AGREEMENT-OPERATE A HOMELESS CASE MANAGEMENT PROGRAM THROUGH THE CLEARWATER HOMELESS INTERVENTION PROGRAM
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AGREEMENT
THIS AGREEMENT is entered into this 1st day of October, 1997, by and
between the City of Clearwater, a Florida municipal corporation, having its
principal office at 112 South Osceola Avenue, Clearwater, Florida,
hereinafter referred to as the "City", and the Salvation Army, hereinafter
referred to as the "Provider". A Georgia Corporation
WITNESSETH:
WHEREAS, the City has entered into an agreement with the U.S.
Department of Housing and Urban Development for the purpose of conducting a
Housing and Community Development Program (HUD) with federal financial
assistance under Title I of the Housing and Community Development Act of
1974, as amended, hereinafter called "Act"; and the Cranston-Gonzalez
National Affordable Housing Act of 1990; and
WHEREAS, the City has determined through its Fiscal Year 1997-98
Consolidated Plan of Objectives and Projected Use of Funds, which was
adopted by City of Clearwater July 17, 1997, the necessity for providing
case management; and
WHEREAS, the City desires to engage the Provider to render certain
services in connection therewith:
NOW, THEREFORE, the parties hereto agree as follows:
SECTION,I:
SCOPE OF SERVICES
A. The Provider agrees to implement the homeless case management program,
in accordance with the projected accomplishments attached and made a
fully binding part of this Agreement, as Appendix 1, as follows:
Funding will be provided for administrative support to operate a
homeless case management program through the Clearwater Homeless
Intervention Program. Services to be provided will give homeless
individuals the tools and encouragement to move out of their current
situation of homelessness into independent living and a more productive
life. Services provided in this case management program includes
financial mentoring, job placement assistance, showers, clothing, food,
access to telephone and receipt of messages, receipt of mail, and
access to mental health.
SECTION II:
CONDITION OF SERVICE
The Provider hereby agrees to the following:
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A. The Program shall serve eligible low and moderate income persons living
primarily in Clearwater.
B. The Provider shall maintain in its file the documentation on which
basis it determines that the project benefits low and moderate income
persons, minorities and residents of Clearwater. Such records shall
include, but not be limited to profiles identifying financial
classification, head of household, ethnicity, race and gender, or area
benefit data, as required.
C. The Provider shall maintain a citizen participation mechanism, which
will include, but not be limited to the following:
1 Logging citizen comments or complaints when received.
2. Copies of comments and/or complaints received in writing.
3. Copies of responses to complaints and/ or explanations of
resolutions to complaints.
D. The Provider shall comply with the following attachments to the Office
of Management and Budget (OMB) Circular No. A-1I0, "Uniform
Administrative Requirements for Grants and Agreements with Institutions
of Higher Education, Hospitals and Other Non-Profit Organizations",
incorporated by reference into this Agreement.
1.
Attachment A, "Cash Depositories" ,
concerning deposit insurance.
except for paragraph 4
2. Attachment E, "Bonding and Insurance".
3. Attachment C, "Retention and Custodial Requirements for Records",
except that in lieu of the provisions in paragraph 4, the
retention period for records pertaining to individual CDBG
activities starts from the date of expiration of this Agreement,
as prescribed in 570.507, in which the specific activity is
reported on for the final time.
4. Attachment F, "Standards for Financial Management Systems".
5. Attachment H, "Monitoring and Reporting Program Performance",
paragraph 2.
6. Attachment N, "Monitoring Management Standards", except for
paragraph 3 concerning the standards for real property and except
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that paragraphs 6 and 7 are modified so that in all cases in which
personal property is sold, the proceeds shall be "program income"
and that personal property not needed by the sub-recipient for
CDBG activities shall be transferred to the recipient for the CDBG
program or shall be retained after compensating the recipient.
7. Attachment 0, "Procurement Standards".
E. Costs incurred under this program shall be in compliance with Federal
Management Circular No. A-122, "Cost Principles for Non-Profit
Organizations", incorporated by reference into this Agreement.
F. The Provider shall abide by those provisions of 24 CFR Part 570 subpart
J, when applicable, incorporated by reference into this Agreement.
G. No expenditures or obligations shall be incurred for the program prior
to approval and release of funds from the u.s. Department of Housing
and Urban Development. Further, it is expressly understood that in the
event no funds are released from the U. S. Department of Housing and
Urban Development in connection with this Program, then the City is not
liable for any claims under this contract.
H. The Provider shall certify, pursuant to Section 109 of the Act, that no
person shall be denied the benefits of the program on the ground of
race, color, national origin or sex.
1.
The Provider agrees that to the extent that it staffs
personnel not presently employed by said party,
affirmative action in attempting to employ low income
in the City of Clearwater, particularly minority group
the Program with
it will take
persons residing
members.
J. The Provider shall comply with the provisions of 24 CFR 570.504 (c),
"Program Income", gross income directly generated from the use of CDBG
funds. In those instances where the City allows the sub-recipient to
retain program income, these funds shall be expended for CDBG eligible
activities, previously approved by the City in accordance with the
projected accomplishments and budget descriptions attached to this
Agreement.
K. The Provider shall adhere to the applicable requirements contained in
the "Acknowledgement of Economic Development Activities", attached
hereto and made a part hereof as Appendix 2, if applicable.
L. The Provider shall comply with First Amendment Church/State principles,
as follows:
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1. It will not discriminate against any employee or applicant for
employment on the basis of religion and will not limit employment
or give preference in employment to persons on the basis of
religion.
2. It will not discriminate against any person applying for public
services on the basis of religion and will not limit such services
or give preference to persons on the basis of religion.
3. It will provide no religious instruction or counseling, conduct no
religious worship or services, engage in no religious
proselytizing, and exert no other religious influence in the
provision of such public services.
4. The portion of a facility used to provide public services assisted
in whole or in part under this Agreement shall contain no
sectarian or religious symbols or decorations.
5. The funds received under this Agreement shall not be used to
construct, rehabilitate, or restore any religious facility which
is owned by the Provider and in which the public services are to
b~ provided. However, minor repairs may made if such repairs are
directly related to the public services; are located in a
structure used exclusively for non-religious purposes; and
constitute, in dollar terms, only a minor portion of the CDBG
expenditure for the public services.
M. The Provider shall transfer to the City upon expiration of this
Agreement, any CDBG funds on hand at the time of expiration and any
accounts receivable attributable to the use of CDBG funds. The
following restrictions and limitations apply to any real property under
the Provider's control which was acquired or improved in whole or in
part with CDBG funds in excess of $25,000:
1. Any real property under the Provider's control must be used to
meet one of the National Objectives in the CDBG Regulations, Part
570.208 until five years or such longer period of time as
determined appropriate by the City after expiration of the
Agreement.
2. If the real property is sold within the period of time specified
above, the property must be disposed of in a manner which results
in the City being reimbursed in the amount of the current fair
market value of the property, less any portion thereof
attributable to expenditures on non-CDBG funds for acquisition of,
or improvement to, the property. Such reimbursement is required.
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N. The Provider agrees that when sponsoring a project financed in whole or
in part under this Agreement, all notices, informational pamphlets,
press releases, advertisements, descriptions of the sponsorship of the
proj ect, research reports, and similar public notices prepared and
released by the Provider shall include the statement:
FUNDED BY THE CITY OF CLEARWATER
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
In written materials, the words "CITY OF CLEARWATER COMMUNITY
DEVELOPMENT BLOCK GRANT FUNDS ADMINISTERED BY THE DEPARTMENT OF
ECONOMIC DEVELOPMENT" shall appear in the same size letters or type as
the name of the Provider.
O. The Provider shall ensure the following when entering into a sub-
contract agreement:
1. The full correct legal name of the party shall be identified.
2. The "Scope of Services" shall describe the activities to be
performed.
P. The Provider shall maintain sufficient records in accordance with 24
CFR 570.502 and 570.506 to determine compliance with the requirements
of this Agreement, the Community Development Block Grant Program and
all applicable laws and regulations.
This documentation shall include, but not be limited to, the following:
1. Books, records and documents in accordance with generally accepted
accounting principles, procedures and practices which sufficiently
and properly reflect all revenues and expenditures of funds
provided directly or indirectly by this Agreement, including
matching funds and program income.
2. Time sheets for split-funded employees who work on more than one
activity, in order to record the CDBG activity delivery cost by
project and the non-CDBG related charges.
3. How the Statutory National Objective(s) and the eligibility
requirement(s) under which funding has been received, have been
met. These also include special requirements such as necessary
and appropriate determinations, income certifications, written
agreements with beneficiaries, where applicable.
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Q. The Provider is responsible for maintaining and storing all records
pertinent to this Agreement in an orderly fashion in a readily
accessible, permanent and secured location for a period of three (3)
years after expiration of this Agreement, with the following exception:
if any litigation, claim or audit is started before the expiration date
of the three year period, the records will be maintained until all
litigation, claims or audit findings involving these records are
resolved. The City shall be informed in writing after close-out of
this Agreement, of the address where the records are to be kept.
SECTION III:
TERM OF AGREEMENT
This Agreement shall be deemed effective upon approval and release of funds
by the U. S. Department of Housing and Urban Development and being duly
executed by both parties, whichever is later.
This project shall become operational as of October 1, 1997, and shall
continue through September 30, 1998.
SECTION IV:,
TERMINATION
The City and the Provider agree:
A. This Agreement may be terminated by either party hereto by written
notice of the other party of such intent to terminate at least thirty
(30) days prior to the effective date of such termination.
B. This Agreement may be terminated in whole or in part, for convenience,
when both parties agree upon the termination conditions. A written
notification shall be required and shall include the following: reason
for the termination, the effective date, and in the case of a partial
termination, the actual portion to be terminated. However, if, in the
case of a partial termination, the City determines that the remaining
portion of the Agreement will not accomplish the purposes of such
Agreement, the City may terminate such in its entirety.
C. The City may place the Provider in default of this Agreement, and may
suspend or terminate this Agreement in whole, or in part, for cause.
1. Cause shall include, but not be limited to, the following:
a. Failure to comply and/or perform in accordance with this
Agreement, or any federal statute or regulation.
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b. Submitting reports to the City which are late, incorrect or
incomplete in any material respect.
c. Implementation of this Agreement, for any reason, is rendered
impossible or infeasible.
d. Failure to respond in writing to any concerns raised by the
City, including substantiating documents when
required/requested by the City.
e. Any evidence of fraud, mismanagement, and/or waste, as
determined by the City's monitoring of the subrecipient, and
applicable HUD rules and regulations.
2. The City shall notify the Provider in writing when the Provider
has been placed in default. Such notification shall include
actions taken by the City, such as withholding of payments,
actions to be taken by the Provider as a condition precedent to
clearing the deficiency and a reasonable date for compliance,
which shall be no more than fifteen (15) days from notification
date.
3.
The City
cause is
shall be
writing,
taken by
shall notify the Provider in writing when sufficient
found for termination of this Agreement. The Provider
given no more than fifteen (15) days in which to reply in
appealing the termination prior to final action being
the City.
D. Let it be further understood that upon curtailment of, or regulatory
constraints placed on, the funds of the U.S. Department of Housing and
Urban Development, this Agreement will terminate effective as of the
time that it is determined such funds are no longer available.
E. Costs of the Provider resulting from obligations incurred during a
suspension or after termination, are not allowable unless the City
expressly authorizes them in the notice of suspension or termination or
subsequently. Other costs during suspension or after termination which
are necessary and not reasonably avoidable are allowable if:
1. The costs result from obligations which were properly incurred
before the effective date of suspension or termination, are not in
anticipation of it, and in the case of termination, are
noncancelable, and
2. The costs would be allowable if the award were not suspended or
expired normally at the end of the Agreement in which the
termination takes effect.
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F. Upon termination of the Agreement, the Provider and the City shall meet
to discuss the City's determination if any amounts are to be repaid to
the City or if additional amounts are due the Provider.
SECTION V:
AMENDMENTS
Any alterations, variations, modifications or waivers of this Agreement
shall only be valid when they have been reduced to writing and duly signed
by both parties. Any changes which do not substantially change the scope of
the project and/or the Project Implementation Schedule or increase the total
amount payable under this Agreement, shall be valid only when reduced to
writing and signed by the City Administration and the Provider.
The City shall not reimburse the Provider for outlays in excess of the
funded amount of the Agreement unless and until the City officially, in
writing, approves such expenditure by executing a written modification to
the original Agreement.
SECTION VI:
METHOD OF PADENT
It is expressly understood and agreed that the total compensation to be paid
hereunder for actual expenditures incurred shall not exceed Fifty Thousand
Six Hundred and Thirteen Dollars ($50,613.00). Such funds must be expended
during the term of the Agreement, and any remaining balance of funds shall
revert to the City. Such compensation shall be paid in accordance with the
projected accomplishments and budget descriptions attached hereto and made a
part hereof as Appendix 1.
A. The Provider shall submit monthly requests for payment for actual
expenditures, including applicable back-up documentation, no later than
the tenth (10th) day of the succeeding month and the City will provide
reimbursement, upon approval, within ten (10) working days after
receipt of the same, if submitted by the deadline data for inclusion on
the drawdown request.
B. The City agrees to pay the Provider for expenditures incurred under
this Agreement on a monthly basis in accordance with the Budget and
Project Implementation Schedule attached hereto and made a part hereof
as Appendix 1. Line item transfers are allowable only within each
component and may not exceed in the aggregate fifteen percent (15%) of
each line item without prior written approval of the City. All changes
amounting to more than fifteen percent (15%) require prior written
approval.
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SECTION VII: CONFLICT OF INTEREST
The Provider covenants that no person, under its employ who presently
exercises any functions or responsibilities in connection with Community
Development funded activities, has any personal financial interests, direct
or indirect, in this Agreement. The Provider covenants that in the
performance of this Agreement, no person having such conflicting interest
shall be employed. The Provider covenants that it will comply with all
provisions of 24 CFR 570.611 "Conflict of Interest", and the State Statutes
governing conflicts of interest. The Provider shall disclose, in writing,
to the City any possible conflicting interest or apparent impropriety that
is covered by the Above provisions. This disclosure shall occur immediately
upon knowledge of such possible conflict. The City will then render an
opinion which shall be binding on both parties.
SECTION VIII:
INDEMNIFICATION AND INSURANCE
The Provider shall indemnify and hold harmless the City from any and all
claims, liability, losses and causes of action which may arise out of the
Agreement. The Provider shall pay all claims and losses of any nature
whatsoever in connection therewith and shall defend or pay to defend all
suits brought against the City, when requested, and shall pay all costs and
judgements which may issue thereon.
Automobile and vehicle coverage shall be required when the use of
automobiles and other vehicles are involved in any way in the performance of
the Agreement.
The Provider shall submit to the City an ORIGINAL Certificate of Insurance.
All liability insurance coverage shall be approved by the City's Risk
Management Office prior to the release of any funds under this Agreement.
Generally, the amount of coverage necessary would be at a minimum of
$300,000.
Further, in the event evidence of the required insurance is not forwarded to
the Risk Management Office within thirty (30) days after the execution of
this Agreement, this Agreement may be terminated at the City's option and
any payments then due may be permanently withheld by the City and the City
will have no further obligation under this contract or any subrecipient
contract.
SECTION IX;
REPORTING AND EVALUATION REQUIREMENTS
Maintaining credibility for the community development effort rests heavily
on the ability to produce an impact in low/moderate income areas, through
progress in accomplishing scheduled activities. An effective method for
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maintaining proj ect progress against a previously established schedule is
through project evaluation and reporting, which will consist of both written
reports and staff discussions on a regular basis. The Provider also assures
prompt and efficient submission of the following:
A. Monthly Reports are due no later than the tenth (10th) day of the
succeeding month and shall include the request for payment when
applicable. Contents of the Monthly Report, attached hereto and made a
part hereof as Appendix 3, shall include but not necessarily be limited
to the following:
1. The Narrative Report Form
2. The Financial Summary Form, which shall include the request for
payment and documentation, as applicable.
3. The Client Profile Form
B. Final Evaluation. Within twenty (20) days of contract completion, a
final report documenting how the Statutory National Objective and the
eligibility requirements were met, must be submitted by the Provider to
the City's Economic Development Department for review and approval.
The contents of same shall include a cumulative total of the data
submitted during the program's operation. Further, such report shall
include statistical findings which depict program efficiency; i.e., the
number of dollars spent, including non-CDBG funding sources, to render
actual service to program recipients, and an overall evaluation of the
program's effectiveness, and quantitative results. The final report
will be evaluated and the Provider will be notified if additional data
is necessary or that the project/activity is considered "closed-out".
Other Reporting Requirements may be required by the City in the event of
program changes, need for additional information or documentation and/or
legislation amendments. The Provider shall be informed, in writing, if any
changes become necessary.
Reports and/or requested documentation not received by the due date, shall
be considered delinquent, and may be considered by the City as sufficient
cause to suspend CDBG payments to the Provider.
SECTION X:
AUDIT AND INSPECTIONS
At any time during normal business hours and as often as City and/or Federal
Government representatives may deem necessary, there shall be made available
to representatives of the City and/or the Federal Government an opportunity
to review, inspect or audit all records, documentation, and any other data
relating to all matters covered by the Agreement.
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An annual organization audit shall be submitted to the City 120 days after
the end of the Provider I s fiscal year. The audit shall be performed in
accordance with OMB Circular A-110 Attachment F, OMB Circular A-133 or OMB
Circular A-128, as applicable. If this Agreement is closed-out prior to the
receipt of an audit report, the City reserves the right to recover any
disallowed costs identified in an audit after such close-out.
SECTION XI: COMPLIANCE WITH LOCAL, STATE & FEDERAL REGULATIONS
The Provider agrees to comply with all applicable federal regulations as
they may apply to program administration. Additionally, the Provider will
comply with all state and local laws and ordinances hereto applicable.
SECTION XII:
ADDITIONAL CONDITIONS AND COMPENSATION
It is expressly understood and agreed by the parties hereto that monies
contemplated by this Agreement to be used for compensation originated from
grants of federal Community Development Block Grant funds, and must be
implemented in full compliance with all of HUD's rules and regulations.
It is expressly understood and agreed that in the event of curtailment or
non-production of said federal grant funds, that the financial sources
necessary to continue to pay the Provider compensation will not be available
and that this Agreement will thereby terminate effective as of the time that
it is determined that said funds are no longer available.
In the event of such determination, the Provider agrees that it will not
look to, nor seek to hold liable, the City or any individual member of the
City Commission thereof personally for the performance of this Agreement and
all of the parties hereto shall be released from further liability each to
the other under the terms of this Agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by their duly authorized officials on the day and date first above
indicated.
The SALVATION ARMY A Georgia:Qorp6iatk>n.
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Countersigned:
Approved as to form & legal
sufficiency:
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.1. Attorney car~
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Secretary' _,,' TlHlWS--
NOV (:5 :997
Date
CITY OF CLEARWATER, FLORIDA
By1
Michael J. Roberto
City Manager
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ATTEST:
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Cynt l Goudeau
City erk
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PROJECT NAME:
GOAL AND PROGRAM IMPLEMENTATION SCHEDULE
Funding Year: 1997 - 1998
Organization: The Salvation Army
Planned Implementation Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Steps
--- --- --- --- --- --- --- --- --- --- --- --
1. Serve an average of 200 200 200 200 200 200 200 200 200 200 200 200 200
unduplicated case files per
month
2 . 100% of clients will be 100 100 100 100 100 100 100 100 100 100 100 100
below 50% of meridan income.
3. Serve an average of 100 100 100 100 100 100 100 100 100 100 100 100 100
unduplicated shelter clients
monthly
4 . Meet weekly to team x x x x x x x x x x x x
conference with other
agencies
L:\DATA\CDO\CONTRACT.TBL
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LEVERAGE WORKSHEET
PROJECT BUDGET SUMMARY SHEET
Funding Year 1997-1998
Agency: Salvation Army - Public Services
Project Title:
Category Category Breakdown Amount Other Funds Other Funding Sources Total Funds
Number Requested Proposed/Conunitted
1 Salaries & Fringe $50,613 $51,036 $53,671 PineIlas County $155,320
The Salvation Army
2 Security $14,040 Clearwater Police $14,040
3 Food $9,000 St. Vincent de Paul $9,000
4 Rent $9,000 The Salvation Army $9,000
5 Utilities $'10,200 Pine lIas County $10,200
6 Property. Upkeep $3,600 PineIlas County $3,600
7 Supplies $6,900 PineIlas County $6,900
8 Cleaning $3,600 PiineIlas County $3,6
9 Financial Assist. $2,400 The Salvation Army $2,400
10 Administration $20,300 The Salvation Army $20,300
Grand Total: $234,360
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Department of Economic Deveropment
COflSolidatBd PIaD Fiscal Year 1996-97
Program Ac!JvJty Report
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Client Incomes as a % 01 lllledlan CII81lt Racial StIUsti~ . .- - Head 01 HDvnhald Statistics
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!BecwBen 50'31 BdWeen 80' iact. .. . {.n- > 1~1iin- :0 I": ftmdet ~ 26 Aged <41 Owr-
C2IenIs Served 8ekNr~ HIsp.Dc lPacilic F8i8s ~~
am 80% IInCt 120%._ . ~aric ltspri: AIa:stan : ! IsIande; Ag. 19 to ~-~~: to 40 1064 .6:'
. Mon.Ul ,.. - Origin} ~)'. kUive ;, ... , .._I';~_'~ .. -,.
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THE SALVATION ARMY POLICY STATEMENT
ON RELATIONSHIPS WITH OTHER GROUPS AND ORGANIZATIONS
The Salvation Army in the United States works cooperatively with many groups _
governmental, social service, civic, religious, business, humanitarian, educational,
health, character buildmg, and other groups - in the pursuit of its mission to preach the
Christian Gospel and meet human need.
Any agency, governmental or private, which enters into a contractual or cooperative
relationship with The Salvation Army should be advised that:
1. The Salvation Army is an international religious and charitable movement,
organized and operated on a quasi-military pattern, and is a branch of the
Christian church.
2. All programs of The Salvation Army are administered by Salvation Army
Officers, who are ministers of the Gospel.
3. The motivation of the organization is love of God and a practicalconcem
for the needs of humanity.
4. The Salvation Army's provision of food, shelter, health services, counseling,
and other physical, social, emotional, psychological and spiritual aid, is
given on the basis of need, available resources and established program
policies.
Organizations contracting and/or cooperating with The Salvation Army may be assured
that because The Salvation Army is rooted in Christian compassion and is governed by
Judeo-Christian ethics, The Salvation Army will strictly observe all provisions of its
contracts and agreements.
Commissioners Conference:
May I 996
, I Icate 0 nsurance cI
THIS CERTIFICATE IS ISSUED AS A MATTER OR, FORMATION ONLY AND CONFERS NO RIGHTS UPON Y\ld THE CERTIFICATE HOLDER. THIS
CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED
BELOW.
This is to Certif that
THE SALVATION ARMY
1424 NORTHEAST EXPRESSWAY
ATLANTA, GA 30329
Name and
address of
Insured
LIBERTI f&
MUTUALW
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the
listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of
h d ' h h' h h' T b' d
any contract or ot er ocument Wit respect to W IC t IS certl Icate may e Issue
CERTIFICATE EXP. DATE
TYPE OF POLICY * 0 CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY
o EXTENDED
IX! POLICY TERM
Coverage Afforded Under WC EMPLOYERS LIABILITY
Law of the Following States:
10/01/99 W A 1-65D-004052-278 AL,AR,DC, FL,GA,KY ,LA, Bodily Injury By Accident Each
-.WORKERS .', - -MO,MS,OK,NC,SC,TN,TX 1-,000,000 -Accident
COMPENSATION va Bodily Injury By Disease Policy
1,000,000 Limit
Bodily Injury By Disease Each
1,000,000 Person
GENERAL LIABILITY General Aggregate-Other than Prod/Completed Operations
$5,000,000
o CLAIMS MADE Products/Completed Operations Aggregate
$500,000
I RETRO DATE t 10/01/99 RG2-651-004052-288 Bodily Injury and Property Damage Liability Per
$500,000 Occurrence
Personal and Advertising Injury Per Person!
[K] OCCURRENCE $500,000 Organization
Other: I Other:
AUTOMOBILE 10/01/99 AS2-651-004052-298 $500,000 Each Accident - Single Limit -
LIABILITY B. I. and P. D. Combined
[K] OWNED GARAGE COVERAGE FORM Each Person
[K] NON-OWNED Each Accident or Occurrence
[K] HIRED Each Accident or Occurrence
OTHER
_"__ - _o_u ..-- -_. -----. '''----. -' --- - ---- - ------ _.-"- -
ADDITIONAL COMMENTS: Customer is self insured for Physical Damage
TIlE SALVATION ARMY CLEARWATER, Fl.-OVERNIGHT SHELTER
*IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED IF COVERAGE IS TERMINATED OR REDUCED
BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE.
SPECIAL NOTICE.. OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,
SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS Liberty Mutual
ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT Insurance Gro p
CANCEL OR REDUCE THE INSURANCE AFFORD EO UNDER THE ABOVE POliCIES UNTIL ..JJ "
UNTIL ATLEAST 30 DAYS NOTICE OF SUCH CANCELlATION HAS BEEN MAILED TO~'<t or: ~
CERTIFICATE CITY OF CLEARWATER AUTHORIZED REPRESENTATIVE
HOLDER 112 SOUlll OSCELOA AVENUE Linda F, Childs
CLEARWATER, FL
10/01/98
DATE ISSUED
NORCROSS
OFFICE
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies
BS 772R6
.......
e ca e 0 nsurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF FORMATION ONLY AND CONFERS NO RIGHTS UPON Y THE CERTIFICATE HOLDER. THIS
CERTIFICATE IS NOT AN INSURANCE POLICY ArID DOES NOT AMEND, EXTEND, OR ALTER THE COVERA'E AFFORDED BY THE POLICIES LISTED
BELOW.
This is to Certify that
THE SALVATION ARMY
1424 NORTHEAST EXPRESSWAY
ATLANTA, GA 30329
Name and
address of
Insured
LIBERlYfe
MUTUAL~
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the
listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of
anv contract or other document with respect to which this certificate mav be issued.
~ERTIFICATE EXP. DATE
TYPE OF POLICY * 0 CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY
o EXTENDED
III POLICY TERM
Coverage Afforded Under WC EMPLOYERS LIABILITY
Law of the Following States:
10/01/99 WA 1-650-004052-278 AL,AR,DC,FL,GA,KY,LA, Bodily Injury By Accident Each
WORKERS MD,MS,OK,NC,SC,TN,TX 1,000,000 Accident
.," ,,- - ,-,-- --- - .. - - -
COMPENSATION va Bodirylnjury By Disease' Policy
1,000,000 Limit
Bodily Injury By Disease Each
1 ,000,000 Person
GENERAL LIABILITY General Aggregate-Other than Prod/Completed Operations
$5,000,000
D CLAIMS MADE Products/Completed Operations Aggregate
$500,000
I RETRO DATE t 10/01/99 RG2-651-004052-288 Bodily Injury and Property Damage Liability Per
$500,000 Occurrence
Personal and Advertising Injury Per Person/
IKJ OCCURRENCE $500,000 Organization
Other: I Other:
AUTOMOBILE 10/01/99 AS2-651-004052-298 $500,000 Each Accident - Single Limit -
LIABILITY B. I. and P. D. Combined
IKJ OWNED GARAGE COVERAGE FORM Each Person
IKJ NON-OWNED Each Accident or Occurrence
IKJ HIRED Each Accident or Occurrence
OTHER
- ,- .-'- ---- i-- ----- ,- - - -------.---..--.--..-- . ------------ - ------ ----- ----
-
ADDITIONAL COMMENTS: Customer is self insured for Physical Damage
THE SALVATION ARMY CLEARWAlER, FL -lEMPORARY OVER1'ri1GHT SHELTER AT: 1120 N. BEITY LANE
*IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED IF COVERAGE IS TERMINATED OR REDUCED
BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE.
SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,
SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS Liberty Mutual
ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT Insurance Group
CANCEl ()fl REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POU"ES UNTIL ~
UNTIL ATLEAST 30 DAYS NOTICE OF SUCH CANCEUATION HAS BEEN MAILED m fl......~( 07; ~
CERTIFICATE CITYOFCLEARWAIT~ AUTHORIZED REPRESENTATIVE
HOLDER 112 SOUTH OSCEOLA AVENUE Linda F. Childs
CLEARW AlBR. FLORIDA
10/01/98 NORCROSS
DATE ISSUED OFFICE
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded bv Those Companies BS 772R6
e I Ica e 0 nsurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF, FORMATION ONLY AND CONFERS NO RIGHTS UPON Y THE CERTIFICATE HOLDER. THIS
CERTIFICATE IS NOT AN INSURANCE POLICY AI"ID DOES NOT AMEND, EXTEND, OR ALTER THE COVERA E AFFORDED BY THE POLICIES LISTED
BELOW.
This is to Certif that
THE SALVATION ARMY
1424 NORTHEAST EXPRESSWAY
ATLANTA, GA 30329
Name and
address of
Insured
LIBER1Y~
MUTUALW
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the
listed policy(ies) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of
h d . h h' h h' T b' d
any contract or ot er ocument Wit respect to W IC t IS certl Icate may: e Issue
~ERTlFICATE EXP. DATE
TYPE OF POLICY * 0 CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY
o EXTENDED
[R] POLICY TERM
Coverage Afforded Under WC EMPLOYERS LIABILITY
Law of the Following States:
10/01/99 W A 1-65D-004052-278 AL,AR,DC,FL,GA,KV,LA, Bodily Injury By Accident Each
WORKERS MD,MS,OK,NC,SC,TN,TX 1,000,000 Accident
-,..- I - -' -- -
COMPENSATION va Bodily Injury By Disease Policy
1 ,000,000 Limn
Bodily Injury By Disease Each
1,000,000 Person
GENERAL LIABILITY General Aggregate-Other than Prod/Completed Operations
$5,000,000
D CLAIMS MADE Products/Completed Operations Aggregate
$500,000
I RETRO DATE t 10/01/99 RG2-651-004052-288 Bodily Injury and Property Damage Liability Per
$500,000 Occurrence
Personal and Advertising Injury Per Personl
IKl OCCURRENCE $500,000 Organization
Other: I Other:
AUTOMOBILE 10/01/99 AS2-651-004052-298 $500,000 Each Accident - Single Limit -
LIABILITY B. I. and P. D. Combined
IKl OWNED GARAGE COVERAGE FORM Each Person
IKl NON-OWNED Each Accident or Occurrence
IKl HIRED Each Accident or Occurrence
OTHER
.- --~---,._-- ---- - ----- --~--,- -
----~-
ADDITIONAL COMMENTS: Customer is self Insured for Physical Damage
1HE SALVA nON AR1Y1Y CLEARW A lER. FL - OVERNIGHT SHEL 'fER
*IF THE CERTIFICATE EXPIRATION DATE IS CONTINUOUS OR EXTENDED TERM, YOU WILL BE NOTIFIED IF COVERAGE IS TERMINATED OR REDUCED
BEFORE THE CERTIFICATE EXPIRATION DATE. HOWEVER, YOU WILL NOT BE NOTIFIED ANNUALLY OF THE CONTINUATION OF COVERAGE.
SPECIAL NOTICE - OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER,
SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS Liberty Mutual
ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT I G
CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL ~ /"'\ J . :s~rance roup
UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: .-.~ ~
.A)1j'( ci(-
AUTHORIZED REPRESENTATIVE
Linda F. Childs
CERTIFICATE CITY OF CLEARW AlER
HOLDER 112 SOUTH OSCEOLA AVE."\iUE
CLEARW AlER. FLORIDA
10/01/98
DATE ISSUED
NORCROSS
OFFICE
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies
BS 772R6