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09-052 Human Service Grant Funds, Catholic Charities Long Term Care Ombudsman Program HUMAN SERVICE GRANT FUNDS CITY/NON-PROFIT CONTRACT THIS Contract is entered into between the CITY OF CUPERTINO, a political subdivision of the State of California (hereinafter "CITY"), and CATHOLIC C;RARITIES a non-profit corporation (hereinafter "CORPORA'T'ION"). The allocation of funds pursuant to this Contract will be a grant. CITY approved the allocation and disbursement of Human Service Grant funds (hereinafter "Grant") to CORPORATION on Apri115, 2008. WITNESS>E;TH WHEREAS, CITY has reserved a portion ~~f its General Fund to be used on activities that benefit Cupertino's residents; and, WHEREAS, CITY has agreed to the use b:y CORPORATION of a portion of CITY' S Human Service Grant budget for the Project as de:;cribed below to be operated within CITY and will benefit low and very low-income households; NOW, THEREFORE, the parties agree as :follows; I. PRO~fECT CITY agrees to allocate a portion of its current Human Service Grant budget to CORPORATION, being the sum of Three Thousand One Hundred Eighty Seven Dollars and No Cents ($3,187.001 for the purpose of impleme~iting the CORPORATION'S project (hereinafter "Project"), as more particularly described in numerous exhibits marked as noted herein, attached to this Contract, incorporated by this reference, as though fully set forth, as follows: Exhibit "A" (Project Description), Exhibit "B" (Project Work Plan), Exhibit "C" (Proposed Implementation Time Schedule), Exhibit "D" (Project Budget), Exhibit "E" (Certifications), Exhibit "F" (Assurances), and Exhibit "G" (Indemnity and Insurance Requirements). II. TERM A. The purpose of this Contract is for the CITY to disburse Grant funds for eligible activities. Unless amended prior to its expiration, the term of this Contract for disbursement purposes will begin on 7/1/08 and will end on 6/3(1/09 unless terminated earlier pursuant to Section VI or Section VII of this Contract. B. The term of the expenditure by CORPORATION of the allocation provided for herein will begin on 7/1/08 and terminate on the earliest of the following dates as set forth herein: 6/30/09, or later date per amendment to this Contr~~ct; or upon the termination date established pursuant to Section VI or Section VII of this Contc~act. III. SECOND YEAR RENEWAL OPTIONS The term of this Contract may be extended by an amendment to disburse the CITY' S Grant funds authorized by City Council for the fiscal year subsequent to the initial term of this Contract, contingent on the following requirements and process: A. Authorization by CITY from the U.S. Department of Housing and Community Development (HUD) to expend funds for the purposes of this Contract; B. CITY'S appropriation of funds for this Project effective until July 1, 2009; C. CORPORATION'S satisfactory performance, as determined by the CITY, of all it's obligations as stated in this Contract for the period July 1, 2008 through June 30, 2009; D. Submission to CITY of Proof of Insurance for the period July 1, 2009 through June 30, 2010. IV. OBLIGATIONS OF CORPORATION A. Organization of CORPORATION. CORPORATION will: 1. Provide CITY with copies of the following documents, evidencing filing with the appropriate governmental agency: a) Its Articles of Incorporation under the laws of the State of California; b) A copy of the current Bylaws of CORPORATION; c) Documentation of its Internal Revenue Service non-profit status; d) Names and addresses of the current Board of Directors of CORPORATION; and, e) An adopted copy of CORPORATION' S personnel policies and procedures. 2. During the Contract term, immediately report any changes, subsequent to the date of this Contract, in CORPORATION'S Articles of Incorporation, Bylaws, Board of Directors, personnel policies and procedures, or tax exempt status to DIRECTOR. 3. Maintain no member of its Board of Directors as a paid employee, agent, independent contractor, or subcontractor under this Contract. Page 2 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc 4. Open to the public, meetings of its Board of Directors, if required by California's open meeting laws, except meetings, or portions thereof, dealing with personnel or litigation matters or as otherwise provided by law. 5. Keep minutes of all its regular ~tnd special meetings. 6. Comply with all provisions of California and Federal Non-Profit Corporation Laws. B. Program Performance by CORPORATION. CORPORATION shall: 1. Conduct the PROGRAM withui the City of Cupertino, for the purpose of benefiting low and very low-income housf;holds. 2. File quarterly reports as required by CITY on the type and number of services rendered through the operation of the PRC?GRAM, and a description of the beneficiaries of these services, and which reports will e,~aluate the manner in which the PROGRAM is achieving its objectives and goals according to the standards established by CITY. The progress reports will be due ten days after the close of each reporting period and must cover the three months immediately preceding the date on which the report is filed. 3. Coordinate its services with other existing organizations providing similar services in order to foster community cooperation and to avoid unnecessary duplication of services. 4. Seek out and apply for other sot;`rces of revenue in support of its operation or services from local, state, federal and priv~rte sources and, in the event of receipt of such award, inform CITY within ten days. 5. Include an acknowledgement of CITY funding and support on CORPORATION stationery and on all apI>ropriate project-related publicity and publications using words to the effect: "funded in whole or in part by the City of Cupertino General Funds." 6. CORPORATION agrees it will carry out the principles as provided in Presidents Executive Order 11246 of September 24, 1965. 7. CORPORATION will comply with Section 281 of the National Affordable Housing Act. C. Fiscal Responsibilities of CORPORATION. CORPORATION will: 1. Appoint and submit the name o:F a fiscal agent who will be responsible for the financial and accounting activities of CORPORATION, including the receipt and disbursement of CORPORATION funds. The CITY must immediately be notified in writing of the appointment of any new fiscal agent and that agent's name. Page 3 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Cba~ities\2008-09 Long Term Care Ombudsman.doc 2. If the term of this Contract is extended by an amendment for a second fiscal year, submit a satisfactory Audit within 150 days of CORPORATION'S fiscal year encompassed by the first year of this Contract. 3. Document all PROJECT costs by maintaining records in accordance with Section III, Paragraph D below. 4. Submit to the CITY, based on an agreed upon schedule, a request for payment, together with all supporting documentation. Invoices requesting disbursements submitted after the expiration of the Contract will be honored only for eligible charges incurred during the Contract term. All invoices must be submitted by the Contract expiration date or within such other time period specified by the CITY for this Contract term. Funds not disbursed will be returned to the Competitive Housing Pool for future reallocation. 5. Certify current and continuous insurance coverage, subject to CITY approval and in accordance with requirements as outlined in Exhibit G, "Indemnity and Insurance Requirements." 6. Items 1) through 6) above are express conditions precedent to disbursement of any CITY funding and failure to comply with these conditions will, at discretion of CITY, result in suspension of funding or termination of this Contract. 7. If CORPORATION does not use CDBG funds in accordance with the requirements of this Contract; CORPORATION is liable for repayment of all disallowed costs. Disallowed costs may be identified through audits, monitoring or other sources. CORPORATION is required to respond to any adverse findings, which may lead to disallowed costs subject to provisions of OMB Circular A-122, "Cost Principles for Non- Profit Organizations." D. Establishment and Maintenance of Records. CORPORATION shall: 1. Maintain complete and accurate records of all its transactions including, but not limited to, contracts, invoices, time cards, cash receipts, vouchers, canceled checks, bank statements, client statistical records, personnel, property and all other pertinent records sufficient to reflect properly (a) all direct and indirect costs of whatever nature claimed to have been incurred or anticipated to be incurred to perform this Contract or to operate the PROJECT, and (b) all other matters covered by this Contract. 2. Maintain client data demonstrating client eligibility for services provided for the Project. Such data will include, but not be limited to, client name, address, income level or other basis for determining eligibility, and description of service provided. Such information will be made available to CITY monitors for review upon request. E. Preservation of Records. CORPORATION will preserve and make available its records: Page 4 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 ~.ong Term Care Ombudsman.doc 1. Until five years following date of final payment of this contract, or 2. For such longer period, if any a~ is required by applicable law; or 3. If this Contract is completely or partially terminated, the records relating to the work terminated will be preserved and made available for a period of five years from the date of termination. F. Examination of Records and Facilities. A~: any time during normal business hours, and as often as may be deemed necessary, CORPORATION agrees that the CITY, and/or any duly authorized representatives may until expiration of (a) five years after final payment under this Contract, (b) five years from the date of termination of this Contract, or (c) such longer period as may be described by applicable law, have access to and the right to examine its plants, offices and facilities used in the performance of this Contract or the operation of the PROJECT, and all its records with respect to the PROJECT and all matters covered by this Contract. CORPORATION also agrees that CITY or any duly authorized representatives will have the right to audit, examine, and make excerpts or tran~~actions of and from, such records and to make audits of all contracts and subcontracts, invoices, ~~ayrolls, records of personnel, conditions of employment, materials and all other data relating ~:o the PROJECT and matters covered by this Contract. CORPORATION will be notified in advance that an audit will be conducted. CORPORATION will be required to respond to alley audit fmdings, and have the responses included in the final audit report. The cost of any such audit will be borne by CITY. G. Compliance with Law. CORPORATION will become familiar and comply with and cause all its subcontractors, independent contractors, and employees, if any, to become familiar and comply with all applicable federal, state and l~~cal laws, ordinances, codes, regulations and decrees. H. Suspension and Termination. Suspension or termination of this Contract may occur if the CORPORATION materially fails to comply with :any term of the award, and that the award may be terminated for convenience. I. Reversion of Assets. Upon expiration or t~:rmination of this Contract, the CORPORATION will transfer to the CITY any Haman Service Grant funds on hand at the time of expiration and any accounts receivable attributable to the use of funds. IV. OBLIGATIOr1S OF CITY A. Method of Payment. During the term of this Contract, CITY shall disburse CDBG funds to CORPORATION on a reimbursement basis unless otherwise provided herein for all allowable costs and expenses incurred in connection with thc; PROJECT, not to exceed the total sum of Three Thousand One Hundred Eighty Seven Dollars and No Cents ($3,187.001. CITY may, at any time in its absolute discretion, elect to suspc;nd or terminate payment to CORPORATION, in whole or in part, pursuant to this Contract based on CORPORATION'S non-compliance, including, but not limited to, incomplete documentation of expenses, failure to substantially meet goals and objectives as required in Exhibit B, ("Project Work Plan"), failure to submit adequate progress reports as required herein or other incidents ofnon-compliance as described in Section Page 5 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Chazities\2008-09 Long Term Caze Ombudsman.doc VI, Paragraph B of this Contract or based on the refusal by CORPORATION to accept any additional conditions that may be imposed by HUD at any time, or based on the suspension or termination of the grant to CITY made pursuant to the Housing and Community Development Act of 1974, as amended. V. PROGRAM COORDINATION A. CITY. The CITY Executive will assign a single DIRECTOR for CITY who will render overall supervision of the progress and performance of this Contract by CITY. All services agreed to be performed by CITY will be at the overall direction of the DIRECTOR. B. CORPORATION. As of the date hereof, CORPORATION has designated Gregory Kepferle to serve as EXECUTIVE DIRECTOR and to assume overall responsibility for the progress and execution of this Contract. The CITY will be immediately notified in writing of the appointment of a new EXECUTIVE DIRECTOR. C. NOTICES. All notices or other correspondence required or contemplated by this Contract shall be sent to the parties at the following addresses: CITY: Attention: Vera Gil Housing Services Division Community Development Department City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 CORPORATION: Gregory Kepferle Executive Director Catholic Charities of Santa Clara County Corporation 2625 Zanker Road. Suite 200 Address of Corporation San Jose. CA 95134 City, State, ZIP All notices will either be hand delivered or sent by United States mail, registered or certified, postage prepaid. Notices given in such a manner will be deemed received when hand delivered or seventy-two (72) hours after deposit in the United States mail. Any party may change his or her address for the purpose of this section by giving five days written notice of such change to the other party in the manner provided in this section. Page 6 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc VI. CONTRACT COMPLIANCE A. Monitoring and Evaluation of Services. Evaluation and monitoring of the PROJECT performance is the mutual responsibility of both CITY and CORPORATION. CORPORATION must furnish all data, statements, records, information and reports necessary for DIRECTOR to monitor, review and evaluate the performance of the PROJECT and its components. CITY will have the right to request the services of an outside agent to assist in any such evaluation. Such services shall be paid for by CITY. B. Contract Noncompliance. If CORPORA"LION fails to comply with any provision of this Contract; CITY will have the right to require corr~:ctive action to enforce compliance with such provision as well as the right to suspend or terminate this Contract. Examples of noncompliance include, but are not limited to: 1. If CORPORATION (with or without lcliowledge) has made any material misrepresentation ofany nature with respect to any information or data furnished to CITY in connection with the PROJECT. 2. If there is pending litigation with respect to the performance by CORPORATION if any of its duties or obligations under this Contract, which may materially jeopardize or adversely affect the undertaking of or the carrying out of the PROJECT. 3. If CORPORATION has taken any action pertaining to the PROJECT, which action required CITY approval, and such approval was not obtained. 4. If CORPORATION is in default under any provision of this Contract. 5. If CORPORATION makes illegal use of CITY funds. 6. If CORPORATION submits to CITY ally report which is incorrect or incomplete in any material respect. 7. If CORPORATION fails to meet the stated objectives in Exhibit B ("Project Work Plan"). C. Corrective Action Procedure. CITY, in its absolute discretion and in lieu of immediately terminating this Contract upon occurrence or discovery of noncompliance by CORPORATION pursuant to this Contract, will have the right to give CORPORATION notice of CITY' S intention to consider corrective action to enforce compliance. Such notice must indicate the nature of the non-compliance and the procedure whereby CORPORATION will have the opportunity to participate in formulating any corrective action recommendation. CITY will have the right to require the presence of CORPORATION' S officer(s) and EXECUTIVE DIRECTOR at any hearing or meeting called for the purpose of considering corrective action. Page7of12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc In the event that CORPORATION does not implement the corrective action recommendations in accordance with the corrective action timetable, CITY may suspend payments hereunder or terminate this Contract as set forth in Section VII below. VII. TERNIINATION A. Termination for Cause. CITY may terminate this Contract by providing written notice to CORPORATION, for any of the following reasons: uncorrected Contract non-compliance as defined in Section VI, Paragraph B; CORPORATION is in bankruptcy or receivership; a member of the CORPORATION'S Board of Directors or the executive director is found to have committed fraud or; there is reliable evidence that CORPORATION is unable to complete the Project as described in the attached Exhibits. The date of termination will be as specified in the notice. B. Termination for Convenience. In addition to the CITY' S right to terminate for cause set forth in Section VI, either CITY or CORPORATION may suspend or terminate this Contract for any reason by giving thirty (30) days prior written notice to the other party. Upon receipt of such notice, performance of the services hereunder will be immediately discontinued. C. In the event that this Contract is terminated, CORPORATON may be required to return funds according to HUD regulations. D. Upon termination of this Contract, CORPORATION must immediately provide CITY access to all documents, records, payroll, minutes of meetings, correspondence and all other data pertaining to the CDBG entitlement fund granted to CORPORATION pursuant to this Contract. VIII. PURCHASING REAL OR PERSONAL PROPERTY CORPORATION and CITY will comply with all applicable Federal Regulations as detailed by 24 CFR Part 570, Subpart J, i.e. 570.500 (Definitions), 570.503 (Agreements with Subrecipients), 570.504 (Program Income), and 570.505 (Use of Real Property), with regards to the use and disposal of Real or Personal Property purchased in whole, or in part, with CDBG funds. In addition, 24 CFR Part 85 (the Common Rule) includes definitions which apply to CDBG Real Property, however, the Common Rule section governing Real Property (CFR 85.31) DOES NOT APPLY TO CDBG ACTIVITIES. A. The following definitions apply to this Contract pursuant to 24 CFR, Part 58 (Common Rule) 85.3: 1) Equipment means tangible, non-expendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. 2) Title as defined in detail in 24 CFR, Part 85.32 (a). Page 8 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc 3) Use as defined in detail in 24 CFR, Part 85.32 (c) (1). 4) Supplies as defined in detail in 24 CFR, Part 85.33. 5) Procurement, Use and Dispositic?n of Real Property as defined in detail by 24 CFR, Part 570.503 (Agreements with Subrecipierits), 570.505 (LTse of Real Property), and 570.504 (Program Income). B. Security Document. As a condition precedent to CITY loaning funds for the purchase of real property or an option to purchase real property, CORPORATION will prepare and execute a Loan Agreement (Exhibit I~, Promissory Note, Deed of Trust and such other Contracts restricting the use of said real property for purposes consistent with this Contract, HLJD and CDBG requirements. C. Grants. If a grant is provided for the acquisition of real property, CORPORATION will continually operate its Project for a minimum per7:od of six (6) years from the effective date of this Contract. This obligation will survive the teen of this Contract, the assignment or assumption of this Contract and the sale of the property prior to expiration of the obligation period as set forth in this paragraph. If this obligation is not fully met, CORPORATION may be required to reimburse the CITY. The CITY may consider, but will not be limited by, the following factors in calculating the reimbursement obligation: initial grant sum; the duration of the initial contractual obligation to operate the Project versus the actual duration of operation and; the appreciated value. D. Relocation, Acquisition, and Displacement. CORPORATION agrees to comply with 24 CFR 570.606 relating to the acquisition and disposition of all real property utilizing CDBG funds, and to the displacement of persons, busine~;ses, and non-profit organizations as a direct result of any acquisition of real property utilizing CDBG funds. CORPORATION agrees to comply with applicable state laws, City Ordinances, Resolutions, and Policies concerning displacement of individuals from their residences. IX. PROGRAM INCOME Income generated by the Project, is Program Income and shall be regulated by all provisions of Title 24 CFR 570 Subpart J "Grant Administratio~i," 570.503 "Agreements with Subrecipients," and 570.504 "Program Income." CORPORATIONv will annually report all program income generated by activities carried out with CDBG funds made available under this Contract. By way of further limitations, CORPORATION may use such income during the Contract period for activities permitted under this Contract and shall reduce requests for additional funds by the amount of any such program income balances on hand. All unused program income shall be returned to the CITY at the end of the Contract period. X. INDEPENDENT CONTRACTOR This is a Contract by and between independent co~itractors and is not intended and will not be construed to create the relationship of agent, servant, employee, partnership, joint venture or Page 9 c?f 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc association between CORPORATION and CITY. CORPORATION, including its officers, employees, agents or independent contractors or subcontractors, shall not have any claim under this Contract or otherwise against CITY for any Social Security, Worker's Compensation, or employee benefits extended to employees of CITY. XI. ASSIGNABILITY A. None of the work or services to be performed hereunder will be assigned, delegated or subcontracted to third parties without the prior written approval of CITY. Copies of all third party contracts shall be submitted to CITY at least ten days prior to the proposed effective date. In the event CITY approves of any such assignment, delegation or sub-contract, the subcontractors, assignees or delegates shall be deemed to be employees of CORPORATION, and CORPORATION will be responsible for their performance and any liabilities attaching to their actions or omissions. B. This Contract may not be assumed nor assigned to another CORPORATION, person, partnership or any other entity without the prior written approval of CITY. XII. DISCLOSURE OF CONFIDENTL~I. CLIENT INFORMATION CITY and CORPORATION agree to maintain the confidentiality of any information regarding applicants for services offered by the PROJECT pursuant to this Contract or their immediate families which may be obtained through application forms, interviews, tests, reports from public agencies or counselors, or any other source. Without the written permission of the applicant, such information will be divulged only as necessary for purposes related to the performance or evaluation of the services and work to be provided pursuant to this Contract, and then only to persons having responsibilities under this Contract, including those furnishing services under the PROJECT through approved subcontracts. XIII. HOLD HARNH,ESS In addition to the indemnity obligations set forth in Exhibit G, "Indemnity and Insurance Requirements," CORPORATION will indemnify and hold harmless the CITY, its employees, agents, and officials, members of boards and commissions, from any and all claims, actions, suits, charges and judgments whatsoever, with respect to any damages, including attorney's fees and court costs, arising out of the failure of the CORPORATION'S Project to comply with applicable laws, ordinances, codes, regulations and decrees, including without limitation those set forth in Exhibit E, "Certifications." XIV. WAIVER OF RIGHTS AND REMEDIES In no event will any payment by CITY constitute or be construed to be a waiver by CITY of any breach of the covenants or conditions of this Contract or any default which may then exist on the part of CORPORATION, and the making of any such payment while any such breach or default will in no way impair or prejudice any right or remedy available to CITY with respect touch breach or default. In no event will payment to CORPORATION by CITY in any way constitute a Page 10 of 12 H:\-CDBG\Subrecipient Ageements\Human Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc waiver by CITY of its rights to recover from CORPORATION the amount of money paid to CORPORATION on any item, which is not eligible for payment under the PROJECT or this Contract. XV. NON-DISC'RIlVIINATION CORPORATION will comply with all applicable Federal, State and local laws and regulations including the City of Cupertino's policies concenung nondiscrimination and equal opportunity in contracting. Such laws include but are not limited to the following: Title VII of the Civil Rights Act of 1964 as amended; Americans with Disabilities Act of 1990; The Rehabilitation Act of 1973 (Sections 503 and 504); California Fair Em~~loyment and Housing Act (Govenunent Code sections 12900 et seq.); and California Labor Code sections 1101 and 1102. CORPORATION will not discriminate against any subcontractor, employee, or applicant for employment because of age, race, color, national origin, ancestry, religion, sex/gender, sexual orientation, mental disability, physical disability, medical condition, :political beliefs, organizational affiliations, or marital status in the recnzitment, selection for training including apprenticeship, hiring, employment, utilization, promotion, layoff, rates of pay or other forms of compensation. Nor shall CORPORATION discriminate in provision of services provided in this Contract because of age, race, color, national origin, ancestry, religion., sex/gender, sexual orientation, mental disability, physical disability, medical condition, ;?olitical beliefs, organizational affiliations, or marital status. This non-discrimination provision must be included in CORPORATION's contracts with sub- contractors and vendors when utilizing the CDBC~ funds disbursed for this project. XVI. AMENDMENTS .Other than the amendment related to a second ye~~r renewal option as stated in Article III. above, amendments to the teens or conditions of this Contract must be requested in writing by a duly authorized representative of the party desiring such amendments, and any such amendment shall be effective only upon the mutual agreement in writing of the parties hereto. Amendments will not invalidate this Contract, nor relieve or release the CITY or the CORPORATION. from its obligations under this Contract. XVII. INTEGRATED DOCUMENT This Contract contains the entire Agreement between CITY and CORPORATION with respect to the subject matter hereof. No written or oral Agreements with any officer, agent or employee of CITY prior to execution of this Agreement shall affect or modify any of the teens of obligations contained in any documents comprising this Agreement. - XVIII. MISCELLANEOUS A. The captions and section headings used in this Contract are for convenience of reference only, and the words contained herein will, in no v~~ay, be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the provisions of this Contract. Page 11 of 12 H:\-CDBG\Subrecipient Agreements\Human Service Grants\Catholic Chazties\2008-09 Long Term Caze Ombudsman.doc C. The persons signing below are duly authorized to execute this Contract. IN WITNESS WHEREOF, the parties have executed this Contract the day and year above written. AGENCY: Catholic Charities of Santa Clara CITY OF CUPERTINO: County By: Gregory Keuferle By: (print name) /~2'3 ~05 f~ ,1G . b9 Executiv irect Date David W. Knapp Date City Manager APPROVED AS TO FORM AND ATTEST: LEGALITY: CGl ~ Igo ~-q Date Kimberly Smit Date City Attorney City Clerk Page 12 of 12 H:\-CDBG\Subrecipient Agreements\IIuman Service Grants\Catholic Charities\2008-09 Long Term Care Ombudsman.doc EXHIBIT A PROJECT PROPOSAL COVER SHEET Name of Applicant: Catholic Charities of San Jose, dba Catholic Charities of Program Year: Santa Clara County July 1, 2008- June 30, 2009 Contact Person: Title: Project # (For Office Use Only) Wanda Hale Pro ram Mana er Address: City: State: Zip Code: 2625 Zanker Road, Suite 200 San Jose CA 95134-2107 Telephone number: Fax Number: E-mail Address: 408-325-5260 408-944-0776 whale@ccsj.org Name of ProjecUProgram: Lon Term Care Ombudsman Pro ram ProjecUProgram Location: 2625 Zanker Road, Suite 200, San Jose, CA 951:54-2107 Project Type: ? Single Family ? Homeownership ? New Construction ? Mixed Use ? Multifamily ? Rental ? Rehabilitation ~ Public Service Project Description: Please describe the project with as many details a:~ possible. Include general information, such as the number of units, number of Cupertino residents that will be served, services that will be provided, etc. Ombudsmen have a combination of functions: visitation, complaint and crisis response and advocacy. Ombudsmen will advocate f~~r the dignity, compassionate treatment, quality of life and quality of care for residents of Cupertino's long term care facilities to make sure they have a voice in their own carE~ and treatment. Our clients are the frail, chronically ill, primarily elderly individuals with physical and/or mental impairments that prevent them from living independently. Ombudsmen will provide community contact through regular visitation to long term care facilities and positively influence the outcome of complaints On behalf of the residents of Cupertino long term care facilities the Long Term Care Ombudsman Program will provide advocacy to make sure they have a voice in their own care and treatment. The Program will demonstrate and maintain a regular, ongoing visibility to these residents (200 unduplicatedlyr) through the presence of trained and certified Ombudsmen. Unannounced visitation (36/yr) allows the Ombudsman to personally observe any actual or potential problems and the opportunity to identify and address issues before they become larger systemic problems. Ombudsmen will identify, receive, investigate, and resolve complaints (12/yr), including violations of personal rights and allegations of elder abuse for primarily elderly (60+) residents in Cupertino's 3 Nursing Facilities and 6 Assisted Living/Residential Care Facilities for the Elderl . EXHIBIT B CITY OF CUPERTINO PROJECT WORK PLAN FY 2008/2009 AGENCY NAME Catholic Charities of San Jose dba Catholic Charities of Santa Clara County DATE PREPARED December 31,2008 PROJECT NAME Long Term Care Ombudsman Program Specific Activities Products or Milestones to be accomplished Benchmarks or Beneficiaries (Use Specific Numerical Data When Possible) For Each Quarter Quanti When Possible 1st 2" 3~ 4` TOTAL Ombudsman Presence Ombudsman visitation will promote the 1.a. Conduct a minimum of 36 on site visits to 9 9 9 9 36 interest, well being and rights of Cupertino long term care facilities. Cupertino long term care facility residents. Ombudsman will observe the 1.b. Personal contact with a minimum of environment and monitor conditions in 200 residents in Cupertino long term long term care facilities and work to care facilities 50 50 50 50 200 improve the delivery of long term care services. Complaint Investigation The primary purpose of the Long Term 2. Investigate a minimum of 12 complaints 3 3 3 3 12 Care Ombudsman Program is to receive, identify, investigate and impartially resolve complaints made by, or on behalf of residents of long term care facilities. Anyone may initiate a complaint on behalf of the resident. EXHIBIT C Proposed Implementation Time Schedule Fiscal Year 2008 -2009 Agency Name: Catholic Charities of San Jose, dba Catholic Charities of Santa Clara County Date: December 31, 2008 Project Name: Long Term Care Ombudsman Program S ecific Activities Jul Au Se Oct Nov Dec Jan Feb Mar A r Ma Jun 25 25 15 15 15 15 15 15 15 15 15 15 Resident contacts -200 unduplicated residents contacted during site visits 3 3 3 3 3 3 3 3 3 3 3 3 Facility site visits - 36 on site visit to Cupertino long term care facilities Complaint Investigations -Investigate 12 complaints 1 1 1 1 1 1 1 1 1 1 1 1 made by or on behalf of Cupertino long term care residents EXHIBIT D BUDGET For Grant Amount 3,187 FY 2008 /2009 Agency Name: Catholic Charities of San Jose, dba Catholic Charities of Santa Clara County Date Prepared: December 31, 2008 Project Name: Long Term Care Ombudsman Program CATEGORY BUDGET FOR YEAR SALARIES: 3,187 Personnel Benefits Taxes OFFICE EXPENSE: Rent Telephone/Fax Printing Travel Utilities Office Supplies Postage Equipment Maintenance /Repair PROJECT EXPENSES: Accounting Services Auditing Fees Insurance Davis Bacon Compliance PROJECT CONSTRUCTION: Appraisal Engineering Services ArchitecturaUDesign Acquisition TOTAL: 3,187 EXHIBIT E BASIC INSURANCE AND BOrJD REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as t:he word is used herein is the party contracting with the City of Cupertino for the direct distribution of CDBG funds. If your organization will be contracting for construction work (such as general contractors building rental apartments) to undertake a Program (as defined in this Non-Profit/City Contract) then the requirements set forth herein shall be complied with by the party contracted with for construction work protecting both the non-profit and the City. Indemnity The Contractor shall indemnify, defend, and hold harmless the City of Santa Clara (hereinafter "City"), its officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performan~~e of this Contract by Contractor and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City. The Contractor shall reimburse the City for all costs, attorneys' fees, expenses and liabili~:ies incurred with respect to any litigation in which the Contractor is obligated to indemnify, defend and hold harmless the City under this Contract. Insurance Without limiting the Contractor's indemnification of the City, the Contractor shall provide and maintain at its own expense, during the term of this Contract, or as may be further required herein, the following insurance coverages and provi:~ions: A. Evidence of Coverage Prior to commencement of this Contract, the Contr~~ctor shall provide on the City's own form or a form approved by the City's Insurance Manager yin original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract: number and project name must be stated on the Certificate of Insurance. The City's Special Endorsement form shall accompany the certificate. Individual endorsements executed by the insurance carrier may be substituted for the City's Special Endorsement form if they provide thy: coverage as required. In addition, a certified copy of the policy or policies shall be provided by th.e Contractor upon request. This verification of coverage shall be sent to the :address as shown on the City's Certificate of Insurance form and to the Housing and Community Development Program at the address set forth in this Contract at Section VI. PROGRAM 1~00RDINATION, Paragraph C., NOTICES. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance h~~s been approved by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. EXHIBIT E -NON-PROFITS 1 REVISED 6/8/95 B. Notice of Cancellation of Reduction of Coverage All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. C. Quali ing Insurers All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII, according to the current Best's Key Rating Guide, unless otherwise approved by the City's Insurance Manager. D. Insurance Required 1. Comprehensive General Liability Insurance -for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence. OR 2. Commercial General Liability Insurance -for bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate - $2,000,000 c. Products/Completed Operations- $1,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commercial General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require additional coverage to be purchased by the Contractor to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/ aggregate to be maintained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. EXHIBIT E -NON-PROFITS 2 REVISED 6/8/95 d. Personal Injury liability. e. Independent Contractors' (Protective;) liability. £ Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City: a. Additional Insured Endorsement: Such insurance as is afforded by this policy shall also apply to the City of Cupertino, and members of the ~~ity Council, and the officers, agents and employees of the City of Cupertin~~, individually and collectively, as additional insureds. b. Primary Insurance Endorsement: Such insurance as is afforded by the: additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino, its officers, agents, and employees shill be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: This policy may not be cancelled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino at the addres;~ shown on the Certificate of Insurance. d. Contractual Liability Endorsement: This policy shall apply to liability assLUned by the insured under written contract with the City of Cupertino. e. Personal Injury Endorsement: The provisions of this policy shall provide Personal Injury coverage. f. Severability of Interest Endorsement: The insurance afforded by this police shall apply separately to each insured that is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit o:F liability. EXHIBIT E -NON-PROFITS 3 REVISED 6/8/95 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Worker's Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all- states endorsement. b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. c. Inclusion of the City and its governing board(s), officers, representatives, agents, and employees as additional insureds, or a waiver of subrogation. 7. Professional Errors and Omissions Liability Insurance This type of insurance should be provided by persons/entities you contract with to provide you with professional services. a. Limits of not less than one million dollars ($1,000,000). b. If this policy contains a self retention limit, it shall not be greater than ten thousand dollars ($10,000) per occurrence/event. c. This coverage shall be maintained for a minimum of two (2) years following termination of this Contract. The City must first approve any exceptions to the above requirements. 8. Bond Requirements Fidelity Bond -Before receiving compensation under this Contract, Contractor will furnish City with evidence that all officials, employees, and agents handling or having access to funds received or disbursed under this Contract, or authorized to sign or countersign checks, are covered by a BLANKET FIDELITY BOND in an amount of AT LEAST fifteen percent (15%) of the maximum financial obligation of the City cited herein. If such bond is cancelled or reduced, Contractor will notify City immediately, and City may withhold further payment to Contractor until proper coverage has been obtained. Failure to give such notice may be cause for termination of this Contract, at the option of the City. 9. ~ecial Provisions EXHIBIT E -NON-PROFITS 4 REVISED 6/8/95 The following provisions shall apply to this Contract: a. The foregoing requirements as to th~~ types and limits of insurance coverage to be maintained by the Contractor and any approval of said insurance by the City or its insurance consultant(s) are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Contractor pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The City acknowledges that some insurance requirements contained in this Contract may be fulfilled by self-insurance on the part of the Contractor. However, this shall not in any wa:~ limit liabilities assumed by the Contractor under this Contract. The City shall aI>prove any self-insurance in writing. c. The City reserves the right to withhold payments to the Contractor in the event of material noncompliance with the insurance requirements outlined above. d. If the Contractor fails to maintain such insurance as is called for herein, the City must order the Contractor to immediately suspend work at Contractor's expense until a new policy of insurance is in effect. EXHIBIT E -NON-PROFITS 5 REVISED 6/8/95 ADDENDUM TO EXHIBIT "E" BASIC INSURANCE AND BOND REQUIREMENTS FOR CONSTRUCTION PROJECTS USING CITY FUNDS If your organization will be contracting for construction work (such as general contractors building rental apartments) to undertake a Program (as defined in this Non-Profit/City Contract) then the requirements set forth in this Addendum to Exhibit "E" shall be complied with by the party contracted with for construction work protecting both the non-profit and the City. Indemnity The General Contractor (hereinafter referred to as "General") shall indemnify, defend, and hold harmless the City of Cupertino (hereinafter "City"), its officers, agents and employees, and the Contractor, it's officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performance of this Contract by General and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City or the Contractor. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City and the Contractor. The General shall reimburse the City and the Contractor for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the General is obligated to indemnify, defend and hold harmless the City and the Contractor under this Contract. Insurance Without limiting the General's indemnification of the City and the Contractor, the General shall provide and maintain at its own expense, during the term of this Contract, or as may be further required herein, the following insurance coverages and provisions: A. Evidence of Coverage Prior to commencement of this Contract, the General shall provide an original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and project name must be stated on the Certificate of Insurance. Individual endorsements executed by the insurance carrier shall accompany the Certificate. This verification of coverage shall be sent to the Contractor at the address stated below and to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance has been approved by the Contractor and final approval by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. B. Notice of Cancellation or Reduction of Coverage EXHIBIT E -NON-PROFITS 6 REVISED 6/8/95 All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department as stated above, and the Contractor at the following address: Catholic Charities of San Jose, dba Catholic Charities of Santa Clara County Contractor'; Name 2625 Zanker Road, Suite 200 Street Address San Jose, CA 95134-2107 City, State, Zip C. Quali ing Insurers 1. All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not le:;s than A VIII, according to the current Best's Key Rating Guide, unless otherwise approvE~d by the City. 2. Surety coverage (including bid, performance and payment bonds) shall be required as follows: a. For projects in excess of $100,000: 1. Either a California Admitted Surety OR a current Treasury Listed Surety (Federal Register); and either a current A.M. Best A IV rated Surety OR a current Standard and Poors (S&P) rating of A; 2. An admitted surety insurer v~~hich complies with the provisions of the Code of Civil Procedure, Section 995.660*; OR 3. In lieu of 1 & 2, a company of equal financial size and stability that is approved by the City's Insurar,_ce/Risk Manager. b. For projects between $25,000 and not exceeding $100,000: 1. A California Admitted Surety and either a current A.M. Best B rated Surety OR a current Standard and Poors (S&P) rating of B B; OR 2. An admitted surety insurer v~~hich complies with the provisions of the Code of Civil Procedure, Section 995.660*; * California Code of Civil Procedure Section 995.660 in sumrrary, states that an admitted surety must provide: 1) the original, or a certified copy of instrument authorizing the perso~i who executed the bond to do so; 2) a certified copy of EXHIBIT E -NON-PROFITS 7 REVISED 6/8/95 the Certificate of Authority issued by the Insurance Commissioner; 3) a certificate from City Clerk of Santa Clara City that Certificate of Authority has not been surrendered, revoked, canceled, annulled or suspended; 4) a financial statement showing the assets and liabilities of the insurer at the end of the quarter calendar year, prior to 30 days next preceding the date of the execution of the bond. EXHIBIT E -NON-PROFITS 8 REVISED 6/8/95 OR 3. In lieu of 1 & 2, a company of equal financial size and stability that is approved by the City's Insurance/Risk Manager. D. Insurance Re wired 1. Comprehensive General Liability Insurance -for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence;. OR 2. Commercial General Liability Insurance - fir bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate -$2,000,00() c. Products/Completed Operations- $1.,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commerci~il General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require addition~~l coverage to be purchased by the General to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/aggregate to be mai~rtained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. d. Personal Injury liability. e. Independent Contractors' (Protective) liability f. Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City and thf; Contractor: EXHIBIT E -NON-PROFITS 9 REVISED 6/8/95 a. Additional Insured Endorsement: Insurance afforded by this policy shall also apply to the City of Cupertino and Contractor as additional insureds. b. Primary Insurance Endorsement: Insurance afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino and the Contractor shall be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: This policy may not be canceled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino CDBG Program, and the Contractor at the addresses set forth on page 10 of this Addendum. d. Severability of Interest Endorsement: The insurance afforded by this policy shall apply separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Worker's Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all- states endorsement. b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. 7. Work and Materials Insurance (including but not limited to Builder's Risk, Course of Construction, Installation Floater or similar first party property insurance for covering the interest of the Contractor and the City) shall be provided by the Contractor. The Contractor's coverage shall provide the following: EXHIBIT E -NON-PROFITS 10 REVISED 6/8/95 a. Coverage shall be provided on an "a.ll-risk" basis. b. Coverage shall be provided on the work and materials which are the subject of this Contract, whether in proces:c or manufacture or finished, including "in transit" coverage to the final agreed upon destination of delivery, and including loading and unloading operations, and such coverage shall be in force until the work and materials are accepted by the City. c. City and non-profit shall be named- as additional insured as its interests may appear at the time of loss. d. Coverage shall be in an amount no less than the full replacement value of the property at the time of loss. e. The deductible shall not exceed $1,000 per occurrence unless otherwise approved by the City and shall be borne by thf; Contractor. f. If the construction contractor fail ~ to maintain such insurance as is called for herein, the City shall have cause to terminate this Contract in accordance with Section V, paragraph B. 8. Bond Requirements The following bond requirements apply: a. Contract Bonds -Prior to execution of the Contract, Contractor shall file with the City on the approved forms, the two surety bonds in the amounts and for the purposes noted below, duly executc;d by a reputable surety company satisfactory to City, and Contractor shall pay ~~ll premiums and costs thereof and incidental thereto. Both Contractor and the sureties shall sign each bond. b. The "payment bond for public works" shall be in an amount of one hundred percent (100%) of the Co~itract price, as determined from the prices in the bid form, and shall insure to the benefit of persons performing labor or furnishing materials in connection ~~ith the work of the proposed Contract. This bond shall be maintained in full for~~e and effect until all work under the Contract is completed and accepted by the City, and until all claims for materials and labor have been paid. c. The "performance bond" shall be in aii amount of one hundred percent (100%) of the Contract price as determined from the prices in the bid form. and shall insure the faithful performance by Contractor of all work under the Contract. It shall also insure the replacing of, or snaking acceptable, any defective materials or faulty workmanship. EXHIBIT E -NON-PROFITS 11 REVISED 6/8/95 Should any surety or sureties be deemed unsatisfactory at any time by the City notice will be given Contractor to that effect, and Contractor shall forthwith substitute a new surety or sureties satisfactory to the City. No further payment shall be deemed due or will be made under the Contract until the new sureties qualify and are accepted by the City. All alterations, time extensions, extra and additional work, and other changes authorized by the Specifications, or any part of the Contract, may be made without securing consent of the surety or sureties on the contract bonds. 9. ~ecial Provisions The following provisions shall apply to this Contract: a. The foregoing requirements as to the types and limits of insurance coverage to be maintained by the General and any approval of said insurance by the City or the Contractor are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the General pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The Contractor reserves the right to withhold payments to the General in the event of material noncompliance with the insurance requirements outlined above. c. The Contractor shall notify the City Community Development Department promptly of all losses or claims over $25,000 resulting from work performed under this contract, or any products/completed operations loss or claim against the contractor resulting from any of the contractor's work. EXHIBIT E -NON-PROFITS 12 REVISED 6/8/95 EXHIBIT F ASSURANCES CORPORATION hereby assures and certifies that it ~Nill comply with all regulations, policies, guidelines and requirements applicable to the acceptance and use of Federal funds for this Federally- assisted program and will be responsible for implementing and complying with all relevant future changes to Federal Regulations or OMB Circulars. Specifically CORPORATION gives assurances and certifies with respect to the PROGRAM that it is in a~mpliance with the following Regulations as defined by 24 CFR, Part 570, Subpart J; 24 CFR, Part 570, Subpart K; and will be conducted and administered in conformity with "Public Law 88.352 and Public Law 90-284. 1. 570.601. Public Law 88-352 and Public Law 90-284; affirmatively furthering fair housing; Executive Order 11063, as amended by Executive Order 12259 addresses discrimination. HUD regulations implementing Executive Order 11063 are contained in 24 CFR, Part 107. 2. 570.602. Section 109 of the Act addresses di~:crimination. 3. 570.603. Labor Standards. 4. 570.604. Environmental Standards. 5. 570.605. National Flood Insurance Program. 6. 570.606. Relocation, Displacement and Acquisition. 7. 570.607. Employment and Contracting Opportunities. 8. 570.608. Lead-Based Paint. 9. 570.609. Use of Debarred, Suspended, or Ineligible Contractors or Subrecipients. 10. 570.610. Uniform Administrative Requirement and Cost Principles. The CITY, its Subrecipients, agencies or instrumentalities, shall comply with the policies, guidelines, and requirements of 24 CFR Part 85 (Common Rule), and OMB Circulars A-110 (Grants and Agreements with Non-Profit Organizations), E~-122 (Cost Principles for Non-Profits), A-128 (Audits of State and Local Governments-implemented at 24 CFR, Part 24), and A-133 (Audits of Institutions of Higher Education and Other [~lon-Profit Institutions), as applicable, as they relate to the acceptance and use of Federal funds under this part. The applicable sections of 24 CFR, Part 85 and OMB Circular A-100 are set: forth at 570.502. 11. 570.611. Conflict of Interest. 12. 570.612. Executive Order 12372 allows States to establish its own process for review and comment on proposed Federal financial assist~ince programs, specifically the use of CDBG funds for the construction or planning of water or sewer facilities. EXHIBIT F -ASSURANCES 1 REVISED 11/1 S/00 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 C O P E RT I N O WEBSITE: www.cupen:ino.org May 5, 2009 Marlene Siebert Long Term Care Ombudsman Program 2625 Zanker Road, Suite 200 San Jose, CA 95134 To Whom It May Concern: A fully executed copy of your agreement with the: City of Cupertino is enclosed. If you have any questions or need additional information, please contact the Community Development Department at (408) 777-3308. Sincerely, CITY CLERK'S OFFICE Enclosure