name STAFF DULY STATEMENT (Complete one for each Job category) Job TAIe: vnrrtrarr.-r'n O3OR Tm rnR (Use same true throughout apphcatron (No, o Positions) Hours per week 30 Supervised by Whom (Job Ttae): x vcrtnMM, n rREMM Requirements for POsItion: 1. Minimum of 2-3 years coordinating experience in management, operations or human services field. 2. Must be flexible and have the ability to direct, advise -and counsel volunteers. 3• Must have the ability to interface with department heads, ascertain operatieal needs and be familiar with rudem entary record keeping.. 4. Must have the ability to occasionally act as agency spokesperson in regard to volunteer opportunities. 5. Must be bondable. Job Duties: I 1. Responsible for interfacing with department heads to determine volunteer Personnel needs and requirements. 2. Shall develop strategies for on-going volunteer. recruitment. 3. Responsible for documentation and maintenance of.volunteer personnel files, i.e. job description, hours, etc. 4. Attend staff meetings for formal communications regarding on-going concerns. 5. Act as direct supervisor for volunteers involved in registration and congregate meal cashiers at Hart Park location. 6. Obtain and submit participant intakes to the Statistician. 7. Conduct periodic volunteer staff meetingstoensure the volunteers experience is enriching to the individual. 8. Conduct periodic individual volunteer evaluations for open productive corrmmnications. 9. Assist the Activity Coordinator with staffing' needs. 10. Other associated duties as assigned by the Executive Director. ._ .. ...... 30 —�. ....... STAFF qV STATEMF�JT (Complete one for each job category) Job Title: CUSIbpTAN (Use same tttle throughout application ) (No, of )ositions) Hours per week 40 Supervised by Whom (Job Title): SITE MANA6132.g SUPERVISOR Requirements for Position: 1. Sane custodial experience. 2. Ability to keep accurate and timely reports 3. Ability to learn. and carry out. policy and procedures as set donw by Area Agency on Aging, Health Deparbynent and Conmittee on Aging. 4. Ability to relate well to seniors. 5. Valid California Class III Driver's -License. 6. Must have good driving record. 7. Must be 25 years of age or older. 8. Ability to meet insurance carriers requirements. 9. .Able to read and write English. Job Duties: 1. Sets up for activities, after receiving setup schedule from Senior Center: Director, 2. Cleans, sweeps and mops the title floors. 3. Vacuums rugs and carpets. 4. Dusts, cleans and polishes furniture and furnishings w . 5. washed door -glass, mirrors and windows. 6. washes walls, ceilings and high light fixtures working on ladders. 7. Polishes metalwork. 8. Cleans, disinfects cabinets, washbowls and toilet room fixtures and other equipment. 9. Replenishes toilet room supplies. 10. mess furniture and heavy equiprent in connection with cleaning or rearranging ter space 11. InventoriesJanitorial supplies 12. Routinely do deep cleanig tasks y• that all of the facility g th following a regular schedule which ensure 13. Works cooperatively t5' will be throughly cleaned peroclically. peratively with other staff members to ensure a clean.and safe facility. 14. Secures the building at night. 15. Atterx1a staff meetings and In -Service training as required: 16. other minor duties as required. '31 Santa Clarity Valley r�I tt,p a ren Aging Corporation Agency Name STAFF DUTY STATEMENT (Complete one for each job category) . (C.H.I.S.S.) JobThle: INFURMATICN AND REFERRAL SPECIALIST, (Title V Trainee) (Use same title throughout application {No. of Positions) Hours per weak 20 Supervised by'Whorn (Job Title): — SUPPORTIVE SERVICES DIRE)Cim Requirements for Position: 1. Ability to interview and.relate to older people and their needs. 2. Ability to organize information and service referrals into a usable system. 3. Be able to screen callers as to the purpose of their calls. 4. Be able to maintain clear and accurate records. 5. Ability to work well with others. 6. Must be flexible and adaptable. Job Duties: 1. Answers phone calls and walk-ins and responds to Information and Referral - inquires; giving information -about resources,.programs and services. 2. After assessing clients needs then refers them to appropriate services. 3. Maintains written records on each Information and Referral contact. - 4. Follow-up on refferals to'detexmine the quality and effectiveness of service Provided to a client. 5. Maintains and updates a current roster of agency and aanmutity resources. 6. Canmunicates "at risk" seniors to Supportive Services Director. 7. Maintains familiarity with and adheres to all policies and procedures of the agency. 8. Works Cooperately with all staff members to ensure that each client receives the most appropriate available service when needed. 9. General clerical duties as needed and if pertinent (filing etc.) 10.Provides unbiased information to older consumers relating to housing issues. STAFF DUTY STATEMENT Agency Name (Complete one for each job category) Job Title: Peer Counselor (Volunteer) e same title throughout application (No. of Positions) Hours per week_ 6 Supervised by Whom (Job Title: Supportive Services Director Requirements for Position: 1. Must attend 30 hours of Peer Counseling training prior to doing in-home visits or working with participants. 2. Must have an interest in working with the elderly population and be aware of their unique needs. 3. Must committ-to volunteer for at least 6 hours per week for a 6'month period. 4. Must have a valid California drivers license and current automobile insurance. 5. -Must be•familar with community resources. Job Duties: - - 1.. Will respond to all assigned requests on behalf of senior citizens regardless of race, ethnicity, creed.or means, 2. Will provdie advocacy, information -and referral as needed. 3. Will do in-home visits to frail and or -isolated seniors who reside in the city of Santa Clarital in -order -to provide informa- tion and -referral as well as to provide reassurance -and emotional support, 4. Will maintain accurate documention on each particpant or service rendered. 5._Wilr attend weekly supervision.and in-service training. 6. Will maitain a current resource guide. 33 CERTIFICATE OF INSURANCE ISSUE 06/30/92Y PRODUCER •—TWS-MTIFIC-ATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND ,— *ABI SEPCIAL RISK, INC. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_. WELLINGTON -ROSS INSURANCE SERVICES COMPANIES AFFORDING COVERAGE 15760 VENTURA BLVD., SUITE 1400 ENCINO, CA 91436-3095 COMPANY (818) 377-3800 LETTER *GREAT AMERICAN INSURANCE COVERAGES.• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTO DATE (MMIDO/YY) DATE (MM/DD/YYI LIMITS GENERAL LIABILITY GENERAL AGGREGATE COMPANY B INSURED PRODUCTS-COMP/OP AGG. LETTER GOLDEN EAGLE INSURANCE CLAIMS MADE X OCCUR. PAC2162474 7/01/92 7/01/93 PERSONAL BADV. INJURY COMPANY C SANTA CLARITA COMMITTEE ON AGING CORP. LETTER Chubb (The Federal Ins. Co.) 22900 MARKET STREET COMPANY D SANTA CIARITA, CA 91321 LETTER AUTOMOBILE LIABILITY COMBINED SINGLE 3 COMPANY E LIMIT DISEASE—POLICY LIMIT S 1,000,000 LETTER • COVERAGES.• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTO DATE (MMIDO/YY) DATE (MM/DD/YYI LIMITS GENERAL LIABILITY GENERAL AGGREGATE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S 1,000,000 A X CLAIMS MADE X OCCUR. PAC2162474 7/01/92 7/01/93 PERSONAL BADV. INJURY S 1,000,000 X OWNER'S d CONTRACTOR'S PROT. EACH OCCURRENCE S 1,000,000 X $500 PROPERTY DAMAGE DEDUCTIBLE PER OCCURRENCE FIRE DAMAGE (Any one fire) E 50,000 STATUTORY LIMITS - MW. EXPENSE (Arty" person) S 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE 3 ANY AUTO LIMIT DISEASE—POLICY LIMIT S 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY S (Per person) BODILY INJURY 3 (Per accident) PROPERTY DAMAGE 3 _ EXCESS LIABILITY EACH OCCURRENCE It 4,000,000 A X UMBRELLA FORM UMB216215000 7/01/92 7/01/93 AGGREGATE S 4,000,000 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS - EACH EACH ACCIDENT S 1,000,000 AND B 7/01/92 7/01/93 DISEASE—POLICY LIMIT S 1,000,000 EMPLOYERS' LIABILITY • DISEASE—EACH EMPLOYEE E 1,000,000 OTHER $3,000,000 each loss X Directors &.Officers 81272735 7/01/92 7/01/93 $3,000,000 each po.year $10,000 deductible DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF SANTA CLARITA SHALL APPLY IN EXCESS IF AND NOT CONTRIBUTE PROVIDED BY THIS INSURANCE POLICY (APPLIES TO PACKAGE ONLY). THE CITY OF SANTA CLARIIA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSUREDS AS RESPECTS OPERATIONS AND ACTIVITIES OF OR ON BEHALF OF THE NAMED INSURED, PERFORMED UNDER CONTRACT WITH THE CITY OF SANTA CLARII'A. CERTIFICATE HOLDER CANCELLATIU E7CCHPT *f0 DAYS'POR NOR PAYMENT OF'PRSMIUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SANTA CLARITA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO' ATTN: CITY CLERK MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 23920 VALENCIA BLVD., /300 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR SANTA CLARITA, CA 91355 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA E WELLINGTON -ROSS INSURANCE SERVICES BRUCE L. LATHROP ACORD 25-S (7190) x OACORD CORPORATION 1990 AG:41�:Ip, CERTIFICA' --OF INSURANCE ISSUE DATE (MM1OWYY) 06/30/92 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND— CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE *ABI SEPCIAL RISK, INC. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE I POLICIES BELOW. WELLINGTON -ROSS INSURANCE SERVICES COMPANIES AFFORDING COVERAGE 15760 VENTURA BLVD., SUITE 1400 ENCINO, CA 91436-3095 COMPANY (818) 377-3800 LETTER A *GREAT AMERICAN INSURANCE GOLDEN EAGLE INSURANCE Chubb (The Federal Ins. Co.) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MWDONY) DATE (MWDDIYYI X COMMERCIAL GENERAL LIABILITY A X CLAIMSMADEX OCCUR. PAC2162474 7/01/92 7/01/93 X OWNER'S 3 CONTRACTOR'S PROT. - . - TX- $500 PROPERTY DAMAGE DEDUCTIBLE PER OCCURRENCE ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON,OWNED AUTOS 1 GARAGE LIABILITY EXCESS LIABILITY A X UMBRELLAFORM im216215000 7/01/92 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION B AND PWC113568 EMPLOYERS' LIABILITY - OTHER X Directors & Officers 81272735 LIMITS GENERAL AGGREGATE 3 1,000,000 PRODUCTS-COMP/OP AGO. S 1,000,000 PERSONAL 8 ADV. INJURY 3 1,000,000 EACH OCCURRENCE 3 1,000,000 '.FIRE DAMAGE (My an, ire) i /:'' S0, 000 , MED_EXPENSE(AY"pw" 3 _—._5,000 COMBINED SINGLE S LIMIT BODILY INJURY S (Per person) BODILY INJURY 3 (Per AttmenU PROPERTY DAMAGE 3 EACH OCCURRENCEua— 3 4,000,000 7/01/93 AGGREGATE 6 4,0003000 7/01/92 7/01/9 3 7/01/92 7/01/93 - STATUTORY LIMITS-_�--1-- EACH ACCIDENT S 1,000,000 DISEASE—POLICY LIMIT S 1,000,000 DISEASE—EACH EMPLOYEE 3 1,000,000 $3,000,000 each loss $3,000,000 each po.year $10,000 deductible DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS IT 15 AGREED THAT ANY INSURANCE MAINTAINED BY THE CRY OF SANTA CLARIfA SHALL APPLY IN EXCESS IF AND NOT CONTRIBUTE PROVIDED BY THIS INSURANCE POLICY (APPLIES TO PACKAGE ONLY). THE CRY OF SANTA CLARITA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSUREDS AS RESPECTS OPERATIONS AND ACTIVITIES OF OR ON BEHALF OF THE NAMED INSURED, PERFORMED UNDER CONTRACT WITH THE CITY OF SANTA CLARITA. cEAYIFICATEHOLDER - .-. CANCELLATION*EXCEPT 10 DAYS FOR NON PAYMENT OF PREMIUM CITY OF SANTA CLARITA ATTN: CITY CLERK 23920 VALENCIA BLVD., #300 SANTA CLARITA, CA 91355 ACORD 25-S (7/90) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO - MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTArf E WELLINGTON -ROSS INSURANCE SERVICES BRUCE CACORD CORPORATION 199 1990 COMPANY B INSURED LETTER COMPANY r.. SANTA CLARITA COMMITTEE ON AGING CORP. LETTER 22900 MARKET STREET COMPANY D SANTA CLARITA, CA 91321 LETTER COMPANY E LETTER GOLDEN EAGLE INSURANCE Chubb (The Federal Ins. Co.) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MWDONY) DATE (MWDDIYYI X COMMERCIAL GENERAL LIABILITY A X CLAIMSMADEX OCCUR. PAC2162474 7/01/92 7/01/93 X OWNER'S 3 CONTRACTOR'S PROT. - . - TX- $500 PROPERTY DAMAGE DEDUCTIBLE PER OCCURRENCE ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON,OWNED AUTOS 1 GARAGE LIABILITY EXCESS LIABILITY A X UMBRELLAFORM im216215000 7/01/92 OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION B AND PWC113568 EMPLOYERS' LIABILITY - OTHER X Directors & Officers 81272735 LIMITS GENERAL AGGREGATE 3 1,000,000 PRODUCTS-COMP/OP AGO. S 1,000,000 PERSONAL 8 ADV. INJURY 3 1,000,000 EACH OCCURRENCE 3 1,000,000 '.FIRE DAMAGE (My an, ire) i /:'' S0, 000 , MED_EXPENSE(AY"pw" 3 _—._5,000 COMBINED SINGLE S LIMIT BODILY INJURY S (Per person) BODILY INJURY 3 (Per AttmenU PROPERTY DAMAGE 3 EACH OCCURRENCEua— 3 4,000,000 7/01/93 AGGREGATE 6 4,0003000 7/01/92 7/01/9 3 7/01/92 7/01/93 - STATUTORY LIMITS-_�--1-- EACH ACCIDENT S 1,000,000 DISEASE—POLICY LIMIT S 1,000,000 DISEASE—EACH EMPLOYEE 3 1,000,000 $3,000,000 each loss $3,000,000 each po.year $10,000 deductible DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS IT 15 AGREED THAT ANY INSURANCE MAINTAINED BY THE CRY OF SANTA CLARIfA SHALL APPLY IN EXCESS IF AND NOT CONTRIBUTE PROVIDED BY THIS INSURANCE POLICY (APPLIES TO PACKAGE ONLY). THE CRY OF SANTA CLARITA, ITS OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSUREDS AS RESPECTS OPERATIONS AND ACTIVITIES OF OR ON BEHALF OF THE NAMED INSURED, PERFORMED UNDER CONTRACT WITH THE CITY OF SANTA CLARITA. cEAYIFICATEHOLDER - .-. CANCELLATION*EXCEPT 10 DAYS FOR NON PAYMENT OF PREMIUM CITY OF SANTA CLARITA ATTN: CITY CLERK 23920 VALENCIA BLVD., #300 SANTA CLARITA, CA 91355 ACORD 25-S (7/90) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO - MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTArf E WELLINGTON -ROSS INSURANCE SERVICES BRUCE CACORD CORPORATION 199 1990 MNIM). CERTIFICATE OF INSURANCE IEEUOAT I`"92DNr1 PRODUCER* ABi Special Risk, Inc. FFfITCEATifTtaTEIS ISBUEb AS AVATTER'00 INFORMATION ONCY AHD, CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE American Business Insurance I DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._- Brok• rS T ca Angeles Inc 15760 Ventura Blvd., 11 1400 COMPANIES AFFORDING COVERAGE Encino, Ca. 91436 CCMPA NY LETTER. A *Great American insurance COMPANY EI - INSURED LETTER Santa Clarita Committee on Aging COMPANY Corp., 22900 Market Street LETTER Santa Clarita, Ca. 91321 COMPANY LETTER D COMPANY E LETTER COVERAGES PERIOD TND CHISTAT D, NOTW THSTAND NGTO CERTIFY THAT THEOANIYIREGUI ES EMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIOF INSURANCE'LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDDTH RESPECT TOFORTHELICY WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMMOIl'Y; DATE fMMIDDfY.) w.+ GENERAL LIABILITY _..r - +••-«� -N GENERAL AGGREGATE X COMMERCIAL GENERAL LIAIKIT� PROOUCTS.COMPICP AGO. S - CLAIMS MADE OCCUR. PERSONAL E ADV. ;NJURY S CwNER'S B CCNTRACTOWS PROT. EACH OCCURRENCE S FIRE DAMAGE IAPy Pn• IIr•) E MED. EXPENSE (Amy IN P•gRn) B .... AUTOMOBILE LIABILITY COMBINED SINGLE' S S LIMIT ANY AUTO ALL OWNED AUT06 BODILY INJURY g (Par Pitman) SOHEOULED AUTOS S -� HIRED AUTOS BODILY INJURY S fear •eelRm;) NON•OWNED AUTOS ; OAPAO E LIABILITY PROPERTY DAMAGE S .... •M'l•�-�+`�, EACX OCCURRENCE _Y� EXCESS LIABILITY-�M��-^�_�w+�_•J'^-~-��-+��••--'w AGGREGATE S -� UMBRELLA FORM - OTHER THAN UMBRELLA FORM - I •. ••+.. li rte......_....—.�...•---�.—..._..�..-.....---..._.. BtniuTorvlLilTs i, ._..�._ WORKER'S COMPENSATION EACH ACCIDENT S AND DISEASE-POLICY'LIMIT B '. EMPLOYERS' LIABILITY MSEASE.-EACH EMPLOYEE S OTHER Crime PAC2162474 7/1/92 7/1/93 Employee Dishonesty - $206000. linit,$500.ded. DESCRIPTION OF OPERATIONSILOCATIONSNEXICLELVECIAL ITSMS �- -,_ �_ - ^—�� •' CANCELLATION * ..""" P ..,..._„. ...—�.___... P y CERTIFICATE HOLDER - e7LCe t ten days for non- z meat SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Santa Clarita EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TC 23920 Valencia Blvd., 11300 MAIL30+ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER'NAMED TC THE Santa Clarita, Ca. 91355 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL -IMPOSE NO OBLIGATION Or LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. A HORIXED PEPRESENTATIV cORD CORPORATION 795 ;ACORO 23-S (7/90)J� =NI oT- 11.1 ry0-1d-82 . t;llr'm , AUG 15 '92 10,59 PARATRANSIT INS CGRP �U': 1 ,Q. 1:149 RSH.'rUP'. iS Ny (415) ;•4s 3W 01d3773dy4- 005 292 P02 .y.�r,r..,.-+.•.�.M.�..w,r�.,. •5. +4•�1'�•rvw�y.I,,...yr . ..r , •M F•2 �.. IRS •. i• •AiWW.....r.::+...i.A •.L:Jw + ASH/C. bay It Co. Ins. stsevlett SO Fremont IL, Sntt• $300 .♦ �i:l�t.111T..{ h11 .. .. M:.{t: Y,�}�•� CON01" Ho Al T UPON TME Ca ti ICAT[ HOLDER. YK6 C[A ICA COS•NOTANYNO,SXTEIIDOAALTIATHC COVIRA44WORDID1YTM Pouclef MOW. OCWANM3A"ORDWGCOVERAGE sen Fr+neitat, CA 14105 4Ts-s40-x140 A -Md[- -- - ----- tri ►[i°1Gt 0 n W C ; pal lisp Matiamm,- Seats Qlsrita Vs1loy COA e/e Wa1tIh4t6A-s4049 1114. 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A.tt7.:r.�, ....v .�A.R,..F.O.rRaM�P:O�,..:R„►iC ERr:YF'�CyfA w. •: , ,.'A P` OrG::'s PCMD ANY OJ THE AEOV[ 09=Q90 POLICY[ it CANCV-LED 04FORt TW �1EXOPAICN DATE ?440/. TK 4111^3 C,UPAW.. WILL tMXAVCR TO I F2KIM►E^�bArS WRITTENNOY <tip iM: CEA$ KATE HQL".£gNAN[J t0 TME City of sant• Cl ar i is LSPT, Bur aALLRE TO MAA, SUCH NOTICE SHALL NOOSE NO C900414N OR 23320 Valanatt Blvd. Iu114 300 L:ABN,ITYCIS ANY +.V4OUPON TKCL'w•NT.STSACEVTSORPEPRESENTATnV[& 9onts ClOrits, CA 11368 P nA N ATTNI CITY CLSAK wTs492t2Es Ob 4ti iL-9 j ��'}9!AS(ii>:'��.'.i! 1;c._.w,. IL'�.1. T—..�`,.r. 1,�r1, r�.��lrc.v. y y� r '.r ,Zy C 1, y _2c ^ i.., •ti%?,.;. ,_,'...PiA �`,�'acc EoG7MM,W AfJOH'.L[w GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN:241426U WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY DECLARATION Item 1: Item 2: Insured's Name and Address: SANTA CLARITA VALLEY COMMITT' 22900 MARKET STREET SANTA CLARITA CA 91321 Policy No: PWC -113568-01 Insured is: CORPORATION ON AGING ET AL., PER WC001 -4'7U ,iF.0 i iJ AUD:T Locations: All usual workplaces of the Insured at or from which operations covered by this policy are conducted are located at the address of the Insured unless otherwise stated herein. ADDITIONAL LOCATIONS PER WC002- Policy Period From: 1 JUL 92 To: 1 JUL 93 12:01 a.m. standard time at the address of the Insured as stated herein. Item 3: Coverage A of this policy applies to the Workers' Compensation laws and any occupa- tional disease law of each of the following states: CALIFORNIA Item 4: Classification of Operations: SEE SCHEDULE ATTACHED Estimated Annual Standard Premium: $28,936 Deposit Premium: $2j,930 Including CIGA Surcharge of: $0 User Assessment Funding Fee: $40 Minimum Premium: _ $2,500 Adjustments of Premium Shall be Made: MONTHLY Item 5: Limit of Liability for Coverage B - Employers' Liability: $1j,0001000 SUBJECT TO ALL TERMS OF THIS POLICY HAVING REFERENCE THERETO. Numbers of Endorsements Forming a Part of this Policy on its Effective Date: WC200 WCO29 WC335 WC166A WC001 WC002 NCO07 WC505A WC514 WC8382 WC520 Issued at: SAN DIEGO, CALIFORNIA Date of Issue: 24 JUN 92 Plan Name: PARTICIPATING — 1 YR Type Plan: P—i—i Agent: WELLINGTON—ROSS INSURANCE SERVICES Code: 15760 VENTURA BLVD., #1400 Renews Policy: ENCINO CA 91436-3095 Countersigned by: `}_ Prepared By: WC 17 (9/90) Insur s Cap 01-05072/10.00 PWC -113568-00 63/103 GOLDEN EAGEE INSURANCE COMPANY P,O. Box 85826 - San Diego, CA 92186-5826 PCN:24142e34 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY SCHEDULE OF CLASSIFICATIONS OF OPERATIONS Policy No: PWC -113568-01 Classifications Code No. Estimated Rate Estimated Annual Per Annual Remuneration $100 Premium RESTAURANTS OR TAVERNS — ALL 9079(1) 136,065 7.88 $10,722 EMPLOYEES — INCLUDING MUSICIANS AND ENTERTAINERS — N.P.D. COLLEGES OR SCHOOLS — PRIVATE — 8868 132,000 2.45 $3,234 NOT AUTOMOBILE SCHOOLS PROFESSORS, TEACHERS OR PROFESSIONAL EMPLOYEES BUS OR LIMOUSINE OPERATIONS — ALL 7382 IF ANY 15.04 TBD EMPLOYEES CLERICAL OFFICE EMPLOYEES — N.O.C. 8810(1) 136,689 .94 $1,285 STORES — RETAIL—.N.O.C. 8017(1) 15,000 5.58 $837 Inclusions: BERENS# BRAD —DIRECTOR 8868 40,000 2.45 Coverage B Limit Increase : USL&H Charge : Total Premium Subject to Exp. Modification : Experience Modification 1 : Experience Modification 2 : Subject to a Minimum Premium Charge of : Company Surcharge : C.I.G.A. Surcharge: Insurance Assessment Charge : Facultative Reinsurance Premium Estimated Annual Standard Premium: Date of Issue we 18 19/901 Insured's Copy 1.54 (154%) N/A .10 (l0%) 24 JUN 92 $980 $0 N/A $17,058 $9,211 $0 $2,500 $2,627 $0 $40 N/A $28,936 GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN:24142634 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY POLICY TERMS AND CONDITIONS Policy No: PWC -113568-01 GENERAL SECTION Page A. The Policy ........................................ 1 B. Who Is Insured ...................................... 1 C. Workers' Compensation Law .............................. 1 D. State ............................................ 1 E. Locations ......................................... 1 Part One - WORKERS' COMPENSATION INSURANCE A. How This Insurance Applies .............................. 1 B. We Will Pay ........................................ 1 C. We Will Defend ..................................... 2 D. We Will Also Pay ... 2 E. Other Insurance ..................................... 2 F. Payments You Must Make ............................... 2 G. Recovery From Others ................................. 2 H. Statutory Provisions ................................... 2 Part Two - EMPLOYERS' LIABILITY INSURANCE A. How This Insurance Applies 3 B. We Will Pay ....................................... 3 C. Exclusions ........................................ 3 D. We Will Defend ..................................... 4 E. We Will Also Pay .................................... 4 F. Other Insurance 4 G. Limits Of Liability .................................... 4 H. Recovery From Others ................................. 4 I. Actions Against Us ................................... 5 Part Three - OTHER STATES INSURANCE A. How This Insurance Applies 5 B. Notice ........................................... 5 Part Four -YOUR DUTIES IF INJURY OCCURS ....................... 5 Part Five - PREMIUM A. Our Manuals ....................................... 5 B. Classifications ................. . ................. 5 C. Remuneration 6 D. Premium Payments ................................... 6 E. Final Premium ....................................... 6 F. Records .......................................... 6 G. Audit .. , ...... 6 Part Six - CONDITIONS A. Inspection ......................................... 6 B. Long Term Policy .................................... 7 C. Transfer Of Your Rights And Duties 7 D. Cancellation 7 E. Sole Representative. ................................... 7 IMPORTANT: This page is not part of the Workers' Compensation and Employer's Liability Insurance policy and does not provide covers ge. Refer to the policy itself for actual contractual -provisions. READ TI IE POLICY CAREFULLY. WC200110/90) Insured's Copy 4. Jurisdiction over you isjurisdictioa over us for purposes of the Workers' Compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the Workers' Compensation law that apply to: benefits payable by this insurance; and special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the Workers' Compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. Part Two - EMPLOYERS' LIABILITY INSURANCE A. How Thls Insurance Applies This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3 of the Declaration Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period - 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B. We Will Pay We will pay all sums you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers' Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1. for which you are liable to a third paity by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee•, 2. for care and loss of services; and 3. for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a. workmanlike manner. 2. punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3. bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; wC2o0110MI I. Actions Against Us There will be no right of action against us under this ms'urance unless; 1. you have complied with all the terms of this policy; and 2. the amount you owe has been determined with our consent or by actual trial and final judgement. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. Part Three - OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3 of the Declaration Page. 2. If you begin work in any one of those states and are not insured or are not self-insured for such work, the policy will apply as though that state were listed in Item 3 of the Declaration Page. 3. We will reimburse you for the benefits required by the Workers' Compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. B. Notice Tell us at once if you begin work in any state listed in Item 3 of the Declaration Page. Part Four - YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties aro listed here. 1. Provide for immediate medical and other services required by the Workers' Compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. Part Five - PREMIUM A. Our Manuals All premiums for this policy will be determined by our manitals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Declaration Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classification, rates and premium basis by endorsement to this policy. WC200 (10/90) C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of. 1. all your officers and employees engaged in work covered by this polic/; and 2.. all other persons engaged in work that could make us liable under Part One (Workers' Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their Workers' Compensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a Workers' Compensation law is not valid. E. Final Premium The premium shown on the Decimation Page, schedules, and.endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise. I. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate cancellation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. Part Six - CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations,, codes or standards. Insurance rate service organizations have the same rights we have under this provision. WC200 1101901 IVGOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN:24142634 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY LIABILITY COVERAGE AMENDATORY ENDORGEMENT Pollcy No: PWC -113568-01 The insurance afforded by Part Two - Employers' Liability Insurance by reason of designation of California in Item 3 of the Declaration Page is subject to the following provisions: A. "How This Insurance Applies`, is amended to read as follows: This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical or mental injury, including resulting death. Bodily injury does not include emotional distress, anxiety, discomfort, inconvenience, depression, dissatisfaction or shock to the nervous system, unless caused by either a manifest physical injury or a disease with a physical dysfunction or condition resulting in treatment by a licensed physician and surgeon. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in California. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C. 'Exclusions', is amended to read as follows: This insurance does not cover 1. Liability assumed under a contract; 2. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 3. Any obligation imposed by a Workers' Compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 4. Bodily injury intentionally caused or aggravated by you; 5. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 6. Bodily injury arising out of termination of employment; 7. Bodily injury arising out of the coercion, demotion, reassignment, discipline, defamation, harassment or humiliation of, or discrimination against any employee. WC 335 410190) Insured's Copy GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826. PCN:241426a4 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY CALIFORNIA AMENDATORY ENDORSEMENT Policy No: PWC -113566-01 It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Declaration Page is subject to the following provisions: 1. Minors Illegally Employed - Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2. Punitive or Exemplary Damages - Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefor is prohibited by law or contrary to public policy. 3. Increase in Indemnity Payment - Uninsurable. This policy does not cover an increase in indemnity payment as provided for in subdivision (e) of Section 4650 of the Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are responsible for the amount of increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($ 100). 4. Application of Policy. Part One - Workers' Compensation Insurance. A. "How This Insurance Applies", is amended to read as follows: This Workers' Compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. Rate Changes. This policy is issued by us and accepted by you with the agreement that you will accept any increase in premium or in the rates of premium which may be promulgated under any rating plan approved by the Insurance Commissioner of the State of California, and that the effective date of any such increase shall be the effective date thereof fixed in accordance with the provisions of any such rating plan so approved by the Insurance Commissioner. Also the rates used to determine the premium are subject to increase during the term of the policy if an increase in rates applicable to policies in force is approved by the Insurance Commissioner of the State of California, and that the effective date of any such increase shall be the date fixed by the Insurance Commissioner. 6. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve month period, or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period. 7. Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case ofyour legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition; provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. WC 166A 11/911 Insured's Copy GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 rcN:241426aa WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY NAMED INSURED ENDORSEMENT Policy No: PWC -113568-01 The Named Insured reads as follows: WC 001 (10/90) SANTA CLARITA VALLEY COMMITTEE ON AGING CORP. SANTA CLARITA VALLEY CENTER OF ON AGING INC. SANTA CLARITA VALLEY SENIOR CENTER Insured's Copy GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN:24142rM WORKERS'. COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY ADDITIONAL LOCATIONS ENDORSEMENT Policy No: PWC -113568-01 The above mentioned policy is amended to include the following locations: No. Address City State 23P 01 22900 MARKET STREET SANTA CLARITA 02 19310 AVENUE OF THE OAKS SANTA CLARITA 03 23520 WILEY CANYON RD. ' SANTA CLARITA WC 002 (10190) Insured's Copy CA -91321 CA 91321 CA 91351 IVGOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 ecrr:241426s4 WORKERS' COMPENSATION AND EMPLOYERS' .LIABILITY INSURANCE POLICY EXPERIENCE RATING ENDORSEMENT Policy No: PWC -113568-01 Bureau File No: 2 51 77 26 F It is agreed that the premium developed at manual rates is subject to adjustment of the below indicated Experience Modification. This endorsement is subject to the exclusions, conditions and other terms of the policy which are not inconsistent herewith. Experience Modification: 1.54 (154%) 01 JUL 92 WC 007 n 0190) Insured's Copy GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN: 2.4142&U WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY FLAT SURCHARGE ENDORSEMENT Policy No: PWC -113568-01 It is agreed that in addition to the premium determined for the policy in accordance with the manual rates and applicable experience modification, if any, there shall be added thereto a Company surcharge of: .100 (10.0%) Signed and Accepted Date we 605A norsat Insured's Copy IVGOLDEN EAGLE INSURANCE COMPANY r P.O. Box 85826 - San Diego, CA 92186-5826 PCN:241426a4 ' WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY INTERIM PREMIUM PAYMENT ENDORSEMENT Policy No: PWC -113568-01 It is agreed that the estimated annual premium for the policy is payable as follows: Interim Period Premium From To Payment 01 AUG 92 31 AUG 92 $3,256 01 SEP 92 30 SEP 92 $3,250 01 OCT 92 31 OCT 92 $3,250 01 NOV 92 30 NOV 92 $3,250 01 DEC 92 31 DEC 92 $3,250 01 JAN 93 31 JAN 93 $3,250 01 FEB .93 28 FEB 93 $3,250 01 MAR 93 31 MAR 93 $3,250 Deposit Premium: $20890 C.I.G.A. Surcharge: $0 Insurance Assessment Charge: $40 Reinsurance Premium: N/A Total Estimated Premium: $28,936 It is further agreed that the deposit premium shall be paid upon delivery of the policy and the interim premiums on the indicated dates. Upon expiration of the policy the earned premium shall be computed in accordance with the basis of premium as specified in the policy and the deposit premium and interim premiums shall be credited thereto. If the earned premium exceeds the deposit premium plus the interim premiums, the insured shall immediately pay to the company the additional earned premium; if it be less, the company shall return the difference to the insured but shall, in any event retain the minimum premium charge. WC 614 1101901 Insured's Copy' IVGOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PCN:24142634 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY PARTICIPATING PROVISION ENDORSEMENT Policy No: PWC -113568-01 Nothing in this endorsement contained shall be held to vary, alter, waive or extend any of the terns or conditions of the policy, except as hereinafter set forth. The insured shall participate in the earnings of the company represented by surplus accumulated from premiums on California Workers' Compensation policies to the extent and upon the conditions determined by the Board of Directors of the company in accordance with law and made applicable to this policy, provided that no dividend shall be payable hereunder unless the insured has complied with the terms of the policy in respect to the payment of premium. Under California Law it is unlawful for an insurer to promise the future payment of dividends under an unexpired Workers' Compensation policy or to misrepresent the conditions for dividend payment. Dividends are payable only pursuant to conditions determined by the Board of Directors or other governing board of the company following policy expiration. WC 8382/101901 Insured's Copy GOLDEN EAGLE INSURANCE COMPANY P.O. Box 85826 - San Diego, CA 92186-5826 PM:24142na4 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY. INSURANCE POLICY INDUSTRIAL MEDICAL PROVIDERS In case of accident refer the injured worker to the nearest medical facility. For your convenience, we have listed below several industrial medical providers in your area. Advantage Care Metropolitan Advantage Care/Leonis Alameda Industrial Medical 437 E. Washington Blvd. 2770 Leonis Blvd. 1907 E. Washington Blvd. Los Angeles, CA 90015 Vernon, CA 90058 Los Angeles, CA 90021 (213) 747-0634 (213) 585-7165 (213) 747-7667 California Primary Physicians Centinela Hospital Airport Central Industrial Medical Clinic 1025 W. Olympic Blvd. 5970 S. Sepulveda Blvd. 5970 So. Central Avenue Los Angeles, CA 90015 Los Angeles, CA 90045 Los Angeles, CA 90001 (213) 623-3065 (213) 215-6020 (213) 233-3377 Citizens Medical Group Citizens Medical Group Hollywood Health Center 1300 N. La Brea 11560 W. Pico Blvd. 1462 N. Vine Street Los Angeles, CA 90028 W. Los Angeles, CA 90064 Hollywood, CA 90028 (213) 464-1336 (213) 477-8285 (213) 461-9355 Miller Medical Clinic Pico Medical & Industrial Clinic Shelton -Livingston Medical Group 88M So. Sepulveda Blvd. 1120 So. Robertson 1401 S. Hope St, Ste. #202 Los Angeles, CA 90045 Los Angeles, CA 90035 Los Angeles, CA 90015 (213) 641-2171 (213) 652-8010 (213) 749-2321 Spectrum Industrial Medical Group Venice Culver Industrial Center White Memorial Occupational Medical 4730 Eastern Avenue 12095 W. Washington Blvd. #105 414 N. Boyle Avenue City of Commerce, CA 90040 W. Los Angeles, CA 90066 Los Angeles, CA 90033 (213) 728-9078 (213) 391-5241 (213) 260-5750 Advantage Care/Artesia industrial Advantage Care/Olympian industrial Allcare Medical Group 2499 S. Wilmington Avenue 500 N. Nash Street 2675 E. Slauson Avenue Compton, CA 90220 EI Segundo, CA 90245 Huntington Park, CA 90255 (213) 638.1113 (213) 640-9911 (213) 589-6681 Bay Shores Medical Group Del Amo Industrial Medical Group Manhattan Medical Group 502 Torrance Blvd. 2107 E. Del Amo Blvd. 15401 S. Main Street Redondo Beach, CA 90277 Carson, CA 90220 Gardena, CA 90248 (213) 316-0811 (213) 637-9611 (213) 323.0484 Reiss Woznak Medical Clinic Tri -City Industrial Medical Advantage Care/Medical Clinic (Torrance; 1908 Santa Monica Blvd., Ste.5 128 W. Gardena Blvd. Suite 1 2055 W. Torrance Blvd. Santa Monica, CA 90404 Gardena, CA 90248 Torrance, CA 90501 (213) 870-2254 or (213) 828-5571 (213) 323-2330 (213) 542.6982 Maple Medical Center The Medical Group of Torrance Colorado Family Health Center 505 Maple Ave. 19000 Hawthorne Blvd., Ste.100 1141 E: Colorado Street Torrance, CA 90503 .. Torrance, CA 90503 Glendale, CA 91205 (213) 618-9200 (213) 542-6982 (818) 956-1141 cLA 2000 a 11901 Insured's Copy