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121311 CC Agenda
In compliance with the Americans with Disabilities Act, if you need special assistance to participate in this meeting, please contact the office of the City Clerk (951) 694-6444. Notification 48 hours prior to a meeting will enable the City to make reasonable arrangements to ensure accessibility to that meeting [28 CFR 35.102.35.104 ADA Title II] AGENDA TEMECULA CITY COUNCIL A REGULAR MEETING CITY COUNCIL CHAMBERS 41000 MAIN STREET DECEMBER 13, 2011 — 7:00 PM At approximately 9:45 P.M., the City Council will determine which of the remaining agenda items can be considered and acted upon prior to 10:00 P.M. and may continue all other items on which additional time is required until a future meeting. All meetings are scheduled to end at 10:00 P.M. Next in Order: Ordinance: 11-11 Resolution: 11-82 CALL TO ORDER: Mayor Ron Roberts Prelude Music: Music Heritage Foundation Invocation: Rabbi Yitzchok Hurwitz of Chabad of Temecula Valley Flag Salute: Council Member Naggar ROLL CALL: Comerchero, Edwards, Naggar, Washington, Roberts PRESENTATIONS/PROCLAMATIONS Presentation to Retiring City Manager Shawn Nelson PUBLIC COMMENTS A total of 30 minutes is provided so members of the public may address the City Council on items that appear within the Consent Calendar or ones that are not listed on the agenda. Each speaker is limited to three minutes. If the speaker chooses to address the City Council on an item listed on the Consent Calendar or a matter not listed on the agenda, a Request to Speak form must be filled out and filed with the City Clerk. Once the speaker is called to speak, please come forward and state your name for the record. For all Public Hearing or Council Business items on the agenda, a Request to Speak form must be filed with the City Clerk prior to the City Council addressing that item. There is a five-minute time limit for each speaker. CITY COUNCIL REPORTS Reports by the members of the City Council on matters not on the agenda will be made at this time. A total, not to exceed, 10 minutes will be devoted to these reports. 1 CONSENT CALENDAR NOTICE TO THE PUBLIC All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless Members of the City Council request specific items be removed from the Consent Calendar for separate action. 1 Standard Ordinance and Resolution Adoption Procedure RECOMMENDATION: 1.1 Motion to waive the reading of the text of all ordinances and resolutions included in the agenda. 2 Action Minutes RECOMMENDATION: 2.1 Approve the action minutes of November 22, 2011. 3 List of Demands RECOMMENDATION: 3.1 Adopt a resolution entitled: RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 4 City Treasurer's Report as of October 31, 2011 RECOMMENDATION: 4.1 Approve and file the City Treasurer's Report as of October 31, 2011. 5 Financial Statements for the Three Months Ended September 30, 2011 RECOMMENDATION: 5.1 Receive and file the Financial Statements for the Three Months Ended September 30, 2011; 5.2 Approve an appropriation decrease of $147,145 for Operating Transfers Out in the State Transportation fund and an offsetting $147,145 increase for Operating Transfer Out in the State Gas Tax fund. 2 6 Vehicle Repair and Maintenance Agreement Amendment RECOMMENDATION: 6.1 Approve a three-year Vehicle Repair and Maintenance Agreement Amendment with Old Town Tire & Service LLC, in an amount not to exceed $86,000 annually. 7 Office Supplies and Related Services Agreement RECOMMENDATION: 7.1 Approve a one-year Agreement between the City of Temecula and Staples Advantage for $65,000 annually for the purchase of office supplies and related services, with the option to renew for three additional one-year terms. 8 Geotechnical, Material Testing, and Special Inspection Professional Services Agreement for the Roripaugh Ranch Street Improvements, Phase 1 — Project No. PW09-02 RECOMMENDATION: 8.1 Approve an Agreement with Geocon West, Inc. to provide professional geotechnical, material testing, and special inspection services associated with the Roripaugh Ranch Street Improvements, Phase 1 — Project No. PW09-02, in the amount of $100,000 and authorize the Mayor to execute the Agreement; 8.2 Authorize the City Manager to approve Extra Work Authorizations not to exceed the contingency amount of $10,000 which is equal to 10% of the Agreement amount. 9 Memorandum of Understanding and Amended Service Agreement with Eastern Municipal Water District for Water and Sewer Facilities Associated with the Roripaugh Ranch Street Improvements, Phase 1 — Project No. PW09-02 RECOMMENDATION: 9.1 Approve a Memorandum of Understanding (MOU) and a Standard Water and/or Sewer Facilities and Amended Service Agreement with Eastern Municipal Water District (EMWD) for water and sewer facilities associated with the Roripaugh Ranch Street Improvements, Phase 1 — Project No. PW09-02, and authorize the City Manager to execute the MOU and Service Agreement on behalf of the City; 9.2 Authorize payment of $67,900 to EMWD, as outlined in the amended Service Agreement, which represents EMWD engineering, inspection, and material/construction expenses for the project. 3 10 Cooperative Agreement with Caltrans for Construction of Phase 1 of the French Valley Parkway Interchange — Project No. PW07-04 RECOMMENDATION: 10.1 Adopt a resolution entitled: RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING A COOPERATIVE AGREEMENT NO. 08-1508, BETWEEN THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION (CALTRANS) AND THE CITY OF TEMECULA FOR THE CONSTRUCTION OF THE FRENCH VALLEY PARKWAY/INTERSTATE-15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS PROJECT — PHASE I 11 Agreement with Harris and Associates for Construction Management Services for Phase 1 of the French Valley Parkway Interchange Improvements — Project No. PW07-04 RECOMMENDATION: Accelerate the appropriation and funding in the amount of $566,270.30 from the Construction Engineering line item for the French Valley Parkway/Interstate-15 Over -Crossing and Interchange Improvements, Phase I — Project No. PVV07-04, from fiscal year 2012-13 to fiscal year 2011-12; 11.2 Approve an agreement with Harris & Associates in an amount not to exceed $2,332,973 to provide professional construction management services for the French Valley Parkway/Interstate-15 Over -Crossing and Interchange Improvements, Phase I — Project No. PW07-04; 11.3 Authorize the City Manager to approve Extra Work Authorizations not to exceed the contingency amount of $ 233,297.30, which is 10% of the agreement amount. 12 Transportation Uniform Mitigation Fee (TUMF) Reimbursement Agreement with the Western Riverside Council of Governments (VVRCOG) for the French Valley Parkway/I- 15 Overcrossing and Interchange — Plans, Specifications, and Estimates (PS&E) Phase RECOMMENDATION: 12.1 Approve, in substantially the form attached, the TUMF Reimbursement Agreement, in the amount of $8,925,000, between the Western Riverside Council of Governments (VVRCOG) and the City of Temecula for the French Valley Parkway/I-15 Overcrossing and Interchange — Plans, Specifications, and Estimates (PS&E) Phase (Agreement No. 06 -SW -TEM -1079); 12.2 Authorize the City Manager to execute the Agreement. 4 13 Increase to the Construction Contingency and City Manager Approval Authority for the Winchester Road Pavement Rehabilitation — Project No. PW10-11 RECOMMENDATION: 13.1 Approve an increase to the contingency of the Pavement Rehabilitation Program, Winchester Road — Project No. PVV10-11, in the amount of $80,000 and increase the City Manager approval authority by that same amount. 14 Notification to Business License Applicants of new State Legislation prohibiting Cities from requiring Employers to use E -Verify and of the Federal Law prohibiting Employers from knowingly hiring an Undocumented Worker RECOMMENDATION: 14.1 Receive and file this report describing the notices that Staff will include in business license applications beginning December 14, 2011, concerning E - Verify and federal law concerning the prohibition on hiring undocumented workers. 15 Second Reading of Ordinance No. 11-10 RECOMMENDATION: 15.1 Adopt an ordinance entitled: ORDINANCE NO. 11-10 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING SECTION 3.32.010 OF THE TEMECULA MUNICIPAL CODE REGARDING THE CONSTRUCTION ON PUBLIC PROJECTS ******************** RECESS CITY COUNCIL MEETING TO SCHEDULED MEETINGS OF THE TEMECULA COMMUNITY SERVICES DISTRICT, THE CITY OF TEMECULA REDEVELOPMENT AGENCY, THE TEMECULA HOUSING AUTHORITY, AND THE TEMECULA PUBLIC FINANCING AUTHORITY ******************** 5 TEMECULA COMMUNITY SERVICES DISTRICT MEETING Next in Order: Ordinance: No. CSD 11-01 Resolution: No. CSD 11-09 CALL TO ORDER: President Jeff Comerchero ROLL CALL: DIRECTORS: Edwards, Naggar, Roberts, Washington, Comerchero CSD PUBLIC COMMENTS A total of 30 minutes is provided so members of the public may address the Board of Directors on items that appear within the Consent Calendar or ones that are not listed on the agenda. Each speaker is limited to three minutes. If the speaker chooses to address the Board of Directors on an item listed on the Consent Calendar or a matter not listed on the agenda, a Request to Speak form must be filled out and filed with the City Clerk. Once the speaker is called to speak, please come forward and state your name for the record. For all Public Hearing or District Business items on the agenda, a Request to Speak form must be filed with the City Clerk prior to the Board of Directors addressing that item. There is a five-minute time limit for each speaker. CSD CONSENT CALENDAR 16 Action Minutes RECOMMENDATION: 16.1 Approve the action minutes of November 22, 2011. 17 Financial Statements for the Three Months Ended September 30, 2011 RECOMMENDATION: 17.1 Receive and file the Financial Statements for the Three Months Ended September 30, 2011. 18 License Agreement to add Parking for the Theater RECOMMENDATION: 18.1 Approve a license agreement between Temecula Community Services District (TCSD) and Dennis G. Munyon for use of the Oakpark Executive Suites parking lot. This is a three-year agreement with an annual payment of $9,500.00. 6 CSD BUSINESS 19 Appointment of President and Vice President of the Temecula Community Services District for calendar year 2012 RECOMMENDATION: 19.1 Entertain motions from the Board of Directors to appoint the President, effective January 1, 2012, to preside until the end of calendar year 2012; 19.2 Entertain motions from the Board of Directors to appoint the Vice President, effective January 1, 2012, who will assume the duties of the President in the President's absence, and hold this office until the end of calendar year 2012. CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGERS REPORT CSD BOARD OF DIRECTORS REPORTS CSD ADJOURNMENT Next regular meeting: Tuesday, January 10, 2012, at 5:30 P.M., for a Closed Session, with regular session commencing at 7:00 PM., City Council Chambers, 41000 Main Street, Temecula, California. 7 TEMECULA REDEVELOPMENT AGENCY MEETING Next in Order: Ordinance: No. RDA 11-01 Resolution: No. RDA 11-12 CALL TO ORDER: Chair Person Mike Naggar ROLL CALL: AGENCY MEMBERS: Comerchero, Edwards, Roberts, Washington, Naggar RDA PUBLIC COMMENTS A total of 30 minutes is provided so members of the public may address the Agency Members on items that appear within the Consent Calendar or ones that are not listed on the agenda. Each speaker is limited to three minutes. If the speaker chooses to address the Agency Members on an item listed on the Consent Calendar or a matter not listed on the agenda, a Request to Speak form must be filled out and filed with the City Clerk. Once the speaker is called to speak, please come forward and state your name for the record. For all Public Hearing or Agency Business items on the agenda, a Request to Speak form must be filed with the City Clerk prior to the Agency Members addressing that item. There is a five-minute time limit for each speaker. RDA CONSENT CALENDAR 20 Action Minutes RECOMMENDATION: 20.1 Approve the action minutes of November 22, 2011. 21 Financial Statements for the Three Months Ended September 30, 2011 RECOMMENDATION: 21.1 Receive and file the Financial Statements for the Three Months Ended September 30, 2011. RDA BUSINESS 22 Appointment of Chair Person and Vice Chair Person of the Temecula Redevelopment Agency for calendar year 2012 RECOMMENDATION: 22.1 Entertain motions from the Agency Members to appoint the Chair Person to preside, effective January 1, 2012, until the end of calendar year 2012; 8 22.2 Entertain motions from the Agency Members to appoint the Vice Chair Person, effective January 1, 2012, who will assume the duties of the Chair Person in the Chair Person's absence, and hold this office until the end of calendar year 2012. RDA EXECUTIVE DIRECTORS REPORT RDA AGENCY MEMBERS REPORTS RDA ADJOURNMENT Next regular meeting: Tuesday, January 10, 2012, at 5:30 P.M., for a Closed Session, with regular session commencing at 7:00 PM., City Council Chambers, 41000 Main Street, Temecula, California. 9 TEMECULA HOUSING AUTHORITY MEETING - no meeting TEMECULA PUBLIC FINANCING AUTHORITY MEETING - no meeting RECONVENE TEMECULA CITY COUNCIL PUBLIC HEARING Any person may submit written comments to the City Council before a public hearing or may appear and be heard in support of or in opposition to the approval of the project(s) at the time of the hearing. If you challenge any of the project(s) in court, you may be limited to raising only those issues you or someone else raised at the public hearing or in written correspondence delivered to the City Clerk at, or prior to, the public hearing. 23 AB 1600 Financial Reports RECOMMENDATION: 23.1 Approve the AB 1600 Financial Reports for fiscal year ending June 30, 2011. CITY COUNCIL BUSINESS 24 Appointment of Mayor and Mayor Pro Tem for calendar year 2012 RECOMMENDATION: 24.1 Entertain motions from the City Council Members to appoint the Mayor to preside, effective January 1, 2012, to the end of calendar year 2012; 24.2 Entertain motions from the City Council Members to appoint the Mayor Pro Tem, effective January 1, 2012, who will assume the duties of the Mayor in the Mayor's absence, and hold this office until the end of the calendar year 2012. 25 Community Service Funding Program for fiscal year 2011-12 RECOMMENDATION: 25.1 Review and approve the fiscal year 2011-12 Community Service Funding Program grants pursuant to the attached spreadsheet outlining the Ad Hoc Subcommittee's recommendations of $60,000 to 13 organizations. DEPARTMENTAL REPORTS 26 City Council Travel/Conference Report - November 2011 CITY MANAGER REPORT CITY ATTORNEY REPORT ADJOURNMENT Next regular meeting: Tuesday, January 10, 2012, at 5:30 PM, for a Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. 11 NONCE TO THE PUBLIC The agenda packet (including staff reports) will be available for viewing at the Main Reception at City Hall (41000 Main Street, Temecula) or at the Temecula Library (30600 Pauba Road, Temecula) after 4:00 PM the Friday before the City Council meeting. At that time, the packet may as well be accessed on the City's website — www.cityoftemecula.orq Supplemental material received after the posting of the Agenda Any supplemental material distributed to a majority of the City Council regarding any item on the Agenda, after the posting of the Agenda, will be available for public review at the Main Reception at the Civic Center (41000 Main Street, Temecula — 8:00 — 5:00 PM). In addition, such material will be made available on the City's web — www.cityoftemecula.orq — and will be available for public review at the respective meeting. If you have any questions regarding any item of business on the Agenda for this meeting, please contact City Clerk's Department — 951-694-6444. 12 PRESENTATIONS CONSENT CALENDAR Item No. 1 Item No. 2 ACTION MINUTES TEMECULA CITY COUNCIL A REGULAR MEETING CITY COUNCIL CHAMBERS 41000 MAIN STREET NOVEMBER 22, 2011 — 7:00 PM 6:15 P.M. — The City Council/Temecula Redevelopment Agency will convene in Closed Session in the Canyons Conference Room on the third floor of the Temecula City Hall concerning the following matters: 1) City's purchase of Conference with real property negotiators pursuant to Government Code Section 54956.8 regarding the acquisition of real property interests in one parcel of real property owned by Front Street Service Station at the south west corner of Temecula Parkway and Old Town Front Street (APN 922-210-057). The parties to the negotiations for the purchase of the property are the Front Street Service Station and the City of Temecula. Negotiators for the City of Temecula are: Greg Butler, Amer Attar and Avlin Odviar. Under negotiation are price and the terms of the the property interests. Public Information concerning existing litigation between the City and various parties may be acquired by reviewing the public documents held by the City Clerk. The City Council meeting convened at 7:00 P.M. CALL TO ORDER: Mayor Ron Roberts Prelude Music: Caroline Nelms Invocation: Reverend tony Foster of True Vine Pentecostal Church Flag Salute: Council Member Edwards ROLL CALL: Comerchero, Edwards, Naggar, Washington, Roberts PRESENTATIONS/PROCLAMATIONS Impaired Driver Awareness Month Proclamation Certificate of Achievement for Eagle Scout Alec Shaw Twelfth Annual Community Candlelight Tribute Day Proclamation PUBLIC COMMENTS The following individual addressed the City Council: • Kathleen Hamilton • Lorena Spencer • Bernard Budney CITY COUNCIL REPORTS Action Minutes1112211 1 CONSENT CALENDAR 1 Standard Ordinance and Resolution Adoption Procedure — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 1.1 Motion to waive the reading of the text of all ordinances and resolutions included in the agenda. 2 Action Minutes — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 2.1 Approve the action minutes of November 1, 2011. 3 List of Demands — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 3.1 Adopt a resolution entitled: RESOLUTION NO. 11-80 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 4 City Treasurer's Report as of September 30, 2011 — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 4.1 Approve and file the City Treasurer's Report as of September 30, 2011. 5 Liability Insurance Renewal — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 5.1 Approve the insurance policy renewal for liability insurance with Travelers Indemnity Company/Travelers Indemnity Company of Connecticut (Travelers) and excess liability insurance with Ironshore Specialty Insurance Company (Ironshore), in the amount of $219,099, for the period of December 1, 2011 through December 1, 2012. 6 Acceptance of Implementation and Notice of Completion for the Citywide Adaptive Action Minutes1112211 2 Traffic Signal Synchronization System, Phase I and Phase II — Project No. PW10-06 — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 6.1 Accept the Implementation of the Citywide Adaptive Traffic Signal Synchronization System, Phase I and Phase II, Project No. PW10-06, as complete; 6.2 Direct the City Clerk to file and record the Notice of Completion. 7 Approval of an Amendment to the City's Proposition 1B Spending Plan and Approval of Plans and Specifications and Authorization to Solicit Construction Bids for the Citywide Crackfill Project FY2010-2011 — Project No. PW11-04 — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 7.1 Approve an amendment to the City's Proposition 1B Spending Plan for FY 2008- 09 to include the Citywide Crackfill Project FY 2010-2011; 7.2 Approve the plans and specifications and authorize the Department of Public Works to solicit construction bids for the Citywide Crackfill Project — Project No PW11-04. 8 Approval of Plans and Specifications and Authorization to Solicit Construction Bids for the Citywide Pavement Rehabilitation Program, Project Numbers PW10-12 — Rancho California Road (Jefferson to Ynez), and PW10-13 —Winchester Road (Jefferson to Ynez) — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 8.1 Approve the plans and specifications and authorize the Department of Public Works to solicit construction bids for the Citywide Pavement Rehabilitation Program — Project No. PW10-12 and Project No. PW10-13. 9 Approval of Plans and Specifications and Authorization to Solicit Construction Bids for the Community Recreation Center (CRC) Roof Replacement — Project No. PW11-06 — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 9.1 Approve the plans and specifications and authorize the Department of Public Works to solicit construction bids for the Community Recreation Center (CRC) Roof Replacement — Project No. PW11-06. Action Minutes1112211 3 10 Amendment to Animal Friends of the Valleys Contract and Spending Authorization for Debt Service and Sheltering Services to the Southwest Communities Financing Authority — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 10.1 Approve an amended contract with Animal Friends of the Valleys; 10.2 Approve purchasing authorization for Fiscal Year 201112012 payable to Southwest Communities Financing Authority to pay for annual sheltering service costs in the amount of $127,500 annually; 10.3 Authorize the City Manager to approve additional sheltering service costs to Southwest Communities Authority/County of Riverside in the amount of $30,000 annually; 10.4 Approve purchasing authorization for Fiscal Year 2011/2012 payable to Southwest Communities Financing Authority to pay for debt service in the amount of $42,387. 11 Support for HR 41, the Beauty Mountain and Aqua Tibia Wilderness Act of 2011— Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 11.1 Adopt a resolution entitled: RESOLUTION NO. 11-81 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA SUPPORTING THE HOUSE OF REPRESENTATIVES BILL HR 41 (ISSA) FOR THE BEAUTY MOUNTAIN AND AGUA TIBIA WILDERNESS ACT OF 2011 12 Agreement for funding the acquisition of open space property (Assessor's Parcel No. 940-030-002) Morgan Stanley Trust, between Western Riverside County Regional Conservation Authority and the City of Temecula — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: 12.1 Approve the funding agreement for the acquisition of open space property (Assessor's Parcel No. 940-030-002) Morgan Stanley Trust, between Western Riverside County Regional Conservation Authority (RCA) and the City of Temecula in the amount of $154,000. 13 Second Reading of Ordinance No. 11-09 — Approved Staff Recommendation (5-0-0) Council Member Edwards made the motion; it was seconded by Council Member Comerchero; and electronic vote reflected unanimous approval RECOMMENDATION: Action Minutes1112211 4 13.1 Adopt an ordinance entitled: ORDINANCE NO. 11-09 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADDING SECTION 9.60.045 TO THE TEMECULA MUNICIPAL CODE CONCERNING TIME, PLACE, AND MANNER RESTRICTIONS FOR RESIDENCES OF SEX OFFENDERS ON HALLOWEEN At 7:32 P.M., the City Council convened as the Temecula Community Services District, the Redevelopment Agency, and the Temecula Public Financing Authority. At 7:50 P.M., the City Council resumed with regular business. CITY COUNCIL BUSINESS 20 Repeal of Temecula E -Verify Ordinance as mandated by new State legislation prohibiting cities from requiring employers to use E -Verify • Wayne Hall addressed the City Council during this item. Council Member Naggar made the motion to direct the City Attorney to bring back a report to the City Council. Council Member Comerchero seconded the motion; and electronic vote reflected unanimous approval (5-0-0) Council Member Naggar made the motion to introduce the ordinance and voted in denial of repealing the ordinance. It was seconded by Council Member Comerchero; and voice vote reflected unanimous approval (5-0-0) Council Member Naggar directed staff to enforce the business license process in consideration with State law, thereby, not requiring E -verify; it was seconded by Council Member Comerchero and voice vote reflected unanimous approval (5-0-0) RECOMMENDATION: 20.1 Introduce and read by title only an ordinance entitled: ORDINANCE NO. 11 - AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA REPEALING CHAPTER 5.06, LAWFUL HIRING COMPLIANCE (E -VERIFY), OF THE TEMECULA MUNICIPAL CODE 21 Increase Public Project Force Account, Negotiated Contract, Purchase Order Limit — Approved Staff Recommendation (5-0-0) Council Member Naggar made the motion; it was seconded by Council Member Washington; and voice vote reflected unanimous approval RECOMMENDATION: 21.1 Introduce and read by title only an ordinance entitled: Action Minutes1112211 5 ORDINANCE NO. 11-10 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING SECTION 3.32.010 OF THE TEMECULA MUNICIPAL CODE REGARDING THE CONSTRUCTION ON PUBLIC PROJECTS 22 Public/Traffic Safety Commission Appointments — Reappointed Commissioner Youmans to a full three-year term; appointed Robert Carter to a full three-year term, expiring October 2014; and appointed Al Cosentino to fill the unexpired term, ending October 2013. (5-0-0) Council Member Naggar made the motion; it was seconded by Council Member Washington; and voice vote reflected unanimous approval RECOMMENDATION: 22.1 Appoint three applicants to serve on the Public/Traffic Safety Commission, two for full three-year terms through October 10, 2014 and one un -expired term through October 10, 2013. CITY MANAGER REPORT CITY ATTORNEY REPORT ADJOURNMENT At 8:30 P.M., the City Council meeting was formally adjourned to Tuesday, December 13, 2011, at 5:30 P.M., for a Closed Session, with regular session commencing at 7:00 P.M., City Council Chambers, 41000 Main Street, Temecula, California. Ron Roberts, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] Action Minutes1112211 6 Item No. 3 Approvals City Attorney Director of Finance City Manager ffiie-r- OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: List of Demands PREPARED BY: Pascale Brown, Accounting Manager Leah Thomas, Accounting Specialist RECOMMENDATION: That the City Council: 1. Adopt a resolution entitled: RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A BACKGROUND: All claims and demands are reported and summarized for review and approval by the City Council on a routine basis at each City Council meeting. The attached claims represent the paid claims and demands since the last City Council meeting. FISCAL IMPACT: All claims and demands were paid from appropriated funds or authorized resources of the City and have been recorded in accordance with the City's policies and procedures. ATTACHMENTS: Resolution List of Demands RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. That the following claims and demands as set forth in Exhibit A, on file in the office of the City Clerk, has been reviewed by the City Manager's Office and that the same are hereby allowed in the amount of $4,938,933.11 Section 2. The City Clerk shall certify the adoption of this resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 13th day of December, 2011. Ron Roberts, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 11- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 13th day of December, 2011, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: Susan W. Jones, MMC City Clerk CITY OF TEMECULA LIST OF DEMANDS 11/17/2011 TOTAL CHECK RUN: $ 1,223,474.52 11/23/2011 TOTAL CHECK RUN: 1,227,776.24 12/01/2011 TOTAL CHECK RUN: 2,063,951.57 11/23/2011 TOTAL PAYROLL RUN: 398,211.36 12/01/2011 TOTAL PAYROLL RUN: 25,519.42 TOTAL LIST OF DEMANDS FOR 12/13/2011 COUNCIL MEETING: $ 4,938,933.11 DISBURSEMENTS BY FUND: CHECKS: 001 GENERAL FUND $ 1,013,539.39 130 RECOVERY ACT JAG FUNDING 263.69 140 COMMUNITY DEV BLOCK GRANT 2,225.76 165 AFFORDABLE HOUSING 17,571.39 170 MEASURE A FUND 69,359.41 190 TEMECULA COMMUNITY SERVICES DISTRICT 424,971.84 192 TCSD SERVICE LEVEL B 279.83 194 TCSD SERVICE LEVEL D 1,084.82 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 7,250.52 197 TEMECULA LIBRARY FUND 64,095.32 210 CAPITAL IMPROVEMENT PROJECTS FUND 2,601,332.98 280 REDEVELOPMENT AGENCY - CIP PROJECT 22,200.00 300 INSURANCE FUND 23,680.63 310 VEHICLES FUND 113,708.58 320 INFORMATION TECHNOLOGY 37,391.68 330 SUPPORT SERVICES 12,227.36 340 FACILITIES 25,191.56 472 CFD 01-2 HARVESTON A&B DEBT SERVICE 4,312.00 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 231.64 477 CFD- RORIPAUGH 519.39 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 2,007.90 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 1,806.78 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 2,573.93 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 334.50 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 2,175.68 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 1,479.36 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 887.65 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 7,921.06 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 109.28 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 537.16 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 80.32 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 5,357.89 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP. 1,097.03 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 732.60 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATES 658.12 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 1,996.13 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 92.28 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 4,765.07 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 1,990.92 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 8,758.47 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 10,302.10 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 238.88 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 255.75 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 5,932.61 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 2,448.60 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 102.24 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 633.78 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 8,344.29 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 144.16 $ 4,515,202.33 001 GENERAL FUND $ 247,108.95 165 AFFORDABLE HOUSING 16,382.49 190 TEMECULA COMMUNITY SERVICES DISTRICT 108,741.97 192 TCSD SERVICE LEVEL B 416.12 194 TCSD SERVICE LEVEL D 2,213.90 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 993.49 197 TEMECULA LIBRARY FUND 1,182.53 300 INSURANCE FUND 1,344.36 320 INFORMATION TECHNOLOGY 24,297.21 330 SUPPORT SERVICES 5,733.09 340 FACILITIES 12,978.80 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 85.96 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 57.61 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 68.34 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 12.55 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 138.72 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 25.22 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 35.62 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 235.62 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 1.89 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 10.68 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 6.50 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 157.11 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP. 33.41 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 19.25 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATES 16.91 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 39.23 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 3.21 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 145.60 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 77.92 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 211.12 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 357.45 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 8.84 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 9.35 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 201.04 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 64.89 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 2.90 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 9.35 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 296.39 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 5.19 423,730.78 TOTAL BY FUND: $ 4,938,933.11 apChkLst Final Check List Page: 1 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA Check # Date Vendor Description Amount Paid Check Total 148713 11/10/2011 013288 STUDIO 33 Deposit -ice skating rink srvcs:old town 36,000.00 36,000.00 148714 11/16/2011 002185 POSTMASTER Postage for TCSD W/S'12 Rec Guide 7,204.37 7,204.37 148715 11/11/2011 013975 28500 PUJOL ST., L.P. refund:eng grad deposit 995.00 995.00 148716 11/11/2011 008552 ADKINS DESIGN CONSULTING Oct graphic design svcs: Theater 1,414.22 1,414.22 148717 11/11/2011 009374 ALLEGRO MUSICAL VENTURES piano tuning svcs: theater 1,140.00 1,140.00 148718 11/11/2011 004422 AMERICAN BATTERY signal batteries: pw traffic 218.20 218.20 CORPORATION 148719 11/11/2011 014511 AMERICAN FOUNDATION refund:sec dep:picnic rental:RRSP 150.00 150.00 148720 11/11/2011 004431 AMERICAN PAYROLL Gov't/Public Sector materials:payroll 395.00 395.00 INSTITUTE INC 148721 11/11/2011 014513 ANTHONY, REX Stipend: RFP Ph II Artist Interviews 400.00 400.00 148722 11/11/2011 008249 ANTHONY, STEVEN & YVETTE refund:eng grad dep:apn945-080-017 995.00 995.00 148723 11/11/2011 011752 ASAN SOCIETY GROUP - refund:security deposit CRC 150.00 150.00 148724 11/11/2011 011961 AT&T MOBILITY Oct Trip wires:graffitti:Police 135.80 135.80 148725 11/11/2011 001823 ATKINSON, DAVID MICHAEL Cfd 88-12 reimbursement FY 09/10 202.02 202.02 148726 11/11/2011 013883 AURORA LOAN SERVICES CFD 88-12 Reimbursement FY 09/10 1,441.06 1,441.06 148727 11/11/2011 013553 AVENO, RUTH refund:sec dep:rm rental:CRC 719.00 719.00 148728 11/11/2011 013296 BAKER, JOHN W CFD 88-12 Reimbursement FY 09/10 328.30 328.30 148729 11/11/2011 004635 BALES, LARRY CFD 88-12 Reimbursement FY 09/10 403.60 403.60 Pagel apChkLst Final Check List Page: 2 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description 148730 11/11/2011 005709 BAMM PROMOTIONAL softball awards: sports prgms PRODUCTS 148731 11/11/2011 011007 BARNETT, KIRK reimb: repair parts fire house/vacuum 148732 11/11/2011 014499 BENNETT, SR., CHRIS Stipend: RFP Ph II Artist Interviews 148733 11/11/2011 004040 BIG FOOT GRAPHICS TCSD instructor earnings 148734 11/11/2011 014284 BLAKELY'S TRUCK SERVICE vehicle repair/maint: pw maint vehicle repair/maint: pw maint vehicle repair/maint: pw maint vehicle repair/maint: pw maint vehicle repair/maint: pw maint vehicle repair/maint: pw maint vehicle repair/maint: pw maint 148735 11/11/2011 014329 BOOK WHOLESALERS, INC (4) books: library (1) book: library (57) books: library (3) books: library (3) books: library (8) books: library (1) books: library (19) books: library (10) books: library (12) books: library Amount Paid Check Total 4,983.44 4,983.44 87.20 87.20 400.00 400.00 273.00 273.00 120.00 141.71 61.71 61.71 893.60 1,232.18 517.14 69.31 20.62 947.51 73.45 127.72 130.46 14.53 248.91 177.05 160.36 3,028.05 1,969.92 148736 11/11/2011 014299 BOOKS ON TAPE (2) books on tape: library 48.48 (1) book on tape: library 36.37 84.85 148737 11/11/2011 013121 BOYD, KELLY D refund:sec dep:picnic rental:pala park 150.00 150.00 148738 11/11/2011 004641 BROTTEN, MICHAEL CFD 88-12 Reimbursement FY 09/10 303.04 303.04 148739 11/11/2011 000128 BROWN & BROWN OF CALIF policy #70210716:CNA Surety GY 350.00 350.00 INC 148740 11/11/2011 005889 BROWN, PASCALE employee computer loan pgrm 2,000.00 2,000.00 148741 11/11/2011 003138 CAL MAT PW patch truck materials 397.94 PW patch truck materials 445.60 PW patch truck materials 338.54 PW patch truck materials 299.87 1,481.95 Page:2 apChkLst Final Check List Page: 3 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148742 11/11/2011 000647 CALIF DEPT OF CONSUMER license renewal: 59602 Odviar, A 125.00 125.00 AFFAIRS 148743 11/11/2011 014512 CALIFORNIA VIRTUAL refund:sec dep:rm rental:TCC 150.00 150.00 148744 11/11/2011 010514 CAMPINI'S ITALIAN DELI add'I (10) Iunches:CERT trn 11/5 84.50 84.50 148745 11/11/2011 000131 CARL WARREN & COMPANY Oct liability claims mgmnt svcs 518.38 518.38 INC 148746 11/11/2011 013226 CENTRONE, DOMENIC CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148747 11/11/2011 009640 CERTIFION CORPORATION Oct database subscr: Police 158.95 158.95 148748 11/11/2011 014013 CHAPARRAL VILLAGE DENTAL refund:overpayment bus lic 035058 148749 11/11/2011 012902 CHOUCAIR OUEIJAN, CAROLE Stipend: RFP Ph II Artist Interviews 35.00 35.00 400.00 400.00 148750 11/11/2011 004652 COHN, STEPHEN R. CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148751 11/11/2011 002945 CONSOLIDATED ELECTRICAL misc electrical supplies:Civic Ctr 247.52 DIST. misc electrical supplies: TCSD 26.94 misc electrical supplies: TCSD 18.86 misc electrical supplies: TCSD 61.69 355.01 148752 11/11/2011 013379 COUSSOU, CELINE TCSD Instructor Earnings 168.00 TCSD Instructor Earnings 263.20 431.20 148753 11/11/2011 014503 CRAFTS UNLIMITED BOUTIQUE refund:Temp use permit fee PA11-0259 300.00 300.00 148754 11/11/2011 010650 CRAFTSMEN PLUMBING & lobby tile repair: civic center 400.00 400.00 HVAC INC 148755 11/11/2011 014364 CUNNINGHAM, GRISELDA TCSD Instructor Earnings 616.00 616.00 CLEMENTINA 148756 11/11/2011 014434 D & D BALLOONING ballooning: Daisen guests 11/30 540.00 540.00 148757 11/11/2011 003272 DAISY WHEEL RIBBON plotter supplies: GIS 88.24 88.24 COMPANY INC 148758 11/11/2011 011402 DE LA ROSA, GEORGE reimb:Pool Certification 10/25-26 90.16 90.16 Page:3 apChkLst Final Check List Page: 4 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description 148759 11/11/2011 008943 DEPT OF GENERAL SERVICES case #:518/508/514/715/520 (DGS) 148760 11/11/2011 007057 DERNBACH, ESTHER MARIE TCSD instructor earnings 148761 11/11/2011 013230 DEUTSCHE BANK NATL TRUST CFD 88-12 Reimbursement FY 09/10 CO 148762 11/11/2011 003945 DIAMOND ENVIRONMENTAL SRVCS Amount Paid Check Total 400.00 400.00 1,039.50 1,039.50 202.02 202.02 portable restrooms:Halloween 675.50 Nov restroom svc: Vail Ranch Pk Nov restroom svc: Riverton Park Nov restroom svc: Long Cyn Park Nov restroom svc: Veterans Park Nov restroom svc: GOHS 148763 11/11/2011 014505 DOOLEY, KRISTINA & refund:sec dep:rm rental:CRC GREGORY 52.78 52.78 52.78 52.78 52.78 939.40 150.00 150.00 148764 11/11/2011 004068 ECALDRE MANALILI-DE VILLA, TCSD Instructor Earnings 462.00 AILEEN TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings 148765 11/11/2011 010977 EICHBERGER-HARNED, refund:sec dep:rm rental:CRC JOANNE 148766 11/11/2011 003665 EXCEL COMMERCIAL Oct long distance phone svcs 420.00 210.00 98.00 420.00 266.00 140.00 2,016.00 150.00 150.00 54.37 54.37 Page:4 apChkLst Final Check List Page: 5 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 148768 11/11/2011 001056 EXCEL LANDSCAPE Description landscape maint: civic center irrigation repair: villages IRRIGATION REPAIR: WOLF CREEK Oct landscape maint: parks Oct landscape maint: north slopes Oct landscape maint: south slopes irrigation repair: vail ranch irrigation repair: avondale IRRIGATION REPAIR: TRADEWINDS irrigation repair: rancho highlands irrigation repair: vail ranch IRRIGATION REPAIR: WOODCREST IRRIGATION REPAIR: VINTAGE HILL IRRIGATION REPAIR: RANCHO HIGF IRRIGATION REPAIR: HARVESTON IRRIGATION REPAIR: PAVILION POI Oct landscape maint: parks Oct landscape maint: medians Oct landscape maint: city facilities irrigation repair: villages irrigation repair: vintage hills IRRIGATION REPAIR: PAVILION POI irrigation repair: tradewinds irrigation repair: tradewinds IRRIGATION REPAIR: RANCHO HIGF 148769 11/11/2011 009240 FANG, LINA CFD 88-12 Reimbursement FY 09/10 Amount Paid Check Total 412.16 112.32 372.74 50,935.88 19,749.97 34,844.87 344.15 85.87 315.30 648.19 208.62 100.45 134.41 381.31 277.50 166.46 47,825.10 16,469.70 9,443.13 190.98 236.89 107.85 167.85 278.53 107.64 183,917.87 303.04 303.04 Page:5 apChkLst Final Check List Page: 6 11/17/2011 11:41 :33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148770 11/11/2011 003347 FIRST BANKCARD CENTER 009720 STARBUCKS CORPORATION GY refreshments: exec staff tmbldg 44.95 014516 RAINBOW OAKS RESTAURANT GY lunch meeting: BJ/GY/AA/cnslt 39.05 014517 ALOFT NATIONAL HARBOR GY htl:PD Bowers trn Wash DC 254.04 HOTEL 008326 AVIS RENT -A -CAR GY refund prepayment: PD Bowers -14.35 000154 C S M F 0 GW regist conf 11/7:Bilby, David 150.00 000871 HILTON RR htl: SCAG mtg LA 10/5 121.00 005786 SPRINT RR cell phone holder 37.70 006942 ONTARIO AIRPORT RR parking:Rail Volution Wash DC 90.00 001256 MARRIOTT HOTEL RR htl:Rail Volution Wash DC 10/16-20 1,258.42 006952 PAYPAL HP Verisign Payflow Pro Transaction 193.30 009568 SEW WHAT? INC. HP drapes: Theater 515.57 009568 SEW WHAT? INC. HP drapes: Theater 51.89 006952 PAYPAL GW Verisign Payflow Pro Transaction 59.95 000154 C S M F 0 GW regist conf 11/7:Cardenas, R 100.00 2,901.52 148771 11/11/2011 009243 FRAZIER, DARYN CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148772 11/11/2011 013912 FUN ZONE BOAT COMPANY sea lion tour: Daisen Guests 11/28 84.00 84.00 148773 11/11/2011 014510 GAN, DANILO refund:sec dep:rm rental:TCC 150.00 150.00 148774 11/11/2011 014234 GEARS 2 ROBOTS, LLC TCSD Instructor Earnings 784.00 784.00 148775 11/11/2011 005405 GILLILAND, ROBIN reimb: gift Daisen guests 94.49 94.49 148776 11/11/2011 004333 GRIFFITH, PAUL JON CFD 88-12 Reimbursement FY09/10 202.02 202.02 148777 11/11/2011 014402 GROEPPER, BROOKE TCSD Instructor Earnings 2,301.89 TCSD Instructor Earnings 3,276.00 TCSD Instructor Earnings 2,226.57 TCSD Instructor Earnings 1,528.80 9,333.26 148778 11/11/2011 004670 GUARANTY FEDERAL BANK CFD 88-12 Reimbursement FY 09/10 2,550.62 2,550.62 Page:6 apChkLst Final Check List Page: 7 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148779 11/11/2011 014059 GUZMAN, BEATRIZ refund:sec dep:kitchen rental:CRC 150.00 150.00 148780 11/11/2011 013890 HARTMAN, MELANIE SUE CFD 88-12 Reimbursement FY09/10 202.02 202.02 148781 11/11/2011 012655 HICKMAN, MAYLEN refund:sec dep:rm rental:CRC 400.00 400.00 148782 11/11/2011 011565 HOPE, WILLIAM CFD 88-12 Reimbursement FY09/10 202.02 202.02 148783 11/11/2011 003624 HOWELL, ANN MARIE graphic design svcs: QLMP 2,970.00 graphic design svcs: Autumnfest 2,665.91 5,635.91 148784 11/11/2011 013420 INGRAM LIBRARY SERVICES (19) BOOKS: LIBRARY 208.64 INC (26) BOOKS: LIBRARY 308.89 (2) BOOKS: LIBRARY 19.85 537.38 148785 11/11/2011 011228 INLAND PLANNING AND Oct cnslt: jefferson corridor 2,200.00 2,200.00 DESIGN INC 148786 11/11/2011 014506 INVESTORS BUSINESS DAILY refund:sec dep:rm rental:CRC 150.00 150.00 148787 11/11/2011 014491 JOE O'CONNELL CREATIVE Stipend:RFP Ph II Artist Interviews 400.00 400.00 148788 11/11/2011 000820 K R W & ASSOCIATES 9/23-11/3 pinck svc:pw land dev 3,025.00 3,025.00 148789 11/11/2011 014387 KASA CONSTRUCTION, INC Oct const:Margarita Rd ROW 121,779.00 121,779.00 148790 11/11/2011 012462 KIMCO PALM PLAZA CFD 88-12 Reimbursement FY 09/10 16,238.12 16,238.12 148791 11/11/2011 006452 LANIER, DENISE reimb: calpers forum 10/23-25 690.58 690.58 148792 11/11/2011 005513 LARA, MANUEL ENRIQUE CFD 88-12 Reimbursement FY 09/10 353.54 353.54 148793 11/11/2011 003975 LAWRENCE, JEFF reimb: tv light bulb teen room CRC 85.61 85.61 148794 11/11/2011 009260 LEONHARDI, RYAN A. CFD 88-12 Reimbursement FY 09/10 252.54 252.54 148795 11/11/2011 013769 LIGHTSQUARED LP NOV SATTELITE PHONE SVC:FIRE/CM 147.96 147.96 148796 11/11/2011 013188 LINFIELD CHRISTIAN SCHOOL refund:50% app fee Tess CEQA 6,600.50 6,600.50 Page:7 apChkLst Final Check List Page: 8 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148797 11/11/2011 002784 MAILBOX, THE 1 yr subscr:tinytots prgm 29.95 29.95 148798 11/11/2011 003782 MAIN STREET SIGNS Misc signs:PW Maint 219.81 219.81 148799 11/11/2011 004141 MAINTEX INC Misc cleaning supplies:library 103.92 Misc cleaning supplies:Impsc 18.58 122.50 148800 11/11/2011 012364 MASTERS, TRACY Reimb:ws'12 rec guide 175.00 175.00 148801 11/11/2011 004704 MCADAM, CONSTANCE J. CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148802 11/11/2011 012264 MIRANDA, JULIO C. TCSD Instructor Earnings 1,004.50 TCSD Instructor Earnings 672.00 TCSD Instructor Earnings 336.00 2,012.50 148803 11/11/2011 001868 MIYAMOTO-JURKOSKY, SUSAN TCSD Instructor Earnings 122.50 A. TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings 109.20 172.80 226.80 631.30 148804 11/11/2011 012477 MORILLO, DIANE CFD 88-12 Reimbursement FY 09/10 404.06 404.06 148805 11/11/2011 014464 MSA SYSTEMS, INC Barcode-PDA's:police traffic 15,898.79 15,898.79 148806 11/11/2011 002925 NAPA AUTO PARTS Veh repair & maint: Sta 84 44.39 44.39 148807 11/11/2011 000727 NATIONAL FIRE PROTECTION Misc publication for Fire Prevention 130.78 130.78 ASSN 148808 11/11/2011 013699 NAT'L ASSN OF EMS renew ann'I mbrshp: P. Rawlings 18185 160.00 160.00 PHYSICIANS 148809 11/11/2011 008234 NEDELJKOVIC, VERA CFD 88-12 Reimbursement FY 09/10 353.54 353.54 148810 11/11/2011 012480 NOORDYK, JESSIE JO CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148811 11/11/2011 002139 NORTH COUNTY TIMES Oct advertising: Temecula Presents 943.49 Credit:billing adjustment/theater -200.00 743.49 148812 11/11/2011 002139 NORTH COUNTY TIMES Oct newspaper subscr:MPSC 27.30 27.30 Page:8 apChkLst Final Check List Page: 9 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148813 11/11/2011 002105 OLD TOWN TIRE & SERVICE CITY VEHICLE MAINT SVCS:PW MAINT 75.00 CITY VEHICLE MAI NT SVCS:PW MAI 79.37 CITY VEHICLE MAI NT SVCS:PW MAI 79.37 City Vehicle Maint Svcs:PW CIP 529.52 CITY VEHICLE MAINT SVCS:PW MAI 1,328.57 CITY VEHICLE MAI NT SVCS:PW MAI 924.44 3,016.27 148814 11/11/2011 005557 OLVEDA, VICTOR CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148815 11/11/2011 013923 ONEWEST BANK FSB CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148816 11/11/2011 012100 OUR NICHOLAS FOUNDATION FY 10/11 Community Srvc Funding 5,000.00 5,000.00 148817 11/11/2011 011118 PALM SPRINGS AERIAL Aerial Tramway tour 11/29 Sister Cities 167.65 167.65 TRAMWAY 148818 11/11/2011 013289 PALM SPRINGS AIR MUSEUM Museum tour 12/1 Sister Cities 90.00 90.00 INC 148819 11/11/2011 007638 PARDELL, CHRISTOPHER A. Old Town Public Art RFP stipend 400.00 400.00 148820 11/11/2011 014460 PATEL, MEERA refund:sec dep:rm rental:TCC 150.00 150.00 148821 11/11/2011 006657 PAYNE, CHRIS ee computer purchase prgm 2,000.00 2,000.00 148822 11/11/2011 012833 PC MALL GOV, INC. support software:Info Tech 78.21 78.21 148823 11/11/2011 014518 PERALTA, STEPHANIE refund:Tos'n Pots 1360.204 30.00 30.00 148824 11/11/2011 013381 PEREZ, AARON TROY TCSD Instructor Earnings 245.00 TCSD Instructor Earnings 560.00 805.00 148825 11/11/2011 002498 PETRA GEOTECHNICAL INC Apr geotech srvcs:trf sgnls r.c./yukon 465.00 465.00 148826 11/11/2011 002185 POSTMASTER Ann'I PO Box Fee:Police 390.00 390.00 148827 11/11/2011 014504 PRESCOTT COMMUNICATIONS refund:50% app fee less CEQA fee 2,651.00 2,651.00 INC 148828 11/11/2011 014379 PROFESSIONAL IMAGE Street banner pgrm:eco dev 1,928.33 1,928.33 ADVERTISING Page:9 apChkLst Final Check List Page: 10 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148829 11/11/2011 013239 PYLES, RAGAN CFD 88-12 Reimbursement FY 09/10 303.04 303.04 148830 11/11/2011 004529 QUAID TEMECULA Veh repair & maint:police 652.37 652.37 HARLEY-DAVIDSON 148831 11/11/2011 000262 RANCHO CALIF WATER Oct Lndscp meter:Calle Elenita 70.12 DISTRICT Oct var water meters:41951 Moraga 707.26 Oct var water meters:40135 Village rd 132.31 Oct D.C. meter:Landings Rd 15.31 Novvarwater meters:TCSD svc IevC 10,266.73 11,191.73 148832 11/11/2011 000947 RANCHO REPROGRAPHICS Oct reproduction srvcs:PW CIP Prjts 36.19 36.19 148833 11/11/2011 009725 RAZAVI, MANDIS TCSD Instructor Earnings 453.60 453.60 148834 11/11/2011 014515 RED FEATHER JOINT Old Town Public Art RFP stipend 400.00 400.00 VENTURE 148835 11/11/2011 009299 REEG, MATTHEW ROBERT CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148836 11/11/2011 004584 REGENCY LIGHTING Electrical supplies:civic center 85.34 Electrical supplies:park sites 57.93 143.27 148837 11/11/2011 002110 RENTAL SERVICE EQUIP RENTAL:PW MAINT DIV 82.30 82.30 CORPORATION 148838 11/11/2011 010685 REYES, MARTIN CFD 88-12 Reimbursement FY 09/10 606.76 606.76 148839 11/11/2011 002412 RICHARDS WATSON & Sept 2011 legal services 118,716.65 GERSHON credit:Oct 2011 legal services -98.00 Oct 2011 legal services 7,828.75 126,447.40 148840 11/11/2011 013902 RIO DE ORO PROP CFD 88-12 Reimbursement FY 09/10 454.56 454.56 148841 11/11/2011 000406 RIVERSIDE CO SHERIFFS Race for the Cure patrol srvcs 10/16 8,282.38 DEPT Help Ride patrol srvcs 10/29 1,904.32 Fall Rod Run patrol srvcs 10/14-15 17,097.90 fy 10/11 law enforcement facility 354,905.77 382,190.37 148842 11/11/2011 012260 ROSS, TATIANA To correct payroll return 100.00 100.00 148843 11/11/2011 013827 RYAN MONTELEONE Drainage system repairs:long cyn 53,700.00 53,700.00 EXCAVATION INC Page:10 apChkLst 11/17/2011 11:41:33AM Final Check List CITY OF TEMECULA Page: 11 Bank : union UNION BANK OF CALIFORNIA Check # Date Vendor (Continued) Description 148844 11/11/2011 013648 SABER-MOTAMEDI, HUGH AND Facade Impry Prgm: Emporium Bldg JOICE 148845 11/11/2011 000278 SAN DIEGO UNION TRIBUNE Oct recruitment advertising:HR 148846 11/11/2011 013904 SEASCAPE PROP CFD 88-12 Reimbursement FY 09/10 148847 11/11/2011 013992 SEM, PETER Refund:Teach Yourself Korean Bk 148848 11/11/2011 000537 SO CALIF EDISON 148849 11/11/2011 001212 SO CALIF GAS COMPANY 148850 11/11/2011 013864 SO PACIFIC MASTERS ASSN 148851 11/11/2011 005786 SPRINT 148852 11/11/2011 013790 STANDARD PACIFIC 148853 11/11/2011 006145 STENO SOLUTIONS TRANSCRIPTION 148854 11/11/2011 000465 STRADLEY, MARY KATHLEEN 148855 11/11/2011 012789 STUART, JENNIFER SARAH 148856 11/11/2011 008164 SUN CITY GRANITE INC 148857 11/11/2011 013941 TAHQUITZ DISTRICT OF THE BOY 148858 11/11/2011 000305 TARGET BANK BUS CARD SRVCS Jul -Oct 2-28-629-0507:Library Oct 2-28-171-2620:40820 Winchester Oct 2-31-419-2659:26706 Ynez TC1 Oct 2-31-693-9784:26036 Ynez TC1 Oct 2-29-974-7568:26953 Ynez TC1 Nov 2-33-237-4818:30499 Rncho Cal Oct 2-26-887-0789:40233 Village rd PE Oct 2-30-608-9384:28582 Harveston Nov 2-33-777-1950:40135 Village Rd Aug -Oct 055-475-6169-5:PBSP Nov 015-575-0195-2:32211 Wolf vly rd '12 membership dues:Aquatics prgm Sept 26 -Oct 25 cellular usage/equip Refund:sq ftg revised B10-1425,27,28 Refund:overcharged permit B10-1276 Oct transcription srvcs:Police TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings Pavers:Veterans Memorial '10 Light Parade Overall Winner Misc supplies:harveston center Misc supplies: high hopes prgrm Amount Paid Check Total 20,000.00 343.62 6,205.56 23.94 55,338.17 757.61 96.61 370.39 192.99 105.82 1,581.11 524.27 320.07 667.41 177.24 40.00 5,262.48 15.17 170.00 302.82 747.60 436.80 3,806.25 1,252.00 200.00 65.21 20,000.00 343.62 6,205.56 23.94 59,287.04 844.65 40.00 5,262.48 185.17 302.82 1,184.40 3,806.25 1,252.00 200.00 88.93 154.14 Page:11 apChkLst Final Check List Page: 12 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description 148859 11/11/2011 004274 TEMECULA VALLEY SECURITY Locksmith srvcs:childrens museum CENTR 148860 11/11/2011 003862 THYSSENKRUPP Elevator Inspection:civic center ELEVATOR.BRNCH 37 148861 11/11/2011 010276 TIME WARNER CABLE Nov high speed internet:32364 Overland 148862 11/11/2011 005554 TOWER OFFICE PLAZA I LLC CFD 88-12 Reimbursement FY 09/10 CFD 88-12 Reimbursement FY 09/10 148863 11/11/2011 012725 TRZOP, NICHELLE TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings Amount Paid Check Total 95.00 95.00 720.00 720.00 44.95 44.95 404.06 11,313.66 2,217.60 2,217.60 3,187.80 3,196.20 11,717.72 10,819.20 148864 11/11/2011 011504 U S BANK NATIONAL ASSN CFD 88-12 Reimbursement FY 09/10 303.04 303.04 148865 11/11/2011 014265 VAN GONKA, JEFF DESIGN/CONST/INSTALL:IWCM 14,677.50 14,677.50 EXHIBIT 148866 11/11/2011 004261 VERIZON Novxxx-0073 general usage 89.97 89.97 148867 11/11/2011 004789 VERIZON Nov Internet svcs:Civic Center 175.11 Oct Internet svcs:Theater 134.99 310.10 148868 11/11/2011 012751 VERIZON BUSINESS various phone lines:gen usage:IT 114.54 114.54 148869 11/11/2011 004848 VERIZON SELECT SERVICES Oct long distance phone svcs 10.42 INC Oct long distance phone svcs 17.55 27.97 148870 11/11/2011 008223 VINCENT, CLAYTON P. CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148871 11/11/2011 012513 WEIMANN, A. JAMES CFD 88-12 Reimbursement FY 09/10 202.02 202.02 148872 11/11/2011 003730 WEST COAST ARBORISTS INC Tree trimming & removal:signet series 392.00 392.00 Page:12 apChkLst Final Check List Page: 13 11/17/2011 11:41:33AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 148873 11/11/2011 011506 WGA BEL VILLAGGIO CFD 88-12 Reimbursement FY 09/10 3,762.80 CFD 88-12 Reimbursement FY 09/10 1,540.48 CFD 88-12 Reimbursement FY 09/10 1,464.70 CFD 88-12 Reimbursement FY 09/10 1,111.16 CFD 88-12 Reimbursement FY 09/10 3,661.78 CFD 88-12 Reimbursement FY 09/10 202.02 CFD 88-12 Reimbursement FY 09/10 404.06 CFD 88-12 Reimbursement FY 09/10 883.88 CFD 88-12 Reimbursement FY 09/10 2,853.66 CFD 88-12 Reimbursement FY 09/10 4,343.64 CFD 88-12 Reimbursement FY 09/10 833.36 CFD 88-12 Reimbursement FY 09/10 580.84 CFD 88-12 Reimbursement FY 09/10 5,353.78 26,996.16 148874 11/11/2011 000341 WILLDAN ASSOCIATES INC Engineering srvcs:pw traffic 4,397.87 4,397.87 148875 11/11/2011 014514 WILSON, GUY Old Town Public Art RFP stipend 400.00 400.00 148876 11/11/2011 014507 WILSON, MARK refund:sec dep:picnic rental:Harveston 150.00 150.00 148877 11/11/2011 011583 YANG, SHU HUI CFD 88-12 Reimbursement FY 09/10 202.02 202.02 Grand total for UNION BANK OF CALIFORNIA: 1,223,474.52 Page:13 apChkLst Final Check List Page: 14 11117/2011 11:41:33AM CITY OF TEMECULA 164 checks in this report. Grand Total All Checks: 1,223,474.52 Page:14 apChkLst Final Check List Page: 1 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA Check # Date Vendor Description Amount Paid Check Total 1813 11/23/2011 010349 CALIF DEPT OF CHILD Support Payment 738.45 738.45 SUPPORT 1814 11/23/2011 000389 NATIONWIDE RETIREMENT OBRA- Project Retirement Payment 2,510.16 2,510.16 SOLUTION 1815 11/23/2011 000246 PERS (EMPLOYEES' PERS ER Paid Member Contr Payment 131,330.63 131,330.63 RETIREMENT) 1816 11/23/2011 001065 NATIONWIDE RETIREMENT Nationwide Retirement Payment 10,781.32 10,781.32 SOLUTION 1817 11/23/2011 000283 INSTATAX (IRS) Federal Income Taxes Payment 75,735.93 75,735.93 1818 11/23/2011 000444 INSTATAX (EDD) State Disability Ins Payment 22,367.57 22,367.57 149041 11/23/2011 013367 ACTIVE MICRO INC misc tools/equip: pw traffic 101.59 misc tools/equip: pw traffic 12.95 114.54 149042 11/23/2011 008698 ADVANCED APPLIED May eng design: 79S Park & Ride 2,385.00 2,385.00 ENGINEERING 149043 11/23/2011 009787 ALTEC INDUSTRIES INC vehicle repair/maint: PW Maint 736.77 736.77 149044 11/23/2011 013353 AMERICASPRINTER.COM printing: Wnterfest Flyers 2,006.57 2,006.57 149045 11/23/2011 012951 APPLIED DEVELOPMENT Oct cnslt svc:quality of life plan 1,977.39 1,977.39 ECONOMICS 149046 11/23/2011 012938 B & T WORKS INC Oct const: city concrete repairs 68,686.29 68,686.29 149047 11/23/2011 013957 BAGCHI, MOUSUMI refund:sec dep:rm rental:CRC 150.00 150.00 149048 11/23/2011 011438 BAKER, BLYTHE EDEN TCSD Instructor Eamings 225.00 225.00 149049 11/23/2011 012583 BLANCA Y PRICE landscape pinck: PA11-0261 360.00 360.00 149050 11/23/2011 008605 BONTERRA CONSULTING 9/9-10/7 CNSLT:RRSP DESILTING 975.74 975.74 BASIN 149051 11/23/2011 014329 BOOK WHOLESALERS, INC (26) books: library (1) book: library 563.53 49.13 612.66 Pagel apChkLst Final Check List Page: 2 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149052 11/23/2011 000154 CSMFO Description Amount Paid Check Total '12 CSMFO mb: Brown, Pascale 12 CSMFO mb: Crummel, Jennifer 12 CSMFO mb: Wilson, Genie 12 CSMFO mb: Graciano, Rudy 110.00 110.00 110.00 110.00 440.00 149053 11/23/2011 003138 CAL MAT PW patch truck materials 313.93 PW patch truck materials 235.28 549.21 149054 11/23/2011 004971 CANON FINANCIAL SERVICES, Nov copier leases: civic center 3,004.54 3,004.54 INC 149055 11/23/2011 014519 CCH, A WOLTERS KLUWER '12 GAAP guide: Finance 281.45 281.45 BUSINESS 149056 11/23/2011 000137 CHEVRON AND TEXACO City vehicles fuel: Police 1,840.60 1,840.60 149057 11/23/2011 004405 COMMUNITY HEALTH Community Health Charities Payment 62.00 62.00 CHARITIES 149058 11/23/2011 013560 CROWN BUILDING MAINT CO OCT JANITORIAL SVCS: CITY 4,077.02 INC FACILITIES OCT JANITORIAL SVCS: FLD OP CTR 763.80 4,840.82 149059 11/23/2011 012600 DAVID EVANS & ASSOCIATES INC 149060 11/23/2011 004192 DOWNS COMMERCIAL FUELING INC 149061 11/23/2011 002390 EASTERN MUNICIPAL WATER DIST 149062 11/23/2011 014309 EPIC LAND SOLUTIONS, INC. OCT CNSLT SVCS:BUTTERFIELD RD 1,798.50 EXT Oct design eng svcs:liefer rd 1,362.50 3,161.00 Fuel for City vehicles: PW Maint 2,235.30 Fuel for City vehicles: TCSD 2,117.16 Fuel for City vehicles: Code Enf 627.24 Fuel for City vehicles: PW cipAd/npdes 421.75 Fuel for City vehicles: B&S 330.42 Fuel for City vehicles: PW Traffic 280.23 Fuel for City vehicles: PW Id/npdes 138.15 6,150.25 Nov 39569 Seraphina Rd 247.15 Nov 39656 Diego Dr 177.85 425.00 ROW svcs: French Valley Pkwy 7,744.95 7,744.95 149063 11/23/2011 011922 FIRST AMERICAN CORELOGIC Oct database subscr:code enf INC 33.00 33.00 Page2 apChkLst Final Check List Page: 3 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149064 11/23/2011 003347 FIRST BANKCARD CENTER 000210 LEAGUE OF CALIF CITIES SJ regist:lawconfll/30-12/2 Flores,G 440.00 014115 GAMBLING COWBOY SJ meal:closed council mtg 10/25 240.00 CHOPHOUSE, THE 014524 EARTH BISTRO SJ meal:closed council mtg 10/11 227.48 007282 AMAZON.COM, INC RJ sprawl repair manual: Planning 181.00 013301 RED GINGER CHINA BISTRO SJ meal:closed council mtg 11/1 169.22 009971 C S N STORES SJ lobby wall display: civic center 116.71 002111 TOGOS RESTAURANT SN Iunch:SW City Mgr's mtg 11/3 64.79 004438 DICK BLICK COMPANY INC RJ artist tape: B&S 37.95 008669 VONS SJ floral:Miyamoto gift council music 32.31 004432 ALBERTSONS GROCERY SJ meal:closed council mtg 11/1 15.98 1,525.44 STORE 149065 11/23/2011 004882 FORTEL TRAFFIC, INC. vcalm solar sign sys: PW Traffic 5,926.25 5,926.25 149066 11/23/2011 002982 FRANCHISE TAX BOARD SUPPORT PAYMENT 50.00 50.00 149067 11/23/2011 010326 G E MOBILE WATER, INC Oct power washer exchg: Stn 73 63.58 63.58 149068 11/23/2011 001937 GALLS INC uniforms: pd traffic unit 1,145.42 1,145.42 149069 11/23/2011 003792 GRAINGER vehicle repair/maint: aquatics 537.17 537.17 149070 11/23/2011 000194 I C M A RETIREMENT -PLAN I C M A Retirement Trust 457 Payment 4,572.90 4,572.90 303355 149071 11/23/2011 013200 JAROTH INC Nov pay phone:RDA:OT bus depot 82.64 82.64 149072 11/23/2011 004141 MAINTEX INC Misc cleaning supplies:Civic Center 53.62 53.62 149073 11/23/2011 000944 MCCAIN TRAFFIC SUPPLY INC PURCH & INSTALL: TRAFFIC SIG SYNC 12,501.40 Traffic signal equip:pw traffic 2,812.28 credit:purch & install/traffic sig sync -2,064.58 13,249.10 149074 11/23/2011 014348 NATURAL JUICE BAR & DELI refreshments:sister cities 12/1/11 90.00 90.00 149075 11/23/2011 010167 ODYSSEYPOWER HVAC REPAIRS:CIVIC CENTER 412.50 412.50 CORPORATION Pages apChkLst Final Check List Page: 4 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149076 11/23/2011 003964 OFFICE DEPOT BUSINESS SVS DIV Description Amount Paid Check Total Printing srvcs: csd 279.30 MISC OFFICE SUPPLIES:PD MALL OFFIC PRINTING SRVCS:FINANCE DEPT Printing srvcs:planning dept Printing srvcs:planning dept MISC OFFICE SUPPLIES:PD MALL OFFIC Printing srvcs: csd 213.10 211.19 194.70 181.99 64.96 36.29 1,181.53 149077 11/23/2011 013127 ON STAGE MUSICALS Theater performance 11/6/11 4,519.75 4,519.75 149078 11/23/2011 014527 PARKVIEW COMMUNITY refund:sec dep:rm rental:CRC 150.00 150.00 HOSPITAL 149079 11/23/2011 000249 PETTY CASH Petty Cash Reimbursement 156.89 156.89 149080 11/23/2011 010338 POOL & ELECTRICAL Pool supplies & chemicals:citywide 350.95 350.95 PRODUCTS INC 149081 11/23/2011 000254 PRESS ENTERPRISE Sept advertising:FIT finale 302.50 302.50 COMPANY INC 149082 11/23/2011 014379 PROFESSIONAL IMAGE Street banner pgrm:eco dev 5,785.00 5,785.00 ADVERTISING 149083 11/23/2011 009623 PUBLIC AGENCY RISK 2012 mbrshp dues: R. Cardenas C765 100.00 100.00 MANAGERS 149084 11/23/2011 002012 R D 0 EQUIPMENT COMPANY Backhoe purchase:pwmaint div 113,708.58 113,708.58 149085 11/23/2011 010281 RAINBOW RACING SYSTEM Racing bibs:FIT finale 5/10k run 250.92 250.92 INC 149086 11/23/2011 014526 RAMSEY, DARREN &AMBER refund:sec dep:rm rental:Harveston 200.00 200.00 149087 11/23/2011 002072 RANCHO CALIF WATER Deposit/constr ph I f.v.pkwy pw07-04 500,000.00 500,000.00 DIST-FEES 149088 11/23/2011 000262 RANCHO CALIF WATER Nov var water meters:TCSD svc lev C 12,501.85 DISTRICT Nov var water meters:TCSD & PW 1,931.13 Nov water meter:30875 Rancho vista 405.36 Nov var water meters:Fire Stns 300.50 Oct water meter:Winchester Creek 229.84 149089 11/23/2011 002654 RANCHO FORD LINCOLN Veh repair & maint: Sta 84 MERCURY 15,368.68 368.88 368.88 Page4 apChkLst Final Check List Page: 5 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149090 11/23/2011 000947 RANCHO REPROGRAPHICS 149091 11/23/2011 004584 REGENCY LIGHTING 149092 11/23/2011 003591 RENES COMMERCIAL MANAGEMENT 149093 11/23/2011 004498 REPUBLIC INTELLIGENT 149094 11/23/2011 012648 REST & RELAX RESPITE AGENCY 149095 11/23/2011 003698 RIVERSIDE CO ECONOMIC 149096 11/23/2011 000411 RIVERSIDE CO FLOOD CONTROL 149097 11/23/2011 001592 RIVERSIDE CO INFO TECHNOLOGY 149098 11/23/2011 000873 ROBERTS, RONALD H. 149099 11/23/2011 008529 SHERIFFS CIVIL DIV - CENTRAL 149100 11/23/2011 009213 SHERRY BERRY MUSIC 149101 11/23/2011 000645 SMART & FINAL INC 149102 11/23/2011 000537 SO CALIF EDISON 149103 11/23/2011 002503 SOUTH COAST AIR QUALITY 149104 11/23/2011 014525 SPATES, SHARLYN Description Amount Paid Check Total Reprographic srvcs:butterfield ext Reproduction srvcs:library prkg Electrical supplies: park sites Electrical supplies:Civic Center R.O.W. clean-up: citywide Traffic signal repair & maint:R.C./Hope Traffic signal repair & maint:PW Traffic Oct traffic signal repair & maint:PW Traffic signal supplies:PW TRAFFIC SIGNAL REPAIR & MAINT:JEFF) refund:sec dep:rm rental:Conf Ctr Real property srvcs:french vly pkwy Credit:Real property srvcs:f.v.pkwy Inspection deposit:R.R. Street Impry Oct radio rental:police/prk rngrs reimb:NLC cf Phoenix 11/8-11 SUPPORT PAYMENT Jazz © the Merc 11/10/11 Misc supplies:mpsc Oct 2-00-397-5059:Comm Svc Utl Oct 2-27-560-0625:32380 Deerhollow Oct 2-30-296-9522:31035 Rancho vista Ann'I emerg gen op fees:FOC Ann'I emerg gen emissions fees:FOC refund:sec dep/rm rental:CRC 149105 11/23/2011 010972 SPORTS FACILITIES GROUP Scoreboard maint:rrsp INC 78.23 34.82 113.05 299.67 266.55 566.22 7,140.00 7,140.00 2,331.36 1,759.56 1,723.80 1,546.56 1,296.95 8,658.23 150.00 150.00 9,177.56 -188.58 8,988.98 35,880.00 35,880.00 1,236.04 1,236.04 494.61 494.61 200.00 200.00 570.00 570.00 307.06 307.06 10,109.22 4,084.77 453.36 14,647.35 303.56 112.85 416.41 744.00 744.00 695.00 695.00 Pages apChkLst Final Check List Page: 6 11/23/2011 10:59:02AM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149106 11/23/2011 002366 STEAM SUPERIOR CARPET CLEANING 149107 11/23/2011 013387 SWEEPING UNLIMITED INC 149108 11/23/2011 003677 TEMECULA MOTORSPORTS LLC 149109 11/23/2011 010493 TEMECULATOWNE CENTER ASSOC LP 149110 11/23/2011 011736 TEMECULA TROPHY INC 149111 11/23/2011 010046 TEMECULA VALLEY CONVENTION & 149112 11/23/2011 010276 TIME WARNER CABLE 149113 11/23/2011 007709 TOYOTA OF TEMECULA VALLEY 149114 11/23/2011 014413 U.S. DEPARTMENT OF EDUCATION 149115 11/23/2011 000325 UNITED WAY 149116 11/23/2011 004261 VERIZON 149117 11/23/2011 009101 VISION ONE INC Description Amount Paid Check Total Carpet cleaning srvcs:civic center 9,600.00 9,600.00 Nov sweeping:Parking Structure 500.00 500.00 Veh repair & maint:police 394.41 394.41 Dec lease payment:pd mall office 1,458.33 1,458.33 Name Plate: Madden 21.55 21.55 Sept '11 Bus. Impry District Asmnts 99,153.04 99,153.04 Nov high speed internet:32211 Wolfvly 102.17 102.17 Veh repair & maint:planning dept 99.00 99.00 SUPPORT PAYMENT 113.62 113.62 United Way Charities Payment 51.00 51.00 Nov xxx-0074 general usage 3,516.38 Nov xxx-5072 general usage 2,096.31 5,612.69 Oct ShoWare ticketing srvcs: Theater 1,881.20 1,881.20 149118 11/23/2011 001342 WAXIE SANITARY SUPPLY INC CLEANING SUPPLIES:CITYWIDE 775.72 CLEANING SUPPLIES:MPSC 149119 11/23/2011 003730 WEST COAST ARBORISTS INC 10/1-15 tree trimming srvcs:citywide 350.42 1,126.14 6,477.00 6,477.00 Grand total for UNION BANK OF CALIFORNIA: 1,227,776.24 Pages apChkLst Final Check List Page: 7 11/23/2011 10:59:02AM CITY OF TEMECULA 85 checks in this report. Grand Total All Checks. 1,227,776.24 Page:7 apChkLst Final Check List Page: 1 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA Check # Date Vendor Description Amount Paid Check Total 1819 12/01/2011 000444 INSTATAX (EDD) State Income Taxes Payment 885.83 885.83 1820 12/01/2011 000283 INSTATAX (IRS) Federal Income Taxes Payment 4,004.53 4,004.53 149120 12/01/2011 011322 AIR CLEANING SYSTEMS INC plymovement repair: Stn 73 482.00 482.00 149121 12/01/2011 003859 ALL ABOUT SELF STORAGE storage units:C332/351/354/G702 8,556.00 8,556.00 149122 12/01/2011 009374 ALLEGRO MUSICAL VENTURES piano tuning svcs: theater 170.00 170.00 149123 12/01/2011 014235 AND ALL THAT JAZZ TCSD Instructor Eamings 182.00 TCSD Instructor Eamings 273.00 TCSD Instructor Eamings 182.00 637.00 149124 12/01/2011 008868 BANK OF SACRAMENTO escrow:2893-159 RJ Noble pw10-11 75,508.34 75,508.34 149125 12/01/2011 008868 BANK OF SACRAMENTO escrow:2893-160 RJ Noble pw10-08 58,009.75 58,009.75 149126 12/01/2011 008868 BANK OF SACRAMENTO escrow:2893-159/31084 PW10-11 496.00 496.00 149127 12/01/2011 014538 BARTHOLOMEW, SHARON refund:sec dep:rm rental:conf ctr 100.00 100.00 HEALEY 149128 12/01/2011 010962 BILBY, DAVID reimb: GFOA CP FO pgrm costs 360.64 360.64 149129 12/01/2011 012583 BLANCAY PRICE Oct landscape planck: Planning 5,280.00 5,280.00 149130 12/01/2011 014433 BOWCON COMPANY, INC Oct const:ped/bicycle bridge 79,429.50 79,429.50 149131 12/01/2011 000128 BROWN & BROWN OF CALIF 70210685 cna surety bond:Johnson, B 350.00 350.00 INC 149132 12/01/2011 014210 BROWNE, BORTZ & Oct cnslt svcs: RDA 2,000.00 2,000.00 CODDINGTON INC 149133 12/01/2011 004778 BUREAU VERITAS NORTH Oct plan review svcs: B&S 4,332.32 4,332.32 AMERICA 149134 12/01/2011 005292 BUTLER, GREG reimb:'12 eng/surveyor license 125.00 125.00 Pagel apChkLst Final Check List Page: 2 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149135 12/01/2011 006908 C C & COMPANY INC entertainers:old town holiday 11/25 149136 12/01/2011 001264 COSTCO WHOLESALE MISC SUPPLIES:ART SHOW RECEPTIONS 149137 12/01/2011 004329 COSTCO WHOLESALE CORP CERT training supplies: 11/4 TELEVISION: STN 73 misc supplies: fire prevention CERT training supplies: 11/4 149138 12/01/2011 014529 DOLLAR TREE STORES, INC. reindeer ears:breakfast w/santa 12/10 149139 12/01/2011 004192 DOWNS COMMERCIAL Fuel for City vehicles: Police FUELING INC 149140 12/01/2011 005880 EDGE DEVELOPMENT INC. Fuel for City vehicles:City Clerk/I.T. Release Stop Notice:Mark Harris PI Stop Notice: Cass Construction Stop Notice: Lozano Caseworks Stop Notice: Union Roofers Trust Stop Notice: Union Roofers Trust Stop Notice: Countywide Mechanical Stop Notice: Mountain Movers Stop Notice: Mark Harris Plumbing Stop Notice: Cass Construction Inc. Release Stp Ntc: Union Roofers Release Stop Notice: Moutain Movers Release Stop Notice: Countywide MAY CONST: CIVIC CENTER JUNE CONST: CIVIC CENTER JULY CONST: CIVIC CENTER AUG CONST: CIVIC CENTER SEPT CONST: CIVIC CENTER OCT CONST: CIVIC CENTER 149141 12/01/2011 014207 ENTERPRISE ELECTRIC electrical svcs: Civic Center DATACOM 149142 12/01/2011 001056 EXCEL LANDSCAPE irrigation repairs: tcsd parks irrigation repairs: redhawk park irrigation repairs: medians irrigation repairs: harveston park irrigation repairs: woodcrest irrigation repairs: harveston 149143 12/01/2011 000478 FAST SIGNS signage: TV Museum exhibits 600.00 421.35 163.06 1,091.71 21.83 101.46 188.56 79.95 62.22 16,805.50 -20,125.00 -202,742.50 -10,470.70 -4,233.81 -291,109.43 -11,800.20 -16,805.50 -39,855.22 14,704.51 11,800.20 208,521.93 12,272.00 176,606.00 109,313.00 29,782.00 124,521.25 279,459.75 6,851.00 193.49 2,580.00 191.55 394.94 213.86 150.00 600.00 421.35 1,378.06 188.56 142.17 386,643.78 6,851.00 3,723.84 88.89 88.89 Page2 apChkLst Final Check List Page: 3 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149144 12/01/2011 003347 FIRST BANKCARD CENTER 000293 STADIUM PIZZA INC 014532 GALLERY ON MAIN 002111 TOGOS RESTAURANT 008669 VONS 005786 SPRINT 004811 HEWLETT PACKARD 008669 VONS 013851 STORM SOURCE, LLC 013851 STORM SOURCE, LLC 149145 12/01/2011 003946 G T ENTERTAINMENT Description Amount Paid Check Total AA refreshments:Rod Run volunteers 255.00 AA photography:civic ctr (3) images 274.76 AA refreshments:QLMP mtg 10/25 57.35 MH Council agenda application 30.00 MH equipment: Info Tech 37.70 MH misc computer supplies:Info Tech 156.17 MH Council agenda application 30.00 MH ms outlook export/support:Info Sys 943.00 MH Appointments Plus:Info Tech 20.00 dj/mc svc:Old Town holiday 11/25 250.00 149146 12/01/2011 001937 GALLS INC uniform svcs:police volunteers 149147 12/01/2011 013552 GANDS PRODUCTIONS LLC sttlmnt: Country at the Merc 11/19 149148 12/01/2011 000177 GLENNIES OFFICE PRODUCTS Office Supplies: Fire Dept INC Office Supplies: Planning Office Supplies: B&S Office supplies: HR Office supplies: Finance Office Supplies: TCSD OFFICE SUPPLIES: MPSC Office Supplies: CRC Office Supplies: TV Museum Office Supplies: Info Tech Office supplies: PW 8.51 832.50 411.12 495.22 334.61 108.54 137.44 578.38 245.64 203.40 30.15 198.80 236.30 1,803.98 250.00 8.51 832.50 2,979.60 Pages apChkLst Final Check List Page: 4 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor 149149 12/01/2011 000186 HANKS HARDWARE INC Description Amount Paid Check Total Hardware supplies: PW Maint 2,228.05 Hardware supplies: PW Traffic 22.61 Hardware supplies: Aquatics 100.83 Hardware supplies: Harveston Pk 214.92 Hardware supplies: Info Tech 61.79 Hardware supplies: B&S 41.76 Hardware supplies: TCC 5.40 Hardware supplies: MPSC 86.11 Hardware supplies: Civic Ctr 373.75 Hardware supplies: tcsd 121.45 Hardware supplies: parks 1,570.14 Hardware supplies: Fire Dept 557.43 Hardware supplies: Ch Museum 38.49 Hardware supplies: Library 9.13 Hardware supplies: Civic Ctr 69.03 Hardware supplies: Theater 8.60 5,509.49 149150 12/01/2011 001135 HEALTH POINTE MEDICAL emp industrial care svcs: HR 60.00 60.00 GROUP INC 149151 12/01/2011 013749 HELIXSTORM INC. IT support: data center/library 5,000.00 5,000.00 149152 12/01/2011 003106 HERITAGE SECURITY Oct security svc:harveston lake pk 1,408.00 1,408.00 SERVICES 149153 12/01/2011 002126 HILLYARD FLOOR CARE supplies: crc gym 3,757.35 3,757.35 SUPPLY 149154 12/01/2011 014487 HM ELECTRONICS, INC misc sound repair/svc: Theater 178.70 178.70 149155 12/01/2011 004406 IGOE & COMPANY INC Nov flex benefit plan pmt 205.00 205.00 149156 12/01/2011 009135 IMPACT MARKETING & DESIGN uniforms: theater 233.02 233.02 INC 149157 12/01/2011 006914 INNOVATIVE DOCUMENT Oct copier maint/usage: Library 667.00 SOLUTIONS Oct copier maint/usage: Citywide 5,302.19 5,969.19 149158 12/01/2011 003266 IRON MOUNTAIN OFFSITE Oct offsite media storage:records 434.43 434.43 149159 12/01/2011 001186 IRWIN, JOHN TCSD instructor earnings 220.50 220.50 149160 12/01/2011 013200 JAROTH INC Dec pay phone:RDA:OT bus depot 82.64 82.64 Page4 apChkLst Final Check List Page: 5 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149161 12/01/2011 007188 LAERDAL MEDICAL CORP. CPR supplies: Paramedics 149162 12/01/2011 003726 LIFE ASSIST INC Medical supplies: Paramedics Medical supplies: Paramedics Medical supplies: Paramedics 149163 12/01/2011 014534 MADRID, MELECIA refund:sec dep:rm rental:CRC 149164 12/01/2011 004141 MAINTEX INC Misc supplies:csd maint 149165 12/01/2011 000217 MARGARITA OFFICIALS ASSN Officiating svcs:softball sports pgrm 149166 12/01/2011 011920 MASTER CONCEPTS LLC TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings 149167 12/01/2011 000944 MCCAIN TRAFFIC SUPPLY INC Traffic signal equip:pw traffic div 149168 12/01/2011 001892 MOBILE MODULAR Modular Bldg Iease:Fire:OATC 149169 12/01/2011 006146 MT SAN JACINTO COMMUNITY Entertainment:OT holiday event 11/24 965.39 965.39 940.98 159.10 284.11 1,384.19 150.00 150.00 2,165.78 2,165.78 3,045.00 3,045.00 973.87 367.50 955.50 679.87 1,102.50 661.50 441.00 220.50 1,102.50 808.50 882.00 441.00 1,038.19 964.69 514.50 294.00 955.50 661.50 1,176.00 220.50 220.50 2,856.00 1,120.87 18,658.49 437.00 437.00 614.18 614.18 425.00 425.00 Pages apChkLst Final Check List Page: 6 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149170 12/01/2011 001986 MUZAK -SOUTHERN Dec music broadcast:Echostar video pgrm CALIFORNIA 149171 12/01/2011 014391 NICHOLS, KELLIE D. TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings TCSD Instructor Eamings 149172 12/01/2011 002139 NORTH COUNTY TIMES ann'I subscr:Finance125887 149173 12/01/2011 006140 NORTH JEFFERSON BUSINESS PARK 123.18 123.18 431.66 630.00 210.00 560.00 105.00 1,936.66 165.00 165.00 Jan -Mar assn dues xx16:F. Vly Intrchg 536.01 Jan -Mar assn dues xx20:F. Vly Intrchg 676.82 Jan -Mar assn dues xx17:F. Vly Intrchg 498.15 1,710.98 149174 12/01/2011 003964 OFFICE DEPOT BUSINESS SVS Printing srvcs: csd 36.29 DIV MISC OFFICE SUPPLIES:CENTRAL SRV( 97.19 133.48 149175 12/01/2011 002105 OLD TOWN TIRE & SERVICE VEH REPAIR & MAINT:PW MAINT DIV- 170.00 VEH REPAIR & MAINT:PW MAINT DIV- 188.11 358.11 149176 12/01/2011 002105 OLD TOWN TIRE & SERVICE Veh repair & maint:csd maint 36.27 36.27 149177 12/01/2011 001171 ORIENTAL TRADING COMPANY Misc supplies:var special events 420.50 INC Misc supplies:tree lighting ceremony 427.95 Misc supplies:var special events 115.99 964.44 149178 12/01/2011 013198 ORTENZO-HAYES, KRISTINE TCSD Instructor Eamings 851.20 TCSD Instructor Eamings 744.80 TCSD Instructor Eamings 425.60 TCSD Instructor Eamings 744.80 TCSD Instructor Eamings 1,288.00 TCSD Instructor Eamings 504.00 4,558.40 149179 12/01/2011 001999 PITNEY BOWES Postage Meter: Fire 101.54 101.54 149180 12/01/2011 010338 POOL & ELECTRICAL Misc supplies:city fountains 328.29 328.29 PRODUCTS INC 149181 12/01/2011 000254 PRESS ENTERPRISE recruitment advertising: HR 460.30 460.30 COMPANY INC 149182 12/01/2011 003155 PRICE CHOPPER INC Recreation supplies: wrist bands 179.65 179.65 149183 12/01/2011 013721 PROPET DISTRIBUTORS INC Pet waste bags - various parks 2,055.95 2,055.95 Pages apChkLst Final Check List Page: 7 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149184 12/01/2011 009425 PRUDENT PUBLISHING Misc supplies: MPSC COMPANY 149185 12/01/2011 005075 PRUDENTIAL OVERALL SUPPLY 548.81 548.81 Credit on Inv#130259181,#130260915 -4.00 Uniform supply srvcs:csd maint 1,072.46 Credit on Inv's #130259180... 149186 12/01/2011 010652 QUALITY CODE PUBLISHING Municipal code srvcs:city clerk 149187 12/01/2011 004457 R J NOBLE COMPANY 149188 12/01/2011 007051 RALPHS 149189 12/01/2011 002654 RANCHO FORD LINCOLN MERCURY 149190 12/01/2011 000947 RANCHO REPROGRAPHICS 149191 12/01/2011 000907 RANCHO TEMECULA CAR WASH 149192 12/01/2011 009725 RAZAVI, MANDIS 149193 12/01/2011 004584 REGENCY LIGHTING Const:pavement rehab Winchester rd Const:pavement rehab marg rd Const:pavement rehab Winchester rd refreshments:breakfast w/santa 12/10 Veh repair & maint: Fire Stn 84 Reproduction srvcs:main st bridge Veh detailing srvcs: B&S Dept TCSD Instructor Eamings Tree lighting: Duck Pond Misc supplies: Harveston lake Electrical supplies:citywide facilities -7.00 1,061.46 1,553.12 1,553.12 679,574.96 522,087.70 4,464.00 1,206,126.66 302.87 302.87 186.49 186.49 10.78 10.78 63.00 63.00 453.60 453.60 1,616.25 243.08 154.90 2,014.23 149194 12/01/2011 004498 REPUBLIC INTELLIGENT Traffic signal repair& maint:pw traffic 247.83 247.83 149195 12/01/2011 005756 RIVERSIDE CO TREASURER, APN 916-511-001-4 Traconis, V 231.64 231.64 149196 12/01/2011 014347 ROBERTS, PATRICIA G. TCSD Instructor Eamings 106.40 106.40 149197 12/01/2011 012251 ROTH, DONALD J. TCSD Instructor Eamings 504.00 TCSD Instructor Eamings 84.00 588.00 149198 12/01/2011 013582 SAN DIEGUITO PUBLISHERS Printing srvcs:csd recreation guide— 1,487.75 INC Printing srvcs:csd recreation guide 16,141.15 17,628.90 149199 12/01/2011 011511 SCUBA CENTER TEMECULA TCSD Instructor Eamings 420.00 420.00 Page:7 apChkLst Final Check List Page: 8 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149200 12/01/2011 011291 SIERRA PACIFIC ELECTRICAL Rel.retention:Traf Sgnl 149201 12/01/2011 009746 SIGNS BYTOMORROW Banners & delivery:college fair 149202 12/01/2011 000645 SMART & FINAL INC Misc supplies:art show receptions 149203 12/01/2011 000537 SO CALIF EDISON Nov 2-21-981-4720:30153 Tem pkwy tpp Oct 2-28-331-4847:32805 Pauba rd LS3 Oct 2-30-099-3847:29721 Ryecrest Oct 2-33-357-5785:44747 Redhawk PED 149204 12/01/2011 001212 SO CALIF GAS COMPANY 149205 12/01/2011 000519 SOUTH COUNTY PEST CONTROL INC 149206 12/01/2011 000293 STADIUM PIZZA INC Nov 101-525-1560-6:27415 Enterprise Nov 095-167-7907-2:30650 Pauba Rd Nov 026-671-2909-8:Comm Theater Nov 091-024-9300-5:30875 Rancho vista Nov 101-525-0950-0:28816 Pujol St Nov 055-2483:40135 Village Rd Oct -Nov 129-582-9784-3:43230 Bus pk Nov 133-040-7373-0:Maint Fac Nov 181-383-8881-6:Museum Nov 021-725-0775-4:Senior Center Nov 125-244-2108-3: Library Nov 196-025-0344-3:Children's Museum Nov 129-535-5236-7:41000 Main St 19,293.91 19,293.91 523.85 523.85 203.26 203.26 40.02 133.34 24.13 27.63 172.15 204.67 193.48 3,191.07 57.99 78.54 37.34 8.93 57.99 135.56 244.03 14.73 1,219.67 pest control srvcs:dog park 7/11 94.00 pest control srvcs:paloma del sol park 94.00 Pest control srvcs:Fire Stn #84 225.12 5,616.15 80.00 268.00 Refreshments:skate park events 80.99 Refreshments:csd prof meetings 109.00 189.99 149207 12/01/2011 003000 STATE WATER RESOURCES annual npdes ms4 permit 7/11-6/12 18,196.00 18,196.00 149208 12/01/2011 000305 TARGET BANK BUS CARD SRVCS 149209 12/01/2011 012265 TEMECULA ACE HARDWARE C/0 149210 12/01/2011 003677 TEMECULA MOTORSPORTS LLC Misc supplies: MPSC 131.26 Misc supplies:children's museum 127.87 259.13 Hardware supplies: Fire Stn 92 3.21 3.21 Veh repair & maint:Police 374.59 374.59 149211 12/01/2011 000306 TEMECULA VALLEY PIPE & Misc supplies:csd maint 4245 42.45 SUPPLY Pages apChkLst Final Check List Page: 9 12/01/2011 3:21:27PM CITY OF TEMECULA Bank : union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 149212 12/01/2011 004274 TEMECULA VALLEY SECURITY locksmith srvcs: Temeku Hills Park CENTR 149213 12/01/2011 011090 TEMECULA VALLEY TCSD Excursions -bus transportation TRANSPORTATION 149214 12/01/2011 014300 THEATER 16, INC. Entertainment:OT holiday event 11/25 Entertainment:OT holiday event 11/25 149215 12/01/2011 010276 TIME WARNER CABLE Dec high speed internet:Civic Center 95.00 95.00 1,150.50 1,150.50 250.00 250.00 500.00 4,439.37 4,439.37 149216 12/01/2011 005554 TOWER OFFICE PLAZA I LLC CFD 88-12 Reimbursement FY 07/08 406.30 CFD 88-12 Reimbursement FY 07/08 11,376.42 11,782.72 149217 12/01/2011 008719 TOWER OFFICE PLAZA II, & III CFD 88-12 Reimbursement FY 07/08 2,361.62 CFD 88-12 Reimbursement FY 07/08 3,885.26 6,246.88 149218 12/01/2011 014413 U.S. DEPARTMENT OF Support Payment Tracking #5376666016 25.94 25.94 EDUCATION 149219 12/01/2011 014533 UNIVERSITY OF CALIFORNIA regist:Harrington,Kturfgrass 12/14 85.00 85.00 149220 12/01/2011 004864 V N W CIRCLE OF CARE INC CDBG reimbursement #1 2,225.76 2,225.76 149221 12/01/2011 008977 VALLEY EVENTS INC MISC RENTAL EQUIP:VAR SPECIAL 1,840.00 1,840.00 EVENTS - 149222 12/01/2011 004789 VERIZON Nov Internet svcs: Library 349.98 Nov Internet svcs:Tem PD DSL 99.98 449.96 149223 12/01/2011 014418 VIDACARE CORPORATION Medical supplies: Medics 1,968.81 1,968.81 149224 12/01/2011 012219 VIERLING, MARIKA carriage rides:old town holiday 11/25 1,200.00 1,200.00 149225 12/01/2011 006248 WALKER, JESSICA TCSD Instructor Earnings 161.00 161.00 149226 12/01/2011 003730 WEST COAST ARBORISTS INC 10/17-21 tree trimming svcs:pw maint 11,726.00 11,726.00 149227 12/01/2011 013556 WESTERN AUDIOVISUAL Old Town sound sys retrofit:CIP 31,233.91 31,233.91 149228 12/01/2011 003776 ZOLL MEDICAL CORPORATION Medical supplies: Medics 1,152.19 Medical supplies: Medics 274.33 1,426.52 Grand total for UNION BANK OF CALIFORNIA: 2,063,951.57 Page9 apChkLst Final Check List Page: 10 12/01/2011 3:21:27PM CITY OF TEMECULA 111 checks in this report. Grand Total All Checks. 2,063,961.67 Pagel 0 Item No. 4 Approvals City Attorney Director of Finance City Manager OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: City Treasurer's Report as of October 31, 2011 PREPARED BY: Rudy Graciano, Revenue Manager RECOMMENDATION: Approve and file the City Treasurer's Report as of October 31, 2011. BACKGROUND: Government Code Sections 53646 and 41004 require reports to the City Council regarding the City's investment portfolio, receipts, and disbursements respectively. Adequate funds will be available to meet budgeted and actual expenditures of the City for the next six months. Current market values are derived from the Local Agency Investment Fund (LAIF) reports, Union Bank of California trust and custody statements, and from US Bank trust statements. Attached is the City Treasurer's Report that provides this information. The City's investment portfolio is in compliance with the statement of investment policy and Government Code Sections 53601 and 53635 as of October 31, 2011. FISCAL IMPACT: None. ATTACHMENTS: City Treasurer's Report as of October 31, 2011 Investments Par Value City of Temecula, California Portfolio Management Portfolio Summary October 31, 2011 Market Value Book %of Value Portfolio Ter m City of Temecula 43200 Business Park Drive P.O. Bax 9033 Temecula, CA, 92590 (951)694-6430 Days to YTM YTM Maturity 360 Equiv. 365 Equiv. Managed Pool Accounts Letter of Credit Local Agency Investment Funds Federal Agency Callable Securities Federal Agency Bullet Securities Investments 58,249,850.20 1.00 42,71 0,83 2.3 0 20,000,000.00 15,000,090.00 135,960,683.50 58,249,850.20 1.00 42,766,700.87 20,221,140.00 1 5,1 53,61 0.00 58,249,850.20 1.00 42,71 0,83 2.3 0 20,000,000.00 14,988,500.00 42.85 0.00 31.42 14.71 11.03 136,391,302.07 135,9 49,183.50 100.00% 1 1 1 1,383 1,167 1 1 1 976 621 0.245 0.000 0.380 1.780 1.530 0.249 0.000 0.385 1.805 1.552 333 213 0.655 0.664 Cash Passbook/Checking (not included in yield calculations) Total Cash and Investments 3,079,709.57 139,040,393.07 3,079,799.57 3,079,709.57 139, 471, 011.64 139,028,893.07 0.000 0.000 333 213 0.655 0.664 Tot al Earnings October 31 Month Ending Fiscal Year To Date Current Year Average Daily Balance Effective Rate of Return 79, 015.25 142,933, 925.60 0.65% Reporting period 10!01!2011-10!31!2011 Run Date: 11/3Q/2011 - 15:18 353,095.81 145,351, 640.97 0.72% Portfolio TEME CP PM (PRF_PM1) SymRept8.42 Report Ver. 5.00 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Investments October 31, 2011 Page 2 Average Purchase Stated YTM YTM Days to Maturity Investment# Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 1 2221 6003-2 CITY COP RE2 ASSURED GUARANTY 1.00 1.00 1.00 1.000 0.986 1.000 1 104348008-1 01-2 IMP 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 104348006-4 01-2 RESA2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 104348016-3 01-2 RESB2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 104348000-4 01-2 SPTAX2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94669911-2 03-1 ACQA2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94669921-3 03-1 ACQB3 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94669902-3 03-1 BON D3 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 94669906-3 03-1 RES A3 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94669916-2 03-1 RES B2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94669900-4 03-1 SPTAX1 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593011-2 03-2 ACQ 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593009-2 03-2 EMW D 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593007-2 03-2 IMP 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593016-4 03-2 LOC 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593010-2 03-2 PWADM2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593006-2 03-2 RES 2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 793593000-3 03-2 SPTX2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 744727011-2 03-3 ACQ2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 744727002-2 03-3 BOND 2 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 744727007-2 03-3 CITY2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 744727009 03-3 EMW D 1 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 744727006-3 03-3 RES3 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 744727000-4 03-3 SP TX 4 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94686001-2 03-4 ADMIN2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94686005-1 03-4 PREP1 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94686000-1 03-4 RED1 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94686006-2 03-4 RES2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 786776002-2 03-6 BON D2 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 786776007-2 03-6 IMP2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 786776006-2 03-6 RES2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 786776000-3 03-6 SP TX3 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 95453510-2 88-12 BON D2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 95453518-4 88-12 GI4 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 1 2221 6003-4 CITY COP RE4 First American Treasury 730.91 730.91 730.91 0.000 0.000 1 122216008-3 CITY COPCIP2 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 1 2221 600 0-2 CITY COPLPF2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94434160-1 RDA 02 INTI First American Treasury 0.00 0.00 0.00 0.000 0.000 1 94 43 41 61-2 RDA 02 PRIN2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 Run Date: 11/30/2011 - 15:18 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 Report Ver. 5.00 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Investments October 31, 2011 Page 3 Average Purchase Stated YTM YTM Days to Maturity Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 107886008-2 RDA 06 CIPA2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 107886001 RDA 06 PRIN First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 107886000-2 RDA O6A INT2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 107886018-3 RDA 06B CIP3 First American Treasury 53,198.54 53,198.54 53,198.54 0.000 0.000 1 107886010-2 RDA O6B INT2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 107886016-2 RDA 06B RES2 First American Treasury 202,115.00 202,115.00 202,115.00 0.000 0.000 1 107886030-2 RDA 07 CAPI2 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 107886027-2 RDA 07 ESC2 First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 107886020-2 RDA 07 INT2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 107886028-2 RDA 07 PROJ2 First American Treasury 4,254.47 4,254.47 4,254.47 0.000 0.000 1 107886026-2 RDA 07 RES2 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 SYSRDA 10 DS 1 RDA 10 DS 1 First American Treasury 0.00 0.00 0.00 0.000 0.000 1 SYSRDA 10A CIP2 RDA 10A CIP2 First American Treasury 07/01/2011 19,394.96 19,394.96 19,394.96 0.000 0.000 1 136343001-2 RDA 10A -INTI First American Treasury 07/28/2011 0.00 0.00 0.00 0.000 0.000 1 136343018-2 RDA 10B CIP2 First American Treasury 07/01/2011 2,531.10 2,531.10 2,531.10 0.000 0.000 1 136343000-1 RDA 106 -INTI First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 94432360-2 TCSD COP INT First American Treasury 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 104348006-5 01-2 RESA11 Federated Tax Free Obligations 440,408.85 440,408.85 440,408.85 0.020 0.020 0.020 1 104348016-5 01-2 RESB11 Federated Tax Free Obligations 202,738.58 202,738.58 202,738.58 0.020 0.020 0.020 1 104348000-5 01-2 SPTAX11 Federated Tax Free Obligations 81,532.08 81,532.08 81,532.08 0.020 0.020 0.020 1 94669921-5 03-01 ACQ11 Federated Tax Free Obligations 15,123.23 15,123.23 15,123.23 0.020 0.020 0.020 1 94669911-5 03-01 ACQA11 Federated Tax Free Obligations 388.82 388.82 388.82 0.010 0.010 0.010 1 94669906-5 03-01 RESA11 Federated Tax Free Obligations 863,941.89 863,941.89 863,941.89 0.020 0.020 0.020 1 94669916-5 03-01 RESB11 Federated Tax Free Obligations 222,960.81 222,960.81 222,960.81 0.020 0.020 0.020 1 94669000-5 03-01SPTAX11 Federated Tax Free Obligations 91,357.02 91,357.02 91,357.02 0.020 0.020 0.020 1 786776006-5 03-06 RES11 Federated Tax Free Obligations 337,891.38 337,891.38 337,891.38 0.020 0.020 0.020 1 786776000-5 03-06SPTAX11 Federated Tax Free Obligations 46,011.26 46,011.26 46,011.26 0.020 0.020 0.020 1 793593011-5 03-2 ACQ11 Federated Tax Free Obligations 6,079.24 6,079.24 6,079.24 0.020 0.020 0.020 1 793593009-5 03-2 EMW D11 Federated Tax Free Obligations 5,190.02 5,190.02 5,190.02 0.020 0.020 0.020 1 793593016-5 03-2 LOC1 1 Federated Tax Free Obligations 141,911.46 141,911.46 141,911.46 0.020 0.020 0.020 1 793593010-5 03-2 PWADM11 Federated Tax Free Obligations 397.88 397.88 397.88 0.010 0.010 0.010 1 793593006-5 03-2 RES11 Federated Tax Free Obligations 368.05 368.05 368.05 0.020 0.020 0.020 1 793593000-5 03-2 SPTX Federated Tax Free Obligations 79,409.52 79,409.52 79,409.52 0.020 0.020 0.020 1 793593007-5 03-2-IMPR11 Federated Tax Free Obligations 1,143.69 1,143.69 1,143.69 0.020 0.020 0.020 1 744727006-5 03-3 RES11 Federated Tax Free Obligations 2,171,225.27 2,171,225.27 2,171,225.27 0.020 0.020 0.020 1 744727011-5 03-3ACQ11 Federated Tax Free Obligations 41,971.21 41,971.21 41,971.21 0.020 0.020 0.020 1 94686001-5 03-4 ADMIN11 Federated Tax Free Obligations 5,515.94 5,515.94 5,515.94 0.020 0.020 0.020 1 94686005-5 03-4 PREP11 Federated Tax Free Obligations 4,077.03 4,077.03 4,077.03 0.020 0.020 0.020 1 94686000-5 03-4 RED11 Federated Tax Free Obligations 6,932.16 6,932.16 6,932.16 0.020 0.020 0.020 1 Run Date: 11/30/2011 - 15:18 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Investments October 31, 2011 Page 4 Average Purchase Stated YTM YTM Days to Maturity Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 94686006-5 03-4 RES11 Federated Tax Free Obligations 744727000-5 03-SSPTAX11 Federated Tax Free Obligations 146161000-5 146161000-5 Federated Tax Free Obligations 1 461 61 006-5 RDA 11 DS11 Federated Tax Free Obligations 146161008-5 RDA 11ACIP11 Federated Tax Free Obligations 1 461 61 009-5 RDA 11ACO111 Federated Tax Free Obligations 94432363 02001 Financial Security Assurance 793593011-1 03-2-1 ACQUI CA Local Agency Investment Fun 793593009-1 03-2-1 EMWD CA Local Agency Investment Fun 793593007-1 03-2-1 IMPRO CA Local Agency Investment Fun 793593010-1 03-2-1 PW AD CA Local Agency Investment Fun 793593006-3 03-2-3 RESER CA Local Agency Investment Fun 1 2221 600 8 CITY COP CIP CA Local Agency Investment Fun 122216003-1 CITY COP RE1 CA Local Agency Investment Fun 107886008-1 RDA 06 CIP-1 CA Local Agency Investment Fun 107886018-2 RDA 06 CIP-2 CA Local Agency Investment Fun 107886030-1 RDA 07 CAP -1 CA Local Agency Investment Fun 107886027-1 RDA 07 ESC -1 CA Local Agency Investment Fun 107886028-1 RDA 07 PRO -1 CA Local Agency Investment Fun 107886026-1 RDA 07 RES -1 CA Local Agency Investment Fun 107886006 RDA 06 RES A MBIA Surety Bond 94434166 RDA TABS RES MBIA Surety Bond SYS95453516-1 95453516-1 USBANK Subtotal and Average 58,216,540.05 73,004.38 73,004.38 73,004.38 0.020 0.020 0.020 1 333,498.63 333,498.63 333,498.63 0.020 0.020 0.020 1 07/27/2011 0.50 0.50 0.50 0.001 0.001 0.001 1 1,308,370.64 1,308,370.64 1,308,370.64 0.020 0.020 0.020 1 14,972,527.78 14,972,527.78 14,972,527.78 0.020 0.020 0.020 1 9,556.91 9,556.91 9,556.91 0.020 0.020 0.020 1 07/01/2011 1.00 1.00 1.00 0.000 0.000 1 28,854,098.11 28,854,098.11 28,854,098.11 0.385 0.380 0.385 1 1,569,532.01 1,569,532.01 1569,532.01 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 289,885.04 289,885.04 289,885.04 0.385 0.380 0.385 1 3,625,411.53 3,625,411.53 3,625,411.53 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 795,441.24 795,441.24 795,441.24 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 0.00 0.00 0.00 0.385 0.380 0.385 1 259,751.73 259,751.73 259,751.73 0.385 0.380 0.385 1 1,109,967.33 1,109,967.33 1,109,967.33 0.385 0.380 0.385 1 1.00 1.00 1.00 0.000 0.000 1 1.00 1.00 1.00 0.000 0.000 1 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 58,249,850.20 58,249,850.20 58,249,850.20 0.245 0.249 1 Letter of Credit 104348006-1 02008 ASSURANCE CO BOND INSURANCE 07/01/2011 Subtotal and Average 1.00 1.00 1.00 1.00 1.00 1.00 1.00 0.000 0.000 1 0.000 0.000 1 Local Agency Investment Funds 94669911-1 03-1 ACQ A2 CA Local Agency Investment Fun 315,148.05 315,148.05 315,148.05 0.385 0.380 0.385 1 94669921-1 03-1 ACQ B2 CA Local Agency Investment Fun 3,903,471.55 3,903,471.55 3,903,471.55 0.385 0.380 0.385 1 744727011-1 03-3 ACQ 2 CA Local Agency Investment Fun 932,051.88 932,051.88 932,051.88 0.385 0.380 0.385 1 744727007-1 03-3 CITY 2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.385 0.380 0.385 1 786776007-1 03-6 IMP 1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.385 0.380 0.385 1 SYSCITY CITY CA Local Agency Investment Fun 11,074,125.43 11,094,585.90 11,074,125.43 0.385 0.380 0.385 1 SYSRDA RDA CA Local Agency Investment Fun 12,280,761.89 12,303,451.73 12,280,761.89 0.385 0.380 0.385 1 SYSRDA 10 DS 2 RDA 10 DS 2 CA Local Agency Investment Fun 1,268,482.96 1,268,482.96 1,268,482.96 0.385 0.380 0.385 1 Run Date: 11/30/2011 - 15:18 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Investments October 31, 2011 Average Purchase Investment# Issuer Balance Date Par Value Page 5 Stated YTM YTM Days to Maturity Market Value Book Value Rate 360 365 Maturity Date Local Agency Investment Funds SYSRDA 10A CIP1 RDA 10A CIP1 CA Local Agency Investment Fun 549.80 549.80 549.80 0.385 0.380 0.385 1 SYSRDA 10 CIP 1 RDA 10B CIP1 CA Local Agency Investment Fun 6,052,545.31 6,052,545.31 6,052,545.31 0.385 0.380 0.385 1 SYSTCSD TCSD CA Local Agency Investment Fun 6,883,695.43 6,896,413.69 6,883,695.43 0.385 0.380 0.385 1 Subtotal and Average 44,239,330.16 42,710,832.30 42,766,700.87 42,710,832.30 0.380 0.385 1 Federal Agency Callable Securities 31331J2P7 01156 Federal Farm Credit Bank 11/17/2010 1,000,000.00 1,000,380.00 1,000,000.00 1.250 1.233 1.250 1,112 11/17/2014 31331J4T7 01159 Federal Farm Credit Bank 12/16/2010 1,000,000.00 1,001,040.00 1,000,000.00 1.350 1.332 1.350 776 12/16/2013 31331KPN4 01169 Federal Farm Credit Bank 06/27/2011 1,000,000.00 1,002,390.00 1,000,000.00 1.050 1.036 1.050 969 06/27/2014 3133724V3 01158 Federal Home Loan Bank 12/30/2010 1,000,000.00 1,001,310.00 1,000,000.00 1.125 1.110 1.125 790 12/30/2013 313372NX8 01165 Federal Horne Loan Bank 02/28/2011 1,000,000.00 1,005,240.00 1,000,000.00 2.000 1.973 2.000 1,123 11/28/2014 313372VP6 01167 Federal Home Loan Bank 03/23/2011 1,000,000.00 1,003,980.00 1,000,000.00 1.250 1.233 1.250 783 12/23/2013 3134G1Y65 01162 Federal Horne Loan Mtg Corp 01/25/2011 1,000,000.00 1,008,170.00 1,000,000.00 1.500 1.479 1.500 997 07/25/2014 3134G1Y99 01163 Federal Home Loan Mtg Corp 02/08/2011 1,000,000.00 1,003,210.00 1,000,000.00 1.650 1.627 1.650 1,011 08/08/2014 3134G2NK4 01170 Federal Horne Loan Mtg Corp 07/11/2011 1,000,000.00 1,003,320.00 1,000,000.00 1.125 1.110 1.125 983 07/11/2014 3134G2RX2 01173 Federal Home Loan Mtg Corp 07/25/2011 1,000,000.00 1,003,370.00 1,000,000.00 1.200 1.184 1.200 997 07/25/2014 3136F9CB7 01088 Federal National Mtg Assn 03/11/2008 2,000,000.00 2,100,260.00 2,000,000.00 4.000 3.945 4.000 496 03/11/2013 3136F9DP5 01090 Federal National Mtg Assn 03/27/2008 1,000,000.00 1,051,700.00 1,000,000.00 4.000 3.945 4.000 512 03/27/2013 3136FJNN7 01148 Federal National Mtg Assn 11/18/2009 1,000,000.00 1,000,650.00 1,000,000.00 2.000 1.973 2.000 1,113 11/18/2014 3136FPZD2 01157 Federal National Mtg Assn 12/03/2010 1,000,000.00 1,006,460.00 1,000,000.00 1.125 1.110 1.125 1,128 12/03/2014 31398A7A4 01160 Federal National Mtg Assn 12/30/2010 1,000,000.00 1,001,630.00 1,000,000.00 1.300 1.282 1.300 790 12/30/2013 31398A7L0 01161 Federal National Mtg Assn 01/24/2011 1,000,000.00 1,002,710.00 1,000,000.00 1.450 1.430 1.450 815 01/24/2014 3136FRZQ9 01171 Federal National Mtg Assn 07/20/2011 1,000,000.00 1,005,530.00 1,000,000.00 1.250 1.233 1.250 1,084 10/20/2014 3136FRB44 01172 Federal National Mtg Assn 07/22/2011 1,000,000.00 1,019,530.00 1,000,000.00 2.125 2.096 2.125 1,725 07/22/2016 3136FTBQ1 01176 Federal National Mtg Assn 10/24/2011 1,000,000.00 1,000,260.00 1,000,000.00 1.350 1.332 1.350 1,819 10/24/2016 Subtotal and Average 21,903,225.81 20,000,000.00 20,221,140.00 20,000,000.00 1.780 1.805 976 Federal Agency Bullet Securities 31331GE47 01135 Federal Farm Credit Bank 07/29/2009 1,000,000.00 1,031,960.00 997,500.00 2.250 2.284 2.316 636 07/29/2013 31331GG37 01137 Federal Farm Credit Bank 08/04/2009 1,000,000.00 1,022,490.00 1,000,000.00 2.150 2.121 2.150 461 02/04/2013 31331GZ44 01144 Federal Farm Credit Bank 10/15/2009 1,000,000.00 1,011,730.00 1,000,000.00 1.550 1.529 1.550 349 10/15/2012 31331KCA6 01164 Federal Farm Credit Bank 02/10/2011 1,000,000.00 1,018,960.00 1,000,000.00 1.375 1.356 1.375 832 02/10/2014 31331KTK6 01174 Federal Farm Credit Bank 08/01/2011 1,000,000.00 1,005,290.00 1,000,000.00 0.875 0.863 0.875 1,004 08/01/2014 31331KE55 01175 Federal Farm Credit Bank 10/06/2011 1,000,000.00 998,090.00 1,000,000.00 1.300 1.282 1.300 1,801 10/06/2016 31331KK58 01177 Federal Farm Credit Bank 10/26/2011 1,000,000.00 999,790.00 1,000,000.00 1.050 1.036 1.050 1,455 10/26/2015 3133XSWM6 01124 Federal Horne Loan Bank 01/23/2009 1,000,000.00 1,004,480.00 1,000,000.00 2.100 2.071 2.100 83 01/23/2012 3133XTN85 01125 Federal Horne Loan Bank 05/07/2009 1,000,000.00 1,000,230.00 1,000,000.00 1.500 1.479 1.500 6 11/07/2011 3133XTXC5 01130 Federal Horne Loan Bank 06/11/2009 1,000,000.00 1,012,120.00 1,000,000.00 2.250 2.219 2.250 223 06/11/2012 Run Date: 11/30/2011 - 15:18 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Investments October 31, 2011 Page 6 Average Purchase Stated YTM YTM Days to Maturity Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Federal Agency Bullet Securities 3133XVEM9 01150 Federal Horne Loan Bank 11/04/2009 1,000,000.00 1,013,580.00 1,000,000.00 1.625 1.603 1.625 386 11/21/2012 3133XVRS2 01151 Federal Home Loan Bank 11/16/2009 1,000,000.00 1,001,420.00 999,750.00 1.000 0.998 1.012 57 12/28/2011 313372UH5 01166 Federal Horne Loan Bank 03/15/2011 1,000,000.00 1,012,920.00 1,000,000.00 1.125 1.110 1.125 682 09/13/2013 313374CZ1 01168 Federal Home Loan Bank 06/22/2011 1,000,000.00 1,009,020.00 1,000,000.00 1.000 0.986 1.000 1,056 09/22/2014 31398AYM8 01139 Federal National Mtg Assn 08/10/2009 1,000,000.00 1,011,530.00 991,250.00 1.750 2.024 2.052 283 08/10/2012 Subtotal and Average 14,085,154.19 15, 000, 000.00 15,153,610.00 14,988,500.00 1.530 1.552 621 Total and Average 142,933,925.60 Run Date: 11130/2011 - 15:18 135, 960,683.50 136, 391,302.07 135,949,183.50 0.655 0.664 213 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 CUSIP City of Temecula, California Portfolio Management Portfolio Details - Cash October 31, 2011 Average Purchase Stated YTM YTM Days to Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Page 7 Retention Escrow Account SYSAAA#1202 AAA#1202 COMMUNITY BANK 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 4110170281 EDGEDEV TORRY PINES BANK 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 23303800 PCL CONST Wells Fargo Bank 07/01/2011 0.00 0.00 0.00 0.000 0.000 1 Passbook/Checking Accounts SYSPetty Cash Petty Cash City of Temecula 07/01/2011 2,810.00 2,810.00 2,810.00 0.000 0.000 1 SYSFIex Ck Acct Flex Ck Acct Union Bank of California 07/01/2011 35,287.51 35,287.51 35,287.51 0.000 0.000 1 SYSGen CkAcct Gen CkAcct Union Bank of California 3,034,820.31 3,034,820.31 3,034,820.31 0.000 0.000 1 SYSParking Ck PARKING CITA Union Bank of California 07/01/2011 6,791.75 6,791.75 6,791.75 0.000 0.000 1 Average Balance 0.00 1 Total Cash and Investments 142,933,925.60 Run Date: 11/30/2011 - 15:18 139,040,393.07 139, 471, 011.64 139,028,893.07 0.655 0.664 213 Portfolio TEME CP PM (PRF_PM2) SymRept 6.42 Cash and Investment Report CITY OF TEMECULA Through October 2011 Fund No. Fund Title Fund Total 001 GENERAL FUND $ 27,147,403.23 100 STATE GAS TAX FUND 973,486.10 120 DEVELOPMENT IMPACT FUND 5,286,254.35 140 COMMUNITY DEV BLOCK GRANT 16,258.27 150 AB 2766 FUND 640,831.10 160 SUPPLEMENTAL LAW ENFORCEMENT SERVICES 2,975.51 165 RDA AFFORDABLE HOUSING 20% SET ASIDE 27,488,023.29 170 MEASURE A FUND 8,792,812.88 190 TEMECULA COMMUNITY SERVICES DISTRICT 1,223,691.43 194 TCSD SERVICE LEVEL "D" REFUSE/RECYCLING 301,028.18 195 TCSD SERVICE LEVEL "R" STREET/ROAD MAINT 5,495.18 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 179,984.18 197 TEMECULA LIBRARY FUND 500,056.49 210 CAPITAL IMPROVEMENT PROJECT FUND 14,063,296.20 273 CFD 03-1 CROWNE HILL IMPROVEMENT FUND 4,234,131.65 275 CFD 03-3 WOLF CREEK IMPROVEMENT FUND 974,023.09 277 CFD-RORIPAUGH 30,436,043.07 280 REDEVELOPMENT AGENCY- CIP PROJECT 187,847.78 300 INSURANCE FUND 690,901.08 310 VEHICLES AND EQUIPMENT FUND 1,052,340.89 320 INFORMATION TECHNOLOGY 600,724.32 330 SUPPORT SERVICES 362,877.74 340 FACILITIES 216,012.09 370 CITY 2008 COP'S DEBT SERVICE 798,312.87 375 SUMMER YOUTH EMPLOYMENT PROGRAM 17,991.95 380 RDA DEBT SERVICE FUND 1,582,494.14 390 TCSD 2001 COP'S DEBT SERVICE 96,642.65 460 CFD 88-12 DEBT SERVICE FUND 84,609.09 472 CFD 01-2 HARVESTON A&B DEBT SERVICE 767,426.17 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 1,209,653.92 474 AD 03-4 JOHN WARNER ROAD DEBT SERVICE 96,895.42 475 CFD 03-3 WOLF CREEK DEBT SERVICE FUND 2,836,777.91 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 415,900.20 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 5,406,085.72 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 5,913.70 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 43,420.48 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 24,942.52 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 1,170.20 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 1,711.52 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 8,079.97 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 888.78 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 11,616.83 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 2,884.70 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 588.95 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 10,264.67 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 61,939.14 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 131.98 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 48,531.57 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 112,144.15 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 73,433.71 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 57.91 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 7,867.26 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 140,866.39 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 15,104.55 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 27.02 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 171,326.63 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 3,925.38 530 SERVICE LEVEL"C"ZONE 30 FUTURE ZONES 34,885.49 Grand Total: $ 139,471,011.64 Item No. 5 Approvals City Attorney Director of Finance City Manager OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: Financial Statements for the Three Months Ended September 30, 2011 PREPARED BY: Pascale Brown, Accounting Manager RECOMMENDATION: That the City Council: 1. Receive and file the Financial Statements for the Three Months Ended September 30, 2011; 2. Approve an appropriation decrease of $147,145 for Operating Transfers Out in the State Transportation fund and an offsetting $147,145 increase for Operating Transfer Out in the State Gas Tax fund. BACKGROUND: The attached Financial Statements reflect the unaudited activity of the City for the three months ended September 30, 2011. Please see the attached Financial Statements footnotes for an analytical review of financial activity for each of the various Funds. The recommendation above includes adjustments to the State Transportation and State Gas Tax Funds. The State of California Controller approved the State Gas Tax Swap in March 2010 which required Proposition 42 State Transportation funds received in fiscal year 2009-10 to be spent by the end of fiscal year 2010-11. If monies were not spent by fiscal year 2010-11, any remaining funds plus interest are required to be returned to the State. Therefore, the remaining Proposition 42 State Transportation funds were transferred to the General Fund to offset qualifying costs made in fiscal year 2010-11 and also recognized as revenues in the prior year. FISCAL IMPACT: None ATTACHMENTS: -Combining Balance Sheet as of September 30, 2011 -Statement of Revenues, Expenditures and Changes in Fund Balance Budget and Actual for the Three Months Ended September 30, 2011 -Combining Statement of Net Assets as of September 30, 2011 -Combining Statement of Revenues, Expenses and Changes In Net Assets for the Three Months Ended September 30, 2011 -Statement of Net Assets - Fiduciary Fund as of September 30, 2011 -Statement of Changes in Fiduciary Net Assets for the Three Months Ended September 30, 2011 CITY OF TEMECULA Combining Balance Sheet as of September 30, 2011 and Statement of Revenues, Expenditures and Changes in Fund Balance Budget and Actual for the Three Months Ended September 30, 2011 and Combining Statement of Net Assets as of September 30, 2011 and Combining Statement of Revenues, Expenses and Changes In Net Assets for Three Months Ended September 30, 2011 and Statement of Net Assets - Fiduciary Fund as of September 30, 2011 and Statement of Changes in Fiduciary Net Assets for the Three Months Ended September 30, 2011 (Unaudited) Prepared by the Finance Department CITY OF TEMECULA COMBINING BALANCE SHEET as of September 30, 2011 General Gas Tax Fund Fund ASSETS: State Transport. Fund Cash and Investments $ 31,813,654 $ 973,055 $ Receivables 5,840,333 234,332 Due from Other Funds 11,422 - Advances to Other Funds 1,242,095 Deposits 79,592 - Inventory 3,058 TOTAL ASSETS LIABILITIES AND FUND BALANCES LIABILIT1 ES: Energy DIF Fees Recovery Efficiency CDBG Fund JAG Fund Conserv. Fund Grant $ 5,228,080 $ 11,955 11,743 3,889 16,258 $ 38,990,154 $ 1,207,387 $ - $ 5,240,035 $ 11,743 $ 3,889 $ 16,258 Due to Other Funds $ - $ $ $ - $ 9,770 $ 3,889 $ 16,258 Other Current Liabilities 8,922,451 - - 17,659 1,973 - - Deferred Revenue 3,863,240 TOTAL LIABILITIES 12,785,691 17,659 11,743 3,889 16,258 FUND BALANCES: Nonspendable: Advances to Other Funds 1,242,095 Deposits 1,325 Inventory 3,058 Land Held for Resale - Notes and Loans - Prepaid Costs 79,592 Restricted For: Community Development Projects Capital Projects - Debt Service - Dutch Villages 150,000 Parks and Recreation - Public Works - Committed To: Contractual Obligation -Encumbrances Economic Uncertainty Assigned To: Capital Projects Compresensive Annual Leave Secondary Reserves Theater Reconstruction Unrealized Gains 1,624,804 10,642,975 6,324,030 1,460,068 1,512,761 2,879,175 284,580 1,207,387 5,222,376 2,674 Unassigned (2,674) TOTAL FUND BALANCES 26,204,463 1,207,387 - 5,222,376 TOTAL LIABILITIES and FUND BALANCES $ 38,990,154 $ 1,207,387 $ - $ 5,240,035 $ 11,743 $ 3,889 $ 16,258 NOTE: Balances are unaudited 1 CITY OF TEMECULA COMBINING BALANCE SHEET as of September 30, 2011 AB2766 SLESF Measure A Fund Fund Fund ASSETS: Capital Project Fund Debt Service Fund TOTAL Cash and Investments $ 640,585 $ - $ 8,693,048 $ 14,272,964 $ 797,550 $ 62,418,936 Receivables 1,478 156,536 99,755 4 6,376,283 Due from Other Funds - - 18,495 29,917 Advances to Other Funds - 1,242,095 Deposits - - - - - 79,592 Inventory 3,058 TOTAL ASSETS LIABILITIES AND FUND BALANCES LIABILITIES: $ 642,063 $ - $ 8,849,584 $ 14,391,214 $ 797,554 $ 70,149,881 Due to Other Funds $ $ $ - $ - $ $ 29,917 Other Current Liabilities - - 31,827 403,352 9,377,262 Deferred Revenue - - 3,863,240 TOTAL LIABILITIES 31,827 FUND BALANCES: 403,352 13,270,419 Nonspendable: Advances to Other Funds 1,242,095 Deposits - - - - - 1,325 Inventory 3,058 Land held for resale - - - - Notes and Loans Prepaid Costs - - 79,592 Restricted For: Community Development Projects - - 5,222,376 Capital Projects 642,063 642,063 Debt Service - - 797,554 797,554 Dutch Villages 150,000 Parks and Recreation - - - Public Works 8,690,002 9,897,389 Committed To: Contractual Obligation- Encumbrances 127,755 7,433,376 9,188,609 Economic Uncertainty - - - - 10,642,975 Assigned To: Capital Projects - - - 6,554,486 - 12,878,516 Compresensive Annual Leave - 1,460,068 Secondary Reserves - - - - - 1,512,761 Theater Reconstruction 2,879,175 Unrealized Gains - - - - 284,580 Unassigned - - - (2,674) TOTAL FUND BALANCES 642,063 8,817,757 13,987,862 797,554 56,879,462 TOTAL LIABILITIES and FUND BALANCES $ 642,063 $ - $ 8,849,584 $ 14,391,214 $ 797,554 $ 70,149,881 NOTE: Balances are unaudited 2 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GENERAL FUND for the Three Months Ended September 30, 2011 Annual Amended Budget Total Percentage Activity of Budget REVENUES: Sales Tax - State $ 19,102,828 $ 2,338,400 12% (1) Sales Tax - Triple Flip 6,130,519 0% (2) Franchise Fees 3,366,101 758,687 23% Motor Vehicle In Lieu - State 811,085 51,960 6% (3) Motor Vehicle In Lieu - Triple Flip 5,980,044 - 0% (2) Property Tax 5,097,423 432,355 8% (2) Property Tax Relief (Homeowner) 74,582 - 0% (2) Property Transfer Tax 491,713 127,182 26% Transient Occupancy Tax 2,204,749 635,670 29% Vehicle Code Fines 773,508 99,294 13% Development Services: Building & Safety 1,331,607 272,848 20% Fire 465,730 168,265 36% Land Development 264,597 340,270 129% (4) Planning 908,419 82,579 9% (5) Public Works - NPDES 3,276 0% Police 490,543 211,696 43% Advertising 40,680 7,710 19% Bids and Proposals 6,300 3,425 54% Business Licenses 300,000 20,490 7% (6) GASB 31 Fair Market Value on Investment - (30,168) 0% Investment 329,700 55,243 17% Investment Interest RDA Loan Repayment 238,633 - 0% (7) Grants 26,879 0% Lease/Rental Income 37,572 9,707 26% Miscellaneous 8,000 4,855 61% Operating Transfers In State Gas Tax 2,731,991 457,185 17% Proposition 42 147,145 0% (8) SLESF 100,000 0% (9) Reimbursements: Financing 163,000 40,750 25% CIP 2,238,698 493,229 22% RDA 110,000 27,500 25% Other 42,000 6,785 16% TOTAL REVENUES $ 53,990,443 $ 6,642,796 12% NOTES: (1) All receipts tor the quarter ending September 30, 2011 are expected to be received no later than December 2011. (2) Property taxes and "triple flip" revenues are scheduled to be received in January and May of this fiscal year. (3) The variance is primarily due to State Budget Trailer Bill, SB 89, approval as part of the fiscal year 2011-12 State budget, which eliminated the direct allocation of MVL revenues to local governments. This will be partially offset by an increase in Law Enforcement SLEFS funds. (4) The variance in Land Development is due to fees received for the Hospital, Time Warner Service Building, Crown Castle, and Paseo Del Sol projects which occurred earlier than anticipated. (5) The variance in Planning is primarily due to revenues based on reimbursements for qualifying transportation grant expenditures for the Jefferson Corridor Study which have not yet occurred, as well as the timing of development activities and the issuance of permits. (6) Business License renewals will primarily occur in January 2012. (7) The annual RDA loan repayment to the General Fund will not be made this year due to legislation and the subsequent litigation at the State Supreme Court. (8) These funds were recognized as revenues in fiscal year 2010-11. (9) Supplemental Law Enforcement Services Fund (SLESF) revenues are not expected until June 2012. CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GENERAL FUND for the Three Months Ended September 30, 2011 Annual Amended Budget EXPENDITURES: Year -to -Date Activity Year -to -Date Encumbrances Activity and Encumbrances Percentage of Budget City Council $ 449,642 $ 96,151 $ 1,789 $ 97,940 22% Community Support 132,150 7,241 181 7,422 6% (1) City Manager 1,545,282 321,600 64,688 386,288 25% Economic Development 733,249 139,164 124,183 263,347 36% City Clerk 1,142,988 257,463 34,532 291,995 26% City Attorney 821,300 173,541 173,541 21% Finance 2,244,070 516,531 40,181 556,712 25% Human Resources 585,271 131,274 48,396 179,670 31% Planning 1,779,310 340,500 103,732 444,232 25% Building & Safety 2,078,171 424,264 81,333 505,597 24% Land Development 1,140,885 262,114 14,552 276,666 24% Public Works 4,860,234 700,696 659,822 1,360,518 28% CIP Administration 2,238,698 527,465 3,885 531,350 24% Police 21,461,442 4,675,004 318,063 4,993,067 23% Fire 4,450,282 1,073,468 129,467 1,202,935 27% Animal Control 409,160 64,054 64,054 16% (2) Non -Departmental 7,318,641 1,755,134 1,755,134 24% TOTAL EXPENDITURES (excluding transfers) 53,390,775 11,465,664 1,624,804 13,090,468 25% Revenues Over/(Under) Expenditures 599,668 (4,822,868) Other Financing Sources (Uses): Transfers Out Revenues Over/(Under) Expenditures and Other Financing Sources (uses) (4,091,079) (1,050,982) (3,491,411) (5,873,850) Net Change in Fund Balances (3,491,411) (5,873,850) Beginning Fund Balance as of 7/01/2011 32,078,313 32,078,313 Ending Fund Balance as of 9/30/2011 $ 28,586,902 $ 26,204,463 NOTES: (1) The variance in the Community Support is due to Community Service Funding Program applications currently being reviewed and not awarded by Council during this quarter. (2) The variance in Animal Control is due to a cost sharing agreement. Reimbursement is not paid until April 2012. 4 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL GAS TAX FUND tor the Three Months Ended September 30, 2011 Annual Amended Budget Total Percentage of Activity Budget REVENUES: Section 2103 - 2107 $ 2,601,233 $ 652,922 25% TOTAL REVENUES 2,601,233 652,922 25% Other Financing Sources (uses): Transfers Out Revenues Over/(Under) Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 (2,845,251) (457,185) 16% (1) (244,018) 195,737 1,011,650 1,011,650 $ 767,632 $ 1,207,387 NOTES: (1) The variance is Operating Transfers In is primarily due to less qualifying expenditures incurred by Public Works to be reimbursed from Gas Tax revenues. CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL STATE TRANSPORTATION FUND tor the Three Months Ended September 30, 2011 REVENUES: Investment Interest TOTAL REVENUES Other Financing Sources (uses): Transfers Out Annual Amended Budget Total Percentage of Activity Budget (147,145) (1) Revenues Over/(Under) Other Financing Sources (uses) (147,145) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 $ (147,145) (1) $ NOTES: (1) The variance is primarily due to Proposition 42 funds that were spent on June 30, 2011 but included in the fiscal year 2011-12 budget. The adjustment request is included in this quarterly financial statement. CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL DEVELOPMENT IMPACT FUND tor the Three Months Ended September 30, 2011 Annual Amended Budget REVENUES: Total Percentage of Activity Budget Open Space $ 269,048 $ 30,405 11% Investment Interest 10,448 0% Quimby 315,946 - 0% Street Improvements 1,415,395 46,372 3% Traffic Signals 211,967 9,040 4% Parks 837,640 88,492 11% Corporate Facilities - 19,987 0% Fire Protection 188,731 21,709 12% Library 283,540 30,401 11% Public Art 14,859 4,078 0% Police 9,159 0% TOTAL REVENUES 3,537,126 270,091 8% (1) Other Financing Sources (uses): Transfers Out (7,423,557) (10,000) 0.1% (2) Revenues Over/(Under) Other Financing Sources (uses) (3,886,431) 260,091 Beginning Fund Balance as of 7/01/2011 4,962,285 4,962,285 Ending Fund Balance as of 9/30/2011 NOTES: (1) The variance in revenues is due to the timing of developers pulling permits. (2) The variance in expenditures is due to the fact that several Capital Improvement Projects budgeted with DIF are in early design stage, currently out to bid and construction contracts have not been awarded yet. Such projects include Open Space Acquisition Program, Tennis Court Lighting Projects, and Main Street. $ 1,075,854 $ 5,222,376 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL RECOVERY ACT JAG FUNDING tor the Three Months Ended September 30, 2011 Annual Year to Date Total % of Amended Activity Encumbrances Activity Budget Budget REVENUES: Grant Revenue $ 73,104 $ 2,755 $ - $ 2,755 4% (1) TOTAL REVENUES 73,104 2,755 2,755 4% EXPENDITURES: Operating Expenditures 73,104 2,755 2,674 5,429 7% (1) TOTAL EXPENDITURES 73,104 2,755 2,674 5,429 7% Revenues Over/(Under) Expenditures Beginning Fund Balance as of 7/01/2011 - Ending Fund Balance as of 9/30/2011 NOTES: (1) The City has yet to be invoiced from the Riverside County Sheriffs Department for qualifying overtime operations for Mall Patrol and Youth Court JAG funded programs. 8 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL ENERGY EFFICIENCY CONSERVATION GRANT for the Three Months Ended September 30, 2011 Annual Amended Budget YTD Total Percentage Activity Activity of Budget REVENUES: Grant Revenue $ 743,483 $ 3,889 $ 3,889 1% (1) TOTAL REVENUES 743,483 3,889 3,889 1% EXPENDITURES: Operating Expenditures TOTAL EXPENDITURES 303,741 3,889 303,741 3,889 Revenues Over/(Under) Expenditures 439,742 3,889 1% (1) 3,889 1% Other Financing Sources (uses): Transfers Out (439,742) 0% (2) Revenues Overl(Under) Expenditures and Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 NOTES: (1) Revenues are based on reimbursements for qualifying grant project expenditures. (2) The construction contract for the Community Recreation Center (CRC) Retrofit project was awarded by City Council on September 13, 2011. All design work and permitting will be completed by March 1, 2012. The physical work at the CRC will be undertaken between March 19, 2012 and May 21, 2012. 9 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL COMMUNITY DEVELOPMENT BLOCK GRANT tor the Three Months Ended September 30, 2011 REVENUES: Grant Revenue TOTAL REVENUES EXPENDITURES: Other Outside Services TOTAL EXPENDITURES Annual Amended Budget $ 1,025,788 1,025,788 45,310 45,310 Revenues Over/(Under) Expenditures 980,478 Total Percentage of Activity Budget 0% 0% 0% 0% (1) (1) Other Financing Sources (uses): Transfers Out (980,478) 0% (1) Revenues Over/(Under) Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 - Ending Fund Balance as of 9/30/2011 NOTES: (1) A Supplemental agreement was approved by City Council on October 11, 2011 authorizing the Community Development Block Grant (CDBG) allocations for fiscal year 2011-12. 10 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL AB 2766 FUND tor the Three Months Ended September 30, 2011 REVENUES: AB 2766 Investment Interest TOTAL REVENUES EXPENDITURES: Other Outside Services TOTAL EXPENDITURES Revenues Over/(Under) Expenditures Annual Amended Budget Total Percentage of Activity Budget $ 124,057 0% 5,500 1,324 24% 129,557 1,324 1% 24,000 24,000 105,557 1,324 0% 0% (1) (2) Other Financing Sources (uses): Transfers Out (651,216) 0% (3) Revenues Overl(Under) Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 (545,659) 1,324 640,739 640,739 $ 95,080 $ 642,063 NOTES: (1) The first quarter revenue allocation for AB 2766 Subvention Fund is not expected until December 2011. (2) Payment for Harveston Trolley and Clean Cities Coalition Air Quality will be made by December 2011. (3) The construction for the Pedestrian Bicycle Bridge was awarded and approved by Council on September 13, 2011. The Temecula Park and Ride and Santa Gertrudis Creek Pedestrian Bicycle Trail Extension and Interconnect are currently in design stage. Transfers will be done when progress payment is paid to vendor. 11 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SUPPLEMENTAL LAW ENFORCEMENT SERVICES FUND(SLESF) tor the Three Months Ended September 30, 2011 Annual Amended Budget Total Percentage of Activity Budget REVENUES: AB 3229 - COPS $ 100,000 0% (1) TOTAL REVENUES 100,000 0% Other Financing Sources (uses): Transfers Out (100,000) 0% (1) Revenues Over/(Under) Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 NOTES: (1) Revenues from the County of Riverside are not expected to be received until June 2012. 12 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL MEASURE A for the Three Months Ended September 30, 2011 REVENUES: Measure "A" Investment Interest TOTAL REVENUES Annual Amended Budget YTD Activity Encumbrances Total Percentage Activity of Budget $ 2,144,903 $ 322,600 $ $ 322,600 15% (1) 77,600 18,230 - 18,230 23% 2,222,503 340,830 - 340,830 15% EXPENDITURES: Operating Expenditures 869,242 333,074 127,755 460,829 53% (2) TOTAL EXPENDITURES 869,242 333,074 127,755 460,829 53% Revenues Over/(Under) Expenditures 1,353,261 7,756 Other Financing Sources (uses): Transfers Out (9,390,864) 0% (3) Revenues Over/(Under) Expenditures and Other Financing Sources (uses) Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 (8,037,603) 7,756 8,810,001 8,810,001 $ 772,398 $ 8,817,757 NOTES: (1) September Measure "A" revenues have yet to be received. (2) The variance is due to Citywide slurry seal and concrete repairs and maintenance that were paid during this quarter. (3) The construction for the Pavement Rehabilitation Program was awarded by City Council on July 26, 2011, for Margarita Road and Winchester Road. The French Valley Parkway Phase I is currently in the design stage. Transfers will be done when progress payment is paid to vendor. 13 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - _ _ BUDGET AND ACTUAL CAPITAL IMPROVEMENT PROJECTS FUND for the Three Months Ended September 30, 2011 Annual Account Year -to -Date % of Number Amended Activity Encumbrances Total Activity Budget Budget REVENUE: Operating Transfers In $ 33,934,776 $ 235,219 $ Grants 7,378,715 $ 235,219 Reimbursements 2,599,507 3,865 3,865 Reimbursements - TUMF 36,520,103 20,117 20,117 Investment Interest 25,069 - 25,069 TOTAL REVENUE EXPENDITURES: 80,433,101 284,270 284,270 1% 0% 0% 0% 0% 0% (1) Citywide Adaptive Traffic Light Synchronization -Phase I 165-501 71,291 - 62,032 62,032 87% Citywide Adaptive Traffic Light Synchronization -Phase 11 165-503 99,857 - 74,679 74,679 75% Nicolas Valley Assessment District Liefer Road 165-504 22,639 - 22,639 22,639 100% Open Space Acquisition Program 165-509 300,000 - - - 0% Road and Storm Drain Repair at Rancho California 165-510 37,995 - - - 0% Road Reconstruction at Jedediah Smith Rd. 165-511 19,163 - - - 0% Slurry Seal at Paloma Del Sol and Temeku Hills 165-512 202,358 - 0% OId Town Police Storefront 165-513 35,909 - 35,909 35,909 100% Temecula Police Station Tenant Improvement 165-514 200,000 - - - 0% OId Town Sound System Retrofit 165-515 60,808 22,463 38,344 60,807 100% Pechanga Parkway Environmental Mitigation 165-516 630,952 32,482 701 33,183 5% Murrieta Creek Bridge / Overland Drive Extension to Diaz Road 165-602 4,829,794 85,871 - 85,871 2% Abbott Corporation Roadway Improvements 165-620 750,000 0% Medians and Parkway Citywide 165-622 226,459 - - - 0% Closed Caption Television Install -State Route 79 South Pechanga 165-635 13,442 - - - 0% Winchester Rd. / State Route 79 North Corridor Beautification 165-638 377,949 20,879 106,101 126,980 34% OId Town Infrastructure Projects- Civic Center 165-643 231,424 50,879 50,879 22% OId Town Infrastructure - Parking Structure, Office and Retail 165-644 323,696 3,345 46,934 50,279 16% Pavement Rehabilitation Program - Citywide 165-655 8,951,715 130,515 4,464,516 4,595,031 51% 14 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - _ _ BUDGET AND ACTUAL CAPITAL IMPROVEMENT PROJECTS FUND - continued for the Three Months Ended September 30, 2011 Annual Account Year -to -Date % of Number Amended Activity Encumbrances Total Activity Budget Budget EXPENDITURES - contd: Western Bypass Bridge Over Murrieta Creek 165-660 370,886 5,056 47,081 52,137 14% Interstate -15 / State Route 79 South Ultimate Interchange 165-662 219,508 32,098 93,293 125,391 57% Flashing Beacons & Speed Advisory Signs 165-670 31,336 7,296 7,296 23% Traffic Signals -Meadows Parkway at Pauba 165-678 4,599 4,599 4,599 100% Traffic Signals -Rancho California and Yukon 165-679 121,852 107,219 17,791 125,010 103% Traffic Signal Equipment Replacement Program -Citywide 165-680 80,000 - - - 0% Signals- Rancho Cal Promnade Chardonnay 165-682 295,000 - - - 0% City Facilities Rehabilitation 165-701 469,018 0% Medians & Ornamental Pedestrian Barriers- Citywide 165-704 40,000 - - - 0% Citywide Storm Drain Improvements 165-715 225,825 18 532 550 0% French Valley Pkwy/I-15 Over -Crossing and Improvements- Phase 1 165-719 22,323,276 90,152 94,479 184,631 1% Butterfield Stage Road Extension 165-723 10,733,604 63,981 82,488 146,469 1% French Valley Pkwy/I-15 Over -Crossing and Improvements- Phase 11 165-726 15,292,375 82,370 116,813 199,183 1% Pedestrian/Bicycle Bridge Over Santa Gertrudis Creek to CHS 165-738 1,239,409 27,406 2,682 30,088 2% Santa Gertrudis Creek Pedestrian Bicycle Trail Extension Interconnect 165-739 294,295 5,462 243,660 249,122 85% Fire Station Roripaugh Ranch Site 165-741 584,313 300,819 300,819 51% Main Street Bridge Over Murrieta Creek Replacement 165-743 6,748,529 13,627 10,045 23,672 0% Temecula Park and Ride 165-747 14,122 400 412 812 6% Old Town Civic Center 165-751 1,415,406 109,350 1,120,082 1,229,432 87% Old Town Public Art 190-121 120,000 - 0% Teen Young Adult Village 190-122 100,000 0% Children's Museum Enhancement Project 190-125 114,000 0% Tennis Court Surfacing -Earle Stanley Gardner Middle School 190-126 47,000 0% Flood Control Channel Reconstruction and Repair 190-127 250,000 - - - 0% Tennis Court Lighting- Great Oak High School 190-128 449,500 - - - 0% Inclusive Play Structure at Patricia H Birdsall Sport Park 190-129 397,000 - - - 0% 15 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - _ _ BUDGET AND ACTUAL CAPITAL IMPROVEMENT PROJECTS FUND - continued for the Three Months Ended September 30, 2011 Annual Account Year -to -Date % of Number Amended Activity Encumbrances Total Activity Budget Budget EXPENDITURES - contd: Parks Improvement Program 190-130 300,000 0% Ronald Reagan Monument Site Preparation 190-131 35,000 0% Senior Citizen Outdoor Fitness Lot 190-133 55,500 - - 0% Redhawk Park Improvements 190-144 9,444 7,339 2,105 9,444 100% Reclaimed Water Irrigation Retrofit - Various Sites 190-150 500,000 - - - 0% CRC Energy Management Retrofit 190-152 399,133 9,343 2,600 11,943 Library Parking Expansion 190-153 366,933 24,526 2,434 26,960 Margarita Road Right -of -Way Enhancements 190-154 288,333 105,371 167,627 272,998 95% Water Slide Replacement CRC Pool 190-156 157,054 12 913 925 1% Old Town Gymnasium 190-186 929,672 63,199 69,441 132,640 14% Ronald Reagan Sports Park Channel Silt Removal and Desilting Pond 190-187 211,824 2,445 125,563 128,008 60% Temecula Community Center Expansion 190-197 1,562 6 1,562 1,568 100% Temecula Children's Museum Refurbish 190-675 16,325 16,325 16,325 100% 3% 7% TOTAL EXPENDITURES 82,637,084 1,044,935 $ 7,433,376 $ 8,478,311 10% (2) Revenues Over/(Under) Expenditures Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 (2,203,983) (760,665) 14, 748, 527 14, 748, 527 $ 12,544,544 $ 13,987,862 NOTES: (1) The variance in revenues is primarily due to several funded Capital Improvement projects where reimbursement for eligible expenditures have not yet been made during this fiscal year. Transfers will be done as progress payment is made to vendor. (2) The variance in expenditures is primarily due to several major Capital Improvement projects that are currently in design stage and construction have not yet been awarded for the projects. 16 CITY OF TEMECULA STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL CERTIFICATES OF PARTICIPATION - DEBT SERVICE FUND -2008 for the Three Months Ended September 30, 2011 REVENUES: Investment Interest Transfers In TOTAL REVENUES EXPENDITURES: Trustee Fees Debt Service Principal Debt Service Interest TOTAL EXPENDITURES Annual Year to Date Total % of Amended Activity Encumbrances Activity Budget Budget $ - $ 3 $ - $ 3 1,578,738 1,020,000 1,020,000 65% (1) 1,578,738 1,020,003 1,020,003 65% 2,725 2,725 2,725 100% (2) 455,000 455,000 - 455,000 100% (3) 1,121,013 563,919 - 563,919 50% (3) 1,578,738 1,018,919 2,725 1,021,644 65% Revenues Over/(Under) Expenditures and Other Financing Sources (uses) - 1,084 Beginning Fund Balance as of 7/01/2011 Ending Fund Balance as of 9/30/2011 796,470 796,470 $ 796,470 $ 797,554 NOTES: (1) The Operating Transfer in was done this quarter for Debt Service Principal and Interest due September 1, 2011. The remaining amount will be transferred when Debt Service Interest is due and payable in April 2012. (2) The variance is due to encumbrances that are recorded for Trustees fees due in April 2012. (3) Debt Service Principal and Interest are due on September 1, 2011 and April 2012. The remaining interest payment is due in April 2012. 17 CITY OF TEMECULA COMBINING STATEMENT OF NET ASSETS as of September 30, 2011 Insurance Fund ASSETS: Vehicles and Information Equipment Technology Fund Fund Support Facilities Services Fund Fund TOTAL Cash and Investments $ 772,096 $ 1,051,957 $ 743,753 $ 388,493 $ 282,138 $ 3,238,437 Receivables 1,513 2,321 6,666 2,379 1,097 13,976 Prepaid Assets 180,524 - - - 180,524 Property, Plant, and Equipment (net of accumulated depreciation) 611,241 117,735 86,061 815,037 TOTAL ASSETS 954,133 1,665,519 868,154 476,933 283,235 4,247,974 LIABILITIES AND NET ASSETS LIABILITIES: Current Liabilities 403,805 - 131,411 23,798 46,666 605,680 Capital Leases Payable - - 111,087 - 111,087 TOTAL LIABILITIES 403,805 131,411 134,885 46,666 716,767 NET ASSETS: TOTAL NET ASSETS $ 550,328 $ 1,665,519 $ 736,743 $ 342,048 $ 236,569 $ 3,531,207 NOTE: Balances are unaudited 18 CITY OF TEMECULA COMBINING STATEMENT OF REVENUES,EXPENSES, and CHANGES IN NET ASSETS INTERNAL SERVICE FUNDS for the Three Months Ended September 30, 2011 Insurance Fund REVENUES: Vehicles and Information Equipment Technology Fund Fund Support Facilities Services Fund Fund TOTAL Investment Interest $ 1,214 $ 2,093 $ 1,122 $ 733 $ 396 $ 5,558 Charges for Services 216,984 64,117 455,672 94,536 301,555 1,132,864 TOTAL REVENUES 218,198 66,210 456,794 95,269 301,951 1,138,422 EXPENSES: Salaries and Wages 14,434 304,947 58,920 136,188 514,489 Operating Expenses 233,696 - 125,308 8,943 152,749 520,696 Interest - - - 6,010 - 6,010 Depreciation 60,191 23,916 13,933 98,040 TOTAL EXPENSES 248,130 60,191 454,171 87,806 288,937 1,139, 235 Revenues Over/(Under) Expenses (29,932) 6,019 2,623 7,463 13,014 (813) Net Assets as of July 01, 2011 580,260 1,659,500 734,120 334,585 223,555 3,532,020 Net Assets as of September 30, 2011 $ 550,328 $ 1,665,519 $ 736,743 $ 342,048 $ 236,569 $ 3,531,207 19 CITY OF TEMECULA STATEMENT OF NET ASSETS - Fiduciary Fund CALIFORNIA EMPLOYEE RETIREE BENEFIT TRUST FUND as of September 30, 2011 CERBT FUND ASSETS: Cash and Investments $ 3,693,556 TOTAL ASSETS 3,693,556 LIABILITIES: Accounts Payable TOTAL LIABILITIES NET ASSETS: 3,693,556 Held in Trust for Retiree Benefits 3,693,556 TOTAL NET ASSETS NOTE: Balances are unaudited $ 3,693,556 CITY OF TEMECULA STATEMENT OF CHANGES IN FIDUCIARY NET ASSETS - Fiduciary Fund CALIFORNIA EMPLOYEE RETIREE BENEFIT TRUST FUND for the Three Months Ended September 30, 2011 CERBT FUND ADDITIONS CONTRIBUTIONS: Employer $ 76,236 Investment Earnings (484,250) TOTAL CONTRIBUTIONS (408,014) DEDUCTIONS: Benefits 76,236 TOTAL DEDUCTIONS TOTAL ADDITIONS Net Assets as of 7/1/2011 Net Assets as of 9/30/2011 76,236 4,177, 806 $ 3,693,556 Item No. 6 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: Vehicle Repair and Maintenance Agreement Amendment PREPARED BY: Roberto Cardenas, Fiscal Services Manager RECOMMENDATION: That the City Council approve a three-year Vehicle Repair and Maintenance Agreement Amendment with Old Town Tire & Service LLC, in an amount not to exceed $86,000 annually. BACKGROUND: The City enters into vehicle maintenance agreements to service the City's fleet once the vehicle manufacturer's warranty has expired, thereby ensuring the continuation of routine preventive and operational maintenance services. Vehicle service includes maintenance, repair, and tire services for City trucks, sedans, vans, SUV's, and heavy equipment on an as needed basis. On October 27, 2009, the City issued a Request for Proposal (RFP) soliciting proposals from proponents experienced in automotive maintenance, repair, and tire services within a reasonable proximity (not to exceed a two-mile radius outside City limits) of City Hall. In addition to listing the RFP on the City's website, staff contacted local car dealership fleet managers by telephone. Furthermore, a news blast regarding the RFP was sent to members of the Temecula Chamber of Commerce. The City received four responses to the RFP on or before the submission deadline of November 6, 2009. Two of the four responses met the City's needs for scheduled preventive maintenance at 4, 12, 24, and 36 -month intervals, and have sufficient facility space, equipment, and trained technicians to perform a wide variety of automotive maintenance, repair, and tire service functions as identified in the RFP. Based on a thorough evaluation process, the evaluation panel determined Old Town Tire & Service LLC to be the most qualified and competitively priced proposal to provide the City with continuous and cost effective vehicle preventative maintenance and repair services. On December 8, 2009, City Council approved an agreement with Old Town Tire & Service LLC, for two years in an amount not to exceed $86,000 annually for a two year total of $174,000. The City now desires to amend the agreement to extend services for three additional years in an amount not to exceed $258,000 (at $86,000 annually) for a five year total agreement amount of $430,000. FISCAL IMPACT: Adequate funds are available in the fiscal year 2011-12 Annual Operating Budget in the various City Department line item budgets. ATTACHMENT: Non -Exclusive Agreement Between The City of Temecula and Old Town Tire & Service LLC for Vehicle Maintenance, Repair & Tire Services. FIN12-10 FIRST AMENDMENT TO AGREEMENT BETWEEN CITY OF TEMECULA AND OLD TOWN TIRE & SERVICE, LLC NON-EXCLUSIVE VEHICLE MAINTENANCE, REPAIR & TIRE SERICES THIS FIRST AMENDMENT is made and entered into as of December 13, 2011 by and between the City of Temecula , a municipal corporation (hereinafter referred to as "City"), and Old Town Tire & Service, LLC, (hereinafter referred to as "Contractor"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. This Amendment is made with the respect to the following facts and purposes: A. On December 8, 2009, the City and Contractor entered into that certain Agreement entitled "Agreement for Non -Exclusive Vehicle Maintenance, Repair & Tire Services", in the amount of $86,000.00 annually for a two year total agreement amount of $172,000. B. The parties now desire to, extend the term of the agreement three additional years to December 8, 2014, increase the payment in the amount of $258,000.00, and to amend the Agreement as set forth in this Amendment. follows: 2. Section 1 of the Agreement entitled "TERM" is hereby amended to read as This Agreement shall remain and continue in effect until tasks herein are completed, but in no event later than December 8, 2014 unless sooner terminated pursuant to the provisions of this Agreement. 3. Section 4 of the Agreement entitled "PAYMENT" at paragraph "a" is hereby amended to read as follows: follows: The City agrees to pay Consultant monthly, in accordance with the payment rates and schedules and terms set forth in Exhibit A, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit A, other than the payment rates and schedule of payment, are null and void. The First Amendment amount shall not exceed two hundred fifty eight thousand dollars ($258,000) for three additional years of vehicle maintenance, repair, and tire services (at eighty six thousand dollars $86,000.00 annually) for a five year total Agreement amount of four hundred thirty thousand dollars ($430,000.00). 4. Section 13 of the Agreement entitled "NOTICES" is hereby amended to read as "Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, 1 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-12101d Town Tire.Amendl.Veh Repair & Maint.FIN12-10.11-30-11 such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager P.O. Box 9033 Temecula, CA 92589-9033 Use this Address for a Delivery Service: City of Temecula or Hand -Deliveries ONLY Attn: City Manager 41000 Main Street Temecula, CA 92590 5. Except for the changes specifically set forth herein, all other terms and conditions of the Agreement shall remain in full force and effect. 2 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-12101d Town Tire.Amendl.Veh Repair & Maint.FIN12-10.11-30-11 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA OLD TOWN TIRE & SERVICE, LLC (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: By: Ron Roberts, Mayor Karl C. Greene III, Owner ATTEST: By: By: Susan W. Jones, MMC, City Clerk APPROVED AS TO FORM: By: Keith Greene, Partner Peter M. Thorson, City Attorney CONTRACTOR OLD TOWN TIRE & SERVICE, LLC Attn: Karl C. Greene, III 2700 Old Town Front Street Temecula, CA 92590 Phone: 951-699-8040 Fax: 951-695-1865 E -Mail: oldtowntire@verizon.net FSM Initials: Date: ..)0:, 3 R:/Finance/Agreements/Finance Dept Agreements/Agreements2011-12/OId Town Tire.Amendl.Veh Repair & Maint.FIN12-10.11-30-11 Item No. 7 TO: FROM: DATE: SUBJECT: Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT City Manager/City Council Genie Wilson, Director of Finance December 13, 2011 Office Supplies and Related Services Agreement PREPARED BY: Roberto Cardenas, Fiscal Services Manager RECOMMENDATION: That the City Council approve a one-year Agreement between the City of Temecula and Staples Advantage for $65,000 annually for the purchase of office supplies and related services, with the option to renew for three additional one-year terms. BACKGROUND: The City of Temecula spends approximately $65,000 annually for office supplies from a variety of vendors. In order to more efficiently track citywide spending patterns and ensure competitive pricing, the City determined it was necessary to enter into an agreement with a preferred provider capable of providing expansive product inventory, desktop statistical reporting, and e -ordering capabilities. Therefore, the Finance Department conducted a Request for Proposal (RFP) for office supplies and other related services utilizing the City's online bid management system, PlanetBids. A total of five Proponents responded to the relevant ordering departments were invited Proponents were invited to participate comprehensive evaluation, the Proponents 1. Staples Advantage 2. Office Depot 3. Glennies Office Products 4. Cole Office Products 5. LD Products RFP. A select group of City employees representing to review and evaluate the proposals. The top three in an oral interview and presentation. After a were ranked as follows: The top three proponents are local vendors. Staples Advantage was determined to be the best qualified Proponent with the most cost effective (competitively priced) proposal to meet the City's current needs and future goals. Staples Advantage, via the National Joint Powers Alliance (NJPA), offers over 15,000 core list discounted items including copy paper and toner. NJPA is a municipal contracting agency and member -owned cooperative that establishes and provides nationally leveraged and competitively solicited purchasing contracts. Staples Advantage's flexible and discounted pricing combined with their local retail store, account management support, expansive product inventory (including green products), e -ordering capabilities, and numerous desktop statistical reporting options will enable the City to more efficiently track citywide spending patterns, ensure competitive pricing, as well as meet strategic budgeting and sustainability reporting requirements for office supplies. Staff recommends Staples Advantage be the preferred office supply vendor for the City of Temecula. In the event Staples Advantage cannot provide the necessary supplies and/or related services, staff recommends entering into a non-exclusive agreement. The non-exclusive agreement will allow the City to purchase from other office supply vendors when necessary. FISCAL IMPACT: Sufficient funds are budgeted annually in department operating accounts throughout the City. ATTACHMENTS: Agreement FIN12-09 NON-EXCLUSIVE AGREEMENT FOR CONTRACTOR SERVICES BETWEEN CITY OF TEMECULA AND STAPLES ADVANTAGE OFFICE SUPPLIES AND RELATED SERVICES THIS AGREEMENT is made and effective as of January 1, 2012, between the City of Temecula , a municipal corporation (hereinafter referred to as "City"), and Staples Advantage, a Corporation (hereinafter referred to as "Contractor"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. TERM This Agreement shall commence on January 1, 2012, and shall remain and continue in effect until tasks described herein are completed, but in no event later than January 1, 2013, unless sooner terminated pursuant to the provisions of this Agreement. The City may, upon mutual agreement, extend the contract for three (3) additional one (1) year term. In no event shall the contract be extended beyond January 1, 2015. 2. SERVICES Contractor shall perform the services and tasks described and set forth in Exhibit A, attached hereto and incorporated herein as though set forth in full. Contractor shall complete the tasks according to the schedule of performance which is also set forth in Exhibit A. The Contractor understands this Agreement is non-exclusive and the City reserves the right to purchase similar goods and services from other contractors. 3. PERFORMANCE Contractor shall at all time faithfully, competently and to the best of his or her ability, experience, and talent, perform all tasks described herein. Contractor shall employ, at a minimum, generally accepted standards and practices utilized by persons engaged in providing similar services as are required of Contractor hereunder in meeting its obligations under this Ag ree me nt. 4. PAYMENT a. The City agrees to pay Contractor monthly, in accordance with the payment rates and terms and the schedule of payment as set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall not exceed Sixty - Five Thousand Dollars and No Cents ($65,000.00) annually unless additional payment is approved as provided in this Agreement. The not to exceed purchase amount listed herein is an estimated expenditure and this Agreement does not guarantee Contractor this amount in purchases. b. Contractor shall not be compensated for any services rendered in connection with its performance of this Agreement which are in addition to those set forth herein, unless such additional services are authorized in advance and in writing by the City 1 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 Manager . Contractor shall be compensated for any additional services in the amounts and in the mariner as agreed to by City Manager and Contractor at the time City's written authorization is given to Contractor for the performance of said services. The City Manager may approve additional work up to ten percent (10%) of the amount of the Agreement as approved by City Council. Any additional work in excess of this amount shall be approved by the City Council. c. Contractor will submit invoices monthly for actual services performed. Invoices shall be submitted between the first and fifteenth business day of each month, for services provided in the previous month. Payment shall be made within thirty (30) days of receipt of each invoice as to all non -disputed fees. If the City disputes any of Contractor's fees, it shall give written notice to Contractor within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice. For all reimbursements authorized by this Agreement, Contractor shall provide receipts on all reimbursable expenses in excess of fifty dollars ($50) in such form as approved by the Director of Finance. 5. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Contractor at least ten (10) days prior written notice. Upon receipt of said notice, the Contractor shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Contractor the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Contractor will submit an invoice to the City, pursuant to Section entitled "PAYMENT" herein. 6. DEFAULT OF CONTRACTOR a. The Contractor's failure to comply with the provisions of this Agreement shall constitute a default. In the event that Contractor is in default for cause under the terms of this Agreement, City shall have no obligation or duty to continue compensating Contractor for any work performed after the date of default and can terminate this Agreement immediately by written notice to the Contractor. If such failure by the Contractor to make progress in the performance of work hereunder arises out of causes beyond the Contractor's control, and without fault or negligence of the Contractor, it shall not be considered a default. b. If the City Manager or his delegate determines that the Contractor is in default in the performance of any of the terms or conditions of this Agreement, it shall serve the Contractor with written notice of the default. The Contractor shall have ten (10) days after service upon it of said notice in which to cure the default by rendering a satisfactory performance. In the event that the Contractor fails to cure its default within such period of time, the City shall have the right, notwithstanding any other provision of this Agreement, to terminate this Agreement without further notice and without prejudice to any other remedy to which it may be entitled at law, in equity or under this Agreement. 2 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 7. OWNERSHIP OF DOCUMENTS a. Contractor shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Contractor shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Contractor shall provide free access to the representatives of City or its designees at reasonable times to such books and records, shall give City the right to examine and audit said books and records, shall permit City to make transcripts there from as necessary, and shall allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be maintained for a period of three (3) years after receipt of final payment. b. Upon completion of, or in the event of termination or suspension of this Agreement, all original documents, designs, drawings, maps, models, computer files containing data generated for the work, surveys, notes, and other documents prepared in the course of providing the services to be performed pursuant to this Agreement shall become the sole property of the City and may be used, reused or otherwise disposed of by the City without the permission of the Contractor. With respect to computer files containing data generated for the work, Contractor shall make available to the City, upon reasonable written request by the City, the necessary computer software and hardware for purposes of accessing, compiling, transferring and printing computer files. 8. INDEMNIFICATION The Contractor agrees to defend, indemnify, protect and hold harmless the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, officials, employees and volunteers from and against any and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, agents, employees or volunteers may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Contractor's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non-performance of this Agreement, excepting only liability arising out of the negligence of the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula. 9. INSURANCE REQUIREMENTS Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by the Contractor, its agents, representatives, or employees. a. Minimum Scope of Insurance. Coverage shall be at least as broad as: 1) Insurance Services Office Commercial General Liability form No. CG 00 01 11 85 or 88. 2) Insurance Services Office Business Auto Coverage form CA 00 01 06 92 covering Automobile Liability, code 1 (any auto). If the Contractor owns no automobiles, a non -owned auto endorsement to the General Liability policy described above is acceptable. 3 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 3) Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. If the Contractor has no employees while performing under this Agreement, worker's compensation insurance is not required, but Contractor shall execute a declaration that it has no employees. b. Minimum Limits of Insurance. Contractor shall maintain limits no less than: 1) General Liability: One million ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this projectilocation or the general aggregate limit shall be twice the required occurrence limit. 2) Automobile Liability: One million ($1,000,000) per accident for bodily injury and property damage. 3) Worker's Compensation as required by the State of California; Employer's Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. c. Deductibles and Self -Insured Retentions. Any deductibles or self-insured retentions shall not exceed Twenty Five Thousand Dollars and No Cents ($25,000). d. Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 1) The City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers are to be covered as insured's, as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, occupied or used by the Contractor; or automobiles owned, leased, hired or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 2) For any claims related to this project, the Contractor's insurance coverage shall be primary insurance as respects the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers. Any insurance or self-insured maintained by the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. 3) Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Temecula, the Temecula Community Services District, and the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 4) The Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 5) Each insurance policy required by this agreement shall be endorsed to state: should the policy be canceled before the expiration date the issuing insurer will endeavor to mail thirty (30) days' prior written notice to the City. 4 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 6) If insurance coverage is canceled or, reduced in coverage or in limits the Contractor shall within two (2) business days of notice from insurer phone, fax, and/or notify the City via certified mail, return receipt requested of the changes to or cancellation of the policy. e. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of A -:VII or better, unless otherwise acceptable to the City. Self insurance shall not be considered to comply with these insurance requirements. f. Verification of Coverage. Contractor shall furnish the City with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by the City before work commences. As an alternative to the City's forms, the Contractor's insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. 10. INDEPENDENT CONTRACTOR a. Contractor is and shall at all times remain as to the City a wholly independent contractor. The personnel performing the services under this Agreement on behalf of Contractor shall at all times be under Contractor's exclusive direction and control. Neither City nor any of its officers, employees, agents, or volunteers shall have control over the conduct of Contractor or any of Contractor's officers, employees, or agents except as set forth in this Agreement. Contractor shall not at any time or in any manner represent that it or any of its officers, employees or agents are in any manner officers, employees or agents of the City. Contractor shall not incur or have the power to incur any debt, obligation or liability whatever against City, or bind City in any manner. b. No employee benefits shall be available to Contractor in connection with the performance of this Agreement. Except for the fees paid to Contractor as provided in the Agreement, City shall not pay salaries, wages, or other compensation to Contractor for performing services hereunder for City. City shall not be liable for compensation or indemnification to Contractor for injury or sickness arising out of performing services hereunder. 11. LEGAL RESPONSIBILITIES The Contractor shall keep itself informed of all local, State and Federal ordinances, laws and regulations which in any manner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Contractor shall at all times observe and comply with all such ordinances, laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Contractor to comply with this section. 12. RELEASE OF INFORMATION a. All information gained by Contractor in performance of this Agreement shall be considered confidential and shall not be released by Contractor without City's prior written authorization. Contractor, its officers, employees, agents or subcontractors, shall not without written authorization from the City Manager or unless requested by the City Attorney, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories or other information concerning the work performed under this Agreement or relating to any project or property located within the City. Response to a subpoena or court 5 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 order shall riot be considered "voluntary" provided Contractor gives City notice of such court order or subpoena. b. Contractor shall promptly notify City should Contractor, its officers, employees, agents or subcontractors be served with any summons, complaint, subpoena, notice of deposition, request for documents, interrogatories, request for admissions or other discovery request, court order or subpoena from any party regarding this Agreement and the work performed there under or with respect to any project or property located within the City. City retains the right, but has no obligation, to represent Contractor and/or be present at any deposition, hearing or similar proceeding. Contractor agrees to cooperate fully with City and to provide City with the opportunity to review any response to discovery requests provided by Contractor. However, City's right to review any such response does not imply or mean the right by City to control, direct, or rewrite said response. 13. NOTICES Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but riot limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager P.O. Box 9033 Temecula, CA 92589-9033 Use this Address for a Delivery Service: City of Temecula or Hand -Deliveries ONLY Attn: City Manager 41000 Main Street Temecula, CA 92590 To Contractor: 14. ASSIGNMENT Staples Advantage Attn:Bill O'Connor Regional Vice President 440 South Royal Lane Coppell, TX 75019 The Contractor shall not assign the performance of this Agreement, nor any part thereof, nor any monies due hereunder, without prior written consent of the City. Upon termination of this Agreement, Contractor's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and the Contractor. 15. LICENSES 6 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 At all times during the term of this Agreement, Contractor shall have in full force and effect, all licenses required of it by law for the performance of the services described in this Ag ree me nt. 16. GOVERNING LAW The City and Contractor understand and agree that the laws of the State of California shall govern the rights, obligations, duties and liabilities of the parties to this Agreement and also govern the interpretation of this Agreement. Any litigation concerning this Agreement shall take place in the municipal, superior, or federal district court with geographic jurisdiction over the City of Temecula. In the event such litigation is filed by one party against the other to enforce its rights under this Agreement, the prevailing party, as determined by the Court's judgment, shall be entitled to reasonable attorney fees and litigation expenses for the relief granted. 17. PROHIBITED INTEREST No officer, or employee of the City of Temecula that has participated in the development of this agreement or its approval shall have any financial interest, direct or indirect, in this Agreement, the proceeds thereof, the Contractor, or Contractor's sub -contractors for this project, during his/her tenure or for one year thereafter. The Contractor hereby warrants and represents to the City that no officer or employee of the City of Temecula that has participated in the development of this agreement or its approval has any interest, whether contractual, non - contractual, financial or otherwise, in this transaction, the proceeds thereof, or in the business of the Contractor or Contractor's sub -contractors on this project. Contractor further agrees to notify the City in the event any such interest is discovered whether or not such interest is prohibited by law or this Agreement. 18. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties relating to the obligations of the parties described in this Agreement. All prior or contemporaneous agreements, understandings, representations and statements, oral or written, are merged into this Agreement and shall be of no further force or effect. Each party is entering into this Agreement based solely upon the representations set forth herein and upon each party's own independent investigation of any and all facts such party deems material. 19. AUTHORITY TO EXECUTE THIS AGREEMENT The person or persons executing this Agreement on behalf of Contractor warrants and represents that he or she has the authority to execute this Agreement on behalf of the Contractor and has the authority to bind Contractor to the performance of its obligations hereunder. The City Manager is authorized to enter into an amendment on behalf of the City to make the following non -substantive modifications to the agreement: (a) name changes; (b) extension of time; (c) non -monetary changes in scope of work; (d) agreement termination. 7 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA STAPLES ADVANTAGE (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: By: Ron Roberts, Mayor Bill O'Connor, Regional Vice President ATTEST: By: By: Susan W. Jones, MMC, City Clerk APPROVED AS TO FORM: By: Kevin Moss, Vice President SBA Sales Peter M. Thorson, City Attorney CONTRACTOR Staples Advantage Attn: Bill O'Connor Regional Vice President 440 South Royal Lane Coppell, TX 75019 Phone: 909-390-0600 ext. 348 (Samantha Fritsch) Cell Phone: 949-500-7727 (Samantha Fritsch) E -Mail: samantha.fritsch@staples.com FSM Initials: Date: 8 R:/Finance/Agreements/Finance Dept Agreements/Agreements2011-12/Staples Advantage.Office Supplies.FIN12-09.11-29-11 EXHIBIT A Tasks to be Performed The specific elements (scope of work) of this service include: Non-exclusive citywide purchase of office supplies and related services on an as needed basis. 9 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 EXHIBIT B Payment Rates and Schedule Staples Advantage shall invoice the City of Temecula by department for supplies and services rendered via online website, telephone, facsimile, and at the Temecula retail store location based on the National Joint Powers Alliance (NJPA) contract #031210 and/or any other agreed upon specialized, bulk, or discounted pricing structure at an annual not to exceed amount of $65,000. The not to exceed purchase amount listed herein is an estimated expenditure and this Agreement does not guarantee Contractor this amount in purchases. 10 R:/Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 Advantage NJPA National Joint Powers Alliance' NJPA Contract #031210 Office & Classroom Related Supplies & Accessories Contract Owner - National Joint Powers Alliance (NJPA) Website: www.nipacoop.org In order to access the pricing and terms of this contract an agency must be a registered member of NJPA. Membership is free and the simple enrollment application can be completed online at the NJPA website. Contract Term - August 1, 2010 — July 31, 2014 (plus a 1 year optional extension) Single Award - Staples Contract & Commercial, Inc, operating as Staples Advantage (other unsuccessful bidder was Independent Stationers Inc.) Products Included - Office, Classroom, Toner, Paper, Facilities, and Transactional Furniture. Additionally Print, Promo, Digital Copy, and specials available as Sourced Goods. Pricing: • Hot List Net Priced: 800+ SKU's: Majority Toner & Paper related products • Ink/toner, cut sheet paper, toilet tissue, paper towels, etc. Staples may request a price change adjustment for Hot List Pricing items by submitting to NJPA, no more than once a calendar quarter, a request for price adjustment(s). Although change does not have to take effect on the start of the calendar quarter. — Price changes require NJPA approval. • Core List Net Priced: Over 15,000 (as of May 2011) in stock Staples SKU's & Classroom Supplies. — Prices fixed for ayear (Jan 1—Dec 31). Staples can submit a request for price changes annually, 30 days prior to Dec 31. Requires NJPA approval. — If approved, Jan. 1st is the effective date of any changes. • Sourced Goods — Wholesalers/Printing/Promo/DCS/Specials/etc. Prices for Sourced Goods including Custom Print and Digital Copy & Print shall be those prices that appear on www.stapleslink.com when ordered or as otherwise established between Staples and each member at the time the order is placed Ceiling Prices - Pricing is to be established as a ceiling price. At no time may the proposed products/services be offered pursuant to this Contract at prices above this ceiling price without approval by NJPA. Volume Price Discounts - Proposers are free to offer volume discounts from the quantity -of -one pricing documented in a Contract resulting from this RFP. Volume considerations shall be determined between the Vendor and individual NJPA Mcmbcrs on a case -by -cast basis. "This document is intended as a reference only and is not an official contract document. Please contact your Local Staples Representative with any questions pertaining to this contract." 11 R:/Finance/Agreements/Finance Dept Agreements/Agreements2011-12/Staples Advantage.Office Supplies.FIN12-09.11-29-11 Rebates - Staples will pay each member a volume rebate of such member's Net Sales annually, to be paid within thirty (30) Calendar Days of each annual anniversary of the member's first order date, calculated as follows or as otherwise agreed to in writing by Staples and the member ("Volume Rebate"): Net Sales Volume Rebate $ 0.00 - $ 75,000 0% $ 75,000.01 - $150,000 1% $150,000.01 - $300,000 2% $300,000.01 - $500,000 3% $500,000.01 - $750,000 4% $750,000.01 or more 5% Payment of all Volume Rebates paid hereunder is (i) contingent upon the member paying all invoices within the payment terms specified in the contract; and (ii) based on the individual member's aggregate annual Net Sales and is payable back to dollar one. "Net Sales" - The gross sales price of the Core Items, Hot List Items, and Sourced Goods (collectively, the `Products") less shipping costs (including freight charges and insurance), taxes, duties, any rebates actually paid, discounts and allowances actually taken, rejections and returns to the extent credit is given or paid, excluding Product purchases made at Staples' retail store locations. Delivery - Staples offers Free next -business -day shipping under the NJPA contract Minimum Order Size - $35.00 Minimum order size Payment Terms — Net 30 Days unless otherwise agreed upon by Staples and a specific buyer Auditing - During the Term, Vendor will, upon not less than fourteen (14) business days' prior written request, make available to NJPA no more than once per calendar year, at Vendor's corporate offices, during normal business hours, the reports and/or documents from Vendor pertaining to all invoices sent by Vendor and payments made by NJPA members for all products/services purchased under this Contract. NJPA may employ an independent auditor or NJPA may choose to conduct such audit on its own behalf. Vendor shall have the right to approve the independent auditor, which approval shall not be unreasonably withheld. Upon approval and after the auditor has executed an appropriate confidentiality agreement, Vendor will permit the auditor to review the relevant Vendor documents. NJPA shall be responsible for paying the auditor's fees. The parties will make every reasonable effort to fairly and equitably resolve discrepancies to the satisfaction of both parties. Retail Stores - Contract pricing is available at Staples retail stores on NJPA contract items (Stapleslink.com Accounts Only) Contract Documents - The cumulative documentation consists of the RFP, the entire Proposer's response, and a fully executed "Acceptance and Award. There is no single contract document. The applicable contract documents can be found at the following link: NJPA Contract # 031210 "This document is intended as a reference only and is not an official contract document. Please contact your Local Staples Representative with any questions pertaining to this contract." 12 R:/Finance/Agreements/Finance Dept Agreements/Agreements2011-12/Staples Advantage.Office Supplies.FIN12-09.11-29-11 1=2 Advantage Pricing Proposal JPA National Jabal ivw<„ ew.nc STP472498 #1 N/S PPR CLIP 1000/PK $2.07 PK STP246850 100 PCNT RCY 3TB FLDR LTR $10.34 BX STP744100 3TAB 14PT MAN FF LTR $8.91 BX STP531152 ADD ROLL 1RL 2.25X125 $0.37 RL DURMN15RT12Z BATTERY,AA,ALK,12PK $8.51 PK DURPC1500BKD BATTERY,AA,PROCELL $20.59 BX DURPC2400BKD BATTERY,AAA,PROCELL $17.50 BX DURMN24RT12Z BATTERY,ALKA,AAA,12/PK $8.51 PK STP395200 BINDER CLIPS MEDIUM 144PK $4.15 PK ACC72020 BNDR CLIP,#20,SM $0.92 DZ ACC72050 BNDR CLIP,#50,MED $1.89 DZ STP831610 BNDR CLIP,2",LG $0.79 DZ STP831602 BNDR CLIP,MED,BLACK,24/PK $2.31 PK AVE03300 BNDR,3RG,11X8.5.1",BE $1.55 EA AVE03301 BNDR.3RG,11X8.5,1",BK $1.09 EA AVE27256 BNDR,3RG,DURBL,1",BK $4.17 EA AVE27556 BNDR,3RG,DURBL,2",BK $7.12 EA AVE17012 BNDR,DURBL VU,1"CAP,WE $3.69 EA AVE17012 BNDR,DURBL VU,1"CAP,WE $3.69 EA AVE17022 BNDR,DURBL VU,1.5"CAP,WE $5.80 EA AVE17022 BNDR,DURBL VU,1.5"CAP,WE $5.80 EA AVE17032 BNDR,DURBL VU.2" CAP,WE $5.86 EA AVE17032 BNDR,DURBL VU,2" CAP,WE $5.86 EA AVE17042 BNDR,DURBL VU,3" CAP,WE $8.93 EA AVE19551 BNDR,VU,3RG,LTR,.5",WE $3.28 EA STP807720 BNDR,VU,3RG,LTR,.5",WE $1,43 EA AVE19601 BNDR,VU,3RG,LTR,1",WE $3.28 EA AVE19651 BNDR,VU,3RG,LTR,1.5",WE $4.35 EA AVE19701 BNDR,VU,3RG,LTR,2",WE $5.83 EA MEA05510 BOOK,THEME,10.5X8 $0.89 EA MEA05512 BOOK,THEME,10.5X8 $1.01 EA STP830262 BOTTLE.CEB42.320Z $0.58 EA SEB822259 BTL,SEB 61,32 OZ $0.63 EA SEB822391 BTL,SEB 64,32 OZ $0.63 EA AAGE71750 CAL,DSK,RFL,APPT,2PPD,12 $4.19 EA STP854602 CAL,DSKPD,12M0,17X22,12 $4.89 EA AAGSK2400 CAL,DSKPD,RCY,12M0,BK,12 $7.74 EA STP466465 CALC,DESK.SM.8DGT $3.21 EA ESS30 CARD,INDEX,3X5,PLN,WE $0.47 PK ESS31 CARD,INDEX,3X5,RULED,WE $0.47 PK ESS41 CARD,INDEX,4X6,RULED,WE $0.91 PK BIN501402 CHALK,DUSTLESS,WE,I2BX $0.40 BX DIX31144 CHALK,DUSTLESS,WHITE,12BX $0.79 BX SAN81803 CLEANER,BOARD,80Z $1.67 EA STP566942 CLIP,BNDR,MINI,3/5,BK $1.19 PK 01C83503 CLIPBOARD, 6"X9",BN $1.27 EA 01C83500 CLIPBOARD,9"X12.5",BN $0.75 EA STP480114 CLIPS,BINDER,SM,144/PK $1.61 PK STP103523 CLIPS,BINDER,SMALL,DZ $0.10 DZ 13 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 01C83506 CLPBRD LOW PROFILE HRDBRD $1.98 EA STP201384 COMPOSITION,100,STPL,2/PK $4.99 PK PAP0660415 CORR FILM,DRYLINE,NRF,1LN $2.67 EA PAP28411 CORR FLUID,.50Z,WE $0.65 EA BICWOC12 CORR FLUID,ALL PURPOSE $0.34 EA BICWOFQDI2 CORR FLUID,QUICKDRY $0.88 EA BICWOFEC12 CORR FLUID,X CVRG,WE $0.88 EA TOM68620 CORR TAPE,1-LINE,WE $2.84 EA BICWOTAPP1IW CORR TAPE,WITE-OUT CTRG $2.41 EA BIN523024 CRAYON,CRAYOLA,24BX $1.20 BX BIN520008 CRAYON,CRAYOLA,PEG BX,8BX $0.47 BX DXS58SAGE CUP,PPR,WTR,50Z,1C/PK $2.69 PK STP634797 DRY ERASE ERASER $1.83 EA STP153841 DVDR,5 TAB,MLTCLR,1/ST $0.84 ST STP459599 ENVELOPE CD/DVD 5X5 WHITE $2.75 BX SAN81505 ERASER,DRY ERS,EXPO $1.83 EA QRT804526 ERASER,FELT.CHALKBRD $1.43 EA ACC12993 FASTENER,BASE,2"CAP,1C/BX $4.41 BX STP907701 FLDR,2 PKT,POR,DBE $3.17 PK STP116806 FLDR,HANG,LTR,1/3,GN,25BX $5.65 BX SMD153L FLDR,MLA,1/3,LTR,1C $9.14 BX STP 116657 FLDR,MLA,1/3,LTR,1C/BX $7.34 BX STP117713 FLDR-FLE INTER LTR 1/3 MA $8.74 BX SFZGVP9LG GLOVE,VYL,DISP,LG $3.54 BX AVE00166 GLUE STICK,.260Z,EA $0.68 EA 01050002 GLUE STICK,.740Z,CL,EA $0.49 EA EPIE379 GLUE,ALL,WE,7 5/80Z $1.09 EA STP932600 HIGHLIGHTER,ASST CLR,12PK $1.65 DZ STP167031 HILITER,BROAD,FYW,DZ $1.55 DZ STP412783 HILITER,PKT,6/PK $0.97 PK STP233601 IND CARD 3X5 WE RLD 500CT $1.12 PK STP462770 INDEX,BNDR,LTR, AST,5TB $1.04 ST AVE23079 INDEX,BNDR,LTR,AST,8TB $2.01 ST STP462754 INDEX.BNDR,LTR,AST,8TB $1.67 ST AVE23284 INDEX,BNDR.LTR,AST,8TB $2.17 ST STP153866 INDEX,BNDR,LTR,AST,8TB $1.04 ST STP153858 INDEX,BNDR,LTR,CL,5TB $0.84 ST STP462788 INDEX,BNDR,LTR,CL,5TB $1.04 ST AVE23281 INDEX,BNDR,LTR,CL,5TB $1.26 ST STP153874 INDEX,BNDR,LTR,CL,8TB $1.04 ST AVE11901 INDEX.WRKSVR,8TB $2.51 ST AVE23075 INDEX,WRTON,LTR,5TB,WE $1.23 ST AVE23078 INDEX,WRTON,LTR,8TB,WE $1.58 ST STP472514 JMB PAPER CLIP N/S 1000PK $5.40 PK AVE5160 LBL,LASR,ADD,2-5/8X1,3M/BX $22.50 BX PENC505HB LEAD,MECH PCL,HB,.5MM,12 $0.51 EA BICDECP4IASST MARKER,DRY ERASE,4,ASST $3.99 ST SDNSDCZ36004GAII MEMORY,FLASH DRIVE,4GB $19.45 EA BIN587708 MRKR,BROAD LINE,BBX $2.55 BX BIN587808 MRKR,CRAYOLA,8ST $2.32 BX STP607069 MRKR,DRY ERS,CHSL,4PK $3.74 PK SAN80074 MRKR,DRY ERS,CHSL,4ST $4.35 ST STP814955 MRKR,DRY ERS,CHSL,BK $10.61 DZ SAN83074 MRKR,EXPO,DRY ERS,4ST $4.73 ST 14 R:1Finance/Agreements/Finance Dept AgreementslAgreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 SAN88074 MRKR,EXPO,DRY ERS,BLT,4ST $4.46 ST SAN83001 MRKR,EXPO,DRY ERS,CHSL,BK $13.13 DZ SAN84074 MRKR,EXPO,DRY ERS,FN,4ST $3.13 PK SAN30001 MRKR,SHARPIE,PERM,FN,BK $5.22 DZ SAN16074 MRKR,VISAVIS,FN,4IST $4.07 ST MMM65412SSCY NOTE,SUPER STICKY,POSTIT 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Finance/Agreements/Finance Dept Agreements/Agreements2011-121Staples Advantage.Office Supplies.FIN12-09.11-29-11 Item No. 8 Approvals City Attorney Director of Finance City Manager OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Greg Butler, Director of Public Works/City Engineer DATE: December 13, 2011 SUBJECT: Geotechnical, Material Testing, and Special Inspection Professional Services Agreement for the Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02 PREPARED BY: Amer Attar, Principal Engineer David McBride, Senior Engineer RECOMMENDATION: 1. Approve an Agreement with Geocon West, Inc. to provide professional geotechnical, material testing and special inspection services associated with Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02, in the amount of $100,000 and authorize the Mayor to execute the Agreement. 2. Authorize the City Manager to approve Extra Work Authorizations not to exceed the contingency amount of $10,000 which is equal to 10% of the Agreement amount. BACKGROUND: On October 11, 2011, the City Council awarded a construction contract for Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02. The purpose of this Agreement is to provide the necessary soil & material testing and special inspection for this phase of the project. The Department of Public Workst requested proposals from firms with extensive experience in geotechnical & material testing and special inspection of similar projects. Sixteen (16) firms responded to the request for proposals. Staff rated Geocon West, Inc. as the firm most qualified to provide the needed services; they have extensive experience with similar projects. Geocon West will provide all the geotechnical & material testing and special inspection services shown in Exhibit "A" of the attached Agreement. FISCAL IMPACT: The geotechnical & materials testing and special inspection services for Roripaugh Ranch Street Improvements Phase 1 project is included in the City's FY2012-16 Capital Improvement Program (CIP) budget as the first phase of Butterfield State Road Extension. It is funded with Community Facilities District (CFD) for Roripaugh Ranch, Reimbursement/Other from Shea Homes and Transportation Uniform Mitigation Fee (TUMF) funds. Adequate funds are available in the project account. ATTACHMENTS: 1. Professional Services Agreement 2. Project Description 3. Project Location Map AGREEMENT FOR CONSULTANT SERVICES BETWEEN CITY OF TEMECULA AND GEOCON WEST, INC. PW09-02 RORIPAUGH RANCH STREET IMPROVEMENTS — PHASE ONE THIS AGREEMENT is made and effective as of December 13, 2011, between the City of Temecula , a municipal corporation (hereinafter referred to as "City"), and GEOCON West, Inc., a corporation (hereinafter referred to as "Consultant"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. TERM This Agreement shall commence on December 13, 2011, and shall remain and continue in effect until tasks described herein are completed, but in no event later than June 30, 2013, unless sooner terminated pursuant to the provisions of this Agreement. 2. SERVICES Consultant shall perform the services and tasks described and set forth in Exhibit A, attached hereto and incorporated herein as though set forth in full. Consultant shall complete the tasks according to the schedule of performance which is also set forth in Exhibit A. 3. PERFORMANCE Consultant shall at all time faithfully, competently and to the best of his or her ability, experience, and talent, perform all tasks described herein. Consultant shall employ, at a minimum, generally accepted standards and practices utilized by persons engaged in providing similar services as are required of Consultant hereunder in meeting its obligations under this Agreement. 4. PREVAILING WAGES Pursuant to the provisions of Section 1773 of the Labor Code of the State of California, the City Council has obtained the general prevailing rate of per diem wages and the general rate for holiday and overtime work in this locality for each craft, classification, or type of workman needed to execute by this Consultant from the Director of the Department of Industrial Relations. Copies may be obtained from the California Department of Industrial Relations Internet website at http://www.dir.ca.gov. Consultant shall provide a copy of prevailing wage rates to any staff or sub -contractor hired, and shall pay the adopted prevailing wage rates as a minimum. Consultant shall comply with the provisions of Sections 1773.8, 1775, 1776, 1777.5, 1777.6, and 1813 of the Labor Code. Pursuant to the provisions of 1775 of the Labor Code, Consultant shall forfeit to the City, as a penalty, the sum of $50.00 for each calendar day, or portion thereof, for each laborer, worker, or mechanic employed, paid less than the stipulated prevailing rates for any work done under this contract, by him or by any subcontractor under him, in violation of the provisions of the Agreement. 5. PAYMENT a. The City agrees to pay Consultant monthly, in accordance with the payment rates and terms and the schedule of payment as set forth in Exhibit B, Payment Rates, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall not exceed One Hundred Thousand Dollars and No Cents ($100,000.00) for the total term of this agreement unless additional payment is approved as provided in this Agreement. b. Consultant shall not be compensated for any services rendered in connection with its performance of this Agreement which are in addition to those set forth herein, unless such additional services are authorized in advance and in writing by the City Manager . Consultant shall be compensated for any additional services in the amounts and in the mariner as agreed to by City Manager and Consultant at the time City's written authorization is given to Consultant for the performance of said services. The City Manager may approve additional work up to ten percent (10%) of the amount of the Agreement as approved by City Council. Any additional work in excess of this amount shall be approved by the City Council. c. Consultant will submit invoices monthly for actual services performed. Invoices shall be submitted between the first and fifteenth business day of each month, for services provided in the previous month. Payment shall be made within thirty (30) days of receipt of each invoice as to all non -disputed fees. If the City disputes any of Consultant's fees, it shall give written notice to Consultant within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice. For all reimbursements authorized by this Agreement, Consultant shall provide receipts on all reimbursable expenses in excess of fifty dollars ($50) in such form as approved by the Director of Finance. 6. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Consultant at least ten (10) days prior written notice. Upon receipt of said notice, the Consultant shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends or terminates a portion of this Agreement such suspension or termination shall riot make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Consultant the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Consultant will submit an invoice to the City, pursuant to Section entitled "PAYMENT" herein. 7. DEFAULT OF CONSULTANT a. The Consultant's failure to comply with the provisions of this Agreement shall constitute a default. In the event that Consultant is in default for cause under the terms of this Agreement, City shall have no obligation or duty to continue compensating Consultant for any work performed after the date of default and can terminate this Agreement immediately by written notice to the Consultant. If such failure by the Consultant to make progress in the performance of work hereunder arises out of causes beyond the Consultant's control, and without fault or negligence of the Consultant, it shall not be considered a default. b. If the City Manager or his delegate determines that the Consultant is in default in the performance of any of the terms or conditions of this Agreement, it shall serve the Consultant with written notice of the default. The Consultant shall have ten (10) days after service upon it of said notice in which to cure the default by rendering a satisfactory performance. In the event that the Consultant fails to cure its default within such period of time, the City shall have the right, notwithstanding any other provision of this Agreement, to terminate this Agreement without further notice and without prejudice to any other remedy to which it may be entitled at law, in equity or under this Agreement. 8. OWNERSHIP OF DOCUMENTS a. Consultant shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Consultant shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Consultant shall provide free access to the representatives of City or its designees at reasonable times to such books and records, shall give City the right to examine and audit said books and records, shall permit City to make transcripts there from as necessary, and shall allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be maintained for a period of three (3) years after receipt of final payment. b. Upon completion of, or in the event of termination or suspension of this Agreement, all original documents, designs, drawings, maps, models, computer files containing data generated for the work, surveys, notes, and other documents ("work product") prepared in the course of providing the services to be performed pursuant to this Agreement shall become the sole property of the City and may be used, reused or otherwise disposed of by the City without the permission of the Consultant. Notwithstanding the foregoing, any use or reuse of the Consultant's work product without Consultant's written authorization, and not contemplated by this Agreement, shall be at Citys' sole risk. With respect to computer files containing data generated for the work, Consultant shall make available to the City, upon reasonable written request by the City, the necessary computer software and hardware for purposes of accessing, compiling, transferring and printing computer files. 9. INDEMNIFICATION A. Indemnity for Design Professional Services. In connection with its design professional services, Consultant shall hold harmless and indemnify City of Temecula, Temecula Community Services District, Redevelopment Agency of the City of Temecula, and its elected officials, officers, employees, servants, designated volunteers, and those City agents serving as independent contractors in the role of City officials (collectively, "Indemnitees"), with respect to any and all claims, demands, damages, liabilities, losses, costs or expenses, including reimbursement of attorneys' fees and costs of defense (collectively, "Claims" hereinafter), including but not limited to Claims relating to death or injury to any person and injury to any property, which arise out of, pertain to, or relate to in whole or in part to the negligence, recklessness, or willful misconduct of Consultant or any of its officers, employees, subcontractors, or agents in the performance of its professional services under this Agreement. B. Other Indemnities. In connection with any and all claims, demands, damages, liabilities, losses, costs or expenses, including attorneys' fees and costs of defense (collectively, "Damages" hereinafter) not covered by Subsection A. of this Paragraph, Consultant shall defend, hold harmless and indemnify the Indemnitees with respect to any and all Damages, including but not limited to, Damages relating to death or injury to any person and injury to any property, which arise out of, pertain to, or relate to the acts or omissions of Consultant or any of its officers, employees, subcontractors, or agents in the performance of this Agreement, except for such loss or damage arising from the sole negligence or willful misconduct of the City, as determined by final arbitration or court decision or by the agreement of the parties. Consultant shall defend Indemnitees in any action or actions filed in connection with any such Damages with counsel of City's choice, and shall pay all costs and expenses, including all attorneys' fees and experts' costs actually incurred in connection with such defense. Consultant's duty to defend pursuant to this Subsection B. shall apply independent of any prior, concurrent or subsequent misconduct, negligent acts, errors or omissions of Indemnitees. 10. INSURANCE REQUIREMENTS Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, or employees. a. Minimum Scope of Insurance. Coverage shall be at least as broad as: 1) Insurance Services Office Commercial General Liability form No. CG 00 01 11 85 or 88. 2) Insurance Services Office Business Auto Coverage form CA 00 01 06 92 covering Automobile Liability, code 1 (any auto). If the Consultant owns no automobiles, a non -owned auto endorsement to the General Liability policy described above is acceptable. 3) Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. If the Consultant has no employees while performing under this Agreement, worker's compensation insurance is not required, but Consultant shall execute a declaration that it has no employees. 4) Professional Liability Insurance shall be written on a policy form providing professional liability for the Consultant's profession. b. Minimum Limits of Insurance. Consultant shall maintain limits no less than: 1) General Liability: One million ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2) bodily injury and property 3) Employer's Liability: One Automobile Liability: One million ($1,000,000) per accident for damage. Worker's Compensation as required by the State of California; million dollars ($1,000,000) per accident for bodily injury or disease. 4) Professional Liability Coverage: One million ($1,000,000) per claim and in aggregate. c. Deductibles and Self -Insured Retentions. Any deductibles or self-insured retentions shall not exceed Twenty Five Thousand Dollars and No Cents ($25,000). d. Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 1) The City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers are to be covered as insured's, as respects: liability arising out of activities performed by or on behalf of the Consultant; products and completed operations of the Consultant; premises owned, occupied or used by the Consultant; or automobiles owned, leased, hired or borrowed by the Consultant. The coverage shall contain no special limitations on the scope of protection afforded to the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 2) For any claims related to this project, the Consultant's general liability and auto liability insurance coverage shall be primary insurance as respects the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers. Any insurance or self-insured maintained by the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, officials, employees or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3) Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Temecula, the Temecula Community Services District, and the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 4) The Consultant's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 5) If the policy is canceled before the expiration date, notice in writing will be provided to the City of such cancellation not less than thirty (30) days' prior to the cancellation effective date. 6) If insurance coverage is canceled or, reduced in coverage or in limits the Consultant shall within two (2) business days of notice from insurer phone, fax, and/or notify the City via certified mail, return receipt requested of the changes to or cancellation of the policy. e. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of A -:VII or better, unless otherwise acceptable to the City. Self insurance shall not be considered to comply with these insurance requirements. f. Verification of Coverage. Consultant shall furnish the City with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by the City before work commences. As an alternative to the City's forms, the Consultant's insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. 11. INDEPENDENT CONTRACTOR a. Consultant is and shall at all times remain as to the City a wholly independent contractor. The personnel performing the services under this Agreement on behalf of Consultant shall at all times be under Consultant's exclusive direction and control. Neither City nor any of its officers, employees, agents, or volunteers shall have control over the conduct of Consultant or any of Consultant's officers, employees, or agents except as set forth in this Agreement. Consultant shall not at any time or in any manner represent that it or any of its officers, employees or agents are in any manner officers, employees or agents of the City. Consultant shall not incur or have the power to incur any debt, obligation or liability whatever against City, or bind City in any mariner. b. No employee benefits shall be available to Consultant in connection with the performance of this Agreement. Except for the fees paid to Consultant as provided in the Agreement, City shall not pay salaries, wages, or other compensation to Consultant for performing services hereunder for City. City shall not be liable for compensation or indemnification to Consultant for injury or sickness arising out of performing services hereunder. 12. LEGAL RESPONSIBILITIES The Consultant shall keep itself informed of all local, State and Federal ordinances, laws and regulations which in any mariner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Consultant shall at all times observe and comply with all such ordinances, laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Consultant to comply with this section. 13. RELEASE OF INFORMATION a. All information gained by Consultant in performance of this Agreement shall be considered confidential and shall not be released by Consultant without City's prior written authorization. Consultant, its officers, employees, agents or subcontractors, shall not without written authorization from the City Manager or unless requested by the City Attorney, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories or other information concerning the work performed under this Agreement or relating to any project or property located within the City. Response to a subpoena or court order shall not be considered "voluntary" provided Consultant gives City notice of such court order or subpoena. b. Consultant shall promptly notify City should Consultant, its officers, employees, agents or subcontractors be served with any summons, complaint, subpoena, notice of deposition, request for documents, interrogatories, request for admissions or other discovery request, court order or subpoena from any party regarding this Agreement and the work performed there under or with respect to any project or property located within the City. City retains the right, but has no obligation, to represent Consultant and/or be present at any deposition, hearing or similar proceeding. Consultant agrees to cooperate fully with City and to provide City with the opportunity to review any response to discovery requests provided by Consultant. However, City's right to review any such response does not imply or mean the right by City to control, direct, or rewrite said response. 14. NOTICES Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but riot limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager P.O. Box 9033 Temecula, CA 92589-9033 Use this Address for a Delivery Service: City of Temecula or Hand -Deliveries ONLY Attn: City Manager 41000 Main Street Temecula, CA 92590 To Consultant: 15. ASSIGNMENT GEOCON West, Inc. Attn: Lisa Battiato 41571 Corning Place, Suite 101 Murrieta, CA 92562-7065 The Consultant shall not assign the performance of this Agreement, nor any part thereof, nor any monies due hereunder, without prior written consent of the City. Upon termination of this Agreement, Consultant's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and the Consultant. 16. LICENSES At all times during the term of this Agreement, Consultant shall have in full force and effect, all licenses required of it by law for the performance of the services described in this Agreement. 17. GOVERNING LAW The City and Consultant understand and agree that the laws of the State of California shall govern the rights, obligations, duties and liabilities of the parties to this Agreement and also govern the interpretation of this Agreement. Any litigation concerning this Agreement shall take place in the municipal, superior, or federal district court with geographic jurisdiction over the City of Temecula. In the event such litigation is filed by one party against the other to enforce its rights under this Agreement, the prevailing party, as determined by the Court's judgment, shall be entitled to reasonable attorney fees and litigation expenses for the relief granted. 18. PROHIBITED INTEREST No officer, or employee of the City of Temecula that has participated in the development of this agreement or its approval shall have any financial interest, direct or indirect, in this Agreement, the proceeds thereof, the Consultant, or Consultant's sub -contractors for this project, during his/her tenure or for one year thereafter. The Consultant hereby warrants and represents to the City that no officer or employee of the City of Temecula that has participated in the development of this agreement or its approval has any interest, whether contractual, non - contractual, financial or otherwise, in this transaction, the proceeds thereof, or in the business of the Consultant or Consultant's sub -contractors on this project. Consultant further agrees to notify the City in the event any such interest is discovered whether or not such interest is prohibited by law or this Agreement. 19. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties relating to the obligations of the parties described in this Agreement. All prior or contemporaneous agreements, understandings, representations and statements, oral or written, are merged into this Agreement and shall be of no further force or effect. Each party is entering into this Agreement based solely upon the representations set forth herein and upon each party's own independent investigation of any and all facts such party deems material. 20. AUTHORITY TO EXECUTE THIS AGREEMENT The person or persons executing this Agreement on behalf of Consultant warrants and represents that he or she has the authority to execute this Agreement on behalf of the Consultant and has the authority to bind Consultant to the performance of its obligations hereunder. The City Manager is authorized to enter into an amendment on behalf of the City to make the following non -substantive modifications to the agreement: (a) name changes; (b) extension of time; (c) non -monetary changes in scope of work; (d) agreement termination. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA GEOCON West, Inc. (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: By: Ron Roberts, Mayor Joseph J. Vete!, Chief Executive Officer ATTEST: By: By: Susan W. Jones, MMC, City Clerk APPROVED AS TO FORM: By: William J. Lydon, Chief Financial Officer Peter M. Thorson, City Attorney CONSULTANT GEOCON West, Inc. Lisa Battiato 41571 Corning Place, Suite 101 Murrieta, CA 92562-7065 Phone (951) 304-2300 Fax (951) 304-2392 Battiato@geoconinc.com FSM Initials: Date: EXHIBIT A Tasks to be Performed The specific elements (scope of work) of this service include: Geotechnical, material and special inspection services on an as needed basis. EXHIBIT B Payment Rates GEOCON W E S T. I N C. GEOTECHNICAL ENVIRONMENTAL € M A T E R I A L S 2010 SCHEDULE OF FEES PROFESSIONAL SERVICES Word Processor/Non-Technical Assistant/Draftsman $60/hr. Engineering Assistant/Lab Technician *60/hr. Engineering Field Technician (Geotechnical Inspection/Testing - Including Equipment - 2 -hour minimum per call -out) 75/hr. Engineering Field Technician (Deputy/Special Inspection - Including Equipment - 4 -hour minimum per call -out) 75/hr. Project Engineer/Geologist 115/hr. Senior Project Engineer/Geologist 1 15/hr. Senior Engineer/Geologist 1 15/hr. 115/h r. Associate Engineer/Geologist Overtime and Saturday Rate 1.5 X Regular Hourly Rate Sunday and Holiday Rate 2 X Regular Hourly Rate Minimum Professional Fee $500/Per Project Minimum Call Out 2/4 hour minimum Soils and Special Inspection TRAVEL No Travel Charges to/from Project Location EQUIPMENT & MATERIALS Nuclear Gauge Included in Technician Rate Stainless Sampling Pump Coring Machine (concrete, asphalt, masonry) $165/day Battery -Powered Pump Generator 85/day Water Level Indicator Asphalt Cold Patch/Concrete (60 -Ib.), Cement (94 -Ib.) 17/bag GPS Unit 160/day Pick-up Truck 1 10/day Equipment Truck 175/day Direct -Push Rig/Operator 125/hour Drive -Tube Sampler 37/day Hand -Auger 37/day Soil Sample Tube (Brass) 8/ea. Soil Sample Tube (Stainless) 11/ea. Bailer (Reusable) 33/day Bailer (Disposable) 13/ea. $1 10/day 55/day 32/day Interface Probe 58/day Photo -Ionization Meter 1 15/day Combustible Gas Meter 80/day pH/Conductivity/Temperature Meter 44/day Turbidity Meter 80/day Level D PPE/Decon Rinse Equipment 44/day De -Ionized Water (5 -gallon) 14/ea. Generator or Air Compressor 85/day 55 -Gallon Drum 55/ea. Visqueen (6 mil 20x100') 84/roll Traffic Cones/Barricades 35/day LABORATORY TESTS COMPACTION CURVES 4 -inch mold (D1557) 6 -inch mold (D1557) California Impact (CAL216) Check Point SOIL AND AGGREGATE PROPERTIES #200 Wash (D1140/C117) $50/ea. Wet Sieve Analysis to #200 (C136) 75/ea. Hydrometer Analysis (D422) 140/ea. Sieve Analysis with Hydrometer (D422) 140/ea. SOIL AND AGGREGATE STABILITY $160/ea. Resistance Value, R -Value (D2844/CAL301) $230/ea. 175/ea. R -Value, Treated (CAL301) 245/ea. 170/ea. California Bearing Ratio (D1883) 500/ea. 80/ea. Stabilization Ability of Lime (C977) 170/ea. AGGREGATE QUALITY Dry Sieve Analysis to #200 (C136) $75/ea. L.A. Rattler Test (500 rev.) (C131) 180/ea. Sulfate Soundness (per sieve size) (C88) 95/ea. Durability Index (D3744) 135/ea. LABORATORY TESTS (CONTINUED) Specific Gravity, Soil (D854) $65/ea. Organic Impurities - Sand (C40) 50/ea. Specific Gravity Coarse Aggregate (C127) 38/ea. Friable Particles (C142) 80/ea. Specific Gravity Fine Aggregate (C128) 65/ea. CONCRETE Moisture Determination, tube sample (D2216) 20/ea Compressive Strength, Cast Cylinders (C39) 20/ea. Moisture Determination and Unit Weight (D2937) 40/ea. Atterberg Limits: Plasticity index (D4318) 120/ea. Sand Equivalent (D2419) 70/ea. pl 1 and Resistivity (CAL643) 125/ea. Sulfate Content (CAL417) 95/ea. Chloride Content (CAL422) 45/ea. SHEAR STRENGTH Unconfined Compression (D2166) $90/ea. Direct Shear, Quick, per point (D3080) 60/pt. Unconsolidated -Undrained Triaxial Shear (D2850) 105/pt. Unconsolidated -Undrained Triaxial Staged (D2850) 150/ea. Consolidated -Undrained Triaxial Shear (D4767) 250/pt. Consolidated -Undrained Triaxial Staged (D4767) 320/ea. Consolidated -Drained Triaxial Shear (EMI 110) 350/pt. Consolidated -Drained Triaxial Staged (EMI 110) 450/ea. PERMEABILITY, CONSOLIDATION AND EXPANSION Permeability, Flexible Wall (D5084) $260/ea. Permeability, Rigid Wall (D5856) 250/ea. Consolidation, per point (D2435) 40/pt. Expansion Index (D4829/UBC 29-2) 130/ea. Unit Weight (C-29) $65/ea. Compressive Strength, Cores (C42) 40/ea. Flexural Strength Beam (C78/C293) 75/ea. Splitting Tensile Test (C496) 65/ea. Mix Design Review 180/ea. Trial Batch 475/ea. Rebar 1 Tensile & 1 Bend Test 100/ea. MASONRY CMU Compressive Strength (C140) $55/ea. Compressive Strength, Grout (C1019/UBC 21-19) 30/ea. Compressive Strength, Mortar (C 109/UBC 21-15,16) 30/ea. CMU Unit Wt., Dimension, Absorption (C140) 55/ea. Compressive Strength, Small Prism <7.62" (C1314) l 05/ea. Compressive Strength, Large Prism >7.62" (C1314) 150/ea. ASPHALT CONCRETE Density, Hveem (D2726/CAL308) $85/ea. Stabilometer (D1560/CAL304) 95/ea. Theoretical Max. Specific Gravity (D2041) 65/ca. Sieve Analysis Extracted Aggregate (D5444) 80/ea. % Asphalt, Ignition Method (CAL382//D6307) 90/ca. % Asphalt, Nuclear Gauge (CAL379) 100/ea. Unit Weight, Core (DI 188) 45/ea. TERMS AND CONDITIONS Listed are typical charges for the services most frequently performed by Geocon. Prices for unlisted services as well as special quotations for programs involving volume work will be provided upon request. Laboratory test prices shown are for laboratory work only, and include reporting of routine results not calling for continents, recommendations or conclusions. 2. All sampling and testing is conducted in substantial conformance with the latest applicable or designated specifications of the American Society for Testing and Materials, Caltrans, American Association of State Highway Officials, or other pertinent agencies. 3. Saturday and overtime hours are charged at time and one-half; Sundays and holidays at double time. Per diem is $ 125.00 per day when location of work dictates. An 8 -hour minimum applies to night work. 4. Fie/d tests and instrumentation installation such as plate bearing, pile load, vane shear, piesometer, slope inclinometer, and other special tests will be charged at applicable hourly rates. Equipment and materials will be billed al cosi plus 15%. Outside services including subcontractors and rental of special equipment are billed at cost plus 15 %. Hourly services are billed portal to portal from closest office in accordance with the stated hourly rates herein, with u mininnrm two-hour charge 5. A surcharge of up to $25.00 per hour will be added to the Professional Services classifications indicated with an asterisk (*) on the Schedule of Fees in order to comply with the prevailing wage requirements of California Labor Code §720, et. seq. 6. Invoices will be submitted at four-week intervals. Terms of payment are net upon presentation of invoice. Invoices become delinquent thirty (30) days from invoice date and subject to one and one-half percent (1-1/2%) service charge per month, or the maximum rate allowed by law, whichever is lower. If Client objects to all or any portion of any invoice, Client will so notes Geocon in writing within fourteen (14) calendar days of the invoice date, identf' the cause of disagreennent, and pay that portion of the invoice not in dispute. The parties will immediately make every effort to settle the disputed portion of the invoice. Payment on delinquent invoices will first be applied to accrued interest and then to the principal amount. All time spent and expenses incurred (including any attorney's fees and costs) in connection with collection of any delinquent amount iwwill be paid by Client to Geocon per Geocon's current fee schedule. 7. Many risks potentially affect Geocon by virtue of entering into this agreement to perform professional engineering services on behalf of Client The principal risk is the potential for human error by Geocon. For Client to obtain the benefit of a fee which includes a nominal allowance for dealing ii'ith our liability, Client agrees to limit our liability to Client and to all other parties for claims arising out of our performance of the services described in the agreement. The aggregate liability of Geocon will not exceed $50,000 for negligent professional acts, errors, or omissions, including attorney's fees and costs which may he awarded to the prevailing party, and Client agrees 10 indemn and hold harmless Geocon from and against all liabilities in excess of the monetary limit established above. -2- CITY OF TEMECULA BUTTERFIELD STAGE ROAD EXTENSION Circulation Project Protect Description: Complete design and construction of four lanes on Butterfield Stage Road from Rancho California Road to Murrieta Hot Springs Road, four lanes on Murrieta Hot Springs Road from Butterfield Stage Road to the City limits, and two lanes on Calle Chapos from Butterfield Stage Road to Walcott Road, totaling approximately 3.2 miles. Benefit: Project will improve traffic circulation by providing a much needed north and south arterial road in the eastern side of the City. Project Status: This project is estimated to be complete in future years. Department: Public Works—Account No. 210.165.723 Project Cost: Actuals to Date 2011.12 2012.13 Priority: I Future Total Project 2013-14 2014-15 2015-16 Years Cost Administration $ 416,474 $ 450,236 $ 525,750 $ 100,000 $ 1,492,460 Acquisition $ 15,006,728 $ 50,000 $ 2,001,352 $ 17,058,080 Construction` $ 25,481 $ 10,173,808 $ 12,484,790 $ 920,459 $ 23,604,538 Construction $ 1,438,000 $ 1,438,000 Engineering $ 8,875 $ 175,562 $ 175,563 $ 1,020,459 $ - $$ - $ 360,000 Design $ 298,508 $ 108,896 $ 52,500 $ 459.904 Environmental $ 40,000 $ 200,000 $ 240,000 Totals $ 15,756,066 $ 10,998.502 $ 15,439,955 $ 1,020,459 $ - $ - $ - $ 43,214,982 Actua Is Source of Funds: to Date 2011-12 2012-13 Future Total Project 2013-14 2014-15 2015-16 Years Cost CFD (Roripaugh Ranch) $ 14,318,066 $ 10,824,694 $15.439,955 $ 1,020,459 $ 41,603,174 Reimbursement/ Other (Shea Homes) $ 173,808 $ 173,808 TUMF $ 1,438,000 $ 1,438,000 Total Funding: $ 15,756,066 $ 10,998,502 $ 15,439,955 $ 1,020,459 $ - $$ - $ 43,214,982 Future Operation & Maintenance Costs: 2012-13 2014-15 *Construction funding is for Phase I in 2011-12 and Phase II in 2012-13 Note: Assumes that only minor right-of-way acquisitions would be necessary and that all major right-of-way dedications are voluntary. 45 ggi U ( w z �z v 11.s �� R COUNTRY MEIN D BUTTERFIELD STAGE ROAD EXTENSION Circulation Project Location SPRINGS RD CAMINO CIELO m r z I GH VALLEyRD LIEFER RD SOUTH LOOP RD Yp KAREN LYNN LN 10 z f� ORO VISTA DEL MO�f= ERD Aerial Data - March 2010 Feet 0 375 750 1,500 44 Item No. 9 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Greg Butler, Director of Public Works/City Engineer DATE: December 13, 2011 SUBJECT: Memorandum of Understanding and Amended Service Agreement with Eastern Municipal Water District for Water and Sewer Facilities Associated with the Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02 PREPARED BY: Amer Attar, Principal Engineer David McBride, Senior Engineer RECOMMENDATION: 1. Approve a Memorandum of Understanding (MOU) and a Standard Water and/or Sewer Facilities and Amended Service Agreement with Eastern Municipal Water District (EMWD) for water and sewer facilities associated with the Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02, and authorize the City Manager to execute the MOU and Service Agreement on behalf of the City. 2. Authorize payment of $67,900 to EMWD, as outlined in the amended Service Agreement, which represents EMWD engineering, inspection and material/construction expenses for the project. BACKGROUND: On October 11, 2011, the City Council awarded a construction contract for Roripaugh Ranch Street Improvements Phase 1, Project No. PW09-02. As part of the project the City will be completing water and sewer facilities that will be turned over to Eastern Municipal Water District (EMWD) for ownership and maintenance. EMWD is the Agency that owns, operates and provides water and sewer services within the project area. The MOU establishes the terms by which EMWD will make the new water and sewer services available for temporary use prior to the facilities being formally accepted by EMWD. The Service Agreement formally establishes the obligations and responsibilities of the City and EMWD relative to proposed improvements and outlines how permanent water and sewer services will be provided. The Service Agreement is noted as amended because EMWD considers the City as the new sponsor of the project, essentially taking over for the original developer (Ashby USA, LLC) and their Service Agreement dated November 17, 2004, which is attached for reference. FISCAL IMPACT: EMWD's expenses of $67,900 for the Roripaugh Ranch Street Improvements Phase 1 project is included in the City's FY2012-16 Capital Improvement Program (CIP) budget as the first phase of Butterfield State Road Extension. It is funded with Community Facilities District (CFD) for Roripaugh Ranch, Reimbursement/Other from Shea Homes and Transportation Uniform Mitigation Fee (TUMF) funds. Adequate funds are available in the project account. ATTACHMENTS: 1. Memorandum of Understanding (two originals) 2. Standard Water and/or Sewer Facilities and Service Agreement (two originals) 3. Standard Water and/or Sewer Facilities and Service Agreement (EMWD and Ashby USA LLC dated 11/17/04) 4. Project Description 5. Project Location Map MEMORANDUM OF UNDERSTANDING FOR TEMPORARY WATER AND/OR SEWER SERVICE This Memorandum of Understanding (MOU) is entered into by and between CITY OF TEMECULA, hereinafter referred to as "Sponsor" and Eastern Municipal Water District, a public agency, hereinafter referred to as "District". 1. On , 201_, a Standard Water and/or Sewer Facilities Service Agreement was entered into between Sponsor and District setting forth financial and other arrangements associated with the subject facilities and the provision of service therethrough. Paragraph 8 of the agreement provided for the execution of a Special Water and/or Sewer Interim Facilities Agreement to make service available prior to District's acceptance of said water and/or sewer facilities. This agreement serves that purpose with the following conditions: a. District agrees to provide temporary water and/or sewer service to those units described on Exhibit "A," attached hereto and by this reference incorporated herein, upon receipt of written notice from Sponsor requesting such service. Notice shall be received by District no less than thirty (30) days prior to the need for temporary service by Sponsor; b. District shall have no obligation to provide temporary water and/or sewer services to any other unit or any portion of the property described and/or depicted in the agreement, unless described in Exhibit "A." No course of dealing between Sponsor and District will operate as an implied or express right to receive temporary water and/or sewer service to any portion of Sponsor's property, except as set forth in a written instrument signed by both parties; c. Sponsor shall remit a $26 processing fee per addendum for Occupancy Release requests, subject to no less than four (4) lots per addendum; and d. Sponsor, at its expense, shall make any repairs or alterations to facilities if they fail to meet District approved standards. 2. Paragraph 11 of Exhibit D to the Standard Water and/or Sewer Facilities Agreement states that upon completion of the water and/or sewer facilities by Sponsor and acceptance of ownership by District, the District will provide service through such facilities in accordance with District's applicable rules and regulations. All of the parties' rights and obligations herein shall cease and be of no further force or effect. 3. District hereby agrees to provide interruptible domestic water service and/or sewer service pending Sponsor's completion of all facilities and acceptance of ownership by District as specified in the Standard Water and/or Sewer Facilities Agreement if the following conditions are met by Sponsor: a. Hold Harmless. Sponsor hereby agrees to indemnify and hold District harmless from any and all claims for damage to property or injuries to persons arising by reason of or in any manner connected with the temporary operations covered by the Agreement and this MOU. Such indemnification shall include attorneys' fees and court costs; and 1 Document ID: 2267690 b. Insurance Policy. Sponsor shall continuously maintain in full force and effect during the term of this MOU, the policies and limits of insurance coverage as set forth in Exhibit L of the Standard Water and/or Sewer Facilities Service Agreement. c. District Inspection/Acceptance. District's inspection personnel shall have authority to enforce District approved construction plans and specifications. Such authority shall include the authority to require Sponsor to make repairs or replace unacceptable materials during the period of temporary utility service. Final District acceptance shall follow District's final inspection and testing and completion of all improvements including other utilities, curbs and paving. District's inspection does not include inspection for compliance with safety requirements by Sponsor or its contractors or subcontractors. Any inspection completed by District shall be for its own benefit, and neither Sponsor nor any third party shall be entitled to rely thereon for any purpose. 4. It is understood and agreed by Sponsor that any changes to the terms and conditions of this MOU or the Agreement shall be in writing and signed by Sponsor and District and that District retains the right to terminate temporary utility service to or through Sponsor's facilities at any time as determined by District in accordance with applicable rules and regulations. 5. This MOU is of no effect until executed by both parties. 6. In the event suit is brought to enforce or interpret any part of the Agreement or this MOU, the prevailing party shall be entitled to recover costs and expenses of the action, including, without limitation: a. Attorneys' fees; b. Direct general overhead and administrative costs incurred by said party in connection with the preparation for and/or participation in the action, including, but not limited to, assisting in investigations and discovery, participating in depositions and in any trial or similar proceeding, and the preparation of records, reports, diagrams, maps and other writings (as defined in Section 250 of the California Evidence Code); c. Expert witness fees; d. Transcript costs, court costs and other similar costs; e. Consultant's fees; f. Any other miscellaneous costs directly relating to the claim or action. SPONSOR EASTERN MUNICIPAL WATER DISTRICT By: By: CITY OF TEMECULA Alicia Arana, Development Coordinator 2 Document ID: 2267690 LEGAL DESCRIPTION PSN#1031253, Tract RORIPAUGH RANCH OFFSITE WATER AND SEWER EXHIBIT A 3 Document ID: 2267690 Project_seq_num: 1031253 Document ID: 2267683 ❑ New ® Amended (To Record New Sponsor) STANDARD WATER AND/OR SEWER FACILITIES AND SERVICE AGREEMENT This Agreement is made and entered into this _ day of , 200_, by and between EASTERN MUNICIPAL WATER DISTRICT a public agency ("District") and CITY OF TEMECULA of TEMECULA, CA ("Sponsor"). RECITALS WHEREAS, Sponsor is planning to develop Tract No. RORIPAUGH RANCH OFFSITE WATER AND SEWER, as generally shown on the map attached hereto as Exhibit A, located within District's ® Water and/or ® Sewer Improvement District No(s) and Service Area(s) ISU25,IWU26,SA34,SA43 ; and WHEREAS, the water and/or sewer system facilities (Subject Facilities) which are generally shown and depicted on the map attached hereto as Exhibit B, are necessary to provide water and/or sewer service for said Subject Development; and WHEREAS, upon completion of the Subject Facilities and fulfillment of Sponsor's obligations and responsibilities, District shall own, operate, maintain and provide service through said Subject Facilities in accord with District's Rules, Regulations and Policies; and WHEREAS, the purpose of this Agreement and the Exhibits attached hereto and by this reference incorporated herein, is to set forth financial and other arrangements between District and Sponsor for the Subject Facilities, Sponsor's initial estimated cost of which is $1,754,100.00 as developed and shown on Exhibit C. NOW, THEREFORE, in consideration of the above recited premises, together with the mutual covenants herein contained and attached hereto, it is agreed that: 1. Terms and Conditions Applicable for this Agreement. Sponsor and District each agrees to fulfill and/or perform each of the obligations and responsibilities identified on Exhibit D as "Applicable" in accordance with the provisions, terms and conditions set forth in the respective paragraphs attached thereto. 2. Financial Participation Based on Sponsor's initial estimated cost developed in Exhibit C, less District's fixed financial participation in the amount of $0.00 as shown on Exhibit E, Sponsor's estimated final cost for the Subject Facilities is $1,754,100.00. 3. Documents to be Furnished to District by Sponsor Sponsor shall furnish to District each of the documents identified on Exhibit F as "Applicable". Each identified document shall be duly executed by Sponsor or the involved other party, and submitted to District in accord with the indicated time schedule for each respective document. FOR DISTRICT USE ONLY Water Construction Order No. 66072 Assigned Date 11/17/04 Sewer Construction Order No. 66073 Assigned Date 11/17/04 4. Payment to be Made by Sponsor to District Unless noted otherwise, Sponsor shall make payment to District of each of the charges identified on Exhibit G as "Applicable" concurrently with Sponsor's execution and delivery of this Agreement to District. Where Sponsor has "deferred" payment of fees, such deferred charges shall be paid by Addendum to this Agreement prior to District's acceptance of the facilities and provision of service to the involved unit(s) 5. Credits to Sponsor Toward Payment of Applicable District Charges District will credit Sponsor with payment of applicable District charges in the amounts indicated on Exhibit H, which credits and all terms and conditions associated therewith are covered in the related documents attached thereto. 6. Districts Right to Complete the Subject Facilities District is hereby granted the unqualified right to complete, at Sponsor's non -reimbursable expense, all or a portion of the Subject Facilities in the event a circumstance arises which, in the opinion of the District, may be a threat to the public's health, safety or welfare. Prior to District taking such action, Sponsor will receive a written Notice specifying the involved problem and will be given a reasonable period of time to take remedial action, satisfactory to District, within the time specified in the Notice. Sponsor shall be exclusively responsible for any and all legal and/or financial ramifications and/or settlements with Sponsor's contractor. 7 Force Majeure If either the District or the Sponsor is delayed, hindered or prevented from performing any term of this Agreement, by any reason beyond either party's control, including without limitation any strike, walkout, inability to procure material, failure of power, restrictive laws or regulations, riot, war, act of God or the default of the other party, then such performance will be excused or tolled during the period of delay and the applicable time period or deadline will be extended by a period equal to the period of such delay. 8. Service Limitations Following completion of construction and testing but prior to Districts acceptance of the Subject Facilities, District may make service available from and through the Subject Facilities under a separate agreement by and between District and Sponsor. Sponsor hereby specifically agrees not to permit any portion or unit of the Subject Development to be occupied until the Subject Facilities have been accepted by District and all of Sponsor's obligations have been fulfilled, including payment of District charges and completion of improvement district annexation/formation legal proceedings, if applicable. 9. Agreement Limitations A. Relative to This Entire Agreement This Agreement shall automatically be canceled and become null and void if it has not been executed on behalf of Sponsor and District and Sponsor has not fulfilled all of its financial and other obligations which are required to be fulfilled concurrently with Sponsor's execution of this Agreement, on or before December 06, 2004; and B. Relative to Financial Participation Charges and Other District Charges The estimated amounts of all applicable Financial Participation Charges and other District Charges to be paid by Sponsor shall be subject to adjustment to reflect the then per unit amount applicable at the time the involved portion(s)/unit(s) have been completed and service is requested, all as determined by District. Sponsor agrees to pay the full adjusted amount of such District Charges prior to District's acceptance of the facilities and provision of service to the involved unit(s). 2 For the purposes of this Agreement, the word completed shall be determined by District and mean: 1) Those water and/or sewer facilities which have been accepted and placed into service by District; and 2) Those units which have been certified for occupancy by the County of Riverside or the involved city (as appropriate) or otherwise approved for release by District for model home or landscape uses. 10. Hold Harmless District and Sponsor each hereby agree to indemnify and hold the other harmless from any and all claims for damage or damages to property or injuries to persons arising by reason of or in any manner connected with the activities provided by the other party and/or its contractor(s). Such indemnification shall include attorneys' fees and courtcosts. 11. Preparation of This Agreement This Agreement shall not be construed against the party preparing it, but shall be construed as if both parties prepared it. 12. Purpose of Captions Captions to Paragraphs are for convenience purposes only and are not part of this Agreement. 13. Binding Provision This Agreement is binding on the heirs, representatives, successors and assigns of the parties hereto. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed as of the date first above written. EASTERN MUNICIPAL WATER DISTRICT CITY OF TEMECULA By: By: Alicia Arana, Development Coordinator Signature Dated: Dated: (Print Name & Title) 3 1 a 1 1 2 1 2 V E 119 1 101fl33W31 AO AlI3 1 A 1 IR 0 0p5 4I l!IHIc EN -56A (Rev. 9/19/03) EAJTERN MUNICIPAL WATER DISTRICT COST ESTIMATE FOR WATER FACILITIES Developer: W .O./C.O.# Estimator's Initials: Ashby Fiesta 99-387 JAT Tract: j Roripaugh Ranch: I.D./S.A.# anchp I.D./S.A.# U -25/U26 & 34/43 Date: 11/06/03 Supervisor's Initials: VJBii Typist Initials: Implementing Facilities: List (1) ." - - I Yes. • ❑ No `CCU M , , (2) 16" WATER PERS D-22587 Water Easement: In Project ❑ Yes ' No Water Pressures: High Lots: Normal Offsite Work Authorization: 0 Yes ❑ No N/A Low Lots: Treatment Plant Notification: Plant: ❑ Water ❑ Needed 2 Not Needed [] Sewer A. Pipeline Installation: 3,031 LF -12" PVC C-900 CL150; 3,713 LF -16" PVC C-905 CL235; 3,583 LF -18" PVC C-905 CL235 $ 614,960 B. Valves, Hydrants, Fittings; & Misc. 5 EA -12" RSGV; 11 EA -16" RSGV; 3 EA -18" RSGV, 26 EA -STD FIRE HYDRANT, 5 EA -SUPER FIRE HYDRANT $ 153,400 6 EA -6" BLOWOFF, 11 EA- 1" A.V. & A.R. 1 Vault W/plping & Meter for Inter -tie C. Force Account Installation: (1) HOT TAP PROPOSED 16" PVC W/L WITH 16" TAPPED SLEEVE CONNECTION W/16" FXF RSGV BY EMWD AT $ 3,000 * DEVELOPER'S EXPENSE 16"X18" INCREASER. D. Install Service Connections 0 EA $ 0 E. 0 meters (EMWD Installed on Dev. Installed service connection) $ 0 SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) $ 771,360 $ 77,140 $ 848,500 Engineering (by Developer's Engineer) ( 6.40 %) (Subtotal 2) $ 54,300 EMWD Inspection ( 4.70 %) (Subtotal 2) $ 39,880 * EMWD Plan Review $ 2,000 * As Builts 25 sheets x $ 35 per sheet $ 875 * Exhibit "C" *Costs included in Exhibit G, Line A TOTAL ESTIMATED COST - WATER $ 945,555 EN-566(Rev.9/19/03) EASTERN MUNICIPAL WATER DISTRICT COST ESTIMATE FOR SEWER FACILITIES Developer: Ashby Fiesta Tract: Roripaugh Ranch O/S W.O./C.O.# 99-387 Estimator's Initials: JAT Supervisor's I.D./S.A.# U -25/U26 & 34/43 Initials: VJB jf(4 Date: November 6, 2003 Typist Initials: A. Sewer line Installation: 1,512 LF -8" SEWER MAIN; 821 LF -12" SEWER MAIN 8,738 LF -15" SEWER MAIN B. Installation of Manholes and Cleanouts: 34 EA -48" DIAMETER STD. MANHOLE 2 EA -MAINLINE CLEANOUT (SB -52) C. Misc. Installation: 1 EA -RECONSTRUCT EXIST MANHOLE; 401 LF -30" STEEL CASING 4 EA -SEWER PLUGS D. T.V. 11,071 feet of Sewer Line $ 491,770 $ 54,580 $ 121,300 $ 5,540 * SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) $ 740,510 Engineering (by Developer's Engineer) ( 6.60 %) (Subtotal 2) $ 48,870 $ 673,190 $ 67,320 EMWD Inspection ( 2.20 %) (Subtotal 2) $ 16,290 * EMWD Plan Review $ 2,000 * As Builts 25 sheets x $ 35 per sheet $ 875 * Exhibit "C" *Costs included in Exhibit G, Line A TOTAL ESTIMATED COST - SEWER $ 808,545 v ' Implementing Facilities: List ❑Yes J No Wirt Sewer Easement: In Project ❑ Yes J No Sewer Backflow Valves: None Offsite Required Lots: Work Authorization: ❑ Yes J No Treatment Plant Notification: ❑ Needed ❑ Not Needed A. Sewer line Installation: 1,512 LF -8" SEWER MAIN; 821 LF -12" SEWER MAIN 8,738 LF -15" SEWER MAIN B. Installation of Manholes and Cleanouts: 34 EA -48" DIAMETER STD. MANHOLE 2 EA -MAINLINE CLEANOUT (SB -52) C. Misc. Installation: 1 EA -RECONSTRUCT EXIST MANHOLE; 401 LF -30" STEEL CASING 4 EA -SEWER PLUGS D. T.V. 11,071 feet of Sewer Line $ 491,770 $ 54,580 $ 121,300 $ 5,540 * SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) $ 740,510 Engineering (by Developer's Engineer) ( 6.60 %) (Subtotal 2) $ 48,870 $ 673,190 $ 67,320 EMWD Inspection ( 2.20 %) (Subtotal 2) $ 16,290 * EMWD Plan Review $ 2,000 * As Builts 25 sheets x $ 35 per sheet $ 875 * Exhibit "C" *Costs included in Exhibit G, Line A TOTAL ESTIMATED COST - SEWER $ 808,545 OBLIGATIONS/RESPONSIBILITIES SPONSOR'S OBLIGATIONS/ PURSUANT TO NOT RESPONSIBILITIES RELATIVE TO: PARAGRAPH APPLICABLE APPLICABLE A Financial Participation 1 ® ❑ B Preparation of Construction Plans/Specifications 2 ® ❑ C Construction of Subject Facilities 3 ® ❑ D Pre -construction Conference/Project Coordination 4 ® ❑ /Designation of Authorized Representative E Inspection of Construction 5 ® ❑ F Field Engineering, Surveys, Compaction and Materials 6 ® ❑ Strength Tests, Disinfection Requirements G Construction and Operate/Maintain Permits 7 ® ❑ H Easements 8 ❑ I Grant Deeds 9 El J Cost Accounting Records 10 ® ❑ K Conveyance of Ownership 11 ® ❑ L Payment to Cover District's Expenses 12 Il ❑ M Environmental Information & Assistance 13 ® ❑ N Payment of Other Applicable Charges 14 ® ❑ O Improvement District annexation/Formation 15 ® ❑ P Assessment District Requirements 16 ❑ Q Street Address 17 ❑ R Water Pressure Conditions 18 ❑ S Treatment Plant Location Notification 19 ❑ T Sewer Backflow Device 20 ❑ U Special Terms and Conditions 21 ® ❑ ✓ Insurance Requirements 22 ® ❑ DISTRICT'S OBLIGATIONS/ REPSONSIBILITIES TO: PURSUANT TO NOT PARAGRAPH APPLICABLE APPLICABLE A Financial Participation 1 ❑ B Plan Review and Approval 2 ® ❑ C Construction of Portions of the Facilities 3 ❑ D Inspection of Construction 5 ® ❑ E Determination of Final Total Costs 10 ® El F Acceptance, Ownership, and Service Responsibilities 11 ® ❑ EXHIBIT D STANDARD TERMS AND CONDITIONS APPLICABLE FOR WATER AND/OR SEWER FACILITIES AND SERVICE 1. Financial Participation Sponsor shall finance the total cost of the Subject Facilities, less District's financial participation, if any. Sponsor shall bill District for the amount of District's Fixed Financial Participation within thirty (30) calendar days after completion of the Subject Facilities and District's acceptance thereof. 2. Preparation of Construction Plans and Specifications Sponsor shall employ, at its sole expense, a qualified professional engineering firm to plan, design and prepare detailed construction plans and specifications for the Subject Facilities covered by this Agreement in accord with District standards. Such plans and specifications shall be reviewed and approved by District, in writing, prior to the beginning of any construction. 3. Construction of the Subject Facilities If the Subject Facilities are being funded with public funds, then Sponsor shall receive a minimum of four (4) competitive bids from properly licensed contractors for the Subject Facilities. With the written concurrence of District, Sponsor shall award the construction contract to the contractor with the lowest bid. In the event Sponsor employs other than the contractor with the lowest bid, the amount of Sponsor's credit shall be subject to adjustment to result, insofar as is possible, in the amount of such credit being equal to the amount which would have resulted if Sponsor had awarded the contract to the lowest bid. Unless otherwise approved by District, District shall furnish all labor, materials and equipment necessary to connect the Subject Facilities to District's existing system facilities and may install other portions of the Subject Facilities, including water meters, as provided for in the plans and specifications. Any work performed by the District shall be paid by Sponsor on an actual (including overhead) cost basis. All facilities furnished, constructed and installed by Sponsor's contractor shall be installed in strict compliance with District approved plans and specifications. Sponsor may not deviate from such approved plans and specifications without prior written approval by District. Sponsor's contractor shall provide a one-year (following District's final acceptance) materials and workmanship guarantee. Any facilities damaged by any party prior to District's final acceptance or within the one-year warranty period, shall be repaired by Sponsor's contractor at no cost to District. If, however, temporary water service is being provided by District through a portion of the Subject Facilities prior to completion of the Subject Development, District shall make any and all repairs to that portion of the Subject Facilities at Sponsor's expense. Notwithstanding the foregoing, District shall have the unqualified right to immediately make any emergency repairs necessary to eliminate any threat to the public's health, safety or welfare and to ensure continuity of service at Sponsor's non -reimbursable expense. 4. Preconstruction Conference/Project Coordination/Designation of Sponsors Authorized Representative Sponsor shall be responsible for coordinating all construction activities associated with the Subject Facilities and any other work to be performed by Sponsor's contractor. In this regard, Sponsor shall schedule a pre -construction conference with District personnel. It shall also be the responsibility of the Sponsor and Sponsor's contractor to hold safety conferences as required by law and comply with applicable Federal, State, local and District safety criteria. At or prior to the pre -construction conference, Sponsor shall officially, in writing, designate those who have authority to represent Sponsor relative to the furnishing and installation of the Subject Facilities and shall immediately advise the District of any subsequent changes in such authorized representation. 5. Inspection of Construction EXHIBIT D District shall be responsible for inspecting the work to be performed by Sponsor's contractor for compliance with the approved plans and specifications. District's inspection personnel shall have the authority to require that any and all unacceptable materials, workmanship and/or installation be replaced, repaired or corrected by Sponsor's contractor at contractors expense. 6. Field Engineering Surveys, Compaction and Materials Strength Tests, and Disinfection Requirements Sponsor's engineer shall provide all field engineering surveys associated with the construction of the Subject Facilities and/or related work to be performed by Sponsor's contractor, as determined necessary by Sponsor's engineer, Sponsor's contractor, and/or District's inspection personnel, at Sponsor's direct expense. Sponsor shall promptly furnish to District all field notes and grade sheets, together with location, offset, and attendant data and reports, resulting from field engineering surveys and/or proposed facility design changes, all of which have been prepared in accordance with accepted professional engineering practices, and allow District sufficient time to approve or make any required facility design changes resulting therefrom prior to construction. Sponsor shall be responsible for paying all soil compaction, concrete and steel strength tests and report costs associated with the Subject Facilities required by Sponsor's engineer, appropriate public agency officials and/or District inspection personnel. Full-time professional soils (compaction) testing and full trench certification are required. Sponsor shall contract with a soils testing firm approved by District. A final report shall be required fully certifying trench compaction prior to acceptance of facilities. Sponsor shall promptly furnish results of all such compaction and concrete and steel strength testing to District for its evaluation as to compliance with the specifications. District shall make every reasonable effort to complete the evaluation within 72 hours after its receipt. Relative to water facilities, Sponsor's contractor shall be responsible for performing all disinfection procedures required by District and the costs associated therewith. 7 Construction and Operate and Maintain Permits Sponsor shall be responsible for obtaining a Construction Permit from the involved City or County agency for those portions, if any, of the Subject Facilities which are to be constructed within an existing City street and/or County road. At the same time such Construction Permit is obtained by Sponsor, the involved City or County agency will issue an Operate and Maintain Permit to District, which will become effective upon the completion of the involved Subject Facilities and District's acceptance thereof. 8. Easements Sponsor shall furnish to District, without cost, duly executed easement document(s) which assure District's unequivocal right to own, operate and maintain the Subject Facilities. 9. Grant Deeds a) For annexation purposes only, Sponsor shall furnish to District a copy of the grant deed(s) verifying ownership of the property; or b) Sponsor shall, for the dollar consideration, if any, set forth in Exhibit C attached to this Agreement, furnish to District a duly executed Grant Deed(s) conveying to District clear unencumbered fee title to the parcel(s) of land identified on the map attached to this Agreement as Exhibit I. 10. Cost Accounting Records Sponsor shall maintain separate accounting records under which all its engineering and construction expenses for each segment/unit of the Subject Facilities will be individually shown and identified. At the time of the pre -construction conference, Sponsor shall provide District with preliminary accounting records showing the estimated cost of construction broken down by unit bid items. Final cost accounting records shall be submitted to the District within 90 days after completion of the Subject Facilities upon which District shall determine the Final Total Cost for each segment/unit of the Subject Facilities for capital value and other accounting record purposes and Sponsor's Final Financial Participation. 11. Conveyance of Ownership EXHIBIT D Concurrently with the execution of this Agreement, Sponsor shall execute the Bill of Sale attached to this Agreement as Exhibit J, conveying to District clear title to the Subject Facilities effective upon their completion and acceptance by District. In this regard, it is specifically understood and agreed that District is not obligated to accept title to or provide service through the Subject Facilities until final inspection (including television) and testing has been completed and Sponsor has fulfilled its obligations and responsibilities provided for in this Agreement. Upon conveyance of ownership to District, District shall own, operate, maintain and provide service there through in accord with District Policies and Rules and Regulations. 12. Payments to District to Cover District's Expenses Concurrently with the execution of this Agreement, Sponsor shall make payment to District covering Districts estimated engineering, inspection, material and construction related expenses. Such payment shall be subject to additional billing(s) to Sponsor, payable within 15 calendar days; or refund(s) by District, upon completion of construction and determination of Districts actual incurred costs. Such payment(s) covering District expenses shall constitute a portion of Sponsor's costs to be included in Sponsor's cost accounting records. 13. Environmental Information and Assistance Upon request by District, Sponsor shall, at its sole expense, assist District in the preparation of an Environmental Impact Assessment, or, if necessary, furnish to District a complete Environmental Impact Report relative to the facilities covered by this Agreement and the Subject Development. In this regard, nothing herein shall be construed or interpreted to require District to take or participate in any legal action for the purpose of securing approval for the facilities covered by this Agreement or the developments to be served thereby. All such legal action shall be solely financed and conducted by Sponsor. 14. Payment of Other Applicable District Charges Prior to receiving service through the Subject Facilities, Sponsor shall pay to District applicable financial participation charges, frontage charges, and other charges as determined by District. 15. Improvement District Annexation/Formation Legal Proceeding Requirements If the lands to be occupied by the Subject Development are not already located within a District improvement district, Sponsor shall furnish District a petition, duly executed by the legal owners of all the involved lands, requesting that the lands be either annexed to an existing District improvement district or, the formation of a new District improvement district, as determined by District. Annexation must be complete prior to transfer of title of any of the involved lands and District's release for occupancy. 16. Assessment District Requirements a) If the lands to be occupied by the Subject Development are in one of the Districts assessment districts and there has been a subdivision of the subject property subsequent to said assessment district formation, Sponsor shall pay the assessment at the time of agreement execution or go through an apportionment of assessment district procedures administered by the District personnel. b) Upon completion of the construction of the involved assessment district financed facilities and the determination of the final combined and individual cash assessments, the District shall determine and establish the amount of the portion, if any, of the cash assessment for each parcel within the involved assessment district which is to be credited by District toward partial payment of applicable District front footage and financial participation charges. EXHIBIT D 17. Street Addresses Concurrently with the execution of this Agreement, Sponsor shall furnish to District a list of approved street addresses for the development to be served by the Subject Facilities. 18. Water Pressures If pressures are expected to be in excess of 80 psi, Sponsor shall install, at his expense, a pressure regulator and/or relief valve. If pressures are expected to be less than 40 psi, Sponsor shall install, at his expense, a booster pump and low pressure switch, to be owned, operated and maintained by the subsequent lot owner. Service will not be provided if available system pressure is determined to be lower than 20 psi. Sponsor agrees to inform subsequent lot owners of high or low water pressure conditions and will hold District harmless from any damages resulting from such condition. A Pressure Agreement executed by the Sponsor/lot owner will be recorded with the County holding District harmless from any damages caused by low or high pressures. 19. Treatment Plant Location Notification In the event any portion of the Subject Development is located within one quarter (1/4) mile of a District treatment plant facility site, Sponsor shall execute a Notice of Condition, recorded with the County, acknowledging the existence and location of the treatment plant and the possibility of nuisance conditions under certain operational and climatic conditions. Such Notice will run with the real property and shall be binding upon subsequent property owners. 20. Sewer Backflow Device Sewer backflow devices will be required for those lots, if any, specified on the construction drawings. Sponsor will furnish and install, at Sponsor's cost, sewer backflow devices in accordance with District standards and specifications, prior to project or lot release by District. 21. Special Terms, Conditions and/or Requirements Sponsor shall fulfill all the Special Terms, Conditions and Requirements set forth in Exhibit K attached to this Agreement. 22. Insurance Requirements Prior to the Pre -job construction meeting, Sponsor or Sponsor's contractor, shall provide District with certificates of insurance coverage in accordance with the requirements set forth in Exhibit L attached to this Agreement. EXHIBIT D EXHIBIT E DOCUMENTS TO BE FURNISHED Due Not DOCUMENTS(S): Date Applicable Applicable A City/County/Road Permits (a) ® ❑ B Easements (a) ❑ El C Deeds (a) ❑ El D Final Cost Accounting Records (b) ® ❑ E Bill of Sale (c) ® ❑ F Petition for Improvement District Annexation/Formation (c) ❑ El G Billing for District's Financial Participation Charges (d) ❑ El H List of Street Addresses (c) ❑ El I Water Pressure Agreement(s) (a) ❑ El J Treatment Plant Location Notification (a) ❑ El K Preliminary Cost Accounting Records (a) ❑ El L Certificate(s) of Insurance (a) ® ❑ (a)Prior to Pre -construction Meeting. (b)Within 90 calendar days after Districts acceptance of the Subject Facilities. (c)Upon Sponsor's execution and delivery of this Agreement to District. (d)Within 30 calendar days after Districts acceptance of the Subject Facilities. EXHIBIT F ESTIMATE OF CHARGES TO BE PAID BY SPONSOR NOT PAYMENT FOR: AMOUNT APPLICABLE APPLICABLE A. Estimated District Engineering & Inspection Expenses $ 67,460.00 ® ❑ B. Estimated District Material & Construction Expenses 3,000.00 ® ❑ C. Non -Reimbursable Frontage Fees: (1) Water 0.00 ❑ (2) Special Water 0.00 ❑ (3) Sewer 0.00 ❑ (4) Special Sewer 0.00 ❑ D. Financial Participation Charges: (1) Domestic Water System Facilities 0.00 ❑ (2) Domestic Water System Facilities (Landscape) 0.00 ❑ (3) Sewer System & Reclaimed Water Facilities 0.00 ❑ (4) Sewer Treatment Plant Capacity Charges 0.00 ❑ E. Water for Testing Purposes (Construction Water) 0.00 ❑ F. Meters 0.00 ❑ G. Source Control Fees 0.00 ❑ H Per Addendum Processing Fee 0.00 ❑ Total $ 70,460.00 Less Previous Fees Paid on 08/14/01 $ 2,500.00 Amount to be Remitted with Agreement $ 67,960.00 Terms of original Agreement are being assumed by the City of Temecula. Deposit funds remaining in original CO's will be applied and there will be no deposit required at this time. *FEES DEFERRED UNTIL SERVICE IS REQUESTED See Exhibit G-2 for estimated amount ALL CHARGES SHALL BE SUBJECT TO ADJUSTMENT TO REFLECT THE APPLICABLE PER UNIT CHARGE AT THE TIME SERVICE IS REQUESTED (SEE Paragraph 9.B of Agreement) EXHIBIT G EXHIBIT G-2 CREDITS TO SPONSOR TOWARD PAYMENT OF APPLICABLE DISTRICT CHARGES AMOUNT OF NOT DESCRIPTION OF WATER RELATED CREDITS CREDIT APPLICABLE APPLICABLE Nonreimbursable Charges Credited to Sponsor: 1) Capacity Charges (Sponsor Required Capacity) ❑ IZ Potentially Reimbursable Charges Credited to Sponsor: 1) Water Frontage Charges 2) Additional Special Water Frontage Charges 3) Capacity Charges Credit 4) Other Water Frontage Charges Previously Paid By Others DESCRIPTION OF SEWER RELATED CREDITS Nonreimbursable Charges Credited to Sponsor: 1) Capacity Charges (Sponsor Required Capacity) Potentially Reimbursable Charges Credited to Sponsor: 1) Sewer Frontage Charges 2) Additional Special Sewer Frontage Charges 3) Capacity Charges Credit 4) Other Sewer Frontage Charges Previously Paid By Others Attachments: H-1 Frontage Charge Memorandum H-2 Computation of Capacity Credits E El E El E El E El E El ri El EXHIBIT H BILL OF SALE For a valuable consideration, receipt of which is hereby acknowledged CITY OF TEMECULA, Tract RORIPAUGH RANCH OFFSITE WATER & SEWER (Seller), hereby bargains, conveys, and grants unto the Eastern Municipal Water District (District), a public agency of the State of California, the following described personal property, such conveyance to become effective upon completion of the construction/installation by Seller's Contractor(s) and acceptance by the District of such personal property, which is more specifically described as: The Subject Facilities which are to be furnished and constructed by Sponsor's Contractor(s) as described and provided for in that certain Agreement, by and between Sponsor (Seller in this Bill of Sale) and District, dated , to which this Bill of Sale is attached as Exhibit J. Seller hereby warrants that the above-described personal property is free and clear of any and all encumbrances. In this regard Seller hereby agrees to protect and defend (Districts) right to own, operate, maintain and provide services through all the personal property hereby transferred to Districts ownership wherein the defense of the Districts right to own, operate, maintain and provide services as provided hereinabove results from any person or entity's alleged rights to any of the personal property described hereinabove or for any monetary damages resulting from the nonpayment by Seller of any person or entity having the right to file a lien against said personal property. Seller further agrees to indemnify the District for any and all losses which may be occasioned or suffered by the District as a result of any claims by others as to clear title of the personal property covered hereby. Subscribed and sworn to before me SELLER this _ day of 200_. By: (Signature) Notary Public in and for the State of California (Print Name and Title) Expiration Date Dated: EXHIBIT J SPECIAL TERMS AND CONDITIONS # Sewer and /or Water Financial participation charges are to be determined at the time of Application for Service. Application for Service will require an individual addenda to this agreement upon submittal of plot plans, city conditions, etc. by each respective site developer. # The City of Temecula has agreed to assume the Standard Water and/or Sewer Facilities and Service Agreement between Ashby USA, LLC and EMWD dated 11/17/04, per notification dated 10/10/11, signed by David McBride, Senior Engineer of the City of Temecula. # IMPLEMENTING FACILITIES Water 1. 16" Water per MS 3767 D-22587/ Sewer 1. None. EXHIBIT K EXHIBIT L INSURANCE REQUIREMENTS PART A - STANDARD INSURANCE REQUIREMENTS FOR NON -CFD PROJECTS & FEES ONLY CFD PROJECTS Prior to the Pre -job construction meeting, Sponsor or Sponsor's contractor, shall provide District with certificates of insurance coverage in accordance with these requirements. II. Sponsor or Sponsor's contractor shall not commence work under this contract until he has obtained all policies of insurance required hereunder, nor shall he allow any subcontractor to commence work until all policies of insurance required of the subcontractor have been obtained. III. Sponsor or Sponsor's contractor shall, during the life of this contract, notify District in writing of any incident, either under his jurisdiction, or any of his subcontractors, resulting in a Bodily Injury or Property Damage claim and any resultant settlements, which may affect the limits of the required coverage, as soon as is reasonable and practical. IV. Sponsor or Sponsor's contractor, and each of his subcontractors, shall take out and maintain the following policies of "occurrence form" type insurance, with coverages reasonably acceptable to the District, at his sole cost and expense at all times during the life of this contract, including the entire time of the Contractor's guarantee. A. Workers' Compensation Insurance to cover employees as required by Section 3700 of the Labor Code of the State of California, and Contractor shall require all subcontractors similarly to provide such workers' compensation insurance for all subcontractors' employees. Such policy shall contain an endorsement that waives all right of subrogation against those persons or entities designated in the policy of Commercial Liability Insurance B. Commercial Liability Insurance. Sponsor or Sponsor's Contractor shall procure and maintain Commercial Liability Insurance in amounts not less than the following: $1,000,000 Each Occurrence $2,000,000 General Aggregate $2,000,000 Products -Completed Operations Aggregate Where excess liability insurance is used in connection with primary liability insurance the combination of such must allow total limits of liability to be in amounts not less than the above specified amounts. C. Automobile Liability Insurance. Sponsor or Sponsor's Contractor shall procure and maintain Automobile Liability Insurance in amounts not less than the following: $1,000,000 Combined Single Limit 042011 Exhibit L Page 1 of 10 D. Equipment. Sponsor or Sponsor's Contractor shall be solely responsible for its tools, equipment, supplies and materials on and off the jobsite, and shall require its subcontractors to be solely responsible for all maintenance, damage, destruction or theft of subcontractor's tools, equipment, supplies and materials on and off the jobsite until the work of this contract is completed, signed off and accepted by the District. V. Each such policy of insurance shall: A. Be issued by insurance carriers that are: 1. Licensed to transact insurance business in California; and 2. Rated no less than A-, Class VIII (8) by the A.M. Best Company. B. Captive and/or Risk Retention groups are not acceptable unless rated no less than A-, Class VIII (8) by the A. M. Best Company; and C. Self Insured Retention (SIR) greater than $100,000 is acceptable subject to Sponsor providing verification of Sponsor's current net -worth as follows: SIR Limit Net -Worth $100,000 N/A $100,001 to $250,000 $2,500,000 $250,001 to $500,000 $5,000,000 $500,001 to $1,000,000 $10,000,000 $1,000,001 to $5,000,000 $50,000,000 VI. Non-admitted/Surplus Lines insurance carriers (carriers not licensed in the State of California), may be acceptable to the District under certain conditions. Non -admitted insurance carriers providing any form of insurance coverage must be: A. Domiciled or authorized to do business in the United States; and/or listed as an approved insurance carrier on the California Department of Insurance L.E.S.L.I. list; B. Rated no less than A-, Class VIII (8) by the A.M. Best Company; and C. Risk Retention Groups and/or Captive Insurance carries are not acceptable unless they can provide an AM Best rating that meets District's policy The District reserves the right to disqualify any admitted or non admitted insurer at any time. In the event an insurer does not meet the requirements herein, Contractor shall have 30 calendar days to submit replacement insurance in conformance with these requirements. VII. Additional Insured: Name and list the District as "Additional Insured" by utilizing endorsement form CG 20 10 11/85, or CG 20 10 10/01 with CG 20 37 10/01 to include Completed -Operations (or equivalent forms) beyond the completion date. Endorsements are required with certificate. VIII. Not be canceled, reduced in coverage or limits until thirty (30) days after receipt by the District of a written notice of such cancellation or reduction of coverages or limits. 042011 Exhibit L Page 2 of 10 IX. Be endorsed for the Aggregate Limit to Apply to this Project by utilizing endorsement form "CG 25 03 03 97" (or equivalent), executed by the insurance carrier. Endorsement required with certificate. X. Show evidence of renewal of an expiring policy in conformance with District standards. Xl. If sponsor is unable to fulfill the insurance requirements stipulated herein, sponsor has the option to: A. Post a Standby Letter of Credit for $1 million, approved by the District, to be in place for 3 years beyond the completion of the project; or B. Post a CD for $1 million, approved by the District, to be in place for 3 years beyond the completion of the project. PART B - INSURANCE REQUIREMENTS FOR SPECIAL FUNDING (AD/CFD) PROJECTS Prior to the Pre job construction meeting, Sponsor and Sponsor's Contractor (if different from Sponsor), shall provide District with certificates of insurance coverage in accordance with these requirements. II. Sponsor and Sponsor's Contractor shall not commence work under this contract until he has obtained all policies of insurance required hereunder, nor shall he allow any subcontractor to commence work until all policies of insurance required of the subcontractor have been obtained. III. Sponsor and Sponsor's Contractor shall, during the life of this contract, notify District in writing of any incident, either under his jurisdiction, or any of his subcontractors, resulting in a Bodily Injury or Property Damage claim and any resultant settlements, which may affect the limits of the required coverage, as soon as is reasonable and practical. IV. Sponsor and Sponsor's Contractor and each of his subcontractors shall take out and maintain the following policies of "occurrence form" type insurance, with coverages reasonably acceptable to the District, at his sole cost and expense at all times during the life of this contract, including the entire time of the guarantee: SPONSOR'S CONTRACTOR AND ALL SUBCONTRACTORS: A. Workers' Compensation Insurance. Sponsor's Contractor and subcontractors shall cover employees as required by Section 3700 of the Labor Code of the State of California, and Contractor shall require all subcontractors similarly to provide such workers' compensation insurance for all subcontractors' employees. Such policy shall contain an endorsement that waives all right of subrogation against those persons or entities designated in the policy of Commercial Liability Insurance. 042011 Exhibit L Page 3 of 10 B. Equipment. Sponsor's Contractor shall be solely responsible for its tools, equipment, supplies and materials on and off the jobsite, and shall require its subcontractors to be solely responsible for all maintenance, damage, destruction or theft of subcontractor's tools, equipment, supplies and materials on and off the jobsite until the work of this contract is completed, signed off and accepted by the District. SPONSOR: A. Commercial Liability Insurance. Sponsor shall procure and maintain Commercial Liability Insurance in amounts not less than the following: $1,000,000 Each Occurrence $2,000,000 General Aggregate $2,000,000 Products -Completed Operations Aggregate Where excess liability insurance is used in connection with primary liability insurance the combination of such must allow total limits of liability to be in amounts not less than the above specified amounts. B. Automobile Liability Insurance. Sponsor shall procure and maintain Automobile Liability Insurance in amounts not less than the following: $1,000,000 Combined Single Limit V. Each such policy of insurance shall: A. Be issued by insurance carriers that are: 1. Licensed to transact insurance business in California; and 2. Rated no less than A-, Class VIII (8) by the A.M. Best Company. B. Captive and/or Risk Retention groups are not acceptable unless rated no less than A-, Class VIII (8) by the A. M. Best Company; and C. Self Insured Retention (SIR) greater than $100,000 is acceptable subject to Sponsor providing verification of Sponsor's current net -worth as follows: SIR Limit Net -Worth $100,000 N/A $100,001 to $250,000 $2,500,000 $250,001 to $500,000 $5,000,000 $500,001 to $1,000,000 $10,000,000 $1,000,001 to $5,000,000 $50,000,000 VI. Non-admitted/Surplus Lines insurance carriers (carriers not licensed in the State of California), may be acceptable to the District under certain conditions. Non -admitted insurance carriers providing any form of insurance coverage must be: A. Domiciled or authorized to do business in the United States; and/or listed as an approved insurance carrier on the California Department of Insurance L.E.S.L.I. list; 042011 Exhibit L Page 4 of 10 B. Rated no less than A-, Class VIII (8) by the A.M. Best Company; and C. Risk Retention Groups and/or Captive Insurance carries are not acceptable unless they can provide an AM Best rating that meets District's policy. The District reserves the right to disqualify any admitted or non admitted insurer at any time. In the event an insurer does not meet the requirements herein, Contractor shall have 30 calendar days to submit replacement insurance in conformance with these requirements. VII, Additional Insured: Name and list the District as "Additional Insured" by utilizing endorsement form CG 20 10 11/85, or CG 20 10 10/01 with CG 20 37 10/01 to include Completed -Operations (or equivalent forms) beyond the completion date. Endorsements are required with certificate. VIII. Not be canceled, reduced in coverage or limits until thirty (30) days after receipt by the District of a written notice of such cancellation or reduction of coverages or limits. IX. Be endorsed for the Aggregate Limit to Apply to this Project by utilizing endorsement form "CG 25 03 03 97" (or equivalent), executed by the insurance carrier. Endorsement required with certificate. X. Show evidence of renewal of an expiring policy in conformance with District standards. XI. If sponsor is unable to fulfill the insurance requirements stipulated herein, sponsor has the option to: A. Post a Standby Letter of Credit for $1 million, approved by the District, to be in place for 3 years beyond the completion of the project; or B. Post a CD for $1 million, approved by the District, to be in place for 3 years beyond the completion of the project Part C- SPECIAL Insurance Requirements for Self -Insured Retention (SIR) and WRAP Programs I. As an alternative, Sponsor or Sponsor's Contractor (if different from Sponsor) may satisfy the requirements of Part A or Part B via Wrap coverage and Self -Insured Retention as provided for in this section. II. Prior to the Pre -job construction meeting, Sponsor or Sponsor's Contractor, shall provide District with Certificates of insurance coverage in accordance with these requirements. III. Sponsor or Sponsors contractor shall not commence work under this contract until he has obtained all policies of insurance required hereunder, nor shall he allow any subcontractor to commence work until all policies of insurance required of the subcontractor have been obtained. 042011 Exhibit L Page 5 of 10 IV. Sponsor or Sponsor's contractor shall, during the life of this contract, notify District in writing of any incident, either under his jurisdiction, or any of his subcontractors, giving rise to any potential Bodily Injury or Property Damage claim and any resultant settlements, whether in conjunction with this or any other project which may affect the limits of the required coverage, as soon as is reasonable and practical. V. Sponsor or Sponsor's contractor, and each of his subcontractors, shall take out and maintain the following policies of "Occurrence form" type insurance, with coverages acceptable to the District, at his sole cost and expense at all times during the life of this contract, including the entire time of the Contractor's guarantee. A. Workers Compensation Insurance to cover employees as required by Section 3700 of the Labor Code of the State of California, and Contractor shall require all subcontractors similarly to provide such worker's compensation insurance for all subcontractors' employees. Such policy shall contain an endorsement that waives all right of subrogation against those persons or entities designated in the policy of Commercial Liability Insurance. Such policy shall provide employers liability limits of $1,000,000.00. B. Commercial Liability Insurance. Sponsor or Sponsor's Contractor shall procure and maintain commercial liability insurance in amounts stated as follows: 1. WRAP Insurance: Sponsor or Sponsor's contractor may satisfy the requirements of General Liability Insurance by providing a "Wrap Insurance Program" that includes all eligible contractors and subcontractors. The program may be structured using a combination of Commercial Liability insurance (primary and excess) and self insurance, which will cover Bodily Injury and Property Damage liability exposures in connection with the Project listed. (Wrap coverage EXCLUDES Auto, Worker's Compensation and Property/Builders Risk coverage.) The maximum limits allowed are set forth below. Sponsor shall provide the District with verification of Sponsor's current net -worth. Net -Worth SIR limit Insurance Limit Occurrence Aggregate Not Required Up to $100,000 $10,000,000 $20,000,000 $2,500,000 $100,001 to $250,000 $15,000,000 $30,000,000 $5,000, 000 $250,001 to $500,000 $15,000,000 $30,000,000 $10,000,000 $500,001 to $1,000,000 $20,000,000 $30,000,000 $50,000,000 $1,000,001 to $5,000,000 $30,000,000 $40,000,000 $100,000,000 $5,000,001 to $10,000,000 $40,000,000 $50,000,000 a. If Sponsor provides Wrap insurance per project, the aggregate limit stated above does not apply. b. Completed operations and Products coverage will be maintained for a minimum of 10 years. 042011 Exhibit L Page 6 of 10 C. Automobile Liability Insurance. Sponsor or Sponsor's Contractor shall procure and maintain Automobile Liability Insurance in amounts not iess than the following: $1,000,000 (Primary and Excess) D. Equipment: Sponsor and or Sponsor's Contractor shall be solely responsible for its tools, equipment, supplies and materials on and off the jobsite, and shall require its subcontractors to be solely responsible for all maintenance, damage, destruction or theft of subcontractor's tools, equipment, supplies and materials on and off the jobsite until the work of this contract is completed, signed off and accepted by the District. VI. EACH such policy shall: A. Be issued by insurance carriers that are: 1. Licensed to transact insurance business in California; and / or 2. Rated no less than A, Class XI (11) for Wrap coverage and A-, Class VIII j for Auto and Worker's Comp by the current A.M. Best Guide B. Captive and/or Risk Retention groups are not acceptable unless rated no less than A, Class XI (11) for Wrap coverage and A-, Class VIII (8) for Auto and Worker's Comp by the current A.M. Best Guide; and VII. Non -admitted / Surplus Lines insurance carriers (carriers not license in the State of California), may be acceptable to the District under certain conditions. Non -admitted insurance carriers providing any form of insurance coverage must be: A. Domiciled in the United States; and / or Listed as an approved insurance carrier on the California Department of Insurance L. E. S.L. I. List; B. Rated no less than A, Class XI (11) for Wrap coverage and A-, Class VIII (8) for Auto and Worker's Comp by the current AM Best Guide; and C. Risk Retention Groups and/or Captive Insurance carriers are NOT acceptable unless they can provide an AM Best rating that meets the District's policy The District reserves the right to disqualify any admitted or non -admitted insured at any time. In the event an insurer does not meet the requirements herein, Contractor shall have 30 calendar days to submit replacement insurance in conformance with these requirements. VIII. Additional Insured: Name and list the District as an "Additional Named Insured" by utilizing endorsement from CG20 10 11/85 ed. or its equivalent (CG 2010 10/01ed with the CG 2037 10/01 ed. for example) to include completed operation/product coverage. Endorsements to the insurance contracts are required to be submitted with the certificates of insurance. A. WRAP programs may include "Blanket Additional Insured endorsement" to the CGL policy under the WRAP policy provided it also provides the equivalent coverage of the Accord CG 20 10 11/85 endorsement. 042011 Exhibit L Page 7 of 10 IX. Not to be cancelled reduced in coverage or limits, until thirty (30) days after receipt by the District of a written notice of such cancellation or reduction of coverages or limits as evidenced by receipt of a registered letter. X. Show evidence of renewal of an expiring policy in conformance with District Standards. 042011 Exhibit L Page 8 of 10 IF SPONSOR IS UNABLE TO FULFILL THE INSURANCE REQUIREMENTS STIPULATED HEREIN, SPONSOR HAS THE OPTION, WITH THE PRIOR WRITTEN CONSENT OF DISTRICT, TO: (a) (i) Cause a financial institution ("Bank") located and doing business in the State of California and acceptable to the District, to issue and deliver to the District an irrevocable standby letter of credit in the sum of One Million Dollars ($1,000,000.00) ("Letter of Credit"). The Letter of Credit shall be reasonably satisfactory to the District as to form and content. The Letter of Credit shall comply in all respects with District's policy or policies (collectively, "Policy") with respect to Letters of Credit on file at District's finance department, if any. In the event of a conflict between the provisions of this Section and the Policy, the Policy shall control. In the event the Sponsor fails to deliver to the District the Letter of Credit when required by the District, the Sponsor shall be required to provide to District all of the insurance required under this Exhibit L. The Letter of Credit shall provide that District shall have the absolute right to draw on the Letter of Credit upon notice to the Bank that there is a claim against the District under the indemnity set forth in the Agreement, or in the event the District determines that the insurance set forth in this Exhibit L would otherwise be applicable. The District, in its option, may draw all or a portion of the funds represented by the Letter of Credit. In the event the District draws on the Letter of Credit, the District shall deposit such sums in an account established by District and may be used by District to satisfy any obligations of Sponsor. If the Letter of Credit is not renewed within thirty (30) days prior to its expiration date and the requirements for release or termination of the Letter of Credit have not then been met, the full amount of the Letter of Credit may be drawn by the District. The Letter of Credit, or a substitute letter of credit ("Substitute Letter of Credit"), shall be renewed not less than thirty (30) calendar days prior to the expiration of the Letter of Credit or the Substitute Letter of Credit then in effect. If the Letter of Credit or Substitute Letter of Credit is not renewed within thirty (30) days prior to its expiration date and the request for release or termination of the Letter of Credit or Substitute Letter of Credit has not then been met, the full amount of the Letter of Credit or Substitute Letter of Credit may be drawn by District and deposited in an account established by District and may be used as provided in this Section. (ii) The District shall return the Letter of Credit or the Substitute Letter of Credit to the Sponsor three (3) years after the District has accepted the last facility or improvement to be constructed or installed by Sponsor under the Agreement. (b) (i) Cause a Bank located and doing business in the State of California and acceptable to the District, to issue and deliver to the District a Certificate of Deposit in the sum of One Million Dollars ($1,000,000.00) ("Certificate of Deposit"). The Certificate of Deposit shall be reasonably satisfactory to the District as to form and content. The Certificate of Deposit shall comply in all respects with District's policy or policies (collectively, "Policy") with respect to Certificates of Deposit on file at District's finance department, if any. In the event of a conflict between the provisions of this Section and the Policy, the Policy shall control. In the event the Sponsor fails to deliver to the District the Certificate of Deposit when required by the District, the Sponsor shall be required to provide to the District all of the insurance required under this Exhibit L. The Certificate of Deposit shall provide that District shall have the absolute right to draw on the Certificate of Deposit at any time the District determines, in its sole and absolute discretion, there is a claim 042011 Exhibit L Page 9 of 10 against the District under the indemnity set forth in the Agreement or in the event the District determines that the insurance set forth in this Exhibit L would otherwise be applicable. The District, at its option, may draw all or a portion of the funds represented by the Certificate of Deposit. In the event the District draws on the Certificate of Deposit, the District shall deposit such sums in an account established by District and may be used by District to satisfy any obligations of Sponsor. The Certificate of Deposit shall provide that it will automatically renew through such period of time which is three (3) years after the District has accepted the last facility or improvement to be constructed or installed by Sponsor under the Agreement. If the Bank does not allow for automatic renewal, Sponsor shall renew the Certificate of Deposit annually. If the Certificate of Deposit is not renewed within thirty (30) days prior to its expiration date and the requirements for release or termination of the Certificate of Deposit have not then been met, the full amount of the Certificate of Deposit may be drawn by the District. The Certificate of Deposit, or a substitute certificate of deposit ("Substitute Certificate of Deposit"), shall be renewed not less than thirty (30) calendar days prior to the expiration of the Certificate of Deposit or the Substitute Certificate of Deposit then in effect. If the Certificate of Deposit or Substitute Certificate of Deposit is not renewed within thirty (30) days prior to its expiration date and the request for release or termination of the Certificate of Deposit or Substitute Certificate of Deposit has not then been met, the full amount of the Certificate of Deposit or Substitute Certificate of Deposit may be drawn by District and deposited in an account established by District and may be used as provided in this Section. (ii) The District shall return the Certificate of Deposit or Substitute Certificate of Deposit to the Sponsor three (3) years after the District has accepted the last facility or improvement to be constructed or installed by Sponsor under the Agreement. 042011 Exhibit L Page 10 of 10 Project_seq num: 1031253 Document ID: 2267683 • STANDARD WATER AND/OR SEWER FACILITIES AND SERVICE AGREEMENT This Agreement is made and entered into this n day of \\1 , 20M, by and between EASTERN MUNICIPAL WATER DISTRICT a public agency ("District") and ASHBY USA LLC of CORONA , CA ("Sponsor"). RECITALS WHEREAS, Sponsor is planning to develop Tract No. RORIPAUGH RANCH OFFSITE WATER AND SEWER, as generally shown on the map attached hereto as Exhibit A, located within District's ® Water and/or ® Sewer Improvement District No(s) and Service Area(s) ISU25,IWU26,SA34,SA43 ; and WHEREAS, the water and/or sewer system facilities (Subject Facilities) which are generally shown and depicted on the map attached hereto as Exhibit B, are necessary to provide water and/or sewer service for said Subject Development; and WHEREAS, upon completion of the Subject Facilities and fulfillment of Sponsor's obligations and responsibilities, District shall own, operate, maintain and provide service through said Subject Facilities in accord with District's Rules, Regulations and Policies; and WHEREAS, the purpose of this Agreement and the Exhibits attached hereto and by this reference incorporated herein, is to set forth financial and other arrangements between District and Sponsor for the Subject Facilities, Sponsor's initial estimated cost of which is $1,754,100.00 as developed and shown on Exhibit C. NOW, THEREFORE, in consideration of the above recited premises, together with the mutual covenants herein contained and attached hereto, it is agreed that: 1. Terms and Conditions Applicable for this Agreement. Sponsor and District each agrees to fulfill and/or perform each of the obligations and responsibilities identified on Exhibit D as "Applicable" in accordance with the provisions, terms and conditions set forth in the respective paragraphs attached thereto. 2. Financial Participation Based on Sponsor's initial estimated cost developed in Exhibit C, less District's fixed financial participation in the amount of $0.00 as shown on Exhibit E, Sponsor's estimated final cost for thepubject Facilities is $1,754,100.00. 3. Documents to be Fumished to District by Sponsor Sponsor shall furnish to District each of the documents identified on Exhibit F as "Applicable". Each identified document shall be duly executed by Sponsor or the involved other party, and submitted to District in accord with the indicated time schedule for each respective document. Water Construction Order No. G 661 Sewer Construction Order No. 60 (:)? FOR DISTRICT USE ONLY (�111�Oti1 Assigned Date Assigned Date 11�17� ' 4. Payment to be Made by SDO sor to District • Unless noted otherwise, Sponsor shall make payment to District of each of the charges identified on Exhibit G as "Applicable" concurrently with Sponsor's execution and delivery of this Agreement to District. Where Sponsor has "deferred" payment of fees, such deferred charges shall be paid by Addendum to this Agreement prior to District's acceptance of the facilities and provision of service to the involved unit(s) 5. Credits to Sponsor Toward Payment of Applicable District Charges District will credit Sponsor with payment of applicable District charges in the amounts indicated on Exhibit H, which credits and all terms and conditions associated therewith are covered in the related documents attached thereto. 6. District's Right to Complete the Subiect Facilities District is hereby granted the unqualified right to complete, at Sponsor's non -reimbursable expense, all or a portion of the Subject Facilities in the event a circumstance arises which, in the opinion of the District, may be a threat to the public's health, safety or welfare. Prior to District taking such action, Sponsor will receive a written Notice specifying the involved problem and will be given a reasonable period of time to take remedial action, satisfactory to District, within the time specified in the Notice. Sponsor shall be exclusively responsible for any and all legal and/or financial ramifications and/or settlements with Sponsor's contractor. 7. Force Majeure If either the District or the Sponsor is delayed, hindered or prevented from performing any term of this Agreement, by any reason beyond either party's control, including without limitation any strike, walkout, inability to procure material, failure of power, restrictive laws or regulations, riot, war, act of God or the default of the other party, then such performance will be excused or tolled during the period of delay and the applicable time period or deadline !will be extended by a period equal to the period of such delay. 8. Service Limitations Following completion of construction and testing but prior to District's acceptance of the Subject Facilities, District may make service available from and through the Subject Facilities under a separate agreement by and between District and Sponsor. Sponsor hereby specifically agrees not to permit any portion or unit of the Subject Development to be occupied until the Subject Facilities have been accepted by District and all of Sponsor's obligations have been fulfilled, including payment of District charges and completion of improvement district annexation/formation legal proceedings, if applicable. 9. Agreement Limitations A. Relative to This Entire Agreement This Agreement shall automatically be canceled and become null and void if it has not been executed on behalf of Sponsor and District and Sponsor has not fulfilled all of its financial and other obligations which are required to be fulfilled concurrently with Sponsor's execution of this Agreement, on or before December 06, 2004; and B. Relative to Financial Participation Charges and Other District Charges The estimated amounts of all applicable Financial Participation Charges and other District Charges to be paid by Sponsor shall be subject to adjustment to reflect the then per unit amount applicable at the time the involved portion(s)/unit(s) have been completed and service is requested, all as determined by District. Sponsor agrees to pay the full adjusted amount of such District Charges prior to District's acceptance of the facilities and provision of service to the involved unit(s). 2 il For the purposes oits Agreement, the word completed shall be determined by District and mean: 1) Those water and/or sewer facilities which have been accepted and placed into service by District; and 2) Those units which have been certified for occupancy by the County of Riverside or the involved city (as appropriate) or otherwise approved for release by District for model home or landscape uses. 10. Hold Harmless District and Sponsor each hereby agree to indemnify and hold the other harmless from any and all claims for damage or damages to property or injuries to persons arising by reason of or in any mariner connected with the activities provided by the other party and/or its contractor(s). Such indemnification shall include attomeys' fees and court costs. 11. Preparation of This Agreement This Agreement shall riot be construed against the party preparing it, but shall be construed as if both parties prepared it. 12. Purpose of Captions Captions to Paragraphs are for convenience purposes only and are riot part of this Agreement. 13. Binding Provision This Agreement is binding on the heirs, representatives, successors and assigns of the parties hereto. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed as of the date first above written. EASTERN MUNICIPAL WATER DISTRICT By: c..N,% Dated: Fred Azimie'rlEngineering Associate II 1l \ice\ a\ 3 ASHBLLC y: �� Signa Dated: 10-13 - o4 VtArlio I `. /3 tnsy Pre.fictaA- (Pritit Name & Title) if 0 awilaMw®uVLmvYwn"LT 1 9 P i 8 5 8 8 8 6 6 6� a 1 1 V111331431 JO AlI3 I Cilic qiiiiii;4',4 loll i iiii ii B1 1 I fg .RR111 Pg R. id 111 I 86584485888888888888888888888888888888554 P IC 6 L 5 $ it,„ 1 i i '� [` 1 to.o0ija A k V N at w e4 EN -56A (Rev. 9/19/03) 4101 ( 410 EA&TERN MUNICIPAL WATER DISTRICT Developer: W .O./C.O.# Estimator's Initials: COST ESTIMATE FOR WATER FACILITIES Ashby Fiesta 99-387 JAT Tract: Roripau • h Ranch, I.D./S.A.# U -25/U26 & 34/43 Date: 11/06/03 Supervisor's Initials: VJB n - Typist Initials: Implementing Facilities: ' res . D No V7, WTI List (1) , . - . - - . (2) 16" WATER PER .! D-22587 Water Easement: ' Dyes f0 No Water Pressures: High Lots: Normal In Project Offsite Work Authorization: 0 Yes • No N/A Low Lots: Treatment Plant Notification: • Needed is Not Needed Plant: ■ Water 0 Sewer A. Pipeline Installation: 3,031 LF -12" PVC C-900 CL150; 3,713 LF -16" PVC C-905 CL235; 3,583 LF -18" PVC C-905 CL235 614,960 B. Valves, Hydrants, Flttings; & Misc. 5 EA -12" RSGV; 11 EA -16" RSGV: 3 EA -18" RSGV, 26 EA -STD FIRE HYDRANT, 5 EA -SUPER FIRE HYDRANT $ 153,400 6 EA -6" BLOWOFF. 11 EA -1" A.V. & A.R. 1 Vault IN/piping & Meter for Inter -tie C. Force Account Installation: (1) HOT TAP PROPOSED 16" PVC W/L WITH 16" TAPPED SLEEVE CONNECTION W/16" FXF RSGV BY EMWD AT $ 3,000 * DEVELOPER'S EXPENSE 16"X18" INCREASER. D. Install Service Connections 0 EA E. $ 0 0 meters (EMWD Installed on Dev. Installed service connection) $ 0 SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) Engineering (by Developer's Engineer) ( EMWD Inspection EMWD Plan Review As Guilts 25 sheets x $ 35 per sheet 6.40 %) (Subtotal 2) 4.70 %) (Subtotal 2) $ 771,360 $ 77,140 $ 848,500 $ 54,300 $ 39,880 * $ 2,000 * $ 875 * Exhibit "C" *Costs included In Exhibit G, Line A TOTAL ESTIMATED COST - WATER $ 945,555 EN -56B (Rev. 9/19/03) EASTERN MUNICIPAL WATER DISTRICT COST ESTIMATE FOR SEWER FACILITIES Developer: Ashby Fiesta W.O./C.O.# 99-387 Estimator's Initials: JAT Supervisor's Initials: Tract: Roripaugh Ranch Oa I.D./S.A.# U -25/U26 & 34143 VJB Jf1o; Date: November 6, 2003 Typist Initials: A. Sewer line Installation: 1,512 LF -9" SEWER MAIN; 921 LF -12" SEWER MAIN 8,738 LF -15" SEWER MAIN B. Installation of Manholes and Cleanouts: 34 EA -48" DIAMETER STD. MANHOLE 2 EA -MAINLINE CLEANOUT (SB -52) C. Misc. Installation: 1 EA -RECONSTRUCT EXIST MANHOLE; 401 LF -30" STEEL CASING 4 EA -SEWER PLUGS D. T.V. 11,071 feet of Sewer Line $ 491,770 $ 54,580 $ 121,300 $ 5,540 * SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) Engineering (by Developer's Engineer) ( 6.60 %) (Subtotal 2) EMWD Inspection ( 2.20 'A) (Subtotal 2) EMWD Plan Review As Builts 25 sheets x $ 35 per sheet $ 673,190 $ 67,320 $ 740,510 $ 48,870 $ 16,290 * $ 2,000 * $ 875 * Exhibit "C" *Costs included in Exhibit G, Line A TOTAL ESTIMATED COST - SEWER $ 808,545 v If NI"L7(o1. Implementing Facilities: List ❑ yes i No \ ` Sewer Easement: In Project ❑ Yes i No Sewer Backflow Valves: None Offsite Required Lots: Work Authorization: Yes ,, No Treatment Plant Notification: ❑ Needed ❑ Not Needed A. Sewer line Installation: 1,512 LF -9" SEWER MAIN; 921 LF -12" SEWER MAIN 8,738 LF -15" SEWER MAIN B. Installation of Manholes and Cleanouts: 34 EA -48" DIAMETER STD. MANHOLE 2 EA -MAINLINE CLEANOUT (SB -52) C. Misc. Installation: 1 EA -RECONSTRUCT EXIST MANHOLE; 401 LF -30" STEEL CASING 4 EA -SEWER PLUGS D. T.V. 11,071 feet of Sewer Line $ 491,770 $ 54,580 $ 121,300 $ 5,540 * SUBTOTAL 1: Contingencies:(10%) (Subtotal 1) SUBTOTAL 2: (Contingencies + Subtotal 1) Engineering (by Developer's Engineer) ( 6.60 %) (Subtotal 2) EMWD Inspection ( 2.20 'A) (Subtotal 2) EMWD Plan Review As Builts 25 sheets x $ 35 per sheet $ 673,190 $ 67,320 $ 740,510 $ 48,870 $ 16,290 * $ 2,000 * $ 875 * Exhibit "C" *Costs included in Exhibit G, Line A TOTAL ESTIMATED COST - SEWER $ 808,545 EiBLIGATIONS/RESPONSIBILITIES SPONSOR'S OBLIGATIONS/ PURSUANT TO NOT RESPONSIBILITIES RELATIVE TO: PARAGRAPH APPLICABLE APPLICABLE A Financial Participation 1 B Preparation of Construction Plans/Specifications 2 C Construction of Subject Facilities 3 D Pre -construction Conference/Project Coordination 4 /Designation of Authorized Representative E • Inspection of Construction 5 F Field Engineering, Surveys, Compaction and Materials 6 Strength Tests, Disinfection Requirements G Construction and Operate/Maintain Permits 7 H Easements 8 I Grant Deeds 9 J Cost Accounting Records 10 K Conveyance of Ownership 11 L Payment to Cover District's Expenses 12 M Environmental Information & Assistance 13 N Payment of Other Applicable Charges 14 O Improvement District annexation/Formation 15 P Assessment District Requirements 16 Q Street Address 17 R Water Pressure Conditions 18 S Treatment Plant Location Notification 19 T Sewer Backflow Device 20 U Special Terms and Conditions 21 ✓ Insurance Requirements 22 z z z z z z z z EI CI z z z z z z z z z DISTRICT'S OBLIGATIONS/ PURSUANT TO NOT REPSONSIBILITIES TO: PARAGRAPH APPLICABLE APPLICABLE A Financial Participation 1 0 B Plan Review and Approval 2 C Construction of Portions of the Facilities 3 0 D Inspection of Construction 5 E Determination of Final Total Costs 10 F Acceptance, Ownership, and Service Responsibilities 11 EXHIBIT D z • • STANDARD TERMS AND CONDITIONS APPLICABLE FOR WATER AND/OR SEWER FACILITIES AND SERVICE 1. Financial Participation Sponsor shall finance the total cost of the Subject Facilities, less District's financial participation, if any. Sponsor shall bill District for the amount of District's Fixed Financial Participation within thirty (30) calendar days after completion of the Subject Facilities and District's acceptance thereof. 2. Preparation of Construction Plans and Specifications Sponsor shall employ, at its sole expense, a qualified professional engineering firm to plan, design and prepare detailed construction plans and specifications for the Subject Facilities covered by this Agreement in accord with District standards. Such plans and specifications shall be reviewed and approved by District, in writing, prior to the beginning of any construction. 3. Construction of the Subject Facilities If the Subject Facilities are being funded with public funds, then Sponsor shall receive a minimum of four (4) competitive bids from properly licensed contractors for the Subject Facilities. With the written concurrence of District, Sponsor shall award the construction contract to the contractor with the lowest bid. In the event Sponsor employs other than the contractor with the lowest bid, the amount of Sponsor's credit shall be subject to adjustment to result, insofar as Is possible, in the amount of such credit being equal to the amount which would have resulted if Sponsor had awarded the contract to the lowest bid. Unless otherwise approved by District, District shall furnish all labor, materials and equipment necessary to connect the Subject Facilities to District's existing system facilities and may install other portions of the Subject Facilities, including water meters, as provided for in the plans and specifications. Any work performed by the District shall be paid by Sponsor on an actual (including overhead) cost basis. All facilities furnished, constructed and installed by Sponsor's contractor shall be installed in strict compliance with District approved plans and specifications. Sponsor may not deviate from such approved plans and specifications without prior written approval by District. Sponsor's contractor shall provide a one-year (following District's final acceptance) materials and workmanship guarantee. Any facilities damaged by any party prior to District's final acceptance or within the one-year warranty period, shall be repaired by Sponsor's contractor at no cost to District. If, however, temporary water service is being provided by District through a portion of the Subject Facilities prior to completion of the Subject Development, District shall make any and all repairs to that portion of the Subject Facilities at Sponsor's expense. Notwithstanding the foregoing, District shall have the unqualified right to immediately make any emergency repairs necessary to eliminate any threat to the public's health, safety or welfare and to ensure continuity of service at Sponsor's non -reimbursable expense. 4. Preconstruction Conference/Project Coordination/Designation of Sponsor's Authorized Representative Sponsor shall be responsible for coordinating all construction activities associated with the Subject Facilities and any other work to be performed by Sponsor's contractor. In this regard, Sponsor shall schedule a pre -construction conference with District personnel. It shall also be the responsibility of the Sponsor and Sponsor's contractor to hold safety conferences as required by law and comply with applicable Federal, State, local and District safety criteria. At or prior to the pre -construction conference, Sponsor shall officially, in writing, designate those who have authority to represent Sponsor relative to the furnishing and installation of the Subject Facilities and shall immediately advise the District of any subsequent changes in such authorized representation. 5. Inspection of Construction EXHIBIT D a • District shall be responsible for inspecting the work to be performed by Sponsor's contractor for compliance with the approved plans and specifications. District's inspection personnel shall have the authority to require that any and all unacceptable materials, workmanship and/or installation be replaced, repaired or corrected by Sponsor's contractor at contractor's expense. 6. Field Engineering Surveys, Compaction and Materials Strength Tests, and Disinfection Requirements Sponsor's engineer shall provide all field engineering surveys associated with the construction of the Subject Facilities and/or related work to be performed by Sponsor's contractor, as determined necessary by Sponsor's engineer, Sponsor's contractor, and/or District's inspection personnel, at Sponsor's direct expense. Sponsor shall promptly fumish to District all field notes and grade sheets, together with location, offset, and attendant data and reports, resulting from field engineering surveys and/or proposed facility design changes, all of which have been prepared in accordance with accepted professional engineering practices, and allow District sufficient time to approve or make any required facility design changes resulting therefrom prior to construction. Sponsor shall be responsible for paying all soil compaction, concrete and steel strength tests and report costs associated with the Subject Facilities required by Sponsor's engineer, appropriate public agency officials and/or District inspection personnel. Full-time professional soils (compaction) testing and full trench certification are required. Sponsor shall contract with a soils testing firm approved by District. A final report shall be required fully certifying trench compaction prior to acceptance of facilities. Sponsor shall promptly fumish results of all such compaction and concrete and steel strength testing to District for its evaluation as to compliance with the specifications. District shall make every reasonable effort to complete the evaluation within 72 hours after its receipt. Relative to water facilities, Sponsor's contractor shall be responsible for performing all disinfection procedures required by District and the costs associated therewith. 7. Construction and Operate and Maintain Permits Sponsor shall be responsible for obtaining a Construction Permit from the involved City or County agency for those portions, if any, of the Subject Facilities which are to be constructed within an existing City street and/or County road. At the same time such Construction Permit is obtained by Sponsor, the involved City or County agency will issue an Operate and Maintain Permit to District, which will become effective upon the completion of the involved Subject Facilities and District's acceptance thereof. 8. Easements Sponsor shall fumish to District, without cost, duly executed easement document(s) which assure Districts unequivocal right to own, operate and maintain the Subject Facilities. 9. Grant Deeds a) For annexation purposes only, Sponsor shall furnish to District a copy of the grant deed(s) verifying ownership of the property; or b) Sponsor shall, for the dollar consideration, if any, set forth in Exhibit C attached to this Agreement, furnish to District a duly executed Grant Deed(s) conveying to District clear unencumbered fee title to the parcel(s) of land identified on the map attached to this Agreement as Exhibit I. 10. Cost Accounting Records Sponsor shall maintain separate accounting records under which all its engineering and construction expenses for each segment/unit of the Subject Facilities will be individually shown and identified. At the time of the pre -construction conference, Sponsor shall provide District with preliminary accounting records showing the estimated cost of construction broken down by unit bid items. Final cost accounting records shall be submitted to the District within 90 days after completion of the Subject Facilities upon which District shall determine the Final Total Cost for each segment/unit of the Subject Facilities for capital value and other accounting record purposes and Sponsor's Final Financial Participation. 11. Conveyance of Ownership EXHIBIT D . • Concurrently with the execution of this Agreement, Sponsor shall execute the Bill of Sale attached to this Agreement as Exhibit J, conveying to District clear title to the Subject Facilities effective upon their completion and acceptance by District. In this regard, it is specifically understood and agreed that District is not obligated to accept title to or provide service through the Subject Facilities until final inspection (induding television) and testing has been completed and Sponsor has fulfilled its obligations and responsibilities provided for in this Agreement. Upon conveyance of ownership to District, District shall own, operate, maintain and provide service there through in accord with District Policies and Rules and Regulations. 12. Payments to District to Cover District's Expenses Concurrently with the execution of this Agreement, Sponsor shall make payment to District covering District's estimated engineering, inspection, material and construction related expenses. Such payment shall be subject to additional billing(s) to Sponsor, payable within 15 calendar days; or refund(s) by District, upon completion of construction and determination of District's actual incurred costs. Such payment(s) covering District expenses shall constitute a portion of Sponsor's costs to be included in Sponsor's cost accounting records. 13. Environmental Information and Assistance Upon request by District, Sponsor shall, at its sole expense, assist District in the preparation of an Environmental Impact Assessment, or, if necessary, furnish to District a complete Environmental Impact Report relative to the facilities covered by this Agreement and the Subject Development. In this regard, nothing herein shall be construed or interpreted to require District to take or participate in any legal action for the purpose of securing approval for the facilities covered by this Agreement or the developments to be served thereby. All such legal action shall be solely financed and conducted by Sponsor. 14. Payment of Other Applicable District Charges Prior to receiving service through the Subject Facilities, Sponsor shall pay to District applicable financial participation charges, frontage charges, and other charges as determined by District. 15. Improvement District Annexation/Formation Legal Proceeding Requirements If the lands to be occupied by the Subject Development are not already located within a District improvement district, Sponsor shall furnish District a petition, duly executed by the legal owners of all the involved lands, requesting that the lands be either annexed to an existing District improvement district or, the formation of a new District improvement district, as determined by District. Annexation must be complete prior to transfer of title of any of the involved lands and District's release for occupancy. 16. Assessment District Requirements a) If the lands to be occupied by the Subject Development are in one of the District's assessment districts and there has been a subdivision of the subject property subsequent to said assessment district formation, Sponsor shall pay the assessment at the time of agreement execution or go through an apportionment of assessment district procedures administered by the District personnel. b) Upon completion of the construction of the involved assessment district financed facilities and the determination of the final combined and individual cash assessments, the District shall determine and establish the amount of the portion, if any, of the cash assessment for each parcel within the involved assessment district which is to be credited by District toward partial payment of applicable District front footage and financial participation charges. EXHIBIT D • • 17. Street Addresses Concurrently with the execution of this Agreement, Sponsor shall furnish to District a list of approved street addresses for the development to be served by the Subject Facilities. 18. Water Pressures If pressures are expected to be in excess of 80 psi, Sponsor shall install, at his expense, a pressure regulator and/or relief valve. If pressures are expected to be less than 40 psi, Sponsor shall install, at his expense, a booster pump and low pressure switch, to be owned, operated and maintained by the subsequent lot owner. Service will not be provided if available system pressure is determined to be lower than 20 psi. Sponsor agrees to inform subsequent lot owners of high or low water pressure conditions and will hold District harmless from any damages resulting from such condition. A Pressure Agreement executed by the Sponsor/lot owner will be recorded with the County holding District harmless from any damages caused by low or high pressures. 19. Treatment Plant Location Notification In the event any portion of the Subject Development is located within one quarter (1/4) mile of a District treatment plant facility site, Sponsor shall execute a Notice of Condition, recorded with the County, acknowledging the existence and location of the treatment plant and the possibility of nuisance conditions under certain operational and climatic conditions. Such Notice will run with the real property and shall be binding upon subsequent property owners. 20. Sewer Backflow Device Sewer backflow devices will be required for those lots, if any, specified on the construction drawings. Sponsor will fumish and install, at Sponsor's cost, sewer backflow devices in accordance with District standards and specifications, prior to project or lot release by District. 21. Special Terms, Conditions and/or Requirements Sponsor shall fulfill all the Special Terms, Conditions and Requirements set forth in Exhibit K attached to this Agreement. 22. Insurance Requirements Prior to the Pre job construction meeting, Sponsor or Sponsor's contractor, shall provide District with certificates of insurance coverage in accordance with the requirements set forth in Exhibit L attached to this Agreement. EXHIBIT D • • DOCUMENTS TO BE FURNISHED Due Not DOCUMENTS(S): Date Applicable Applicable A City/County/Road Permits (a) ® 0 B Easements (a) 0 El C Deeds (a) 0 El D Final Cost Accounting Records (b) ® 0 E Bill of Sale (c) ® ❑ F Petition for Improvement District Annexation/Formation (c) 0 El G Billing for District's Financial Participation Charges (d) 0 El H List of Street Addresses (c) 0 El I Water Pressure Agreement(s) (a) 0 El J Treatment Plant Location Notification (a) 0 El K Preliminary Cost Accounting Records (a) 0 El L Certificate(s) of Insurance (a) ® 0 (a)Prior to Pre -construction Meeting. (b)Within 90 calendar days after District's acceptance of the Subject Facilities. (c)Upon Sponsor's execution and delivery of this Agreement to District. (d)Within 30 calendar days after District's acceptance of the Subject Facilities. EXHIBIT F E ATE OF CHARGES TO BE PAID BY sSSOR NOT PAYMENT FOR: AMOUNT ` APPLICABLE APPLICABLE A. Estimated District Engineering & Inspection Expenses $ 67,460.00 ® 0 B. Estimated District Material & Construction Expenses 3,000.00 ® 0 C. Non -Reimbursable Frontage Fees: (1) Water 0.00 0 El (2) Special Water 0.00 0 El (3) Sewer 0.00 0 El (4) Special Sewer 0.00 0 El D. Financial Participation Charges: (1) Domestic Water System Facilities 0.00 0 El (2) Domestic Water System Facilities (Landscape) 0.00 0 El (3) Sewer System & Reclaimed Water Facilities 0.00 0 El (4) Sewer Treatment Plant Capacity Charges 0.00 ❑ El E. Water for Testing Purposes (Construction Water) 0.00 0 El F. Meters 0.00 0 El G. Source Control Fees 0.00 0 El H Per Addendum Processing Fee 0.00 0 El $ 70,460.00 $ $ Total Less Previous Fees Paid on 08/14/01 Amount to be Remitted with Agreement *FEES DEFERRED UNTIL SERVICE IS REQUESTED See Exhibit G-2 for estimated amount 2,500.00 67,960.00 ALL CHARGES SHALL BE SUBJECT TO ADJUSTMENT TO REFLECT THE APPLICABLE PER UNIT CHARGE AT THE TIME SERVICE IS REQUESTED (SEE Paragraph 9.B of Agreement) EXHIBIT G • • CREDITS TO SPONSOR TOWARD PAYMENT OF APPLICABLE DISTRICT CHARGES AMOUNT OF NOT DESCRIPTION OF WATER RELATED CREDITS CREDIT APPLICABLE APPLICABLE Nonreimbursable Charges Credited to Sponsor: 1) Capacity Charges (Sponsor Required Capacity) 0 El Potentially Reimbursable Charges Credited to Sponsor: 1) Water Frontage Charges 2) Additional Special Water Frontage Charges 3) Capacity Charges Credit 4) Other Water Frontage Charges Previously Paid By Others DESCRIPTION OF SEWER RELATED CREDITS Nonreimbursable Charges Credited to Sponsor: 1) Capacity Charges (Sponsor Required Capacity) Potentially Reimbursable Charges Credited to Sponsor: 1) Sewer Frontage Charges 2) Additional Special Sewer Frontage Charges 3) Capacity Charges Credit 4) Other Sewer Frontage Charges Previously Paid By Others Attachments: H-1 Frontage Charge Memorandum H-2 Computation of Capacity Credits EXHIBIT H 1 • BILL OF SALE For a valuable consideration, receipt of which is hereby acknowledged ASHBY USA LLC, Tract RORIPAUGH RANCH OFFSITE WATER & SEWER (Seller), hereby bargains, conveys, and grants unto the Eastern Municipal Water District (District), a public agency of the State of California, the following described personal property, such conveyance to become effective upon completion of the construction/installation by Seller's Contractor(s) and acceptance by the District of such personal property, which is more specifically described as: The Subject Facilities which are to be furnished and constructed by Sponsor's Contractor(s) as described and provided for in that certain Agreement, by and between Sponsor (Seller in this Bill of Sale) and District, dated , to which this Bill of Sale is attached as Exhibit J. Seller hereby warrants that the above-described personal property is free and clear of any and all encumbrances. In this regard Seller hereby agrees to protect and defend (Districts) right to own, operate, maintain and provide services through all the personal property hereby transferred to District's ownership wherein the defense of the District's right to own, operate, maintain and provide services as provided hereinabove results from any person or entity's alleged rights to any of the personal property described hereinabove or for any monetary damages resulting from the nonpayment by Seller of any person or entity having the right to file a lien against said personal property. Seller further agrees to indemnify the District for any and all losses which may be occasioned or suffered by the District as a result of any claims by others as to clear title of the personal property covered hereby. Subscribed and sworn to before me this _ day of 200_ 0 Z ✓ (Signature) C Notary Public in and for the State of California V[1't�in k. /S lA (Print Name ancrTitle) Expiration Date Dated: 10 ' 13 " a 4 EXHIBIT J CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of y n •_. }ss. On 10-13 1111 Datteo before me, T mtC\/ 1 , B`(C3i Bone, NO-Var�( Fl ibli�/ Name and Title of Officer (e.g., "JaneAoe, Notary Public) �1 personally appeared U�1 n 0 5ND Name(s) of Signets) "personally known to me D proved to me on the basis evidence of satisfactory to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. m C id OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document ,11 Its• Description of Attached Document S Title or Type of Document: �J f I 1 rP C9I;L) CJ vl Document Date: Number of Pages: exh W E 1 w Signer(s) Other Than Named Above: 4 ,_,1 h Capaclty(les) Claimed by Signer f• c.iiN, Signer's Name: l ❑ Individual L!1 0 Corporate Officer — Title(s): 0 Partner — 0 Limited ❑ General g 0 Attorney -in -Fact g ❑ Trustee g 1 0 Guardian or Conservator 0 14D Other: 3, ( Signer Is Representing: 1) 2'" \-.. ✓ \.4•. 4V.�. ,,,,•- \_,4 • ..\_,.-! • .`✓ rig`.---'4s`,.L.4'�•.4 `..s 4�J.-'-�4�..` :ti w,. • 4:• , • v Signature f Notary Public gn re o o u s RIGHT Ti OFS f-IJIABPRINT GNER Top of thumb here ®1999 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.nationalnotaryorg Prod. No. 5907 Reorder. Call Toll -Free 1-800-876-6827 • • SPECIAL TERMS AND CONDITIONS # Sewer and /or Water Financial participation charges are to be determined at the time of Application for Service. Application for Service will require an individual addenda to this agreement upon submittal of plot plans, city conditions, etc. by each respective site developer. # IMPLEMENTING FACILITIES Water 1. 16" Water per MS 3767 D-22587/ Sewer 1. None. EXHIBIT K Revision: 7/06/04 EXHIBIT L — DEVELOPER INSURANCE REQUIREMENTS Prior to the Pre job construction meeting, Sponsor or Sponsor's contractor, shall provide District with certificates of insurance coverage in accordance with these requirements. In addition, Sponsor or sponsor's contractor shall not commence work under this contract until he has obtained all policies of insurance required hereunder, nor shall he allow any subcontractor to commence work until all policies of insurance required of the subcontractor have been obtained. Sponsor or Sponsor's contractor shall, during the life of this contract, notify District in writing of any incident, either under his jurisdiction, or any of his subcontractors, giving rise to any potential Bodily Injury or Property Damage claim and any resultant settlements, whether in conjunction with this or any other project which may affect the limits of the required coverage, as soon as is reasonable and practical. Sponsor or Sponsor's contractor, and each of his subcontractors, shall take out and maintain the following policies of "occurrence form" type insurance, with coverages acceptable to the District, at his sole cost and expense at all times during the life of this contract, including the entire time of the Contractor's guarantee: a. Workers' Compensation Insurance. The District requires that Contractor cover his employees as required by Section 3700 of the Labor Code of the State of California, and Contractor shall require all subcontractors similarly to provide such workers' compensation insurance for all subcontractor's employees. Such policy shall contain an endorsement that waives all right of subrogation against those persons or entities designated in the policy of Commercial Liability Insurance. b. Commercial Liability Insurance. The Contractor shall procure and maintain Commercial Liability Insurance in amounts not less than the following: $1,000,000 Each Occurrence $2,000,000 General Aggregate $2,000,000 Products -Completed Operations Aggregate Where excess liability insurance is used in connection with primary liability insurance the combination of such must allow total limits of liability to be in amounts not Tess than the above specified amounts. EXHIBIT L c. Automobile Liability Insurance. The Contractor shall procure and maintain Automobile Liability Insurance in amounts not Tess than the following: $1,000,000 Combined Single Limit Where excess liability insurance is used in connection with primary liability insurance the combination of such must allow total limits of liability to be in amounts not less than the above specified amounts. Each such policy of insurance shall: 1. Be issued by insurance carriers that are: a. Licensed to transact insurance business in California; and b. Rated no less than A-, Class VII (7) by the A.M. Best Company. Any insurance carver, which is strategically affiliated with a parent insurance company or insurance group, must disclose the name of the parent company or group in any certificate of insurance documentation provided to the District. Non-admitted/Surplus Lines insurance carriers (carriers not licensed in the State of California), may be acceptable to the District under certain conditions. Non -admitted insurance carriers providing any form of insurance coverage must be: a. Domiciled in the United States; and, b. Listed as an approved insurance carrier on the California Department of Insurance L.E.S.L.I. list; and, c. Rated no Tess than A-, Class VII (7) by the A.M. Best Company. d. Risk Retention Groups and Captive Insurance carries are not acceptable unless they can provide an AM Best rating that meets District's policy" The District reserves the right to disqualify any non -admitted insurer at any time without cause. 2. Name and list the District as "Additional Insured" by utilizing endorsement form CG -20 10 or similar executed by the insurance carrier". 3. Not be canceled, reduced in coverage or limits until thirty (30) days after receipt by the District of a written notice of such cancellation or reduction of coverages or limits, as evidenced by receipt of a registered letter; 4. Show evidence of renewal of an expiring policy once the insurance has been approved by the District. Prior approval must be obtained if the coverage or limits of the policy or the carrier has changed. EXHIBIT L • • MEMORANDUM OF UNDERSTANDING FOR TEMPORARY WATER AND/OR SEWER SERVICE This Memorandum of Understanding (MOU) is entered into by and between ASHBY USA LLC, hereinafter referred to as "Sponsor" and Eastern Municipal Water District, a public agency, hereinafter referred to as `"District. 1. On 11 `'•", 2001. , a Standard Water and/or Sewer Facilities Service Agreement was entered into between Sponsor and District setting forth financial and other arrangements associated with the subject facilities and the provision of service therethrough. Paragraph 8 of the agreement provided for the execution of a Special Water and/or Sewer Interim Facilities Agreement to make service available prior to District's acceptance of said water and/or sewer facilities. This agreement serves that purpose with the following conditions: a. District agrees to provide temporary water and/or sewer service to those units described on Exhibit "A," attached hereto and by this reference incorporated herein, upon receipt of written notice from Sponsor requesting such service. Notice shall be received by District no less than thirty (30) days prior to the need for temporary service by Sponsor; b. District shall have no obligation to provide temporary water and/or sewer services to any other unit or any portion of the property described and/or depicted in the agreement, unless described in Exhibit "A." No course of dealing between Sponsor and District will operate as an implied or express right to receive temporary water and/or sewer service to any portion of Sponsor's property, except as set forth in a written instrument signed by both parties; c. Sponsor shall remit a $26 processing fee per addendum for Occupancy Release requests, subject to no less than four (4) lots per addendum; and d. Sponsor, at its expense, shall make any repairs or alterations to facilities if they fail to meet District approved standards. 2. Paragraph 11 of Exhibit D to the Standard Water and/or Sewer Facilities Agreement states that upon completion of the water and/or sewer facilities by Sponsor and acceptance of ownership by District, the District will provide service through such facilities in accordance with District's applicable rules and regulations. All of the parties' rights and obligations herein shall cease and be of no further force or effect. 3. District hereby agrees to provide interruptible domestic water service and/or sewer service pending Sponsor's completion of all facilities and acceptance of ownership by District as specified in the Standard Water and/or Sewer Facilities Agreement if the following conditions are met by Sponsor: a. Hold Harmless. Sponsor hereby agrees to indemnify and hold District harmless from any and all claims for damage to property or injuries to persons arising by reason of or in any manner connected with the temporary operations covered by the Agreement and this MOU. Such indemnification shall include attorneys' fees and court costs; and 1 Document ID: 2267690 • • b. Insurance Policy. Sponsor shall continuously maintain in full force and effect during the term of this MOU, the policies and limits of insurance coverage as set forth in Exhibit L of the Standard Water and/or Sewer Facilities Service Agreement. c. District Inspection/Acceptance. District's inspection personnel shall have authority to enforce District approved construction plans and specifications. Such authority shall include the authority to require Sponsor to make repairs or replace unacceptable materials during the period of temporary utility service. Final District acceptance shall follow District's final inspection and testing and completion of all improvements including other utilities, curbs and paving. District's inspection does not include inspection for compliance with safety requirements by Sponsor or its contractors or subcontractors. Any inspection completed by District shall be for its own benefit, and neither Sponsor nor any third party shall be entitled to rely thereon for any purpose. 4. It is understood and agreed by Sponsor that any changes to the terms and conditions of this MOU or the Agreement shall be in writing and signed by Sponsor and District and that District retains the right to terminate temporary utility service to or through Sponsor's facilities at any time as determined by District in accordance with applicable rules and regulations. 5. This MOU is of no effect until executed by both parties. 6. In the event suit is brought to enforce or interpret any part of the Agreement or this MOU, the prevailing party shall be entitled to recover costs and expenses of the action, including, without limitation: a. Attorneys' fees; b. Direct general overhead and administrative costs incurred by said party in connection with the preparation for and/or participation in the action, including, but not limited to, assisting in investigations and discovery, participating in depositions and in any trial or similar proceeding, and the preparation of records, reports, diagrams, maps and other writings (as defined in Section 250 of the Califomia Evidence Code); c. Expert witness fees; d. Transcript costs, court costs and other similar costs; e. Consultant's fees; f. Any other miscellaneous costs directly relating to the claim or action. SPO . • ' EASTERN MUNICIPAL WATER DISTRICT Y USA LLC By: � • Cwt 2 Fred Azimie, Ciineering Associate 1I Document ID: 2267690 • LEGAL DESCRIPTION PSN#1031253, Tract RORIPAUGH RANCH OFFSITE WATER AND SEWER EXHIBIT A 3 Document ID: 2267690 CITY OF TEMECULA BUTTERFIELD STAGE ROAD EXTENSION Circulation Project Protect Description: Complete design and construction of four lanes on Butterfield Stage Road from Rancho California Road to Murrieta Hot Springs Road, four lanes on Murrieta Hot Springs Road from Butterfield Stage Road to the City limits, and two lanes on Calle Chapos from Butterfield Stage Road to Walcott Road, totaling approximately 3.2 miles. Benefit: Project will improve traffic circulation by providing a much needed north and south arterial road in the eastern side of the City. Project Status: This project is estimated to be complete in future years. Department: Public Works—Account No. 210.165.723 Project Cost: Actuals to Date 2011.12 2012.13 Priority: I Future Total Project 2013-14 2014-15 2015-16 Years Cost Administration $ 416,474 $ 450,236 $ 525,750 $ 100,000 $ 1,492,460 Acquisition $ 15,006,728 $ 50,000 $ 2,001,352 $ 17,058,080 Construction` $ 25,481 $ 10,173,808 $ 12,484,790 $ 920,459 $ 23,604,538 Construction $ 1,438,000 $ 1,438,000 Engineering $ 8,875 $ 175,562 $ 175,563 $ 1,020,459 $ - $$ - $ 360,000 Design $ 298,508 $ 108,896 $ 52,500 $ 459.904 Environmental $ 40,000 $ 200,000 $ 240,000 Totals $ 15,756,066 $ 10,998.502 $ 15,439,955 $ 1,020,459 $ - $ - $ - $ 43,214,982 Actua Is Source of Funds: to Date 2011-12 2012-13 Future Total Project 2013-14 2014-15 2015-16 Years Cost CFD (Roripaugh Ranch) $ 14,318,066 $ 10,824,694 $15.439,955 $ 1,020,459 $ 41,603,174 Reimbursement/ Other (Shea Homes) $ 173,808 $ 173,808 TUMF $ 1,438,000 $ 1,438,000 Total Funding: $ 15,756,066 $ 10,998,502 $ 15,439,955 $ 1,020,459 $ - $$ - $ 43,214,982 Future Operation & Maintenance Costs: 2012-13 2014-15 *Construction funding is for Phase I in 2011-12 and Phase II in 2012-13 Note: Assumes that only minor right-of-way acquisitions would be necessary and that all major right-of-way dedications are voluntary. 45 ggi U ( w z �z v 11.s �� R COUNTRY MEIN D BUTTERFIELD STAGE ROAD EXTENSION Circulation Project Location SPRINGS RD CAMINO CIELO m r z I GH VALLEyRD LIEFER RD SOUTH LOOP RD Yp KAREN LYNN LN 10 z f� ORO VISTA DEL MO�f= ERD Aerial Data - March 2010 Feet 0 375 750 1,500 44 Item No. 10 TO: FROM: DATE: SUBJECT: Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT City Manager/City Council Greg Butler, Director of Public Works / City Engineer December 13, 2011 Cooperative Agreement with Caltrans for Construction of Phase 1 of the French Valley Parkway Interchange, Project No. PW07-04 PREPARED BY: RECOMMENDATION: Amer Attar, Principal Engineer Avlin R. Odviar, Senior Engineer — CIP That the City Council adopt a resolution entitled: RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING A COOPERATIVE AGREEMENT, NO. 08-1508, BETWEEN THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION (CALTRANS) AND THE CITY OF TEMECULA FOR THE CONSTRUCTION OF THE FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER - CROSSING AND INTERCHANGE IMPROVEMENTS PROJECT — PHASE I BACKGROUND: The French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements Project proposes freeway and local arterial improvements designed to reduce current and projected traffic congestion, improve safety and operations, and provide alternative access to Interstate -15 (1-15). Project implementation will occur in two distinct phases, Phase 1 and Phase 11. Phase 1 is designed to provide interim relief by constructing elements which will reduce 1-15 southbound congestion, while Phase 11 will follow up with the balance of proposed improvements. Construction of projects on the state highway system such as this one are typically administered by the State of California, Department of Transportation (Caltrans), but may be delegated to a local agency at the discretion of Caltrans. On March 11, 2011, the City requested authorization to perform the construction contract Advertisement, Award, and Administration (AAA) activities for Phase 1. This request was approved by Caltrans in a letter dated June 28, 2011. The subject Cooperative Agreement No. 08-1508 has been developed in consideration of the delegation of authority from Caltrans to the City and establishes the general conditions, methods, and procedures for implementation of the construction of Phase I. In summary, the City will be responsible for advertising, awarding, and administering the construction contract in accordance with all applicable laws and regulations, while Caltrans will retain its oversight responsibilities. With the exception of Source Inspection activities, each agency will provide staffing and resources for its respective responsibilities. Source Inspection is an established practice of accepting materials manufactured or prefabricated at locations other than the job site. It involves travelling to and from various plants to review and inspect the raw materials, manufacturing processes, and final products of the actual project suppliers. Caltrans requires that certain items undergo Source Inspection as part of the quality assurance process (e.g. steel reinforcement bars to be used in Caltrans bridges). Caltrans maintains in-house staff qualified to perform Source Inspection. As the ultimate owner and maintainer of these items, it is appropriate and common practice for Caltrans to perform Source Inspection. The Cooperative Agreement No. 08-1508 includes provisions which commit the City to pay for the actual costs of Source Inspection up to a maximum of $65,000. FISCAL IMPACT: The French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements Project — Phase I is included in the City's Capital Improvement Program FY 2012-2016 with multiple sources of funds. The subject Cooperative agreement is funded with TUMF funds secured by reimbursements agreements with RCTC & WRCOG. There are sufficient funds within the project account 210-165-719-5805 to cover the cost of this agreement, $65,000. ATTACHMENTS: 1. Cooperative Agreement. 2. Resolution 11-_ 3. Project Location. 4. Project Description. 08-RIV-15 PM 6.6 / 7.8 (KP 10.6/ 12.5) EA: 43271 District Agreement 08-1508 Project Number 0800000670 COOPERATIVE AGREEMENT This agreement, effective on , is between the State of California, acting through its Department of Transportation, referred to as CALTRANS, and: City of Temecula, a body politic and municipal corporation or chartered city of the State of California, referred to as CITY. For the purpose of this agreement, the term PARTNERS collectively refers to CALTRANS and CITY (all signatory parties to this agreement). The term PARTNER refers to any one of those signatory parties individually. RECITALS 1. California Streets and Highways Code sections 114 and 130 authorize PARTNERS to enter into a cooperative agreement for performance of work within the State Highway System (SHS) right of way. 2. This agreement outlines the terms and conditions of cooperation between PARTNERS to complete the construction of the PROJECT for the construction of a portion of a new interchange, on Interstate 15 at the French Valley Parkway in the City of Temecula and City of Murrieta (Phase I), which consists of the construction of the new southbound off - ramp at French Valley Parkway and provision of a second lane on the Winchester southbound off -ramp along with auxiliary lane on approach. For the purpose of this agreement, the construction of a portion of a new interchange, on Interstate 15 (I-15) at the French Valley Parkway in the City of Temecula and City of Murrieta (Phase I), which consists of the construction of two through lanes on French Valley Parkway westbound from I-15 to Jefferson Avenue; one lane of the southbound exit ramp; the southbound auxiliary lane from French Valley Parkway interchange to the Winchester Road interchange southbound exit ramp; and widening of the Winchester Road southbound exit ramp from one to three lanes, will be referred to as PROJECT. All responsibilities assigned in this agreement to complete the construction of the PROJECT will be referred to as OBLIGATIONS. 3. CALTRANS developed the Project Initiation Document; CITY developed the Project Report. PACT Version 10.1.2011_02_17 1 of 22 District Agreement 08-1508 4. As per Cooperative Agreement No. 1217 as amended by 1217 A/1 CITY is developing Plans, Specifications and Estimate (PS&E) and the Right of Way(R/W) Certification for PROJECT . 5. CITY prepared the environmental documentation for PROJECT. CITY, as the CEQA Lead Agency signed Mitigated Negative Declaration for the Initial Study pursuant to CEQA, on December 12, 2009. CALTRANS, as the NEPA Lead Agency, signed the Finding of No Significant Impact for the Environmental Assessment pursuant to NEPA, on January 29, 2010. 6. The estimated date for COMPLETION of OBLIGATIONS is December 31, 2016. 7. In this agreement capitalized words represent defined terms and acronyms. The Definitions section contains a complete definition for each capitalized term. 8. From this point forward, PARTNERS define in this agreement the terms and conditions under which they will accomplish OBLIGATIONS. RESPONSIBILITIES 9. CITY is SPONSOR for 100% of PROJECT. 10. CALTRANS will provide IQA for the portions of WORK within existing and proposed SHS right of way. CALTRANS retains the right to reject noncompliant WORK, protect public safety, preserve property rights, and ensure that all WORK is in the best interest of the SHS. 11. CITY may provide IQA for the portions of WORK outside existing and proposed SHS right of way. 12. CITY is the only FUNDING PARTNER for this agreement. CITY's funding commitment is defined in the FUNDING SUMMARY. 13. CITY is the CEQA Lead Agency for PROJECT. 14. CALTRANS is the CEQA Responsible Agency for PROJECT. 15. CALTRANS is the NEPA Lead Agency for PROJ ECT. 16. CITY is IMPLEMENTING AGENCY for CONSTRUCTION. PACT Version 10.1.2011 02 17 2 of 22 SCOPE Scope: General District Agreement 08-1508 17. PARTNERS will perform all OBLIGATIONS in accordance with federal and California laws, regulations, and standards; FHWA STANDARDS; and CALTRANS STANDARDS. 18. IMPLEMENTING AGENCY for a PROJECT COMPONENT will provide a Quality Management Plan (QMP) for that component as part of the PROJECT MANAGEMENT PLAN. The District Construction Division, with input from Structure Construction must approve the Quality Management Plan (QMP) before the encroachment permit for construction is issued. 19. Any PARTNER may, at its own expense, have representatives observe any OBLIGATIONS performed by another PARTNER. Observation does not constitute authority over those OBLIGATIONS. 20. Each PARTNER will ensure that all of its personnel participating in OBLIGATIONS are appropriately qualified, and if necessary licensed, to perform the tasks assigned to them. 21. IMPLEMENTING AGENCY shall retain consultants and shall invite CALTRANS to participate in the selection and retention of consultants that participate in OBLIGATIONS. At least one representative from the Construction Division of CALTRANS shall participate in the selection process. A construction management firm shall not be selected without the approval by this representative. 22. If WORK is done under contract (not completed by a PARTNER's own employees) and is governed by the California Labor Code's definition of "public works" (section 1720(a)(a)), that PARTNER will conform to sections 1720 — 1815 of the California Labor Code and all applicable regulations and coverage determinations issued by the Director of Industrial Relations. 23. IMPLEMENTING AGENCY for each PROJECT COMPONENT included in this agreement will be available to help resolve problems generated by that component for the entire duration of PROJECT. 24. CALTRANS will issue, upon proper application, the encroachment permits required for WORK within SHS right of way. Contractors and/or agents, and utility owners will not perform WORK without an encroachment permit issued in their name. 25. If any PARTNER discovers unanticipated cultural, archaeological, paleontological, biological, or other protected resources during WORK, all WORK in that area will stop and that PARTNER will notify all PARTNERS within 24 hours of discovery. WORK PACT Version 10.1.201132_17 3 of 22 District Agreement 08-1508 may only resume after a qualified professional has evaluated the nature and significance of the discovery and a plan is approved, by all PARTNERS, for its removal or protection of the discovered resource. 26. PARTNERS will hold all administrative drafts and administrative final reports, studies, materials, and documentation relied upon, produced, created, or utilized for PROJECT in confidence to the extent permitted by law. Where applicable, the provisions of California Government Code section 6254.5(e) will govern the disclosure of such documents in the event that PARTNERS share said documents with each other. PARTNERS will not distribute, release, or share said documents with anyone other than employees, agents, and consultants who require access to complete PROJECT without the written consent of the PARTNER authorized to release them, unless required or authorized to do so by law. 27. If any PARTNER receives a public records request, pertaining to OBLIGATIONS, that PARTNER will notify PARTNERS within five (5) working days of receipt and make PARTNERS aware of any disclosed public records. PARTNERS will consult with each other prior to the release of any public documents related to the PROJECT. 28. If HM -1 or HM -2 is found during a PROJECT COMPONENT, IMPLEMENTING AGENCY for that PROJECT COMPONENT will immediately notify PARTNERS. 29. CALTRANS, independent of PROJECT, is responsible for any HM -1 found within the existing SHS right of way. CALTRANS will undertake HM MANAGEMENT ACTIVITIES related to HM -1 with minimum impact to PROJECT schedule. 30. CITY, independent of PROJECT, is responsible for any HM -1 found within PROJECT limits and outside the existing SHS right of way. CITY will undertake or cause to be undertaken HM MANAGEMENT ACTIVITIES related to HM -1 with minimum impact to PROJECT schedule. 31. If HM -2 is found within PROJECT limits, the public agency responsible for the advertisement, award, and administration (AAA) of the PROJECT construction contract will be responsible for HM MANAGEMENT ACTIVITIES related to HM -2. 32. CALTRANS' acquisition or acceptance of title to any property on which any HM -1 or HM -2 is found will proceed in accordance with CALTRANS' policy on such acquisition. 33. PARTNERS will comply with all of the commitments and conditions set forth in the environmental documentation including the environmental commitments record, environmental permits, approvals, and applicable agreements as those commitments and conditions apply to each PARTNER's responsibilities in this agreement. PACT Version 10.1.2011_02_17 4 of 22 District Agreement 08-1508 34. IMPLEMENTING AGENCY for each PROJECT COMPONENT will furnish PARTNERS with written monthly progress reports during the implementation of OBLIGATIONS in that component. 35. Upon COMPLETION of OBLIGATIONS, ownership or title to all materials and equipment constructed or installed for the operations and/or maintenance of the SHS within SHS right of way as part of WORK become the property of CALTRANS. CALTRANS will not accept ownership or title to any materials or equipment constructed or installed outside SHS right of way. 36. IMPLEMENTING AGENCY for a PROJECT COMPONENT will accept, reject, compromise, settle, or litigate claims of any non -agreement parties hired to do WORK in that component. 37. PARTNERS will confer on any claim that may affect OBLIGATIONS or PARTNERS' liability or responsibility under this agreement in order to retain resolution possibilities for potential future claims. No PARTNER will prejudice the rights of another PARTNER until after PARTNERS confer on claim. 38. PARTNERS will maintain, and will ensure that any party hired by PARTNERS to participate in OBLIGATIONS will maintain, a financial management system that conforms to Generally Accepted Accounting Principles (GAAP), and that can properly accumulate and segregate incurred PROJECT costs, and provide billing and payment support. 39. PARTNERS will comply with the appropriate federal cost principles and administrative requirements outlined in the Applicable Cost Principles and Administrative Requirements table below. These principles and requirements apply to all funding types included in this agreement. PACT Version 10.1.2011_02_17 5 of 22 District Agreement 08-1508 40. PARTNERS will ensure that any party hired to participate in OBLIGATIONS will comply with the appropriate federal cost principles and administrative requirements outlined in the Applicable Cost Principles and Administrative Requirements table below. Applicable Cost Principles and Administration Requirements The federal cost principles and administrative requirements associated with each organization type apply to that organization. Organization Type Cost Principles Administrative Requirements Federal Governments 2 CFR Part 225 OMB A-102 State and Local Government 2 CFR, Part 225 49 CFR, Part 18 Educational Institutions 2 CFR, Part 220 2 CFR, Part 215 Non -Profit Organizations 2 CFR, Part 230 2 CFR, Part 215 For Profit Organizations 48 CFR, Chapter 1, Part 31 49 CFR, Part 18 CFR (Code of Federal Regulations) OMB (Office of Management and Budget) Related URLs: • Various OMB Circular: http://www.whitehouse.gov/omb/grants_circulars • Code of Federal Regulations: http://www.gpoaccess.gov/CFR 41. PARTNERS will maintain and make available to each other all OBLIGATIONS -related documents, including financial data, during the term of this agreement. 42. PARTNERS will retain all OBLIGATIONS -related records for three (3) years after the final voucher. 43. PARTNERS have the right to audit each other in accordance with generally accepted governmental audit standards. CALTRANS, the state auditor, FHWA, and CITY will have access to all OBLIGATIONS -related records of each PARTNER, and any party hired by a PARTNER to participate in OBLIGATIONS, for audit, examination, excerpt, or transcription. The examination of any records will take place in the offices and locations where said records are generated and/or stored and will be accomplished during reasonable hours of operation. The auditing PARTNER will be permitted to make copies of any OBLIGATIONS -related records needed for the audit. The audited PARTNER will review the draft audit, findings, and recommendations, and provide written comments within 30 calendar days of receipt. Upon completion of the final audit, PARTNERS have 30 days to refund or invoice as necessary in order to satisfy the obligation of the audit. PACT Version 10.1.2011 02__17 6 of 22 District Agreement 08-1508 Any audit dispute not resolved by PARTNERS is subject to dispute resolution. Any costs arising out of the dispute resolution process will be paid within 30 calendar days of the final audit or dispute resolution findings. 44. Any PARTNER that hires another party to participate in OBLIGATIONS will conduct a pre -award audit of that party in accordance with the Local Assistance Procedures Manual. 45. PARTNERS will not incur costs beyond the funding commitments in this agreement. If IMPLEMENTING AGENCY anticipates that funding for WORK will be insufficient to complete WORK, IMPLEMENTING AGENCY will promptly notify SPONSOR. IMPLEMENTING AGENCY has no obligation to perform WORK if funds to perform WORK are unavailable. 46. If WORK stops for any reason, IMPLEMENTING AGENCY will place all facilities impacted by WORK in a safe and operable condition acceptable to CALTRANS. 47. If WORK stops for any reason, each PARTNER will continue to implement all of its applicable commitments and conditions included in the PROJECT environmental documentation including environmental commitments record, permits, agreements, or approvals that are in effect at the time that WORK stops, as they apply to each PARTNER's responsibilities in this agreement, in order to keep PROJECT in environmental compliance until WORK resumes. 48. Each PARTNER accepts responsibility to complete the activities that it selected on the SCOPE SUMMARY. Activities marked with "N/A" on the SCOPE SUMMARY are not included in the scope of this agreement. 49. Contract administration procedures shall conform to CALTRANS' Construction Manual, Local Assistance Procedures Manual (if Federal funds are used), and the PROJECT encroachment permits. 50. If the Resident Engineer is not also a registered Landscape Architect, CITY will furnish, at CITY expense and subject to approval of CALTRANS Landscape Architecture, a registered Landscape Architect to perform work related to architecture treatment and landscaping and to perform the function of an Assistant Resident Engineer/Inspector who is responsible for both daily on-site inspection and final decisions including, but not limited to, any highway planting and the irrigation systems that comprise a portion of the PROJECT work, consistent with any applicable measures in the environmental commitments record. Final decisions shall continue to be subject to the satisfaction and approval of CALTRANS. 51. Within one hundred eighty (180) days following the completion and acceptance of the PROJECT construction contract, to furnish CALTRANS with a complete set of "As - PACT Version 10.1.2011_02_17 7 of 22 District Agreement 08-1508 Built" plans (hard copy and electronic formats) in accordance with CALTRANS' then current CADD Users Manual, Plans Preparation Manual, and CALTRANS practice. The submittal must also include all CALTRANS requested contract records, including survey documents and Records of Surveys (to include monument perpetuation per the Land Surveyor Act, section 8771, including but not limited to preconstruction monumentation documents and a post construction Record of Survey). CITY shall also submit corrected full-sized hardcopy structure plans. Scope: Environmental Permits, Approvals and Agreements 52. Each PARTNER identified in the Environmental Permits table below accepts the responsibility to complete the assigned activities. Environmental Permits Permit Coordinate Prepare Obtain Implement Renew Amend 404 USACOE CITY CITY CITY CITY CITY CITY 401 RWQCB CITY CITY CITY CITY CITY CITY FESA Section 7 USFWS CALTRANS CITY CALTRANS CITY CALTRANS CALTRANS 1602 DFG CITY CITY CITY CITY CITY CITY Scope: CONSTRUCTION 53. CITY will advertise, open bids, award, approve and administer the construction contract in accordance with the California Public Contract Code and the California Labor Code. CITY will not advertise the construction contract until CALTRANS completes or accepts the final plans, specifications, and estimate package; CALTRANS approves the Right of Way Certification; and SPONSOR verifies full funding of CONSTRUCTION SUPPORT and CONSTRUCTION CAPITAL. By accepting responsibility to advertise and award the construction contract, CITY also accepts responsibility to administer the construction contract. PARTNERS agree that CITY is designated as the Legally Responsible Person and the Approved Signatory Authority pursuant to the Construction General Permit, State Water Resources Control Board (SWRCB) Order Number 2009-0009-DWQ, as defined in Appendix 5, Glossary, and assumes all roles and responsibilities assigned to the Legally Responsible Person and the Approved Signatory Authority as mandated by the Construction General Permit. 54. CITY will provide a RESIDENT ENGINEER, licensed to practice Civil Engineering in the State of California, and construction support staffs that are independent of the design engineering company and construction contractor. PACT Version 10.1.2011_02_17 8 of 22 District Agreement 08-1508 55. IMPLEMENTING AGENCY will implement changes to the construction contract through contract change orders (CCOs). PARTNERS will review and concur on all CCOs over $50,000. CALTRANS must approve all CCOs affecting public safety or the preservation of property, all design and specification changes, completion of any component of the environmental commitments record, and all major changes as defined in the CALTRANS Construction Manual prior to implementing the CCO. 56. If the lowest responsible construction contract bid is greater than the funding commitment to CONSTRUCTION CAPITAL, all PARTNERS must be involved in determining how to proceed. If PARTNERS do not agree in writing on a course of action within 15 working days, this agreement will terminate. 57. CITY will require the construction contractor to furnish payment and performance bonds naming CITY as obligee, and CALTRANS as additional obligee, and to carry liability insurance in accordance with CALTRANS specifications. 58. CITY will submit a written request to CALTRANS for any SFM identified in the PROJECT plans, specifications, and estimate a minimum of 45 days prior to the bid advertisement date for PROJECT construction contract. CITY will submit a written request to CALTRANS for any additional SFM deemed necessary during PROJECT construction. 59. CALTRANS will make SFM available at a CALTRANS-designated location after CITY requests SFM and pays CALTRANS' invoice for estimated SFM costs. 60. As IMPLEMENTING AGENCY for CONSTRUCTION, CITY is responsible for maintenance within PROJECT limits as part of the construction contract. 61. PARTNERS will execute a separate maintenance agreement prior to COMPLETION of OBLIGATIONS. COST Cost: General 62. The cost of any awards, judgments, or settlements generated by OBLIGATIONS is an OBLIGATIONS COST. 63. CALTRANS, independent of PROJECT, will pay all costs for HM MANAGEMENT ACTIVITIES related to HM -1 found within the existing SHS right of way. 64. CITY, independent of PROJECT, will pay, or cause to be paid, all costs for HM MANAGEMENT ACTIVITIES related to HM -1 found within PROJECT limits and outside of the existing SHS right of way. PACT Version 10.1.2011_02_17 9 of 22 District Agreement 08-1508 65. HM MANAGEMENT ACTIVITIES costs related to HM -2 are CONSTRUCTION SUPPORT and CONSTRUCTION CAPITAL costs. 66. The cost to comply with and implement the commitments set forth in the environmental documentation, including the environmental commitments record, is an OBLIGATIONS COST. 67. The cost to ensure that PROJECT remains in environmental compliance is an OBLIGATIONS COST. 68. The cost of any legal challenges to the CEQA or NEPA environmental process or documentation is an OBLIGATIONS COST. 69. Independent of OBLIGATIONS COST, CALTRANS will fund the cost of its own IQA for WORK done within existing or proposed future SHS right of way. 70. Independent of OBLIGATIONS COST, CITY will fund the cost of its own IQA for WORK done outside existing or proposed future SHS right of way. 71. CALTRANS will provide encroachment permits to PARTNERS, their contractors, consultants and agents, at no cost. 72. Fines, interest, or penalties levied against a PARTNER will be paid, independent of OBLIGATIONS COST, by the PARTNER whose actions or lack of action caused the levy. That PARTNER will indemnify and defend each other PARTNER. 73. Travel, per diem, and third -party contract reimbursements are an OBLIGATIONS COST only after those hired by PARTNERS to participate in OBLIGATIONS incur and pay those costs. Payments for travel and per diem will not exceed the rates paid rank and file state employees under current California Department of Personnel Administration (DPA) rules current at the effective date of this agreement. If CITY invoices for rates in excess of DPA rates, CITY will fund the cost difference and reimburse CALTRANS for any overpayment. 74. The cost of any engineering support performed by CALTRANS includes all direct and applicable indirect costs. CALTRANS calculates indirect costs based solely on the type of funds used to pay support costs. State and federal funds are subject to the current Program Functional Rate. Local funds are subject to the current Program Functional Rate and the current Administration Rate. CALTRANS periodically adjusts the Program Functional Rate and the Administration Rate. PACT Version 10.1.2011_02_17 10 of 22 District Agreement 08-1508 75. If CALTRANS reimburses CITY for any costs later determined to be unallowable, CITY will reimburse those funds. 76. The cost to place PROJECT right of way in a safe and operable condition and meet all environmental commitments is an OBLIGATIONS cost. 77. Because IMPLEMENTING AGENCY is responsible for managing the scope, cost, and schedule of a project component, if there are insufficient funds available in this agreement to place the right of way in a safe and operable condition, the appropriate IMPLEMENTING AGENCY accepts responsibility to fund these activities until such time as PARTNERS amend this agreement. That IMPLEMENTING AGENCY may request reimbursement for these costs during the amendment process. 78. If there are insufficient funds in this agreement to implement applicable commitments and conditions included in the PROJECT environmental documentation, environmental commitments record, permits, agreements, and/or approvals that are in effect at a time that WORK stops, each PARTNER implementing commitments or conditions accepts responsibility to fund these activities, as they apply to each PARTNER's responsibilities, until such time as PARTNERS amend this agreement. Each PARTNER may request reimbursement for these costs during the amendment process. 79. PARTNERS will pay invoices within 30 calendar days of receipt of invoice. Cost: Environmental Permits, Approvals and Agreements 80. The cost of coordinating, obtaining, complying with, implementing, and if necessary renewing and amending resource agency permits, agreements, and/or approvals is an OBLIGATIONS COST. Cost: CONSTRUCTION Support 81. The cost to maintain the SHS within PROJECT limits is an OBLIGATIONS COST until PARTNERS execute a separate maintenance agreement. 82. Each PARTNER listed below may submit invoices for the Source Inspection portion of CONSTRUCTION Support: • CALTRANS may invoice CITY 83. PARTNERS will exchange funds for actual costs up to a maximum of $65,000. PACT Version 10.1.2011 02 17 1 1 of 22 District Agreement 08-1508 CALTRANS will invoice CITY for $10,000 initial deposit 30 working days prior to the construction contract bid advertisement date. This deposit represents two (2) months' estimated support costs for source inspection. Thereafter, CALTRANS will submit to CITY monthly invoices for estimated monthly costs based on the prior month's actual expenditures. After PARTNERS agree that all WORK is complete, CALTRANS will submit a final accounting for all OBLIGATIONS COSTS. Based on the final accounting, PARTNERS will refund or invoice as necessary in order to satisfy the financial commitments of this agreement. Cost: CONSTRUCTION Capital 84. The cost of all SFM is a CONSTRUCTION CAPITAL cost. CALTRANS will invoice CITY for the actual cost of any SFM as a CONSTRUCTION CAPITAL cost. After PARTNERS agree that all WORK is complete, CALTRANS will submit a final accounting for all SFM costs. Based on the final accounting, PARTNERS will refund or invoice as necessary in order to satisfy the financial commitments of this agreement. SCHEDULE 85. PARTNERS will manage the schedule for OBLIGATIONS through the work plan included in the PROJECT MANAGEMENT PLAN. GENERAL CONDITIONS 86. PARTNERS understand that this agreement is in accordance with and governed by the Constitution and laws of the State of California. This agreement will be enforceable in the State of California. Any PARTNER initiating legal action arising from this agreement will file and maintain that legal action in the Superior Court of the county in which the CALTRANS district office that is signatory to this agreement resides, or in the Superior Court of the county in which PROJECT is physically located. 87. All OBLIGATIONS of CALTRANS under the terms of this agreement are subject to the appropriation of resources by the Legislature, the State Budget Act authority, and the allocation of funds by the California Transportation Commission. 88. Any PARTNER performing IQA does so for its own benefit. No one can assign liability to that PARTNER due to its IQA activities. PACT Version 10.1.2011_02_17 12 of 22 District Agreement 08-1508 89. Neither CITY nor any officer or employee thereof is responsible for any injury, damage or liability occurring by reason of anything done or omitted to be done by CALTRANS and/or its agents under or in connection with any work, authority, or jurisdiction conferred upon CALTRANS under this agreement. It is understood and agreed that CALTRANS will fully defend, indemnify, and save harmless CITY and all of its officers and employees from all claims, suits, or actions of every name, kind, and description brought forth under, but not limited to, tortious, contractual, inverse condemnation, or other theories or assertions of liability occurring by reason of anything done or omitted to be done by CALTRANS and/or its agents under this agreement. 90. Neither CALTRANS nor any officer or employee thereof is responsible for any injury, damage, or liability occurring by reason of anything done or omitted to be done by CITY and/or its agents under or in connection with any work, authority, or jurisdiction conferred upon CITY under this agreement. It is understood and agreed that CITY will fully defend, indemnify, and save harmless CALTRANS and all of its officers and employees from all claims, suits, or actions of every name, kind, and description brought forth under, but not limited to, tortious, contractual, inverse condemnation, or other theories or assertions of liability occurring by reason of anything done or omitted to be done by CITY and/or its agents under this agreement. 91. PARTNERS do not intend this agreement to create a third party beneficiary or define duties, obligations, or rights in parties not signatory to this agreement. PARTNERS do not intend this agreement to affect their legal liability by imposing any standard of care for fulfilling OBLIGATIONS different from the standards imposed by law. 92. PARTNERS will not assign or attempt to assign OBLIGATIONS to parties not signatory to this agreement. 93. PARTNERS will not interpret any ambiguity contained in this agreement against each other. PARTNERS waive the provisions of California Civil Code section 1654. 94. A waiver of a PARTNER's performance under this agreement will not constitute a continuous waiver of any other provision. An amendment made to any article or section of this agreement does not constitute an amendment to or negate all other articles or sections of this agreement. 95. A delay or omission to exercise a right or power due to a default does not negate the use of that right or power in the future when deemed necessary. PACT Version 10.1.2011_02_17 13 of 22 District Agreement 08-1508 96. If any PARTNER defaults in its OBLIGATIONS, a non -defaulting PARTNER will request in writing that the default be remedied within 30 calendar days. If the defaulting PARTNER fails to do so, the non -defaulting PARTNER may initiate dispute resolution. 97. PARTNERS will first attempt to resolve agreement disputes at the PROJECT team level. If they cannot resolve the dispute themselves, the CALTRANS district director and the executive officer of CITY will attempt to negotiate a resolution. If PARTNERS do not reach a resolution, PARTNERS' legal counsel will initiate mediation. PARTNERS agree to participate in mediation in good faith and will share equally in its costs. Neither the dispute nor the mediation process relieves PARTNERS from full and timely performance of OBLIGATIONS in accordance with the terms of this agreement. However, if any PARTNER stops fulfilling OBLIGATIONS, any other PARTNER may seek equitable relief to ensure that OBLIGATIONS continue. Except for equitable relief, no PARTNER may file a civil complaint until after mediation, or 45 calendar days after filing the written mediation request, whichever occurs first. PARTNERS will file any civil complaints in the Superior Court of the county in which the CALTRANS district office signatory to this agreement resides. The prevailing PARTNER will be entitled to an award of all costs, fees, and expenses, including reasonable attorney fees as a result of litigating a dispute under this agreement or to enforce the provisions of this article including equitable relief. 98. PARTNERS maintain the ability to pursue alternative or additional dispute remedies if a previously selected remedy does not achieve resolution. 99. If any provisions in this agreement are deemed to be, or are in fact, illegal, inoperative, or unenforceable, those provisions do not render any or all other agreement provisions invalid, inoperative, or unenforceable, and PARTNERS will automatically sever those provisions from this agreement. 100. PARTNERS intend this agreement to be their final expression and supersede any oral understanding or writings pertaining to OBLIGATIONS. 101. If during performance of WORK additional activities and/or environmental documentation is necessary to keep PROJECT in environmental compliance, PARTNERS will amend this agreement to include completion of those additional tasks. 102. PARTNERS will execute a formal written amendment if there are any changes to OBLIGATIONS. 103. This agreement will terminate upon COMPLETION of OBLIGATIONS or an amendment to terminate this agreement, whichever occurs first. PACT Version 10.1.2011 02 17 14 of 22 District Agreement 08-1508 However, all indemnification, document retention, audit, claims, environmental commitment, legal challenge, and ownership articles will remain in effect until terminated or modified in writing by mutual agreement. 104. The following documents are attached to, and made an express part of this agreement: SCOPE SUMMARY, FUNDING SUMMARY. PACT Version 10.1.2011_02_17 15 of 22 District Agreement 08-1508 DEFINITIONS CALTRANS — The California Department of Transportation CALTRANS STANDARDS — CALTRANS policies and procedures, including, but not limited to, the guidance provided in the Guide to Capital Project Delivery Workplan Standards (previously known as WBS Guide) available at http://www.dot. ca. gov/hq/projmgmt/guidance.htm. CEQA (California Environmental Quality Act) — The act (California Public Resources Code, sections 21000 et seq.) that requires state and local agencies to identify the significant environmental impacts of their actions and to avoid or mitigate those significant impacts, if feasible. CFR (Code of Federal Regulations) — The general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government. COMPLETION of OBLIGATIONS — PARTNERS have fulfilled all OBLIGATIONS included in this agreement, and all amendments to this agreement, and have signed a COOPERATIVE AGREEMENT CLOSURE STATEMENT. CONSTRUCTION CAPITAL — See PROJECT COMPONENT. CONSTRUCTION SUPPORT — See PROJECT COMPONENT. COOPERATIVE AGREEMENT CLOSURE STATEMENT — A document signed by PARTNERS that verifies the completion of all OBLIGATIONS included in this agreement and in all amendments to this agreement. COST — The responsibility for cost responsibilities in this agreement can take one of three assignments: • OBLIGATIONS COST — A cost associated with fulfilling OBLIGATIONS that will be funded as part of this agreement. The responsibility is defined by the funding commitments in this agreement. • PROJECT COST — A cost associated with PROJECT that can be funded outside of OBLIGATIONS. A PROJECT COST may not necessarily be part of this agreement. This responsibility is defined by the PARTNERS' funding commitments at the time the cost is incurred. • PARTNER COST — A cost that is the responsibility of a specific PARTNER, independent of PROJECT. FHWA — Federal Highway Administration PACT Version 10.1.2011 02 17 16 of 22 District Agreement 08-1508 FHWA STANDARDS — FHWA regulations, policies and procedures, including, but not limited to, the guidance provided at www.fhwa.dot.gov/topics.htm. FUNDING PARTNER — A PARTNER that commits a defined dollar amount to fulfill OBLIGATIONS. Each FUNDING PARTNER accepts responsibility to provide the funds identified on the FUNDING SUMMARY under its name. FUNDING SUMMARY — The table that designates an agreement's funding sources, types of funds, and the PROJECT COMPONENT in which the funds are to be spent. Funds listed on the FUNDING SUMMARY are "not -to -exceed" amounts for each FUNDING PARTNER. GAAP (Generally Accepted Accounting Principles) — Uniform minimum standards and guidelines for financial accounting and reporting issued by the Federal Accounting Standards Advisory Board that serve to achieve some level of standardization. See http://www.fasab.gov/accepted.html. HM -1 — Hazardous material (including, but not limited to, hazardous waste) that may require removal and disposal pursuant to federal or state law whether it is disturbed by PROJECT or not. HM -2 — Hazardous material (including, but not limited to, hazardous waste) that may require removal and disposal pursuant to federal or state law only if disturbed by PROJECT. HM MANAGEMENT ACTIVITIES — Management activities related to either HM -1 or HM -2 including, without limitation, any necessary manifest requirements and disposal facility designations. IMPLEMENTING AGENCY — The PARTNER responsible for managing the scope, cost, and schedule of a PROJECT COMPONENT to ensure the completion of that component. IQA (Independent Quality Assurance) — Ensuring that IMPLEMENTING AGENCY's quality assurance activities result in WORK being developed in accordance with the applicable standards and within an established Quality Management Plan (QMP). IQA does not include any work necessary to actually develop or deliver WORK or any validation by verifying or rechecking work performed by another partner. NEPA (National Environmental Policy Act of 1969) — The federal act that establishes a national policy for the environment and a process to disclose the adverse impacts of projects with a federal nexus. OBLIGATIONS — All responsibilities included in this agreement. OBLIGATIONS COST — See COST. OMB (Office of Management and Budget) — The federal office that oversees preparation of the federal budget and supervises its administration in Executive Branch agencies. PACT Version 10.1.2011_02_17 17 of 22 District Agreement 08-1508 PARTNER — Any individual signatory party to this agreement. PARTNERS — The term that collectively references all of the signatory agencies to this agreement. This term only describes the relationship between these agencies to work together to achieve a mutually beneficial goal. It is not used in the traditional legal sense in which one PARTNER's individual actions legally bind the other partners. PROJECT — The undertaking to the construction of a portion of a new interchange, on Interstate 15 at the French Valley Parkway in the City of Temecula and City of Murrieta (Phase I), which consists of the construction of two through lanes on French Valley Parkway westbound from 1- 15 to Jefferson Avenue; one lane of the southbound exit ramp; the southbound auxiliary lane from French Valley Parkway interchange to the Winchester Road interchange southbound exit ramp; and widening of the Winchester Road southbound exit ramp from one to three lanes. PROJECT COMPONENT — A distinct portion of the planning and project development process of a capital project as outlined in California Government Code, section 14529(b). • PID (Project Initiation Document) — The activities required to deliver the project initiation document for PROJECT. • PA&ED (Project Approval and Environmental Document) — The activities required to deliver the project approval and environmental documentation for PROJECT. • PS&E (Plans, Specifications, and Estimate) — The activities required to deliver the plans, specifications, and estimate for PROJECT. • R/W (Right of Way) SUPPORT —The activities required to obtain all property interests for PROJECT. • R/W (Right of Way) CAPITAL — The funds for acquisition of property rights for PROJECT. • CONSTRUCTION SUPPORT — The activities required for the administration, acceptance, and final documentation of the construction contract for PROJECT. • CONSTRUCTION CAPITAL — The funds for the construction contract. PROJECT COST — See COST. PROJECT MANAGEMENT PLAN — A group of documents used to guide a project's execution and control throughout that project's lifecycle. QMP (Quality Management Plan) — An integral part of the Project Management Plan that describes IMPLEMENTING AGENCY's quality policy and how it will be used. RESIDENT ENGINEER — A civil engineer licensed in the State of California who is responsible for construction contract administration activities. Said engineer must be independent of the design engineering company and the construction contractor. SAFETEA-LU — Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users PACT Version 10.1.2011_02 17 18 of 22 District Agreement 08-1508 SCOPE SUMMARY — The attachment in which each PARTNER designates its commitment to specific scope activities within each PROJECT COMPONENT as outlined by the Guide to Capital Project Delivery Workplan Standards (previously known as WBS Guide) available at http://www.dot.ca.gov/hq/projmgmt/guidance.htm. SHS (State Highway System) — All highways, right of way, and related facilities acquired, laid out, constructed, improved, or maintained as a state highway pursuant to constitutional or legislative authorization. SPONSOR — Any PARTNER that accepts the responsibility to establish scope of PROJECT and the obligation to secure financial resources to fund PROJECT. SPONSOR is responsible for adjusting the PROJECT scope to match committed funds or securing additional funds to fully fund the PROJECT scope. If a PROJECT has more than one SPONSOR, funding adjustments will be made by percentage (as outlined in Responsibilities). Scope adjustments must be developed through the project development process and must be approved by CALTRANS as the owner/operator of the SHS. SFM (State Furnished Material) — Any materials or equipment supplied by CALTRANS. WORK — All scope activities included in this agreement. CONTACT INFORMATION The information provided below indicates the primary contact data for each PARTNER to this agreement. PARTNERS will notify each other in writing of any personnel or location changes. Contact information changes do not require an amendment to this agreement. The primary agreement contact person for CALTRANS is: Jamal Elsaleh, Project Management Office Chief 464 West 4th Street, 6th Floor, (MS 1229) San Bernardino, California 92401-1400 Office Phone: (909) 383-6710 Mobile Phone: (909) 289-5979 Fax Number: (909) 383-6938 Email: jamal.elsaleh@dot.ca.gov The primary agreement contact person for CITY is: Avlin R. Odviar, Senior Engineer 41000 Main Street Temecula, California 92590 Office Phone: (951) 693-3969 Email: Avlin.Odviar@cityoftemecula.org PACT Version 10.1.2011_02_17 19 of 22 District Agreement 08-1508 SIGNATURES PARTNERS declare that: 1. Each PARTNER is an authorized legal entity under California state law. 2. Each PARTNER has the authority to enter into this agreement. 3. The people signing this agreement have the authority to do so on behalf of their public agencies. STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION APPROVED By: Raymond W. Wolfe, PhD District Director CITY OF TEMECULA APPROVED By: Ron Roberts Mayor Date: Date: CERTIFIED AS TO FUNDS: By: Susan W. Jones CITY Clerk By: Date: Lisa Pacheco Budget Manager Date: PACT Version 10.1.2011_02_17 APPROVED AS TO FORM AND PROCEDURE By: Peter M. Thorson CITY Attorney Date: 20 of 22 08-R1V-15 PM 6.6 / 7.8 (KP 10.6/ 12.5) EA: 43271 District Agreement 08-1508 Project Number 0800000670 SCOPE SUMMARY of lf) CO oo C 0 7-1 0. 'LZ (..) w a) O CALTRANS r I— U Q 5 270 Construction Engineering and General Contract Administration X X 10 Construction Staking Package and Control X 15 Construction Stakes X 20 Construction Engineering Work X 25 Construction Contract Administration Work X X 05 Secured Lease for Resident Engineer Office Space or Trailer X 10 Set Up Construction Project Files X X 15 Pre -Construction Meeting X X 20 Progress Pay Estimates X 25 Weekly Statement of Working Days X 30 Construction Project Files and General Field Office Clerical Work X 35 Labor Compliance Activities X 40 Approved Subcontractor Substitutions X 45 Coordination X 50 Civil Rights Contract Compliance X 99 Other Construction Contract Administration Products X 30 Contract Item Work Inspection X X 35 Construction Material Sampling and Testing X X 05 Materials Sampling and Testing for Quality Assurance X 10 Plant Inspection for Quality Assurance X 15 Independent Assurance Sampling and Testing X 20 Source Inspection X 40 Safety and Maintenance Reviews X X 45 Relief From Maintenance Process X X 55 Final Inspection and Acceptance Recommendation X X 60 Plant Establishment Administration X X 65 Transportation Management Plan Implementation During Construction X X 80 Long -Term Environmental Mitigation/Mitigation Monitoring During Construction Contract X 99 Other Construction Engineering and General Contract Administration X 5 275 Construction Engineering and General Contract Administration of Structures Work X X 5 285 Contract Change Order Administration X X 5 290 Resolve Contract Claims X 5 295 Accept Contract, Prepare Final Construction Estimate, and Final Report X X 4 300 Final Right of Way Engineering X X PACT Version 10.1.2011 02 17 21of22 PM 6.6/7.8 (KP 10.6/ 12.5) FUNDING SUMMARY adA1 spun] 1eloNns 00 0 0 N EF) 0 0 N b9 le;lde3 lemons0 O 0 o v N Ef! O 0 0 0 N Ea ioddng 1e;o;gns O O o 0 o Eh Ki O O 0 ri E» poddns NO3 o 0 o 0 cn EA 0 0 0 0 05 H9 le;lde3 NO3 0 0 0 8 Tr N Eft 0 0 0 8 v N CO adi(1 punj To o J Subtotals by Component Jauped 6ulpun j v a3Jnos 6ulpund LOCAL PACT Version 10.1.2011_02_17 RESOLUTION NO. 11- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING A COOPERATIVE AGREEMENT, NO. 08-1508, BETWEEN THE STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION (CALTRANS) AND THE CITY OF TEMECULA FOR THE CONSTRUCTION OF THE FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS PROJECT — PHASE I THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. Findings. The City Council hereby finds, determines, and declares that: A. The French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements Project — Phase I (Project) includes proposed freeway improvements to Interstate -15. B. In California, construction contracts for freeway improvements are advertised, awarded, and administered (AAA) by Caltrans. C. At its discretion, Caltrans may delegate the AAA activities to a local agency. D. In letter dated March 11, 2011, the City requested authorization to perform the AAA activities for the Project. E. In letter dated June 28, 2011, Caltrans approved the City's request. F. Cooperative Agreement No. 08-1508 establishes the general conditions, methods, and procedures, including the responsibilities of each agency, for implementation of the construction of the Project. Section 2. Approval of Cooperative Agreement. Based on the findings set forth in this Resolution, the City Council hereby approves the Cooperative Agreement No. 08-1508 between the State of California, acting through its Department of Transportation, and the City of Temecula, and authorizes the Mayor to execute said Agreement. Section 3. Certification. The City Clerk shall certify the adoption of this Resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 13th day of December, 2011. Ron Roberts, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 11- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 13th day of December, 2011, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: Susan W. Jones, MMC City Clerk FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS - PHASE I Circulation Project Location Aerial Data - March 2010 0 250 500 Feet 1,000 48 CJ TYOFTEMECLJLA FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS -PHASE I Circulation Project Project Description: Project will include the design, right-of-way acquisition, utility relocation, and construction activities to portions of the French Valley Parkway and Interstate -15 over -crossing and interchange. The project will add a new southbound off -ramp from Interstate -15 to French Valley Parkway, construct the northern half of French Valley Parkway from the off -ramp to Jefferson Avenue, widen the existing southbound off -ramp from Interstate -15 to Winchester, and construct a new auxiliary lane between French Valley Parkway and the Winchester Road southbound off -ramp. Other features include permanent and temporary retaining walls, erosion control and irrigation, and a new traffic signal and roadway improvements at the intersection of French Valley Parkway and Jefferson Avenue. Project requires oversight by Caltrans and coordination with the City of Murrieta. Benefit: Project will improve traffic circulation by providing another southbound off -ramp from Interstate -15 and add a lane to the Interstate -15 southbound off -ramp to Winchester. Project Status: The plans, specifications, and estimates, are expected to be complete during fiscal year 2012. Construction is expected to be complete by the end of fiscal year 2013. Department: Public Works -Account No. 210.165.719 Priority: 1 Project Cost: Actua Is to Date Future Total Project 2011-12 2012-13 2013-14 2014-15 2015-16 Years Cost Administration $ 353,949 $ 210,389 $ 200,000 $25,000 $ 789,338 Acquisition $2,256,952 $ 1,704,666 $ 160,830 $60,000 $35,000 $70,000 $ 3,961,618 Construction $18,200,000 $ 8,855,000 $ 27,055,000 Construction $ 444,203 $ 444,203 Engineering $ 2,000,000 $ 1,000,000 $ 3,000,000 Design $1,382,796 $ 648,303 $ 1,167,801 $ 2,031,099 Environmental $ 15,000 $ 35,000 $35,000 $35,000 $70,000 $ 190,000 MS HCP $ 245,000 $ 245,000 Totals $3,993,697 $23,023,358 $10,090,000 $60,000 $35,000 $70,000 $ - $ 37,272,055 Source of Funds: Actuals to Date Future Total Project 2011-12 2012-13 2013-14 2014-15 2015-16 Years Cost Capital Project Reserves $ 160,830 $60,000 $35,000 $70,000 $ 325,830 DIF (Street Improvements) $ 444,203 $ 444,203 Measure A -Local Street and Road $ 977,181 $ 724,369 $ 1,167,801 $ 2,869,351 Reimbursement/Other (Mjrrieta Land Donation) $ 1,631,631 $ 1,631,631 TUMF (CETAPIROTC)(1) $20,000,000 $ 8,761,369 $ 28,761,369 TUMF(ROTC)r2) $2,462,295 $ 2,462,295 TUM F (WRCOG)(3) $ 110,018 $ 667,358 $ 777,376 Total Funding: $3,993,697 $23,023,358 $10,090,000 $60,000 $35,000 $70,000 $ $ 37,272,055 Future Operation & Maintenance Costs: 2011-12 1 2012-13 2013-14 2014-15 2015-16 $15,000 $15,606 (1) TUFF (CETAP/ROTC) - Funding is pursuant to the RCTCAgreerrent No. 11-72-0036-00 in the amount of $20,000,000 to date. (2) IMF (ROTC) - Funding is pursuant to the RCTC Agreement No. 06-72-048-00 for a total of $75,517,000 ($5,715,000 -ROW and $2,000,000- PS&E). Fhase I is $1,682,000 -ROW and $203,784-PS&E- See also Fhase IL (3) IMF (WRCOG) - Zone funding is pursuant to WRCOG Agreement No. 05 -SW -TEM -1064 for a total of $4,078,000 ($1,165,000-FS&E) - See also Fhase II. $15,300 49 Item No. 11 TO: FROM: DATE: SUBJECT: Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT City Manager/City Council Greg Butler, Director of Public Works / City Engineer December 13, 2011 Agreement with Harris and Associates for Construction Management Services for Phase 1 of the French Valley Parkway Interchange Improvements, Project No. PW07-04 PREPARED BY: RECOMMENDATION: Amer Attar, Principal Engineer Avlin R. Odviar, Senior Engineer — CIP That the City Council: 1. Accelerate the appropriation and funding in the amount of $566,270.30 from the Construction Engineering line item for the French Valley Parkway / Interstate -15 Over - Crossing and Interchange Improvements — Phase 1, Project No. PW07-04, from Fiscal Year 2012-2013 to Fiscal Year 2011-2012; 2. Approve an agreement with Harris & Associates in an amount not to exceed $2,332,973.00 to provide professional construction management services for the French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements — Phase 1, Project No. PW07-04; 3. Authorize the City Manager to approve Extra Work Authorizations not to exceed the contingency amount of $ 233,297.30, which is 10% of the agreement amount. BACKGROUND: The French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements project proposes freeway and local arterial improvements designed to reduce current and projected traffic congestion, improve safety and operations, and provide alternative access to Interstate -15 (1-15). Project implementation will occur in two distinct phases, Phase 1 and Phase 11. Phase 1 is designed to provide interim relief by constructing elements which will reduce 1-15 southbound congestion. These elements include a new southbound off -ramp at French Valley Parkway, the westbound portion of French Valley Parkway between the off -ramp and Jefferson Avenue, widening the existing southbound off - ramp at Winchester Road, and widening southbound 1-15 between Warm Springs Creek and the Winchester Road off -ramp. Phase 11 will include all other elements of the overall project. In a letter dated June 28, 2011, Caltrans delegated its authority over Advertisement, Award, and Administration (AAA) of the Phase I construction contract to the City. The subject Agreement for Consultant Services enlists the professional services of Harris & Associates to perform construction management and engineering services as part of the construction contract administration. On September 28, 2011, the City issued a Request for Proposals (RFP No. 172) inviting qualified consulting firms to submit a proposal to provide construction management services for Phase I. By the time of the filing deadline of October 19, 2011, over 300 firms were notified, approximately 94 firms obtained the RFP, and five consultant teams submitted proposals. A Selection Committee comprised of representatives from the City of Temecula, City of Murrieta, and Caltrans reviewed the proposals, discussed findings, conducted an interview of the top two qualified firms, and ranked the prospective bidders as follows. 1. Harris & Associates 2. AECOM 3. Hill lnternational 4. Nolte Vertical 5 5. RBF Consulting Harris & Associates is a multi -disciplinary engineering firm with extensive experience providing construction management services on freeway projects of comparable size and complexity, under contract to both Caltrans and local agencies. The CM team includes sub -consultants Converse Consultants, David Evans and Associates, Arellano Associates, Entech Consulting Group, and Paleo Solutions. Following the selection process, staff entered negotiations with Harris & Associates and finalized the terms of the attached agreement. The scope of work includes professional administration services necessary during pre -construction, construction, and post -construction such as a review of the plans for constructability, construction inspection, document control, materials testing, public affairs, and project close out. FISCAL IMPACT: The French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements — Phase I is included in the City's Capital Improvement Program FY 2012-2016 with multiple sources of funds. With the acceleration of Construction Engineering funds from Fiscal Year 2012-2013 to 2011-2012, there will be sufficient funds available within project account 210-165-719-5805 to cover the cost of the agreement, $2,332,973.00, plus the contingency amount of $233,297.30 for a total amount of $2,566,270.30. The subject agreement is funded with TUMF funds secured by reimbursements agreements with RCTC & WRCOG. ATTACHMENTS: 1. Agreement 2. Project Description 3. Project Location AGREEMENT FOR CONSULTANT SERVICES BETWEEN CITY OF TEMECULA AND HARRIS & ASSOCIATES FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS — PHASE 1, PROJECT NO. PW07-04 THIS AGREEMENT is made and effective as of December 13, 2011, between the City of Temecula , a municipal corporation (hereinafter referred to as "City"), and Harris & Associates, a California corporation (hereinafter referred to as "Consultant"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. TERM This Agreement shall commence on December 13, 2011, and shall remain and continue in effect until tasks described herein are completed, but in no event later than June 30, 2014, unless sooner terminated pursuant to the provisions of this Agreement. The City may, upon mutual agreement, extend the contract for one (1) additional one (1) year term. In no event shall the contract be extended beyond June 30, 2015. If Agreement is extended beyond the original term, the Agreement price shall be adjusted at the beginning of each calendar year in accordance with the changes in the Consumer Price Index for all Urban Consumers in the Los Angeles -Anaheim -Riverside Area published monthly by the United States Bureau of Labor Statistics (CPI). 2. SERVICES Consultant shall perform the services and tasks described and set forth in Exhibit A, attached hereto and incorporated herein as though set forth in full. Consultant shall complete the tasks according to the schedule of performance which is also set forth in Exhibit A. 3. PERFORMANCE Consultant shall at all time faithfully, competently and to the best of his or her ability, experience, and talent, perform all tasks described herein. Consultant shall employ, at a minimum, generally accepted standards and practices utilized by persons engaged in providing similar services as are required of Consultant hereunder in meeting its obligations under this Agreement. 4. PREVAILING WAGES Pursuant to the provisions of Section 1773 of the Labor Code of the State of California, the City Council has obtained the general prevailing rate of per diem wages and the general rate for holiday and overtime work in this locality for each craft, classification, or type of workman needed to execute by this Consultant from the Director of the Department of Industrial Relations. Copies may be obtained from the California Department of Industrial Relations Internet website at http://www.dir.ca.aov. Consultant shall provide a copy of prevailing wage rates to any staff or sub -contractor hired, and shall pay the adopted prevailing wage rates as a minimum. Consultant shall comply with the provisions of Sections 1773.8, 1775, 1776, 1777.5, 1777.6, and 1813 of the Labor Code. Pursuant to the provisions of 1775 of the Labor Code, Consultant shall forfeit to the City, as a penalty, the sum of $50.00 for each calendar day, or portion thereof, for each laborer, worker, or mechanic employed, paid less than the stipulated prevailing rates for any work done under this contract, by him or by any subcontractor under him, in violation of the provisions of the Agreement. 5. PAYMENT a. The City agrees to pay Consultant monthly, in accordance with the payment rates and terms and the schedule of payment as set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall riot exceed Two Million Three Hundred Thirty Two Thousand Nine Hundred Seventy Three Dollars and No Cents ($ 2,332,973.00) for the total term of this agreement unless additional payment is approved as provided in this Agreement. b. Consultant shall not be compensated for any services rendered in connection with its performance of this Agreement which are in addition to those set forth herein, unless such additional services are authorized in advance and in writing by the City Manager . Consultant shall be compensated for any additional services in the amounts and in the manner as agreed to by City Manager and Consultant at the time City's written authorization is given to Consultant for the performance of said services. The City Manager may approve additional work up to ten percent (10%) of the amount of the Agreement as approved by City Council. Any additional work in excess of this amount shall be approved by the City Council. c. Consultant will submit invoices monthly for actual services performed. Invoices shall be submitted between the first and fifteenth business day of each month, for services provided in the previous month. Payment shall be made within thirty (30) days of receipt of each invoice as to all non -disputed fees. If the City disputes any of Consultant's fees, it shall give written notice to Consultant within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice. For all reimbursements authorized by this Agreement, Consultant shall provide receipts on all reimbursable expenses in excess of fifty dollars ($50) in such form as approved by the Director of Finance. 6. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Consultant at least ten (10) days prior written notice. Upon receipt of said notice, the Consultant shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Consultant the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Consultant will submit an invoice to the City, pursuant to Section entitled "PAYMENT" herein. 7. DEFAULT OF CONSULTANT a. The Consultant's failure to comply with the provisions of this Agreement shall constitute a default. In the event that Consultant is in default for cause under the terms of this Agreement, City shall have no obligation or duty to continue compensating Consultant for any work performed after the date of default and can terminate this Agreement immediately by written notice to the Consultant. If such failure by the Consultant to make progress in the performance of work hereunder arises out of causes beyond the Consultant's control, and without fault or negligence of the Consultant, it shall not be considered a default. b. If the City Manager or his delegate determines that the Consultant is in default in the performance of any of the terms or conditions of this Agreement, it shall serve the Consultant with written notice of the default. The Consultant shall have ten (10) days after service upon it of said notice in which to cure the default by rendering a satisfactory performance. In the event that the Consultant fails to cure its default within such period of time, the City shall have the right, notwithstanding any other provision of this Agreement, to terminate this Agreement without further notice and without prejudice to any other remedy to which it may be entitled at law, in equity or under this Agreement. 8. OWNERSHIP OF DOCUMENTS a. Consultant shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Consultant shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Consultant shall provide free access to the representatives of City or its designees at reasonable times to such books and records, shall give City the right to examine and audit said books and records, shall permit City to make transcripts there from as necessary, and shall allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be maintained for a period of three (3) years after receipt of final payment. b. Upon completion of, or in the event of termination or suspension of this Agreement, all original documents, designs, drawings, maps, models, computer files containing data generated for the work, surveys, notes, and other documents prepared in the course of providing the services to be performed pursuant to this Agreement shall become the sole property of the City and may be used, reused or otherwise disposed of by the City without the permission of the Consultant. With respect to computer files containing data generated for the work, Consultant shall make available to the City, upon reasonable written request by the City, the necessary computer software and hardware for purposes of accessing, compiling, transferring and printing computer files. 9. INDEMNIFICATION The Consultant agrees to defend, indemnify, protect and hold harmless the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, officials, employees and volunteers from and against any and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, agents, employees or volunteers may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Consultant's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non-performance of this Agreement, excepting only liability arising out of the negligence of the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula. 10. INSURANCE REQUIREMENTS Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, or employees. a. Minimum Scope of Insurance. Coverage shall be at least as broad as: 1) Insurance Services Office Commercial General Liability form No. CG 00 01 11 85 or 88. 2) Insurance Services Office Business Auto Coverage form CA 00 01 06 92 covering Automobile Liability, code 1 (any auto). If the Consultant owns no automobiles, a non -owned auto endorsement to the General Liability policy described above is acceptable. 3) Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. If the Consultant has no employees while performing under this Agreement, worker's compensation insurance is not required, but Consultant shall execute a declaration that it has no employees. 4) Professional Liability Insurance shall be written on a policy form providing professional liability for the Consultant's profession. b. Minimum Limits of Insurance. Consultant shall maintain limits no less than: 1) General Liability: Two million ($2,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2) bodily injury and property 3) Employer's Liability: One Automobile Liability: Two million ($2,000,000) per accident for damage. Worker's Compensation as required by the State of California; million dollars ($1,000,000) per accident for bodily injury or disease. 4) Professional Liability Coverage: claim and in aggregate. 5) The policies for general liability, auto liability and professional liability shall not contain any language, limitations, or otherwise, which would potentially reduce the minimum $2 million limit of liability requirement stated herein. For example, and without limitation, no policy shall contain any language which would create a "burning limit," i.e. defense fees and costs incurred in the defense of a potentially covered claim reduces the stated limit of liability under that policy. c. Deductibles and Self -Insured Retentions. Any deductibles or self-insured retentions shall not exceed Twenty Five Thousand Dollars and No Cents ($25,000). d. Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: Two million ($2,000,000) per 1) The City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers are to be covered as insured's, as respects: liability arising out of activities performed by or on behalf of the Consultant; products and completed operations of the Consultant; premises owned, occupied or used by the Consultant; or automobiles owned, leased, hired or borrowed by the Consultant. The coverage shall contain no special limitations on the scope of protection afforded to the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 2) For any claims related to this project, the Consultant's insurance coverage shall be primary insurance as respects the City of Temecula, the Temecula Community Services District, the Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers. Any insurance or self-insured maintained by the City of Temecula, Temecula Community Services District, and/or Redevelopment Agency of the City of Temecula, its officers, officials, employees or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3) Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Temecula, the Temecula Community Services District, and the Redevelopment Agency of the City of Temecula, their officers, officials, employees or volunteers. 4) The Consultant's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 5) Each insurance policy required by this agreement shall be endorsed to state: should the policy be canceled before the expiration date the issuing insurer will endeavor to mail thirty (30) days' prior written notice to the City. 6) If insurance coverage is canceled or, reduced in coverage or in limits the Consultant shall within two (2) business days of notice from insurer phone, fax, and/or notify the City via certified mail, return receipt requested of the changes to or cancellation of the policy. e. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of A -:VII or better, unless otherwise acceptable to the City. Self insurance shall not be considered to comply with these insurance requirements. f. Verification of Coverage. Consultant shall furnish the City with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by the City before work commences. As an alternative to the City's forms, the Consultant's insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. 11. INDEPENDENT CONTRACTOR a. Consultant is and shall at all times remain as to the City a wholly independent contractor. The personnel performing the services under this Agreement on behalf of Consultant shall at all times be under Consultant's exclusive direction and control. Neither City nor any of its officers, employees, agents, or volunteers shall have control over the conduct of Consultant or any of Consultant's officers, employees, or agents except as set forth in this Agreement. Consultant shall not at any time or in any manner represent that it or any of its officers, employees or agents are in any manner officers, employees or agents of the City. Consultant shall not incur or have the power to incur any debt, obligation or liability whatever against City, or bind City in any manner. b. No employee benefits shall be available to Consultant in connection with the performance of this Agreement. Except for the fees paid to Consultant as provided in the Agreement, City shall not pay salaries, wages, or other compensation to Consultant for performing services hereunder for City. City shall not be liable for compensation or indemnification to Consultant for injury or sickness arising out of performing services hereunder. 12. LEGAL RESPONSIBILITIES The Consultant shall keep itself informed of all local, State and Federal ordinances, laws and regulations which in any manner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Consultant shall at all times observe and comply with all such ordinances, laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Consultant to comply with this section. 13. RELEASE OF INFORMATION a. All information gained by Consultant in performance of this Agreement shall be considered confidential and shall not be released by Consultant without City's prior written authorization. Consultant, its officers, employees, agents or subcontractors, shall not without written authorization from the City Manager or unless requested by the City Attorney, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories or other information concerning the work performed under this Agreement or relating to any project or property located within the City. Response to a subpoena or court order shall not be considered "voluntary" provided Consultant gives City notice of such court order or subpoena. b. Consultant shall promptly notify City should Consultant, its officers, employees, agents or subcontractors be served with any summons, complaint, subpoena, notice of deposition, request for documents, interrogatories, request for admissions or other discovery request, court order or subpoena from any party regarding this Agreement and the work performed there under or with respect to any project or property located within the City. City retains the right, but has no obligation, to represent Consultant and/or be present at any deposition, hearing or similar proceeding. Consultant agrees to cooperate fully with City and to provide City with the opportunity to review any response to discovery requests provided by Consultant. However, City's right to review any such response does not imply or mean the right by City to control, direct, or rewrite said response. 14. NOTICES Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager P.O. Box 9033 Temecula, CA 92589-9033 Use this Address for a Delivery Service: City of Temecula or Hand -Deliveries ONLY Attn: City Manager 41000 Main Street Temecula, CA 92590 To Consultant: 15. ASSIGNMENT Harris & Associates Attn: Brett Barnett, Vice President 34 Executive Park, Suite 150 Irvine, CA 92614-4705 The Consultant shall not assign the performance of this Agreement, nor any part thereof, nor any monies due hereunder, without prior written consent of the City. Upon termination of this Agreement, Consultant's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and the Consultant. 16. LICENSES At all times during the term of this Agreement, Consultant shall have in full force and effect, all licenses required of it by law for the performance of the services described in this Agreement. 17. GOVERNING LAW The City and Consultant understand and agree that the laws of the State of California shall govern the rights, obligations, duties and liabilities of the parties to this Agreement and also govern the interpretation of this Agreement. Any litigation concerning this Agreement shall take place in the municipal, superior, or federal district court with geographic jurisdiction over the City of Temecula. In the event such litigation is filed by one party against the other to enforce its rights under this Agreement, the prevailing party, as determined by the Court's judgment, shall be entitled to reasonable attorney fees and litigation expenses for the relief granted. 18. PROHIBITED INTEREST No officer, or employee of the City of Temecula that has participated in the development of this agreement or its approval shall have any financial interest, direct or indirect, in this Agreement, the proceeds thereof, the Consultant, or Consultant's sub -contractors for this project, during his/her tenure or for one year thereafter. The Consultant hereby warrants and represents to the City that no officer or employee of the City of Temecula that has participated in the development of this agreement or its approval has any interest, whether contractual, non - contractual, financial or otherwise, in this transaction, the proceeds thereof, or in the business of the Consultant or Consultant's sub -contractors on this project. Consultant further agrees to notify the City in the event any such interest is discovered whether or not such interest is prohibited by law or this Agreement. 19. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties relating to the obligations of the parties described in this Agreement. All prior or contemporaneous agreements, understandings, representations and statements, oral or written, are merged into this Agreement and shall be of no further force or effect. Each party is entering into this Agreement based solely upon the representations set forth herein and upon each party's own independent investigation of any and all facts such party deems material. 20. AUTHORITY TO EXECUTE THIS AGREEMENT The person or persons executing this Agreement on behalf of Consultant warrants and represents that he or she has the authority to execute this Agreement on behalf of the Consultant and has the authority to bind Consultant to the performance of its obligations hereunder. The City Manager is authorized to enter into an amendment on behalf of the City to make the following non -substantive modifications to the agreement: (a) name changes; (b) extension of time; (c) non -monetary changes in scope of work; (d) agreement termination. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA Harris & Associates (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: By: Ron Roberts, Mayor Byron G. Tobey, Southern Regional Manager ATTEST: By: By: Susan W. Jones, MMC, City Clerk APPROVED AS TO FORM: By: Peter M. Thorson, City Attorney CONSULTANT Harris & Associates Brett Barnett, Vice President 34 Executive Park, Suite 150 Irvine, CA 92614-4705 949-655-3900 bbarnett@harris-assoc.com FSM Initials: Date: EXHIBIT A Tasks to be Performed The specific elements (scope of work) of this service include: EXHIBIT B Payment Rates and Schedule FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS — PHASE I PROJECT NO. PW07-04 SCOPE OF WORK Table of Contents Task -1 - Project Management 1.1 Monthly Project Progress Meetings and Reports 1.2 Document Management System 1.3 Neighborhood Liaison Strategy 1.4 Partnering 1.5 Sub -Consultant Management 1.6 Construction Strategies 1.7 Contract Negotiations Task 2 — Preconstruction Phase Activities 2.1 Constructability Reviews (Including Biddability) 2.2 Bidding Assistance before and during bid period 2.3 Construction Management Plan 2.4 Storm Water Pollution Prevention Plan (SWPPPP) 2.5 Pre -construction walk with contractor 2.6 Cash Flow Projections 2.7 Document Review Task 3 — Construction Administration Activities 3.1 Pre -construction Conferences 3.2 Communications and Correspondence 3.3 Change Management 3.4 Monthly Construction Progress Reports 3.5 Schedule Monitoring 3.6 Cost Monitoring 3.7 Progress / Coordination Meetings 3.8 Payment Recommendations 3.9 Safety 3.10 Environmental Coordination 3.11 Neighborhood Communication 3.12 Submittal Management and Review 3.13 Request for Information (RFI) Management 3.14 Document Management 3.15 Construction Change Order Assistance 3.16 Review Certified Payrolls 1 Task 4 — Construction Inspection Activities 4.1 Inspection and Documentation 4.2 Materials Testing 4.3 Surveying 4.4 Review and maintain "As Constructed Schedule" 4.5 Maintain Photographic and Video Records of Construction Progress 4.6 Review and Maintain "As Built" Drawings 4.7 Final Inspection and Punchlist Task 5 — Construction Closeout Activities 5.1 Contract Closeout 5.2 Project As -Built Drawings 5.3 Final Project Report 5.4 Final Payment 2 GENERAL The City of Temecula, hereafter referred to as CLIENT, is the Project Sponsor and Implementing Agency of the French Valley Parkway / Interstate 15 Overcrossing and Interchange Improvements Project — Phase 1 (Caltrans EA 08-432713, Project ID 0800000670), hereinafter the French Valley Parkway Project. Harris & Associates, hereinafter referred to as Harris, will provide construction management services for the French Valley Parkway project. These services will be performed in accordance with the requirements of the State of California, Department of Transportation as described in its Construction Manual, Construction Manual Supplement for Local Agency Resident Engineers, and Local Agency Structure Representative Guidelines. Construction management services are described in this scope of work,as follows. TASK 1 — PROJECT MANAGEMENT Harris shall provide construction management services for the French Valley Parkway project. Harris shall develop processes and procedures for implementing the following construction management plan and shall adequately staff the project to execute the plan. In addition, Harris will also be responsible for monitoring the project budget and schedule, conducting project team meetings, implementing a quality assurance/quality control program, and communicating with the City of Temecula. 1.1 Monthly Project Progress Meetings and Reports Purpose: To apprise CLIENT management and other stakeholders of Harris' activities under this contract via written report and monthly meeting. Approach: Harris will provide a brief written report covering a summary of the status and expenditures associated with each of the tasks described in this scope of work; including highlights of any unusual contractual issues that arise during the reporting period. Harris will schedule monthly progress meetings, which will provide for discussion of progress reports and issues related to (a) this agreement and (b) the construction agreements. 3 Assumptions: 1. The project monthly progress report will be provided throughout the contract period for an estimated duration of 24 months, including pre -construction, construction, and post -construction phases. 2. A regular monthly meeting date and time will be established in the Project Plan. Meeting date is typically the first week of each month, the same day of the week, i.e., Monday, Tuesday, etc. 3. Written progress reports will be provided to the CLIENT at least 5 working days in advance of each progress meeting. 4. CLIENT to submit proposed changes/amendments to the monthly progress reports, in writing, to Harris for its use. Deliverables: 1. Monthly project progress report 2. Monthly progress review meetings with minutes/summaries. 1.2 Document Management System Purpose: To establish a system for the timely logging, filing, and tracking of project related correspondence to assure timely responses, provide a record of communications to enable efficient retrieval and establish the chronology of events for use in dispute resolution. Approach: Harris will set up a document tracking system; using Primavera Contract Manager to maintain project files for each job site and the project office. Assumptions: 1. Actual logging, filing, and tracking of project information will be performed under separate tasks and subtasks. 2. The Caltrans File Index will be adopted for all project files. Deliverables: Implementation of a computerized document management system including written procedures for use of the Harris project team. 1.3 Neighborhood Liaison Strategy Purpose: To provide a strategy for dealing with issues related to the impacts of construction on the residential neighborhoods and businesses located adjacent to and within the limits of the project. 4 Approach: Harris will develop a strategy for neighborhood communication related to construction phase impacts and mitigation. Assumptions: Harris will be responsible for development of the neighborhood liaison strategy. However, the CLIENT will provide general guidelines for neighborhood affairs, dictate protocol, and initiate contact with local elected officials, if required. Implementation of the strategy will be covered under Task 3. Deliverables: 1. Harris: Draft Action Plan 2. CLIENT: Review and comment on action plan. 3. Harris: Draft Neighborhood affairs strategy memorandum. 4. CLIENT: Comments on draft strategy memorandum. 5. Harris: Final Neighborhood affairs strategy memorandum. 1.4 Partnering Purpose: To establish an agreement between the key participants of a project such as the engineer, contractor, owner, suppliers, and construction manager, to work cooperatively to achieve common goals and timely resolution of issues for mutual benefit. The process is expected to instill a spirit of teamwork and consequently enhance progress and reduce contract disputes. CLIENT and contractor meet to develop a working relationship that promotes cooperation, minimizes confrontation and expeditiously resolves disputes in an amicably manner. Approach: Harris will participate in an initial project -partnering workshop with the CLIENT, its engineer(s), the Construction Contractor, and Harris Construction Management staff. Harris will assist the CLIENT in organizing partnering sessions for the project between the CLIENT, contractor, design engineers, other interested parties and Harris. Assumptions: 1. Harris will attend one project -partnering workshop and two partnering refresher meetings as part of this subtask led by a professional facilitator. 2. The CLIENT will provide for workshop facilities and associated accommodations at a nearby hotel or conference center. 3. Harris may assist the CLIENT in obtaining the services of a professional facilitator. 4. A minimum of 4 Harris staff will attend and take part in both partnering sessions. 5. CLIENT and Harris will send managers authorized to make decisions for their respective organizations. Deliverables: Partnering charter (from the Partnering Workshop Facilitator). 5 1.5 Sub -Consultant Management: Purpose: To coordinate and manage sub -consultant services. Sub -consultants may include inspectors, materials testing consultants, surveyors and /or others, to be determined at a later date and secured at reasonable rates. Approach: Harris will coordinate and manage the utilization of sub -consultants for the CLIENT in order to comply with the terms of the contract documents and the requirements of regulatory agencies. Assumptions: 1. The CLIENT will retain final approval rights over all selected sub -consultants. 2. All costs associated with sub -consultant services will be billed to the CLIENT. Deliverables: 1. Copies of all sub -consultant reports. Original reports will remain with Harris until project closeout, at which time all originals will be forwarded to the CLIENT. 2. Copies of all sub -consultant invoices billed through Harris, if Harris negotiates and enters into sub -consultant agreements at the direction of the CLIENT and for the benefit of the project. 1.6 Construction Strategies Purpose: To provide CLIENT with alternative construction strategies for a project, either prior to bid or as mitigation for impacts during construction. Approach: Harris will provide experienced construction staff to review proposed contract documents, and seek innovative alternatives to reduce contract time and potential CLIENT costs. Harris will assist CLIENT in developing alternate strategies for mitigating delays and impacts for on-going projects. After review of all documents, in both cases Harris will begin by leading a "brain storming" session to put all ideas on the table, and then review and refine alternatives that work best for the situation. Assumptions: The Harris -proposed strategies are alternate solutions and are not meant to be critical of the original design. Deliverables: A narrative report of alternative construction strategies to the original the design. 6 1.7 Contract Negotiations Purpose: To negotiate fair and equitable third -party contracts for the CLIENT, in the event that services not contemplated at the start of the project are required for project completion. Approach: Harris will meet with CLIENT and identify CLIENT concerns and requirements for any proposed third -party contract. Harris will assess conditions and scope of services and develop a strategy for negotiations. Harris will then negotiate with the third party and present negotiated contract to CLI ENT for approval. Assumptions: Harris is acting as Agent for the CLIENT and only the CLIENT will have authority for final approval of the contract. Deliverables: Harris will deliver negotiated contract to CLIENT for final approval and signature. TASK 2 —Pre -Construction Phase Services Harris shall provide specialized services during the project Pre -Construction phase, including the bidding periods of the project. These services are intended to involve the construction manager early in the project and to provide advanced planning for construction phase activities. 2.1 Constructability Reviews (Including Biddability) Purpose: To identify potential issues within the contract documents that may require clarification and/or correction prior to bid, recognizing that there are benefits to the CLIENT in resolving potential cost or schedule issues prior to the acceptance of bids. Approach: Harris will review plans and specifications to identify issues that may lead to confusion during the bid process and potential delays, disputes, and/or Contractor requested change orders during the course of construction. Assumptions: 1. Harris will not be responsible for design errors and/or omissions. 2. The CLIENT and/or Designer will determine which Biddability/Constructability comments, if any, are addressed prior to accepting bids. 3. Harris is responsible for bringing discrepancies within the contract documents to the attention of the CLIENT, but not responsible for deciding the correctness of information contained in the documents. 7 4. The responsibility for determining what contract document information is correct lies with the Designer and the CLIENT. Deliverables: Review report including biddablilty/constructability comments on marked plans and specifications. 2.2 Bidding Assistance before and during bid period Purpose: To provide bidding Contractors with a forum for review of the contract documents prior to bid; to record Contractor questions/concerns pertaining to bid documents and provide the Designer an opportunity to understand and address questions/concerns prior to the submission of bids. Approach. Harris will schedule and organize the pre-bid conference, prepare the agenda, supervise the proceedings, and provide notes from the conference. Assumptions: 1. The CLIENT will provide the meeting venue. 2. Harris will log and forward to the appropriate party all questions raised by bidders during the pre-bid conference and during the remainder of the bid period. 3. A copy of all bid responses will be forwarded to Harris for distribution to the bidders. Deliverables: 1. A written agenda and minutes for the pre-bid conference(s). 2. Electronic copies of pre-bid meeting minutes to the Designer and/or the CLIENT for use in preparing responses. 2.3 Construction Management Plan Purpose: To provide the CLIENT and Harris with uniform procedures and standards for the administration of the construction contract. Approach: Harris will develop a procedures manual that is usable for the construction project utilizing Caltrans Construction Manual, Caltrans Bridge Construction Records and Procedures Manual, and the Harris Construction Management Procedures Manual. The Manual will be a compilation of all appropriate manuals, using various parts from both manuals as appropriate and incorporating a section concerning emergencies. The CLIENT approved manual will used by the CLIENT as it deems appropriate. 8 Assumptions: 1. The final project manual will be bound in a three ring binder to facilitate future revisions. Deliverables: 1. Draft project manual for review by the CLIENT, two copies in loose-leaf binders 2. After review and comments, provide final project manual to the CLIENT, two copies in loose-leaf binders 2.4 Storm Water Pollution Prevention Plan (SWPPP) Purpose: To protect the CLIENT from potential fines from regulatory agencies by monitoring contractors' activities regarding pollution prevention controls and/or activities for general compliance with the contractor's SWPPP Best Management Practices (BMP). Approach: Harris will observe the contractor's work area for general compliance with the SWPPP Best Management Practices (BMP) and notify the contractor if the pollution prevention controls are not in accordance with the SWPPP. Failure to revise and correct conditions will be cause to have the CLIENT take corrective action. Immediate shutdown of the contractor's work may be required, if conditions are in non-compliance with the SWPPP or other permit conditions. Assumptions: 1. Harris will not be responsible for contractor(s) means and methods for complying with the BMP listed in the SWPPP. 2. Harris will not be responsible for costs incurred by the contractor(s) for its failure to comply with its SWPPP. Deliverables: Contractor(s)' SWPPP monitoring reports kept in project file for the record. 2.5 Pre -construction walk with contractor Purpose: To document existing project site and neighboring site conditions prior to the start of construction; to ensure that all parties are aware of and agree to the condition of existing project site and neighboring site conditions prior to the start of construction. Approach: Prior to the issuance of a Notice to Proceed, Harris, the Contractor, and a CLIENT representative will walk the entire project and record existing conditions via a written log, still photographs, and videotape where required. Harris will provide copies of all documentation to the Contractor and the CLIENT. Harris will keep documentation originals in the project files until project completion. 9 Assumptions: Project walk will not take longer than two days with approximately the same amount of time to log, file and copy the information. Deliverables: A written log, still photographs and any videotape depicting existing site conditions, as recorded prior to the start of construction. 2.6 Cash Flow Projections Purpose: To provide the CLIENT with a project's anticipated billings so the CLIENT can better manage available resources. Approach: Harris will review the contractor's baseline schedule, bid proposal, and lump sum bid item breakdowns to determine the contractor's planned schedule of earnings on a project. Harris will extract information and prepare a projection of the Client's cash flow requirements. Assumptions: The CLIENT'S contract documents contain reasonable schedule requirements. Deliverables: Harris will furnish Cash Flow Projections for the project. 2.7 Document Review Purpose: To review the CLIENT'S construction documents for completeness. Approach: Harris will review contract documents prior to bid. "Front end" portions of specifications will be reviewed to ensure that instructions to bidders are complete. General Conditions, Technical Provisions, and Standard Specifications will be reviewed for compatibility and completeness. Contract Drawings will be reviewed for apparent missing drawing sheets, details, and whole discipline sections. NOTE: This review is limited in scope and does not replace a full Biddability/Constructability (B/C) review. Assumptions: The CLIENT will furnish a complete set of documents for review. Deliverables: Written comments with recommended actions for CLIENT and CLIENT's Engineer. 10 TASK 3 — Construction Management Services Harris, on behalf of the CLIENT, will provide construction management services for one construction contract. The contracts involve construction of Phase 1 of the French Valley Parkway project, within the Cities of Temecula and Murrieta. Construction Management services will encompass the enforcement of all construction contract requirements. 3.1 Pre -construction Conferences Purpose: To provide a forum for all essential project participants to meet prior to the start of work. This meeting will outline the CLIENT's administration of the contract, introduction of the participants, and record all comments and questions submitted by the contractor(s). Provides an understanding of the procedures to be used on the project and what the Contractor can expect from the CLIENT and its consultants. Approach: Harris will schedule, prepare the agenda, chair and take minutes of the pre -construction meeting. The meeting will outline project specifics and inform the Contractor of project administration procedures. Assumptions: 1. The CLIENT will provide the meeting venue. 2. The CLIENT will assist Harris in developing the attendee list. 3. Harris will prepare a draft agenda for the CLIENT approval prior to the meeting. Deliverables: 1. Written agendas and minutes of pre -construction conferences. 2. Electronic copies of pre -construction meeting minutes to the attendees. 3.2 Communications and Correspondence Purpose: To provide and/or facilitate effective communication, on behalf of the CLIENT, among all stakeholders in the administration of the construction contract. Approach: Harris will obtain all pertinent information as required to develop a project directory of all key personnel working on the project. Harris will develop a graphic chart indicating the proper flow of correspondence. Harris will log all information received from the Contractor and others, in Contract Manager. Lastly, Harris will prepare and/or forward appropriate responses, obtaining CLIENT approval when required. 11 Assumptions: 1. The Harris Correspondence Log will be used for all correspondence received from the CLIENT, the Contractor and others. 2. All original correspondence will remain with the Harris project files. Only copies will be distributed, with the exception of shop drawing submittals. 3. The Harris project files will be turned over to the CLIENT upon conclusion of the project. Deliverables: Written logs of information received from the CLIENT, the Contractor and/or others. 3.3 Change Management Purpose: To provide a system for logging and tracking all changes on the project. Approach: Harris will review potential change orders for contractual and technical merit, prepare independent cost estimates and schedule analysis of work as necessary, and negotiate change order costs with the Contractor. Harris will prepare change orders with all required support documentation for execution by the CLIENT. Harris will keep the CLIENT appraised of cumulative changes in project cost and project duration. Assumptions: 1. Harris will be allowed to use its sole judgment regarding how best to handle cost negotiations with the Contractor. 2. Harris will obtain final approval of all project cost and/or project time changes from the CLI ENT prior to authorizing the Contractor to proceed with changes. 3. Harris will prepare official change order documentation to be processed with the Contractor's regular application for payment. Deliverables: 1. Independent cost estimates. 2. Change orders ready for execution. 3. Change order summary reports. 3.4 Monthly Construction Progress Reports Purpose: To keep the CLIENT apprised of the project status during the prescribed construction period. 12 Approach: Harris will prepare a monthly report that provides construction status to the CLIENT and other involved parties. The monthly report shall contain the following: 1. Status of contractor's schedule and what the contractor is doing to maintain or catch up if the schedule has slipped. While the focus will be on critical path items, other items that might become critical will be discussed in the report. 2. Photographs to show construction activities and for clarity for special issues. 3. Other information deemed necessary for the CLIENT to have a concise understanding of the construction Projects. Assumptions: The CLIENT will assist Harris in the initial formatting of the first report. Deliverables: Monthly progress report 3.5 Schedule Monitoring Purpose: To monitor and review the Contractor's schedule, after acceptance of baseline schedule, to ensure project is not being delayed over issues within the control of the Contractor. Approach: Harris will develop procedures, using available software, to review the Contractor's monthly schedule updates for logic, duration, and resource changes. Harris will notify the Contractor of discovered changes and document the Contractor's response, for the record. Harris will keep the CLIENT appraised of the Contractor's current construction schedule. Assumptions: Contract specifications will require the Contractor to use Critical Path Method (CPM) scheduling tools/software. Deliverables: Schedule review reports. 3.6 Cost Monitoring Purpose: To provide the CLIENT with a system that is easy to understand and provides up-to- date cost information for making timely decisions. 13 Approach: Using a combination of Contract Manager and Excel software, Harris will generate spreadsheets and graphs for the purpose of monitoring anticipated and actual cost outlays. Assumptions: The CLIENT will provide direction regarding desired cost monitoring information and report formats. Deliverables: 1. Construction and construction manager's costs incurred for the month. 2. Cash flow projections for both the contractor and Construction manager. 3. Potential Issues, pending change orders and executed change orders. 3.7 Progress / Coordination Meetings Purpose: To provide a forum for the review of the project status, the look -ahead schedule , outstanding RFIs and submittals, and project issues. Approach: Harris will conduct regular progress/coordination meetings, to be attended by the CLIENT, the Designer, the Contractor, Harris and invitees. Harris will request the CLIENT, the Designer and the Contractor to submit agenda items for the meetings. Using the proposed agenda items and agenda items developed in house, Harris will prepare a comprehensive agenda for the meeting and distribute the agenda to all parties scheduled to attend. Following the meeting, Harris will distribute meeting minutes, requesting either the concurrence of those who attended, or suggested corrections to the minutes. Minutes will be filed as either approved or amended. Assumptions: 1. The CLIENT's, Designer's and Contractor's staffs will be able to meet on a regular basis with minimal absences. 2. The meeting room will be able to seat a minimum of 15 people. 3. Meetings will not take place more than once a week and will not last longer than one hour. 4. The Contractor will submit a look -ahead schedule (2 or 3 week) at each meeting. Deliverables: 1. Agenda with status of open items from previous meetings. 2. Meeting minutes, for review, with action items noted. 3. Amended meeting minutes, if required. 4. Submittal, Issues log, Change Order log and RFI and RFQ working logs. 14 3.8 Payment Recommendations Purpose: To verify that the Contractor's request for payment does not represent more than an amount that is reasonable for the work done on a monthly basis. To prepare progress payment recommendations on behalf of the CLIENT for work completed and materials stored on hand (if allowed). Approach: Harris will review and approve the Contractor's monthly progress based on the percentage of work activities complete. The Contractor will submit a certified application for payment to Harris for final review. Once approved, Harris will prepare a payment application certificate, using Contract Manager software, for approval and execution by the CLIENT. Assumptions: 1. The CLIENT will make payments in accordance with the contract stipulations and State Law to the Contractor once each month. 2. Contract Manager software is acceptable to the CLIENT for preparing progress payment application certificates. Deliverables: 1. Contractor's certified application for payment. 2. Progress payment request documents suitable for approval and execution by the CLIENT. 3.9 Safety Purpose: To review the Contractor's work site safety and notify the Contractor of unsafe conditions, as observed. Approach: Harris will observe contractors' work area. Contractors to be informed if unsafe work conditions and/or areas are observed. Immediate shutdown of contractors' work may be required if conditions endanger property and/or life. Assumptions: 1. Contract document requires Contractor to submit its safety program and safety officer prior to the start of work 2. Contract documents or Contractor's safety program requires contractor to submit accident reports. 3. Harris assumes no responsibility for safety of Contractor's work areas. 4. Harris assumes no responsibility for implementation of Contractor safety program or its construction means and methods. 15 Deliverables: Accident reports from Contractor 3.10 Environmental Coordination Purpose: To verify the contractor has copies of applicable permits and that the work activities abide by the requirements of the permits granted by regulatory agencies. Approach: Harris will review and enforce requirements stipulated in permits issued by regulatory agencies. The Harris team will include resources with expertise including environmental surveys, paleontological review, biological mitigation, flora and fauna mitigation, as required by the project plans and specifications. Assumptions: 1. All permits will be provided to Harris for review. 2. All permits will be included in the contract documents. Deliverables: 1. Daily inspection reports prepared by Harris inspection staff on site. 2. Correspondence to affected parties. 3.11 Neighborhood Communication Purpose: To provide an efficient means for keeping adjacent residents and businesses appraised of the work activities they will encounter during construction. To provide a local contact telephone number that residents and businesses may contact to pose questions and discuss concerns. Approach: Using the Neighborhood Communication Plan, developed in Task 1, Harris will prepare "Dear Neighbor" letters and door hangers as a means to communicate with adjacent residents and businesses. Assumptions: None. Deliverables: Minutes of any meetings listing questions posed by residents and business owners. 16 3.12 Submittal Management and Review Purpose: To provide an efficient means of processing submittals between the Contractor and the Designer. Approach: Using Contract Manager, Harris will develop a comprehensive submittal list for distribution to the Contractor and the Designer. Harris will update and submit status submittal Togs for review at each coordination meeting. In addition, Harris will work with the Designer and Contractor to encourage timely submission, review and approval of submittals as outlined in the Contract Documents, prior to inclusion of submitted materials in the progress of the work. The following steps will be taken in reviewing the Contractor's submittals: 1. Log into Contract Manager all submittals by Specification Section. 2. Ensure that the Contractor has provided a complete submittal, coordinated with the work of other trades, and that all deviations have been noted. Submittal is returned to the contractor if it is not complete. 3. Harris Resident Engineer or designee reviews submittal for general compliance with the specification. 4. Submittal is forwarded to Designer for formal review. Submittal status is logged into Contract Manager. 5. Submittals are returned to Harris. Submittal status is logged into Contract Manager. 6. Submittals are returned to the Contractor for use in work. Submittal status is logged into Contract Manager. 7. Harris to inform Contractor if a re -submittal is required. 8. Steps may be shortened due to Contract Manager software updates. Assumptions: 1. Harris will not be responsible for errors or omissions in submittal lists. 2. Coordination and submission of submittals in accordance with requirements of the contract is the responsibility of the Contractor. 3. Harris will make an appropriate review of Contractor's submittals, consistent with the needs of the project. Deliverables: 1. Submittal status log. 2. Copy of all submittals and final submittal log. 3.13 Request for Information (RFI) Management Purpose: To provide an efficient means of processing Requests for Information (RFIs) submitted by the Contractor. The efficient management of RFIs permits timely communication between the Designer and the Contractor. 17 Approach: Harris will receive, log and review all RFIs for completeness and verify the question is reasonable and understandable. Harris will provide a short technical review of the RFI to determine if the issue is addressed adequately in the contract documents. Harris will return the RFI if the question is unclear or, in the opinion of Harris staff, the answer is contained in the contract documents, noting where the requested information can be found in the contract documents. Harris will track RFIs, using the Contract Manager software, and facilitate the timely response from the Designer. Assumptions: The Designer will respond with an answer to all RFIs within the contract stipulated time period for response. Facsimile or e-mail will be used to forward RFIs to the Designer and return responses to the Contractor, with original documents to follow. Deliverables: Comprehensive log of all outstanding RFIs and their status. 3.14 Document Management Purpose: To provide the CLIENT with an electronic means of tracking all documents exchanged between the parties involved in the construction of the project. Approach: Harris will use Primavera Contract Manager and the Caltrans File Index to log all documents in the project field office. Documents will be scanned into the document control system and attached to Contract Manager file index categories. All documents will be filed as an electronic file and hardcopy. Assumptions: None. Deliverables: 1. Comprehensive logs of all documents in the project files (electronic and hardcopy). 2. All hardcopy project documents exchanged on the project between the various parties. 3.15 Construction Change Order Assistance Purpose: To provide the CLIENT with assurance that the Contractor is not presenting requests to be paid for additional work included in the original contract. To assure the CLIENT that the associated extra work costs and time extension requests are fair and reasonable to both the CLIENT and the Contractor. 18 Approach: Harris will use the following approach in assisting the CLIENT: Requests for Changes by the CLIENT 1. Harris will forward a Request for Quote (RFQ) to the Contractor for pricing and stipulation of proposed time extension, if requested work can be shown to impact the project's critical path. The RFQ shall contain a description of the extra work (normally provided by the Designer) to fairly price the work. 2. Harris will prepare an independent cost estimate of the extra work. 3. Harris will review the cost quote from the Contractor for completeness, negotiate cost and time extension requests as required and then obtain CLIENT authorization for proceeding with the change, based on definitive cost and time extension values. 4. Should Harris and the Contractor be unable to negotiate a reasonable price, the CLIENT will be consulted prior to directing the work via alternative contract change options such as proceeding on a time and material basis or proceeding by force account. Requests for Changes by Contractor 1. Harris will review requests of proposed cost and/or time impacts for merit. If Harris determines the request fails on merit, the Contractor will be informed of the reasons why the request is denied. Should Harris determine the request has merit, Harris will proceed with steps 2 and 3. 2. Harris will prepare an independent cost estimate and schedule analysis of the work. 3. Harris will negotiate extra work cost and time extensions with the Contractor. 4. Harris will prepare change order documents for approval and execution by the CLIENT. Assumptions: 1. Harris will have authority to make minor changes to work that it determines to have no cost or time impacts to the construction project. 2. The contract will require the Contractor to submit a project schedule fragnet to demonstrate critical path impact to the project's schedule in order to substantiate any/all Contractor requests for contract time extension. 3. The CLIENT will not negotiate with the Contractor on contract changes. 4. Extra work costs successfully negotiated between Harris and the Contractor will be submitted to the CLIENT for approval. Deliverables: 1. Change order documentation ready for approval and execution by the CLIENT. 2. Change order logs. 19 3.16 Review Certified Payrolls Purpose: To verify the Contractor provides certified payroll reports in conformance with the provisions of the contract and applicable State Law. To verify the certified payroll reports contain information required by the Labor Code. Approach: Harris will receive and review certified payrolls from the Contractor and each of its subcontractors. Harris will check for the "Statement of Compliance" from the Contractor and/or subcontractors, and spot-check wages for each classification of laborer or craftsperson. Harris will notify the CLIENT and the Contractor of all discrepancies and/or errors and request a corrected Certified Payroll. Assumptions: 1. Harris will conduct random employee interviews, for the purpose of verifying payment of prevailing wages. 2. Harris will not be held responsible for enforcement of the Labor Code. 3. Harris will maintain a weekly list of subcontractors working on the project. 4. Harris will not be responsible for identifying every worker on site. Deliverables: Hardcopies of the Contractor's certified payrolls maintained in the project files. Task 4 — Construction Inspection Services 4.1 Inspection and Documentation Purpose: To provide the CLIENT with documentation of construction activities, duration of activities, manpower and equipment allocation, inspections, and work conditions. Approach: Harris will provide the CLIENT with knowledgeable people, familiar with construction activities to be performed on the project. Using Contract Manager, Harris will document the Contractors' daily activities, manpower loading, on-site equipment and items considered pertinent to the project. Harris will provide, coordinate and manage the utilization of the project inspectors for the purpose of providing daily inspections and/or special inspections as deemed necessary and beneficial for proper completion of the project, or, at the CLIENT's direction, Harris will negotiate and enter into a sub -consultant agreement(s) with a qualified Special Inspector(s), as defined in Task 1.7. 20 Assumptions: 1. CLIENT will not unreasonably withhold approval of the Inspector(s) proposed by Harris. 2. All inspections will be within the project limits. Deliverables: Harris daily activity reports and Inspector's daily inspection reports, maintained in the Harris project files and turned over to the CLIENT at the completion of the project. 4.2 Materials Testing Purpose: To provide project site and laboratory testing of construction materials used in the project for the purpose of determining that materials incorporated into the work of the project meet specified design criteria. Approach: Harris will utilize Converse Consultants for materials testing and laboratory services. Material testing on site will be performed in accordance with the Caltrans Construction Manual and Caltrans Manual of Test. Assumptions: 1. The CLIENT will not unreasonably withhold approval of the materials testing laboratory proposed by Harris. 2. The approved materials and testing laboratory will be located within a 50 -mile radius of the project site. 3. Caltrans will provide source inspection. Deliverables: Laboratory test reports, maintained in the Harris project files and turned over to the CLIENT at the completion of the project. 4.3 Surveying Purpose: Harris will employ David Evans and Associates, Inc. (DEA) for survey services on the French Valley Parkway Project. DEA understands that the City of Temecula is seeking a professional land surveying firm to provide quality assurance surveying services as part of the construction management team for the French Valley Parkway project. Approach Harris/DEA has taken a proactive approach when providing quality assurance construction surveying services to our clients. We have built a reputation of working closely with the entire team helping to identify constructability issues and assisting with finding solutions before the contractor is working in the area in question. This proactive 21 approach has helped reduce the number of change orders while helping the project to stay on schedule and within budget. We understand the number of survey staff may vary throughout the duration of the project. DEA will maintain continuity of survey staff throughout each phase of the project. This continuity of staff will provide the project with surveyors that are familiar with the survey requirements and the needs on the project. Harris understands the process required by the City of Temecula for compliance with the appropriate standards and specifications necessary for providing quality assurance survey services. In addressing the methodology for a typical interchange improvement project, the Caltrans Survey Manual and its revisions are the governing documents by which all surveying services will be performed. Assumptions: At the inception of the project, Harris will coordinate DEA attendance at a pre -job meeting with the Resident Engineer, Contractor, and other stakeholder's involved in the project. This will clearly identify the chain of command and contact persons for the project. Harris will then field verify the horizontal and vertical project control and its accuracy. Harris understands the established project survey control is the basis for all surveying to be performed. Any supplemental survey control will be adjusted to the designated control values. The Resident Engineer on the project is the surveyor's primary contact and the only person authorized to approve quality assurance survey services to verify the Contractors staking. We further understand this process involves a written request for quality assurance survey services from the Resident Engineer. Deliverables: The Resident Engineer approves the written request and forwards it to surveys. The surveyor schedules the work and prepares a field survey package. This may include checking for current plans or revisions, grade sheets, control, etc. The field survey crew will complete the approved quality assurance survey request as provided. Upon completion, the party chief will sign off on the survey request and return the survey request with the required copies of the field survey notes to the Resident Engineer. All original field notes and all electronic collected data shall be submitted to the City of Temecula at the completion of the project. 4.4 Review and maintain "As Constructed Schedule" Purpose: To track contractor's progress during construction of the project. Approach: Harris will use the daily inspection reports prepared by Harris inspectors, the contractors' schedule, site observations, and other sources of information, to track and document the contractor's actual progress. The contractor's baseline critical path 22 schedule will be used as a basis for comparing planned versus actual progress. The CPM software described in Task 3 will be used to track the contractor's progress and build a schedule based on the contractor's activities. Assumptions: Monitoring will be on a continuous basis and the "as constructed" schedule will be updated monthly. Deliverables: An "As Constructed Schedule" with one electronic file and one hardcopy. 4.5 Maintain Photographic and Video Records of Construction Progress Purpose: To provide the CLIENT with a photographic record of the project, before, during and after construction. Approach: Using 35mm and digital photography, Harris will record the Contractor's progress during construction. Care will be taken to record all items and/or conditions that have or may have a bearing on claimed extra work. Still photographs will be labeled with captions indicating subject matter, date taken, and any description required to further clarify the item/issue being photographed. Assumptions: All photographs will remain at the Harris office until the end of the project. Deliverables: All photographic records. 4.6 Review and Maintain "As Built" Drawings Purpose: To provide the CLIENT with accurate record drawings for the project. Approach: Harris will monitor the contractor's required record drawings on a monthly basis. In addition to monitoring the contractor's drawings, Harris will maintain a copy of the contract plans for the project. Harris will attempt to include items that are not normally shown on the contractor's set of record drawings. This information is not necessarily construction related, but is project related and may be important in future maintenance and/or construction projects. Assumptions: 1. The CLIENT will be responsible for making the changes to the drawings prepared by its design engineers. 23 2. Harris will assist the design engineers in answering its questions regarding the record drawings. 3. Contract documents will require contractor to maintain redline as -built drawings. Deliverables: One set of marked up contract drawings. This set will be in addition to the contractor's marked up set of contract drawings. 4.7 Final Inspection and Punchlist Purpose: To identify elements of construction requiring correction prior to final acceptance by the CLIENT. Approach: Harris will perform a project inspection of the completed construction following substantial completion. During the inspection, Harris will develop a list of contract work requiring correction or rework. The written list of deficient work (punchlist) will be delivered to the CLIENT and CONTRACTOR within three (3) working days of the final inspection. The final punchlist will include items to be corrected that were identified previously during the course of construction. Assumptions: 1. The CLIENT will identify any key CLIENT or other agency personnel to be included in the final inspection. 2. HARRIS will contact and schedule all required final inspection personnel 48 hour prior to the final inspection. 3. HARRIS will prepare the final punchlist. Deliverables: Final punchlist. Task 5 — Construction Closeout Activities 5.1 Contract Closeout Purpose: To provide the CLIENT with final closeout documentation. Approach: Harris will turnover all project files, contract correspondence and documents including final logs at time of project completion. Copy of the Contractor's performance bond, good for the warranty period. 24 Assumptions: CLIENT will file final Notice of Completion and Acceptance of Work. Deliverables: 1. Notice of Completion form for Riverside County. 2. Final project documentation. 5.2 Project As -Built Drawings Purpose: To provide the CLIENT with accurate record drawings indicating all changes and as - built conditions. Approach: Harris will monitor Contractor required record drawings on a monthly basis. In addition to monitoring the Contractor's drawings, Harris will maintain a copy of up-to-date contract plans for the purpose of aiding the Designer in final review of the record drawings. Assumptions: 1. The Contractor will be responsible for preparing the record drawings in both reproducible and electronic formats. 2. Harris will assist the Designer in review and final approval of the record drawings. Deliverables: One set of contract drawings indicating recorded changes to the contract, as maintained by Harris. This set will be in addition to the Contractor's marked up set of contract drawings. 5.3 Final Project Report Purpose: To provide the CLIENT with a written history of the construction contract. Approach: Harris will review the project documents and prepare a written report for the CLIENT. As a minimum, the report will include the following: 1. Names of all organizations involved with the Projects, i.e, CLIENT managers, construction manager, contractor and any other parties that may have a significant part in the construction of the projects. 2. Chronological history of the construction effort, to include all significant dates. 3. Contract amounts at bid time with all other bids in tabular form. 4. Change order history, to include summary statement about each change, negotiated cost of each change and other information deemed necessary by Harris and the CLIENT's Construction Manager. 5. Summary of Requests for Information, in tabular or matrix form. 25 6. Summary of outstanding claims not resolved when the notice of completion is filed. 7. Summary of final contract amount. 8. "Lessons learned" Assumptions: CLIENT will provide input to Harris regarding the form of the final report. Deliverables: One Project Report for each construction project. One hard copy and one electronic file will be provided. 5.4 Final Payment Purpose: To provide the CLIENT with the final contract cost and final balance due the Contractor. Approach: Following completion of the contract work, Harris will, in accordance with the Designer, determine the final quantities and cost of all outstanding unit price work and all outstanding approved change order work. Harris will prepare for the CLIENT and the Contractor, a final balancing change order quantifying the final contract amount. Contractor will include amount of final balancing change order in submission of last certified application for payment, submitted to Harris. Once approved, Harris will forward application for payment to the CLIENT for final approval and processing. Assumptions: 1. There are no outstanding issues or claims. 2. The CLIENT is responsible for filing Notice of Completion and addressing all subcontractor claims prior to release of final payment. Deliverables: 1. Final balancing change order. 2. Contractor's last certified application for payment with application certificate. 26 City of Temecula French Valley Parkway/ Interstate -15 Over -Crossing and Interchange Improvements - Phase l Payment Rates and Schedule - OVERALL FEE Construction Management Cost of Services Worksheet Project Schedule 2011 2012 2013 Calendar days Work days Preconstruction Construction Phase (includes Landscape Est.) Closeout Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 30 31 30 31 31 28 31 30 31 30 31 30 30 31 30 31 31 28 31 30 31 30 31 30 30 31 30 31 21 21 20 21 21 21 22 21 22 21 21 23 19 23 20 20 22 20 21 21 22 20 22 22 20 23 19 21 38 46 40 40 44 40 42 570 $136,114 Senior Inspector Mebane $156.94 88 168 176 168 168 184 152 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 15 16 17 18 19 $153.10 176 168 168 184 152 92 940 $143,910 PAGE 1 of 2 Estimated Fees Position Name Rate Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Totals Project Director Barnett $250.00 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 2 2 2 78 $19,500 Resident Engineer Carney $174.90 40 84 176 168 176 168 168 184 152 184 160 160 176 160 168 168 176 160 44 44 40 2,956 $517,004 Structures Rep. Hannigan $238.80 20 44 42 44 42 42 46 38 46 40 40 44 40 42 570 $136,114 Senior Inspector Mebane $156.94 88 168 176 168 168 184 152 184 160 160 176 160 168 168 176 80 44 44 2,624 $411,820 Structure Inspector Mantuano $153.10 176 168 168 184 152 92 940 $143,910 0E/SWPPP/Inspector Michael $122.43 84 176 168 176 168 168 184 152 184 160 160 176 160 168 168 176 160 44 44 40 2,916 $357,006 Scheduler Wang $84.09 16 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 152 $12,781 Accounting Support Woolf $75.00 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 84 $6,300 0 $0 Monthly Subtotal Labor 0 0 0 0 GB 176 508 562 764 730 730 798 662 706 536 536 588 536 562 520 544 416 146 146 86 0 0 0 Labor $1,604,436 2012 Salary Adjust. (3% assumed) = $ 31,846.32 2013 Salary Adjust. (3% assumed) = $ 33,062.09 Increase $ 33,062.09 ODC`s See Page 2 of 2 allowance ODC's $225,475 Paleological Paler; Solutions allowance Paleo $20,000 Environmental Entech allowance Env. $50,000 Survey/Landscape David Evans allowance Survey $200,000 Materials Testing Converse allowance Testing $200,000 $2,332,973 City of Temecula French Valley Parkway / Interstate -15 Over -Crossing and Interchange Improvements - Phase I Payment Rates and Schedule - ODCs OTHER DIRECT COSTS PAGE 2 of 2 UNIT UNIT QTY COST ($) SUBTOTAL ($) TOTAL ($) A) LEASED VEHICLES/O&M * Chevy Silverado Truck (Resident Engineer) Months 18 1,300 $23,400 Chevy Silverado Truck (Structures Rep.) Hour 570 7.5 $4,275 Chevy Silverado Truck (Roadway Inspector) Months 16 1,300 $20,800 Chevy Silverado Truck (Structures Inspector) Months 6 1,300 $7,800 Chevy Silverado Truck (OE/SW PPP Inspector) Months 17 1,300 $22,100 B) FIELD EQUIPMENT Survey Equipment Rental (Level, Transit, Rods) * Months 18 100 $1,800 Monthly Cell Phone Service* Months 40 75 $3,000 Tools LS 1 200 $200 $78,375 $5,000 G) SAFETY EQUIPMENT & SUPPLIES LS 1 500 $500 (Hard Hats, Vests, Rain Suits) $500 D) FIELD SUPPLIES Digital Camera Each 3 200 $600 Video Camera/Monitor LS 1 1,000 $1,000 $1,600 E) FIELD OFFICE (minimum 1500 SF) Lease with Janitorial, Utilities & Security Months 24 $ 3,000 $72,000 Office Furniture (Used) LS 1 $ 5,000 $5,000 Phones (3) plus Installation LS 1 $ 1,500 $1,500 Telephone Charges, Voice Mail Months 24 $ 500 $12,000 Photocopier Months 24 $ 1,000 $24,000 Fax LS 1 $ 750 $750 Microwave, Refrigerator LS 1 $ 1,000 $1,000 Water Service Months 24 $ 100 $2,400 Internet / Email Service Months 24 150 $3,600 Misc. Office Equipment/Furniture LS 1 $ 5,000 $5,000 $127,250 F) COMPUTER Computer with Software & Service Each 3 1,500 $4,500 Laser Jet Printer Each 1 900 $900 Software Licenses (Contract Mgr, P6) Each 3 500 $1,500 Miscellaneous Hardware/Software LS 1 1,500 $1,500 $8400 G) OFFICE SUPPLIES Initial Supply LS 1 750 $750 Office Supplies* Months 24 100 $2,400 Postage/Express Mail * Months 24 50 $1,200 $4 350 H) MISCELLANEOUS LS 1 0 $0 $0 TOTAL DIRECT EXPENSES $225,475 * Negotiated Fixed Rates. CJ TYOFTEMECLJLA FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS -PHASE I Circulation Project Project Description: Project will include the design, right-of-way acquisition, utility relocation, and construction activities to portions of the French Valley Parkway and Interstate -15 over -crossing and interchange. The project will add a new southbound off -ramp from Interstate -15 to French Valley Parkway, construct the northern half of French Valley Parkway from the off -ramp to Jefferson Avenue, widen the existing southbound off -ramp from Interstate -15 to Winchester, and construct a new auxiliary lane between French Valley Parkway and the Winchester Road southbound off -ramp. Other features include permanent and temporary retaining walls, erosion control and irrigation, and a new traffic signal and roadway improvements at the intersection of French Valley Parkway and Jefferson Avenue. Project requires oversight by Caltrans and coordination with the City of Murrieta. Benefit: Project will improve traffic circulation by providing another southbound off -ramp from Interstate -15 and add a lane to the Interstate -15 southbound off -ramp to Winchester. Project Status: The plans, specifications, and estimates, are expected to be complete during fiscal year 2012. Construction is expected to be complete by the end of fiscal year 2013. Department: Public Works -Account No. 210.165.719 Priority: 1 Project Cost: Actua Is to Date Future Total Project 2011-12 2012-13 2013-14 2014-15 2015-16 Years Cost Administration $ 353,949 $ 210,389 $ 200,000 $25,000 $ 789,338 Acquisition $2,256,952 $ 1,704,666 $ 160,830 $60,000 $35,000 $70,000 $ 3,961,618 Construction $18,200,000 $ 8,855,000 $ 27,055,000 Construction $ 444,203 $ 444,203 Engineering $ 2,000,000 $ 1,000,000 $ 3,000,000 Design $1,382,796 $ 648,303 $ 1,167,801 $ 2,031,099 Environmental $ 15,000 $ 35,000 $35,000 $35,000 $70,000 $ 190,000 MS HCP $ 245,000 $ 245,000 Totals $3,993,697 $23,023,358 $10,090,000 $60,000 $35,000 $70,000 $ - $ 37,272,055 Source of Funds: Actuals to Date Future Total Project 2011-12 2012-13 2013-14 2014-15 2015-16 Years Cost Capital Project Reserves $ 160,830 $60,000 $35,000 $70,000 $ 325,830 DIF (Street Improvements) $ 444,203 $ 444,203 Measure A -Local Street and Road $ 977,181 $ 724,369 $ 1,167,801 $ 2,869,351 Reimbursement/Other (Mjrrieta Land Donation) $ 1,631,631 $ 1,631,631 TUMF (CETAPIROTC)(1) $20,000,000 $ 8,761,369 $ 28,761,369 TUMF(ROTC)r2) $2,462,295 $ 2,462,295 TUM F (WRCOG)(3) $ 110,018 $ 667,358 $ 777,376 Total Funding: $3,993,697 $23,023,358 $10,090,000 $60,000 $35,000 $70,000 $ $ 37,272,055 Future Operation & Maintenance Costs: 2011-12 1 2012-13 2013-14 2014-15 2015-16 $15,000 $15,606 (1) TUFF (CETAP/ROTC) - Funding is pursuant to the RCTCAgreerrent No. 11-72-0036-00 in the amount of $20,000,000 to date. (2) IMF (ROTC) - Funding is pursuant to the RCTC Agreement No. 06-72-048-00 for a total of $75,517,000 ($5,715,000 -ROW and $2,000,000- PS&E). Fhase I is $1,682,000 -ROW and $203,784-PS&E- See also Fhase IL (3) IMF (WRCOG) - Zone funding is pursuant to WRCOG Agreement No. 05 -SW -TEM -1064 for a total of $4,078,000 ($1,165,000-FS&E) - See also Fhase II. $15,300 49 FRENCH VALLEY PARKWAY / INTERSTATE -15 OVER -CROSSING AND INTERCHANGE IMPROVEMENTS - PHASE I Circulation Project Location Aerial Data - March 2010 0 250 500 Feet 1,000 48 Item No. 12 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Greg Butler, Director of Public Works/City Engineer DATE: December 13, 2011 SUBJECT: Transportation Uniform Mitigation Fee (TUMF) Reimbursement Agreement with the Western Riverside Council of Governments (WRCOG) for the French Valley Parkway/I-15 Overcrossing and Interchange - Plans, Specifications and Estimates (PS&E) Phase PREPARED BY: Julie Dauer, Sr. CIP Specialist RECOMMENDATION: That the City Council: 1. Approve, in substantially the form attached, the TUMF Reimbursement Agreement, in the amount of $8,925,000, between the Western Riverside Council of Governments (WRCOG) and the City of Temecula for the French Valley Parkway/I-15 Overcrossing and Interchange — Plans, Specifications and Estimates (PS&E) Phase (Agreement No. 06 -SW -TEM -1079); and 2. Authorize the City Manager to execute the Agreement. BACKGROUND: The proposed French Valley Parkway/I-15 Overcrossing and Interchange project includes the construction of a new freeway interchange, auxiliary lanes, and collector/distributor system between the existing Winchester Road Interchanges and the 1-15/1- 215 junction on the border of the cities of Temecula and Murrieta. The project is recognized in the current WRCOG Southwest Zone 5 -Year Transportation Improvement Program as a TUMF funded project. On September 14, 2010, the City Council approved a TUMF agreement with WRCOG in the amount of $2,650,000 for the Project Approval and Environmental Document (PA & ED) Phase. The City is currently receiving reimbursement for eligible costs associated with this phase of work. The attached Agreement to reimburse TUMF Funds for the French Valley Parkway/I-15 Overcrossing and Interchange Project is for the Plans, Specifications and Estimates (PS & E) Phase of work, in the amount of $8,925.000. The agreement was approved by the WRCOG Executive Committee at their regular meeting of December 5, 2011. Once the agreement is signed by both parties, the City can obligate funds and request reimbursement for all eligible PS & E costs as defined in the Reimbursement Agreement. FISCAL IMPACT: The new WRCOG TUMF Reimbursement Agreement for $8,925,000 will allow the City to recover all eligible costs associated with the PS & E phase of the French Valley Parkway/I-15 Overcrossing and Interchange Project. ATTACHMENTS: Agreement to Reimburse TUMF Funds — (Agreement No. 06 -SW - TEM -1079). 06 -SW -TEM -1079 TRANSPORTATION UNIFORM MITIGATION FEE PROGRAM AGREEMENT TO REIMBURSE TUMF FUNDS FRENCH VALLEY PARKWAY/I-15 OVERCROSSING & INTERCHANGE — PLANS, SPECIFICATIONS AND ESTIMATES (PS&E) PHASE THIS REIMBURSEMENT AGREEMENT (`Agreement") is entered into as of this day of , 2011, by and between the Western Riverside County of Governments ("WRCOG"), a California joint powers authority and the City of Temecula, a California municipal corporation (`Agency"). WRCOG and Agency are sometimes hereinafter referred to individually as "Party" and collectively as "Parties". RECITALS A. WRCOG is the Administrator of the Transportation Uniform Mitigation Fee Program of Western Riverside County ("TUMF Program"). B. WRCOG has identified and designated certain transportation improvement projects throughout Western Riverside County as projects of regional importance ("Qualifying Projects" or "Projects"). The Qualifying Projects are more specifically described in that certain WRCOG study titled "TUMF Nexus Study", as may be amended from time to time. Qualifying Projects can have Regional or Zonal significance as further described in the TUMF Nexus Study. C. The TUMF Program is funded by TUMF fees paid by new development in Western Riverside County (collectively, "TUMF Program Funds"). TUMF Program Funds are held in trust by WRCOG for the purpose of funding the Qualifying Projects. D. The AGENCY proposes to implement a Qualifying Project, and it is the purpose of this Agreement to identify the project and to set forth the terms and conditions by which WRCOG will release TUMF Program Funds. AGREEMENT NOW, THEREFORE, in consideration of the mutual covenants and subject to the conditions contained herein, the Parties hereby agree as follows: I. Description of the Qualifying Project. This Agreement is intended to distribute TUMF Program Funds to the AGENCY for the FRENCH VALLEY PARKWAY/I-15 OVERCROSSING & INTERCHANGE PROJECT (the "Project"), a Qualifying Project. A description of the Project, its implementation schedule, a detailed scope of work and the AGENCY's estimated project cost thereof, is more particularly described in Exhibit "A" attached hereto and, pursuant to Section 19 below, is subject to modification as requested by the AGENCY and approved by WRCOG. It is understood and agreed that the AGENCY shall expend TUMF Program Funds only as set forth in the Agreement and only for the Project. To Page 1 of 23 RVPUBVDBALL NV742260.5 06 -SW -TEM -1079 this end, any use of the funds provided pursuant to this Agreement shall be subject to the review and approval of WRCOG. 2. WRCOG Funding Amount. WRCOG hereby agrees to distribute to AGENCY, on the terns and conditions set forth herein, a sum not to exceed EIGHT MILLION, NINE HUNDRED TWENTY-FIVE THOUSAND DOLLARS (S8,925,000) to be used for reimbursing the AGENCY for eligible Project expenses as described in Section 3 herein ("Funding Amount"). The Parties acknowledge and agree that the Funding Amount may be less than the actual cost of the Project. Nevertheless, the Parties acknowledge and agree that WRCOG shall not be obligated to contribute TUMF Program Funds in excess of the maximum TUMF share identified in the TUMF Nexus Study ("Maximum TUMF Share"), as may be amended from time to time. 3. Project Costs Eligible for Advance/Reimbursement. The total Project costs ("Total Project Cost") may include the following items, provided that such items are included in the scope of work attached hereto as Exhibit "A" ("Scope of Work"): (1) AGENCY and/or consultant costs associated with direct Project coordination and support; (2) funds expended in preparation of preliminary engineering studies; (3) funds expended for preparation of environmental review documentation for the Project; (4) all costs associated with right-of-way acquisition, including right-of-way engineering, appraisal, acquisition, legal costs for condemnation procedures if authorized by the AGENCY, and costs of reviewing appraisals and offers for property acquisition; (5) costs reasonably incurred if condemnation proceeds; (6) costs incurred in the preparation of plans, specifications, and estimates by AGENCY or consultants; (7) AGENCY costs associated with bidding, advertising and awarding of the Project contracts; (8) construction costs, including change orders to construction contract approved by the AGENCY; (9) construction management, field inspection and material testing costs; and (10) any AGENCY administrative cost to deliver the Project. 4. Ineligible Project Costs. The Total Project Cost shall not include the following items which shall be borne solely by the AGENCY without reimbursement: (1) any AGENCY administrative fees attributed to the reviewing and processing of the Project; and (2) expenses for items of work not included within the Scope of Work in Exhibit "A". 5. Procedures for Distribution of TUMF Program Funds to AGENCY. (a) Initial Payment by the AGENCY. The AGENCY shall be responsible for initial payment of all the Project costs as they are incurred. Following payment of such Project costs, the AGENCY shall submit invoices to WRCOG requesting reimbursement of eligible Project costs. Each invoice shall be accompanied by detailed contractor invoices, or other demands for payment addressed to the AGENCY, and documents evidencing the AGENCY's payment of the invoices or demands for payment. Documents evidencing the AGENCY'S payment of the invoices shall be retained for three (3) years and shall be made available for review by WRCOG. The AGENCY shall submit invoices not more often than monthly and not less often than quarterly. Page 2 of 23 RVPUBADBALLNv742260.5 06 -SW -TEM -1079 (b) Review and Reimbursement by WRCOG. Upon receipt of an invoice from the AGENCY, WRCOG may request additional documentation or explanation of the Project costs for which reimbursement is sought. Undisputed amounts shall be paid by WRCOG to the AGENCY within thirty (30) days. In the event that WRCOG disputes the eligibility of the AGENCY for reimbursement of all or a portion of an invoiced amount, the Parties shall meet and confer in an attempt to resolve the dispute. If the meet and confer process is unsuccessful in resolving the dispute, the AGENCY may appeal WRCOG's decision as to the eligibility of one or more invoices to WRCOG's Executive Director. The WRCOG Executive Director shall provide his/her decision in writing. If the AGENCY disagrees with the Executive Director's decision, the AGENCY may appeal the decision of the Executive Director to the full WRCOG Executive Committee, provided the AGENCY submits its request for appeal to WRCOG within ten (10) days of the Executive Director's written decision. The decision of the WRCOG Executive Committee shall be final. Additional details concerning the procedure for the AGENCY's submittal of invoices to WRCOG and WRCOG's consideration and payment of submitted invoices are set forth in Exhibit "B", attached hereto. (c) Funding Amount/Adjustment. If a post Project audit or review indicates that WRCOG has provided reimbursement to the AGENCY in an amount in excess of the Maximum TUMF Share of the Project, or has provided reimbursement of ineligible Project costs, the AGENCY shall reimburse WRCOG for the excess or ineligible payments within 30 days of notification by WRCOG. 6. Increases in Project Funding. The Funding Amount may, in WRCOG's sole discretion, be augmented with additional TUMF Program Funds if the TUMF Nexus Study is amended to increase the maximum eligible TUMF share for the Project. Any such increase in the Funding Amount must be approved in writing by WRCOG's Executive Director. In no case shall the amount of TUMF Program Funds allocated to the AGENCY exceed the then -current maximum eligible TUMF share for the Project. No such increased funding shall be expended to pay for any Project already completed. For purposes of this Agreement, the Project or any portion thereof shall be deemed complete upon its acceptance by WRCOG's Executive Director which shall be communicated to the AGENCY in writing. 7. No Funding for Temporary Improvements. Only segments or components of the construction that are intended to form part of or be integrated into the Project may be funded by TUMF Program Funds. No improvement which is temporary in nature, including but not limited to temporary roads, curbs, tapers or drainage facilities, shall be funded with TUMF Program Funds, except as needed for staged construction of the Project. 8. AGENCY's Funding Obligation to Complete the Project. In the event that the TUMF Program Funds allocated to the Project represent less than the total cost of the Project, the AGENCY shall provide such additional funds as may be required to complete the Project. 9. AGENCY's Obligation to Repay TUMF Program Funds to WRCOG. In the event that: (i) the AGENCY, for any reason, determines not to proceed with or complete the Project; or (ii) the Project is not timely completed, subject to any extension of time granted by WRCOG pursuant to the terms of this Agreement; the AGENCY agrees that any TUMF Program Page 3 of 23 RVPUBADBALLINV742260.5 06 -SW -TEM -1079 Funds that were distributed to the AGENCY for the Project shall be repaid in full to WRCOG. The Parties shall enter into good faith negotiations to establish a reasonable repayment schedule and repayment mechanism. 10. Term/Notice of Completion. The term of this Agreement shall be from the date first herein above written until: (i) the date WRCOG formally accepts the Project as complete, pursuant to Section 6; (ii) termination of this Agreement pursuant to Section 14; or (iii) the AGENCY has fully satisfied its obligations under this Agreement. All applicable indemnification provisions of this Agreement shall remain in effect following the termination of this Agreement. 11. Representatives of the Parties. WRCOG's Executive Director, or his or her designee, shall serve as WRCOG's representative and shall have the authority to act on behalf of WRCOG for all purposes under this Agreement. The AGENCY hereby designates SHAWN D. NELSON, CITY MANAGER, or his or her designee, as the AGENCY's representative to WRCOG. The AGENCY's representative shall have the authority to act on behalf of the AGENCY for all purposes under this Agreement and shall coordinate all activities of the Project under the AGENCY's responsibility. The AGENCY shall work closely and cooperate fully with WRCOG's representative and any other agencies which may have jurisdiction over or an interest in the Project. 12. Expenditure of Funds by AGENCY Prior to Execution of Agreement. Nothing in this Agreement shall be construed to prevent or preclude the AGENCY from expending funds on the Project prior to the execution of the Agreement, or from being reimbursed by WRCOG for such expenditures. However, the AGENCY understands and acknowledges that any expenditure of funds on the Project prior to the execution of the Agreement is made at the AGENCY's sole risk, and that some expenditures by the AGENCY may not be eligible for reimbursement under this Agreement. 13. Review of Services. The AGENCY shall allow WRCOG's Representative to inspect or review the progress of the Project at any reasonable time in order to determine whether the terms of this Agreement are being met. 14. Termination. (a) Notice. Either WRCOG or AGENCY may, by written notice to the other party, terminate this Agreement, in whole or in part, in response to a material breach hereof by the other Party, by giving written notice to the other party of such termination and specifying the effective date thereof. The written notice shall provide a 30 day period to cure any alleged breach. During the 30 day cure period, the Parties shall discuss, in good faith, the manner in which the breach can be cured. (b) Effect of Termination. In the event that the AGENCY terminates this Agreement, the AGENCY shall, within 180 days, repay to WRCOG any unexpended TUMF Program Funds provided to the AGENCY under this Agreement and shall complete any portion of segment of work for the Project for which TUMF Program Funds have been provided. In the event that WRCOG terminates this Agreement, WRCOG shall, within 90 days, distribute to the AGENCY TUMF Program Funds in an amount equal to the aggregate total of all unpaid Page 4 of 23 RV PUB'DBALLIN\742260.5 06 -SW -TEM -1079 invoices which have been received from the AGENCY regarding the Project at the time of the notice of termination; provided, however, that WRCOG shall be entitled to exercise its rights under Section 5(b), including but not limited to conducting a review of the invoices and requesting additional information. Upon such termination, the AGENCY shall, within 180 days, complete any portion or segment of work for the Project for which TUMF Program Funds have been provided. This Agreement shall terminate upon receipt by the non -terminating Party of the amounts due to it hereunder and upon completion of the segment or portion of Project work for which TUMF Program Funds have been provided. (c) Cumulative Remedies. The rights and remedies of the Parties provided in this Section are in addition to any other rights and remedies provided by law or under this Agreement. 15. Prevailing Wages. The AGENCY and any other person or entity hired to perform services on the Project are alerted to the requirements of California Labor Code Sections 1770 et seq., which would require the payment of prevailing wages were the services or any portion thereof determined to be a public work, as defined therein. The AGENCY shall ensure compliance with these prevailing wage requirements by any person or entity hired to perform the Project. The AGENCY shall defend, indemnify, and hold harmless WRCOG, its officers, employees, consultants, and agents from any claim or liability, including without limitation attorneys, fees, arising from its failure or alleged failure to comply with California Labor Code Sections 1770 et seq. 16. Progress Reports. WRCOG may request the AGENCY to provide WRCOG with progress reports concerning the status of the Project. 17. Indemnification. (a) AGENCY Responsibilities. In addition to the indemnification required under Section 15, the AGENCY agrees to indemnify and hold harmless WRCOG, its officers, agents, consultants, and employees from any and all claims, demands, costs or liability arising from or connected with all activities governed by this Agreement including all design and construction activities, due to negligent acts, errors or omissions or willful misconduct of the AGENCY or its subcontractors. The AGENCY will reimburse WRCOG for any expenditures, including reasonable attorneys' fees, incurred by WRCOG, in defending against claims ultimately determined to be due to negligent acts, errors or omissions or willful misconduct of the AGENCY. (b) WRCOG Responsibilities. WRCOG agrees to indemnify and hold harmless the AGENCY, its officers, agents, consultants, and employees from any and all claims, demands, costs or liability arising from or connected with all activities governed by this Agreement including all design and construction activities, due to negligent acts, errors or omissions or willful misconduct of WRCOG or its sub -consultants. WRCOG will reimburse the AGENCY for any expenditures, including reasonable attorneys' fees, incurred by the AGENCY, in defending against claims ultimately determined to be due to negligent acts, errors or omissions or willful misconduct of WRCOG. Page 5 of 23 RVPUBVDBALLIN\742260.5 06 -SW -TEM -1079 (c) Effect of Acceptance. The AGENCY shall be responsible for the professional quality, technical accuracy and the coordination of any services provided to complete the Project. WRCOG's review, acceptance or funding of any services performed by the AGENCY or any other person or entity under this Agreement shall not be construed to operate as a waiver of any rights WRCOG may hold under this Agreement or of any cause of action arising out of this Agreement. Further, the AGENCY shall be and remain liable to WRCOG, in accordance with applicable law, for all damages to WRCOG caused by the AGENCY's negligent performance of this Agreement or supervision of any services provided to complete the Project. 18. Insurance. The AGENCY shall require, at a minimum, all persons or entities hired to perform the Project to obtain, and require their subcontractors to obtain, insurance of the types and in the amounts described below and satisfactory to the AGENCY and WRCOG. Such insurance shall be maintained throughout the term of this Agreement, or until completion of the Project, whichever occurs last. (a) Commercial General Liability Insurance. Occurrence version commercial general liability insurance or equivalent form with a combined single limit of not less than $1,000,000.00 per occurrence. If such insurance contains a general aggregate limit, it shall apply separately to the Project or be no less than two times the occurrence limit. Such insurance shall: (i) Name WRCOG and AGENCY, and their respective officials, officers, employees, agents, and consultants as insured with respect to performance of the services on the Project and shall contain no special limitations on the scope of coverage or the protection afforded to these insured; (ii) Be primary with respect to any insurance or self insurance programs covering WRCOG and AGENCY, and/or their respective officials, officers, employees, agents, and consultants; and (iii) Contain standard separation of insured provisions. (b) Business Automobile Liability Insurance. Business automobile liability insurance or equivalent form with a combined single limit of not less than $1,000,000.00 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. (c) Professional Liability Insurance. Errors and omissions liability insurance with a limit of not less than $1,000,000.00 Professional liability insurance shall only be required of design or engineering professionals. (d) Workers' Compensation Insurance. Workers' compensation insurance with statutory limits and employers' liability insurance with limits of not less than $1,000,000.00 each accident. Page 6 of 23 RVPUBDBALLIN;742260.5 06 -SW -TEM -1079 19. Project Amendments. Changes to the characteristics of the Project, including the deadline for Project completion, and any responsibilities of the AGENCY or WRCOG may be requested in writing by the AGENCY and are subject to the approval of WRCOG's Representative, which approval will not be unreasonably withheld, provided that extensions of time for completion of the Project shall be approved in the sole discretion of WRCOG's Representative. Nothing in this Agreement shall be construed to require or allow completion of the Project without full compliance with the California Environmental Quality Act (Public Resources Code Section 21000 et seq.; "CEQA") and the National Environmental Policy Act of 1969 (42 USC 4231 et seq.), if applicable, but the necessity of compliance with CEQA and/or NEPA shall not justify, excuse, or permit a delay in completion of the Project. 20. Conflict of Interest. For the term of this Agreement, no member, officer or employee of the AGENCY or WRCOG, during the term of his or her service with the AGENCY or WRCOG, as the case may be, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 21. Limited Scope of Duties. WRCOG's and the AGENCY's duties and obligations under this Agreement are limited to those described herein. WRCOG has no obligation with respect to the safety of any Project performed at a job site. In addition, WRCOG shall not he liable for any action of AGENCY or its contractors relating to the condemnation of property undertaken by AGENCY or construction related to the Project. 22. Books and Records. Each party shall maintain complete, accurate, and clearly identifiable records with respect to costs incurred for the Project under this Agreement. They shall make available for examination by the other party, its authorized agents, officers or employees any and all ledgers and books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or related to the expenditures and disbursements charged to the other party pursuant to this disbursements charged to the other party pursuant to this Agreement. Further, each party shall furnish to the other party, its agents or employees such other evidence or information as they may require with respect to any such expense or disbursement charged by them. All such information shall be retained by the Parties for at least four (4) years following termination of this Agreement, and they shall have access to such information during the four-year period for the purposes of examination or audit. 23. Equal Opportunity Employment. The Parties represent that they are equal opportunity employers and they shall not discriminate against any employee or applicant of reemployment because of race, religion, color, national origin, ancestry, sex or age. Such non- discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 24. Governing Law. This Agreement shall be governed by and construed with the laws of the State of California. 25. Attorneys' Fees. If either party commences an action against the other party arising out of or in connection with this Agreement, the prevailing party in such litigation shall be entitled to have and recover from the losing party reasonable attorneys' fees and costs of suit. Page 7 of 23 R V P U B\ MBA LLI W742260.5 42260.5 06 -SW -TEM -1079 26. Time of Essence. Time is of the essence for each and every provision of this Agreement. 27. Headings. Article and Section Headings, paragraph captions or marginal headings contained in this Agreement are for convenience only and shall have no effect in the construction or interpretation of any provision herein. 28. Public Acknowledgement. The AGENCY agrees that all public notices, news releases, information signs and other forms of communication shall indicate that the Project is being cooperatively funded by the AGENCY and WRCOG TUMF Program Funds. 29. No Joint Venture. This Agreement is for funding purposes only and nothing herein shall be construed to make WRCOG a party to the construction of the Project or to make it a partner or joint venture with the AGENCY for such purpose. 30. Compliance With the Law. The AGENCY shall comply with all applicable laws, rules and regulations governing the implementation of the Qualifying Project, including, where applicable, the rules and regulations pertaining to the participation of businesses owned or controlled by minorities and women promulgated by the Federal Highway Administration and the Federal Department of Transportation. 31. Notices. All notices hereunder and communications regarding interpretation of the terms of this Agreement or changes thereto shall be provided by the mailing thereof by registered or certified mail, return receipt requested, postage prepaid and addressed as follows: If to AGENCY: If to WRCOG: City of Temecula P.O. Box 9033 Temecula, CA 92589-9033 ATTN: Shawn D. Nelson, City Manager Telephone: (951) 694-6440 Facsimile: (951) 694-6475 Western Riverside Council of Governments Riverside County Administrative Center 4080 Lemon Street, Third Floor Riverside, California 92501-3609 Attention: Deputy Executive Director Telephone: (951) 955-7985 Facsimile: (951) 787-7991 Any notice so given shall be considered served on the other party three (3) days after deposit in the U.S. mail, first class postage prepaid, return receipt requested, and addressed to the party at its applicable address. Actual notice shall be deemed adequate notice on the date actual notice occurred regardless of the method of service. Page 8 of 23 RVPUBADBALLINV742260.5 06 -SW -TEM -1079 32. Integration: Amendment. This Agreement contains the entire agreement between the PARTIES. Any agreement or representation respecting matters addressed herein that are not expressly set forth in this Agreement is null and void. This Agreement may be amended only by mutual written agreement of the PARTIES. 33. Severability. If any term, provision, condition or covenant of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected thereby. 34. Conflicting Provisions. In the event that provisions of any attached appendices or exhibits conflict in any way with the provisions set forth in this Agreement, the language, terms and conditions contained in this Agreement shall control the actions and obligations of the Parties and the interpretation of the Parties' understanding concerning the Agreement. 35. Independent Contractors. Any person or entities retained by the AGENCY or any contractor shall be retained on an independent contractor basis and shall not be employees of WRCOG. Any personnel performing services on the Project shall at all times be under the exclusive direction and control of the AGENCY or contractor, whichever is applicable. The AGENCY or contractor shall pay all wages, salaries and other amounts due such personnel in connection with their performance of services on the Project and as required by law. The AGENCY or consultant shall be responsible for all reports and obligations respecting such personnel, including, but not limited to: social security taxes, income tax withholding, unemployment insurance and workers' compensation insurance. 36. Effective Date. This Agreement shall not be effective until executed by both Parties. The failure of one party to execute this Agreement within forty-five (45) days of the other party executing this Agreement shall render any execution of this Agreement ineffective. (Signatures on following page) Page 9 of 23 RVPUBADBA LEINV742260.5 06 -SW -TEM -1079 IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed by their duly authorized representatives to be effective on the day and year first above -written. WESTERN RIVERSIDE COUNCIL CITY OF TEMECULA OF GOVERNMENTS By: Date: By: Date: Rick Bishop Shawn D. Neslon Executive Director City Manager APPROVED AS TO FORM: ATTEST: By: Date: By: Date: Steve C. DeBaun General Counsel RVPUBvDBALLlN\74226).5 Susan W. Jones, MMC City Clerk APPROVED AS TO FORM: By: .Date: Page 1.0 of 23 Peter M. Thorson City Attorney 06 -SW -TEM -1079 EXHIBIT A SCOPE OF WORK The French Valley Parkway/I-15 Overerossing and Interchange Improvement Project provides for the construction of a new freeway interchange on I-15 between the existing Winchester Road Interchange and the 1-15/1-216 junction on the border of the cities of Temecula and Murrieta. This proposal utilizes a partial cloverleaf interchange at French Valley Parkway, with loop on - ramps and direct off -ramps in the northwest and southeast quadrants, and direct on -ramps in the southwest and northeast quadrants. Project Location The Scope of Work and TUMF funding under the terms of this Agreement includes Plans, Specifications and Estimates (PS&E). A detailed scope of work for the remaining project phases is provided as follows: • Plans, Specifications and Estimates (PS&E): Develop topographical maps from aerial photogrammetry and ground surveys. Locate existing utilities and coordinate preparation of relocation/protection plans with utility companies. Conduct subsurface geotechnical investigations and analyses. Perform hydrology/hydraulic studies and Exhibit A — 1-1 06 -SW -TEM -1079 structural calculations. Design and prepare the construction Plans, Specifications, and Estimate. • Right of Way (ROW): Develop existing property lines from recorded maps and field surveying. Determine project right of way requirements for acquisitions, easements, temporary construction easements, and impacts to existing improvements. Obtain title reports, perform appraisals, and negotiate settlement. Perform relocation assistance including research for comparable properties and engineering for individual site revision plans and construction. • Construction: Advertise, award, and administer the construction contract. Coordinate utility relocations. Perform Construction Management, Quality Assurance, and Quality Control. Exhibit A — 1-2 06 -SW -TEM -1079 EXHIBIT A-1 ESTIMATE OF COST The funding sources for the French Valley Parkway/I-15 Interchange and Overcrossing are as follows: PHASE Local Agency ($000's) Developer fees/bonds ($000's) State/Fed( Regional ($000's) TUMF Zone ($000's) TUMF ` Regional ($000's) Total Cost By Phase ($000's) PA &ED $5,126 $976 $6,102 PS&E $500 $8,925 $2,000 $11,425 Right of Way $3,586 $6,000 $1,674 ,$5'715 $4,700 $21,675 Construction $92,953 $14,329 $31,200 115,300 $153,782 Total $102,165 $6,000 $42,775 $27,715 $192,984 *represents TUMF CETAP funding for Phase I — replaced TUMF Regional funds Exhibit A— 1-3 06 -SW -TEM -1079 EXHIBIT A-2 PROJECT SCHEDULE PROJECT STATUS / SCHEDULE • Project Approval/Environmental Documents (PA &ED) Phase: - COMPLETED • Plans, Specifications and Estimates (PS&E) Phase: Preliminary Engineering, in the form of the approved Geometric Approval Drawing (GAD), is approximately 30% complete. Horizontal and vertical alignments are locked in. Multi-year design contract was awarded in September 2011. • Right of Way: Development of existing property lines is complete. Based on Preliminary Engineering, approximately 34 properties have been identified which will be impacted by the project. Relocation assistance has been initiated for two properties. • Construction: No construction activities have been initiated. Phase Estimated or Actual Completion Date Project Approval/Environmental Documents (PA & ED) Completed - January 2010 Plans, Specifications and Estimates (PS&E) Estimated: Phase 1 December 2011 Phase II— December 2015 Right of Way Estimated: Phase 1— December 2011 Phase 11 — December 2015 Construction Estimated: Phase I — June 2013 Phase 11 — June 2017 06 -SW -TEM -1079 Elements of Compensation EXHIBIT "B" PROCEDURES FOR SUBMITTAL, CONSIDERATION AND PAYMENT OF INVOICES For professional services, WRCOG recommends that the AGENCY incorporate this Exhibit "B-1" into its contracts with any subcontractors to establish a standard method for preparation of invoices by contractors to the AGENCY and ultimately to WRCOG for reimbursement of AGENCY contractor costs. 2. Each month the AGENCY shall submit an invoice for eligible Project costs incurred during the preceding month. The original invoice shall be submitted to WRCOG's Executive Director with a copy to WRCOG's Project Coordinator. Each invoice shall be accompanied by a cover letter in a format substantially similar to that of Exhibit "B-2". 3. For jurisdictions with large construction projects (with the total construction cost exceeding $10 million) under construction at the same time, may with the approval of WRCOG submit invoices to WRCOG for payment at the same time they are received by the jurisdiction. WRCOG must receive the invoice by the 5'I' day of the month in order to process the invoice with in 30 days. WRCOG will retain 10% of the invoice until all costs have been verified as eligible and will release the balance at regular intervals not more than quarterly and not less than semi-annually. If there is a discrepancy or ineligible costs that exceed 10% of the previous invoice WRCOG will deduct that amount from the next payment. 4. Each invoice shall include documentation from each contractor used by the AGENCY for the Project, listing labor costs, subcontractor costs, and other expenses. Each invoice shall also include a monthly progress report and spreadsheets showing the hours or amounts expended by each contractor or subcontractor for the month and for the entire Project to date. Samples of acceptable task level documentation and progress reports are attached as Exhibits "B-4" and "B-5". All documentation from the Agency's contractors should be accompanied by a cover letter in a format substantially similar to that of Exhibit `B-3". 5. If the AGENCY is seeking reimbursement for direct expenses incurred by AGENCY staff for eligible Project costs, the AGENCY shall provide the same level of information for its labor and any expenses as required of its contractors pursuant to Exhibit "B" and its attachments. 6. Charges for each task and milestone listed in Exhibit "A" shall be listed separately in the invoice. 7. Each invoice shall include a certification signed by the AGENCY Representative or his or her designee which reads as follows: Exhibit B-1 RVPUBADBALLINV742260.5 06 -SW -TEM -1079 "I hereby certify that the hours and salary rates submitted for reimbursement in this invoice are the actual hours and rates worked and paid to the contractors or subcontractors listed. Signed Title Date Invoice No. 8. WRCOG will pay the AGENCY within 30 days after receipt by WRCOG of an invoice. If WRCOG disputes any portion of an invoice, payment for that portion will be withheld, without interest, pending resolution of the dispute, but the uncontested balance will be paid. 9. The final payment under this Agreement will be made only after: (I) the AGENCY has obtained a Release and Certificate of Final Payment from each contractor or subcontractor used on the Project; (ii) the AGENCY has executed a Release and Certificate of Final Payment; and (iii) the AGENCY has provided copies of each such Release to WRCOG. Exhibit B-2 RVPUB`DBAI LIN1742260.5 06 -SW -TEM -1079 EXHIBIT "B-1" [Sample for Professional Services] For the satisfactory performance and completion of the Services under this Agreement, Agency will pay the Contractor compensation as set forth herein. The total compensation for this service shall not exceed ( INSERT WRITTEN DOLLAR AMOUNT ) ($_INSERT NUMERICAL DOLLAR AMOUNT ) without written approval of Agency's City Manager [or applicable position] ("Total Compensation"). 1. ELEMENTS OF COMPENSATION. Compensation for the Services will be comprised of the following elements: 1.1 Direct Labor Costs; 1.2 Fixed Fee; and 1.3 Additional Direct Costs. 1.1 DIRECT LABOR COSTS. Direct Labor costs shall be paid in an amount equal to the product of the Direct Salary Costs and the Multiplier which are defined as follows: 1.1.1 DIRECT SALARY COSTS Direct Salary Costs are the base salaries and wages actually paid to the Contractor's personnel directly engaged in performance of the Services under the Agreement. (The range of hourly rates paid to the Contractor's personnel appears in Section 2 below.) 1.1.2 MULTIPLIER RVPUBVDBA LLINA742260.5 The Multiplier to be applied to the Direct Salary Costs to determine the Direct Labor Costs is , and is the sum of the following components: 1.1.2.1 Direct Salary Costs 1.1.2.2 Payroll Additives The Decimal Ratio of Payroll Additives to Direct Salary Costs. Payroll Additives include all employee benefits, allowances for vacation, sick leave, and holidays, and company portion of employee insurance and social and retirement benefits, all federal and state payroll taxes, premiums for insurance which are measured by payroll costs, and other contributions and benefits imposed by applicable laws and regulations. Exhibit B-1-1 1.1.2.3 Overhead Costs 06 -SW -TEM -1079 The Decimal Ratio of Allowable Overhead Costs to the Contractor Firm's Total Direct Salary Costs. Allowable Overhead Costs include general, administrative and overhead costs of maintaining and operating established offices, and consistent with established film policies, and as defined in the Federal Acquisitions Regulations, Part 31.2. Total Multiplier (sum of 1.1.2.1, 1.1.2.2, and 1.1.2.3) 1.2 FIXED FEE. 1.2.1 The fixed fee is $ 1.2.2 A pro -rata share of the Fixed Fee shall be applied to the total Direct Labor Costs expended for services each month, and shall be included on each monthly invoice. 1.3 ADDITIONAL DIRECT COSTS. Additional Direct Costs directly identifiable to the performance of the services of this Agreement shall be reimbursed at the rates below, or at actual invoiced cost. Rates for identified Additional Direct Costs are as follows: ITEM REIMBURSEMENT RATE insert charges J Per Diem $ /day Car mileage $ /mile Travel $ /trip Computer Charges $ /hour Photocopies $ /copy Blueline $ /sheet LD Telephone $ /call Fax $ /sheet Photographs $ /sheet Travel by air and travel in excess of 100 miles from the Contractor's office nearest to Agency's office must have Agency's prior written approval to be reimbursed under this Agreement. Exhibit B-1-2 12 V PUBADBA (LIN 7422605 06 -SW -TEM -1079 2. DIRECT SALARY RATES Direct Salary Rates, which are the range of hourly rates to be used in determining Direct Salary Costs in Section 1.1.1 above, are given below and are subject to the following: 2.1 Direct Salary Rates shall be applicable to both straight time and overtime work, unless payment of a premium for overtime work is required by law, regulation or craft agreement, or is otherwise specified in this Agreement. In such event, the premium portion of Direct Salary Costs will not be subject to the Multiplier defined in Paragraph 1.1.2 above. 2.2 Direct Salary Rates shown herein are in effect for one year following the effective date of the Agreement. Thereafter, they may be adjusted annually to reflect the Contractor's adjustments to individual compensation. The Contractor shall notify Agency in writing prior to a change in the range of rates included herein, and prior to each subsequent change. POSITION OR CLASSIFICATION RANGE OF HOURLY RATES [ sample Principal $ .00 - $ .00/hour Project Manager $ .00 - $ .00/hour Sr. Engineer/Planner $ .00 - $ .00/hour Project Engineer/Planner $ .00 - $ .00/hour Assoc. Engineer/Planner $ .00 - $ .00/hour Technician $ .00 - $ .00/hour Drafter/CADD Operator $ .00 - $ .00/hour Word Processor $ .00 - $ .00/hour 2.3 The above rates are for the Contractor only. All rates for subcontractors to the Contractor will be in accordance with the Contractor's cost proposal. 3. INVOICING. 3.1 Each month the Contractor shall submit an invoice for Services performed during the preceding month. The original invoice shall be submitted to Agency's Executive Director with two (2) copies to Agency's Project Coordinator. 3.2 Charges shall be billed in accordance with the terms and rates included herein, unless otherwise agreed in writing by Agency's Representative. 3.3 Base Work and Extra Work shall be charged separately, and the charges for each task and Milestone listed in the Scope of Services, shall be listed separately. The Exhibit B -I-3 R V PU BADBALLINV 42260.5 06 -SW -TEM -1079 charges for each individual assigned by the Contractor under this Agreement shall be listed separately on an attachment to the invoice. 3.4 A charge of $500 or more for any one item of Additional Direct Costs shall be accompanied by substantiating documentation satisfactory to Agency such as invoices, telephone logs, etc. 3.5 Each copy of each invoice shall be accompanied by a Monthly Progress Report and spreadsheets showing hours expended by task for each month and total project to date. 3.6 If applicable, each invoice shall indicate payments to DBE subcontractors or supplies by dollar amount and as a percentage of the total invoice. 3.7 Each invoice shall include a certification signed by the Contractor's Representative or an officer of the firm which reads as follows: I hereby certify that the hours and salary rates charged in this invoice are the actual hours and rates worked and paid to the employees listed. Signed Title Date Invoice No. 4. PAYMENT 4.1 Agency shall pay the Contractor within four to six weeks after receipt by Agency of an original invoice. Should Agency contest any portion of an invoice, that portion shall be held for resolution, without interest, but the uncontested balance shall be paid. 4.2 The final payment for Services under this Agreement will be made only after the Contractor has executed a Release and Certificate of Final Payment. Exhibit B-1-4 RVPUBADBALLINV742260.5 EXHIBIT B-2 Sample Cover Letter to WRCOG Date Western Riverside Council of Governments Riverside County Administrative Center 4080 Lemon Street, Third Floor Riverside, California 92501-3679 Attention: Deputy Executive Director ATTN: Accounts Payable Re: Project Title - Invoice # Enclosed for your review and payment approval is the AGENCY's invoice for professional and technical services that was rendered by our contractors in connection with the 2002 Measure "A" Local Streets and Roads Funding per Agreement No. effective (Month/Day/Year) . The required support documentation received from each contractor is included as backup to the invoice. Invoice period covered is from Month/Date/Year to Month/Date/Year . Total Authorized Agreement Atnount: Total Invoiced to Date: Total Previously Invoiced: Balance Remaining: Amount due this Invoice: $0,000,000.00 $0,000,000.00 $0,000,000.00 $0,000,000.00 $0,000,000.00 I certify that the hours and salary rates charged in this invoice are the actual hours and rates worked and paid to the contractors listed. By: cc: Natne Title Exhibit B-2-1 RVPU[MBA LL NV742260.5 EXHIBIT B-3 Sample Letter from Contractor to AGENCY Month/Date/Year Western Riverside Council of Governments Riverside County Administrative Center 4080 Lemon Street, Third Floor Riverside, California 92501-3679 Attention: Deputy Executive Director Attn: Accounts Payable Invoice # For [type of services] rendered by [contractor name] in connection with [name of project' This is per agreement No. XX -XX -XXX effective Month/Date/Year . Invoice period covered is from Month/Date/Year Total Base Contract Amount: Authorized Extra Work (if Applicable) TOTAL AUTHORIZED CONTRACT AMOUNT: Total Invoice to Date: Total Previously Billed: Balance Remaining: Amount Due this Invoice: to Month/Date/Year . I certify that the hours and salary rates charged in this worked and paid to the employees Iisted, By: Name Title Exhibit B-3-1 RVPUBADBAL.LINV742260.5 $000,000.00 $000,000.00 $000,000.00 $000,000.00 $000,000.00 $000,000.00 $000,000.00 nvoice are the actual hours and rates EXHIBIT B-4 SAMPLE TASK SUMMARY SCHEDULE (OPTIONAL) Exhibit B-4-1 RVPUBVDBALLINV742260.5 EXHIBIT B-5 Sample Progress Report REPORTING PERIOD: Month/Date/Year to Month/Date/Year PROGRESS REPORT: #1 A. Activities and Work Completed during Current Work Periods TASK 01 — 100% PS&E SUBMITTAL 1. Responded to Segment 1 comments from Department of Transportation 2. Completed and submitted Segment 1 final PS&E B. Current/Potential Problems Encountered & Corrective Action Problems None C. Work Planned Next Period Corrective Action None TASK 01 — 100% PS&E SUBMITTAL 1. Completing and to submit Traffic Signal and Electrical Design plans 2. Responding to review comments Exhibit B -5-I RVPUEADI3ALLINV742260.5 Item No. 13 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Greg Butler, Director of Public Works/City Engineer DATE: December 13, 2011 SUBJECT: Increase to the Construction Contingency and City Manager Approval Authority for the Winchester Road Pavement Rehabilitation Project, No. PW10-11 PREPARED BY: Amer Attar, Principal Engineer RECOMMENDATION: That the City Council approve an increase to the contingency of the Pavement Rehabilitation Program, Winchester Road, Project No. PW10-11, in the amount of $80,000 and increase the City Manager approval authority by that same amount. BACKGROUND: As part of the Capital Improvement Program and Budget for Fiscal Year 2010-2011, the City Council approved appropriations to support a Citywide Pavement Rehabilitation Program that would implement the recommended maintenance activities identified in the previously completed Pavement Management System (PMS). The PMS prioritized the existing areas in need of repairs and identified the recommended method for these repairs. On May 10, 2011 the City Council approved the Plans and Specifications and authorized staff to solicit construction bids for the Winchester Road Pavement Rehabilitation Project, No. PW10-11. On July 26, 2011, the City Council awarded the contract to RJ Noble Company in the amount of $1,178,654.50. The work for the Winchester Road project consisted of full -depth reclamation on Winchester Road between Roripaugh Road and Nicolas Road. More specifically, the project included the following: pulverizing and cement treating the existing asphalt concrete pavement (AC), aggregate base (AB) and subgrade structural section to a depth of 1.50 feet, placing 0.45 feet of Hot Mixed Asphalt (HMA) section, and placing 0.15 feet of Rubberized Hot Mix Asphalt (RHMA) cap paving and other related work. Construction on this project began on September 19, 2011. The only items of work that remain are the final layer of asphalt, striping, traffic loop detectors and the adjustment of various utility facilities to finished surface. During the course of construction, staff noticed that the segment of Winchester Road between Roripaugh Road and Margarita Road, just west of the project area, is showing early signs of potential failure in the form of surface cracks. Staff requested a proposal from the contractor to extend the final course of asphalt (0.15 foot) from Roripaugh Road to Margarita Road as an overlay for the entire width of Winchester Road. The contractor submitted a proposal of $225,669.80 to do the additional work. Upon approval of the recommended action sufficient funds will be available to cover the cost of the additional work and a contract change order (000) will be prepared directing the contractor to proceed. The CCO will use the remaining project contingency, funding available due to bid item under -runs, and the requested contingency increase amount. FISCAL IMPACT: The Citywide Pavement Rehabilitation Program is identified in the City's Capital Improvement Program (CIP) budget for Fiscal Years FY2012-16 with funding from Measure A and Capital Projects Reserves. Adequate funds are available in the CIP Pavement Rehabilitation Citywide account for the requested $80,000 increase. ATTACHMENTS: 1. Project Description 2. Project Location Map 2011-12 2015-16 CITY OF 7EMECULA PAVEMENT REHABILITATION PROGRAM—CITYWIDE Circulation Project Project Description: Project will include the environmental processing, design, construction of pavement rehabilitation, and reconstruction of major streets as recommended in the Pavement Management System. Benefit: Project will improve pavement conditions so that the transportation needs of the public, business industry, and government can be met. Project Status: This project is ongoing. Department: Public Works—Account No. 210.165.655 Priority: I Project Cost: Actua Is to Date 2011-12 2012-13 2013-14 2014-15 2015-16 Future Total Project Years Cost Administration $ 49,076 $ 309,606 $ 160,000 $ 160,000 $ 160,000 $ 160,000 $ 998, 682 Construction Reserves $8,931,000 $4,570,000 $ 4,570,000 $ 4,570,000 $4,570,000 $27,211,000 Construction Measure A $244,017 $8,682,022 $1,191,157 $1,214,980 $1,239,280 Engineering Unspecified* $ 98,645 $ 50,000 $ 50,000 $ 50,000 $ 50,000 $ 3,770,720 $ 298,645 Design $194,941 $ 168,897 $ 230,000 $ 230,000 $ 230,000 $ 230,000 $5,010,000 $ 1,283,838 Totals $244,017 $9,508,148 $ 5,010,000 - $ 5,010,000 $ 5,010,000 $ 5,010,000 $ - $29,792,165 Actuals Future Total Project Source of Funds: to Date 2011-12 2012-13 2013-14 2014-15 2015-16 Years Cost Capital Project Reserves $ 826,126 $5,010,000 $ 5,836,126 Measure A $244,017 $8,682,022 $1,191,157 $1,214,980 $1,239,280 $12,571,456 Unspecified* $ 3,818,843 $ 3,795,020 $ 3,770,720 $ 11,384,583 Total Funding: $244,017 $9,508,148 $5,010,000 $5,010,000 $5,010,000 $5,010,000 $ - $29,792,165 Future Operation & Maintenance Costs: 2012-13 2013-14 Project cannot be constructed until a funding source is identifed. 63 2014-15 THE CITY OF TEMECULA "Old Traditions, New Opportunities" 0 Winchester Road-(Roripaugh Road to Nicolas Road) 700 1400 2100 ft. Map center: 6288565, 2139973 This map is a user generated static output from an Internet mapping site and is for general reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. THIS MAP IS NOT TO BE USED FOR NAVIGATION. Legend - City Streets Parcels Scale: 1:7,212 Item No. 14 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Peter M. Thorson, City Attorney DATE: December 13, 2011 SUBJECT: Notification to Business License Applicants of new State Legislation prohibiting Cities from requiring Employers to use E -Verify and of the Federal Law prohibiting Employers from knowingly hiring an Undocumented Worker RECOMMENDATION: That the City Council receive and file this report describing the notices that Staff will include in business license applications beginning December 14, 2011, concerning E -Verify and federal law concerning the prohibition on hiring undocumented workers. BACKGROUND: Effective January 1, 2012, new Labor Code §§ 2811 to 2813 (enacted by Chapter 619 of the statues of 2011, AB 1236) provide that the state, cities, counties, and special districts will be prohibited from requiring employers within their boundaries to use an electronic employment verification system such as "E -Verify." The state, cities, counties, and special districts will only be allowed to use E -Verify for their own employees or when required by federal law or as a condition of receiving federal funds. As a result of the mandate of this legislation, Chapter 5.06, Lawful Hiring Compliance, of the Temecula Municipal Code, the City's E -Verify ordinance requiring employers in Temecula to verify the employment eligibility of a new employee through the federal E -Verify program as a condition of receiving a business license, is no longer enforceable. On November 22, 2011, the City Council held a lengthy discussion on the E -Verify Ordinance and the appropriate response to this new legislation. The Council requested that the City Attorney develop some type of notification to be included in the applications for business licenses that notifies employers of the fact the City will no longer require employers to use E -Verify as a condition of issuing a business license and remind employers that federal law still prohibits employers from knowingly employing an undocumented worker. The text of the proposed notification will be: R:/Agenda Reports/E-Verify Notice Mailing 121311 "EFFECTIVE IMMEDIATELY "USE OF E -VERIFY "The California Legislature recently enacted Labor Code Sections 2811 to 2813 that now prohibit cities from requiring employers within their boundaries to use an electronic employment verification system such as E -Verify. As a result of this state mandate, businesses in the City of Temecula will no longer be required to use the E -Verify System to verify that newly hired workers have the legal right to work in the United States as a condition of receiving a business license. "We wish to remind you, however, that even though the City of Temecula will not require businesses to use the E -Verify System, federal law still prohibits employers from knowingly employing an undocumented worker. (Section 1324a of Title 8 of the United States Code.) Additionally, the E -Verify program of the United States Department of Homeland Security remains available to employers to verify the employment eligibility of their employees. "For more information on this matter, please contact Rudy J. Graciano, City of Temecula, at (951) 693-3937." DISCUSSION: Section 1324a of Title 8 of the United States Code prohibits employers in the United States from knowingly employing an undocumented worker. The federal government's E -Verify Program is a program to assist employers in complying with this statute by providing an electronic employment verification system that allows employers to verify worker's employment authorization with the federal government. While the new California legislation prohibits the City from requiring E -Verify as a condition of issuing a business license, the federal law still prohibits employers from knowing employing an undocumented worker and still allows employers to use E -Verify to verify a worker's employment status. The notice will enable the City to fulfill its obligation to comply with the new state legislation while providing a reminder to employers that they are still subject to federal laws concerning the hiring of workers and prevent confusion from conflicting state and federal laws. The notice will be included as an insert in the business license renewal applications that will be sent to businesses beginning December 14, 2011, and new business license applications requested after this date. The text of the notice will also be added to the business license pages of the City's website and as a note to Chapter 5.06 of the Temecula Municipal Code, E - Verify Ordinance. FISCAL IMPACT: notice. ATTACHMENTS: There is no significant fiscal impact as a result of the E -Verify Notice Concerning E -Verify for Business License Applications Chapter 619 if the Statutes of 2011 Chapter 5.06 of the Temecula Municipal Code, E -Verify Ordinance R:/Agenda Reports/E-Verify Notice Mailing 121311 City of Temecula Finance Department 41000 Main Street ■Temecula, CA 92590■Mailing Address: PO Box 9033■Temecula, CA 92589-9033 (951) 694-6430 ■ Fax (951) 694-6479 EFFECTIVE IMMEDIATELY USE OF E -VERIFY The California Legislature recently enacted Labor Code Sections 2811 to 2813 that now prohibit cities from requiring employers within their boundaries to use an electronic employment verification system such as E -Verify. As a result of this State mandate, businesses in the City of Temecula will no longer be required to use the E -Verify System to verify that newly hired workers have the legal right to work in the United States as a condition of receiving a business license. We wish to remind you, however, that even though the City of Temecula will not require businesses to use the E -Verify System Federal law still prohibits employers from knowingly employing an undocumented worker. (Section 1324a of Title 8 of the United States Code.) Additionally, the E -Verify program of the United States Department of Homeland Security remains available to employers to verify the employment eligibility of their employees. For more information on this matter, please contact Rudy J. Graciano, City of Temecula, at (951) 693-3937. Assembly Bill No. 1236 CHAPTER 691 An act to add Article 2.5 (commencing with Section 2811) to Chapter 2 of Division 3 of the Labor Code, relating to employment. [Approved by Govemor October 9, 2011. Filed with Secretary of State October 9, 2011.] LEGISLATIVE COUNSEL'S DIGEST AB 1236, Fong. Employment: hiring practices: electronic employment verification. The E -Verify Program of the United States Department of Homeland Security, in partnership with the United States Social Security Administration, enables participating employers to use the program, on a voluntary basis, to verify that the employees they hire are authorized to work in the United States. The bill would prohibit the state, or a city, county, city and county, or special district, from requiring an employer other than one of those government entities to use an electronic employment verification system except when required by federal law or as a condition of receiving federal funds. The people of the State of California do enact as follows: SECTION 1. The Legislature finds and declares all of the following: (a) Federal law establishes an electronic employment verification system, originally known as the Basic Pilot Program (enacted by Section 404 of Public Law 104-208) and renamed in 2007 as the E -Verify Program, as an experimental and temporary system available to employers on a voluntary basis. (b) A 2007 independent evaluation commissioned by the federal Department of Homeland Security found that the electronic employment verification database was still not sufficiently up to date to meet requirements for accurate verification. This has led to employers being unable to hire employees in a timely manner and kept workers from earning wages. (c) Mandatory use of an electronic employment verification program would increase the costs of doing business in a difficult economic climate. The United States Chamber of Commerce estimates that the net societal cost of all federal contractors using the E -Verify Program would amount to $10 billion a year, federally. (d) California businesses would face considerable odds in implementing such a program. Employers using the program report that staff must receive 96 Ch. 691 additional training that disrupts normal business operations. If E -Verify had been made mandatory for all employers in 2010, it would have cost businesses $2.7 billion, $2.6 billion of which would have been borne by the small businesses, which drive our economy. (e) Employers report that the cost, technological demands, and staff time that an electronic employment verification system requires to use and implement come at a time when they are already struggling. (f) California's unemployment rate has risen to 11 percent. The state must pursue all avenues in facilitating and incubating job development and economic growth. (g) Therefore, it is the intent of the Legislature that the state maintain the intent of federal law by ensuring that private employers retain the ability to choose whether to participate in the electronic verification program. SEC. 2. Article 2.5 (commencing with Section 2811) is added to Chapter 2 of Division 3 of the Labor Code, to read: Article 2.5. Electronic Employment Verification Systems 2811. This article shall be known and may be cited as the Employment Acceleration Act of 2011. 2812. Except as required by federal law, or as a condition of receiving federal funds, neither the state nor a city, county, city and county, or special district shall require an employer to use an electronic employment verification system, including under the following circumstances: (a) As a condition of receiving a govemment contract. (b) As a condition of applying for or maintaining a business license. (c) As a penalty for violating licensing or other similar laws. 2813. For purposes of this article, the following terms have the following meanings: (a) "Electronic employment verification system" means an employment verification system that allows employers to electronically verify workers' employment authorization with the federal government. This includes the Basic Pilot Program, enacted by Section 404 of Public Law 104-208 and renamed in 2007 as the E -Verify Program, and other pilot programs for electronic employment eligibility confirmation. The term "electronic employment verification system" does not include the I-9 Employment Eligibility Verification form or any other employment eligibility systems that are required by federal law. (b) "Employer" means an employer other than the state, or a city, county, city and county, or special district. 0 96 Chapter 5.06 LAWFUL HIRING COMPLIANCE Page 1 of 3 Temecula Municipal Code Up Previous Next WI Collapse Search Print No Frames Title 5 BUSINESS LICENSES AND REGULATIONS Chapter 5.06 LAWFUL HIRING COMPLIANCE 5.06.010 Definitions. Except as otherwise expressly set forth herein, the following words and terms as used in this chapter shall have the following meanings: "City clerk" means the city clerk of the city and designee(s). "City manager" means the city manager of the city or designee responsible for administering this chapter. "Employ" means hiring an employee after January 31, 2011. "Employee" means any person who provides services or labor within the city for an employer for wages or any other remuneration. An independent contractor is not an employee for the purpose of this chapter. "Employer" means any person that is: (1) transacting business in the city; (2) employs one or more employees in the city; and (3) is required to obtain a business license certificate under Title 5 of this code. "E -verify program" means the electronic verification of work authorization program of the Illegal Immigration Reform and Immigration Responsibility Act of 1996, as amended, and operated jointly by the United States Department of Homeland Security and the United States Social Security Administration, or a successor electronic verification of work authorization program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work authorization status of newly hired employees pursuant to the Immigration Reform and Control Act of 1986, Pub. L. No. 99-603. "Independent contractor" means any individual or entity that carries on an independent business, that contracts to do a piece of work according to the individual' s or entity's own means and methods and that is subject to control only as to results. Whether an individual or entity is an independent contractor is determined on a case-by-case basis through various factors, including whether the individual or entity: 1. Supplies the tools or materials; 2. Makes services available to the general public; 3. Works or may work for a number of clients at the same time; 4. Has an opportunity for profit or loss as a result of labor or service provided; 5. Invests in the facilities for work; 6. Directs the order or sequence in which the work is completed; 7. Determines the hours when the work is completed. "Knowingly employ an undocumented worker" means the actions described in Section 1324a of Title 8 of the United States Code. This term shall be interpreted consistently with Section 1324a of Title 8 of the United States Code and any applicable federal rules and/or regulations. "Person" means all domestic and foreign corporations, associations, syndicates, joint stock corporations, partnerships of every kind, clubs, businesses, trusts, societies and individuals transacting and carrying on any business in the city other than as an employee. "Transacting business" means engaging in any activity for profit within the city, including, but not limited to, providing goods or services, whether the business is physically located within the city or located outside the city with a substantial amount of business transacted within city limits. "Undocumented worker" means a worker who does not have the legal right or authorization under federal http://www.qcode.us/codes/temecula/view.php?topic=5-5_06&showAll=1&frames=on 12/5/2011 Chapter 5.06 LAWFUL HIRING COMPLIANCE Page 2 of 3 law to work in the United States as described in Section 1324a(h)(3) of Title 8 of the United States Code. (Ord. 10-12 § 1) 5.06.020 Knowingly employing undocumented workers. An employer shall not knowingly employ an undocumented worker. If, in the case when an employer uses a contract, subcontract, or other independent contractor agreement to obtain labor of workers in the city, the employer knowingly contracts with an undocumented worker or with a person who employs an undocumented worker to perform the labor, the employer violates this section. (Ord. 10-12 § 1) 5.06.030 Verification of employment eligibility. A. After January 1, 2011, every employer, after hiring an employee, shall verify the employment eligibility of the employee through the e -verify program. B. An employer shall maintain records sufficient to establish that it has complied with the requirement set forth in subsection A of this section with respect to each employee and shall retain such records for the duration of such employee's employment; provided, however, that an employer shall retain and maintain such records for a longer period of time if required by an applicable state or federal law, regulation or rule. The records maintained pursuant to this section shall be immediately made available to the city for inspection and audit upon written notice to the employer by the city manager. C. The city manager may establish such regulations as necessary or convenient to implement the provisions of this chapter, including, but not limited to, the certification of compliance with the requirements of this chapter as part of the application process for a business certificate or the renewal of a business certificate pursuant to Chapter 5.04 of this code. (Ord. 10-12 § 1) 5.06.040 Violations. A. On a finding of a first violation of this chapter, the city manager shall demand that the employer terminate the employment of all undocumented workers in the city hired in violation of this chapter and demand that the employer sign a declaration under penalty of perjury within ten business days stating that the employer has terminated the employment of all undocumented workers in the city and that the employer will comply with the requirements of this chapter. B. On a finding of a second violation of this chapter, the city manager may revoke any license or business certificate that has been issued to and that is held by an employer pursuant to Title 5 of this code, including, without limitation, a business certificate issued pursuant to Chapter 5.04 of this code. For the purpose of this section, a second violation shall be a violation that occurs within twenty-four months of a finding of a first violation. C. Notwithstanding any other provision of this code, the penalty for a violation of this chapter shall be limited to the penalties set forth in this section. (Ord. 10-12 § 1) 5.06.050 Appeal. If an employer is aggrieved by any decision of the city manager regarding the finding of a violation or the revocation of a license issued pursuant to Title 5 of this code, the employer may appeal the decision pursuant to the provisions of Section 5.04.310. (Ord. 10-12 § 1) http://www.qcode.us/codes/temecula/view.php?topic=5-5_06&showAll=1&frames=on 12/5/2011 Chapter 5.06 LAWFUL HIRING COMPLIANCE Page 3 of 3 5.06.060 Severability. This chapter and the various parts, sections and clauses thereof are declared severable. If any part, sentence, paragraph, section or clause is adjudged unconstitutional or invalid, the remainder of this chapter shall not be affected thereby. The city council declares that it would have passed this chapter and each part thereof, regardless of the fact that one or more parts thereof be declared unconstitutional or invalid. (Ord. 10-12 § 1) http://www.qcode.us/codes/temecula/view.php?topic=5-5_06&showAll=1&frames=on 12/5/2011 Item No. 15 ORDINANCE NO. 11-10 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING SECTION 3.32.010 OF THE TEMECULA MUNICIPAL CODE REGARDING THE CONSTRUCTION ON PUBLIC PROJECTS THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY ORDAIN AS FOLLOWS: Section 1. Section 3.32.010 (Construction on public projects) of the Temecula Municipal Code is hereby amended to read as follows: "3.32.010. Construction on public projects. The provisions of this chapter shall apply to the construction on public projects not more than one hundred seventy-five thousand dollars ($175,000). Public projects of forty-five thousand dollars ($45,000) or less may be performed by city employees by force account, by negotiated contract or by purchase order. Public projects of one hundred seventy-five thousand dollars ($175,000) or less may be let to contract by informal procedures as set forth in this chapter." Section 2. If any section or provision of this Ordinance is for any reason held to be invalid or unconstitutional by any court of competent jurisdiction, or contravened by reason of any preemptive legislation, the remaining sections and/or provisions of this Ordinance shall remain valid. The City Council hereby declares that it would have adopted this Ordinance, and each section or provision thereof, regardless of the fact that any one or more section(s) or provision(s) may be declared invalid or unconstitutional or contravened via legislation. Section 3. The Mayor shall sign and the City Clerk shall certify to the passage and adoption of this Ordinance and shall cause the same to be published pursuant to the provisions of law and this Ordinance shall take effect thirty (30) days after passage. R:/Ords 2011/Ords 11-10 1 PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 13th day of December, 2011. Ron Roberts, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Ordinance No. 11-10 was duly introduced and placed upon its first reading at a meeting of the City Council of the City of Temecula on the 22" day of November, 2011, and that thereafter, said Ordinance was duly adopted by the City Council of the City of Temecula at a meeting thereof held on the 13th day of December, 2011, the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: Susan W. Jones, MMC City Clerk R:/Ords 2011/Ords 11-10 2 TEMECULA COMMUNITY SERVICES DISTRICT Item No. 16 ACTION MINUTES of NOVEMBER 22, 2011 City Council Chambers, 41000 Main Street, Temecula, California TEMECULA COMMUNITY SERVICES DISTRICT MEETING The Temecula Community Services District Meeting convened at 7:32 P.M. CALL TO ORDER: President Jeff Comerchero ROLL CALL: DIRECTORS: Edwards, Naggar, Roberts, Washington, Comerchero CSD PUBLIC COMMENTS None. CSD CONSENT CALENDAR 6 Action Minutes — Approved Staff Recommendation (5-0-0) — Director Edwards made the motion; it was seconded by Director Washington; and electronic vote reflected unanimous approval. RECOMMENDATION: 6.1 Approve the action minutes of November 1, 2011. CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGERS REPORT CSD BOARD OF DIRECTORS REPORTS CSD ADJOURNMENT At 7:50 P.M., the Temecula Community Services District meeting was formally adjourned to a meeting on Tuesday, December 13, 2011, at 5:30 PM, fora Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Jeff Comerchero, President ATTEST: Susan W. Jones, MMC City Clerk/District Secretary [SEAL] CSD Action Minutes1112211 1 Item No. 17 Approvals City Attorney Director of Finance City Manager OcL TEMECULA COMMUNITY SERVICES DISTRICT AGENDA REPORT TO: General Manager/Board of Directors FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: Financial Statements for the Three Months Ended September 30, 2011 PREPARED BY: Jennifer Crummel, Senior Accountant RECOMMENDATION: That the City Council receive and file the Financial Statements for the Three Months Ended September 30, 2011. BACKGROUND: The attached financial statements reflect the unaudited activity of the Temecula Community Services District for the three months ended September 30, 2011. Please see the attached Financial Statements for an analytical review of financial activity. FISCAL IMPACT: None. ATTACHMENTS: -Combining Balance Sheet as of September 30, 2011 -Statement of Revenues, Expenditures and Changes in Fund Balance — Budget and Actual for the three months ended September 30, 2011. TEMECULA COMMUNITY SERVICES DISTRICT Combining Balance Sheet as September 30, 2011 and Statements of Revenues, Expenditures and Changes in Fund Balance — Budget and Actual for the Three Months Ended September 30, 2011 (Unaudited) Prepared by the Finance Department TEMECULA COMMUNITY SERVICES DISTRICT COMBINING BALANCE SHEET as of September 30, 2011 Parks & Service Level Service Level Service Level Service Level Recreation B C D R ASSETS: Cash and Investments $ 355,237 $ 448 $ 895,740 $ 195,389 $ 5,033 Due From other Funds 7,874 - - - - Receivables 185,119 11,998 3,530 117,475 472 Deposit 4,994 - - - TOTAL ASSETS $ 553,224 $ 12,446 $ 899,270 $ 312,864 $ 5,505 LIABILITIES AND FUND BALANCES LIABILITIES: Other Current Liabilities TOTAL LIABILITIES $ 457,821 $ 61 $ 31,280 $ 5,649 $ 457,821 61 31,280 5,649 FUND BALANCES: Nonspendable: Deposits 4,994 - - - Restricted for: Debt Service - - - Committed to: Contractual Obligation - Encumbrances 90,409 12,385 598,913 4,330 Assigned to: Community Services District - 269,077 302,886 5,505 TOTAL FUND BALANCES 95,403 12,385 867,990 307,216 5,505 TOTAL LIABILTIES and FUND BALANCES $ 553,224 $ 12,446 $ 899,270 $ 312,864 $ 5,505 NOTE: Balances are unaudited 1 TEMECULA COMMUNITY SERVICES DISTRICT COMBINING BALANCE SHEET as of September 30, 2011 Service Level L ASSETS: Summer Library Youth Program 2001 Debt Service Total Cash and Investments $ 200,705 $ 508,581 $ 18,246 $ 495,643 $ 2,675,022 Due from other Funds - - - - 7,874 Receivables 814 1,345 - 38 320,791 Deposit - 4,994 TOTAL ASSETS LIABILITIES AND FUND BALANCES $ 201,519 $ 509,926 $ 18,246 $ 495,681 $ 3,008,682 LIABILITIES: Other Current Liabilities $ 11,468 $ 49,081 $ 253 $ - $ 555,613 TOTAL LIABILITIES 11,468 49,081 253 - 555,613 FUND BALANCES: Nonspendable: Deposits - - - 4,994 Restricted for: Debt Service - - 495,681 495,681 Committed to: Contractual Obligation - Encumbrances 73,147 263,760 17,993 1,060,937 Assigned to: Community Services District 116,904 197,085 - - 891,457 TOTAL FUND BALANCES TOTAL LIABILTIES and FUND BALANCES NOTE: Balances are unaudited 190,051 460,845 17,993 495,681 2,453,069 $ 201,519 $ 509,926 $ 18,246 $ 495,681 $ 3,008,682 2 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL CITYWIDE OPERATIONS for the Three Months Ended September 30, 2011 Annual Year -to -Date Percentage Amended Activity Encumbrances Total Activity of Budget Budget REVENUES: Special Tax $ 3,847,431 $ 135,349 $ 135,349 4% (1) TCSD Admin Fee Credit/"REST" 6,140,227 1,535,057 1,535,057 25% Recreation Program 2,069,767 483,469 483,469 23% Investment Interest 1,900 1,034 1,034 54% Development Services 72,795 54,587 54,587 75% TOTAL REVENUES EXPENDITURES: 12,132,120 2,209,496 2,209,496 18% Parks, Medians, and Arterial Street Lighting 6,619,703 1,347,568 1,311,265 2,658,833 40% Seniors 307,758 63,858 19,254 83,112 27% Community Recreation Center (CRC) Recreation Programs 576,189 119,611 37,008 156,619 27% 953,123 251,784 66,888 318,672 33% Temecula Community Center (TCC) 192,848 33,304 14,491 47,795 25% Museum 249,379 54,740 19,588 74,328 30% Aquatics 617,759 185,651 32,179 217,830 35% Sports 307,489 76,130 36,762 112,892 37% Children's Museum 351,732 76,104 38,929 115,033 33% Community Theater 1,109,486 257,869 90,633 348,502 31% Cultural Arts 343,903 77,767 45,899 123,666 36% Old Town Maintenance 132,937 18,015 33,095 51,110 38% Harveston Clubhouse 287,908 48,716 48,134 96,850 34% Conference Center 38,600 1,977 - 1,977 5% TOTAL EXPENDITURES 12,088,814 2,613,094 1,794,125 4,407,219 36% (2) Revenues Over/(Under) Expenditures Transfers Out Revenues Over/(Under) Expenditures and Transfers Beginning Fund Balance as of July 1, 2011 Ending Fund Balance as of September 30, 2011 NOTES: 43,306 (403,598) (691,480) (691,480) (648,174) (1,095,078) 1,190,481 1,190,481 $ 542,307 $ 95,403 (1) Special assessment taxes are primarily received in January and May each fiscal year. (2) The variance in expenditure is due to encumbrances that are recorded for the entire year. 3 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SERVICE LEVEL B - RESIDENTIAL STREET LIGHTS for the Three Months Ended September 30, 2011 Annual Amended Budget REVENUES: Year -to -Date Percentage of Activity Budget Assessments $ 641,435 $ 11,960 (1) TCSD Admin Credit/"REST" 293,365 143,841 49% (2) Street Lighting Fees 2,160 Investment Interest 400 55 TOTAL REVENUES 937,360 155,856 17% EXPENDITURES: Salaries and Wages 17,905 4,518 25% Street Lighting Fees 926,600 230,921 25% Operating Expenditures 14,225 - TOTAL EXPENDITURES 958,730 235,439 25% Revenues Over/(Under) Expenditures (21,370) (79,583) Beginning Fund Balance as of July 1, 2011 91,968 91,968 Ending Fund Balance as of September 30, 2011 $ 70,598 $ 12,385 NOTES: (1) Special assessment taxes are primarily received in January and May of each fiscal year. (2) Contribution is funded based on operational needs of Service Level B. 4 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SERVICE LEVEL C - PERIMETER LANDSCAPING AND SLOPE MAINTENANCE for the Three Months Ended September 30, 2011 Annual Year -to -Date Percentage Amended Activity Encumbrances Total Activity of Budget Budget REVENUES: Assessments $ 1,583,122 $ 100 $ 100 Slope Inspection Fees 1,945 1,945 Investment Interest 3,900 2,246 2,246 58% TOTAL REVENUES 1,587,022 EXPENDITURES: 4,291 4,291 (1) Salaries and Wages 104,364 25,514 25,514 24% Landscape Maintenance 983,755 106,594 598,738 705,332 72% (2) Rehabilitation 8,000 - - Operating Expenditures 670,907 147,275 175 147,450 22% TOTAL EXPENDITURES 1,767,026 279,383 598,913 878,296 50% Revenues Over/(Under) Expenditures Beginning Fund Balance as of July 1,2011 Ending Fund Balance as of September 30, 2011 (180,004) (275,092) 1,143,082 1,143, 082 $ 963,078 $ 867,990 NOTES: (1) Special assessment taxes are primarily received in January and May each fiscal year. (2) The variance in landscape maintenance is due to encumbrances that are recorded for the entire year. 5 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SERVICE LEVEL D - REFUSE COLLECTION, RECYCLING AND STREET SWEEPING for the Three Months Ended September 30, 2011 Annual Year -to -Date Total Percentage of Amended Activity Encumbrances Activity Budget Budget REVENUES: Assessments $ 6,000,795 $ - $ - 0% (1) Grants 26,821 27,685 27,685 103% (2) Recycling Program 5,000 531 531 11% (3) Investment Interest 2,100 1,807 1,807 86% TOTAL REVENUES 6,034,716 30,023 30,023 EXPENDITURES: Salaries and Wages 72,336 17,661 Refuse Hauling 5,972,905 - Operating Expenditures 98,420 11,004 17,661 24% 4,330 15,334 11% TOTAL EXPENDITURES 6,143,661 28,665 4,330 32,995 Revenues Over/(Under) Expenditures (108,945) 1,358 Beginning Fund Balance as of July 1, 2011 305,857 305,857 Ending Fund Balance as of September 30, 2011 $ 196,912 $ 307,216 NOTES: (1) Special assessment taxes are primarily received in January and May each fiscal year. (2) California State Grant was budgeted and received this quarter. (3) The recycling program revenue is expected to be received by January 2012. (4) The first payment to CR&R for refuse services is expected to be paid by December 2011. 6 (4) TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SERVICE LEVEL R - STREETS AND ROADS for the Three Months Ended September 30, 2011 REVENUES: Assessments Investment Interest TOTAL REVENUES EXPENDITURES: Annual Percentage of Amended Total Activity Budget Budget $ 7,376 $ 461 6% (1) 11 7,376 472 Emergency Street Maintenance 10,000 0% (2) Property Tax Admin Fees 150 TOTAL EXPENDITURES 10,150 Revenues Over/(Under) Expenditures (2,774) 472 Beginning Fund Balance as of July 1, 2011 5,033 5,033 Ending Fund Balance as of September 30, 2011 $ 2,259 $ 5,505 NOTES: (1) Special assessment taxes are primarily received in January and May each fiscal year. (2) The variance is due to less than expected storm drain routine maintenance repair. 7 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL SERVICE LEVEL L - LAKE PARK MAINTENANCE for the Three Months Ended September 30, 2011 Annual Percentage of Amended YTD Activity Encumbrances Total Activity Budget Budget REVENUES: Assessments $ 225,596 $ $ - Harveston Lake Boat Fees 3,000 894 894 30% Investment Interest 1,600 492 492 31% TOTAL REVENUES 230,196 1,386 1,386 EXPENDITURES: Salaries and Wages Operating Expenditures TOTAL EXPENDITURES Revenues Over/(Under) Expenditures Beginning Fund Balance as of July 1, 2011 Ending Fund Balance as of September 30, 2011 (1) 44,450 11,033 - 11,033 25% 217,900 39,543 73,147 112,690 52% (2) 262,350 50,576 73,147 123,723 47% (32,154) (49,190) 239,241 239,241 $ 207,087 $ 190,051 NOTES: (1) Special assessment taxes are primarily received in January and May each fiscal year. (2) The variance in operation expenditures is due to encumbrances that are recorded for the entire fiscal year. 8 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL REVENUES: Library Services Investment Interest TOTAL REVENUES EXPENDITURES: TEMECULA LIBRARY for the Three Months Ended September 30, 2011 Annual Year to Date Total Percentage Amended Activity Encumbrances Activity of Budget Budget $ 520,512 $ 38,000 9,300 1,238 $ 38,000 7% 1,238 13% 529,812 39,238 39,238 7% Salaries and Wages 46,690 12,453 12,453 27% County Contract 180,000 - - - (1) Operating Expenditures 535,980 114,245 263,760 378,005 71% (2) TOTAL EXPENDITURES 762,670 126,698 263,760 390,458 51% Revenues Over/(Under) Expenditures (232,858) (87,460) Beginning Fund Balance as of July 1, 2011 548,305 548,305 Ending Fund Balance as of September 30, 2011 $ 315,447 $ 460,845 NOTES: (1) Semi annual payment to County is due in January 2012 and June 2012 of each fiscal year. (2) The variance in operation expenditures is due to encumbrances that are recorded for the entire fiscal year. 9 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL MAYOR SUMMER YOUTH PROGRAM for the Three Months Ended September 30, 2011 REVENUES: Operating Transfers In Investment Interest TOTAL REVENUES EXPENDITURES: Salaries and Wages TOTAL EXPENDITURES Annual Year to DatePercentage of Amended Activity Total Activity Budget Budget $ 4,000 $ 4,000 $ 4,000 100% (1) (3) (3) 4,000 3,997 3,997 100% 4,000 3,926 3,926 4,000 3,926 3,926 Revenues Over/(Under) Expenditures - 71 Beginning Fund Balance as of July 1, 2011 Ending Fund Balance as of September 30, 2011 17,922 17,922 $ 17,922 $ 17,993 NOTES: (1) The operating transfer is processed this quarter for the Mayor Summer Youth Program. 98% 98% (2) (2) The variance in salaries and wages is due to all of the activities for this program occur during the summer months. 10 TEMECULA COMMUNITY SERVICES DISTRICT STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL REVENUES: Investment Interest Transfers In TOTAL REVENUES EXPENDITURES: DEBT SERVICE FUND for the Three Months Ended September 30, 2011 Annual Year to Date Total Percentage of Amended Activity Encumbrances Activity Budget Budget $ - $ 24 $ 24 495,480 495,480 495,480 100% (1) 495,480 495,504 495,504 100% Debt Service - Principal 300,000 - - (2) Debt Service - Interest 191,630 - (2) Operating Expenditures 3,850 3,850 3,850 100% (3) TOTAL EXPENDITURES 495,480 - 3,850 3,850 Revenues Over/(Under) Expenditures 495,504 Beginning Fund Balance as of July 1, 2011 Ending Fund Balance as of September 30, 2011 177 177 $ 177 $ 495,681 NOTES: (1) The operating transfer is processed this quarter for principal and interest payment due October 2011. (2) Debt service principal and interest are scheduled to be paid on October 1, 2011. (3) The variance is due to encumbrances for trustees fees that are recorded for the entire year. 11 Item No. 18 Approvals City Attorney Director of Finance City Manager TEMECULA COMMUNITY SERVICES DISTRICT AGENDA REPORT TO: General Manager/Board of Directors FROM: Aaron Adams, Assistant City Manager DATE: December 13, 2011 SUBJECT: License Agreement to Add Parking for the Theater PREPARED BY: Barbara Smith, Senior Management Analyst RECOMMENDATION: That the Board of Directors approve a license agreement between Temecula Community Services District (TCSD) and Dennis G. Munyon for use of the Oakpark Executive Suites parking lot. This is a three year agreement with an annual payment of $9,500.00. BACKGROUND: The Old Town Temecula Community Theater has recently celebrated its sixth anniversary and has proven to be a very busy and successful city facility. Since the theater's opening adequate parking has been problematic. Dennis Munyon owns Oakpark Executive Suites, an office complex located north of and adjacent to the theater. The offices operate predominantly from 9 am to 5 pm weekdays which allows for a good opportunity for a shared parking arrangement. There are approximately 33 parking spaces and the lot is accessible from Old Town Front and Fourth Streets. The license agreement will allow public parking from 5 pm on weekdays and from 5 pm on Fridays through midnight on Sundays. Mr. Munyon will receive $9,500 per year, paid in quarterly installments for the license. The license also allows the City to place temporary signage during events adjacent to the parking lot indicating it is available for public use. FISCAL IMPACT: The total $7,125.00 (three quarterly payments) has been identified to fund the license in the FY 11-12 budget. Future budgets will include the annual payment within the TCSD operating budgets. ATTACHMENTS: License Agreement LICENSE AGREEMENT BETWEEN THE CITY OF TEMECULA AND DENNIS G. MUNYON FOR USE OF REAL PROPERTY FOR OLD TOWN COMMUNITY THEATER PARKING THIS LICENSE AGREEMENT is entered into by and between the City of Temecula, a municipal corporation ("City") and Dennis G. Munyon ("Owner") and is made as of November 1, 2011. In consideration of the mutual agreements contained herein, the parties hereto agree as follows: 1. Right to Use the Property. Owner is the owner of a parcel of real property located at 28581 Old Town Front Street in Old Town Temecula, which is described on Exhibit A, attached hereto and incorporated by this reference (hereafter "Property"). Owner hereby grants a license to the City to use the Property for the parking of vehicles in Old Town Temecula, after 5:00 pm on weekdays and between the hours of 5:00 pm Friday through midnight on Sunday of each week, subject to the terms and conditions of this Agreement. 2. Term of License. The term of this License Agreement shall be from November 1, 2011 to October 31, 2014. Either party may terminate this License Agreement, with or without cause, on six (6) months prior written notice to the other. 3. License Fee. City shall pay to the Owner the fee of nine thousand five hundred dollars ($9,500.00) annually for the license. Payment shall be paid quarterly in advance; by the 5th of the month payment is due. (November 5th, February 5th, May 5th and August 5th). First payment shall be made within 2 weeks of the City's receipt of the fully executed document. 4. Responsibilities of the Parties A. Owner shall, at its own expense and effort, cause the Property to be maintained in a neat, clean and safe condition during its use. B. The City shall comply with all applicable local, state and federal laws, ordinance, rules and regulations in the conduct of its operations on the Property. C. The City may use the Property for the parking of vehicles, including, without limitation, public parking, reserved parking or valet parking. D. The City shall be authorized to place a temporary sign or signs on the Property and areas adjacent to the Property indicating that the Property may be used for public parking on the day of the event. E. The City shall not modify the paving or the striping on the Property, but shall be authorized to place traffic cones, traffic delineators or similar traffic control devices on the Property in order to control the flow of traffic. F. The City shall not directly or indirectly, create or permit to be created or to remain, and will promptly discharge, at its expense, any lien, encumbrance or charge of the Property, or any part thereof. 1 5. Indemnification. The City shall defend, indemnify, assume all responsibility for and hold the Owner harmless from all costs (including attorneys fees and costs), claims, demands, mechanics liens, liabilities or judgments for injury or damage to property and injuries to persons, including death that may be caused by any of the actions or inactions of the City or users of the Subject Property or that may result from the City's use, or any person directly or indirectly employed or contracted by the City and whether such action shall accrue or be discovered before or after termination of this Agreement; provided however, Owner shall be responsible for and shall indemnify the City of Temecula, Temecula Community Services District and the Redevelopment Agency of the City of Temecula and their officers, officials, employees and volunteers for such claims, demands, mechanics liens, liabilities or judgments for injury or damage to property and injuries to persons, including death, which may be caused by the negligence of the Owner. This section shall survive termination of this License Agreement. 6. Assignment. City shall not assign its interest in this Agreement or in the Property to any person or entity without first obtaining the Owner's written consent, except that consent shall not be required for the City to assign this agreement to the Temecula Community Services District. 7. Notice. Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by written notice to the other party. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. City Mailing Address: CITY OF TEMECULA P.O. Box 9033 Temecula, CA 92589-9033 Attention: City Manager Use this Address for a Delivery Service or Hand Deliveries ONLY: Owner: CITY OF TEMECULA 41000 Main Street Temecula, CA 92590 Attention: City Manager Dennis G. Munyon 945 N. Los Alisos Road Fallbrook, CA 92028 8. Interpretation. Each party had the full opportunity to participate in the drafting of this Agreement and, therefore, the Agreement shall not be interpreted against any party on the ground that the party drafted the Agreement or caused it to be prepared. 2 9. Authority to Enter Into Agreement. Each person signing below personally warrants and represents to the City that the Licensee has approved this License, intends to be bound by its terms and that they are duly authorized to execute this License Agreement on behalf of the Licensee. 10. Legal Remedies; Attorney Fees. Each party shall have all remedies as may be allowed by law or equity to enforce its rights in this Agreement. No legal action shall be filed by one party against the other until such time as the other party has received the notice of default as provided in this agreement. Any such action shall be filed in Riverside County, California. The prevailing party in a court action shall be entitled to reasonable attorney's fees and costs. 10. Entire Agreement. This Agreement and any documents attached hereto or mentioned herein, contain all of the Agreements of the parties regarding the Subject Property, and no prior agreement or understanding pertaining to any such matter shall be effective for any purpose. 11. Amendments. No provision of this Agreement may be amended except by the written agreement of both parties. 3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written. TEMECULA COMMUNITY SERVICES DISTRICT, a community services district By: Name: Jeff Comerchero Title: President ATTEST: Susan Jones, MMC City Clerk APPROVED AS TO FORM: Peter M. Thorson City Attorney FSM Initials: Date: OWNER: Dennis G. Munyon Owner atricia Munyon Owner 4 EXHIBIT "A" DESCRIPTION OF SUBJECT PROPERTY PARCEL 1: LOTS 1 TO 8 INCLUSIVE IN BLOCK 26 OF THE TOWN OF TEMECULA, IN THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 15, PAGE 726 OF MAPS, IN THE OFFICE OF THZ COUNTY RECORDER OF SAN DIEGO COUNTY. NOTE: A CERTIFICATE OF PARCEL MERGERING LOTS 6, 7 AND 8 WITH PARCEL 2 DESCRIBED BELOW WAS RECORDED AUGUST 5, 1986 AS INSTRUMENT NO. 186289, OFFICIAL RECORDS. PARCEL 2: THE SOUTHEAST 30.00 FEET OF LOTS 9, 10 AND 11 OF BLOCK 26 OF THE TOWN OF TEMECULA, IN THE COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 15, PAGE 726 OF HAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAN DIEGO COUNTY. 5 EXHIBIT "B" DEPICTION OF SUBJECT PROPERTY AND LOCATION OF BUILDING I0 This map ;s a user generated static output from an Internet mapping site and is for general reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. THIS MAP IS NOT TO BE USED FOR NAVIGATION. 0 100 200 300 ft. tiiiiirip OtOtr:ji �/ PPPPP�����• - Yiy.(�= r r r f s •; �`� :: S r / f, • _, %AEI; ' r � i / ,_ .1, ,, �! •�,r ,tsi• ! - 4 / N tl� 1 u ys /J • •,: 4 . + 6'TTT f Subject Parking Lot � A rA c. N d r 7 N a 0 DISTRICT BUSINESS Item No. 19 Approvals City Attorney Director of Finance City Manager OcL TEMECULA COMMUNITY SERVICES DISTRICT AGENDA REPORT TO: General Manager/Board of Directors FROM: Susan W. Jones, City Clerk/Director of Support Services DATE: December 13, 2011 SUBJECT: Appointment of President and Vice President of the Temecula Community Services District for calendar year 2012 RECOMMENDATION: That the Board of Directors: 1. Entertain motions from the Board of Directors to appoint the President, effective January 1, 2012, to preside until the end of calendar year 2012; 2. Entertain motions from the Board of Directors to appoint the Vice President, effective January 1, 2012, who will assume the duties of the President in the President's absence, and hold this office until the end of calendar year 2012. BACKGROUND: The Temecula Community Services District Board of Directors appoints a member to serve as President and Vice President annually. These offices are assumed at the first meeting of the Community Services District in January and the newly elected officers will preside through the calendar year of 2012. FISCAL IMPACT: None REDEVELOPMENT AGENCY Item No. 20 ACTION MINUTES of NOVEMBER 22, 2011 City Council Chambers, 41000 Main Street, Temecula, California TEMECULA REDEVELOPMENT AGENCY MEETING The Temecula Redevelopment Agency Meeting convened at 7:35 P.M. CALL TO ORDER: Chair Person Mike Naggar ROLL CALL: AGENCY MEMBERS: Comerchero, Edwards, Washington, Roberts, Naggar RDA PUBLIC COMMENTS • Stephen Eldred addressed the City Council. RDA CONSENT CALENDAR 7 Action Minutes — Approved staff recommendation (5-0-0) — Agency Member Comerchero made the motion; it was seconded by Agency Member Washington; and electronic vote reflected unanimous approval RECOMMENDATION: 7.1 Approve the action minutes of November 1, 2011. RDA EXECUTIVE DIRECTORS REPORT RDA AGENCY MEMBERS REPORTS RDA ADJOURNMENT At 7:45 P.M., the Redevelopment Agency meeting was formally adjourned to Tuesday, December 13, 2011, at 5:30 PM, for a Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Michael S. Naggar, Chair Person ATTEST: Susan W. Jones, MMC City Clerk/Agency Secretary [SEAL] RDA Action Minutes1110111 1 Item No. 21 Approvals City Attorney Director of Finance City Manager OcL TEMECULA REDEVELOPMENT AGENCY AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: Financial Statements for the Three Months Ended September 30, 2011 PREPARED BY: Pascale Brown, Accounting Manager RECOMMENDATION: That the Agency Members receive and file the Financial Statements for the Three Months Ended September 30, 2011. BACKGROUND: The attached financial statements reflect the unaudited activity of the Redevelopment Agency for the three months ended September 30, 2011. Please see the attached financial statements for an analytical review of financial activity. FISCAL IMPACT: None ATTACHMENTS: -Combining Balance Sheet as of September 30, 2011 -Statement of Revenues, Expenditures and Changes in Fund Balance — Budget and Actual for the Three Months Ended September 30, 2011. TEMECULA REDEVELOPMENT AGENCY Combining Balance Sheet as of September 30, 2011 and Statements of Revenues, Expenditures and Changes in Fund Balance — Budget and Actual for the Three Months Ended September 30, 2011 (Unaudited) Prepared by the Finance Department TEMECULA REDEVELOPMENT AGENCY COMBINING BALANCE SHEET As of September 30, 2011 Affordable Capital Project Housing Fund Fund ASSETS: Debt Service TOTAL Cash and Investments $ 27,429,786 $ 315,739 $ 1,586,844 $ 29,332,369 Receivables 18,193,413 902,919 514 19,096,846 Due from Other Fund 505,000 505,000 Advances to Other Funds- SERAF 5,250,954 - - - 5,250,954 Land Held for Resale 6,616,177 98,484 6,714,661 TOTAL ASSETS $ 57,490,330 $ 1,822,142 $ 1,587,358 $ 60,899,830 LIABILITIES AND FUND BALANCES LIABILITIES: Due to Other Funds-SERAF $ $ 5,250,954 $ - $ 5,250,954 Advances from Other- City - - 1,242,095 1,242,095 Other Current Liabilities 72,597 30,935 23,050 126,582 Due to Other Fund 505,000 505,000 Deferred Revenue 17,833,981 901,797 - 18,735,778 TOTAL LIABILITIES 17,906,578 6,183,686 1,770,145 25,860,409 FUND BALANCES: Nonspendable: Advances to other funds Inventory Land held for resale Notes and loans Prepaid cost Restricted for: Capital projects Community Development Projects Debt Service Committed to: Contractual Obligation -Encumbrances Assigned to: Capital Projects Unassigned TOTAL FUND BALANCES 5,250,954 6,616,177 345,819 26, 027,561 1,343,241 98,484 222,603 13,150 (4,682,631) 5,250,954 6,714,661 345,819 26, 027, 561 1,578,994 (195,937) (4,878,568) 39,583,752 (4,361,544) (1) (182,787) (2) 35,039,421 TOTAL LIABILITIES and FUND BALANCES $ 57,490,330 $ 1,822,142 $ 1,587,358 $ 60,899,830 NOTES: (1) The deficit Fund Balance in the RDA Capital Project Fund is due to the fiscal years 2009-10 and 2010-11 Supplemental Educational Revenue Augmentation Fund (SERAF) Obligations pursuant to state law AB4x26. Funds are being borrowed from the RDA Affordable Housing Fund to meet the required obligations. On October 11, 2011, City Council took action to amend 2011-12 Redevelopment Fund 280 and reduce the Annual Operating Budget appropriations by $518,000. This action is included in this quarterly financial statements. (2) The deficit Fund Balance in the RDA Debt Service Fund is due to Debt Service Principal and Interest paid in August. Tax Increment received in January and May are used to pay for debt service commitments. Please note that these balances are unaudited. 1 TEMECULA REDEVELOPMENT AGENCY STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET __ ____AND_A_CTU_AL__ REDEVELOPMENT AGENCY AFFORDABLE HOUSING for the Three Months Ended September 30, 2011 REVENUES: Property Tax Increment Investment Interest Loan Interest / Forgivable Loans Monitoring Fees Rental Income Reimbursements TOTAL REVENUES EXPENDITURES: Annual Year -to -Date Amended Activity Encumbrances Total Activity % of Budget Budget $ 3,858,200 $ - $ 142,954 10,291 56,147 10,032 155,000 344,372 172,186 10,291 56,147 172,186 4,510,558 238,624 238,624 0% 7% 0% 0% 0% 50% 5% (1) (2) (3) (4) (4) (5) CAPITAL PROJECTS: Affordable Housing - Temecula Gardens 305,000 305,000 305,000 100% (6) Affordable Housing - Old Town Mixed Use -Summer House 1,080,262 1,080,262 1,080,262 100% (7) Affordable Housing Project 9,543,852 - 0% (8) Affordable Housing Project -Land Acquisition 6,443,590 - 0% (8) NW RDA Property Grading NPDES Compliance 65,000 - 0% (8) OPERATING EXPENDITURES: Salaries and Benefits 726,768 173,217 173,217 24% ** Debt Service - Principal 250,000 250,000 250,000 100% (9) Debt Service - Interest 2,018,156 959,362 959,362 48% (9) First Time Home Buyer Program 750,000 - 0% (10) Residential Rehab Program 400,000 0% (10) General Fund Prepayment 3,858,200 - 0% ** Operating and Administrative Expenditures 740,975 116,215 262,979 379,194 51% (11) TOTAL EXPENDITURES: 26,181,803 1,803,794 1,343,241 3,147,035 12% Revenues Over/(Under) Expenditures (21,671,245) (1,565,170) Beginning Fund Balance as of July 1, 2011 41,148,922 41,148,922 Ending Fund Balance as of September 30, 2011 $ 19,477,677 $ 39,583,752 NOTES: (1) Property Tax increment is received in January and May of this fiscal year. (2) The variance in Investment interest is due to lower interest rates than expected on pooled and trustee held cash and investments. (3) The variance is due to residual receipts payment received in July 2011 from 28500 Pujol Streets Apartments. (4) The annual rent and monitoring fees from Temecula Gardens is due by April of this fiscal year. (5) The variance is due to partial reimbursement received from US Treasurer for Debt Service payment. (6) The annual Pledge Fund is due to Affirmed Housing by July 15, 2011 for Temecula Gardens Apartments. (7) The variance is due to encumbrances recorded for Summerhouse Project for the remaining of the fiscal year. (8) AMCAL Pujol Apartments and Third Front Street projects were approved by the Agency on February 22, 2011. The developer is currently working to secure construction financing for the Third and Front Street project. The developer closed escrow on a portion of the property for the AMCAL Pujol Project and planned to close on the balance of the property by the end of this calendar year. (9) Debt Service principal and interest expenditures for Affordable Housing TABS represent payments made in August of this fiscal year. (10) Residential Rehab and First Time home Buyer programs are currently frozen due to legislation passed by the State of California. (11) The variance is due to encumbrances recorded for Jefferson Corridor Environmental Impact Report and consulting services for this fiscal year. ** On October 11, 2011, the City Council approved an increase in appropriation of $4,130,560 in the Affordable Housing Fund Annual Operating Budget for the payment of Alternative Voluntary Redevelopment Program (AVRP), Personnel and Internal Services Fund expenditures. This action is included in this quarterly financial statements. 2 TEMECULA REDEVELOPMENT AGENCY STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - BUDGET AND ACTUAL REDEVELOPMENT AGENCY - CIP for the Three Months Ended September 30, 2011 Annual Amended Budget REVENUES: Year -to -Date Activity Encumbrances Total Activity % of Budget Investment Interest $ 5,500 $ 735 $ - $ 735 13% (1) Transfers In 208,310 0% (2) Rental Income & Misc. 45,660 10,710 10,710 23% TOTAL REVENUES EXPENDITURES: 259,470 11,445 11,445 4% OPERATING EXPENDITURES: Consulting Services 3,483 3,347 136 3,483 100% (3) Other Outside Services 107,843 7,000 100,843 107,843 100% (3) Tenant Improvement-CSUSM 288,584 101,624 101,624 35% (3) Abbott OPA 159,400 0% (4) Old Town Building Facades 20,000 20,000 20,000 100% (5) TOTAL EXPENDITURES: 579,310 10,347 222,603 232,950 40% Revenues Over/(Under) Expenditures (319,840) 1,098 Other Financing Sources (uses): Transfers Out (49,465) Revenues Over/(Under) Expenditures and Other Financing Sources (uses) (369,305) 1,098 Beginning Fund Balance as of July 1, 2011 (4,362,642) (4,362,642) Ending Fund Balance as of September30, 2011 $ (4,731,947) $ (4,361,544) (6) NOTES: (1) The variance in Investment Interest is due to lower interest rates than expected on pooled and trustee held cash and investments. (2) The variance is due to the timing of the operating transfer in for this fund. (3) The variance is due to encumbrances that are recorded for CAL State San Marcos and consulting services for this fiscal year. (4) The payment to Abbott OPA is expected to be made by the end of December 2011. Staff is currently reviewing the request. (5) The variance is due to encumbrances that are recorded for the Facade Improvement Emporium Project. The payment was made to vendor on November 17, 2011. (6) The deficit Fund Balance in the RDA Capital Project Fund is due to the fiscal years 2009-10 and 2010-11 Supplemental Educational Revenue Augmentation Fund (SERAF) Obligations pursuant to state law AB4x26. Funds are being borrowed from the RDA Affordable Housing Fund to meet the required obligations. **On October 11, 2011, the City Council approved to reduce the Redevelopment Fund Annual Operating Budget by $518,000. This action in included in this quarterly financial statements. 3 TEMECULA REDEVELOPMENT AGENCY STATEMENT OF REVENUES, EXPENDITURES, and CHANGES IN FUND BALANCE - _ BUDGET AND ACTUAL REDEVELOPMENT AGENCY - DEBT SERVICE for the Three Months Ended September 30, 2011 REVENUES: Property Tax Increment Investment Interest TOTAL REVENUES OPERATING EXPENDITURES: Trustee Admin Fees Property Tax Admin Fees Pass-through Agreements Debt Service - Principal Debt Service - Interest Annual Year -to -Date % of Amended Activity Encumbrances Total Activity Budget Budget $ 15,432,800 1,900 $ - $ - 0% (1) 742 742 39% 15, 434, 700 742 13,150 186,400 10, 957, 288 1,085,000 3,020,490 TOTAL EXPENDITURES: 15,262,328 Revenues Over/(Under) Expenditures Other Financing Sources (uses): Transfers Out Revenues Over/(Under) Expenditures and Other Financing Sources (uses) Beginning Fund Balance as of July 1, 2011 Ending Fund Balance as of September 30, 2011 742 0% 13,150 765,000 1,009,226 13,150 100% (2) 09'o (3) 0% (1) 765,000 71% (4) 1,009,226 33% (4) 1,774,226 13,150 172,372 (1,773,484) (448,916) (276,544) # (1,773,484) 1,590,697 1,590,697 $ 1,314,153 $ (182,787) 1,787,376 12% NOTES: (1) Property Tax increment and Pass -Through Agreement obligations are received in January and May of this fiscal year. (2) Trustees admin fees for RDS TAB's are paid in August of this fiscal year. (3) Property Tax admin Fees are recorded in January and May when the RDA tax increment is received. (4) Debt Service Principal and interest expenditures for RDA TAB's represent payments made in August of this fiscal year. The next principal and interest payments are due in December 2011 and April 2012. (5) The deficit Fund Balance in the RDA Debt Service Fund is due to Debt Service Principal and Interest paid in August. Tax increment received in January and May are used to pay for debt service commitments. ** On October 11, 2011, the City Council approved a net reduction of $363,402 in the RDA Debt Service Fund. This action is included in this quarterly financial statements. 4 ** AGENCY BUSINESS Item No. 22 Approvals City Attorney Director of Finance City Manager OcL TEMECULA REDEVELOPMENT AGENCY AGENDA REPORT TO: Executive Director/Agency Members FROM: Susan W. Jones, City Clerk/Director of Support Services DATE: December 13, 2011 SUBJECT: Appointment of Chair Person and Vice Chair Person of the Temecula Redevelopment Agency for calendar year 2012 RECOMMENDATION: That the Board of Directors: 1. Entertain motions from the Agency Members to appoint the Chair Person to preside, effective January 1, 2012, until the end of calendar year 2012; 2. Entertain motions from the Agency Members to appoint the Vice Chair Person, effective January 1, 2012, who will assume the duties of the Chair Person in the Chair Person's absence, and hold this office until the end of calendar year 2012. BACKGROUND: The Temecula Redevelopment Agency Board of Directors appoints a member to serve as Chair Person and Vice Chair Person annually. These offices are assumed at the first meeting of the Temecula Redevelopment Agency in January and the newly elected officers will preside through the calendar year of 2012. FISCAL IMPACT: None Item No. 23 PUBLIC HEARING Approvals City Attorney Director of Finance City Manager OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: AB 1600 Financial Reports PREPARED BY: Pascale Brown, Accounting Manager RECOMMENDATION: That the City Council approve the AB 1600 Financial Reports for Fiscal Year Ending June 30, 2011. BACKGROUND: Government Code Sections 66006 requires that an accounting of the developer impact fees be made public and the information reviewed in a regularly scheduled public hearing. The Legislature finds and declares that the timely and proper allocation of development fees promotes economic growth and is, therefore, a matter of statewide interest and concern. Annually, the City Finance Department staff compiles a report of expenditures made with the developer impact fees collected and interest accrued during the year. Staff has compiled the AB 1600 Report for this purpose and recommends acceptance and approval of the report of expenditures made with the developer impact fees after hearing public testimony. FISCAL IMPACT: Monies must be used within five years for specified purposes or returned to the developer. All funds are programmed to be spent in accordance with the fiscal years 2012-2016 Capital Improvement Program adopted June 14, 2011, by the City Council. ATTACHMENTS: AB 1600 Financial Reports City of Temecula Attachment No. 1 - OPEN SPACE LAND ACQUISITIONS Government Code 66000 Calculation FY 2010-11 The impact fees for Open Space Land Acquisitions are based on the cost of land needed to maintain the City's existing ratio of open space acreage to population. Because these fees are population - driven, they apply only to residential development. The fee is $600.77 per residential attached unit (condominium, apartment, townhouse, and duplex), and $838.57 per residential detached unit (single family), payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: Transfer from Murrieta Creek Trails -210.190.142 $ 191,446 $ 3,503 100.00% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 140,113 $ 194,949 100.00% Expenditures & Other Uses: $ 12,532 100.00% 27.00% Capital Projects Transfers Out Total Uses 100.00% $ - Transfer to Pedestrian Bicycle Bridge -210.165.738 $ 9,862 100.00% 27.00% Total Total Available $ 303,430 $ 194,949 $ 498,379 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A $ 27,630 $ 177,748 $ 98,052 $ 194,949 Total Ending Fund Balance $ 498,379 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee Transfer from Murrieta Creek Trails -210.190.142 $ (152,645) 100.00% 46.00% Transfer to Open Space Acquisition -210.165.509 $ 140,113 100.00% 100.00% Transfer to Pedestrian Bicycle Bridge -210.165.738 $ 12,532 100.00% 27.00% Transfer from Roripaugh Ranch Trails -210.190.19e $ (9,862) 100.00% 83.00% Transfer to Pedestrian Bicycle Bridge -210.165.738 $ 9,862 100.00% 27.00% Total $ - City of Temecula Attachment No. 2 - STREET IMPROVEMENTS Government Code 66000 Calculation FY 2010-11 The fees are collected based on the total cost of such improvements and number of peak hour vehicle trips generated by future development. The fee is $1,220.22 per residential attached unit (condominium, apartment, townhouse, and duplex), $1,743.17 per residential detached unit (single family), and $2.39-$6.67 per square foot of floor area for commercial development, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: 210.165.622 Medians and Parkways -Citywide $ 1,049,247 $ 20,053 100.00% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ (286,520) $ 1,069,300 20.00% Expenditures & Other Uses: $ 135,000 Capital Projects Transfers Out Total Uses 100.00% $ 135,000 Transfer from Medians -210.165.622 $ (11,460) 100.00% 75.00% Transfer to Murrieta Creek Bridge -210.165.602 Total Available $ 2,199,534 $ 934,300 $ 3,133,834 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A $ 183,079 $ 1,625, 729 $ 255,726 $ 1,069, 300 Total Ending Fund Balance $ 3,133,834 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee 210.165.622 Medians and Parkways -Citywide $ 135,000 100.00% 100.00% Transfer from Pechanga Parkway -210.165.668 $ (286,520) 100.00% 20.00% Transfer from Temecula Creek Crossing - 210.165.677 $ (16,594) 100.00% 100.00% Transfer from Medians -210.165.622 $ (11,460) 100.00% 75.00% Transfer to Murrieta Creek Bridge -210.165.602 $ 314,574 20.00% 75.00% Transfer from Pechanga Parkway -210.165.668 $ (154,405) 100.00% 20.00% Transfer to Highway 79 S Stripping -210.165.676 $ 154,405 100.00% 100.00% Transfer from Highway 79 S Stripping -210.165.67E $ (247,712) 100.00% 100.00% Transfer to Main Street Bridge -210.165.743 $ 247,712 20.00% 43.00% Transfer from Pechanga Parkway -210.165.668 $ (457,468) 100.00% 20.00% Transfer to Main Street Bridge -210.165.743 $ 457,468 43.00% Total $ 135,000 City of Temecula Attachment No. 3 - TRAFFIC SIGNALS AND TRAFFIC CONTROL SYSTEMS Government Code 66000 Calculation FY 2010-11 The fees are collected based on the total cost of such improvements and number of peak hour vehicle trips generated by future development. The fee is $172.72 per residential attached unit (condominium, apartment, townhouse, and duplex), and $246.75 per residential detached unit (single family), and $0.35- $0.94 per square foot of floor area from commercial development, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: $ 161,494 $ 5,123 Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 166,617 Expenditures & Other Uses: $ 386,041 Capital Projects Transfers Out Total Uses $ 386,041 Total Available $ 479,053 $ (219,424) $ 259,629 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A N/A $ 52,317 $ 40,695 $ 166,617 Total Ending Fund Balance $ 259,629 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee 210.165.501 Citywide Adaptive Light Synchronization- Phase II 210.165.503 Citywide Adaptive Light Synchronization -Phase I 210.165.678.Traffic Signals Meadows @ Pau ba Rd. 210.165.679 Traffic Signals Rancho California @ Yu kon Transfer from Signals Meadows@Pauba- 210.165.678 Transfer to Signals Rancho Cal@Yukon- 210.165.679 Transfer from Traffic Signal Interconnect - 210.165.712 Transfer to Signals Rancho Cal@Yukon- 210.165.679 $ 132,000 $ 28,265 $ 11,184 $ 214,592 $ (14,000) $ 14,000 $ (16,770) $ 16,770 Total $ 386,041 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 20.52% 7.28% 10.42% 100.00% 100.00% 100.00% 100.00% 100.00% City of Temecula Attachment No. 4 - PARK and RECREATION IMPROVEMENTS Government Code 66000 Calculation FY 2010-11 The fee is collected for park improvements based on the cost of improvements needed to maintain the City's existing ratio of improved park acreage to population. The fee for recreation facilities is based on the existing ratio of facility replacement cost to population. Because the fees are population driven, it only applies to residential developments. The fee is $2,061.13 per residential attached unit (condominium, apartment, townhouse, and duplex), and $2,876.99 per residential detached unit (single family), payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: $ 558,266 $ 4,016 Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 562,282 Expenditures & Other Uses: $ 303,473 Capital Projects Transfers Out Total Uses $ 303,473 Total Available $ 37,572 $ 258,809 $ 296,381 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A N/A N/A N/A $ 296,381 Total Ending Fund Balance $ 296,381 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee 210.190.151 Neighborhood Security Lighting 210.190.156 Water Slide Replacement CRC pool 210.190.179 Play Structure Retrofit- Various Parks 210.190.197 Temecula Community Center Transfer from Play Structure Retrofit -210.190.179 Transfer to Temecula Community Center -210.190.19 $ 40,000 $ 15,000 $ 57,664 $ 190,809 $ (33, 000) $ 33,000 Total $ 303,473 100.00% 10.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 10.39% 100.00% 12.00% City of Temecula Attachment No. 5 - CORPORATE FACILITIES Government Code 66000 Calculation FY 2010-11 Fees are collected for City administrative and maintenance facilities. The need for future City Hall space is due to the demand of services housed in City Hall. The need for maintenance facilities is due to an increase in street and park maintenance. The fee is $253.58 per residential attached unit (condominium, apartment, townhouse, and duplex), $472.93 per residential detached unit (single family), and $0.16-$0.46 per square foot of floor area for commercial developments, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: 210.165.751 Civic Center $ 165,399 $ 821 100.00% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 584,122 $ 166,220 Expenditures & Other Uses: $ 584,122 Capital Projects Transfers Out Total Uses $ 584,122 Total Available $ 417,902 $ (417,902) $ - Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A N/A N/A N/A N/A Total Ending Fund Balance Result : Five year spent test met in accordance with Government Code 66001. Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee 210.165.751 Civic Center 584,122 100.00% 1.70% Total $ 584,122 City of Temecula Attachment No. 6 - FIRE PROTECTION FACILITIES Government Code 66000 Calculation FY 2010-11 Fees are collected to provide future fire protection facilities and apparatus. The fee is $277.63 per residential attached unit (condominium, apartment, townhouse, and duplex), $598.28 per residential detached unit (single family), and $0.11-$0.16 per square foot of floor area for commercial developments, payable at the time of issuance of building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: $ 144,816 $ 1,959 Developer Fees Interest Income Contributions from Property Owners Total Sources $ - $ 146,775 Expenditures & Other Uses: $ - Capital Projects Transfers Out Total Uses $ - Total Available $ 224,907 $ 146,775 $ 371,682 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A $ 34,844 $ 136,102 $ 53,961 $ 146,775 Total Ending Fund Balance $ 371,682 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee Total $ - City of Temecula Attachment No. 7- LIBRARY Government Code 66000 Calculation FY 2010-11 Fees are collected to provide future facilities and materials. Because these fees are population -driven, they apply only to residential development. The fee is $548.98 per residential attached unit (condominium, apartment, townhouse, and duplex), and $766.28 per residential detached unit (single family), payable at the time of issuance of building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: 210.190.153 Library Parking Expansion 210-199-129 Library* $ 197,857 $ 865 20.00% 100.00% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 217,149 $ 198,722 Expenditures & Other Uses: $ 217,149 Capital Projects Transfers Out Total Uses $ 217,149 Total Available $ 92,318 $ (18,427) $ 73,891 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A N/A N/A N/A $ 73,891 Total Ending Fund Balance $ 73,891 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects FY 2010-11 % Complete % Funded With Fee 210.190.153 Library Parking Expansion 210-199-129 Library* $ 44,000 $ 173,149 20.00% 100.00% 100.00% 25.53% Total $ 217,149 *Note: Repayment of advance of Library DIF for Library City of Temecula Attachment No. 8 - PUBLIC ART Government Code 66000 Calculation FY 2010-11 Fees are collected to enhance the quality of life for City residents, workers, and visitors by providing for the acquisition, placement, and maintenance of public art work. The fees are equal to 10% of 1% of the building value in excess of $100,000, payable at the time of issuance of building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance FY 2010-11 Ending Fund Balance Revenues & Other Sources: 210.165.751 Civic Center $ 7,020 $ 1,348 100% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 20,000 $ 8,368 Expenditures & Other Uses: $ 20,000 Capital Projects Transfers Out Total Uses $ 20,000 Total Available $ 181,936 $ (11,632) $ 170,304 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 NIA $ 117,208 $ 37,481 $ 7,247 $ 8,368 Total Ending Fund Balance $ 170,304 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects $ - % Complete % Funded With Fee 210.165.751 Civic Center $ 20,000 100% 0.0900% Total $ 20,000 City of Temecula Attachment No. 9 - POLICE FACILITIES Government Code 66000 Calculation FY 2010-11 Fees are collected to provide future space for police facilities and equipment. The fee is $445.68 per residential attached unit (condominium, apartment, townhouse, and duplex), $251.91 per residential detached unit (single family), and $0.06-$0.25 per quare foot of floor area for commercial development, payable at the time of issuance of a building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance $ - Ending Fund Balance Revenues & Other Sources: 210.165.513 Old Town Police Storefront 210.165.514 Temecula Police Tenant Improvement $ 86,534 $ 1,662 100.00% 2.02% Developer Fees Interest Income Contributions from Property Owners Transfers In Total Sources $ 341,000 $ 88,196 Expenditures & Other Uses: $ 341,000 Capital Projects Transfers Out Total Uses $ 341,000 Total Available $ 359,538 $ (252,804) $ 106,734 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2011 Previous Years Revenues Revenues Collected from FY2007/08 Revenues Collected from FY2008/09 Revenues Collected from FY2009/10 Revenues Collected from FY2010/11 N/A N/A N/A $ 18,538 $ 88,196 Total Ending Fund Balance $ 106,734 Result : Five year spent test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects $ - % Complete % Funded With Fee 210.165.513 Old Town Police Storefront 210.165.514 Temecula Police Tenant Improvement $ 340,000 $ 1,000 100.00% 2.02% 100.00% 100.00% Total $ 341,000 COUNCIL BUSINESS Item No. 24 Approvals City Attorney Director of Finance City Manager OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Susan W. Jones, City Clerk/Director of Support Services DATE: December 13, 2011 SUBJECT: Appointment of Mayor and Mayor Pro Tem for calendar year 2012 RECOMMENDATION: That the City Council: 1. Entertain motions from the City Council Members to appoint the Mayor to preside, effective January 1, 2012, to the end of calendar year 2012; 2. Entertain motions from the City Council Members to appoint the Mayor Pro Tem, effective January 1, 2012, who will assume the duties of the Mayor in the Mayor's absence, and hold this office until the end of the calendar year 2012. BACKGROUND: The City Council appoints a member to serve as Mayor and Mayor Pro Tem annually. These offices are assumed at the first meeting of the City Council in January and the newly elected Mayor and Mayor Pro Tem will preside through the calendar year of 2012. FISCAL IMPACT: None ATTACHMENTS: None Item No. 25 Approvals City Attorney Director of Finance City Manager io) OtoL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Genie Wilson, Director of Finance DATE: December 13, 2011 SUBJECT: Community Service Funding Program for Fiscal Year 2011-12 PREPARED BY: Judith M. McNabb, Administrative Assistant RECOMMENDATION: That the City Council review and approve the fiscal year 2011-12 Community Service Funding Program grants pursuant to the attached spreadsheet outlining the Ad Hoc Subcommittee's recommendations of $60,000 to 13 organizations. BACKGROUND: Community Service Funding Program applications were e-mailed or mailed to approximately 50 non-profit organizations in the Temecula Valley area. Applications were sent to community-based organizations that were in the City's database from the last distribution period, as well as those organizations that called or stopped by City Hall requesting an application. In addition to the e -mailing and mailing, advertisements were placed in the local newspapers, and the application and guidelines were posted on the City's website. A total of 36 organizations submitted applications requesting $167,100 in grant funding. The City Council appointed Mayor Pro Tem Chuck Washington and Council Member Mike Naggar to the fiscal year 2011-12 Community Service Funding Ad Hoc Subcommittee to allocate grant funds up to $5,000 per non-profit organizations that provide community services to the citizens of Temecula. The Ad Hoc Subcommittee, along with staff members, reviewed the requests for funding based on criteria previously adopted by the entire City Council to continue to support those non-profit organizations who offer community -wide services such as food, clothing, shelter, and medical care. After review and discussion, the Ad Hoc Subcommittee recommends 13 of the 36 organizations receive funding as outlined on the attached spreadsheet, totaling $60,000. Mayor Pro Tem Washington did not participate in discussion and abstained from recommending funding to All From the Heart, Inc., and Council Member Naggar requested that it be noted that he nor his family receives services from Our Nicholas Foundation, Inc. FISCAL IMPACT: Adequate funds are available in the fiscal year 2011-12 Community Service Funding line item budget to fund these grants totaling $60,000. ATTACHMENTS: FY 2011-12 Community Service Funding Program Ad Hoc Subcommittee Recommendation Spreadsheet FY 2011-12 Community Service Funding Program Applications CITY OF TEMECULA FY 2011-12 Community Service Funding Program Ad Hoc Subcommittee Recommendations Account No. 001-101-999-5267 APPS NO. NAME OF ORGANIZATION PROJECT 2010-11 AWARD 2011-2012 REQUEST Ad Hoc Subcommittee Recom m en dation Comments 1 ALL FROM THE HEART, INC. Refurbish used power wheelchairs and power scooters and give them to those veterans in need $ - $ 5,000 $ 5,000 ber Council Washington on Abstained 2 ASSISTANT LEAGUE OF TEMECULA VALLEY Remodeling of Operation School Bell's administration rooms $ 5,000 $ 5,000 $ 5,000 3 BIRTH CHOICE OF TEMECULA, INC. Purchase of pregnancy brochures, educational videos and materials, supplies to support client visits, maternity and baby supplies, and newborn bassinets $ 5,000 $ 5,000 $ 5,000 4 BOYS & GIRLS CLUB OF SOUTHWEST COUNTY Before and After School Transportation Program - Repaint one of the school buses and replace a vandalized rear window in a bus donated by RTA used for the Program $ 5,000 $ 5,000 $ 5,000 5 CAMP DEL CORAZON Purchase items necessary for campers with heart disease to attend camp $ - $ 5,000 $ _ 6 CHAPARRAL HIGH SCHOOL EDUCATION FOUNDATION Class of 2012 Grad Nite $ - $ 5,000 $ - 7 CITIZEN'S SCHOLARSHIP FOUNDATION (Chaparral High School) Provide scholarships for graduating high school seniors who have met the academic requirements $ 1,000 $ 5,000 $ - 1 APPS NO. NAME OF ORGANIZATION PROJECT 2010-11 AWARD 2011-2012 REQUEST Ad Hoc subcommittee Recom m en dation Comments 8 CITIZEN'S SCHOLARSHIP FOUNDATION (Great Oak High School) Provide scholarships for graduating high school seniors who have met the academic requirements $ 1,000 $ 5,000$ - 9 CITIZEN'S SCHOLARSHIP FOUNDATION (Rancho Vista / Nelson High School) Provide scholarships for graduating high school seniors who have met the academic requirements $ 1,000 $ 5,000 $ _ 10 CITIZEN'S SCHOLARSHIP FOUNDATION (Temecula Valley High School) Provide scholarships for graduating high school seniors who have met the academic requirements $ 1,000 $ 5,000$ - 11 COMMUNITY ALLIANCE FOR RESPONSIBLE EDUCATION ACADEMY Psycho-educational Assessment and Evaluations Library Program - Provide financially accessible mental health and educational services to those in the community who can demonstrate a financial need, including purchase and provide free or low cost screenings, assessments and evaluations for ADHD, autism, career aptitude, cognitive abilities, learning disabilities, and emotional health issues $ - $ 5,000 $ - EMPTY CRADLE Materials, information, and supplies for the bereavement packets provides to the families who experience infant loss $ 1,000 $ - - 12 COMMUNITY CONNECT 2-1-1 Call Center Program - Provide information and referral resources for social services $ - $ 2,500 $ - 13 COUTURE GIRL'S CLOSET Operation Prom 2012 Program - Assist high school girls with paying for school events such as the prom, including purchase of dresses, dry-cleaning, salon services, and ticket purchases $ - $ 5,000 $ - 2 APPS NO. NAME OF ORGANIZATION PROJECT 2010-11 AWARD 2011-2012 REQUEST Ad Hoc Subcommittee Recommendation Comments 14 GOD'S FAN CLUB (Project T.O.U.C.H.) Homeless Outreach and Police Reponses - Provide services and resources to the homeless $ 5,000 $ 5,000 $ 5,000 15 HABITAT FOR HUMANITY A Brush with Kindness Project - Funds will be used to benefit low-income homeowners in Temecula to offset the cost of home repair materials $ - $ 5,000 $ - 16 HEMET HOSPICE INCORPORATED Patient Special Needs Program - Provide hospice patients and their families with needed resources so that the patient is able to spend his or her last days in comfort $ - $ 5,000 $ _ 17 HOPE FOR ALL, INC. Replace the shade covering over the lower playground picnic area at Hope Lutheran Church $ - $ 5,000 $ _ 18 HOSPICE OF THE VALLEYS Senior Assistance Program - Provides care for terminally ill patients and their families such as running errands, emotional support, reading, shopping, meal preparation, housekeeping, etc. $ - $ 5,000 $ 2,500 19 INTERNATIONAL CHRISTIAN ADOPTIONS (d/b/a Institute for Children's Aid) Mobile Children's Peace Exhibit Program - Goal is to reach Temecula Valley high schools by offering education through classroom presentations and the mobile exhibit to bring awareness about children's rights $ - $ 5,000 $ _ 20 JONBOYS INC. The Annual Challenge Cup/Baker to Vegas Relay - an event offered to law enforcement officers to give them a reason to maintain a physical program so as to help them better perform their duties $ - $ 5,000 $ _ 21 NEIGHBORHOOD HEALTHCARE Children's Healthcare - provide medication and medical treatment for children in Temecula area whose parents cannot afford care and have no insurance $ - $ 1,000 $ - 3 APPL NO. NAME OF ORGANIZATION PROJECT 2010-11 AWARD 2011-2012 REQUEST Ad Hoc Subcommittee Recom m en dation Comments 22 OAK GROVE INSTITUTE FOUNDATION INC. Performing Arts & Visual Arts Program - Provide Temecula students with exposure to music, song- writing, drama, film, drumming, performing and job skills training, and become familiar with resources the City offers $ - $ 2 500 $ - 23 OUR NICHOLAS FOUNDATION, INC. Autism Programs - Expand on the Nicks Buddies Program with TVUSD, after school sports programs, soccer programs, and offer swimming lessons to those with autism $ 5,000 $ 5,000 $ 5,000 Council Member NaggaSidekicks/Peer he nor his fad that he nor his family receives services from this non-profit. 24 SANTA ROSA PLATEAU FOUNDATION Third Grade Education Program - provide a unique teaching environment $ - $ 5,000 $ - 25 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. Food Bank - Provide food for over 13,000 low income seniors and families $ 5,000 $ 5,000 $ 5,000 26 SPECIAL OLYMPICS OF SOUTHERN CALIFORNIA, INC. Sports training and competition programs for athletes with intellectual disabilities within the City of Temecula $ 1,000 $ 5,000 $ - 27 SPIRIT OF GREAT OAK BAND & GUARD (Great Oak Academic Leadership Society) HM Queen of England New Year's Day Parade - funds will be used to assist students in paying for the cost of the London trip $ - $ 5,000 $ _ 28 TEAM EVANGELICAL ASSISTANCE MINISTRIES OF RANCHO-TEMECULA- MURRIETA VALLEY Community Food Pantry - funding will be used to help pay overhead so that other donated funds can be used for food purchases $ 5,000 $ 5,000 $ 5,000 4 APPL NO. NAME OF ORGANIZATION PROJECT 2010-11 AWARD 2011-2012 REQUEST Ad Hoc Subcommittee Recom m en dation Comments 29 TEMECULA VALLEY CHRISTIAN CENTER Royal Family Kids of Crossroads Church - this program is designed to take approximately 50 abused and/or neglected children who are in the foster care system to a summer camp $ - $ 5,000 $ _ 30 TEMECULA VALLEY GARDEN CLUB Temecula Valley Flower and Garden Show - The requested amount will offset increasing costs at the City of Temecula facility, rental of tables and chairs, and cost of publicity $ - $ 1 ,100 $ _ 31 TEMECULA VALLEY PEOPLE HELPING PEOPLE Care to Share Program - assist other organizations to raise money, gifts, toys, food, and other items for those in need $ 5,000 $ 5,000 $ 5,000 32 TRAUMA INTERVENTION PROGRAMS, INC. Respond to a crisis at the request of Temecula's First Responders and provide emotional first aid and practical support to traumatized citizens in crisis $ - $ 5,000 $ _ 33 URBAN COMMUNITY ACTION PROJECTS Medical Outreach Services Program - Partnering with Project Touch to provide medical services once a week to homeless individuals within the City of Temecula $ - $ 5,000 $ _ 34 VETERANS OF FOREIGN WARS Food Box Program - Assists veterans and families, families of POW/MIA's, troops and their families who reside in Temecula with monthly food boxes, baby supplies, clothing, etc. $ 5,000 $ 5,000 $ 2,500 35 VNW-CIRCLE OF CARE, INC. Circle of Care Food Ministry - Purchase new 45' refrigerated trailer for bulk perishable storage, replace a standard freezer, purchase Mobile Hot Spot device and desk top computer $ - $ 5,000 $,000 5 2010-11 2011-2012 Ad Hoc APPS NO. NAME OF ORGANIZATION PROJECT REQUEST Subcommittee Comments Recommendation AWARD 36 WOMEN'S BREAST CANCER RESOURCE CENTER (Michelle's Place) Breast Health Assistance Program - provides education, information, services and awareness about breast health $ 5,000 $ 5,000 $ 5,000 TOTAL $ 56,000 $ 167,100 $ 60,000 6 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 1 CITY OF TE1IECUL4 City of Temecula SEP 1‘9 2011 FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAM2I Nt (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ Project Name: Project Start Date: Project End Date: (Maximum allowable $5,000) ORGANIZATION INFORMATION Name of Organization: ,ill 'd/17 7771-6— ,%9-/7'J Contact Name J dy /I)ajle3J Title/Position: 1- rem/u,,5'y Mailing Address: 4/66q6 Crecy /de. Telephone:961, y /0/ Fos/ /c .-4 /Ik'; iii. //71 cam" 1 E -Mail Address: C /UG jqr%ef— D,* 1a2� Year Organization Founded: (23 Geographic Area(s) Served: Number of Paid Staff: Number of Volunteers: Is this organization incorporated in Califomia as a non-profit organization? Yesni > No Effective Date: i�,o9b. If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: If "no": Federal identification number: p[v� ' C 9 53 D7q State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. P I/e ani r-- h he- UGf r /i ce Gzr `f ��JI / Gf1�l,l�C-� Fel ,art rn ,s-cs- k 7 G, 1/14 H---/cer:d �r Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) l4Je EJB a v!rd/, G �I I - t' i� . an6q {/e��ar) �l v (aar� jb Torltivy rha� C�Jrdppra_e ate_ 7P 07- Vele egfe_. ndioptoacro 41111 r--/cde_as- Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: AME and TITLE (Please Print or Type) AME and TITLE (Please Print or Type) L ORGANIZATION NAME. 116 // ar 7/217: MAILING ADDRESS: `5 6�6 rtes r' bley_ Cf -.9 72 TELEPHONE: 9'37 "9 ; 705 l E -Mail Address. /„K4/4A DATED THIS � of \ ? , 2011. (Date) (Month) Submit Application by September 15, 2011: Mall Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judy.mcnabb(cDcityoftemecuia.ora Facsimile: 951-694-6479 Application — Page 5 4:36 PM 07/14/11 Accrual Basis All From The Heart, Inc Trial Balance As of June 30, 2011 )mmerce Bank - Operating uaranty Bank - Operating nrestrict (retained earnings) onations slshort term Inv arned revenues:Interest-saving lank Charges 'und Raising Expenses:Wheels tor Warriors:Wheelchair Repairs /Ilse expenses Jlisc expenses:Insurance - non-employee Vlisc expenses:Membership dues - organization Misc expenses:Other expenses Misc expenses:Outside computer services Other personnel eXpenses:Accounting fees nses:Professio al fees - other Other personnel expe Taxes - other Fundraising Income:SOT 2010 Fundraising Income:Temecula Wine & Music 2011 Fundraising Expense:SOT 2010 Fundraising Expense:Temecula Wine & Music 2011 DTAL Jun 30, 11 Debit Credit 26,219.48 0.00 318.05 2,961.86 235.75 780.00 230.00 877.66 15.00 240.00 3,500.00 10.00 24,101.64 3,928.77 35.57 400.00 15,872.00 690.00 8,260.18 44,337 98 44,337.98 Page 4:36 PM 07/14/11 Accrual Basis All From The Heart, Inc Profit & Loss June 2011 Ordinary Income/Expense Income Earned revenues Interest-savings/short-term Inv Jun 11 6.56 Total Earned revenues 6.56 Total Income 6.56 Expense Bank Charges 52.72 Mise expenses Membership dues - organization 230.00 Other expenses 139.22 Total Mlsc expenses 369.22 Other personnel expenses Professional fees - other 500.00 Total Other personnel expenses 500.00 Total Expense Net Ordinary Income Other Income/Expense Other Income Fundraising Income Temecula Wine & Music 2011 Total Fundraising Income Total Other Income Net Other Income Net Income 921.94 -915.38 645.00 645.00 645.00 645.00 •270.38 0 V = v Q t4 O E 113 .0 w ) ~ j EC 20 u- -co V 0 N z C 0 Cn O C. N 0) O) '- r .- (0 (D M 1` (t) pp O P.. P.crpp.-000O0000QD OaQ(.CD P. Nf) (9r-nOe�O r- MCND P.N NCA CANNCI( CVNN O n t[) P. O O O O CA O M O 00 CA CD O n CA V O O O O r O r O N r CA P.: 1.: n M 6O CO O 6 O V6 (0 sf C0 ' M ' 'It MmrNNMN v- CORN (n co 0) _C C C_ _C 0 Zj 0) N 0 CA r 40 L 0. N CO CO f0 q p. x F= ii V 0) o 0 o N 0) 0) y = ctEEEE°'Eto 0)a)�' c m.- a) a) wCl.c.c m (9c2CiggF-mNdO2Ocgoo = U XXXXXXXXXXXXXXX 2 O. r. Accrual Basis E Z 60 (0 co CO CA 6 o ti ti ej T 1N 0 CO (` M O O N 8 O M N c) icl M 4«iso; NM N r r P.VAMOOOC) V r r O N M Cn 4 O o6 M r Nr co Cn CO 00 OD CO CO 03 CO CO CO E EEE E 888888 0) 0) 0 (1) u) 0) 0) 0) 0) 0) 0) E E E E E SEEEEE E E E E E EEEEEE o 0 000 0 000000 y y y N .2 O 0) O O o 0 0 0 aaa0) � Q. 0 0000O. T T O. acu s O E • 0 OSc60y t Z u o __ :.- m t' d L 0 0 0 0 0 O `' " y Q..OV,.2O m m w w rnE a)vTca R oa ZZQY0000.0 ..)C 00 F - F- H o7) Fo co _1—F - o WWUJ UJ (1)DUJUJ 000 0 =0000 r O O O O O O O O O O O O OOO QC N N,QV NQV NN £V N N E• N Ccf�M1 Q �anrn' `V CAO,,.. N COCDN p CD CO CD CO CD CO(O CO CO (O((O40 Cg0( g0 it� O N C1 o O c) • y Y m E z : ����E >� tits -6-615 O O O 8-6t1-6-6-6 Lp yL O y O 41, E•C c c L 0) 0) 0) pay L L G L L L d V y a 0) E0000oo0000o000O m ` EO 0 H Total Interest-savings/short-term inv Total Eamed revenues F- H 00 r r r N N N N M CO *a CO Total Bank Charges 0 CO Z °)i 0 0y 42F'F' ooT(c, 0 ,0)0)13-5 0 Y.o '00 F- F• F- 1— co • mmamm � 0v000 Total Membership dues - organization 0 0 0 0 0 0 N N` N N N SCA C`CO;5O ` 1 N Q N M CO CO CO a) 40 CO y c 0) U Y U U y U C) U W 0 0 0 0 0 U Total Other expenses N N M Total Misc expenses O E Accrual Basis E 2 am a O O O O 10 0 o 0 O 1n O O O O 11) 0 0 0 O 1n O O 0 0 0 N O 0 0 0 O O O 0 M tri n tri 7 M oo00 o 0 0 0 M Tr 0 O^ tV N CO 03030"m 43 E EECU EEcu O 0 0 0 0 ✓ 0000 Judy Harter Nilson Total Other personnel expenses N CO (.0 O O O 0 0 O. a 0. 0. 0 0 0 0000 )) 0 0 0 0 O O O O a W Q) a�maD 0000 .-0000 .-r 0800 2 E� � C 'L" C ± C A E aaa. 28888 u. 0 0 Total Temecula Wine & Music 2011 O O tri 0 0 Total Fundraising Income -J 0 O O 0 O 0 ELI 006222 IRSDepartment of the Treasury !Eternal Revenue Service OGDEN UT 84201-0038 ALL FROM THE HEART INC KELLY M DANIELS 27475 YNEZ RD STE 215 TEMECULA CA 92591-4612759 In reply refer to: 0437758652 Mar. 06, 2008 LTR 4180C E0 22-3953079 000000 00 000 00024588 BODC: TE Employer Identification Number: 22-3953079 Advance Ruling Period Ends: Dec. 31, 2010 Person to Contact: K. Wardleigh Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your Feb. 26, 2008, request for information regarding your tax-exempt status. Our records indicate that a determination letter was issued in July 2007, that recognized you as exempt from Federal income tax, and reflect that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records also indicate that you are classified as a public charity under sections 509(a)(1) and 170(b)(1)(A)(vi) of the Code until the advance ruling period ending date shown above. Within 90 days from the end of the advance ruling period, you must submit Form 8734, Support Schedule for Advance Ruling Period, to enable the IRS to determine whether you meet the applicable public charity support tests and make a final determination of your public charity status. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Grantors and contributors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you submit the required information within 90 days, grantors and contributors may continue to rely on the advance determination until the Service makes a final determination of your public charity status. 1 0437758652 Mar. 06, 2008 LTR 4180C E0 22-3953079 000000 00 000 00024589 ALL FROM THE HEART INC X KELLY M DANIELS 27475 YNEZ RD STE 215 TEMECULA CA 92591-4612759 If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, Deborah Bingham Accounts Management I I City of Temecula 2011-12 CS Funding Program APPLICATION NO. 2 CITY OF TEMECUL4 FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 (Maximum allowable $5,000) Project Name: Assistance League Interior Building Improvements Project Start Date: June 2011 Project End Date: June 2012 ORGANIZATION INFORMATION Name of Organization: Assistance League of Temecula Valley Contact Name: Ann Reese President Title/Position: Mailing Address: 28720 Via Montezuma, Temecula, CA 92590-2510 Telephone: 951.694.8 018 E -Mail Address: altemeculact?yahoo. com Year Organization Founded: 6/15/89 Geographic Area(s) Served: Temecula , Murrieta Number of Paid Staff: None Number of Volunteers: 201 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 6/15/89 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 6/15/89 If "no": Federal identification number: 33-0360419 State identification number:14 6 3 4 5 6 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application - Page 1 X Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Mission Statement: Assistance League of Temecula Valley, a chapter of National Assistance League, is a non-profit, volunteer philanthropic organization dedicated to serving the needs of families in Southwest Riverside County. Goal and objectives: To be a regionally recognized organization empowering volunteers to meet the changing needs of the Temecula Valley area. (1) Create and operate philanthropic programs to meet identified community needs. (2) Raise and administer adequate funds to support Assistance League of Temecula Valley's philanthropic programs and chapter administration. Application - Page 2 PROJECT DESCRIPTION Since December 1996, Assistance League of Temecula Valley has been located at 28270 Via Montezuma, Temecula. This building houses our thrift store and administrative offices, as well as a general meeting room that is available for reservation by non-profit organizations in the community. The following describes the remodeling of Operation School Bell administration rooms, project objectives, included estimate of costs, as these improvements are needed to the Assistance League's building: Room #1: Remodeled to expand this pace to the current sales floor space. Opened up a wall the existing sales floor. Added a dressing room. Painted and finished moulding around doors and along the floor. Added slat wall for displaying merchandise. Corrected old electrical problems for safety. Locksmith to fix locks to two doors for access. This room now houses Boutique sales. Room #2 and #3: Painted both rooms to match existing color. Electrician moved light switches. Added a circuit for the copy machine. Added double door for better access. Installed computer and phone lines. This room is the new Executive Office. Room #5: Tore down dressing rooms in Operation School Bell. Found windows behind dressing room. Cleaned off windows. Paint room to match existing color. Replace damaged carpeting. Executive Board Meeting room. Room #6: Paint room to match existing color. Remove wall board covering windows. Replace door. Projected costs for remodeling expenses for June 2011 through June 2012: $5,623.08 Assistance League of Temecula Valley respectfully submits this application as enumerated above regarding building improvements in the amount of $5,000.00, under the Community Service Funding Program application. Thank you for your consideration and support for our efforts to positively impact the families in our community. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. $5,000 awarded last year for the exterior painting of our building. Assistance League's philanthropic programs provide funds and support to families in need in Temecula and Southwest Riverside County. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: Kathy Laurin, Chapter House Manager NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Ann Reese , President NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Assistance League of Temecula Valley MAILING ADDRESS: 28720 Via Montezuma, Temecula, CA 92590-2510 TELEPHONE: 951.694.8018 E -Mail Address: altemecula@yahoo.com DATED THIS / /',;— of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabb@coftemecula.orq 951-694-6479 Application - Page 5 2:19 PM 09/05/11 \ccrual Basis Assistance League of Temecula Valley Statement of Activities August 2011 Ordinary Income/Expense Income 41000 • Fundraising Revenue 41250 • Direct Mail Campaign Total 41000 • Fundraising Revenue 43000 • Direct Public Support 43450 • Individual Contributions 43470 • Donations - Restricted Total 43000 • Direct Public Support 43491 • Gifts in Kind - Goods 43494 • Gifts in Kind-Fraleigh Ministry 43497 • Gifts in kind - Salvation Army 43495 • Gifts In Kind - Miscellaneous Total 43491 • Gifts in Kind - Goods 45000 • Investments 45030 • Interest -Savings, Short-term CD Total 45000 • Investments 46400 • Other Types of Income 46410 • Thrift Store Sales 46412 • Thrift Store Sales - Assisteens Aug 11 50.00 50.00 30.00 300.00 330.00 920.00 410.00 1,866.87 3,196.87 29.60 29.60 19,320.76 2,339.27 Total 46400 • Other Types of Income 21,660.03 47200 • Membership Income 47230 • Membership Dues 47265 • Assisteens Member Total 47230 • Membership Dues 47330 • Luncheons/Parties/Outside Event Total 47200 • Membership Income 90.00 90.00 1,125.00 1,215.00 Total Income 26,481.50 Gross Profit 26,481.50 Expense 61000 • Contract Services 61110 • Accounting Fees Total 61000 • Contract Services 62000 • Facilities and Equipment 62200 • Building Repairs & Maintenance 62205 • Chapter House Improvements 62240 • Janitorial Services 62250 • Thrift Shop Equipment 62550 • Landscape Maintenance 62560 • Trash 62590 • Truck 62600 • Utilities 62610 • Electricity 62630 • Water 2,299.86 216.46 612.50 612.50 428.88 946.92 800.00 825.00 150.00 288.72 70.60 Total 62600 • Utilities 2,516.32 Total 62000 • Facilities and Equipment 6,026.44 63000 • Administration 63100 • Postage, Mailing Service 4.13 63400 • Telephone, Telecommunications 305.70 63600 • Copier Rental and Maintenance 334.14 63000 • Administration - Other 128.03 Total 63000 • Administration 772.00 Page 1 2:19 PM 09/05/11 Accrual Basis Assistance League of Temecula Valley Statement of Activities August 2011 64100• Insurance 64160 • Insurance Interest 64120 • Directors and Officers 64130 • Property Insurance 64140 • Gen Liability, Auto 64150 • Accident Insurance Total 64100 • Insurance 64200 • Membership 64250 • Hospitality 64284 • Parties and/or Luncheons 64200 • Membership - Other Total 64200 • Membership 64500 • Community Relations 64510 • Public Relations 64512 • PR Philanthropic Programs 64520 • Community Ambassadors Committee Total 64500 • Community Relations 65200 • Fundraising Expenses 65220 • Thrift Store Supplies 65230 • Thrift Store Sales Tax Expense Total 65200 • Fundraising Expenses 65300 • Resource Development Expenses 65410 • Grant Writing Total 65300 • Resource Development Expenses 66100 • PROGRAM SERVICE EXPENSE 66105 • Operation School Bell 66110 • OSB Clothing 66111 • OSB - Chapters for Children Total 66105 • Operation School Bell 66160 • Heart and Hand 66175 • Operation Bear Hug 66161 • Operation Helping Hand 66164 • Helping the Homeless 66165 • Helping the Hungry Total 66161 • Operation Helping Hand 66170 • Operation Non -Profit Assistance 66177 • Gifts in Kind-Fraleigh Ministry 66172 • Gift In Kind - Salvation Army 66174 • Gift In Kind - Miscellaneous Aug 11 6.54 37.50 244.00 352.31 64.50 704.85 164.98 1,544.77 150.85 1,860.60 592.61 58.50 200.00 851.11 128.49 1,774.00 1,902.49 42.00 42.00 26,688.37 4,537.87 31,226.24 812.07 501.05 457.86 100.46 558.32 920.00 410.00 1,516.87 Total 66170 • Operation Non -Profit Assistance 2,846.87 Total 66100 • PROGRAM SERVICE EXPENSE 66900 • Reconciliation Discrepancies 68300 • Travel and Meetings 68310 • Conference - Executive Board 68311 • Conference-Mbrshp Registration 35,944.55 8,077.60 34.00 -2,025.00 Total 68300 • Travel and Meetings -1,991.00 Total Expense 54,803.14 Net Ordinary Income -28,321.64 Page 2 2:19 PM 09/05111 'ccrual Basis Assistance League of Temecula Valley Statement of Activities August 2011 Other Income/Expense Other Expense 90000 . Transfers In/Out Total Other Expense Net Other Income Aug 11 638.80 638.80 -638.80 Net Income -28,960.44 Page 3 0 0 O $ Over Budget ® c • V m !G Q ( O 0 ; CD 7Fli 1-13 03 ▪ Q N V ▪ N CD >, m a) • ▪ E r— D) a • 1 gym= • N —J • 0 N (1) 06•= 0 O ao. Accrual Basis $ Over Budget Jun '11 - May 12 Zig 0 0 0 0 U )00000 U) U) 10 10 U) ri CD N- N- CO O 0) 0 0 0 0 0 • O O O O r) 000 O U) O 0 0 0 0 U) O O O O O 00000 (` 00000 U) 0 0 0 0 0 C0 O O O N 0 0 0 0 (0 N U) O U) U) 01 Ul N M N e et O M M M O O O 0 0 0 0 0 0 O 0 0 0 0 0 0 O 00000 CO O 000001 of U) N O CO CD U) CO U) N y- O 0 0 0 0 0 U)00000 N O O co; O U) (0 O U) CO V O) N 0) N M CO N M N m U Fa m v a • L') m E Lai m E 7 _ E E o ❑ E ` °' - E rn a m C C C c t 2 o c 0 2 om) a- E m m . N a0 Q cO t'n a s ¢¢ E 11).-0(00(0 m • M a 10 N (D (0 O N N N N N N • M r. r- r r- r. n N V et et .! .t 7 CD f` O N et O O O O O O O O O O co; O 0 0 0 0 (n0 (nO 0) r5 V - CD 0 0 0 0 O 0 0 0 0 N O O O cd U) U) (0 T- V - Total 47230 • Membership Dues o o o 0 O r N M 0)MMM r.nnn a.tva N (0 O U) 0) O co O O O co CO N CD Ul 0 U) O Total 47200 • Membership Income N CO CO N N 0 O O Total Income 0 r; et0 O U) O Gross Profit co N Oo O O) • n O O O 0 O O O N U)0 N O PP - CD O 0 0 Cp 0 O O O O O O CJ N 0 w X -c um)m,4 0cm)yE �j 0 ad • c • 0 C co ra '�mytL • .-co co 0) ,aar m0 0 0 0 y o 0 o o rn(oCD(D m 0 am X w 60941 • Taxes 60940 • Fees & Permits - Other Total 60940 • Fees & Permits 0 0) N N Total 60900 • Business Expenses O O O 0 O 0 N_ (0 cn 0 N 0 a) a) o CO 2 W C O 0 E CQ 0 • U o O O r' o co (D 0 0 00000 0 0 0 0 0 M r) O U) O O O (0 O O Co vi 6 V O N N O N.- 0 0 0 O U) N W M U) CO O (00)00Cl) O ON (0 0) O 0) 0) O O .- O O U) 0) (O O (0 e- 0 0 0 0 CD 0 - et d' 0) O (0 U) O U) V O O o) M N W O U) O 0) 00 e- (0 Nq (D N7N(`,3 O 0 0 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 O 0 0 0 0 co; 0 co; co; 0 0 00000000000 O O Co (0 U) O CO CO ,- (0 O O o0 O N N 4- CO- (Nr) N 0 nj U) N O V N O o.- 0 0 1 M000000CDOOU) (0 O r) co; M 6 0 0 6) O OLo r- Lo (0 ON N6�) V CO O N 0) N - Total 61000 • Contract Services 0 U X ra c • a LI • o(n000000000 • 0 0 N ' U) 0 U) CO r+ CO CO O N N N N N U) U) U) U) (A U) O N N N N N N N N N N N 0 CD ID (D (D CD (D (D (D (D (D (D N (0 S2 (73 1-11 3 V 0 ;E VS LaE f}�l�/ V W 0 co 0 .0 cn cu v/ r 0 J m 15 N � a Accrual Basis 0 co m 0 0 V) Jun '11 - May 12 CZ) O O O O O O O O O c Lo 47 C3 N M O N N th O Q W 10 01 0 (0 00 (0 CO co (O 0 m m rs co E5 al O CD N00'1 p (o (0 (0 (OO CCOO CO C 04 ND N (0 (D (O O (O t` Total 62600 • Utilities W O) (0 NT M Cr) N O O O O O O W N N N O co n co f0 O) OA O O N O N O 0 0 0 0 O W 0 O OOa NC70� O (n O OCA O OOOCA O er4Oti W Nt` N N N O O O O O O O O O O O O O O O O O O CO O W 0 0 (0 W N N'•t O47 CD CD 41 CD 0000)) O CV 000(()(4 � N (0 N O 1,- N CD ON 0 C 0 0 0 CO COc E o E M o. Q 7 c ` 10' 0 ac 0 E c2 E mac c ccv0 c c o t al m r 4 co —Ua (a m c_ c CA C W m C F- w ,� CO .moo Cil Q C (o 0 05 <L .0.. d Q c O `a p 0. CO m aE Ca v . C., u) Fm- > co < O Q O O N OD -ii O 01 V O O O O OD 10 00 0 pO(")(")o 0 ( (0()10(7 .V O Wm F (O(0(O CO CO 0 el H CO N '4t 0) 0) N CD CO (ND4D Ni 0OD 000N 10050cy (. N (000N N O O O O O O N 0 0 O c D O N CV O v- W CD 40 OD C')00 Total 63000 • Administration N O O N O O O O 4'0 0 O) 10 f� itl+�t M.7 04)(0 N M Ccoo,0 m C4 c = C 0 EmU J E C o m U ce = 0 0 0 0 0 - (ONO7b po33(D av(Oa (D 'Q CO 0 M '0. o 0 0 0 0 0 0 0 CO OOONNOI,. 0 o CO .t 1s -O .-NCj((j 4e) O (NI a0 0- 4 M 1) N O (0 (0 O Total 64100 • Insurance Cr) Nv- 04 - N CO O W 0 1.Or.-0 W C") CD Nr O W W O N O O CC) O M Cl) p N�ft (•) N CAO 4041') t0 u? rC7a?O N O 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 O O p p p p 0 0 0 OOOOO OO Cf)O O O ( (O 1` 040 (D (•') (0 N .- N N 47 COI 41 Oe70 CA CAON CD O(OO,:ttt01,- COW 6 Ost 064040 C- co W O 40 O Nt n N co.- N M NCA (0 ra 0 3 o 0 co 0c 0 730 --� z c m -c m m R p Cy CO at 3 O c z wO 3 $ Over Budget Accrual Basis Jun '11 - May 12 O O O O 0 o O ((00 or - CV V V 0) 0 w op an C m ` I'D a= 2 o .. N N N a o 0 0 O 2 = _ 2 r N O u)(nU) CP ad. N O CO co (O (. N 0 0 0 0 0 0 0 0 , u) 0 0 0 0 V Oc•)000oo CO 0)ON 00 N ON 00000 000)co.- N V O 0 0 0 0- 0 N O N O O O 0- O a0 O (0 O o 0 0) 0(0-000000 o r)c?u)o(n.--w N o 0 0 0 0 0 0 0 o O o 0 0 0 0 0 0 0 0 0 0 0 0 0 O O UI 0 0 0 0 0 (0 M V u7O(n C) UD I(. COr COa- 6 (D 00)0000-00) N 00- 000N000 CD CO O O O O O O OO 00 (0 (f) Total 64250 • Hospitality N 0 0 0 U_ H 0C o c 00. .c m E m . w m.a� m c c,_ E O c.(o000 E J a m— o a 0 . in .0 c c :E. C C m M C m 0 E 7 Uf m m '.=f(() E23J 8L.0 y _" 0.c (TC 0 C 0 x2❑U�a-J:E O O. N M O O (O N 00 Co 00 00 O (CV CV CV CV CV CV CV CV (00 (a0 (VD CO (0 V CO CO O O Ul0 0) N Ul 0 N co 0) Total 64200 • Membership LO N r -- co M co O 0) O CO 10 (D (n (0 O N V M CO Co (O (D u) Cr.) M (0 M (0 CO (n 00 D) 0- ui (0 co co co N 0 0 E E O E 0 O O) V o V) CO a00 o c•a� C O o X m• C C m � v . 2 E -a t!)E Ea.a.o.o 0 o O N u7 O • a- r r N O N N (0 (0 23333 (O Total 64500 • Community Relations 0 0 0) M O N O) r �V o 0 0 0 0 0 0 0 o 0 0 0 o 0 0 0 O CO N Co V O 'I. - CO r CO U3 (0 O V O N V O (0 O r V 0) (n O CO 0) N N 6 NOON V •-- • (0 m cri m a m W 0 m 00 CL F. X w c 0 CU 03 ra a. W 0m ° b m 0)220• N 0C u) u) v7 0 Lo •c •cL •c c N C F-HmF- 0 ((-00000 • r N M V 10 O N N N N N coo (0 (0 N N N (D (O CO (O (O N (O 0 0 (n u) eri 0 0 - a o f') N O r N0 O N O O V O (0 O V (D (D 0) N 0) N O r 0 0 0 0.-000 O (0 Oo O O C) 0) 0 O (n (n om W 0 U? N O V7 o O O O 0 0 0 0 0 0 O 0 0 0 0 0 I o N 60006 V7 Cf)- o 0 0 0 0 00 co (n 0 0 0 0 N M r co O 00 0) 0i Total 65200 • Fundraising Expenses O CO O O O O Oo O O O O ei (NI Co0 V o (0 V CCo(noro • O Orr (0 0 M (O (D (O CO (D u7 (O 0) 0 (n O) 0) Total 65300 • Resource Development Expenses r+ N Accrual Basis $ Over Budget Jun '11 - May 12 0 aD 0 0( 0 0 ON00 N Cao sr 04 00 O M O n 0 0 r O M O O 1. N O (D OO (O CD CD OD OO U) ? O O ui N U1 • 00000o 000000 000000 0 0 0 0 0 0 OO U)U)00 0(DN-I)r 0 N- 0 (+) 00 (7(000700 C)( c) 00 b U) (D NI' NI U3 P- 000v N (N - oic O a0 O O T. Cn N NOO Nr CD (O (D 6 6 cri 6 O) Ts O O D) D) O N 0 0 0 0 0 0 00000 0 o o 0 0 0 o N 1� r 0 0 0 0 0 O Of, M crO N O W N r 0 00 (n NV v- 5 0040 CD CO C3 00 (V ) NO 0 OMMP- C3 O O O r O U) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 b O N U)U)ON- CD NOO 01101 OD f-00 U70 O ei NOO 00 00 C7 C3 U7 M r0)coO 0 r C7)U7D 0 (^D((D NO ct O O) M 0 0 0 OOOCD 0 O O O M m 0 0 O M O N 0000n D)oo0v . - O) 0) 1,-O) 10 N 0 0 o 0 O O r N M CO (0 (D N 0 0 0 e" 6 -!z OOOO O) 000(n(D (700 U70 O O O s- O 0000) 0 0 0 0 1 ION (D CO N O 0 0 0 (D 0 0 0 0 0 0.1 00000 N 0 0 0 0 0 VT O N CO CO N r r 07 0) b v 000(00 0000Do uo) 000(00 Or. r ( y 0 0 c .4 w w cm E v cv'E E ' °° c tO W y co a .c c m E m cQ o Qo a Cl- m N a Z - m m ,- E o x -� e[o m +• X X_ m ca a— U U x 1 c oo.-iii 0 a w �t co 0) (co o w w E c c© m = m w Wm 0m 0 =a CO m ni o Q am>m_o a a U E CD w e'4 c o V Y _� rn�a E C a Ti o �° io m c` `� c e> 0 Z'u')01 afl-t U o �rY m W� E CO o o c u cxx x a`LLm�►-� 7t w rn-° cY3WwJ2 rev«03wam,m 0 /mmWmm7�mmav% p CCOOt7O O O cX�mWOO UV c „00 CLE c oramxm2� 1,-., Y� m a o z c c c c' U E cd« > c:E . o U V N U . 0 m r r c c m m.. c g m c c Y Y Y Y ` w w (.gww oe— g. mmmmmm O 0. 2 iO7-1 7.3oo E m na�� O— c c c c To' (7 c R p c m000000 =1 o w� �° L°o E m m (Go; o— a m E m c m o (7 a b t� a m m>wxzV)U mU' (7 (9 C9(9 • U o a v— m as m a ` Qvi(iEz �OO�NMtON .1 -• CO () 100 NMvt b(P !, m OI�N coMV m a O X �-NM V'11) to . O OOOOb SCD 42 CD t(rDBU m(O U btA (D U7 CD O 7 NN (V C�( Gr CUD m COCDm mm ��, (")�b'n to CD CO CD CDU A (D CDC)U7(O U O U QN (0(NO fl CND at- CI(D V- U0 U UU CUD ODD CO CO 0 co O m U g(0 (D CO CD tD CO F CO 1- CO N (D CD O CD 1-- (D >1 Q N C.i ; N O a a mc -r1 CD f 2 Ln. 41 NCD J O N JCD a, v 0 C � N 0 N d Accrual Basis $ Over Budget m rn CO Jun '11 - May 12 0 0 0 0 0 0 0 0 0 O O O O O O O O 0 0 0000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000000ui O O O O O O O O O N N 000 CO 000(D ON 0 0 0 0 0 0 0 0 0 0 0000000000 000000000 Uri O O O O O O O O O N N O CO CO 0 0 010 O N N� NMN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a y a W 0 t 0 C o E y L L u) u coE in OJ �+ f0� y as O > co '6` L (0 7 om yn ,.aV V E I?, c.0 y r 0 N 0 y O LL Q. 10 (0C 0) L 0 c.=. ti) 'Q.' E Ez mL « m O OCI3 13 U O N u) n (0 B O L L - m 02cnaoOO -c y < Zea- NMV. N(D I- 00 co • M M (M M cM M C) M M 'a O N N N N N N N N N N (•r) (D (O (D (D (O (D (D (D (O (D (V CO (D CO t0 (D (D t0 (D CO CO 0 (D co triO ti i O O 10 N Ul O O Total 66230 • Assisteens Program Service Exp N O O N N N 10 (0 Total 66220 • Assisteens Auxiliary 0 0 0 0 (n O O af000 M N O O O O O (D O O O N- '000 N N O CO O O O O O 0000 O O O O O (0 O O O N O N N (n 0 0 (vi r 0000 (D n V 0 0 0 O N 6 O O I's N N Total 66200 - Auxiliaries/Standing Committees O 1 Cw > m O CO 0. c CL 0. 0 p)K E.C(/� c w X 0) 0c to ea C E2 c c_6 my d co m `O •V A m Y°-) w•. 0 0. C M 0 0 0 0 N >a) EO O Z •O cc )- Oe- O O (0 N O O M M M M 0 0 0 0 0 CO O) M (D (D CO (D (D CO (D (D (0 N Total 68300 • Travel and Meetings 01 M O M 0 Total Expense 0 0 O O O O Net Ordinary Income 0 CO M 3 O 'c O E c C O 1�A X Go a y to W c~ Ili a0) • cs () w O C tto O > O) OO 0 Total Other Expense 0 0 O O O O 0 O M 3 Net Other Income 0 0 0 O O O Net Income CRITERIA A. Assistance League® of Temecula Valley, a California nonprofit 501(c)(3), benefit corporation, was incorporated in 1989 and chartered in 1992 as the 815t chapter of National Assistance League®. Assistance League is now linked with more than 26,000, community volunteers through more than 123 chapters in 26 states. PHILANTHROPIC PROGRAMS B. Our overall community services are the following: Operation School Bell®, one of Assistance League's main philanthropic programs, provides new school clothing, backpacks and hygiene items. During 2010/2011, we assisted 1,466, Southwest Riverside County needy children. Temecula resident students served under this program were 554 served, at a cost of $100 per child for new school clothing. Operation School Bell provides "Save our Students" sports bag supporting Head Start, State Preschool and First Five preschool programs with hygiene and clothing items to assist teachers in the classroom when children need help because of a personal accident. Sometimes a student comes to school needing clean clothing, toothbrush, comb, or a bandage, and due to recent school budget cuts, these supplies are not always available. Save our Students' sports bags have these items. Bags were provided to each classroom, and the inventory is replaced often. We served: Temecula Valley Unified School District: 131 preschool children in 8 classrooms, at a cost of $40 per bag. This chapter of Assistance League, partners with eleven Southern California Assistance League chapters, under Operation School Bell program, and provides boys' jeans for Camp Pendleton children whose parents are deployed. 540 children were served by this program, called "Chapters for Children" during August 2011. Assisteens®: This junior auxiliary, has 36 members in grades 7 through 12, instills the values of volunteerism and service to the community. Assisteens support its philanthropic programs by working in the Assistance League's thrift store each Saturday. Through their budget, they plan and provide two events: Fall Harvest Festival for approximately 50 Temecula preschool children and families, and in the spring a Peter Rabbit event for approximately 160 children and their families. Assisteens encourage student reading literacy and give new books through their program Operation Book Worm to needy students at events they host or directly to the schools in Temecula. Assisteens expanded its philanthropic programs to the community by providing funds to Temecula Valley Unified School District high school seniors, selected by school staff for who want to attend Grad Night and may be unable to do so, because of lack of funds. Assisteens also 1 buy bedding for Rancho Damacitas' 36 residents, and they also host a Holiday Christmas Dinner and give gifts to these children. Kids on the Block®: This program consists of a special troupe of Assistance League members' puppeteers using life-size puppets providing education programs enlightening 3rd grade Temecula Valley children on disability awareness, medical differences, social concerns and issues. Last year, Kids on the Block performed skits for 920 students. This unique form of communication provides young students with an environment in which to learn and develop an attitude of smart decision-making, sensitivity, and understanding that should serve them well in the future. Heart and Hand: This program provides recipients with one time, emergency or short-term provisions that other community organizations are not able to provide on short notice. Several Temecula resident families were assisted during 2010/2011. During Thanksgiving November 2010, we provided 20 turkeys to Temecula families, $25 gift cards to several Temecula children at Christmas, and three $25 gift cards for People Helping People. Approximately, 6 students where provided emergency clothing from Temecula. During August 2011, these Temecula residents were provided assistance in the amount of $539.87.: o Family #1: a Temecula family of 3 needed school supplies and backpacks. The mother is a widow and has a middle school daughter and high school son. $29.74 was spent. o Family #2: A Single unemployed Temecula father who rode his bicycle to our thrift store inquiring about school clothes for his high school senior son. This family was met at a local retail store and new school clothing was purchased for this student. The boy arrived with a frown on his face and left with a huge smile. Assistance League received a three page thank you for this assistance. $132.16 was spent. o Family #3: A referral came from a local church that a single mother who has a spinal injury and is not able to work. The father decided in the last 2 months that he is longer going to work and says he is "permanently unemployed." Mom with 2 daughters are set to be evicted in 2 weeks, have absolutely no income, and were denied assistance by welfare, SSI and unemployment. The church provided the necessary school supplies for the daughter who is home schooled and needs to print her schoolwork. The second daughter, who is 10, has worn the same pair of pants to school every day since school started. Heart and Hand chairman met the Temecula family at a Temecula retail store. The girls came into the store looking like their whole world was falling apart. By the time they left they kept telling the chairman how much fun they had and couldn't stop hugging her. Clothing provided was $125 per child. The mother was given a $75 gas card, so she can go back to Social Services and the Social Security office to reapply. 2 SMILE Program: This program provides free emergency dental care for needy children in grades kindergarten through high school, not insured by private, state or federally funded dental programs. During 2010/2011, there were 26 recipients of this program. Temecula residents served were 12. Operation Bear Hug: This program provides first responder's with stuffed teddy bears to give to children experiencing a tragic situation, such as fire or an automobile accident. Last year, 134 children were recipients of this program. This program will also support the new Operation Lend a Hand. Operation Non -Profit Assistance: Our meeting room is available free of charge to nonprofit 501(c) 3, organizations for their meetings and events, for 107 people. Calendar of room usage is available upon request. The following nonprofits agencies that used our facility are: Temecula/Murrieta Interagency Council; Prevent Child Abuse/Victim Services; Women, Infants & Children Nutrition Services; Pack 319 Temecula Cub Scouts; Barbara Tooker, Parenting Classes, Temecula; TVUSD Transition Services; Grant Writing, U.S.A.; Holistic Mom's Network. Operation Lend a Hand: This brand new program offers assistance to Southwest Riverside County residents who are homeless, have senior care needs, experiencing hunger, emancipated youth leaving the foster care, and partners with the Southwest Family Justice Center Rape Crisis Unit and S.A.F.E. (Safe Alternatives for Everyone) agencies. MEMBERSHIP AND LONGEVITY C. Assistance League has been active in Southwest Riverside County since 1989. We have 201 members. During fiscal year (June 1 through May 31) ending May 31, 2011, members gave 28,929, hours of volunteer service. These volunteer hours helped fund our philanthropic programs and operated our main fundraiser, the resale store. RESOURCE Funds from the resale store's proceeds help support Assistance League's philanthropic programs selling gently -used items donated by the public. Donations are received from local businesses, individuals, and local government agencies. SCHOOL DISTRICTS — Program Signed Agreements: Lake Elsinore Unified School District, Menifee Union Elementary School District, Murrieta Valley Unified School District, Temecula Valley Unified School District. D. Temecula Valley Unified School District is one of four school districts served through our philanthropic programs. Temecula Valley Unified School District Superintendent Tim Ritter writes: 3 "The many programs offered by your organization give children the extra help they need ... clothes to keep them warm and in line with their peers, dental services to keep them smiling and healthy, awareness programs so they learn an attitude of smart decision-making and sensitivity to others." Under Temecula Valley Unified School District, First 5 Family Literacy Program, Community Liaison, Meredith Killion, writes: "... thank you to the volunteers for the great bags of clothing. All our families were very happy and appreciate the gift. Some of the children were wearing the new outfits and looked good!" Murrieta Valley Unified School District, Stan Scheer, Superintendent writes: "The caring and commitment your organization provides is truly unprecedented and speaks volumes regarding your support of the needs of our community. It comes at a time when there is such a need for support for our children and their families." Lake Elsinore Unified School District, Dr. Frank E. Passarella, Superintendent writes: "Through the efforts of this valuable non-profit organization, numerous children in our public school district have been provided with essential materials, supplies and services that they otherwise would not receive. The purpose of this letter is to express our support and appreciation for the positive relationship the Lake Elsinore Unified School District and the Assistance League of Temecula Valley have established." Wanda Jennings from Elsinore Middle School writes: "Thank you so much for your recent donation of school supplies to our school. Our students are often in need between paydays and at the end of the month. We appreciate all of your help! Rest assured the supplies you graciously donated will be given to students in need. We pride ourselves on helping our students in any way we can and your gift will allow us to do even more." Menifee Union Elementary School District: Superintendent Linda Callaway, Ed.D writes: "Operation School Bell has provided complete outfits of clothing for many children...the children and their parents have been so grateful for this opportunity for their children. Please accept our ongoing gratitude for this community service." Assistance League was the recipient of 60 volunteers and their painting skills, who are employees from Abbott Vascular on August 26, 27, 2011, through United Day of Caring, supplied paint and materials to paint walls in our furniture display room, and the administrative offices. E. We have an all volunteer workforce. Computerized accounting procedures and an annual independent audit provide checks and balances on the accuracy of the accounting information. F. Assistance League has served this community since 1989. 4 G. Assistance League provides help to Temecula residents in three distinct ways: Operation School Bell clothed 554 school children; Assisteens' auxiliary provided special events for 210 children and families enrolled in preschool programs, and SMILE Program served 26 children. H. Assistance League of Temecula Valley is free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. I. This organization does not require attendance or participation in any political, religious or social activity. J. Financial statements are included with this submission using appropriate methods of accounting and sound financial management. K. Included with this submission is Assistance League's annual budget for fiscal year 2011/2012. L. Assistance League of Temecula Valley's services are all community-based programs to benefit residents in Southwest Riverside County, including cities of Lake Elsinore, Menifee, Murrieta, Temecula and Wildomar, geared for needy school age children, from kindergarten through high school. Children and families are referred to Operation School Bell and Smile Program by health staff members and teachers, from the four school districts served. M. Assistance League of Temecula Valley evaluates its philanthropic programs annually. National Assistance League evaluates Assistance League of Temecula Valley every third year; our next evaluation will be in 2013. Our most recent membership evaluation was November 2, 2010. 5 Assistance League of Temecula Valley Special Board Meeting Motions July 12, 2011 President Ann Reese called the July 12, 2011 Special Board Meeting to order at 12:10 PM. Sue Sampson, secretary, present. Board Members Present: Georgia Reece, Barbara Miller, Gwen Leevers, Ginny Wetzel, Leticia Plummer, Jean Clower, Kathy Laurin, Barbara Card, Merrilee Batchelor, Trudy Lenz and Dorcas Shaktman. Absent: Sumru Vance. Trudy Lenz, parliamentarian, was present. Motion: 07/10/11 It was moved and seconded, by direction of the Grants Committee, that the Assistance League of Temecula Valley apply for this grant: City of Temecula grant -Community Service Funding Program -$5,000 (2011/2012) Motion: ADOPTED President Ann Reese adjourned the meeting at 12:20 PM. Ann Reese President Date ')//>j/ Sue Sampson Secretary Date ///l/ll .. •I z:'G`��s�+ :`f��'.L' :iii ..lora 4 il'bs. i 1+ fid. 4 . f; !D' s'v.•:'•, ''! �,,; -_..'•lib:.': .. Stcite �f Caiifornia OFFICE OF THE SECRETARY OF STATE CORPORATION DIVISION 1, MARCH FONG EU, Secretary of State of the State of California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. IILC1STATg Pawn C114107 IN WITNESS WHEREOF, 1 execute this certificate and affix the Great Seal of the State of California this JUN 191989 iAtiauei Secretary of Stets • VALLEY. 1463456 ENDORSED FLED ARTICLES OF INCORPORATION "ere °"'"'s duisLCOVC, of »o or �,. sok d cosa�•,,;, -OF- ASSISTANCE GUILD OF TEMECCpLA VALLEY J U N 1 5 1989 A California Nonprofit Public Benefit Corporation I. MAME MARCH FONG EU. Secretary qt $ The name of the corporation is ASSISTANCE GUILD OF TEMECULA II. PURPOSES A. This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for charitable purposes. B. The specific purpose of this corporation is to carry on a program of philantropic work in the community and to control and administer at least one major philanthropic project. III. INITIAL AGENT FOR SERVICE OF PROCESS The name and address in the State of California of this corporation's initial agent of the corporation for service of process is: MARJORIE B. BARNUM, 46569 El Viento Seco Drive, Temecula, CA. 92390 IV. LIMITATION ON CORPORATE ACTIVITIES A. This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501 (c)(3) of the Internal Revenue Code or the corresponding provisions of any future United States Internal Revenue Law. Notwithstanding any other provision of these articles, this corporation shall not, except to an insubstantial degree, engage in any activities or exercise any powers that are not in furtherance of the purposes of this corporation, and the corporation shall not carry on any other activities not permitted to be carried (a) by a corporation exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States Internal Revenue Law, or (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States Internal Revenue Law. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or 1 intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. v. DEDICATIONN AND DISSOLUTION The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of this corporation shall ever inure to the benefit of any director, officer or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for charitable purposes and which has established its tax exempt status under Section 501 (c)(3) of the Internal Revenue Code (or the corresponding provision of any future United States Internal Revenue law). The organization shall be National Assistance League, if it qualifies as a distributes under the provisions of this Article. IN WITNESS WHEREOF, the undersigned, being the Incorporator of ASSISTANCE GUILD OF TEMECULA VALLEY has executed these Articles of Incorporation this /'f day of June, 1989. ORPORAPOR 1 THOMAS S. HUNTINGTON I hereby declare that I as the person who executed the foregoing Articles of Incorporation, which execution is my act and deed. THOMAS S . : 1 INGTON 2 r= : ? : i• �.'.". �. +'!'�Y1�iR�°::+.'!.fGS6M•taL. f!r State or Caiifornia OFRCE OF THE SECRETARY Of STATE CORPORATION DIVISION A417175 1, MARCH FONG EU, Secretary of State of the State of California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. swsr,vsa Poor CL -107 IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this APR 2 L tA,GRAA qvitei Soesrtsy of state 1{ 4OYa CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION LA DONNA JIMENEZ AND BETTY THOMPSON certify that: 1. They are the president and the secretary, respectively, of Assistance Guild of Temecula Valley, a California Nonprofit Public Benefit Corporation. 1417175 Ai 4.d J E E? in meoftmeofltw^. rsso4sry of Site :f the :deo!C.'"xno APR 1 3 1992 tAlCis!f ONC,V,Se iefaryodS to 2. Article , , N.AK$ of the articles of incorporation of this corporation is amended to read as follows: The name of the corporation is ASSISTANCE LEAGUE OF TEMECULA VALLEY. 3. The foregoing amendment of articles of incorporation has been duly approved by the board of directors. 4. The foregoing amendment of articles of incorporation has been duly approved by the required vote of members. We further declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true and correct of our own knowledge. DATE: April 8, 1992 NONPROFIT COMMUNITY SERVICE FUNDING PROGRAM FISCAL YEAR 2011-12 TABLE OF CONTENTS Application, page 1, with following attachments: o Special Board Meeting Minutes o State of California I.D. # 1463456 Proof of nonprofit status o Assistance League's Criteria, page 1-5 Application, page 2, with following attachments: Financial Statements: o Statement of Activities — August 2011 o Budget — June 2011— May 2012 Application, page 3 Application, page 4 Application, page 5 JW assistance league' Temecula Valley September 15, 2011 City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, California 92589-9033 Dear Ms. McNabb: City of Temecula SEP 12 2011 Finance Department Assistance League® of Temecula Valley requests consideration and support through this submittal of our application for the Community Service Funding Program for the interior repair and improvements to our building for Fiscal Year 2011-12. Pursuant to the instructions of this program, we are submitting one original and one copy of Assistance League's application. Eligibility requirements for funding by Assistance League are: • a California nonprofit public benefit corporation • tax exempt status, • no paid employees, • does not have debts as part of this funding request, • located in the City of Temecula, • maximum allowable funding award requested is $5,000.00. Should you have questions or comments, please direct them to the undersigned. With kind regards, Ann Reese, President Enclosures 28720 Via Montezuma • Temecula, CA 92590-2510 • 951-694.8018 altemecula@yahoo.com • www.temeculavalley.assistanceleague.org City of Temecula 2011-12 CS Funding Program APPLICATION NO. 3 City of Temecula CITY OF TEMECULA FISCAL YEAR 2011-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011A2sProgra n Submiss;on Deadline: Thursday, September 15, 2011 (original,. plus one) SEP 14 2011 Finance Department PROJECT INFORMATION Amount Requested: $ 5,000 (Maximum allowable $5,000) Project Name: Birth Choice of Temecula Pregnancy Resource Services for Community Project Start Date: November 2011 Project End Date: August 31, 2012 application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large ORGANIZATION INFORMATION Name of Organization: BIRTH CHOICE OF TEMECULA Contact Name: Jennifer Cartel! Title/Position: Executive Director Mailing Address: 27488 Enterprise Circle West, #4, Temecula, CA 92590 Telephone: 951-699-9808 Ext. 105 or cellular 951-551-5428 Year Organization Founded: 1989 Number of Paid Staff: (4) 2.5 FTE Number of Volunteers: (90) + with board; (1000 with event participants)_ Geographic Area(s) Served: All Temecula area residents Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 1990 If "yes": Date of incorporation as a non-profit 1990 Federal identification number 33-0302353 " Include a copy of your statement of non-profit status from the State of California. If "no": Name of sponsoring organization N/A Federal identification number FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. Please see attached for end year 2010 and to date. Please also see budget for 2011. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Birth Choice of Temecula is a Pregnancy Resource Center that serves the community with life-saving alternatives including adoption referrals and pregnancy counseling and resources. We also provide extensive material support, as well as referrals to other organizations such as food pantries, homeless shelters, host homes and transitional facilities, drug and alcohol rehab, ADV and legal support sources. We have an on- site Mommy and Baby Boutique that has provided maternity, layette and small baby items for Moms, Dads and Grandparents in need at no cost to them. Our goal is to offer education, options counseling, material support and support of pregnancy and post pregnancy to 2 years of age. We also help the entire family including small children with clothing, gas and food cards, charity car referrals, baby food and formula, baby clothing, baby nursery furnishings and other baby items that are useful to them. Our counseling allows families to keep and support their babies if they desire to. We offer a Mommy and Baby Boutique, including maternity and baby clothing, nursery items, food and formula, diapers, wipes and bottles, gas and food cards and hygiene items for Moms and babies. A. Is the organization currently non-profit? Yes, Birth Choice of Temecula is currently a non- profit organization ID # 33-0302353 B. Does the organization provide a service to the overall community? Yes, Birth Choice of Temecula provides no -cost pregnancy counseling, material goods for Pregnant Moms and Dads and for their babies and small children. Also, referrals for all members of our community who need help. h; -r) Is the size and make-up of the organization equipped to provide the program/service to the overall community? Yes, Birth Choice of Temecula is currently staffed by an Executive Director, Asst. Director and greater than (90) volunteers that provide no cost services to our clients. We are managed by a Board of Directors comprised of (10) Board Members from various backgrounds and educational D. What is the public reaction to the group? The community has been very supportive of this ministry, having provided most of our support. Numerous individuals, churches and business supporters have been involved in this organization for greater than 20 years. As seen in our newsletters, our clients are very happy that they received timely assistance that allowed them to support their baby and the other young children in their home. We have prevented homelessness on numerous occasions in the past four years. E. Does the organization have a high quality level of fiscal management? Yes, Birth Choice employs a retired Naval Officer who holds a Master's Degree in Healthcare Administration as their Executive Director. Additionally, the Board of Directors provides monthly oversight with a Treasurer who has expertise in corporate accounting. Our part-time Accounting Secretary provides weekly oversight of the budget, tax receipts and preparation of financial documents for monthly Board Meetings. F. Is the group well organized to ensure longevity in the City of Temecula? Yes, Birth Choice of Temecula has been existence in Temecula for greater than 20 years and recently advanced the center to include increased services with an expanded volunteer staff of receptionists, counselors, volunteer mentors, RN's and community outreach volunteers. G. Is there evidence of satisfactory service provided to the City's citizens? Yes, Birth Choice of Temecula served 2035 clients and their families in 2010 and continues to see nearly 200 clients per month for counseling and material support and referrals. Numerous client testimonials attest to our outstanding and caring support to them. In 2010, we helped numerous families to find resources for their babies and young children and to prevent homelessness. They were provided gas and food cards, maternity and baby clothing, diapers and formula and hygiene items for their family when unemployment or their salaries were not enough to sustain them. This was done when all other agencies contacted had no available funds or services. Our networking with nearly 125 area churches, allowed us to provide via generous donations of time, materials and monies from our community. H. Is the organization free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation? Yes, Birth Choice of Temecula is non- denominational and provides equal access to services regardless of race, religion, creed, nationality, sex, marital status or political affiliation. Does the organization require attendance or participation in any political, religious or social activity? No, Birth Choice is non -denominational. J. Can the organization provide financial statements (prepared using an appropriate method of accounting) to demonstrate sound financial management? Yes, Birth Choice maintains monthly financial reports by an Accounting Secretary for review by the Executive Director and Board of Directors. Also, end year statements using Quick Books for Non -profits. Our 990 is filed yearly. K. Can the organization provide a budget for the fiscal year of request demonstrating cost- effectiveness? Yes, the center has established a budget for 2011 and cost controls. We have been continually improving our financial standing through fundraisers, grants, church missions support and community outreach. L. Does the organization make its services available to all? Yes, services are provided to all who seek our help at no cost to them. M. Does the organization possess ongoing program evaluation tools? Yes, Birth Choice of Temecula has established Strategic Goals and Measures of Effectiveness and the Executive Director reports on the achievement of those goals each month with a written report and an Annual Report PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) If awarded this city grant funding, Birth Choice of Temecula will use the funding to purchase pregnancy support and educational supplies for_community teens, women and families facing unplanned or financially difficult pregnancies. We will provide brochures, material goods and referrals in support of pregnancy, maternity and baby clothing and newborn layettes. We will also provide post -delivery nursery supplies and educational materials such as books, DVD's, pamphlets related to pregnancy and caring for new babies. All consumable supplies will help our pregnant clients with their pregnancy and post -pregnancy period, as well as help them to care for their child. Client families will benefit from our services on a daily basis. We will expand our operating hours by 15%. Objective One: To be available for all teens, women and families with pregnancy resource support through a 15% increase in center operating hours and days, an after-hours hotline and website and an increased community awareness and outreach program. Objective Two: To increase our clients and outreach contacts by 100% in 2011-2012 Objective Three: To ensure every baby born in this community and their mother has a safe bed, food and formula (preferably breast feeding) and proper clothing. (Collaboration with other organizations) Objective Four. To ensure all teens and women in this community are given educational resources regarding their options so they are not forced to give up their babies. Objective Five: To reduce the number of unplanned pregnancies and STD's in our community through a Community Based Abstinence Education Program, Mentoring Program referrals to (2) mentoring organizations in the area, RN counseling and MD referrals for healthy babies and Moms. See budget for project: BUDGET PROPOSAL FOR CITY OF TEMECULA COMMUNITY SERVICE FUNDING FOR BIRTH CHOICE OF TEMECULA PREGNANCY RESOURCE CENTER Consumable Supplies: Quantity Cost Subtotal Total Cost Pregnancy brochures 25,000 .50 5000.00 12,500.00 Pregnancy 20 18.00 360.00 360.00 Educational videos/lending Material goods pregnancy and Baby (maternity, baby, food) 1,800 20.00 36000.00 36000.00 Newborn bassinets 60 100.00 6000.00 6000.00 Supplies to support client visits 2800 1.00 1800.00 2800.00 Prenatal Care educational mtls 1800 1.00 1800.00 1800.00 Total Cost: .S59. 460 1. Requested Amount: $5,000 2. Expected Program Expenses: $59,460 3. Other financial resources $30,000 estimated from fundraising events; $25,000 estimated from donors For more details on our services, please visit our website at www.birthchoicetemecula.com PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. PAST PROJECT BENEFITS Application Page 5 If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Birth Choice of Temecula received a $5K grant from the City last year. With the addition of these monies, Birth Choice of Temecula was able to provide expanded pregnancy support services and hours to greater than 2035 families in 2010 and nearly 200 clients per month in 2010. (Seventy-one (71) babies have been saved in the past 3 years through counseling and material support for those who wished to keep their babies or place them for adoption with a loving family, but needed help to do so. We have expanded our center days to include Monday -Thursday and expanded our hours by 25% as per our goal. We have further added more volunteers such as receptionists, counselors and boutique workers to ensure that our expanded (4) phone lines are answered timely to support nearly 200 client visits and numerous phone calls each day, up 40% over the past year. We have a volunteer Nurse Manager, (6) volunteer RN's and a volunteer MD OB/GYN provider to provide medical counseling and referrals for earlier prenatal care healthier pregnancies, including healthy babies and Moms. We will continue to help all families until their babies are two years of age, while also helping them to make good choices for their lives and helping them to become self-sufficient. Referrals to complete high school diplomas, college courses are included where needed in counseling sessions. Additionally, parents are being given abstinence counseling for their teens to prevent unplanned pregnancy and life-threatening disease such as HIV/AIDS, Hepatitis and others. Greater than 5,000 people participated in Birth Choice events providing much needed community service and volunteer support to members of our community including the Walk for Life, Race for Humanity, Baby Bottle Boomerang, Community Health Fairs, Community Expo's, Temecula Chamber events, Middle School, High School and correctional Community Service Programs, numerous church health and Missions Fairs, abstinence education to students from numerous schools, Educational Work experience for students and adults from Mount San Jacinto, University of California San Marcos, Azusa Pacific, UC Riverside, Calvary Bible College Murrieta and Adult Work Programs for the Disabled including Care Right and Toward Maximum Independence (TMI). Local area high schools, Riverside Courts and Job Corps call us for Community Service referrals, Study programs and as guest presenters for the schools. We have a mutually beneficial relationship with Neighborhood Health Clinics, WIC, the Social Service offices and many areasloclors office, clinicsand.hospitals. Birth Choice has presented a loving approach to pregnancy resource support and we remain a source of help and hope for many who have none. With your support, we can help even more. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. Prepared By:_ Signature: Jennifer Cartel!, Executive Director NAME AND TITLE (Please Print or Ty, President or Authorized Officer: Dr. Paul Simeteys, President Board of Directors NAM AND TI LE (Please Print or Type) Signature: Zia lai Organization Name: BIRTH CHOICE OF TEMECULA Mailing Address of Organization: 27488 Enterprise Circle West, #4, Temecula, CA 92590 Telephone: Center: 951-699-9808 Ext 105; Cellular: 951-551-5428 DATED THIS 9th__ of _September, 2011. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: Fax: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 (951) 694-6479 2:32 PM 02/18/11 Cash Basis Birth Choice of Temecula Balance Sheet As of January 31, 2011 ASSETS Current Assets Checking/Savings First Citizens Bank Pacific Trust Bank Checking Pacific Trust Bank Savings Petty Cash S.B.Grant Petty Cash Jan 31, 11 50,651.14 32,305.37 595.09 200.00 300.00 Total Checking/Savings 84,051.60 Total Current Assets 84,051.60 TOTAL ASSETS 84,051.60 LIABILITIES & EQUITY Equity Opening Bal Equity Unrestrict (retained earnings) Net Income Total Equity TOTAL LIABILITIES & EQUITY 41,375.33 45,853.78 -3,177.51 84,051.60 84,051.60 Page 1 1:55 PM Birth Choice of Temecula 01/07/11 Profit & Loss Year to Date Cash Basis January through December 2010 Jan - Dec 10 Ordinary Income/Expense Income Donations Baby Bottle Boomerang Blessed Teresa Church 26.72 Calvery Chapel 35.52 Community Service 1,441.80 Dr.Bridgette Briggs 89.96 Life ChurchlWhittier 429.98 Linfleld School 1,290.08 Mountain View Community Church 1,364.49 Murrieta Valley Church 1,032.97 Oakstone Community Church 290.53 Rancho Community Church 18.17 St. Catherine Catholic Church 98.08 St. Jeanne's 15.73 St. Martha Catholic Church 5,764.28 Stone Creek Church 418.54 Sunridge Church 187.84 Team Temecula 35.42 Baby Bottle Boomerang - Other 1,091.33 Total Baby Bottle Boomerang 13,631.44 Banquet 17,754.00 Christmas Card 7,263.00 Church Periodic Calvary Chapel of Menifee 1,200.00 Canyon Lake Community Church 3,600.00 Crossroads Church 1,872.66 Lighthouse Assembly of God 900.00 Murrieta Knights Ladies Auxilia 23.85 Oakstone Communtiy Church 1,100.00 Rancho Community Cburch 4,512.50 Southwest Christian Church 1,500.00 Stone Creek Bible Church 1,439.32 Temecula Hills Christian Church 2,250.00 Temecula United Methodist Women 392.00 Total Church Periodic 18,790.33 General Online Income 3,405.50 General - Other 0.00 Total General Kings Koiffures Salon Race For Humanity Donations - Other 3,405.50 115.05 26, 817.17 28,477.51 Total Donations 116,254.00 Grants Income God's Gift 15,000.00 Matching Grant 1,793.40 Mentoring Grant 43,883.05 Mission Increase Foundation 20,000.00 Total Grants Income 80,676.45 Interest Income 1.77 Newsletter 1,350.00 Total Income 198,282.22 Page 1 1:55 PM 01/07/11 Cash Basis Birth Choice of Temecula Profit & Loss Year to Date January through December 2010 Jan - Dec 10 Expense A.Payroll Expenses Gross Payroll - Salaries 67,174.50 Payroll Service Fees 1,066.34 Payroll Taxes 5,968.95 Special W2 Invoice 76.50 Total A.Payroll Expenses 74,286.29 B.Other personnel expenses Misc Fees 903.48 Staff Christmas Gifts 60.00 Staff development 88.05 Volunteer Expenses 191.64 Volunteer/Staff Appreciation 2,689.83 Workman's Comp 764.41 B.Other personnel expenses - Other 48.00 Total B.Other personnel expenses 4,745.41 C.Non-personnel expenses Bank Service Fee 0.00 Client Education Material 1,197.26 Client Supplies 791.04 Computer 1,073.99 Equip rental & maintenance 2,568.48 Mailing services 480.00 Office Supplies 5,851.61 Postage, shipping, delivery 1,535.59 Printing & copying 1,312.17 C.Non-personnel expenses - Other 66.81 Total C.Non-personnel expenses 14,876.95 Church Outreach 54.85 D.Occupancy expenses Building/Maintenance 929.70 Electricity 1,511.99 Gas 376.19 Rent 16,740.00 Telephone & telecommunications 5;293.90 Total D.Occupancy expenses 24,851.78 E. Advertising 10,986.30 F.Community Outreach 7,543.82 G. Insurance 2,726.84 H. Fund Raiser Expense Banquet 7,066.72 Christmas 1,284.15 Race for Humanity Expense 6,553.75 Total H. Fund Raiser Expense 14,904.62 I. Miscellaneous Center Improvements 341.48 Membership dues - organization 135.00. Online Expense 1,114.85 I. Miscellaneous - Other -668.51 Total I. Miscellaneous 922.82 J. Grant Expense Matching Grant Mentoring Grant Expense San Bernardino Grant Expense St. Martha"s Gas & Food Cards San Bernardino Grant Expense - Other Total San Bernardino Grant Expense 1,052.00 878.06 1,200.00 333.33 1,533.33 Page 2 1:55 PM Birth Choice of Temecula 01/07/11 Profit & Loss Year to Date Cash Basis January through December 2010 Jan - Dec 10 J. Grant Expense - Other 21.64 Total J. Grant Expense 3,485.03 Medical Exam Room Supplies 1,798.53 Insurance/Licenses 840.00 Medical Travel & Training Medical Equipment 1,591.00 Medical Travel & Training - Other 449.60 Total Medical Travel & Training 2,040.60 Medical - Other 65.00 Total Medical 4,744.13 Rachel's Vineyard 920.00 Reconciliation Discrepancies 9.00 Travel & meetings expenses Travel 263.37 Total Travel & meetings expenses 263.37 Total Expense 165,321.21 Net Ordinary Income 32,961.01 Net Income 32,961.01 Page 3 2:37 PM 02/18/11 Cash Basis Birth Choice of Temecula Profit & Loss Budget Overview January through December 2011 Jan - Dec 11 Ordinary Income/Expense Income Donations Baby Bottle Boomerang 35,000.00 Banquet 20,000.00 Christmas Card 10,000.00 Church Periodic 35,000.00 General 25,700.00 Walk For Life 20,000.00 Wash For Life 500.00 Total Donations 146,200.00 Grants Income City of Temecula Grant 5,000.00 Discretionary Grant 1,000.00 God's Gift 15,000.00 Matching MI 20,000.00 San Bernardo Diocese Grant 5,000.00 Total Grants Income 46,000.00 Total Income 192,200.00 Expense A.Payroll Expenses Gross Payroll - Salaries Total A.Payroll Expenses B.Other personnel expenses C.Non-personnel expenses Church Outreach D.Occupancy expenses E. Advertising F.Community Outreach G. Insurance H. Fund Raiser Expense Baby Bottle Boomerang Walk for Life Total H. Fund Raiser Expense 1. Miscellaneous Membership dues - organization Online Expense Total 1. Miscellaneous J. Grant Expense Matching Grant San Bernardino Grant Expense Total J. Grant Expense Medical Exam Room Supplies Insurance/Licenses Medical Travel & Training Total Medical Rachel's Vineyard 95, 500.00 95,500.00 4,800.00 15,190.00 2,000.00 25,000.00 10, 000.00 5,000.00 2,800.00 2,000.00 3,000.00 5,000.00 150.00 1,100.00 1,250.00 500.00 3,500.00 4,000.00 1,500.00 850.00 1,500.00 3,850.00 500.00 Page 1 2:37 PM Birth Choice of Temecula 02/18/11 Profit & Loss Budget Overview Cash Basis January through December 2011 Jan - Dec 11 Travel & meetings expenses Travel 250.00 Travel & meetings expenses - Other 100.00 Total Travel & meetings expenses 350.00 Total Expense 175,240.00 Net Ordinary Income 16,960.00 Net Income 16,960.00 Page 2 State of California Secretary of State 1, DEBRA BOWEN, Secretary of State of the State of California, hereby certify: That the attached transcript of _ page(s) was prepared by and in this office from the record on file, of which it purports to be a copy, and that it is full, true and correct. • 100 (gEv i/200/) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of JUN 1 7 2009 DEBRA BOWEN Secretary of State N :�..,- , - State of California �' ...._ Secretary of State �uroar`� Statement of Information (Domestic Nonprofit, Credit Union and Consumer Cooperative Corporations) V Filing Fee: $20.00. If amendment, see instructions. IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM N , \ • `.' ' �(Y`, ^, tf This Space for Filing Use Only 1. CORPORATE NAME Birth Choice of Temecula • Due Date: Complete Principal Office Address (Do not abbreviate the name of the city. Item 2 cannot be a P.O. Box.) 2. STREET ADDRESS OF PRINCIPAL OFFICE IN CALIFORNIA, IF ANY CITY STATE ZIP CODE 27488 Enterprise Circle West #4 Temecula CA 92590 3. MAILING ADDRESS OF THE CORPORATION, IF REQUIRED CITY STATE ZIP CODE Same Names and Complete Addresses of the Following Officers (The corporation must list these three officers. A comparable title for the I officer may be added; however, the preprinted titles on this form must not be altered.) 4. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE Jennifer Cartel' 40062 Cannes Court Temecula CA 92591 5. SECRETARY ADDRESS CITY STATE ZIP CODE Gerard Meyers 29402 Via La Plaza Murrieta CA 92563 6. CHIEF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE Michael Klein 28344 Tierra Vista Road Temecula Ca 92592 Agent for Service of Process (If the agent is an individual, the agent must reside in California and Item 8 must be completed with a California address (a P.O. Box address is not acceptable). If the agent is another corporation, the agent must have on file with the California Secretary of ; certificate pursuant to California Corporations Code section 1505 and Item 8 must be left blank.) 7. NAME OF AGENT FOR SERVICE OF PROCESS Jennifer Cartel' 8. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY STATE ZIP CODE 27488 Enterprise Circle West #4 Temecula CA 92590 Davis -Stirling Common Interest Development Act (California Civil Code section 1350, et seq.) development under the Davis -Stirling Common li by Common Interest Development Asso on the reverse side of this form. 9. Check here if the corporation is an association formed to manage a common interest Development Act and proceed to Items 10, 11 and 12. NOTE: Corporations formed to manage a common interest development must also file a Statement (Form SI -CID) as required by California Civil Code section 1363.6. Please see instructions 10 ADDRESS OF BUSINESS OR CORPORATE OFFICE OF THE ASSOCIATION. IF ANY CITY STATE ZIP CODE 11 FRONT STREET AND NEAREST CROSS STREET FOR THE PHYSICAL LOCATION OF THE COMMON INTEREST DEVELOPMENT 9 -DIGIT ZIP CO( (Complete if the business or corporate office is not on the site of the common interest development.) 12 NAME AND ADDRESS OF ASSOCIATION'S MANAGING AGENT. IF ANY CITY STATE ZIP CODE 13 THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT ATE r TYPE/PRINT NAME OF PERSON COMPLETING FORM TITLE ••-- 'SIGNATURE SI -100 (REV 10/2010) APPROVED BY SECRETARY OF .-7,1' T. r.. t.�.;-..cry.,:fl �. ,L---.L•i.+�..T1.+'- t'S �'J'TG-Cw^� «-.T-�1�'-`.., .. _nom--IIe•.. •- .aa-��. 'ca..• =V •.YRC'S Internal Revonue Service Department of the Treasury P 0 BOX 2350 ROOM 5127 ATTN: E.O. LOS ANGELES, CA 900532350 Date: MAR. 20, 1989 BIRTHRIGHT OF TEMECULA -42890-RG•EN-A-STREET- 28677 Front St TEMECULA, CA 92.390 P.O. Box 2129 Temecula, CA. 92390 Dear Applicant: Date: In reply reNt to: Employer Identification Number: 33-0302353 Case Number: 959030023 Contact Person: • THORNTON, B. Contact Telephone Number: (213) 894-4170 Accounting Period Ending: December 31 Foundation Status Classification: see attached Advance Ruling Period Ends: Dec. 31, 1992 Caveat Applies: no Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Because you are a newly created organization, we are not now making a final determination of your foundation status under section 509(a) of the Code. However, we have determined that you can reasonably be expected to be a publicly supported organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). Accordingly, you will be treated as a publicly supported organization, and not as a private • foundation, during an advance ruling period. This advance ruling period begins on the date of your inception and ends on the date shown above. • Within 90 days after the end of your advance ruling period, you must submit to us information needed to determine whether you have mot the requirements of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, you wilt be--classIfi-ed.as-a rection O -9 -(a) -(1) --or- 509(0(2) organization-as-long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, you will be classified as a private foundation for future periods. Also, if you are classified as a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you subrnit the required information within the 90 days, grantors and donors Letter 1065 (CG) -3 - BIRTHRIGHT OF TEMECULA Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If the heading of this letter indicates that a caveat applies, the caveat below or on the enclosure is an integral part of this letter. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, C. AJL Frederick C. Nielsen District Director Letter 1045(CG) 1111111 11111 (1111 11111 III 11111 11111 I 1111 11111 1111 1111 Department of the Treasury Internal Revenue Service FRESNO, CA 93888 1111111 11111111 IIIIIIIIIIII 1I II II 111 11)1111111111111111111111 I1) BIRTH CHOICE OF TEMECULA INC PO BOX 2129 TEMECULA CA 92593-2129297 Date of this notice: JULY 25, 1994 Taxpayer Identifying Number 33-0302353 Form: Tax Period: For assistance you may call us at: 1-800-829-1040 ST. I WE CHANGED YOUR NAME AND/OR ADDRESS THANK YOU FOR YOUR CORRESPONDENCE. AS YOU REQUESTED, WE'VE MADE THE FOLLOWING CHANGES TO YOUR NAME AHD/OR ADDRESS: NAME AND ADDRESS PREVIOUSLY NAME AHD ADDRESS NOW SHOWN ON YOUR ACCOUNT SHOWN ON YOUR ACCOUNT BIRTHRIGHT OF TEMECULA BIRTH CHOICE OF TEMECULA INC PO BOX 2129 PO BOX 2129 TEMECULA CA 92593-2129297 TEMECULA CA 92593-2129297 IF YOU DON'T AGREE WITH THIS CHANGE, PLEASE LET US KNOW. CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION agLo CNDOfl D FILED In the office of the Secretory of Stan of the Slaw of Cofifornio rJUi: 1 8 1994 Arlene Siroky and Margaret A. Ustick certify that: TONY MILLER, kGng Secretary o1StIt9 1. They are the Director and the Secretary, respectively of BIRTHRIGHT OF TEMECULA, INC. a California Corporation. 2. Article I of the articles of incorporation of this corporation is amended to read as follows: BIRTH CHOICE OF TEMECULA, INC. 3. The foregoing amendment of articles of incorporation has been duly approved by the Board of Directors. 4. The corporation has no members. We further declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true and correct of our own knowledge. DATE: FCrleen Siroky, Director . ;1,A_ Margaret ,. Ustick, Secretary NONPROFIT City of Temecula 2011-12 CS Funding Program APPLICATION NO. 4 CITY OF TEM E CULA City of Temecula FISCAL YEAR 201 O-1 1 SEP 1 5 2011 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) Finance Department 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: Project Name: $ 5,000 (Maximum allowable $5,000 Before and After School Transportation Program - Temecula Project Start Date: Spring 2005 Project End Date: Ongoing ORGANIZATION INFORMATION Name of Organization: Boys & Girls Clubs of Southwest County ("The Clubs") Contact Name: John Whann Title/Position: Director of Operations Mailing Address: P.O. Box 892349, Temecula, CA 92590 Telephone: 951-699-1526 x105 Year Organization Founded: 1989 Number of Paid Staff: 65 Number of Volunteers: 400+ Geographic Area(s) Served: Temecula. Murrieta, Wildomar, Lake Elsinore, Canyon Lake, French Valley Is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: 1989 If "yes" (Must provide a copy of your statement of non-profit status from the State of California): Date of incorporation as a non-profit: 1989 Federal identification number: 33-0475756 State identification number: If "no": Name of sponsoring organization Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Members -at -Large Application — Page 1 Board of Directors FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Boys and Girls Clubs of Southwest County is to inspire and enable all youth to realize their full potential as productive, responsible, and caring citizens by providing stimulating and challenging programs through interaction with dedicated caring people. Established in 1990 in Temecula, CA the Boys & Giris Clubs of Southwest County (The Clubs) is a 501c3 Corporation that provides a safe, enriching, and educational place for children to become all they can be. Temecula children, ages 6-18 are served at two clubhouse locations, one in Old Town, and one in the Wolfe Creek Development. Services are provided without consideration of race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. Both Temecula Clubhouses are open each school day, Mon -Fri from 6:30am to 6:30pm, and during school breaks and summer vacation. On Saturdays, more than 1,000 children participate in BGC Sports Leagues at Ken Hintergardt Park supported by more than 400 community volunteers. Each day, 35 full and part time trained, professional staff members provide daily transportation to/from Temecula schools and back to the Clubs, where children are offered daily tutoring, and fun enrichment programs in the areas of health and fitness, nutrition, sports, computer tech, music, the arts, leadership, and community service. Program impacts are carefully tracked using comprehensive computer programs that measure outcomes through program post- and pre-tests, school report cards, physical fitness skills, cognitive competency, and sound decision making. All programs are developed by the Boys & Giris Clubs of America and have been proven to have long lasting positive impacts on childhood development. Since incorporation, the Boys & Giris Clubs of Southwest County have gamered strong community support from all sectors including the Temecula Valley Unified School District, City of Temecula, County of Riverside, RTA, RCTC, Cal State San Marcos, Mt. San Jacinto Community College, PTA Council, Universal Health Systems, the Promenade Mall, the Temecula Rod Run, the greater business community, other local non -profits, and Temecula residents. This high level of support confirms that the Boys & Giris Clubs of Southwest County continues to fill a vital need for quality before and after school care and enrichment programs and that these programs are making a measurable, positive impact on the community and the lives of Temecula's children and their families. The Clubs are governed by a 20 -member volunteer Board of Directors comprised of local business owners, professionals, and community members. Day-to-day Club operations are managed by the professional staff who constantly monitor, review, and update programs and protocols as needed to ensure community needs are being met in accordance with the Bylaws of the Corporation. The Executive Committee (corporate officers), the Board, and Board sub -committees each meet monthly and have direct oversight for every aspect of Club operations including finance & fiscal stability, facilities, marketing/community development, operations, board development, and programs. Club financials are reviewed and updated daily by the Director of Finance and are reviewed by the President/CEO for accuracy and urgency. Financials are reviewed 3x per month by the Executive Committee including the Treasurer to ensure The Clubs have adequate funding to accomplish the Mission. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) CSF Funds will be used to repaint one of 7 (seven) school busses owned by The Clubs and used in the Before and After School Transportation Program. (see Program details below) This bus is currently out of service after an August CHP inspection determined it was "faded" and needed to be repainted prior to being placed back in service. The estimated cost to paint this bus is $3500 CSF funds will also be used to replace a vandalized rear window in a bus donated by RTA in 2010. This bus is also used in the Before and After School Transportation Program. Estimated cost to replace the broken rear window is $1500. Program Narrative The Boys & Girls Clubs of Southwest County operates the largest private transportation program in Southwest Riverside County, second only to local school districts. In 2011-12, busses serving Temecula schools will provide equivalent transports that will eliminate 50,400 vehicle trips from Temecula's streets near 18 school sites. This huge reduction in traffic at Temecula school sites will ease congestion, improve student safety, improve traffic circulation through neighborhoods, and improve air quality. The breakdown of schools and students transported is as follows: GREAT OAK CLUBHOUSE: 79 RIDERS DAILY Jackson Ele 25; Tony Tobin 2; Pauba Valley 8; Red Hawk 10; TMS 3; Crowne Hill 6; Abby Reinke 2; Paloma 5; Vintage Hills 8; Vail Ranch Middle 8; River Springs Charter 2. OLD TOWN CLUBHOUSE: 61 RIDERS DAILY MMS 8; Barnett 1; Rancho 2; Nicholas 9; DMS 10; Vail 15; Temecula 16. 79 + 61 = 140 transports x 2 trips per day = 280 transports/day 280 transports/day x 180 school days/year = 50,400 transports per year The Boys & Girls Clubs Before and After School Transportation Program provides a vital service to children who need a safe and fun place to go before and after school and require outside transportation to get them there, . Parents (or a caregiver) may bring their child(ren) to one of the two Temecula Clubs at 6:30am on their way to work. The children receive a snack and are then loaded onto one of 13 full sized school busses or extended vans and driven to the front door of their school. After school, Club busses/vans pick children up at the front door and return them to their Clubhouse where they receive a snack and go directly to "Power Hour/Project Learn" for private tutoring and homework help, followed by participation in any of 5-6 specialized fun programs being offered that day (See program explanation on Page 1) All Club drivers are drug screened, background checked, and CHP certified, holding a Class P, Class S, or Commercial driver's license. Drivers inspect each vehicle twice daily to ensure CHP safety compliance and mechanical reliability. All vehicles are inspected monthly by CHP inspectors for safety compliance and mechanical reliability. The Before and After School Transportation Program helps Temecula's working parents by providing a safe place for their children from 6:30am to 6:30pm every day. It helps the children access the great programs and services offered at The Clubs, and it removes 50,400 vehicle trips from Temecula streets at 18 school sites, easing congestion and improving air quality. Application — Page 3 PAST PROJECT RENEFI'I'S If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. In 2010-11 the Boys & Girls Clubs of Southwest County received $5000 for the Power Hour/Project Learn program. This program instilled in our children a love of leaming by challenging the mind and lifting the spirit through individual project goal setting and completion. As always, the "learning was hidden inside the fun" as children completed assigned tasks and reached their goals in a positive environment of encouragement and acknowledgement. Excellence in performance and leaming was rewarded through participation in special events and field trips. Demonstrated academic improvement was noted on each child's chart and tabulated on a daily, weekly, and monthly basis in the areas of technology, academics, the arts, and world study. Children's performance habits, cognitive skills, attention spans, and overall outcomes were demonstrably improved by the conclusion of the program. City of Temecula CSF Grant funds were instrumental in the success of this program, provided the necessary tools and supplies to engage the children and provide an incentive for them to reach higher and go farther. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: John Whann, Director of Operations SIGNATURE: NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Ted Kristensen, Chief Volunteer Officer NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Boys & Girls Clubs of Southwest County MAILING ADDRESS: P.O. Box 892349 Temecula, CA 92590 TELEPHONE: 951-699-1526 xt. 105 15 DATED THIS 1,6th of September , 2011. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula; CA 92590 Application — Page 5 J 0 888 8 8g8 0 88 8 � � r 0 m 0 (V N N 08 8 N:4.4 n O O N O) ..� lV (V N 88 8 n 0 0) NN N 08 8 r n N' N N 88 8 r r+ F- gg 0 N N N 888 8 8.5;C-0. 0) ti N h h O O 8 8 80)0) 0) N h fV r h 888 8 04-: n n 8g,0. N- <604N. h $$8 8 g'r. 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W C 9 C IT F d Q OC a0° nc.=- ay `° E• acc r oCm a n o a 2 E C C c '00 7$ N fn F C N C •�L c_ 1-- ~ O b W O weeoffip v� O�0 L2 �oz•a` ea0 zco�E c itl 24 00ca El '5 a �t09_1mtan F1w-a A. 1 00,ntA: ,'ya~ 0. 8•Ee o e o mromc439 o8muogw a aaa 1- a 1- a'a'taW4At) rCOI-D o a Boys & Girls Clubs of Southwest County Balance Sheet As of August 31, 2011 ASSETS Current Assets CheckinglSavings Bank of America 2123 (LE) First Citizens 4221 (MURR) Merrill Lynch 4105 (Stock) Pac Western OCTL 3894 Pac Western Operation Acct 3878 Pac Western Payroll Acct 3449 Pac Western Visa/MC 3886 Petty Cash Total Checking/Savings Accounts Receivable Due From Capital Campaign Grants Receivable Aug 31, 11 1,382.94 1,113.61 0.83 1,519.61 17,720.16 56,005.48 3,358.03 256.16 81,356.82 3,934.57 10,319.50 Total Accounts Receivable 14,254.07 Other Current Assets Prepaid Expense 22,255.70 Stock - donated 1,595.81 Total Other Current Assets 23,851.51 Total Current Assets 119,462.40 Fixed Assets Buildings 2,826,047.94 French Valley Land 1,230,000.00 Furniture, Fixtures, Equipment 175,200.88 Improvements 77,366.78 Office Equipment 142,410.89 Pujol Land 235,000.00 Vehicles 323,056.35 zAccumulated Depreciation -1,090,226.00 Total Fixed Assets 3,918,856.84 TOTAL ASSETS 4,038,319.24 LIABILITIES & EQUITY Liabilities Current Liabilities Accounts Payable Accounts Payable 271,518.78 Total Accounts Payable 271,518.78 Credit Cards Credit Cards 14,009.96 Total Credit Cards 14,009.96 Other Current Liabilities Pacific Western LOC 7019 422,116.92 Payroll Liabilities 57,636.53 Total Other Current Liabilities 479,753.45 Total Current Liabilities 765,282.19 Long Term Liabilities Key Equipment Finance 23,356.68 Mission Oaks Bank 1500 - Murr 16,117.86 Mission Oaks Bank 8300 - Pujol 12,304.19 Total Long Term Liabilities 51,778.73 Total Liabilities 817,060.92 Equity Capital Campaign Transfer Acct Retained Earnings Net Income Total Equity 87,781.82 3,369,594.23 -238,117.73 3,221,258.32 TOTAL LIABILITIES & EQUITY 4,038,319.24 12:43 PM 09/14/11 Accrual Basis Boys & Girls Clubs of Southwest County Profit & Loss January through August 2011 Jan - Aug 11 Ordinary Income/Expense Income Contributions Income 77,091.14 Fundraising 124,166.68 Grants 285,815.26 Membership Dues 45,202.25 Miscellaneous Income 13,081.47 Program Fees 650,155.32 Rental Income 26,250.00 Vending 78.18 Total Income 1,221,840.30 Gross Profit 1,221,840.30 Expense 401 K Administration 923.36 401K Employee Match 3,658.63 Automobile Expense 86,012.13 Awards & Recognition 5,549.91 Background Check 1,348.56 Bank Service Charges 209.45 Community Contributions 1,547.74 Credit Card Fees 7,271.88 Depreciation Expense 88,000.00 Drug Testing 2,192.00 Dues and Subscriptions 15,881.92 Equipment Rental 18,152.23 Fund Raising Expenses 46,268.32 Insurance 106,522.17 Interest Expense 13,013.95 Internet Service 2,398.10 Licenses and Permits 545.18 Marketing 186.48 Office Supplies 22,663.20 Payroll Expenses 725,574.00 Payroll Taxes 55,062.09 Postage and Delivery 1,805.52 Printing and Reproduction 14,575.75 Professional Fees 13,678.09 Program Supply Expenses 84,916.97 Rent 6,596.78 Repairs and Maintenance 38,193.98 Security 1,567.27 Snack Program Expense 755.29 Staff Training 6,482.51 Staff Uniforms 324.87 Taxes 1,428.94 Telephone 30,436.80 Utilities 40,575.85 Work Travel 13,660.13 Total Expense 1,457,980.05 Net Ordinary Income -236,139.75 Depreciation Expense 88,000.00 NET INCOME -148,139.75 Page 1 of 1 BOYS AND GIRLS CUM OP SOUTHWEST Cin (A California Public mit; Corporation) AUDIT REPORT For the Year Ended December 31, 2010 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY (A CALIFORNIA PUBLIC BENEFIT CORPORATION) AUDIT REPORT For the Year Ended December 31, 2010 Table of Contents FINANCIAL SECTION Page Independent Auditors' Report 1 BASIC FINANCIAL STATEMENTS Statement of Financial Position 2 Statement of Activities 3 Statement of Cash Flows 4 Statement of Functional Expenses 5 Notes to Financial Statements 6 INDEPENDENT AUDITORS' REPORT Board of Directors Boys and Girls Clubs of Southwest County Temecula, California We have audited the accompanying statement of financial position of Boys and Girls Clubs of Southwest County (A California Public Benefit Corporation) as of December 31, 2010, and the related statements of activities, cash flows, and functional expenses for the year then ended. These financial statements are the responsibility of Boys and Girls Clubs of Southwest County's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Organization's internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Boys and Girls Clubs of Southwest County as of December 31, 2010, and the change in its net assets and its cash flows for the year then ended in conformity with accounting principles generally accepted in the United States of America. August 19, 2011 1 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Financial Position December 31, 2010 ASSETS Current Assets: Cash Investments Pledges receivable (Net of uncollectible amounts) Grants receivable Prepaid expenses Total Current Assets 1,944,200 5,806 1,232,287 58,575 23,270 3,264,138 Fixed Assets (Net of accumulated depreciation): 4,916,876 TOTAL ASSETS LIABILITIES AND NET ASSETS Liabilities Current Liabilities: Accounts payable Accrued expenses Line of credit Capital lease - current portion Vehicle loans - current portion Notes payable - current portion Total Current Liabilities Long Term Liabilities: Capital leases Notes payable Total Long Term Liabilities Total liabilities $ 8,181,014 158,515 63,632 422,117 17,671 2,774 26,854 691,563 76,537 20,397 96,934 788,497 Net assets Unrestricted 3,455,173 Temporarily restricted 3,937,344 Total net assets 7,392,517 TOTAL LIABILITIES AND NET ASSETS See accompanying notes to financial statements. 2 $ 8,181,014 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Activities For the Year Ended December 31, 2010 Unrestricted REVENUES, GAINS, AND OTHER SUPPORT Temporarily Restricted Total Membership income $ 59,827 $ - $ 59,827 Pledge income 15,922 15,922 Donations 112,031 5,856 117,887 In-kind donations 42,000 42,000 Indirect contributions (United Way) 3,456 - 3,456 Grant income 722,906 5,000 727,906 Fundraiser income 349,180 11,085 360,265 Program service fees 921,593 - 921,593 Interest income 39 13,772 13,811 Realized gain on sale of stock 264 - 264 Miscellaneous income 67,120 67,120 Net assets released from restrictions: Pledge income 129,000 (129,000) TOTAL REVENUES, GAINS, AND OTHER SUPPORT 2,407,416 (77,365) 2,330,051 EXPENSES Program services 1,646,654 1,646,654 Supporting services Management and general 685,038 685,038 Fundraising 241,618 241,618 TOTAL EXPENSES 2,573,310 2,573,310 CHANGE IN NET ASSETS (165,894) (77,365) (243,259) NET ASSETS AT BEGINNING OF YEAR 3,621,067 4,014,709 7,635,776 NET ASSETS AT END OF YEAR $ 3,455,173 $ 3,937,344 $ 7,392,517 See accompanying notes to financial statements. 3 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Cash Flows For the Year Ended December 31, 2010 CASII FLOWS FROM OPERATING ACTIVITIES Change in Net Assets $ (243,259) Adjustments to reconcile increase (decrease) in net assets to net cash provided (used) by operating activities Depreciation expense 147,635 Net unrealized (gain)/loss on investments 4,683 (Increase) decrease in: Pledges receivable 351,590 Grants receivable (12,471) Prepaid expenses (8,934) Increase (decrease) in: Accounts payable 53,979 Accrued expenses (6,689) NET CASH PROVIDED BY OPERATING ACTIVITIES 286,534 CASH FLOWS FROM INVESTING ACTIVITIES Proceeds on sale of investments 9,740 Purchase of fixed assets (392,862) NET CASH USED BY INVESTING ACTIVITIES (383,122) CASH FLOWS FROM FINANCING ACTIVITIES Net proceeds from credit line 14,858 Payments on notes payable (24,927) Net proceeds from capital leases 94,208 Payments on vehicle loans (13,074) NET CASH PROVIDED BY FINANCING ACTWITIES 71,065 NET INCREASE (DECREASE) IN CASH (25,523) Cash balances, January 1, 2010 1,969,723 Cash balances, December 31, 2010 $ 1,944,200 OTHER REQUIRED INFORMATION: See accompanying notes to financial statements. Interest Paid 4 $ 26,479 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Functional Expenses For the Year Ended December 31, 2010 EXPENSES Advertising Awards and recognition Bank charges Credit card fees Community contribution Depreciation Dues and subscriptions Fundraising events Insurance Interest expense Internet services Licenses and fees Miscellaneous Office supplies Payroll taxes Postage and delivery Printing Professional fees Program events Rent Repair and maintenance Retirement plan Salaries Security Staff recruitment Staff uniforms Taxes Telephone Transportation Utilities Unrealized (gains)/losses Totals Program Services Supporting Services Management Youth and Total Services General Fundraising Expenditures $ 21,967 $ $ 21,967 15,343 15,343 739 - 739 11,872 3,287 15,159 155 - - 155 101,617 46,018 147,635 6,085 18,726 24,811 - 149,237 149,237 212,736 37,542 250,278 5,162 21,317 26,479 9,116 9,116 1,732 - 1,732 4,075 18,049 22,124 17,475 12,976 30,451 51,334 31,358 4,796 87,488 620 1,732 2,066 4,418 13,780 1,024 4,002 18,806 13,505 10,797 24,302 122,619 122,619 48,773 13,377 62,150 48,494 1,937 50,431 13,736 13,736 738,230 334,432 78,230 1,150,892 4,737 4,737 17,732 17,732 1,251 1,251 33,354 33,354 20,437 27,169 47,606 138,687 16,373 155,060 58,819 58,819 - 4,683 4,683 $ 1,646,654 $ 685,038 $ 241,618 $ 2,573,310 See accompanying notes to financial statements. 5 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 1 —NATURE OF ACTIVTTIES AND SIGNIFICANT ACCOUNTING POLICIES A. Nature of Activities The Boys and Girls Clubs of Southwest County (the "Organization") was established in August 1990. The Organization is a member of the Boys and Girls Clubs of America chartering organization and provides services to youth, the objectives of which are to foster and to promote the physical, social, and educational, vocational, and character development of boys and girls in or near Southwest Riverside County, California. Major classes of programs include after school care, day camp and youth sports programs. The Organization operates facilities in Temecula, Murrieta and Lake Elsinore. The Organization is funded through membership dues, performance of services for the City of Temecula (the "City") and sponsorships from businesses and the general public in conjunction with its fundraising efforts. B. Basis of Presentation The Organization's policy is to prepare its financial statements on the accrual basis of accounting. This means that revenues are recorded when earned, rather than when received, and expenses are recorded when incurred, not when they are paid. C. Recognition of Revenue Revenues are received primarily from pledge income, fundraising, before direct expenses, and program service fees. Membership dues are recorded as revenue in the year received. Management believes that recognizing membership dues pro -rata on a monthly basis would have an immaterial effect on the Organization's financial statements. Program fees represent fees related to member participation in specific day camp, youth sports, before and after school and transportation programs are recorded as revenue in the year received. Fund raising revenues, which consist of the "Our Kids Rock" dinner, golf tournament and annual giving campaign are recorded when the event occurs. Contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted support depending on the existence and/or nature of any donor restrictions. The Organization has not received any contributions with donor -imposed restrictions that would result in permanently restricted net assets. 6 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 1— NATURE OF ACTIVITIES AND SIGNIFICANT ACCOUNTING POLICIES (continued) C. Recognition of Revenue (continued) Unrestricted: These generally result from revenues generated by receiving unrestricted contributions, providing services, and receiving interest from investments less expenses incurred in providing program related services, raising contributions and performing administrative functions. Temporarily Restricted: The Organization reports gifts of cash and other assets as temporarily restricted support when they are received with donor stipulations that limit the use of the donated assets. When the donor restriction expires, i.e. the stipulated time restriction ends or the purpose of the restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the Statement of Activities as net assets released from restrictions. D. Donated Services The Organization's accounting policy for donated materials and equipment is to record these items as contributions at the estimated fair market value as stated by the donor at the date they are received. Contributions of donated services that create or enhance non financial assets or that require specialized skills, are provided by individuals possessing those skills, and would typically need to be purchased if not provided by donation, are recorded at the fair values in the period received. Numerous hours of volunteer services were performed on behalf of the Organization during the year ended December 31, 2010 in support of its programs. Since these services do not meet the criteria specified in Statement of Financial Accounting Standards No. 116, Accounting for Contributions Received and Contributions Made, for recognizing a monetary value of these services, no such value has been assigned to these services in the Organization's financial statements. E. Property and Equipment Property with a cost of $1,000 or greater is capitalized and recorded as additions to property and equipment. Donated property is recorded at the estimated fair value at the date of the gift. Buildings and equipment are depreciated using the straight-line method over and estimated useful life of forty years and ten years, respectively. Maintenance and repair costs are charged to expense as incurred. F. Cash and Cash Equivalents The Organization considers cash on hand and certificates of deposit with maturity dates of three months or less at the date of investment to be cash and cash equivalents. 7 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 1— NATURE OF ACTIVITIES AND SIGNIFICANT ACCOUNTING POLICIES (continued) G. Investments Investments are recorded at fair value. Unrealized gains and losses are recorded as increases or decreases on the statement of activities. H. Concentration of Risk The Organization maintains its cash in various accounts at several financial institutions. At various times during the year, the amount on deposit with a single financial institution may exceed federal depository insurance limits. At December 31, 2010, the Organization had balances on deposit approximating $1,264,000 in excess of such limits. Management does not believe that this represents a significant risk to the Organization. I. Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. J. Income Taxes The Organization is a non-profit public benefit corporation organized under the laws of California and, as such, is exempt from federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and corresponding state statutes. The Organization is classified as other than a "private foundation" by the IRS. Accordingly, no provision for income taxes has been provided for in the financial statements. K. Fair Value of Financial Instruments The following methods and assumptions were used by the Organization in estimating its fair value disclosures for financial instruments: Cash and accounts payable as reported in the balance sheet approximate fair value because of the short maturities of those instruments. L. Functional Expenses The costs of providing the various programs and other activities have been summarized on a functional basis in the combining statement of activities. Accordingly, certain costs have been allocated among the programs and supporting services based on the benefits derived. 8 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 2 — INVESTMENTS Investments consist of stock donated to the Organization. The following discloses the aggregate carrying amount of investments by major types at December 31, 2010. Stock - Auriga Laboratories, Inc. Stock - Biogold Fuels Corporation Total investments at fair value Shares Estimated Fair Value Market Price December 31, 2010 1,450,756 0.0011 $ 1,596 1,052,632 0.0040 4,210 Investment Return: Net realized gain $ 264 Net unrealized loss (4,683) $ (4,419) NOTE 3 — CAPITAL ASSETS Land, building and equipment as of December 31, 2010 consisted of the following: $ 5,806 Balance, Balance, January 1, 2010 Additions Decreases December 31, 2010 Capital assets not being depreciated: Land $ 1,465,000 $ - $ $ 1,465,000 Construction in progress 554,920 291,287 846,207 Total capital assets not being depreciated 2,019,920 291,287 2,311,207 Capital assets being depreciated: Buildings 2,826,048 - 2,826,048 Furniture, equipment & improvements 364,305 101,575 - 465,880 Vehicles 323,057 - 323,057 Total capital assets being depreciated 3,513,410 101,575 3,614,985 Total accumulated depreciation (861,681) (147,635) (1,009,316) Total capital assets being depreciated, net 2,651,729 (46,060) 2,605,669 Total capital assets, net $ 4,671,649 $ 245,227 $ $ 4,916,876 9 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 4 —LINE OF CREDIT The Organization has a line of credit from Pacific Western Bank available for its use. The line of credit is as follows: Pacific Western Bank December 31, 2010 Initial rate: 4.20% Credit limit: $ 500,000 Loan date: April 13, 2009 Maturity date: April 17, 2011 Balance at year end $ 422,117 NOTE 5 — NOTES PAYABLE Murrieta Building During 2002 the Organization borrowed $127,780 to purchase a building. Monthly payments are $1,381, with a variable interest rate through September 2012. The note is secured by the purchased building. December 31, 2010 Total loan balance $ 26,680 Less current portion (15,834) Long-term portion $ 10,846 Future maturities of loan: Year ending December 31, Payment 2011 $ 15,834 2012 10,846 Total $ 26,680 10 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 5 — NOTES PAYABLE (continued) Pujol Land During 2007 the Organization borrowed $50,258 to purchase land. Monthly payments are $1,016, including interest at a rate of 7.75 percent through September 2012. December 31, 2010 Total loan balance $ 20,571 Less current portion (11,020) Long-term portion $ 9,551 Future maturities of loan: Year ending December 31, Payment 2011 11,020 2012 9,551 Total $ 20,571 NOTE 6 — VEHICLE LOANS The Organization had one car loan at the end of the year. This loan has an interest rate of 8.5% with a principal balance of $2,774 due in 2011. NOTE 7 — LEASES The Organization began leasing the land for its Great Oak Facility under a 40 -year lease from the City of Temecula. The term of this lease agreement extends through June 30, 2046 with an annual lease payment of $1. 11 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 7 - LEASES (continued) Statement of Financial Accounting Standards No. 116 Accounting for Contributions Received and Contributions Made, requires recognition at fair value of such discounted lease costs. Management estimated that the fair value of such discounted lease costs is approximately $42,000 per year. This amount is included in both revenues and expenses on the statement of activities. The Organization leases certain equipment under agreements that provide for title to pass upon expiration of the lease period. Future minimum lease payments are as follows: Year ending December 31, Payment 2011 2012 2013 2014 2015 Total Less Amount Representing Interest 27,456 26,136 26,136 26,136 13,926 119,790 (25,582) Present Value of Net Minimum Lease Payments $ NOTE 8 — EMPLOYEE RETIREMENT PLAN 94,208 The Organization maintains a defined contribution retirement plan conforming to the provisions of Section 401(k) of the Internal Revenue Code for its salaried employees. Such employees become eligible to participate in the Plan after reaching age 21 and accumulating 1,000 hours of service during the year with the Organization. The Organization matches employee contributions to a maximum of five percent of each employee's eligible compensation, as defined in the Plan, and may also make discretionary contributions. Employee contributions are fully vested at all times. Employer matching and discretionary contributions vest ratably over a five-year period. If an employee terminates employment prior to age 65, the distribution from employer matching and discretionary accounts is limited to the vested portion based upon years of eligible service. The Organization's matching contributions were approximately $13,700 for the year ended December 31, 2010. 12 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 9 — PLEDGE INCOME Contributions are recognized when the donor makes a promise to give to the Organization that is, in substance, unconditional. In 2005, the Organization established a "Capital Campaign" which was created to fund a new facility in the City of Temecula. The pledges amounted to $100 for the year ended December 31, 2010. In 2009, the Organization established a "Sustainability Campaign" which was created to fund another new facility in the City of Temecula. The pledges amounted to $15,922 for the year ended December 31, 2010. NOTE 10 — PLEDGES RECEIVABLE Pledges receivable are recorded when the donor makes a promise to give to the organization. The amount of the pledges receivable at December 31, 2010 amounted to $1,282,287. The Organization estimates an allowance for uncollectible pledges based on management's consideration of donors, historical activity and economic conditions. The allowance for uncollectible pledges amounted to $50,000 at December 31, 2010. NOTE 11— CONTINGENCIES Grant activities are subject to monitoring and review by the respective grantor. As a result of such review, costs may be questioned and subsequently disallowed. Management has not been notified of any such disallowance. NOTE 12 — TEMPORARILY RESTRICTED Temporarily restricted net assets are comprised of the following: Capital campaign — use restriction December 31, 2010 $ 3,925,629 Sustainability 11,715 $ 3,937,344 13 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2010 NOTE 13 —FUNDRAISING EVENTS The Organization conducted the following fundraising events: December 31, 2010 Revenues Expenses Net Auction $ 239,565 $ 113,498 $ 126,067 Golf Tournament 32,715 5,926 26,789 Field of Dreams 49,582 6,593 42,989 Other 38,403 115,601 (77,198) $ 360,265 $ 241,618 $ 118,647 NOTE 14 —SUBSEQUENT EVENTS Events subsequent to December 31, 2010 have been evaluated through August 19, 2011, the date at which the Organization's audited financial statements were available to be issued. No events requiring disclosures have occurred through this date. If events requiring disclosures have occurred between the balance sheet date and the date of the financial statements were available to be issued they would be disclosed here. 1 State orifornia =.- OFFICE OF THE SECRETARY OF STATE 1671809 1, MARCH State of CORPORATION DIVISION FONG EU, Secretary of State of the California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this SEP - 4 1990 Secretary of State SEC/STATE FORM CE -107 86 40888 September 15, 2011 Ms. Judy McNabb City of Temecula Community Service Funding P.O. Box 9033 Temecula, California 92589-9033 Dear Ms. McNabb, City of Temecula SEP 1 5 2011 Finance Department ty of Tem: ula S 42011 Fin-. ce Dep:. ment The Boys and Girls Clubs of Southwest County submits with this letter an application for Community Service Funding for 2011-12. We appreciate the association we have had with the city for many, many years and hope to continue that relationship by providing a save and enriching environment for Temecula's children. Please contact me if you require additional information of have questions. Sincerely, John Whann Director of Operations enclosure The Positive Place For Kids The Boys & Girls Clubs of Southwest County is a non-profit organization qualifying for tax-exempt status under Section 501(c) (3) of the internal Revenue Code. Tax ID # 33-0475756 United Way United Weeper theki..dv.nrr. BOYS & GIRLS CLUBS OF SOUTHWEST COUNTY P.O. Box 892349 Temecula, CA 92589 www.becswc.org Old Town Temecula Clubhouse 28790 Puiol Street Temecula, CA 92590 Tel 951-699-1526 Pechanga Great Oak Clubhouse 31465 Via Cordoba Temecula, CA 92592 Tel 951-695-0181 Murrieta Clubhouse 40550 California Oaks Road Murrieta, CA 92562 Tel 951-698-3838 Alberhill Ranch Clubhouse 3711 Nichols Road Lake Elsinore, CA 92530 Tel 951-245-4499 Officers Ted Knstensen Board Chair Mke Shirley First Vice -Chair GREG PRUDHOMME Treasurer BRENT LOWE Secretary MARYANN EDWARDS Chief Executive Officer Board of Directors WALT ALLEN STEVE AMANTE VICKIE ASHMORE TONY BERARDINO ROB CRISELL NATHAN GARN LEIF JACOBSEN BRUCE KESSMAN JEFF KURTZ JAMI MCNEES JOHN PANIQUE WIM SELDERS VIET TRAN TIM URE ALAN WINKELSTEIN' 'Past Chair GREAT FUTURES START AT CL City of Temecula 2011-12 CS Funding Program APPLICATION NO. 5 CITY OF TEMECULI City of Temecula 5 AUG 0 4 2011 FISCAL YEAR 201 1-12 Finance Deoartment COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please PtTnt oar Type) — 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000 Project Name: Camp del Corazon (Maximum allowable $5,000) Project Start Date:June 2012 Project End Date: September 2012 ORGANIZATION INFORMATION Name of Organization: Camp del Corazon Contact Name: Janene Hogan Title/Position: Board Member Mailing Address: 41833 Carleton Way - Temecula, CA 92591-2800 Telephone: 951-265-9718 E -Mail Address:janene(a�rancon.com Year Organization Founded:1995 Geographic Area(s) Served:Temecula, Murrieta, Riverside County Number of Paid Staff: 5 prof -1- Number of Volunteers: 300+ Annually Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 1995 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit:1995 Federal identification number: 95-4599670 If "no": State identification number: 2192099 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Application — Page 1 Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH. COPIES OF THE-CURRENT-BUD6E-T-OFTME-ORGANIZA IOWA►NIXFINANCIAL —=--= STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Pl(Pace (ree aPetrl en -f Application — Page 2 City of Temecula - Camp del Corazon Community Service Funding Program Request MISSION STATEMENT and DESCRIPTION Camp del Corazon is a non-profit organization that provides a free -of -charge, medically supervised, residential summer camp for children ages 7-17 who are living with heart disease. The children who qualify for our camp have had heart transplants, surgeries to repair defects in their hearts, or have otherwise been diagnosecluit11-4,hearLcondition=—Out-main-c-arap=is loFated ori=Ge lira=I$ n ; es off_ the=ealifesliva coastline, and each year serves approximately 300-450 children. In 2011, we will be holding three camp sessions at Catalina with a target of 150 campers per session, allowing as many as 450 children to experience camp, most for the first time in their lives. "My hope for the coming year is that the camp will be able to offer all they can dream. What has been done for the kids in growth I can't even begin to say. They come home changed each year. We cannot thank you enough."- Teany, Camper Mom (three campers) Need According to the American Heart Association, at least nine of every 1,000 infants born a year have a heart defect — that's approximately one to two percent of live-born infants. Every year in the United States alone about 40,000 babies are born with a heart defect. Sometimes the defect is so mild that there are no outward symptoms. In other cases, it's so severe that the newborn becomes ill soon after birth. Still, in other cases, signs and symptoms occur only in later childhood. Many of these children can be helped by surgery even if the defect is severe. Most people are unaware that up to 1.3 million Americans alive today have some form of congenital heart defect and about one-half of these individuals are less than 25 years of age. Yet funding for pediatric cancer research is five times higher than for children with congenital heart disease. Resources for these children are very scarce. The overwhelming amount of funds raised by prominent charities goes toward adults with coronary artery disease, heart attack and stroke, and of late, obesity and diabetes. In spite of the amount of attention paid to adults with heart disease, there is virtually nothing for children born with damaged hearts. There is no charge for those who attend our camp. The American Heart Association estimates that over $2.2 billion are spent on medical care for heart disease each year in the United States alone. The families that are affected by this disease already incur incredible financial burdens from medical bills and often have to seek private or home schooling due to numerous doctors' appointments and extended hospital stays. Oftentimes, these children need to see specialists far from home, so their parents also incur travel expenses in addition to overwhelming medical expenses. Aside from the inability to afford the sometimes exorbitant cost of summer camp, the children served by Camp del Corazon are typically not even eligible for the typical summer camping experience due to the fact that they require round-the-clock medical supervision and care. Outsiders often worry "What if something happens while he/she is in my care?" Many of these children have had several open heart surgeries, pacemakers and/or heart transplants, and many face several more surgeries in their futures. These children and their families live every day knowing that they are at a high risk for mortality. We offer these children opportunities to be `normal', to forget their ailments and to connect with others who share similar experiences and scars. For most of these children, this is the only experience they have away from home, as they are often too sick to go on vacations or stay overnight at a friend's house, away from their parents, who have to monitor their health on a 24 hour basis. Parents of children with heart conditions are often fearful that activities enjoyed by `normal' kids could be harmful. There are very few camps with the ability or medically trained staff to provide for these special needs children. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served;-areaserviced, ndnumberofvolunteersinvoived. -Be specific- Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Please P-ee at-H-cChpd( do eu 114,e -6- Application Application — Page 3 City of Temecula - Camp del Corazon Community Service Funding Program Request "Keep camp going. This camp makes Ali feel like she fits in the world." - Megan, Camper Mom A 2008 study published by the American Heart Association states that depression is about three times more c-omaao att-aack—s ��-imQ£s--anc tho 1�nspits' Ze _1 ea.1 1 5 rl�nn tl�� +nnvreL pn 11. Depression has been linked with increased morbidity and mortality, poorer risk factor modification, lower rates of cardiac rehab, and reduced quality of life. Our camp gives these children an outlet to bond with others who understand and know what they are going through, thus helping decrease the onset of depression. The environment we provide establishes and maintains traditions while providing for the child of today — away from television and video games. Camp studies have proven that camp helps to strengthen the confidence and self-esteem of children. Your support will give these very special children life -affirming experiences that cannot be put into words. Most of our campers return year after year to relive the experiences they can't get anywhere else. This is a testimony to the impact our camp has on these young souls. Still, there are hundreds of children we are not yet able to serve. We hope that with increased support we can expand our scope so that we never have to turn a deserving camper away. Camp del Corazon enriches the lives of children living with heart disease. We are more than just a summer camp though. Not only do we provide a summer camp experience for children, but we also provide opportunities for growth, education and support through various programs custom designed for our population. As our camper population has matured, we have found that there are no specific programs designed for the 18-25 year olds who are going through the transition phases into adulthood while living with their medical problems and issues. In response to this, we have created forums and weekend retreats through this program which provide additional self-esteem and personal growth programs, as well as continued support. PROJECT DESCRIPTION With the exception of a part-time office staff, Camp del Corazon is run entirely on a volunteer basis. All monies that may be awarded will go (and have previously gone) to assist in direct camp expenses. All previous grant monies were leveraged with other donors' gifts to purchase and provide items and expenses necessary for campers to attend and to make camp happen, such as: water bottles, name badges, camp t - shirts, boat/transportation expenses (also used unfortunately for any emergency med-evacuation purposes), and medical and safety supplies. We are extremely modest and strive to be good stewards if our donations. It is an incredible undertaking for 350+ campers, 160+ volunteers and our medical team to attend our camp sessions. Most of our expenses are due in advance (boat fees, camp rental, food, program materials, medical supplies and medications), prior to getting the children and our supplies out to the Catalina Island camp site. Your funding will directly assist in the entire camping program. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 City of Temecula : Camp del Corazon Community Service Funding Program Request PAST PROJECT BENEFITS Every year, we have several campers and counselors from Temecula who attend our camp. The cost to send one camper is approximately $1,200, and we provide this experience free of charge to all campers. We - It sea c n gla duet ast, gfaill&-Lllerdic l expenses. This camp is oftentimes their only opportunity to ever go to camp, or be away from their parents at all. Their medical needs are so great and so cumbersome, that staying away from their parents even for one night was an unattainable dream for many of these kids before Camp del Corazon. We provide a place for our kids to feel "normal," where they don't stand out or feel different, where they feel comfortable baring their scars when they go swimming, and talking about their surgeries or challenges. 2011 Temecula Area Campers: Mary Sutherland Caleb Bennett Elsa Burnside Rebecca Klein Madison Wright Evan McDuffie MacKenzie Dawes Allison Von Zup Rene Baca Janae Wright Mark Tellez Amanda Pinal Isabella Portlock SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. - PREPARED BY: !2 thh-a- wdictee.O'r.Efi t2 NAME and TITLE (Please Pr'nt r Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: ORGANIZATION NAME: MAILING ADDRESS: a-prvcewi" LISA )0I6)}IT1 (Z .ti -E+6CvJ'' j -ecto2 NAME and TITLE (Please Print or Type) !/ l p Otd ae_a 2601 L {/ 733 C R-Je-fv i (Nay (e41 ee4a I C61 QN 1 TELEPHONE: qs i 2 Ces-- X1718 E -Mail Address: k2is`hhn . kA(t e2 ev14pdt Celut� • viaj DATED THIS c I of (Date) jjonth) , 2011. Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judv.mcnabbAcitvoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 Camp del Corazon 2011 Proposed Budget m 0 0 o a) 0 0 o O ao o N O V (0 0 o (n N (0 0 0 V r) 0 0 0 ri0 a) O) 0 0 h M D 0 0) f, o 0 M O c C a (C $ 8;1837.00 $ 341855.00 S 131!R4'1 nn 0 0 of V s9 o 69 0 0 a) (0 r) (R 0 0 0) V 00 rn 0) CO __ 0 0 (ri V __L0. m CO a' V) -_ 0 0 cO co _0)] r CO V) 0 0 m 0) CO at r V) 0 0 ri n _A._CO_ (0 CO (A 0(7 0 o (O v N- (A 0 o _LO. CO (0 0 0 0 a) (A __ m N 0)) 0 0 a: 0) .4'!. 0) o 0 o0 t0 N 03 a 7 o U p Q N 0) O O N S 10g S 14 ' -- v) 4 o N V 0 — (f) — t7 U) — 0 0) n 0) co r) U) (c C n (A a) N fA Income Contribution Income Honors & Memorials N 03 C7 Program Revenue (Incl. Restricted Grants) Special Events Other Income (Refunds, Interest, etc.) C) E 0 U C 2 01- G & A Expense Salaries & Related Expenses Program Expense (office only) [Program Fundraising Expense Insurance Contract Labor and Professional Fees Telephone & Fax Postage, shipping, delivery Dues, Subscriptions (ACA, WAIC), etc. Other G&A Total Program Expenses Catalina Camp Expense Carnp Director Salary and Related Expenses Program Expense Facility Rental and Food Medical Expenses & Emergency Prep. Transportation Trainings and Conferences Other G&A Total Catalina Camp Program Expenses PROPOSED 2010-2011 Budget $ 125,000.00 S 18,000.00 O 0 0 0 0 (ri V) O o 0 0 o 0 03 0 O 0 0 O 0 0) ) 0 1$ 5,000.00 O O O 0 0 a) N CO V) 0 O O 0 0 o V EA $ 40,000.00 0 0 O 0 0 o N N V) $ 11,000.00 $ 20,000.00 0 0 O 0 0 1.6ri 0) $ 5,000.00 0 0 0 0 (n (A $ 30.000.00 0 0 O (o 'o N O O O 0 0 r) 0- O 0 0 0 o 00 (R 00000'06 0 0 0 0 co- V) 0 O 0 o (0 (A 0 0 0 0 0 LO 0 $ 5,000.00 0 0 0 00 vi CO N W Income Contribution Income Honors & Memorials w 7 1Program Revenue (Incl. Restricted Grants) Special Events Other Income (Refunds, Interest, etc.) F- y E U G & A Expense Salanes & Related Expenses Program Expense (office only) Program Fundraising Expense Insurance Contract Labor and Professional Fees Telephone & F1ax 0 U) 3 va >Q ,y v N - O a .Q a V 01 03 i o O C7 al i ITotal Program Expenses Catalina Camp Expense Camp Director Salary and Related Expenses 'Program Expense Facility Rental and Food Medical Expenses & Emergency Prep. Transportation Trainings and Conferences Other G&A (Total Catalina Program Expenses 0 0 tri ri w 769,500.00 Notal Expenses N Total Expenses 5:09 PM 06/16/11 Accrual Basis Camp Del Corazon Inc Profit & Loss November 1, 2010 through June 16, 2011 Ordinary Income/Expense Income 4000 • Contributions Income 4010 • Individuals 4015 • Matching Gifts 4020 • Foundations & Trusts 4030 • Corporations 4040 • United Way/Payroll Donations 4050 • Special Campaigns 4054 • Newsletter 4064 • Scrip Rebate 4073 • UCLA Gyms 2011 4074 • Friends of Davi 4050 • Special Campaigns - Other Total 4050 • Special Campaigns 4099 • General Donation Total 4000 • Contributions Income 4100 • Honor Donations 4104 • Dr. Kevin Shannon 4199 • Other Honor Donations Nev 47- t0.- un46 k - 13,953.60 72.00 61,972.88 2,564.92 3,696.38 4,836.00 3.36 5,060.95 375.00 0.95 10,276.26 2,236.58 94,772.62 100.00 4,098.00 Total 4100 • Honor Donations 4,198.00 4200 • Memorial Donations 4201 • Scott Antolick 3,540.00 4299 • Other Memorial Donations 3,172.00 Total 4200 • Memorial Donations 6,712.00 4300 • Grants 4310 • Foundation Grants 72,500.00 4320 • Government Grants 6,000.00 4330 • Corporations 10,000.00 Total 4300 • Grants 88,500.00 4400 • Program Service Revenue 4410 • Program Fees 4,110.15 Total 4400 • Program Service Revenue 4,110.15 4500 • Special events 4510 • Admissions/Ticket Sales 71,500.00 4515 • Dinner Tickets Sale 4517 • Reimburse - Food / Bev Charges 444.00 4515 • Dinner Tickets Sale - Other 3,120.00 Total 4515 • Dinner Tickets Sale 4520 • Auction Revenue 4530 • Event Contributions 4540 • Sponsorship 4502 • Tee Sign only 4540 • Sponsorship - Other 3,564.00 87,106.32 200,464.96 800.00 38,000.00 Total 4540 • Sponsorship 38,800.00 Total 4500 • Special events Total Income Gross Profit Expense 6000 • Salaries & related expenses 6010 • Officers & directors salaries 6011 • Other Comp 6010. Officers & directors salaries - Other 401,435.28 599,728.05 5,314.58 47,135.42 599,728.05 Total 6010 • Officers & directors salaries 52,450.00 6015 • Salaries - Fundraising 22,104.48 Page 1 5:09 PM Camp Del Corazon Inc 06/16/11 Profit & Loss Accrual Basis November 1, 2010 through June 16, 2011 6020 • Salaries Office 6050 • Payroll Fees Wells Fargo 6060 • Payroll Taxes Employee Tax Employee Taxes Witholding Employer Taxes _t4o.v1,._10 tun_15,11 — 16,506.00 1,007.95 20,254.34 -20,254.34 7,697.02 Total 6060 • Payroll Taxes 7,697.02 Total 6000 • Salaries & related expenses 99,765.45 6200 • Contract Labor 6210 • Professional Fees 6222 • Legal Fees Total 6210 • Professional Fees 6240 • Independent Contractors 6250 • Office Cleaning 410.00 410.00 3,600.00 4,139.00 Total 6200 • Contract Labor 8,149.00 7000 • Program & Event Expenses 7010 • Advertising 1,312.50 7015 • Arts & Crafts Supplies 1,562.51 7020 • Auction Expenses 17,212.41 7024 • Athletic Programs & Equipment 625.44 7030 • Auto & Truck Maintenance 3,856.41 7040 • Awards & Prizes 153.27 7061 • Boat storage rentsl 2,420.00 7065 • Boat Maintenance 3,958.14 7100 • Camp Supplies 950.54 7150 • Conferences 6,367.11 7190 • Event Shirts & Goody Bag Items 4,005.40 7210 • Facilities Rental 48,620.75 7215 • Flowers and Decorations 4,000.00 7220 • Food & Catering 68,894.63 7240 • Fuel 2,969.90 7250 • Insurance -Automobile, Boat 2,053.38 7270 • Gifts 120.72 7300 • Licenses, Taxes & Permits 746.56 7400 • Medical Supplies 1,867.50 7440 • Music Equipment 453.82 7500 • Parking 92.40 7520 • Photography 697.36 7530 • Printing and Reproduction 11,530.47 7610 • Staff Training & Education 105.00 7620 • Storage 18,584.00 7700 • Transportation 799.58 7800 • Video Production 10,792.48 7902 • Fundraising Expenses 119.90 7903 • Gala Fundraising Expenses 3,185.10 7904 • Davi Goff Tourn Expenses 1,976.86 7909 • Fam Fest Expenses 597.70 Total 7000 • Program & Event Expenses 220,631.84 8000 • General & Administrative Exp 8010 • Accounting & Tax Preparation 6,580.00 8030 • Alarm & Security 343.35 8050 • Bank Charges 1,162.53 8070 • Bookkeeping 8,700.00 8150 • Contributions 150.00 8200 • Dues, Subscription, Publication 1,825.81 8300 • Equipment Rental 436.73 8301 • Food/Catering -GA 251.29 8304 • Fuel -GA 1,069.82 8351 • Insurance - Liability 6,329.33 8501 • Maintenance - office 223.69 8525 • Meals & Entertainment 733.18 8530 • Merchant Fee 4,042.20 Page 2 5:09 PM 06116/11 Accrual Basis Camp Del Corazon Inc Profit & Loss November 1, 2010 through June 16, 2011 8550 • Miscellaneous 8606 • Repair- Equipment 8620 • Office Supplies 8680 • Postage, shipping, delivery 8800 • Software 8820 • Telephone & telecommunications 8850 • Travel 8900 • Utilities 8920 • Waste 8930 • Water Office Supplies 8950 • Website 8000 • General & Administrative Exp - Other e.0—_.lun�4611 452.64 95.00 10,170.23 3,721.35 1,499.88 12,462.17 4,919.60 6,555.98 100.00 199.96 16,460.75 -380.38 Total 8000 • General & Administrative Exp 88,105.11 Total Expense 416,651.40 Net Ordinary Income 183,076.65 Other Income/Expense Other Income 9000 • Investment Income 9020 • Interest Income 2.76 9040 • Dividend paid/Reinvested 7.44 Total 9000 • Investment Income 10.20 Total Other Income 10.20 Net Other Income 10.20 Net Income 183,086.85 Page 3 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: FEB 13 2001 CAMP DEL CORAZON 5655 HALBRENT AVE STE 10 LOS ANGELES, CA 91411 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification N L bei : 95-4599670 DLN: 17053027718031 Contact Person: -ERIK FILIAULT ID# 31303 Contact Telephone Number: (877) 829-5500 Our Letter Dated: •March 1997 Addenduni'Applies: .No • Thid modifies our letter of the above date in-which'we stated that you would be treated as an organization that is not a private' foundation until the expiration of your advance ruling period. : Your exempt status under• section 501(a) of the Internal Revenue Code as an organization described in section '501(c)(3).is.still in:effect: .Biased on the information you submitted, we have determined that you ar'e•not.a.private foundation within the meaning..• of. section 509(a) of the Code. because:. you. are an organization of .the type described in section 509'(a) (1) .and 170(b)(1) (AY (vi) . . ' Grantors. and contributors flay rely on ,this determination unless the InternalRevenue Service publishes notice to the' contrary. However, if you lose your section .509(a)00 status, a grantor or contributor may not rely on this determination if .he. or she was `.n..part responsible -for,' -or was= aware of, the act or failure to act,.or the substantial_or material change on the:.part of the organization that resulted in your loss of.such status,. -or if he or she acquired knowledge that. the Internal Revenue.Service had givennotice that you would no longer be classified as a section 5.09(a)(1) organization. You are required to make.your annual information return, Form 990 or Form.990-EZ, available, for public' inspection for three years after the later of the due date of the return or the da,te the return is.:f:iled. You are also required to--mate-availabi'e• for 'public' napection your-exeth toa..appli;cation, any supporting documents, and your exemption letter. Copies of these. documents are also required to be provided to .any.individual upon written or in person request without charge other than reasonable fees."for copying and postage.' You may fulfill. this requirement •by'placing` these documents .on the Internet.' Penalties may be imposed for failureIto comply with these. requirements. Additional information is available in Publication 557•, Tax -Exempt Status for Your Organization; or you may call our toll free number shown above. If we have indicated in the heading of this letter that an addendum applies, the addendum enclosed is an integral part"of this letter. Letter 1050 (D'0/CG) -2 - CAMP DEL CORAZON 'Because this letter could help resolve any questions about your private foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, Steven T. Miller Birector--Exempt—prganrzations- • Letter 1050 (DO/CG) CaM?dEL' i Co'azoN A nonprofit organization providing year-round opportunities for children with heart disease. July 29, 2011 Camp Office 11615 Fleshy Street N. Hollywood, CA 91601 T (818) 754-0312 F (816) 754-0642 www.campdelcorazon.org City of Temecula Community Service Funding Program ATTN: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Dear Ms. McNabb, ACCREDITED We are so excited to submit this grant proposal for your review, and look forward to a wonderful continued relationship with the City of Temecula. Camp del Corazon was founded 16 years ago with the idea of creating a place for children who are living with heart disease to feel normal, not singled out from their peers, and to be able to participate in activities that they wouldn't otherwise have the opportunity to. We are a non-profit organization that provides a medically supervised, residential summer camp for children ages 7-17 who were born with heart defects. Our camp is located on Catalina Island, 22 miles off the California coastline, and has served approximately between 300 and 450 children per year, with over 150 volunteers. Our camping program is offered free -of -charge, as the families affected by this disease already incur incredible cost§ and financial burdens. It is estimated that nine in 1,000 children are born each year with a heart defect, yet they are among the most underserved pediatric populations in the nation in regard to funding and life-style programs. As the City of Temecula considers its Community Service Funding this year, we invite you to join us once again in making a difference in the lives of these extraordinary children. Enclosed you will find a funding application in the amount of $5,000 to help fund camperships for these deserving children, as well as more information about our organization and the children we serve. We hope that you will consider joining us in continuing to provide a life -changing experience for these very special children. We understand you receive requests for funding from many worthwhile organizations, and we thank you for your consideration once again this year. Should you need any additional information please feel free -to contact me at 818-754-0312 or Kristina.Wallace@campdelcorazon.org. Kristina Wallace, Director of Development Camp del Corazon City of Temecula 2011-12 CS Funding Program APPLICATION NO. 6 City of Temecula 5EN 13 Nil CITY OF TEMECULA. FISCAL YEAR 201 1 � 12 �'ma �� ����rtmPni COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5, 000.00 or any amount Project Name: Chaparral High School Grad. Night Project Start Date: 08/09/2011 (Maximum allowable $5,000) Project End Date: 0608/2012 ORGANIZATION INFORMATION Name of Organization: Chaparral High Fet elati^^ Gr"� gh Contact Name: Lisa Solorzano Title/Position: Pres ident Mailing Address: 39466 Bainbridge Circle Murrieta, Calif 92563 Telephone: 951-695-4200 ex 152 E -Mail Address: lsolorzano@tvusd. k12 . ca. us Year Organization Founded: 1998 GeographicArea(s)Served: Greater Temecula Valley Number of Paid Staff: None Number of Volunteers: 200 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 05/15/1998 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: May 15, 1998 Federal identification number: If "no": 33-0800705 State identification number: 2039208 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors x Members -at -Large Application - Page 1 MISSION STATEMENT Application Page 2 Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2. The Chaparral High School Grad Night Committee operates under the Chaparral High School Education Foundation, a non-profit organization. The committee's goal is to provide a safe, memorable celebration for the Chaparral High School (CHS) graduates after commencement exercises. The Grad Night Celebration begins at 9:00 PM and continues until 5:00 AM. The evening provides a drug and alcohol free environment for the graduates to celebrate this milestone in their lives. The graduates enjoy games, dancing, food, entertainment, and many exciting activities. This night is a much anticipated and climatic event for our seniors to share a fun and memorable evening! We do not discriminate based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. We do not require attendance or participation in any political, religious or social activity. We cater to the needs of our seniors whether it be wheelchair accessibility or allergies to latex. Donations also help us provide free tickets for those students that cannot afford to attend the event. We continue to provide an opportunity for juniors to earn a free Grad Night ticket by helping with the clean up. Over the past nine years Grad Night has received overwhelming positive feedback from both graduates and parents. Many graduates return to help with Grad Night after they leave Chaparral. The planning for the 2011 Grad Night Celebration has already begun. The event requires hundreds of parents, faculty/staff, and community volunteers coming together for one common goal: saving the lives of our teenagers. PROJECT DESCRIPTION Application Page 3 How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and numbered of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information (Please type or print legibly), At this time, the Class of 2012 is approximately 650 students. Of course, the more donations we receive, the more we pass on to the seniors. They may also enter drawings for door prizes such as a computer, free dinners, a compact refrigerator, bicycles and many more items. All of the activities, entertainment, and food are free for the entire evening. The cost of entertainment is the greatest expense we incur. Entertainment varies from year to year but may include a rock climbing wall; carnival games; hypnotist; magician; caricature artist; inflatable laser tag; casino games; and bungee trampoline. We will be holding fund-raisers and soliciting local businesses for donations. In recent years it has become increasingly difficult to obtain donations due to the growth in Temecula and surrounding areas. This year we anticipate that acquiring donations will continue to be difficult due to recent state budget cuts, specifically in education. The event also provides a great sense of pride the volunteers feel for providing such a worthwhile and successful event. We also received help from individuals that responded to the local newspaper articles, which stated our need for volunteers. Our volunteer this year will be hosting the Mystery part at an undisclosed location until the night of the event, where we then let the parent know where we will be busing the kids to. We check all kids to make sure they have their permission slips signed, then off on a bus to the event. The students when they arrive are at awe as they enter a fun decorated venue full of fun, prizes, dancing & food. After the night is over and the kids are getting back on the bus to head back to Temecula their eyes tired from being up all not they turn to us to thank us for a night they will never forget. That's when we know we have provided a safe fun night for our graduation Seniors the class of 2012 PAST PROJECT BENEFITS Application Page 4 If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. CHS students have attended the past ten Grad Night celebrations and experienced a safe & sober evening. They created great memories of the last night of their high school career. Over three hundred graduates attended last years' celebration. Grad Night kept the young adults away from private parties and driving on our streets. Local reports show no accidents or arrests of CHS graduates. We feel this can largely be attributed to the Grad Night celebration. We gave them an exciting alternative that kept them safe, sober, and drug free. Two years ago we used the funds we generously received from the City of Temecula to purchase student gifts and supplies for decorating. Each student was given a duffle bag with CHS luggage tag, and an opportunity to spin the wheel for a prize. We also gave away 15 grand prizes ranging from cameras, to laptops. Thank you for your time and consideration. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Lisa Solorzano SIGNATURE: NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Lisa Solorzano President CHS Grad Night d9\_..../___6_ NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Chaparral High School Foundation Grad Night MAILING ADDRESS: 39466 Bainbridge Circle Murrieta. Calif. 92563 TELEPHONE: 951-695-4200 ex 152 E -Mail Address: lsolorzano@tvusd.k12.ca.us DATED THIS 13th of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judo. mcnabbna.citvoftemecula.orc( Facsimile: 951-694-6479 Application - Page 5 September 1, 2011 Ms. Judy McNabb City of Temecula Community Service Funding P.O. Box 9033 Temecula, CA 92589-9033 Dear Ms. McNabb, Attached you will find the documentation to substantiate the funds Chaparral High School Grad Night received from the City of Temecula. Below is an itemized list of expenditures. Vendor Amount Spent Description of Expenditure WalMart $ 1,512.54 Prizes for Students — laptop, GPS, system, Microwave Office Max $ 76.11 Prize for Students — Digital Camera So Cal Events $10,000.00 Venue, Decorations, Food, Entertainment Oriental Trading $ 85.75 Decorations TOTAL: $ 11,673.82 Once again, thank you for your generous support of the 2012 Chaparral High School Grad Night. The support of the City of Temecula was instrumental to the success of the evening. Please call if you have any questions or require more information. Sin'rely), f V .4 i 6ii ... - _.) isa olorzano 2012 Grad Night ommittee (951) 677-9954 cheerontori@verizon.net or lsolorzanoOtvusd.k 12.ca.us CHAPARRAL HIGH SCHOOL GRAD NIGHT COMMITTEE 2006 40335 Winchester Rd. Ste. PMB233 `Temecula, CA. 92591 rr , CHAYAHHAI HIUH SUHUUI EDUCATION FOUNDATION EA : limns! dote,..rel Grad Night Proposed Budget 2011-2012 Amount to be paid by students if attending Mystery Grad Night Event cost 150.00 per student @ 200 students ASB account $30,000.00 Fundraising: Wine tasting $1,200.00 Bingo nights x 4 $2,000.00 Christmas tree presales $350.00 Pat & Oscar Dinner night $200.00 Inventory sale from props $250.00 Total <$3,750.00> Donations Temecula City Grant $1,000.00 Abbott Labs $1,000.00 Storage Unit to be sold to Dance $500.00 Margret Turner Insurance $200.00 City Grant if approved $1,000.00 Total < $3,700.00> Expense Event venue difference between 150.00 and 160.00 to be raised @ 200 per person $2,000.00 Bus charges to event $25.00@200 Total $5,000.00 Expenses for Wine tasting Total $150.00 End Balance to purchase gift/ prizes for our senior class $1,700.00 SECRETARY OF STATE 1, BILL JONFS, Secretary of State of the State of California, hereby certify. That the attached transcript has been compared with the record on file in this office, of which it purports to be . a copy, and that it is full, true and correct. IN WITNESS WHEREOF, the Great this certificate and F Seal of the State of California this MAY 1 5 199 Secretary of State ARTICLES OF INCORPORATION OF MAY 15 1998 CHAPARRAL HIGH SCHOOL EDUCATION FOUNDATION DLL JONES, Secretary of State The name of this corporation is CHAPARRAL HIGH SCHOOL EDUCATION FOUNDATION. 2039208 ENDORSED • FILED b the office of the Secretary of State et* State of California This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for charitable purposes. - The specific purpose of this corporation is Jo promote and support excellence and innovation in education for students in the Temecula Valley Unified School District. The name and address in the State ofCalifornia of this _corporation's initial agent for service of process is John K. Ruffner, 27215 Nicolas Rd., Temecula, California, . 92591-7324. This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c) (3) of the Internal Revenue Code. Notwithstanding any other provisions of/hese articles, the col poration shall not carry on any other activities not permitted to be carried on (a) by a corporation exempt from federal income tax under Section 501 (c) (3) of the Internal Revenue Code or (b) by a corporation to which contributions are deductible under Section 170 (c) (2) of the Internal Revenue Code. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of -Statements) on•behalf of any candidate. for public office. The property of this corporation is irrevocably dedicated to cht�ritablepurposes and no part oftht'not incQn're or assets of this corporation shall :ever inuit-tp .rho benefit. of any director, f i =.br•nlember thereof or to the:bene fit of any private. person -y UptSri• the :; discoiutiori' r`Wiiindingr.up of the`'eorporation, its..as3ets rem.aining.af & ,,ayiribii(, ort' , • -provisions fo:r. paytridnt 'of all des: antil liabilitiesn this corporation s,1141l be distributed. to a nonprofit' d;=fouridatton.or conlrtlratigti wluck #-o'rganized and- up'erate2iiOcclusively for chant i1 p.•uz pses'an ,.which Iias established` its tax exempt statussu'nder Section 501 : (c) {3) of the 1i Trial R #eiiiie Code. t. PANE 1. OP. 2 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 7 City of Ternecula CITY OF TEMECULA SEP 13 2011 FISCAL YEAR 201 1-12 �=1nan e�a COMMUNITY SERVICE FUNDING PROGRAM APPLlC lTION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORiMATION Amount Requested: $ 5,000.00 FOR CHAPARRAL HIGH SCHOOL. (Maximum allowable $5,000) SCHOLARSHIP FUNDS FOR GRADUATING SENIORS Project Name: Project Start Date: SEPTEMBER 2011 Project End Date: MAY 2012 ORGANIZATION INFORMATION —LC+rC'‘ 1 Name of Organization: CITIZENS' SCHOLARSHIP OF—PEMEC[7LA VA±,LEY—' Contact Name: MARILYN WILLIAMS Title/Position: CHAPTER PRESIDENT Mailing Address: 40755 CALLE KATERINE, TEMECULA, CA. 92591 Telephone: E -Mail E -Mail Address: m.williams777©yahoo.com Year Organization Founded:1987 Geographic Area(s) Served: Number of Paid Staff: 0 TVUSD Number of Volunteers: 15 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: JULY 21, 19 8 7 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: JULY 21, 19 8 7 If "no": Federal identification number: 06-1209452 State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application - Page 1 X Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizens' Scholarship Foundation of Temecula Valley is t expand educational opportunities for resident high school students. CSF of Tcmccula Vallcy io a non profit, tax exempt (501C 3 otatuo) organization charted in 1987 with the Citizens' Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, Creat Oak and Rancho Victa/Suoan H. Ncloon high cchoolc, that aopirc to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, corporation or organization cubccribing to the purpocc of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with the minimum G.P.A. o • scholarships, students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. Thes( funds are sent directly to the collerj, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is April 1, 2012. The City of Temecula is encouraged to have representative; re the . _.s • -.. ... -. high school students of Chaparral High School. • - Application - Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $4,000.00 to qualified Temecula Valley, Chaparral, Great Oak and Rancho Vista/Susan H. Nelson High School MD e ve $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of • eview. The students have until March 1, 2012 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of till Citizens' Scholarship Foundation of Temecula Valley, I thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: MARILYN WILLIAMS CHAPTER PRESIDENT SIGNATURE:C-4 Y la Vc NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: MARILYN WILLIAMS CHAPTER PRESIDENT NAME and TITLE (Please Print or Type) SIGNATURE:L ' ORGANIZATION NAME: CITIZENS' SCHOLARSHIP FOUNDATION OF TEMECULA VALLEY MAILING ADDRESS: 40755 CALLE KATERINE , TEMECULA , CA. 92591 TELEPHONE: 951-795-4617 E -Mail Address: m.williams777@yahoo.com DATED THIS �,�� of Moate) Q ytitLy/ , 2011. (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judy.mcnabb@cityoftemecula.org Facsimile: 951-694-6479 Application - Page 5 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 8 CITY OF TEMECULA SEP 1 3 2011 City olTemecula FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLIGIbN (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 FOR GREAT OAK HIGH SCHOOL • (Maximum allowable $5,000) SCHOLARSHIP FUNDS FOR GRADUATING SENIORS Project Name: Project Start Date: SEPTEMBER 2011 Project End Date: MAY 2012 ORGANIZATION INFORMATION Name of Organization: CITIZENS' SCHOLARSHIP OF—TEMECULA VALLEY Contact Name: MARILYN WILLIAMS Title/Position: CHAPTER PRESIDENT Mailing Address: 40755 CALLE KATERINE, TEMECULA, CA. 92591 Tele hone:951-795-4617 m.williams777@yahoo.com P E -Mail Address: Year Organization Founded:19 8 7 Geographic Area(s) Served: TWSD Number of Paid Staff: 0 Number of Volunteers: 15 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: JULY 21, 19 8 7 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: JULY 21, 19 8 7 If "no": Federal identification number: 06-1209452 State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application — Page I X Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizens' Scholarship Foundation of Temecula Valley is expand educational opportunities for resident high school students. CSF of Temecula Valley is a non profit, tax exempt (501C 3 otatuo) organization charted in 1987 with the Citizens' Scholarship of America, INC. Our purpoE is to provide financial aid to the students of Chaparral, Temecula Valley, ZZ to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, tion and making an annual voluntary contribution of funds. The funds are manage by the board of trustees. All high school seniors with the minimum G.P.A. 3.0 or higher are encouraged to apply for ccholarchips. By providing scholarships, students are encouraged to seek higher education. An educate community is something the City of Temecula should strive for to ensure it br'ght future. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. The -=nts upon receipt of proof of enrollment. The deadline for funding a scholarshi is April 1, 2012. The City of Temecula is encouraged to have representativ . -. high school students of Great Oak High School. - . - . Application - Page 3 re th PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $4,000.00 to qualified Temecula Valley, Chaparral, Great Oak and Rancho Vista/Susan H. Nelson High School seniors. Four recipients, one per high school, were eelected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who hav been selected for the City of Temecula Scholarships to submit proof of e ? t e eview The students have until March 1, 2012 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of t Citizens' Scholarship Foundation of Temecula Valley, I thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: MARILYN WILLIAMS CHAPTER PRESIDENT SIGNATURE�'��y 1. NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: MARILYN WILLIAMS CHAPTER PRESIDENT NAME and TITLE (Please Print or Type) SIGNATURE: ? '_G � ; 4) e/ ORGANIZATION NAME: CITIZENS' SCHOLARSHIP FOUNDATION OF TEMECULA VALLEY MAILING ADDRESS: 40755 CALLE KATERINE , TEMECULA , CA . 92591 TELEPHONE: 951-795-4617 E -Mail Address: m.wi11iams777@yahoo.com DATED THIS /6:5 L4 (Date) , 2011. (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: Judy.mcnabb(Wcityoftemecula.org Facsimile: 951-694-6479 Application - Page 5 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 9 CITY OF TEMECUI.ti City of Temecula SEP 13 2011 FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPL °'RN (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $5, 000.00 FOR Rancho Vista/SHN HIGH SCHOOL allowable $5,000) SCHOLARSHIP FUNDS FOR GRADUATING ENIORS Project Name: Project Start Date: SEPTEMBER 2011 Project End Date: MAY 2012 ORGANIZATION INFORMATION Name of Organization: CITIZENS' SCHOLARSHIP OF-TENtR � EY Contact Name: MARILYN WILLIAMS Title/Position: CHAPTER PRESIDENT Mailing Address: 40755 CALLE KATERINE, TEMECULA, CA. 92591 Telephone: 951-795-4617 E -Mail Address: m.williams777@yahoo.com Year Organization Founded:19 8 7 Geographic Area(s) Served: TVUSD 0 Number of Paid Staff: Number of Volunteers: 15 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: JULY 21, 19 8 7 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: JULY 21, 19 8 7 If "no": Federal identification number: 06-1209452 State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizens' Scholarship Foundation of Temecula Valley is t expand educational opportunities for resident high school students. CSF of Temecula Valley io a non profit, tax exempt (501C 3 otatuo) organization charted in 1987 with the Citizens' Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, tion and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with the minimum G.P.A. o 3.0 or higher are encouraged to apply for scholarships. By providing scholarships, students are encouraged to seek higher education. An educated alba community is something the City of Temecula should strive for to ensure its bright future. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. Thest funds are sent directly to the college-, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is April 1, 2012. The City of Temecula is encouraged to have representative: re the m . - • • .- .. high school students of Rancho Vista/Susan H. Nelson School. - Application - Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $4,000.00 to qualified Temecula Valley, Chaparral, Great Oak and Rancho Vista/Susan H. Nelson High School ve $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to -you for review. The students have until March 1, 2012 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of thi Citizens' Scholarship Foundation of Temecula Valley, I thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: MARILYN WILLIAMS CHAPTER PRESIDENT NAME and TITLE (Please Print or Type) ,(D/Jt n, , �<J PRESIDENT or AUTHORIZED OFFICER: MARILYN WILLIAMS CHAPTER PRESIDENT NAME and TITLE (Please Print or Type) SIG NATURE:C--/l) !62(p (4)-(.�,�1,sh:u ORGANIZATION NAME: CITIZENS' SCHOLARSHIP FOUNDATION OF TEMECULA VALLEY MAILING ADDRESS: 40755 CALLE KATERINE , TEMECULA , CA. 92591 TELEPHONE: 951-795-4617 E -Mail Address: m.wi11iams777@yahoo.com DATED THIS 47?of%?)-/('r'— , 2011. (Date) ✓ (Month/ ) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judy.mcnabb(a�cityoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 10 City of Temecula CITY OF TEMECULA SEP 1 3 2011 FISCAL YEAR 201 1-12 Finance Dept. COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 FOR TEMECULA VALLEY H.S. (Maximum allowable $5,000) SCHOLARSHIP FUNDS FOR GRADUATING SENIORS Project Name: Project Start Date: SEPTEMBER 2011 Project End Date: MAY 2012 ORGANIZATION INFORMATION 1 kic,-1,011 Name of Organization: CITIZENS' SCHOLARSHIP oF-TEMEC-ULA-VALLEY Contact Name: MARILYN WILLIAMS Title/Position: CHAPTER PRESIDENT Mailing Address: 40755 CALLE KATERINE, TEMECULA, CA. 92591 Telephone: E -Mail E -Mail Address: m.williams777@yahoo.com Year Organization Founded:1987 Geographic Area(s) Served: TVUSD 0 Number of Paid Staff: Number of Volunteers: 15 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: JULY 21, 19 8 7 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: JULY 21, 19 8 7 If "no": Federal identification number: 06-1209452 State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application - Page 1 X Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizens' Scholarship Foundation of Temecula Valley is t expand educational opportunities for resident high school students. CSF of Temecula Valley io a non profit, tax exempt (501C 3 otatuo) organisation charted in 1987 with the Citizens' Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, corporation or -organization cubccribing to the purp cc of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with the minimum G.P.A. o 3.0 or higher are encouraged to apply for ccholarships. By providing scholarships, students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its bright future. - Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. These funds are sent directly to the college, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is April 1, 2012. The City of Temecula is encouraged to have representative: high school students of Temecula Valley High School. Application - Page 3 re the PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $4,000.00 to qualified Temecula Valley, Chaparral, Great Oak and Rancho Vista/Susan H. Nelson High School seniors. Four recipients, one per high school, were selected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to you for review. The students have until March 1, 2012 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of thf Citizens' Scholarship Foundation of Temecula Valley, I thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information belief. PREPARED BY: I �►:�� t tri SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: SIGNATURE(L/l a contained in this application is true to the best of our knowledge and ULD 1, ; ),NC r NAME and TITLE (Please Print or Type) /-0 )11I .�, gyp, I L1 (ms- cr NAME and TITLE (Please Print or Type) )diuma.) ORGANIZATION NAME:C(4( 2PM( ?0.1rifsc -t 1:) ,Si ()I-) D-(. e �OcnJc� Q. MAILING ADDRESS: �)'2A(,) 9c -'59J TELEPHONE: 1-795-�/(ii7 E -Mail Address: int OM, Owls 9%'%)Vl'f10r), cool DATED THIS /o?' ---6 of , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabbCa�cityoftemecula.orq 951-694-6479 Application - Page 5 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 11 CITY OF TEMECULA SEP 15 2011 City of Temecula FISCAL YEAR 201 1.12 COMMUNITY SERVICE FUNDING PROGRAPf ' 'r AII (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ $5,000.00 (Maximum allowable $5,000) Project Name: Psycho -educational Assessment and Evaluations Library Project Start Date: December 2011 Project End Date: Ongoing ORGANIZATION INFORMATION 0— VOL kit'a &AOcc la y Pc kt j Title/Position: CEO Name of Organization's ' - -' "' ' = Contact Name: Jill Diamond , ' .- Mailing Address: 27715 Jefferson Ave. Ste. 112, Temecula, CA. 92590 Telephone: 951-288-6835 E -Mail Address: jill@carelearningcenters.org Year Organization Founded: 2006 GeographicArea(s) Served: Temecula/Murrieta Number of Paid Staff: 7 Number of Volunteers: 7 Is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: 2007 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a no n -profit: 2007 Federal identification number: 20-8630752 If "no": State identification number: 2972332 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors x Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if ava ilable. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. CARE (Community Alliance for Responsible Education) is an organization of licensed psychological and educational professionals committed to providing financially accessible mental health and educational services to l%1111t1Lull, a.dulcst:cllt, adult, t111d clticlly TeLIw.,u icsldcuts. Spct;ifically, CARES ubjectivc is to pluvide free and low-cost counseling, psycho -educational assessments, and tutoring services for those in our community who can demonstrate a financial need. We accomplish this with the support of committed volunteer administrators who upVldtk tl Lc iVelised t.oallsCluls aLi U t.uullscliug interns dLt.ept clients fol f1Gc of a low -fee. CARE is appreciated by and benefits individual members of the community who utilize our services; by our professional colleagues including physicians, psychiatrists, and counselors who otherwise cannot afford to offer fact, our colleagues are our best referral sources, especially those who recognize the need for integrative services that we provide and support the multiple life domains impacted by mental health issues. Specific examples of organizations Riverside Health Services, and Oak Grove Center for Education and the Arts as these organizations serve children and the community who struggle academically, behaviorally, and socially. CARE has demonstrated a history of eer-to- • . • • • • . •: Peer tutoring paid internship program where local high school students who have demonstrated academic achievement are hired to tutor and coach their kindergarten through 12th grade peers in study skills, math, science, uch of the business aspects of the Peer Tutoring program under the supervision of CARE's management. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) CARE will use the grant award to build a Psycho -educational Assessments and Evaluations Library. While we are financially self-sufficient as an organization, we are eager to invest in a comprehensive research -based assessments and evaluations library which would better serve. the community Administration and scoring of psycho- educational assessments is beyond the financial capabilities of low-income individuals and are typically not covered by insurance. Yet, the results of the assessments and evaluations are extremely valuable to teachers, physicians, and counselors who use the results to identify cognitive, learning, or mental disabilities in order to better understand their students and patients strengths and needs. CARE will use the award to purchase several key assessments and invite the community tor tree and low cost screenings, assessments, and evaluations tor ADHD, autism career aptitude, cognitiveabilities, learning disabilities, and emotional health issues including depression, anxiety, and substance abuse issues. There are presently four full-time volunteers who operate CARE including the (;EU, (;UU, and CPO. Shared responsibilities tor this project in particular include the financial management of the project and award; community outreach; and management of the project and its outcomes. Other volunteers include three psychological interns and trainees who are responsible for administering and scoring the assessments under the supervision of UAKL's licensed psychologists and therapists. Nsycho-educational assessments and evaluations for low-income children of Temecula are the projects primary target and priority although the free assessments will be available for adults and the elderly in the Temecula area. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Jill Diamond, CEO NAME and TITLE (Please Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: Jules Fairchild, COO NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: CARE Learning Center & Counseling Services MAILING ADDRESS: 27715 Jefferson Ave. Ste. 112, Temecula, CA. 92590 TELEPHONE: 951-288-6835 E -Mail Address: DATED THIS 1 of September (Date) (Month) jill@carelearningcenters.org , 2011. Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judv.mcnabbr7a citvoftemecula.ord Facsimile: 951-694-6479 Application — Page 5 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: PRESIDENT or AUTHORIZED OFFICER Jules Fairchild, COO AMEIand TITLE (Please Print or Type) -X SIGNATURE: ej, , C -Ci j 6 Print or Type) ORGANIZATION NAME: CARE Learning Center & Counseling Services MAILING ADDRESS: 277)5 Jefferson Ave. Ste. 112, Temecula, CA. 92590 TELEPHONE: 951-288-6835 E -Mail Address: jill@carelearningcenters.org DATED THIS 1 of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver In Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: iudv.mcnabbAcitvoftemecuia.orq Facsimile: 951-694-6479 Application — Page 5 Evaluations and assessments to be purchased include: Assessment/Evaluation Purpose Cost wISC The WISC4-IV provides more than IQ scores. It provides essential information and critical clinical insights into a child's cognitive functioning. The WISC-IV is designed to meet several goals: • Expand and strengthen clinical utility to support your decision making • Develop the four Index Scores as the primary interpretive structure • Improve the assessment of fluid reasoning, working memory, and processing speed $1,815.00 WAIS The WAIS -IV is designed to meet several goals for adults: • Expand and strengthen clinical utility to support your decision making • Develop the four Index Scores as the primary interpretive structure • Improve the assessment of fluid reasoning, working memory, and processing speed $1,269.00 BRIEF - Behavior Rating Inventory of Executive Function The BRIEF is useful in evaluating children with a wide spectrum of developmental and acquired neurological conditions, such as: Learning disabilities, Low birth weight, Attention- deficit/hyperactivity disorder, Tourette's disorder, Traumatic brain injury, Pervasive developmental disorders/autism. $385.00 10:18 PM 09/13/11 Accrual Basis CARE Learning Center Profit & Loss Budget Overview January 1 through September 13, 2011 Jan11 Feb11 Mar11 Apr11 Ordinary Income/Expense Income Consulting Income Counseling Services 520.00 1,500.00 1,500.00 1,500.00 Total Income 520.00 1,500.00 1,500.00 1,500.00 Expense Advertising and Promotion Automobile Expense Bank Service Charges Bank fees 15.00 15.00 15.00 15.00 CC Fees 11.00 11.00 11.00 11.00 Bank Service Charges - Other Total Bank Service Charges 26.00 26.00 26.00 26.00 Business License Charitable Contributions Computer and Internet Expenses Continuing Education Contract Labor Tutoring Contract Labor - Other Total Contract Labor Depreciation Expense Dues and Subscriptions 10.00 10.00 10.00 10.00 Insurance Expense General Liability Insurance 131.25 Insurance Expense - Other Total Insurance Expense 131.25 Interest Expense Meals and Entertainment 10.00 10.00 10.00 10.00 Misc Expense Office Supplies 25.00 25.00 25.00 25.00 Payroll Expenses Postage and Delivery 5.00 5.00 5.00 5.00 Printing 48.00 Professional Fees 250.00 250.00 250.00 250.00 Rent Expense 200.00 200.00 Repairs and Maintenance Telephone Expense 75.00 75.00 75.00 75.00 Travel Expense Utilities Website Total Expense 401.00 401.00 732.25 649.00 Net Ordinary Income 119.00 1,099.00 767.75 851.00 Other Income/Expense Other Expense Ask My Accountant Total Other Expense Net Other Income 0.00 0.00 0.00 0.00 Net Income 119.00 1,099.00 767.75 851.00 Page 1 10:18 PM 09/13/11 Accrual Basis Ordinary Income/Expense Income Consulting Income Counseling Services Total Income CARE Learning Center Profit & Loss Budget Overview January 1 through September 13, 2011 May 11 Jun 11 Jul 11 Aug 11 1,500.00 1,500.00 1,500.00 1,500.00 1,500.00 1,700.00 1,500.00 1,700.00 Expense Advertising and Promotion Automobile Expense Bank Service Charges Bank fees 15.00 15.00 15.00 15.00 CC Fees 11.00 11.00 11.00 11.00 Bank Service Charges - Other Total Bank Service Charges 26.00 26.00 26.00 26.00 Business License Charitable Contributions Computer and Internet Expenses Continuing Education Contract Labor Tutoring Contract Labor - Other 80.00 80.00 Total Contract Labor 80.00 80.00 Depreciation Expense Dues and Subscriptions 10.00 10.00 10.00 10.00 Insurance Expense General Liability Insurance 43.00 43.00 43.00 43.00 Insurance Expense - Other Total Insurance Expense 43.00 43.00 43.00 43.00 Interest Expense Meals and Entertainment 10.00 10.00 10.00 10.00 Misc Expense Office Supplies 25.00 25.00 25.00 25.00 Payroll Expenses Postage and Delivery 5.00 5.00 5.00 5.00 Printing 48.00 Professional Fees 250.00 250.00 250.00 250.00 Rent Expense 200.00 361.00 361.00 361.00 Repairs and Maintenance Telephone Expense 75.00 75.00 75.00 75.00 Travel Expense Utilities 76.00 76.00 76.00 Website 50.00 Total Expense 644.00 931.00 1,009.00 961.00 Net Ordinary Income 856.00 569.00 491.00 739.00 Other Income/Expense Other Expense Ask My Accountant Total Other Expense Net Other Income 0.00 0.00 0.00 0.00 Net Income 856.00 669.00 491.00 739.00 Page 2 10:18 PM 09113/11 Accrual Basis Ordinary Income/Expense Income Consulting Income Counseling Services Total Income Expense Advertising and Promotion Automobile Expense Bank Service Charges Bank fees CC Fees Bank Service Charges - Other Total Bank Service Charges CARE Learning Center Profit & Loss Budget Overview January 1 through September 13, 2011 TOTAL Sep 1 -13, 11 Jan 1 - Sep 13, 11 0.00 0.00 780.00 12,000.00 780.00 12,000.00 0.00 0.00 0.00 0.00 6.50 126.50 4.77 92.77 0.00 0.00 11.27 219.27 Business License 0.00 0.00 Charitable Contributions 0.00 0.00 Computer and Internet Expenses 0.00 0.00 Continuing Education 0.00 0.00 Contract Labor Tutoring 0.00 0.00 Contract Labor - Other 34.67 194.67 Total Contract Labor 34.67 194.67 Depreciation Expense Dues and Subscriptions Insurance Expense General Liability Insurance Insurance Expense - Other Total Insurance Expense 0.00 0.00 4.33 84.33 0.00 303.25 159.90 159.90 159.90 463.15 Interest Expense 0.00 0.00 Meals and Entertainment 4.33 84.33 MIsc Expense 0.00 0.00 Office Supplies 10.83 210.83 Payroll Expenses 0.00 0.00 Postage and Delivery 2.17 42.17 Printing 0.00 96.00 Professional Fees 108.33 2,108.33 Rent Expense 359.23 2,042.23 Repairs and Maintenance 0.00 0.00 Telephone Expense 32.50 632.50 Travel Expense 0.00 0.00 Utilities 86.67 314.67 Website 0.00 50.00 Total Expense 814.23 6,542.48 Net Ordinary Income -34.23 5,457.52 Other Income/Expense Other Expense Ask My Accountant 0.00 0.00 Total Other Expense 0.00 0.00 Net Other Income 0.00 0.00 Net Income 44.23 5,457.52 Page 3 8:32 PM 09/13111 CARE Learning Center Statement of Cash Flows January 1 through September 13, 2011 Jan 1 - Sep 13, 11 OPERATING ACTIVITIES Net Income 5.19 Adjustments to reconcile Net Income to net cash provided by operations: Accounts Receivable 65.00 Net cash provided by Operating Activities 70.19 INVESTING ACTIVITIES Security Deposits Asset -1,458.00 Net cash provided by Investing Activities -1,458.00 FINANCING ACTIVITIES Loan-JDahlglish 1,035.00 Net cash provided by Financing Activities 1,035.00 Net cash increase for period Cash at beginning of period Cash at end of period -352.81 2,139.62 1,786.81 Page 1 8:21 PM 09/13/11 Accrual Basis CARE Learning Center Balance Sheet As of September 13, 2011 Sep 13, 11 ASSETS Current Assets Checking/Savings Checking 879.31 Total Checking/Savings 879.31 Accounts Receivable Accounts Receivable -65.00 Total Accounts Receivable -65.00 Other Current Assets Undeposited Funds 907.50 Total Other Current Assets 907.50 Total Current Assets 1,721.81 Other Assets Security Deposits Asset 1,458.00 Total Other Assets 1,458.00 TOTAL ASSETS 3,179.81 LIABILITIES & EQUITY Liabilities Long Term Liabilities Loan-JDahlglish 1,035.00 Total Long Term Liabilities 1,035.00 Total Liabilities 1,035.00 Equity Opening Balance Equity 700.80 Retained Earnings 1,438.82 Net Income 5.19 Total Equity 2,144.81 TOTAL LIABILITIES & EQUITY 3,179.81 Page 1 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 : O Date: r�E �'J',< COMMUNITY ALLIANCE FOR RESPONSIBLE EDUCATION ACADEMY 41625 VIA LILIA TEMECULA, CA 92592 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 20-8630752 DLN: 17053044025019 Contact Person: RACHEL M LEIFHEIT ID# 31617 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: March 6, 2007 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributione to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221 -PC, Compliance Guide for 501.(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) STATE OF CAI iFOHN A FRANCHISE TAX BOARD PO BOX 1286 RANCHO CORDOVA CA 95/41-1286 In reply refer to 755:G :SIK March 12, 2009 COMMUNITY ALLIANCE FOR RESPONSIBLE EDUCATION ACADEMY JILL R PORRAS 41625 VIA LILIA RD TEMECULA CA 92592-7400 Purpose SCHOOL Code Section 23701d Form of Organization Corporation Accounting Period Ending: December 31 Organization Number 2972332 EXEMPT DETERMINATION LETTER We determined you are exempt from California franchise or income tax under the California Revenue and Taxation Code section shown above. The tax-exempt status is effective as of 03/06/2007. To retain exempt status, organizations are required to be organized and operating for nonprofit purposes within the provisions of the above section. An inactive organization is not entitled to exemption. This decision is based on information you submitted and assumes that your present operations continue unchanged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect on your exempt status. Any change of name or address must also be reported. In the event of a change in relevant statutory, administrative, judicial case law, a change in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon which this opinion is based, this opinion may no longer be applicable. It is your responsibility to be aware of these changes should they occur. This paragraph constitutes written advice, other than a chief counsel ruling, within the meaning of Revenue and Taxation Code Section 21012(a)(2). For the organization's filing requirements, read enclosed Pub. 1068, Exempt Judy McNabb From: Jill Porras <jillporras@msn.com> Sent: Thursday, September 15, 2011 8:02 PM To: Judy McNabb Subject: Community Service Funding Program - CARE Learning Center & Counseling Services Attachments: 501 c3.jpg; Assessments to be Purchased.docx; Balance Sheet Sept 13 2011 (1).pdf; Grant Application Final.pdf; P&L Budget overview (1).pdf; Signature Page.jpg; State Exempt.jpg; Statement of Cash flow Sept 13 2011 (1).pdf Attn: Judy McNabb, CARE Learning Center & Counseling Services Application for Community Services Funding Program Psycho -educational Evaluations and Assessments Library Project Sincerely, Jill Diamond 1 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 12 City of Tcmectga CITY OF TEMEC!ILA SEP 15 2011 FISCAL YEAR 201 1-12 Finance COMMUNITY SERVICE FUNDING PROGRAM APPLICA 614 (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 2500.00 Project Name: 211 Riverside County Project Start Date: July 1, 2011 (Maximum allowable $5,000) Project End Date: June 30, 2 012 ORGANIZATION INFORMATION Name of Organization: Community Connect formerly the Volunteer Center of Riverside County Contact Name: Craig Redelsperger Title/Position: 211 Program Director Mailing Address: 2060 University Avenue, Suite 21.2 Riverside, Ca. 92507 Telephone: 951 329-2586 E -Mail Address: craig@connectriverside.org Year Organization Founded: 1966 GeographicArea(s) Served: all of Riverside County Number of Paid Staff: 50 Number of Volunteers: 100 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: December 1966 If'yes' (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: December 14, 1966 If "no": Federal identification number: State identification number: 95-2287250 C0519207 Name of sponsoring organization: #4 Federal identification number: /VA State identification number: /K4 This application has been authorized by the organization's: Executive Committee X Board of Directors Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. The current budget, financial statements, and audit are attached. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. 211 Riverside provides education and access to resources for the residents of Temecula. 211 is a 24 hours a day, 7 days a week information and referral hotline available to all residents of Temecula. Resources are only good to the public if the public is aware of the resources. 211 has over 3000 programs (resources) listed in the 211 data base for health and human services. 211 can enhance the services provided by the City of Temecula. City staff can refer the multitude of calls they receive for resources to 211. Voice mail messages can refer callers to 211 when the City is closed for business. 211 can be posted on the City's web site as a resource. In addition to being a resource for health and human services such as food, housing, utility assistance, health care, and hundreds of other needs, 211 has an MOU with the County Office of Emergency Services. During times of disasters or emergencies such as fires or earthquakes, 211 is activated to provide accurate, timely information to residents. This helps provide relief for 911 and other disaster lines during times of crisis. 211 also provides public health information to the residents of Temecula such as information about flu shots or whopping cough immunizations. Our mission is to "connect those in need with those who can help" and 211 connects Temecula residents with resources 24 hours a day, 365 days a year. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) • to information and resources for health and human services and emergency information A callar is rPTPrrPd to ragnurrPs hasPri nr tine caller's zip code area. Last year, 211 operators assisted 2,010 callers from t-hP City of TPmaruia Most rallPrs rPprPSPnt hniisPhnlrls of multiple persons. The average household size for Riverside County is 3.0 persons, this, 211 Riverside assistPri . pprnx-imat'ly tini(l TPmirula rPalr7Pnt S which represents about 6% of Temecula's population. 211 Riverside operators are also crisis trained hPransP many of the callers are in distress. Callers also have multiple needs when calling 211. For example. somebody calling for help to pay their utilities may also need help getting emergency food. Somebody calling for help with employment might also need transportation. 211 is a community asset to all nonprofits who provide services to Temecula residents as 211 refers the residents appropriately to the agencies to utilize their services. 211 provides services throughout all of Riverside County. Last year 211 operators assisted 80,180 callers County wide. Currently 211 is staffed with 11 staff and 5 volunteers. Funding would be used for the telecommunications system which includes phones, internet service, IT maintenance and repair, all of which is critical towards maintaining the data base and phone system. A copy of the 211 program budget is attacPied. Application - Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. 211 Riverside did not receive City of Temecula funding in the previous year Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: Roberta Neff, CEO NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: SIGNATUREk7 Marsha Locke, President NAME and TITLE (Please Print or Type) ORGANIZATION NAME: MAILING ADDRESS: Community Connect 2060 University Avenue, Suite 212 Riverside, Ca. 92507 TELEPHONE: 951 3294706 E -Mail Address: bobbie@conectriverside.org DATED THIS of (Date) , 2011. Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabbc citvoftemecula.orq 951-694-6479 Application - Page 5 Community Connect 211 Riverside Program Budget 2011-2012 FY2011 /2012 Budget Income Grants City of Riverside 23,500 Foundation Awards 121,000 State 211 21,804 Food Bank 15,544 Housing Authority 101,400 United Way Inland Valley 30,000 United Way Desert 11,000 United Way Corona/Norco 7,000 City/County support 90,400 DPSS 70,000 Dept. of Public Health 24,500 Total Grants 515,648 Miscellaneous Income Misc. Income - Other 500 Total Misc. Income 500 500 Total Income 516,148 Expenses Contracted services 75,245 Payroll Processing 912 Accounting & audit 3,880 Supplies 2,386 Telecommunications 12,000 Postage 2,340 Office lease 7,000 Equipment maint/lease 2,812 Insurance volunteers 200 Printing 725 Staff business/meeting expense 200 Staff mileage/travel 766 Dues and fees 1,045 Salary 50,249 Sick 6,000 Vacation 8,000 Holiday 7,150 Hourly Rate 292254 Taxes payroll 21237 Taxes unemployment 5100 Insurance work comp 4,147 EE benefit Health Net ins 12,500 Total Expense 516,148 Community Connect Budget Description Department 2010-2011 Actual 2010-2011 Budget 2011-2012 Budget ome Alternative Sentencing Program 4000 - Community Service - Riverside County ASP 349.789.50 428,000.00 379,000.00 4005 • Community Service - Outside County ASP 63,401.00 62,000.00 63,500.00 4010 • Juvenile Community Service ASP 22.950.00 33,000.00 23,000.00 4015 • Dom. Violence - Anger Management ASP 141,582.50 144,000.00 143,000.00 4020 • VIP - Victim Impact Panel ASP 750.00 1,000.00 800.00 4021 • Interlock ASP 1,190.00 1,100.00 1,100.00 4025 - Parole ASP 180.00 500.00 100.00 4030 • TEMPO - Teen Drunk Driving ASP 52,412.00 50,000.00 53,000.00 4035 - Probation Formal ASP 43,605.00 46,000.00 44,000.00 4050 • HAM - Hospital Morgue Mentoring ASP 28,236.00 15,300.00 30.000.00 4055 • AWARE - TEMPO ASP 56,240.79 45,000.00 58,000.00 4060 • Boating DUI ASP 100.00 400.00 100.00 4070 • Victim Awareness ASP 1,625.00 400.00 1,000.00 4150 • ASP Agency Fees ASP - - - Total Alternative Sentencing Program 762,061.79 826,700.00 796,600.00 ants 4200 • County General -Info / Referral 211 7,000.00 10,100.00 10,000.00 4210 • Mental Health - HELPline Helpline 65,000.00 50,000.00 73,305.00 4215 • Probation - Alt. Sentencing ASP 8,000.00 8,000.00 8,000.00 4225 • Aging - Facility Visits Ombudsman 54,875.78 61,000.00 66,499.00 4226 - Aging- Ombudsman Initiative Ombudsman 42,424.68 51,000.00 51,588 00 4231 • Aging - Volunteer Recruitment Ombudsman 40,883.55 53,600.00 42,917.00 4240 - Aging - One Time Only Grant Ombudsman 134,253.44 87,600.00 101,024.00 4246 CDBG - Corona- Shared Housing Shared Housing 16,902.62 15,000.00 12,526.00 4248 . Corona Rent Guarantee Program Shared Housing 80,000.00 80,000.00 80,000.00 4250 CDBG - Hemet Ombudsman- - - 4251 CDBG - City of Riverside/211 211 8,282.41 9,000.00 7,500.00 4252 - CDBG - County of Riverside Ombudsman - - - 4255 - CDBG-City of Moreno Valley 211 5,000.00 - 5,000.00 4261 - Mon Valley Initiative Shared Housing 16,004.03 26,000.00 45,000.00 4276 EFSP - Emergency Food & Shelter Shared Housing 10,201.00 20,495.00 59,577.00 4320 - TAP - Transportation Access TAP/Admin 190,916.22 140,000.00 165,000.00 4330 • Foundation Awards Various 31,500.00 30.000.00 151,500.00 4372 . First Five of Riverside- Resource Ctr Resource Center 72,764.03 84,135.00 - 4374 - California Wellness Resource Center 86,421.83 50,000.00 50,000.00 4375 - First Five of Riverside -211 211 - 1.500.00 - 4377 • DPSS - 211 Grant 211 70,000.00 70,000.00 70,000.00 4378- DPSS- Helpline Helpline 11,997.00 10.000.00 11,997.00 4391 - California Volunteers Volunteer Connection 29,817.63 - 22,392.00 4392- Americorps Volunteer Connection- - 4393- City of Moreno Valley Shared Housing 72,369.29 72,000.00 - 4394- Food Bank (Stamps) 211 7,150.17 41.100.00 15,544.00 4395 - State 211 211 53,610.00 28,675.00 21,804.00 4396 - County Housing HPRP 211 211 72,671.00 14,400.00 101,400.00 4397 - Riv. County Public Health 211 24,500.00 Total Grants 1,188,044.68 1,013,605.00 1,197,073.00 iblic Support 4400 Contributions / Donations Various 2,065.76 3,500.00 2,065.00 4410 - Designated Donations - Program Various 323.78 1,000.00 300.00 4417 • Annual Appeal Admin. 2,115.00 4,000.00 2.500.00 4420 - United Way Inland Valleys Various 72,445.39 72,445.00 71,003.00 4421 • United Way Payroll Contribution Admin. 248.36 350.00 200.00 4422 • United Way SupporUPVG N/A- - - 4423 - United Way of the Desert 211 11,000.00 17,500.00 11,000.00 4425 • Corona/Norco United Way Various 11,000.00 8,000.00 8,000.00 4440 • Grandparent's Day Flowers Admin. 1,300.00 1,500.00 1.300.00 4450 • Special Events Various 380.00 1,000.00 400.00 4451 - Mardi Gras Gala Admin. 17,246.00 - 25,000.00 4457 - Coverlet Income Admin. 3,046.62 8,500.00 1,000.00 4459 - Diva Day Admin. 8,000.00 4480 - City/County Support, 2-1-1 Services 211 48,277.29 71,600.00 49,000.00 Community Connect Budget Description Department 2010-2011 Actual 2010-2011 Budget 2011-2012 Budget Total Public Support 169,448.20 189,395.00 179,768.00 source Center 4505 • Workshops Resource Center 16,935.00 12,500.00 17,000.00 4510 • Consultants Resource Center 3,075.00 1,400.00 3,075.00 4515 - Non -Profit Day Resource Center (25.00) 10,500.00 9,200.00 4520 . Membership Dues Resource Center 9,570.00 5,500.00 9,500.00 4525 . Sponsorships Resource Center 1,000.00 3,500.00 1,000.00 4530 . Miscellaneous Resource Center 361.75 1,000.00 350.00 4500 -Other Income Resource Center 7,250.00 - - Total Resource Center Income 38,166.75 34,400.00 40,126.00 scellaneous Income 4115 • Directory Sales Admin. - - - 5100 • Interest Income Admin. 642.41 1,300.00 640.00 5205 - Volunteer Recogntion Event Volunteer Connection 6,504.00 4,700.00 6,500.00 5200 - Misc. Income - Other Various 5,128.59 200.00 3,500.00 Total Misc. Income 12,275.00 6,200.00 10,640.00 Total Income 2,169,996.42 2,070,200.00 2,224,206.00 lenses Payroll Expenses 6305. Salaries and Wages 1,155.611.68 1,181,298.00 1,300,078.00 6330 • Payroll Taxes 84,976.38 87,810.00 95,556.00 6332 • Insurance - Unemployment 21,455.61 25,000.00 25,000.00 6335 - Worker's Compensation 20,216.13 19,000.00 22,000.00 6340 • Employee Insurance Benefits 40,217.87 56,500.00 45,000.00 Total Payroll Expenses 1,322,477.67 1,369,608.00 1,487,634.00 lerating Expenses 6010 - Contracted Services 130.487.96 129,100.00 130,500.00 6011 . Consultant Fee - Resource Center 33,058.26 16,500.00 38,000.00 6019 Payroll Processing 3,486.20 6,100.00 4,000.00 6020 • Accounting/Audit 16,821.25 20,000.00 20,000.00 6025 - Supplies 32.843.76 30,000.00 32,000.00 6035 Telecommunications 70,482.46 70,000.00 70,000.00 6036 • Fingerprinting 30.00 500.00 200.00 6037 - MADD meetings/TEMPO 1,000.00 1,500.00 1,500.00 6038 Debriefing - Tempo/ASP 2.000.00 2,700.00 2,200.00 6040 - Internet/Database Services 2,500.00 - - 6045 - Postage 10,641.64 9,500.00 11,000.00 6050 - Office Lease - VCRC 32,757.53 32,788.00 32,758.00 6051 • Office Lease - Other 5,775.00 5,400.00 6,900.00 6053 • Office Maintenance & Repairs 4,584.93 10.000.00 5,000.00 6060 - Equipment MaintlLease 16,540.39 18,000.00 17,000.00 6075 - Insurance - Volunteers - 960.00 - 6080 • Insurance - General 9,838.66 14,900.00 12,960.00 6090 . Printing - Other 1,612.44 4,000.00 4,000.00 6095 Advertising/Classifieds 4,592.41 3,000.00 5,000.00 6100 • Staff Business/Meeting Expense 6,139.82 3,000.00 4,500.00 6105 - Staff Mileage & Travel 20,320.19 20,000.00 20,500.00 6115 • Volunteer Travel / Mileage 8,632.55 9,000.00 8,700.00 6130 - Staff Training 1,462.40 2,300.00 1,000.00 6132-Reference/Training Materials 1,181.06- - 6135 Dues, Fees, Subscriptions 8,639.00 7,000.00 4,700.00 6136 Bank Charges 4,523.38 3,050.00 3,100.00 6138 -Taxes and Fees 1,184.55 100.00 400.00 6140 • Interest Expense 3,381.39 2.550.00 3,500.00 6145 - Miscellaneous 1,894.68 500.00 1,018.00 6161 . Volunteer Recog - Vol Connection 5,399.46 4,200.00 5,000.00 6162 . Volunteer Recog - Ombudsman 3,474.06 3,000.00 3,500.00 6163 . Volunteer Recog - Other 59.35 - - 6175 - Fundraising -Mardi Gras Gala 11.166.90 5,400.00 13,000.00 Community Connect Budget Description Department 2010-2011 Actual 2010-2011 Budget 2011-2012 Budget 6175-12 - Fundraising -Diva Day - - 1,000.00 6176 . Fundraising - Non Profit Day 5,736.63 4,800.00 5,800.00 6177. Fundraising - Grandparents Day 1,254.27 900.00 900.00 6185 • Bus Tickets 139.708.00 86.000.00 107,351.00 6400 . Rental Assistance - EFSP 10,798.00 20,093.00 58,385.00 6405 . Rental Assistance - Corona Rest Guarantee 69.692.19 70,000.00 70,000.00 6407 - Rental Assistance -City o1 Moreno vaney 85,614.05 62,000.00 - 7000 • Capital Expenditures - 21,751.00 31,200.00 Total Operating Expenses 769,314.82 700,592.00 736,572.00 Total Expenses 2,091,792.49 2,070,200.00 2,224,206.00 Net Surplus (Deficit) 6139 • Depreciation Expense Net Surplus (Deficit) After Depreciation 78,203.93 0.00 0.00 15,454.36 30,000.00 15,000.00 62,749.67 (30,000.00) (15,000.00) y j S I Dcpartntunt of the Trsasury IRS Internal Itevonua Service P.O. Box 2508, Room 4010 In reply refer to: 4077550279 2cinnati OH 45201 Mar. 09, 2011 LTR 4168C 0 95-2287250 000000 00 00032229 BODC: TE 3923 COMMUNITY CONNECT PO BOX 5376 RIVERSIDE CA 92517-5376 Employer Identification Number: 95-2287250 Person to Contact: Sophia Brown Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your Jan. 24, 2011, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in November 1971. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section 509(a)(2). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irs.gov/eo for information regarding filing requirements. Specifically, section 6033(j) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was reokedd tinder section 6033(j) of the Code on our website beginning in ea 2011. City of Temecula 2011-12 CS Funding Program APPLICATION NO. 13 CITY OF TEMECULA. City of Temecula SEP 15 2011 FISCAL YEAR 20 'I 1.12 COMMUNITY SERVICE FUNDING PROGRAMS ' 31I (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 (Maximum allowable $5,000) Project Name: Operation Prom 2012 Project Start Date: 12/2011 Project End Date: 6/2012 ORGANIZATION INFORMATION Name of Organization: P Couture Girl's Closet Contact Name: Tracy MacKellar Title/Position: President / Founder Mailing Address: 27540 Ynez Road, Suite J15 Telephone: (951) 699-5758 Year Organization Founded: 2008 E -Mail Address: thecouturegirlscloset@msn.com Geographic Area(s) Served: All of Inland Empire Number of Paid Staff: 0 Number of Volunteers: 2 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 10/6/2008 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 10/6/2008 If "no": Federal identification number: 80-0270681 State identification number: 3165417 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application — Page 1 Members -at -Large x FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Do you remember getting asked to the prom? Or that butterfly feeling in your stomach from excitement? Going nome ana telling your parents now excitea you are to go to the prom, ana your parents tell you "I'm sorry, but we don't have the money to buy you a dress. Well, Phe Couture Girl's Closet was created tor situations just like this. This organization was formed by a High School Sophomore and her mother. With assistance from the Public Schools and other organizations, we give young women the opportunity to select a dress, and attend their school event feeling confident, stylish and included! This organization was formed because the High School Sophomore was saddened by the fact that many girls did not attend the Formal Event's because they did not have or could not afford to purchase their own dresses. She knew that many other girls, including family and friends; even she had beautiful dresses hanging in their closets waiting to be worn again. Thus, The Couture Girl's Closet doors were opened. Due to economic frustrations, many young ladies miss out on high school memories and typically are unable to attend prom, forgoing a memory of a lifetime. The Couture Girl's Closet's mission is to offer donated new and used semi -formal and formal gowns to deserving high school girls. We want them to know they should never let themselves be bound by temporary financial hardships. We collect the dresses and have them dry cleaned. When the next Formal Event is scheduled, the girls can stop by our "Borrow Boutique" and choose the perfect dress for the evening. There is a minimal charge to the girls of $10.00 for the use of the dresses & accessories to help cover cost of dry-cleaning. High school girls with proof of current school enrollment are eligible to shop The Couture Girl's Closet "Borrow Boutique". Students must present a valid school ID card or a letter from their principal or guidance counselor to prove current enrollment in high school, and have a parent present. Our goal is to help as many young girls as possible. In order to be successful, The Couture Girl's Closet needs the help and support of our wonderful community. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) The cost of each event for a high school girl starts at approx. $80.00 - $500.00 for a dress and tickets depending on the event, and many of these young girls will not have the resources made available to pay for these events themselves. The Couture Girl's Closet would use the assistance to help with the cost of dresses, dry-cleaning and ticket purchases, as well as operating costs for our new store. Last year's prom season, The Couture Girl's Closet provided a "Prom Package / Salon Services" to (4)deserving high school girls. Each girl received a dress from our borrow boutique, a pair of prom tickets and professional salon services which included hair & make-up application. EXAMPLE: PROM DRESS: PROM TICKETS $250.00 - $500.00 $100.00 - $200.00 Pair of Tickets SALON SERVICES $75.00 EACH This is not one specific high school; this is available to high school girls in Riverside/ North San Diego County. We have never turned down a high school girl in need of our services specific for a high school event. While we do not require proof of financial need, we rely on the students and parents honesty to verify their need. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. N/A Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: Tracy MacKellar, President NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: Tracy MacKellar, President NAME and TITLE (Please Print or Type) ctA,12e1L,A, ORGANIZATION NAME: MAILING ADDRESS: The Couture Girls Closet 27540 Ynez Road, Suite J15 Temecula, CA 92591 TELEPHONE: (951) 699-5758 E -Mail Address: thecouturegirlscloset@msn.com DATED THIS 14 of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judv.mcnabb(c�citvoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 FINANCIAL STATEMENTS: INCOME AND EXPENSE FOR CURRENT FISCAL YEAR: January -September 2011 Assets Liabilities & Fund Balance Cash and Investments $ Current Payables $ Receivables (detail) Notes Payable Inventory $ 50,000.00 Fund Balance Fixed Assets Other Assets Total Assets $ 50,000.00 Total Liabilities & Fund Balance $ End of the year income statement for the immediate past year. Income Expenses Fundraising $ Salaries $ 0 Foundation Grants Utility Expenses $ 600.00 MO. United Way Liability Insurance $100.00 MO. Government Funds *See note Below Organization Fees $235.00 YR. Other Grant *See note Below (Temecula Chamber Member) Other Sources Total Income Other Expenses $500.00 MO. $ Dry Cleaning Dresses $ 0 Total Expenses $ 1,200.00 MO. Please note with an asterisk (*) any amounts that require additional explanation, and comment on these items. IN 2009 WE RECEIVED A ONE TIME $500.00 GRANT & IN 2010 WE RECEIVED A ONE TIME $2,000.00 FROM HEARST PUBLICATIONS FOR OUR COMMUNITY EFFORTS. WE ALSO RECEIVED A ONE TIME $1,000.00 SPONSORSHIP FROM PECHANGA RESORT & CASINO IN 2009, AND IN 2010 WE RECEIVED A $1,000.00 COMMUNITY IMPROVEMENT GRANT FROM SUPERVISOR JEFF STONE AND THE COUNTY OF RIVERSIDE 3 j 1 bbil 11 State of California Secretary of State 1, DEBRA BOWEN, Secretary of State of the State of California, hereby certify: That the attached transcript of ! page(s) has been compared with the record on file in this office, of which it purports to be a copy, and that it is full, true and correct. Sec/Stale Form CE -107 (REV 1/2007) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of 7 11E s DEBRA BOWEN Secretary of State - •, OSP 06 99734 t> t 6:7 ! J ARTICLES OF INCORPORATION :he Secretary of Stak liC�t'¢ n California. The name of the corporation is "The Couture Girls Closet" 11 A. This corporation is a nonprofit Public Benefit Corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for: ( ) Public purposes. Or ( X) Charitable purposes. Or ( ) Public and Charitable purposes. B. The specific purpose of this corporation is to provide donated gently used Semi- formal and Formal dresses "free of charge" to High School girls who are financially unable to purchase their own dresses. so that they can attend an event such as "Homecoming or High School Prom". III The name and address in the Sate of California of this corporation's initial agent for service of process is: Name: Tracy L. MacKellar Address: 33260 Susan Grace Court City: Temecula State CALIFORNIA Zip Code 92592 IV A. This corporation is organized and operated exclusively for charitable purposes within the meaning of Internal Revenue Code section 501(c) (3). B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. V The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of this corporation shall ever inure to the benefit of any director, officer or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for charitable purposes and which has established its tax exempt status under Internal Revenue Code section 501(c) (3). tc Tracy L. MacKellar, Incorporator :NTERNAL REVENUE SERVICE ). O. BOX 2508 :INCINNATI, OH 45201 )ate : MAR 3 I. 2UU3 • 'HE COUTURE GIRLS CLOSET 33260 SUSAN GRACE CT 'EMECULA, CA 92592 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 80-0270681 DLN: 17053077000019 Contact Person: RENEE RAILEY NORTON ID# 31172 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: October 6, 2008 Contribution Deductibility: Yes Addendum Applies: No Ate are pleased to inform you that upon review of your application for tax axempt status we have determined that you are exempt from Federal income tax ander section 501(c)(3) of the Internal Revenue Code. Contributions to you are 3eductibie under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 Dr. 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Jrganizations exempt under section 501(c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221 -PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) 'HE COUTURE GIRLS CLOSET nclosures: Publication 4221 -PC -2- Robert Choi Director, Exempt Organizations Rulings and Agreements Letter 947 (DO/CG) Community Service Funding Program Policy Fiscal Year 2011 - 12 Name of Organization: The Couture Girl's Closet Contact Person: Tracy MacKellar Phone: (951) 699-5758 Criteria In making funding determinations, the City's Community Service Funding AD Hoc Committee will consider the following criteria. A. Is the organization currently non-profit? YES B. Does the organization provide a service to the overall community? YES C. Is the size and make-up of the organization equipped to provide the program/service to the overall community? WE ARE VERY EQUIPPED TO SERVICE THE TEMECULA VALLEY AS WELL AS ALL OF INLAND EMPIRE, SPECIFIC TO WHAT WE DO. D. What is the public reaction to the group? I AM TOLD ON A DAILY BASIS FROM PARENTS AND STUDENTS, WHAT A WONDERFUL CONCEPT AND SERVICE THAT WE PROVIDE TO THE COMMUNITY (WE CAN PROVIDE PICTURES AND LETTERS IF REQUESTED) E. Does the organization have a high quality level of fiscal management? AS PRESIDENT OF MY HOMEOWNERS ASSOCIATION, I HAVE SUCESSFULLY MANAGED THE ASSOCIATION ON MY OWN FOR THE PAST 3 YEARS, HIRING CONTRASCTORS AND ENSURING THAT ALL ASPECTS OF THE ORGANIZATION WERE TAKEN CARE OF, KEEPING COSTS WITHIN BUDGET. F Is the group well organized to ensure longevity in the City of Temecula? YES, WITH ALL MY PREVIOUS EXPERIENCE AS A COMMUNICATIONS DISPATCHING SUPERVISOR FOR SAN DIEGO COUNTY SHERIFF FOR 10 YEARS. I ALSO WORKED IN THE CONSTRUCTION INDUSTRY AS AN ESTIMATOR FOR A CUSTOM HOME BUILDER IN RANCHO SANTA FE. I AM CURRENTLY THE PRESIDENT OF MY HOME OWNERS ASSOCIATION. What is the evidence of satisfactory service provided to the County's citizens? OUR ORGANIZATIONS HAS LOANED OUT OVER 1,000 DRESSES IN THE PAST 3 YEARS FOR EVENTS SUCH AS PROM, HOMECOMING, WINTER FORMALS AND MOST RECENTLY SOME MILITARY BALLS. WE ARE ALSO THE RECIPIENTS OF TWO SEPERATE NATIONAL GRANTS FROM HEARST PUBLICATIONS FOR OUR COMMUNITY EFFORTS. Is the organization free from discrimination based on race, color, creed, nationality, sex marital status, disability, religion, or political affiliation? WE SERVICE ALL GIRLS 1 WHO MEET THE REQUIREMENTS OF OUR SERVICE, WE HAVE NEVER DISCRIMINATED AGAINST ANYONE WHOM HAS CONTACTED US FOR ASSISTANCE. AND FOR 2 YEARS WE ASSISTED STUDENTS WHO ATTENDED A "SPECIAL EDUCATION PROM" HELD AT GREAT OAK HIGH SCHOOL. Does the organization require attendance or participation in any political, religious or social activity? NO, THE ONLY REQUIREMENT IS THAT YOU ARE CURRENTLY IN HIGH SCHOOL, ATTENDING A HIGH SCHOOL FUNCTION. J. Can the organization provide financial statements (prepared using an appropriate method of accounting) to demonstrate sound financial management? YES, IF WE ARE CONSIDERED A CANDIDATE, WE CAN PROVIDE OUR INCOME AND EXPENSE RECORDS KEPT ON QUICKEN (WE DO NOT USE A CPA FOR FILING NON- PROFIT TAXES). Can the organization provide a budget for the fiscal year of request demonstrating cost- effectiveness? YES, SEE OUR ATTACHED FINANCIAL STATEMENT. Does the organization make its services available to all? IT IS SPECIFICALLY DESIGNED TO ASSIST HIGH SCHOOL GIRLS, BUT WE MOST RECENTLY OPENED UP ARE SERVICES TO ASSIST THE MILITARY WIVES FOR SOME OF THE MILITARY BALLS AS WELL. M. Does the organization possess ongoing program evaluation tools? THROUGH CONSISTANT FEEDBACK FROM RECIPIENTS WE HAVE ATTEMPTED TO PRESENT A QUALITY ORGANIZATION. WHAT WE HAVE DONE THUS FAR, IS KEEP TRACK OFF ALL OUR CUSTOMERS IN A DATABASE RECORD KEEPING SYSTEM. EACH YEAR WE ARE IN OPERATION, WE DETERMINE POSITITVE CHANGES TO ENSURE MORE SUCCESS FOR THE FOLLOWING SEASONS. 2 City of Temecula SEP 15 2011 � 46;7ce Dept oatimee r:. !J`r .i (-&P.1 f° ii4mbite, along comas a fairytale, Owner / Founder 27540 Ynez Road, Suite 315 Temecula, CA 92591 (951) 699-5758 Open Mon - Wed & Fn. 2:30 - 6:00 pm Become a Fan on Facebook thecoutureglrlsdoset smsn. com www.thecoutureglrlsdoset.com tJ Wea4e 2011 - tio,„„ke tciA.kny City of Temecula 2011-12 CS Funding Program APPLICATION NO. 14 UJQLFL.E ?)-1i-11A31.:7.4 RC.1.) CITY OF TEMECU.LA. City of Temecula FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICW "I6I4» (Please Print or Type) Finance De •i 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5 ;con. CO (Maximum allowable $5,000) Project Name: 7QQ3 e.} - • 0.0 .C. \ C . ro‘vac_Nsz :�S cov'e di' (t ncA PAA\ce qe` )'15'E. W(Lcccom Project Start Date: 0 I 01 Project End Date: t C-7-CCAD \-'(.1 a CI ( Name of Organizati Contact Name: A n: RGANIZATION INFOR ► ATION c - ca—Q6.�y OnriT.h03fl-k-- Title/Position: -t) �;Aexm-- Mailing Address:e��`')U1 y \ AY\ \e X X ?c iPu\ 1 • QAc 3 , j\i\en'% -cec c .� i 8LA Telephone: C1 S\ '&ofl - 9 to to 1 E -Mail Address: Year Organization Founded: C9 COS Geographic Area(s) Served: ie n oleL, Sc n i '.S -R iver;'t Number of Volunteers: \ DO k CO 1 • ` Number of Paid Staff: Is this organization incorporated in California as a non-profit organization? Yes V c No Effective Date: CA —DLO" (-G.1 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: smbe.0 Federal identification number: 1 ?� -- \ �3c iD U State identification number: 53D Co 1 If "no": Name of sponsoring organization: Federal identification number. State identification number: This application has been authorized by the organization's: Executive Committee 04 Board of Directors Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. e3s ate Part c� `� c1 i v ! 6 00_1 c.a CA1\eeAvue. ()r '\es vQ . :\. f> CM sr COMMk t k `es --tone he r w\3v) c-2")` %`)Sc31"�, *a C.-CCeC..'�;c��l OVerc' CeCINP.. V\OMC S,E - E I-\e.ss Ubs't<c-- 4? -0•0 ��� ►�� .� �z ��-t ,.s �� �-r \L. fr-45J-cr L/ 4- E Lit,L11JS 4 6 v- 06 Lt. 41.u4..l lT 1/4'/ '11-t r vU t4 `� --rbr ,�-�c - w ►T1� j�-t� Locp,L tc T ?'1l -t ta4- i2 Hve--Liles J\ -i. -to C 1 i&i--t-revi=i�-- i 3 i / mss �J 5"t (1JJ T 'Fru_ 1147H LSftP.s / ()L�- Agedb., Doe AuV Lax.t ri-ALc ri S ) s-46- aS L - !rL-fWM- -vri -ec'P/L) 42s t 14-4ae-14 41-2A.d..4 FtUD --s 6 v?ce- C 1 --(Lc., pe ) • i W &t.. 1 ( f SIS lki-1,0 UN -1 Pr -1- O! 4E, Jr- 4 -1&, -(i -AS -ACO 6 4--t ft g- fi 1 p 'i) -1D OE &3,e -vg , Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) �C�t�(�vtrJ•� KLt R`pik.Alc(„4.-SS rr� re, ,s„. ilk u.c \)tP ` k - R 3l 4...-r- T . v . o. c_. - C A 4.-t_ 1 -zz . LJr ��- rx-.)1„q t.,_ so(s -rif) L7i-77Mc-tr.Y13- 1-17,4-4t-LoCS LJL IAL tY; 1LtZ(tc ks t 11-4l,/ Vim D c c Fay '3 ��-� rtr, � p JIB f i� P / t7� U e6inleP#!/4, Vvt; t"t INVE 117 H AALL tD t S G` r ty FGi� i ? C1C (/�:i.-tT $ Lc Se-12--t/0-R- v t LL ' l -4O GG c-_ e .SZ.( .1--1C-Lx) 1-4, 6'I`]rl �s 1=o1�D , 01_61-4t/�- i- -fl ckeTg bs /A .) 1 --to 1k4A4 a Z 61 1--163cps ' ka,-r LoLLL. (J--� - ./4.Gcr .1 "D6 .U Yui 3 1 L( ±iU us /44. *ue/-i- (SU e - Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Flecsr 4-( Itd.-Ec it -b4 -Acts 14-4 /?-&--1-6T- Lc vFS AL40 u)Pec-3-4 -� S 4 cap- 1 �c- -PG cseL.G /4_41-D - p t z -f » 2.is�'-��; . A- s, • Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. I C�r. PREPARED BY: L \ ` 7�i� ()) (c'\ E and TITLE (Please Print or Type) SIGNATUR . : (Th9 PRESIDENT or AUTHORIZED OFFICER: re ' e _ (\ mo c 4 -A- SIGNATURE: NAME a (Please Print or Type) ORGANIZATION NAME:iZC� eCk . C). \) . G» MAILING ADDRESS: OI Lt 1 Ac(1 \ oc-N.-?,. oe c> Me vee , 9n y TELEPHONE: \ 5 k -1o11-9 lip Lc) 1 E -Mail Address: •p r q ec H-ovch 1 DATED THIS of ).‘ , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judv.mcnabbcityoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 10:21 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss Budget Overview December 2010 through November 2011 Dec 10 Ordinary Income/Expense Expense 60300 • Specific Assist to Individuals 60310 • Mote! Stays 650.00 60320 • Food 150.00 60330 • Gas 100.00 60340 • Clothing 50.00 60350 • Hygiene 50.00 60360 • Misc 150.00 60370 • Automotive Repairs 100.00 60380 • Utilities 1,200.00 60390 • Rental Assistance 1,250.00 60400 • Bus Pass & Transportation 125.00 60410 • Medication 35.00 60420 • Cash Assistance 55.00 Total 60300 • Specific Assist to Individuals 3,915.00 Total Expense 3,915.00 Net Ordinary Income -3,915.00 Net Income -3,915.00 Jan 11 Feb 11 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 1,250.00 125.00 35.00 55.00 3,915.00 3,915.00 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 1,250.00 125.00 35.00 55.00 3,915.00 3,915.00 -3,915.00 -3,915.00 -3,915.00 -3,915.00 Page 1 10:21 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss Budget Overview December 2010 through November 2011 Ordinary Income/Expense Expense 60300 • Specific Assist to Individuals 60310 • Motel Stays 60320 • Food 60330 • Gas 60340 • Clothing 60350 • Hygiene 60360 • Misc 60370 • Automotive Repairs 60380 • Utilities 60390 • Rental Assistance 60400 • Bus Pass & Transportation 60410 • Medication 60420 • Cash Assistance Total 60300 • Specific Assist to Individuals Total Expense Net Ordinary Income Net Income Mar 11 650.00 150.00 100.00 50,00 50.00 150.00 100.00 1,200.00 2,600.00 125.00 35.00 55.00 5,265.00 5,265.00 -5,265.00 -5,265.00 Apr11 May11 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 2,600.00 125.00 35.00 55.00 5,265.00 5,265.00 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 2,600.00 125.00 35.00 55.00 5,265.00 5,265.00 -5,265.00 -5,265.00 -5,265.00 -5,265.00 Page 2 10:21 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss Budget Overview December 2010 through November 2011 Ordinary Income/Expense Expense 60300 • Specific Assist to Individuals 60310 • Motel Stays 60320 • Food 60330 • Gas 60340 • Clothing 60350 • Hygiene 60360 • Misc 60370 • Automotive Repairs 60380 • Utilities 60390 • Rental Assistance 60400 • Bus Pass & Transportation 60410 • Medication 60420 • Cash Assistance Total 60300 • Specific Assist to Individuals Total Expense Net Ordinary Income Net Income Jun 11 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 9,436.00 125.00 35.00 55.00 12,101.00 12,101.00 -12,101.00 •12,101.00 Jul 11 Aug 11 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 10,451.00 125.00 35.00 55.00 13,116.00 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 12,856.00 125.00 35.00 55.00 15,521.00 13,116.00 15,521.00 -13,116.00 -13,116.00 -15,521.00 -15,521.00 Page 3 10:21 AM God's Fan Club, A Non -Profit Organization 09/14/11 Profit & Loss Budget Overview Accrual Basis December 2010 through November 2011 Ordinary Income/Expense Expense 60300 • Specific Assist to Individuals 60310 • Motel Stays 60320 • Food 60330 • Gas 60340 • Clothing 60350 • Hygiene 60360 • Misc 60370 • Automotive Repairs 60380 • Utilities 60390 • Rental Assistance 60400 • Bus Pass & Transportation 60410 • Medication 60420 • Cash Assistance Total 60300 • Specific Assist to Individuals Total Expense Net Ordinary Income Net Income Sep 11 650.00 150.00 100.00 50.00 50.00 150.00 100.00 1,200.00 12, 856.00 125.00 35.00 55.00 15,521.00 15,521.00 -15,521.00 -15,521.00 Oct 11 Nov 11 650.00 650.00 150.00 150.00 100.00 100.00 50.00 50.00 50.00 50.00 150.00 150.00 100.00 100.00 1,200.00 1,200.00 12,856.00 12,856.00 125.00 125.00 35.00 35.00 55.00 55.00 15,521,00 15,521.00 15,521.00 15,521.00 -15,521.00 -15,521.00 -15,521.00 -15,521.00 Page 4 10:21 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss Budget Overview December 2010 through November 2011 TOTAL. Dec '10 - Nov 11 Ordinary Income/Expense Expense 60300 • Specific Assist to Individuals 60310 • Motel Stays 7,800.00 60320 • Food 1,800.00 60330 • Gas 1,200.00 60340• Clothing 600.00 60350 • Hygiene 600.00 60360 • Misc 1,800.00 60370 • Automotive Repairs 1,200.00 60380 • Utilities 14,400.00 60390 • Rental Assistance 82,861.00 60400 • Bus Pass & Transportation 1,500.00 60410 • Medication 420.00 60420 - Cash Assistance 660.00 Total 60300 • Specific Assist to Individuals 114,841.00 Total Expense 114,841.00 Net Ordinary Income -114,841.00 Net income -114,841.00 Page 5 10:40 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss December 2010 through August 2011 Ordinary Income/Expense Income 43400 • Direct Public Support 43440 • Gifts in Kind - Goods 43450 • Individ, Business Contributions Total 43400 • Direct Public Support 44000 • Program Service Revenue 44500 • Grants 44800 • Indirect Public Support 44820 • United Way, CFC Contributions Total 44800 • Indirect Public Support 45000 • Investments 45030 • Interest -Savings, Short-term CD Total 45000 • Investments 49000 • Special Events Income- Fundrais Total Income Dec '10 - Aug 11 726.38 46,577.84 47, 304.22 40, 558.34 20,000.00 2,414.78 2,414.78 1.24 1.24 11,655.00 121,933.58 Gross Profit 121,933.58 Expense 60300 • Specific Assist to Individuals 60310 • Motel Stays 6,027.60 60320 • Food 988.52 60330 • Gas 1,639.13 60340 • Clothing 950.83 60350 • Hygiene 430.94 60360 • Misc 4,394.09 60370 • Automotive Repairs 461.58 60380 • Utilities 6,073.06 60390 • Rental Assistance 42,831.85 60400 • Bus Pass & Transportation 782.10 60410 • Medication 354.50 60420 • Cash Assistance 561.50 60300 • Specific Assist to Individuals - Other 132.00 Total 60300 • Specific Assist to Individuals 60900 • Business Expenses 60920 • Business Registration Fees 60930 • Fines, Penalties, Judgments 60940 • Taxes - Not UBIT Total 60900 • Business Expenses 62100 • Contract Services 62110 • Accounting Fees 62150 • Outside Contract Services 62100 • Contract Services - Other Total 62100 • Contract Services 62800 • Facilities and Equipment 62840 • Equip Rental and Maintenance 62890 • Rent, Utilities 62800 • Facilities and Equipment - Other Total 62800 • Facilities and Equipment 65,627.70 206.00 450.00 35.00 691.00 2,282.50 13,873.50 1,950.00 18,106.00 549.92 5,916.55 24.82 6,491.29 Page 1 10:40 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Profit & Loss December 2010 through August 2011 65000 • Operations 65010 • Books, Subscriptions, Reference 65020 • Postage, Mailing Service 65030 • Printing and Copying 65040 • Supplies 65050 • Telephone, Telecommunications 65060 • Payment Processing Fee 65070 • Bank Service Fees 65080 • Website Hosting 65000 • Operations - Other Total 65000 • Operations 65100 • Other Types of Expenses 65110 • Advertising Expenses 65120 • Insurance - Liability, D and 0 65150 • Memberships and Dues 65160 • Other Costs 65170 • Staff Development 65180 • Charitable Donations 65190 • Gifts & Promotions 65100 • Other Types of Expenses - Other Total 65100 • Other Types of Expenses 68300 • Travel and Meetings 68310 • Conference, Convention, Meeting 68320 • Travel 68325 • Mileage Reimburse- Volunteers 68330 • Business Meals Total 68300 • Travel and Meetings 69000 • Special Events 69030 • Printing & Copying 69070 • Event Planning-M&E Total 69000 • Special Events Dec '10 - Aug 11 554.26 304.51 531.53 1,994.73 2,760.17 434.99 171.00 590.32 180.72 7,522.23 1,271.15 2,134.38 374.85 877.69 2,000.00 850.00 385.38 50.00 7,943.45 198,50 826.20 2,755.69 950.78 4,731.17 161.47 52.43 213.90 Total Expense 111,326.74 Net Ordinary Income 10,606.84 Net Income 10,606.84 Page 2 10:43 AM 09/14/11 Accrual Basis God's Fan Club, A Non -Profit Organization Balance Sheet As of August 31, 2011 ASSETS Current Assets Checking/Savings 10000 • God's Fan Club -Wells Fargo-Ck 10001 • Men of Influence-WellsFargo-Ck 10002 • Project TOUCH- Wells Fargo- Ck 10003 • The Brook- Wells Fargo- Ck 10100 • Hotel Hope- Wells Fargo- Saving 10101 • Shelter- Wells Fargo- Savings 10102 • MOI -Wells Fargo -Savings 10103 • GFC- Wells Fargo- Saving 10200 • Petty Cash- Anne 10201 • Petty Cash- Office 10202 • Petty Cash- The Brook 10203 • Petty Cash -Fundraising Events Total Checking/Savings Accounts Receivable 11000 • Accounts Receivable Total Accounts Receivable Total Current Assets Fixed Assets 15000 • Furniture and Equipment 16000 • Accumulated Depreciation Aug 31, 11 3,332.21 1,875.69 30,777.00 974.05 1,275.44 4,492.50 0.02 0.02 448.34 1,116.57 200.00 200.00 44,691.84 6,467.57 6,467.57 51,159.41 290.20 -15.00 Total Fixed Assets 275.20 Other Assets 18600 • Other Assets 2,940.00 Total Other Assets 2,940.00 TOTAL ASSETS 54,374.61 LIABILITIES & EQUITY Liabilities Current Liabilities Accounts Payable 20000 • Accounts Payable 1,422.80 Total Accounts Payable 1,422.80 Total Current Liabilities 1,422.80 Total Liabilities 1,422.80 Equity 32000 • Unrestricted Net Assets 42,344.97 Net Income 10,606.84 Total Equity 52,951.81 TOTAL LIABILITIES & EQUITY 54,374.61 Page 1 i • IRS Deparhnent :=T=7 Internal Re 13910 P.O. Box 2508 Cincinnati OH 45201 GODS FAN CLUB KAREN CARUSO 30141 ANTELOPE RD D103 MENIFEE CA 92584-8066 In reply refer to: 0248667583 July 13, 2011 LTR 4168C E0 73-1681483 000000 00 00012487 BODC: TE Employer Identification Number: 73-1681483 Person to Contact: Ms. Mosley Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your July 01, 2011, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in November 2004. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irs.gov/eo for information regarding filing requirements. Specifically, section 6033(j) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(.) of the Code on our website beginning in early 2011. City of Temecula 2011-12 CS Funding Program APPLICATION NO. 15 City of Temecula SEP 15 2011 CITY OF TEMECU L4 FISCAL YEAR 201 1-12 Finance Department COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5 , 000 Project Name: A Brush with Kindness (Maximum allowable $5,000) Project Start Date: January 1, 2012 Project End Date: June 30, 2 012 ORGANIZATION INFORMATION n i ki ii � i eke .1 (V: Name of Organization: Habitat for Humanity-Tnl and valley - Contact Name: Tammy Marine Title/Position: Executive Director 27475 Ynez Road, Suite 390, Temecula, CA 92591 Mailing Address: Telephone: 951-296-3362 E -Mail Address: tammy@habit a t4 inl andva l 1 ey . org Year Organization Founded: 1991 Geographic Area(s) Served: Southwest Riverside County Number of Paid Staff: 6 Number of Volunteers: 375 Is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: October 24 , 2001 if "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: October 24, 2001 Federal identification number: 33-0461804 State identification number: C1681922 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee _ Board of Directors X Members -at -Large Application - Pagel 15 L FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Please see attached. Application - Page 2 4i. Ha.bitat for Humanity Mission Statement The mission of Habitat for Humanity Inland Valley, in partnership with God, is to facilitate the dream of homeownership as well as improve living conditions for those in the community. Habitat gives a "hand -up, not a hand-out!" A. Habitat for Humanity Inland Valley is a non-profit organization with a Federal ID 33-0461804. B. Habitat for Humanity serves the entire community through a variety of projects. Affordable housing is a staple of Habitat affiliates, but our agency also provides low-cost exterior home repair services to low-income homeowners to help keep the appearance of homes and neighborhoods. In addition, we operate ReStore facilities which enable surplus construction supplies, gently used appliances, furniture and home decor pieces to be repurposed, rather than be disposed of in landfills, once again, serving the community as a whole. C. Last year Habitat for Humanity purchased, rehabilitated and sold 10 foreclosed homes to worthy families, restoring neighborhoods while providing affordable housing to families needing decent housing. The entire project was roughly $1.7 million, and Habitat successfully utilized all available funding. With staffing in place and a strong Board of Directors, Habitat was and is positioned to continue serving our community's home ownership, repair and conservation needs. D. Habitat has a relatively high number of regular volunteers, demonstrating a positive public reaction to our organization. All of Habitat's projects result in a positive impact in neighborhoods; therefore the public reaction is typical ly positive, supportive and encouraging. E. Our agency is debt -free as a result of our history of fiscally conservative business practices. Each Habitat home that is built, or rebuilt, is done without debt, allowing our agency to build future sustainability for our agency and enhance our ability to continue providing affordable housing in the future. Ongoing financial oversight is provided by our Board of Directors including our co -treasurers from the banking industry. One is a Vice President of California Bank and Trust, and the other serves as Regional Director of Citi Bank. G. Evidence of satisfactory service provided to the City's citizens can easily be seen through the number of volunteers, individual donors, and businesses that support Habitat and the work we accomplish in the community. In addition to volunteer and financial support, our agency receives many requests for assistance from Temecula residents, once again demonstrating that our agency provides exceptional services to residents. H. & 1. Habitat does not discriminate based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. Habitat does not require attendance or participation in any political, religious or social activity. J. Habitat recently completed the first agency audit, resulting in no findings. A copy has been provided. K. A draft operating budget for 2012 has been provided. L. Habitat serves the entire community by providing affordable housing, neighborhood beautification, exterior home repair and significantly discounted construction and hone decor items through ReStore. M. Habitat has successfully implemented and maintained on-going programming for many years with program evaluation tools already in place. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Please see attached Application — Page 3 Project Description Habitat for Humanity inland Valley will use funding to directly benefit low-income homeowners in Temecula. Specifically, funding will be used to offset the cost of home repair materials to homeowners. Our agency recently began the A Brush with Kindness program in an effort to increase the number of families living in safe, decent and affordable homes. Typically our programs focus solely on providing affordable housing to one family, but recent economic circumstances have resulted in many families struggling to keep up with mortgage payments, let alone home repairs. A Brush with Kindness helps these families by providing exterior home repair services such as painting, minor exterior repairs, landscaping, exterior clean-up and weatherization. Groups of 10-20 volunteers work alongside the homeowner to revitalize a home's exterior. The program utilizes volunteers and donated materials, when available, and no interest loans to make repairs affordable, helping low-income homeowners continue to live independently and securely in their homes while simultaneously improving the visual beauty of neighborhoods. Traditionally supplies are provided by homeowners, but funding from the City of Temecula would allow our agency to extend our reach by providing $5,000 worth of -construction and repair materials. By providing the materials necessary to complete repairs, we will be able to serve more families than we are currently able to serve. For the purposes of this funding, the Brush with Kindness program will serve any low-income homeowner within the City ofTemecula with minor exterior home repair services. We will serve 60 homeowners between January 1, 2012 and June 30, 2012. Habitat has a loyal dedicated team of volunteers, and the A Brush with Kindness program is an excellent way for volunteers to utilize their skills between traditional construction builds. We estimate that 100-200 volunteers will be volunteering 500-1,000 hours to improve the neighborhood appearances of housing tracts within the City of Temecula. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Habitat for Humanity Inland Valley did not receive funding from the City of Temecula in 2010. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: Tammy -Marine, Executive Director • // NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: --Tammy Marine, Executive Director t4AME and TITLE (Please Print or Type) SIGNATURE: i ORGANIZATION NAME: Hal/at for Humanity Inland Valley MAILING ADDRESS: 274,7.5Ynez Road, #390 Temecula, CA 92591 TELEPHONE: 951-296-3362 E -Mail Address: tammy@habitat4inlandvalley. org DATED THIS 12th of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: jt0y,nicrtgrIppciiypfteme:c,31a,org Facsimile: 951-694-6479 Application - Page 5 Habitat For Humanity A Brush with Kindness Project Budget for City of Temecula Construction/Repair Materials $2,500 Marketing (banners, fliers, public relations) $ 500 Office Supplies $ 100 Trash Removal $ 500 T -Shirts for Volunteers $ 500 Water and box lunches for volunteers $ 400 Equipment Rental $ 200 Vehicle Expense $ 300 $5,000 HABITAT FOR HUMANITY INLAND VALLEY, INC. AUI)I'i' REPORT JUNE 30, 2010 Habitat for Humanity Inland Valley, Inc. Table of Contents June 30, 2010 Page(s) Independent Audit Report 1 Financial Statements: Statement of Financial Condition 2 Statement of Activities 3, 4 Statement of Cash Flows 5 Notes to Financial Statements 6. 7 Thomas A. Ralston Certified Public Accountant 41800 Enterprise Circle South Suite Temecula, California 92590 April 7, 2011 The Board of Directors Habitat for Humanity Inland Valley, Inc. 27475 Ynez Road #390 Temecula, California 92591 Phone: 951-296-9030 Fax: 951-296-9033 Email: tomralstancpaCuahoo.com INDEPENDENT AUDITOR'S REPORT We have audited the accompanying statement of financial position of Habitat for Humanity Inland Valley, Inc. (a nonprofit organization) as of June 30, 2010.and the related statements of activities, functional expense, and cash flows for the year then ended. These financial statements are the responsibility of the management of Habitat for Humanity Inland Valley, Inc. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatements. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statements presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects. The financial position of Habitat for Humanity Inland Valley, Inc., as of dune 30, 2010 and the changes in its net assets and its cash flows for the year then ended in conformity with accounting principles generally accepted in the United States of America. Our audit was made for the purpose of forming an opinion on the basic financial statements of Habitat for Humanity inland Valley, Inc. taken as whole. The accompanying schedule of direct agency support allocations is presented for the purpose of additional analysis and is not a required part of the financial statements. Such information has been subjected to the auditing procedures applied in the audit of the financial statements and, in our opinion, is fairly stated in all material respects in relation to the basic financial statements taken as whole. Sincerely, a Thomas A. Ralston Certified Public Accountant 1 INLAND VALLEY HABITAT FOR 1AJMANITY STATEMENT OF FINANCIAL POSITION JUNE 30. 2010 ASSETS Current Assets Cash and Cash Equivalents $ 139,419 Credit Card Receivable 1,805 Grants Receivable -NSP 114,672 Prepaid Credit Card 4,063 Total Current Assets $ 259,959 Fixed .Assets Property and Equipment Less Accumulated Depreciation (Note 2) 25,136 (10,930) Total Fixed Assets 14,206 Other Assets Sc eurity Deposit -Restore (Note 1) 11,600 First Trust Deeds (Note 3) 608,742 Second Trust Deeds (Note 3) 668,050 Total ()tiler Assets 1,288,392 Total Assets $1.562,557 LIABILITIES AND NET ASSETS LIABILITIES Current Liabilities Escrow Funds $ 6,791 Workers Comp Insurance Payable 22,972 Sales Tax Payable 6,382 Total Current Liabilities $ 36,145 Long -Term Liabilities - Habitat Way Street Maintenance 1.130 Total Liabilities 37,275 NET ASSETS Net Assets Unrestricted Total Liabilities and Net Assets SEE ACCOUNTANT'S AUDIT REPORT 2 1,525,282 $1,562,557 INLAND VALLEY HABITAT FOR HUMANITY STATEMENT OF ACTIVrrIES FOR THE YEAR ENDED JUNE 30, 2010 HABITAT RESTORE COMBINED INCOME Donations $ 10,413 S 107 5 10,520 Grant - Community Action Partners 59,952 59,952 Grant- NSP 114,672 Grants - Other 32,697 32,697 Fundraising 45,457 45,457 Earned Revenues - 694,504 694,504 Refunds 995 995 TOTAL INCOME 264,186 694,611 954,797 R LS'1'ORE OPERATING EXPENSES Depreciation Expense 4,332 4.332 Thick Expense - 7,669 7.669 E -Bay Expenses 140,617 140,617 Telephone/ Internet 6,920 6,920 • Equipment Rental 28 28 Advertising 21,103 21,103 Landscape Expenses 3,000 3,000 Merchant Account Fees 7,883 7,883 Repairs & Maintenance 3,315 3,315 Rents 153,819 153,819 Utilities 11,016 11,016 Employee Expenses 144,250 144,250 Insurance 2,754 2,754 Store Supplies 54,124 54,124 Printing 845 845 Dues - 2,658 2,658 3 INLAND VALLEY HABITAT FOR IIUJMANITY STATEMENT OF ACTIVITIES FOR THE YEAR ENDED JUNE 30, 2010 HABITAT RESTORE COMBINED HABITAT EXPENSES Employee Expenses 123,505 123,505 Grant Expenses -CAP 69.145 69,145 Grant Expenses -NSP 114.672 114,672 Public Relations 1.1,41.2 11,412 Fundraising Expenses 2.1.829 21,829 Brush with Kindness 2,051 2,051 Outside Services 6,719 6,719 Other Direct Expenses 13.981 13,981 Debt Forgiveness 22,450 22,450 Office Expenses 14,637 14,637 Insurance Expense 6,524 6,524 Op TOTAL EXPENSES 406,925 564.333 971,258 NET INCREASE (DECREASE) IN NET ASSETS BEFORE OTHER INCOME (142,739) 130,278 (12,461) OTHER INCOME Interest Income 172 172 NET INCREASE (DECREASE) IN NET (142,567) 130,278 (12,289) ASSETS NET ASSETS BEGINNING OF YEAR 1,484,328 53,243 1,537,571 NET ASSETS END OF YEAR $ 1,341,761 8 183,521 $ 1,525,282 SEE ACCOUNTANT'S AUDIT REPORT 4 INLAND VALLEY HABITAT FOR HTJMAN 'TY STATEMENT OF CASH F[.OWS FOR THE YEAR ENDED TUNE 30, 2010 CASH FLOWS FROM OPERATING ACTIVITIES Decrease in Net Assets $ (12,289) Net Increase in Fixed Assets (4,372) Net Increase in Accumulated Depreciation 4,332 Net Increase in Security Deposits (4,100) Net Increase in Grant Receivable (114,672) Net Decrease in Note Receivable 47,914 Net increase in Prepaid Credit Card (2.062) Net Increase in Credit Card Receivable (1.416) Net Increase in Insurance Payable 14,227 Net Decrease in Escrow Account (6,080) Net Decrease in Sales Tax Payable (2,253) Net Increase in Long Term Liabilities 1,130 Decrease in Cash and Cash Equivalents (79,641) Cash and Cash Equivalents, Beginning of the Year 219,060 Cash and Cash Equivalents, End of the Year $ 139,419 SEE ACCOUNTANT'S AUDIT REPORT 5 Habitat for Humanity Inland Valley, Inc. Notes to Financial Statements June 30, 2010 Habitat for Humanity Inland Valley is dedicated to serving families within southwest Riverside County. One of the many ways that the agency accomplishes that is through the building of affordable homes for worthy families. While that is the main focus, they also serve the entire community by participating in neighborhood revitalization and beautification projects, senior minor home repair and most recently rehabilitation of foreclosed homes creating affordable housing for families. In addition, the agency has opened two ReStore locations, one in Temecula and one in Lake Elsinore. Habitat ReStore is a unique retail facility, operated by Habitat for Humanity Inland Valley, which offers the community the opportunity to purchase new and used building materials, appliances and household items at greatly reduced prices. The materials and appliances sold are donated by local vendors, construction companies and individuaLs which are then resold to the public rather than being thrown away and filling up landfills. Families that Habitat for Humanity Inland Valley serves are considered low-income by HUD standards. For families to be selected for a Habitat house, they must have income that cannot exceed 80% of the Riverside County median income and they cannot qualify for conventional financing. Additionally, families are selected on need, ability to pay and willingness to partner with Habitat for Humanity. Each family must contribute 300-500 "sweat -equity" hours in the construction of their home, or other Habitat projects. Habitat does not discriminate, nor are families chosen based on race, ethnicity or age. The agency chooses families who meet the criteria set in our selection process and who demonstrate the biggest need for assistance. Habitat for Humanity is dedicated to making affordable housing readily available within southwest Riverside County. The Habitat for Humanity Inland Valley, Inc. is a 501 (c)(3) nonprofit organization. The organization maintains its books on the accrual basis of accounting. NOTE 1: DEPOSITS Rental Deposits on two retail stores .located at 27479 Enterprise Circle West, Temecula, California and 570-1 Central Avenue, Lake Elsinore, California. NOTE 2: FIXED ASSETS Fixed Assets are recorded at cost. Depreciation is calculated using MACR's method of depreciation, which is consistant with Internal Revenue Service calculations. Fixed Assets Consist of: Restore Truck $ 20,150 Equipment 614 Tenant Improvements 4.272 Total Fixed Assets 25,036 Less Accumulated Depreciation (10,930) Net Fixed Assets ,1_14206 Habitat for Humanity Inland Valley, Inc. Notes to Financial Statements (cont.) June 30, 2010 NOTE 3: NON-INTEREST BEARING NOTES Non -Interest bearing notes are securred by real property held by Habitat for Humanity. There arc certain restrictions that apply to the notes with incentives for the homeowners to stay in the house for a minimum of 5 years. 7 Internal Revenue Service Department of the Treasury Date: OCT 2 4 2001 Habitat for Humanity International, Inc. Inland Valley c/o Deborah Hollingsworth 27475 Ynez Road, #390 Temecula, CA 92591-4612 Dear Madam: P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Brett Siereveld 31-02633 Customer Service Specialist Toll Free Telephone Number: 8:00 A.M. to 9:30 P.M. EST 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 33-0461804 Group Exemption Number: 8545 We have received your request for affirmation of your organization's tax exempt status. Please note that the Federal Identification Number you provided in your letter is not the correct one for your organization. The number shown in the heading of this letter is the one assigned to you and is the only one you should use. Your organization is exempt under section 501(c)(3) of the Code because it is included in a group ruling issued to Habitat for Humanity International, Inc., located in Americus, Georgia. Individual exemption letters are not available to organizations included in group rulings. The group exemption letter applies to all of the subordinate organizations on whose behalf Habitat for Humanity International, Inc. has applied for recognition of exemption. If you want a copy of the group exemption letter, please contact your parent organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of S10,000, when a return is filed late, unless there is reasonable cause for the delay. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely avaiiable, such as by pos?'rg them on the Internet (World Wide Web). You may be liable for a penalty of S20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return). -2 - Habitat for Humanity International, Inc. Inland Valley 33-0461804 If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, ly JZ John E. Ricketts, Director, TE/GE Customer Account Services Judy McNabb From: melissa@writtenforyou.net Sent: Thursday, September 15, 2011 3:34 PM To: Judy McNabb Cc: Tammy Marine Subject: Community Service Funding Program Application Attachments: Application.pdf; Narrative.pdf; IRS 501 c 3.pdf; ABWK Project Budget.pdf; 2010 Audit.pdf Hi Judy, I have attached the completed application for the Community Service Funding Program for 2011-2012 for Habitat for Humanity Inland Valley. Would you kindly confirm receipt of our application? And please let me know if you need any additional information. Thank you, Melissa DieIs Written for You 951.704.5921 ph 888.899.1218 fx melissa@writtenforyou.net 1 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 16 City of Temecula CITY OF TEMECUI.A SEP 0 6 2011 FISCAL YEAR 201 1.12 Finance Dept. COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000 (Maximum allowable $5,000) Project Name: Patient Special Needs Project Start Date: January 1, 2012 Project End Date: June 30, 2 012 ORGANIZATION INFORMATION Name of Organization: Hemet Hospice eers Comm r' y ospice Contact Name: Rachel Mason Title/Position: Executive Director Mailing Address: 41769 Enterprise Circle North, Suite 102, Temecula, CA 92590 Telephone: 951.766.9629 E -Mail Address: rmason@hemethospice . orq Year Organization Founded: 1979 Geographic Area(s) Served: Southwest Riverside County 275 Number of Paid Staff: 12 Number of Volunteers: Is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: June 11, 1980 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: June 11, 1980 Federal identification number: 95-3499016 If "no": State identification number: 29017621 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application — Page 1 x Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Please see attached. Application — Page 2 Hemet Hospice/`Community Volunteers ` Hospice Services Hemet Hospice Volunteers/Community Hospice Services Community Service Funding Program Application Attachment MISSION STATEMENT Hemet Hospice Volunteers Inc., and it's Temecula based office, Community Hospice Services is a community based, non-profit organization, providing resources for special needs of hospice patients and the bereaved with love and compassion during end -of -life care. A. Hemet Hospice is deemed a 501 c 3 non-profit organization by the Internal Revenue Service, and was founded in 1979. B. Hemet Hospice serves throughout all of southwestern Riverside County and has offices in Temecula and Hemet. Our agency serves anyone in need of end -of -life care, or their family members, regardless of their ability to pay, or their city of residency, although many of our clients are from Temecula. C. With over three decades of loyal service to our community, Hemet Hospice is financially capable of providing services to any individual or family seeking services. In addition, our caring and experience staff and volunteers are prepared to help each individual circumstance to ensure the best possible experience. Our executive team, along with our Board of Directors, continually raise funds for our organization to continue provide services without cost to the family. D. While surveys consistently show that 90% of people would prefer to die in a comfortable home, surrounded by loved ones, more than half of deaths occur in a hospital setting (Gallup 1996). A hospice support agency such as ours fills a desperate need in our culture for patients and families to say a peaceful goodbye on their own terms. While numerous people turn to clergy for support during a terminal illness, many religious leaders receive little or no specialized training in grief counseling. They are unaware of the diverse options for patients and families. Our experienced and trained volunteers know how to kindly, compassionately guide families in their choices and assist with bereavement issues. The increase in the number of individuals and families seeking services easily demonstrates both the need for quality end-of-life care in our community, as well as a positive public reaction. E. Hemet Hospice is governed by a Board of Directors which is drawn from our local community. Our Board is a diverse blend of professionals from the banking industry, the medical community and the business community. Financial oversight is provided by our Board of Directors and has resulted in our agency continually operating for over 30 years without debt. Because of our conservative business practices our agency was able to accept a donation of a home, which is currently under construction to become our new Arbor Hospice Home providing dedicated hospice care in a home-like setting for 6 individuals at a time. The Arbor House is a direct result of fiscally sound business practices and planning of our organization fulfillment of our mission statement. F. Hemet Hospice has been serving southwest Riverside County for over 30 years and annually serves over 1,100 individuals; however, our reach goes beyond care for the individual needing end of life care and extends to their family as well, although they are not calculated in the number served. G. Within the past two years, our agency has experienced a 75% increase in the number of those seeking services, demonstrating our community's need for quality end-of-life care, bereavement support and a positive public response. H. Hemet Hospice is free from all discrimination based on race, color, creed, nationality, sex, marital status, disability, religion or political affiliation. Our agency maintains board-approved non- discrimination policies. Hemet Hospice does not require any attendance or participation in any political, religious or social activities to receive services. Hemet Hospice does offer grief and bereavement support groups, but attendance is not required. J. Hemet Hospice's desire is to have transparent financial accountability, as evidenced by timely filing of 990 documents and the preparations of audited financial statements, which are attached within this application. K. An operating budget has been attached for your review. All services provided by Hemet Hospice are provided at no cost to our clients, and every resource is used as efficiently as possible to expand our potential reach within the community. L. Services provided by Hemet Hospice are available to any individual or family in need of end -of -life care, or grief and bereavement counseling or support. M. Hemet Hospice does have program evaluation tools in place to monitor the number of individuals or families seeking services and the types of services they need in order to plan and prepare for future services. Our youth bereavement program is evaluated utilizing pre and post -participation questionnaires, and responses have been more positive than we had even hoped. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Please see attached. Application — Page 3 PROJECT DESCRIPTION Hemet Hospice Volunteers Inc. is a community based, non-profit organization, providing resources for special needs of hospice patients, families, and the bereaved with love and compassion during end -of -life care. Hemet Hospice was founded in 1979 to supply compassionate, end -of -life care for patients with terminal illnesses. We partner with local hospice care providers to ensure every hospice patient in need is provided the best medical and psychosocial end of life care possible. Our Special Needs Program ensures that patients receive those services necessary toward the best quality of life possible during the last few months, days or moments of their lives. The Patient Special Needs Program provides hospice patients and their families with needed resources so that the patient is able to spend his or her last days in comfort. For most senior hospice patients, hospice care is covered by Medicare. However, many younger patients lack insurance or are underinsured, which often results in patients doing without the care they need due to cost. We work with many hospice providers so that we can ensure that any hospice patient in our community has the opportunity to benefit from the program. For any hospice patient who is in need of funds to cover hospice expenses we can help. We also recognize that many patients have other needs not covered by the hospice benefit. These needs often include basic necessities of life such as food, utility payments, simple household modifications and repairs, and caregiver support. We work with many hospice providers so that we can ensure that any hospice patient in our community has the opportunity to benefit from the program. This program is based on both the patient's fmancial needs and their quality of life. We encourage patients and their families to talk about what is needed for the patient to spend their last days in comfort, discuss their last wishes and ask how Hemet Hospice can help. Last wishes are often simple things such as visiting a horse ranch, a last day at the beach, or attending a baseball game. We are able to support this through our Hemet Hospice Retail Outlet, and donations from private donors. The budget for the Special Needs Program is $99,261, of which over 90% goes directly to direct patient support. We are able to keep administrative costs low through the ample use of volunteer hours. We currently have over 275 volunteers who faithfully donate their time and energy to our agency. Through this program we served over 100 patients and families in 2010, and we expect to serve close to 200 patients and families in 2012. Funding from the City of Temecula would provide direct patient support, which provides hospice care for those in financial need. A detailed project budget has been attached. As for all programs, our Patient Special Needs Program will serve any individual or family within southwest Riverside County. Historically we have served over 1,100 individuals annually, with a variety of services. For this project we have established the following project objectives: 1. Serve 200 individuals and/or families with financial assistance for hospice care 2. Expend 95% of funds received from the City of Temecula on direct patient care PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Hemet Hospice Volunteers/Community Hospice Services has not received funding from the City of Temecula. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Rachel Mason, Executive Director NAME and TITLE (Please Print or Type) SIGNATURE. PRESIDENT or AUTHORIZED OFFICER: Rachel Mason, Executive Director NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: MAILING ADDRESS: Hemet Hospice Volunteers/Community Hospice Services 41769 Enterprise Circle North, Suite 102 Temecula, CA 92590 TELEPHONE: 951.766.9629 E -Mail Address: rmason@hemethospice.org_ DATED THIS (Date) of , 2011. (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: iudv.mcnabb(citvoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 Hemet Hospice Volunteers, Inc. Hospice Patient Special Needs Program 2011 Budget INCOME Source Amount Non-cash Donations $ 15,010 Memorial Donations $ 11,694 General Donations $ 6,453 Memberships $ 2,240 Fund Raisers -Net $ 22,278 Grants $ 25,00o Retail Store Net $ 7,291 Memorial Tree Donations $ 463 TOTAL INCOME $ 90,428 EXPENSES Item Amount Direct Patient Support $ 90,000 Administrative Staffing Costs $ 6,541 Supplies $ 500 Printing and copying $ 750 Telephone and fax $ 1,320 Postage and delivery $ 150 TOTAL EXPENSE $ 99,261 Hemet Hospice Volunteers, Inc. dba. Community Hospice Services 2011 Budget INCOME Bequest (Estimated): Non-cash donations (vehicles) Non-cash donations (Mobile Homes) Memorials: Donations: General Labor of Love Memberships Interest Income Fund Raisers: LUAL Golf Craft Group Miscellaneous Community Hospice Services Kids Camp Grants Retail Net Memorial Tree Donation TOTAL REVENUES EXPENSES Salaries & Wages Payroll Taxes Mileage Allowance Medical Benefits Dental Advertising Accounting Bank Charge Computer Support Dues & Subs Insurance: General Liability D&O Workman's Comp Legal Fees Appreciation/Staff Meetings Taxes, Licenses & Fees Rent Hospice Life Newsletter $ 500,000 15,355 29,676 35,081 11,734 7,627 6,720 51,560 19,601 41,234 6,000 500 48,436 4,500 75,000 21,874 1,388 $ 876,285 $ 419,420 45,785 10,932 38,616 3,096 2,999 10,300 1,502 1,914 6,525 4,199 2,696 4,797 500 3,i63 750 200 63,548 26,658 1 Hemet Hospice Volunteers, Inc. dba. Community Hospice Services 2011 Budget EXPENSES Con'td General Office 16,459 Equipment Lease 12,795 Postage 5,981 Printing 12,615 Staff Education 4,500 Storage 1,050 Telephone/Fax 9,313 Subtotal $ 710,312 Fundraising Golf 11,916 LUAL 7,500 Misc. Events/Fees 13,969 Sub -Total $ 33,385 Community Outreach Volunteer Appreciation 1,500 Annual Vol Awards Venue 3,500 Annual Vol Awards 2,000 Business Dev. 9,521 Memorial Tree 675 Supplies 250 Outreach 5,564 Sub -Total $ 23,010 Pt./Clients Programs Bereavement supplies 300 Happy Hearts Kids Camp 9,972 RVNA&H Support -Direct 140,000 * Patient Special Needs Support 90,000 Volunteer Training 250 Grant Expenses 2,000 Sub -Total $ 242,522 TOTAL EXPENSE $ 1,009,229 NET INCOME (LOSS) $ 132,943 ** *Last year for funding their Electric Medical Rcords program **Expected shortfall to be funded by increased grantseeking for program support and new memorial/donation request campaign. 2 HEMET HOSPICE Profit & Loss January through December 2010 Accrual Basis Jan - Dec 10 N O N CO O 0 0 O 0 (D 0 (D r O) 0 O 0 O r- O) O CO 01 (n 0 0 O O CO N N (D 0 0 0 0 0 0 • O (n N (n 0 0 O) M N (() CD I— W 6) O O O O (D 0) (1) O) O) CO Tr 0 r 0 r (D 0) N (n I- 0 r 0 '- CO N N CO (D V- V CO M (O O) O) 1n N t() (D O (0 (O O - - N- CO N co- 00 00 • N '— M (0 (O co M (n v a DD (N1 t a) c O 341,383.96 • O Q) — M f-- 10 0 0 DO M co O O V CO N (f) 0 1) (D (D 6) O) M In O O (V N N N- 0) CO •4" cr Cr) Q) r- O (D 6) N O (D .- N CO CD N O - Q) N N O N M- O (D ❑ o t u) a� _ 2 y t d c > E U — Z c O O c (oQ ❑❑ N O c C y rte- cZ .c _c c w a) Z O p >, w yZ a) N❑> y y a J (p1 y Z c E d coVJ rn N re U U • .K d yW VI CA CD EO ` • Cr o o a aci aa) JOU �i H 0-002 a� .5 _ o ▪ o •� y d aci v m • mdd�Ci' JJ r2 2Y rL(nU 0UE5 E❑QQm F O N r M M M M. . M c y • E O r M O r N (A 0 0 0 0 0 0 0 N O r 0 0 (A (D c N Nr 10 O r (1) CO O O O r r r NCIM M r r r r N0 a- r N N M (D O (D a) r r O N N N N N ('M 'Cr a0 C 0000OOOOrN V'hr-OOOQ1 Cf) 0)Tcc) (7) r 0.00000000000 V (D CO (D (D (D (D (D (D (D (D (D (D (D (D (D (D ID (D ID (D (D O X (D (D CO O DD CO CO 0.0 O 0.0 0.0 E F- w O 0 HEMET HOSPICE Profit & Loss January through December 2010 Accrual Basis Jan - Dec 10 M N N LD V O O M,- cr N O O C0 CO (D O N Ln M (0 0 0 0 0 (0 '— Lo M ti r T- L() LC) M N 00 N N Ln O N CD 00 N CO (n T- T- 41 D) 40 N In r CO QD O O r- O CO CO N M 00 T- N N 00 O ti N ti ti N 00 0) O N M Ln T2 M v 01 In (D N L!) O M 4 4 M 00 6 M M M N O (0 N 00 M Q1 00 10 (f) (D N Ln 4 00 N M (0 - N Nt M N — ti O N co 4 (0 N- co f— M CO N - — 0) N `cf 00 N c- r- O I-- 0) - M N- (V Ln V (V 10 0) N N N L() V CO- Ln N I� L!) 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L() O M4 N•) N Ln (D ti r- n OO OO CO 00 00 O Cn Cn 0n 0) O O O N N N N N M Cl Cl 01 Cl (D (D N N N N N N N N N N N N N N N N N N N N CO 00 00 CO CO 00 CO 00 CO CO 00 00 CO CO CO CO CO CO 03 00 00 CO 00 CO CO 00 CO 00 CO 00 CO 00 CO 00 CO CO 00 HEMET HOSPICE Profit & Loss January through December 2010 Accrual Basis Jan - Dec 10 N- co N CO 'nr r O O) - O) (O N 00 r M N 0 r N 00 O 0) 00 N r N N N r r Comm. Ed. 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W Q E p d O ...1e W 4= o (0-I o� I Zs 2 41 oz LIJ 0. 3 U Q� U E. zWN� �1x . 0 OUJ BJ C dui 0 E 1— i E 00? 0 0v=0' -NM C a. 0 0 0 0 m t 0 0 0 0 o Accrual Basis Total Other Income W d N U 0. C ac6 d 10 .co Total Other Expense Net Other Income Net Income City of Temecula 2011-12 CS Funding Program APPLICATION NO. 17 rtment CITY OF TEMECUTA FISCAL YEAR 20 I 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) G,ty orTemecCa 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) SEP 14 2011 PROJECT INFORMATION Finance Depa Amount Requested: $ 5,000.00 Project Name: Hope for All (Maximum allowable $5,000) Project Start Date: Project End Date: June 30 , 2012 ORGANIZATION INFORMATION Name of Organization: Hope for All, Inc. Contact Name: John R. Embree Title/Position:President 29141 Vallejo Avenue, Temecula, CA 92592 Mailing Address: Telephone: 951.676.6262 6/21/2004 E -Mail Address: www . hope temecul a . org Year Organization Founded: Geographic Area(s) Served: Temecula, CA Number of Paid Staff: None Number of Volunteers: Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 6/21/2004 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 1/13/2008 Federal identification number: 20-5981571 State identification number: 2666112 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The specific purpose of this corporation is to provide educational opportunities and services for the Community through specific programs that focus on the various needs of people of all ages including. but not limited to leadership and training and to provide, hands-on experience for children, youth, and adults. Application - Page 2 Project description: Hope proposes to replace the shade covering over the lower playground picnic area at Hope Lutheran Church. The covering provides shade to school children for the Julian Charter School that Hope provides space for. Cost estimates range from $5,000 to $6,000 for the replacement of the canopy cover over the picnic area of the playground. The contractor proposes to take down the current cable system on the frame work of the canopy and replace it with steel bars around the entire framework. This would allow them to wrap the new cover around and pop rivet it to the bars. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. None. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. Paula Fenton, Secretary PREPARED BY: NAME a • LE (Please Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: John R. Embree, President of Hope for All, Inc. SIGNATURE: --7-:ZJAME a E (Please Print or Type) ORGANIZATION NAME: Hope for All, Inc. 29141 Vallejo Avenue, Temecula, CA 92592 MAILING ADDRESS: TELEPHONE: 951.676.6262 E -Mail Address: www . hopetemecula . org DATED THIS Py". of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judv.mcnabb@cityoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 Hope For All Balance Sheet as of Setember 12, 2011 Assets: First Citizens Bank $ 8,213.82 Total Assets $ 8,213.82 Liabilities 0 Available for Funding $ 8,213.82 Income & Expense Statement 2011 YTD 1/1/2011 Starting Balance at bank $ 16,369.59 1/31/2011 Interest $ 1.35 2/14/2011 Compressor - Education Wing $ (2,100.00) Printing of checks $ (59.12) 3/28/2011 State of California $ (20.00) 5/15/2011 Eagle Scout Project $ (135.00) 6/26/2011 Bell Ringer Seminar grant $ (840.00) 6/24/2011 Luther Seminary scholarship $ (1,000.00) 6/26/2011 Wartburg Seminary scholarship $ (1,000.00) 6/26/2011 Rancho Damacitas Serenity Garden $ (2,000.00) 6/27/2011 Refund from State of California $ 20.00 8/9/2011 Directors Liability Insurance $ (1,023.00) 9/12/2011 Balance at bank $ 8,213.82 CRITERIA A. Yes. Hope for AII, Inc., a California nonprofit 501(c) (3), Benefit Corporation, was incorporated in 2008. The corporation is affiliated with Hope Lutheran Church, which has had a presence in the City of Temecula for over twenty-five years. PROGRAMS B. Our overall community services provide the following: a. During September 2011, Hope Lutheran Church provided backpacks and school supplies for Temecula children. b. During October 2010, Hope for All, Inc., hosted a free medical, informational clinic and assisted residents in need to agencies that could help with these families. c. The Julian Charter School has 98 Temecula students who use this playground area weekly. d. Outdoor movies for Temecula community and church's members used this area during the summer. e. Camp and Vacation Bible School: Attendance for this year: Day Camp — 23 children Drama Camp: 32 children for Drama 1; Drama 2: 28 Vacation Bible School: 123 children God Squad: 12 to 20 children per month using the playground PowerZone (Hope's middle school children) and Transformers (Hope's High School youth) also use the playground from time to time. Attendance ranges from 15 to 40 children. MEMBERSHIP AND LONGEVITY C. Hope Lutheran Church has been active in Temecula for 25 years. We have 400 member families. Hope Lutheran ministries serve the residents of Temecula. We provide annual events with Temecula resident participation, such as Trunk or Treat in October, Craft Faire in December, variety of camping experiences in the summer, and Hope Preschool.. D. Computerized accounting procedures and an annual independent audit provide checks and balances on the accuracy of the accounting information. E. Hope for All, Inc. through Hope Lutheran Church has served this community 2008. 1 F. Hope for All, Inc. through Hope Lutheran Church provides help to Temecula residents by providing grocery bags of food to residents in need, scholarships for summer programs, and outdoor movie events at our lower playground area. G. Hope for All, Inc., through Hope Lutheran Church is free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. H. This organization does not require attendance or participation in any political, religious or social activity. I. Financial statements are included with this submission using appropriate methods of accounting and sound financial management. J. Included with this submission is Hope for All, Inc.'s annual financial statement for fiscal year 2011/2012. K. Hope for All, Inc. ,through Hope Lutheran Church provides services through its community- based programs to benefit residents in the City of Temecula, California. L. Hope for All, Inc., and Hope Lutheran Church evaluate all programs annually. 2 The following picture provides a sample of the covering proposed. Cover Example The project would have an impact the following: 98 Temecula students that attend Julian Charter School. 210 Temecula residents from Hope Lutheran Church Congregation. Over 150 Children served during summer community programs provided at Hope. 85 individuals from the community during Church sponsored Free Video nights. `, ofe i ,4e€. 10 4. Special Board Meeting Minutes 8/18/11 CEO John Embree called the August 18th special board meeting to order at 11:05 am. Paula Sletten-Fenton, Secretary, present. Board Members Present: CEO John Embree, Secretary Paula Sletten-Fenton, Treasurer Carol Rosingana, Director Ann Reese, and Director Roger Hayward. Motion: 8/18/11 It was moved and seconded, by direction of this corporation, that Hope for All, Inc. apply for the Temecula Community Service Funding Program (fiscal year 2011-12) in the sum of $5000.00. Motion: UNANIMOUSLY ADOPTED CEO John Embree adjourned the meeting at 11:30 am. John Embree CEO 8/28/11 John Embree Paula Sletten-Fenton Secretary 8/18/11 HOPE FOR ALL, INC. EXHIBIT 1 FED ID# 20-5981571 ARTICLES OF INCORPORATION FORM 1023 266662 1 The name of this corporation is HOPE FOR ALL, INC. ( /Ai c;l( /O''•.J // FILED �`''i in the office of the Secretary of State of the State of California JUN 2 1 2004 2'S4. KEVIN $H .LLEY, SECRETA OF STATE A. This corporation is a nonprofit PUBLIC BENEFIT CORPORATION and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for: public and charitable purposes. 11 B. Tbe specific purpose of this corporation is to provide educational opportunities and services for the Community through specific programs that focus on the various needs of people of all ages including but not limited to leadership and training and to provide hands-on experience for children, youth, and adults. ID The name and address in the State of California of this corporation's initial agent for services of process is: Harry G. McComas, IV 31400 Britton Circle Temecula, California 92591 IV A.. This corporation is organized and operated exclusively for public and charitable purposes within the meaning of Section 501(c)(3), Internal Revenue Code. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. V The property of this corporation is irrevocably dedicated to public and charitable purposes and no part of the net income or assets of this corporation shall ever inure to the benefit of any director, officer or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for public purposes and which has established its tax exempt status under Section 501(c)(3), Infernal Revenue Code. 117x. G. Mc .mas, IV, Incorporator COMMUNITY SERVICE FUNDING PROGRAM FISCAL YEAR 2011-12 TABLE OF CONTENTS Application, page 1, with following attachments: o Special Board Meeting Minutes o State of California I.D. # 2666112 Proof of nonprofit status o Criteria, page 1-2 Application, page 2, with following attachments: Financial Statements: o Statement of Activities —September 12, 2011 Application, page 3 — Project Description Application, page 4 — Past Project Benefits Application, page 5 — Signature Page l_utkeran Churck anchomd in Chriat.. HOPE LUTHERAN CHURCH G ...q - , dee e4, 7)a cut Pia, Ems aaroe. 29141 Vallejo Avenue, Temecula, CA 92592-2319 Office: 951-676-6262 Fax: 951-694-3451 Preschool: 951-694-3607 www.hopetemecula.org staff@hopetemecula.org September 15, 2011 City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, California 92589-9033 Dear Ms. McNabb: tV T$, Hope for All, Inc. submits this application for the Community Service Funding Program requesting $5,000.00, for the replacement of an outdoor canopy cover for the church's outdoor playground. We are submitting one original and one copy of Hope for All's application. Should you have questions or comments, please direct them to the undersigned. Sincerely -y �3 R. Embree, President `/Hope for All, Inc. Enclosures City of Temecula 2011-12 CS Funding Program APPLICATION NO. 18 CITY OF TEMECU A. City of Temecula SEP 15 2011 FISCAL YEAR 201 1.12 COMMUNITY SERVICE FUNDING PROGRAM APP iFION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ J ) 0 0 0 , 0 t) (Maximum allowable $5,000) Project Name: /-1-06-pi CC/ of'iz,c il(e rec/S Sco/ '6? -r Ass- s'han cz& Pro j k-zt� Project Start Date: No V, d D (1 Project End Date: JC't ORGANIZATION INFORMATION Name of Organization: H"OSp? (',e, o'1 +he 5 Contact Name: -161,-P-1--j 4 Z- k 014 Title/Position: Mailing Address: 025,2 L1O H r' c o c/6.. 4v'c . Telephone: 5( - :0 0 - `-7�Ov E-MailAddress:1Z( Z"K0 zc( tt0VSC Year Organization Founded: / 67'2— Geographic Area(s) Served: 5(-1,d"h w -e S I- kr' ✓e r s cue, Number of Paid Staff: S Number of Volunteers: ?' `f3 Is this organization incorporated in California as a non-profit organization? Yes No Effective Date: 1' SP- 3 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: /873 Federal identification number: `15 - 3 3 / ti State identification number: 3 01( -150V-a (P If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors ` Members -at -Large Application — Page 1 Co un FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Application - Page 2 Hospice of the Valleys Mission Statement Hospice of the Valleys has been offering loving care to people with life-threatening illnesses, support to their families and service to the community in a spirit of enriching lives since 1982. As the only non-profit hospice headquartered in Temecula Valley, we understand that coping with. terminal illness presents many challenges - physical, emotional and spiritual - to the patient and family. Our caring, experienced team of professionals and volunteers is prepared to meet those challenges and we believe that no one, regardless of illness, age or ability to pay, should die alone or in pain. We believe that everyone has the right to be surrounded by love as they complete their life. At Hospice of the Valleys, we are committed to providing the highest quality hospice care available. We have a company -wide integrated and comprehensive quality assessment/ performance improvement, (QAPI) program and we use nationally recognized, industry specific evaluation tools to measure our family satisfaction. These standardized tools were created by the National Hospice and Palliative Care Organization and are used by hospices all over the country to measure family satisfaction. Hospice of the Valleys scores are compared to other hospices in CA as well as other hospices around the country. Hospice of the Valleys consistently scores above state and national averages for providing "medicine to relieve the patient's pain", "patient treated with respect", "helped with patient's feelings of anxiety/sadness" and "help with patient's breathing." Each quarter, we consistently achieve the highest score from the families we serve that say they would recommend our hospice organization to others 100% of the time. We take pride in offering the highest standards of excellence in the provision of hospice care and count it a privilege to serve our community in such a vital and meaningful way. 25240 Hancock Ave., Suite 120, Murrleta, CA 92562 • 951-200-7800 • www.hospiceofthevalleys.orQ Hospice of the Valleys Mission We foster reverence for life, relief of suffering, and compassion in loss for the terminally ill residents and their families of Southwest Riverside communities. Vision Recognized leader of excellence in comprehensive end -of -life care. Values We seek to embody the hospice philosophy in all we do, including: the affirmation of life, promotion of self-determination, education, understanding, and acceptance. We dedicate ourselves to the values of compassionate care, loving presence, and the sustenance of hope for those dealing with the many difficult challenges at the end of life. We believe that transformation and healing are a part of the dying process and change all who participate in this sacred experience. We advocate sensitivity, attentiveness, and respect of all persons as we honor each life entrusted to our care. We support a culture of teamwork and professional collaboration. We embrace the calling to work diligently to provide leadership as educators and advocates for the suffering and dying in our community. We hold ourselves accountable for the valuable resources which we have been given and vow to use them responsibly. We are committed to the highest standards of personal and professional ethics and integrity and maintain the highest standards of excellence in the provision of care. We continue our professional growth through advanced training and educational certification. 25240 Hancock Ave., Suite 120, Murrieta, C4 92562 951-200-7800 www.hospiceofihevalleys.orI PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Application — Page 3 Hospice of the Valleys Senior Assistance Program Project Description Hospice of the Valleys (HOV) provides care for terminally ill patients and their families, addressing their personal experiences affecting the body, mind and spirit. This is accomplished through work of the corresponding members of the interdisciplinary team (Physician/ Nurse/Hospice Aide, Social Worker, and Spiritual Care Provider) who make house calls in a regular basis throughout the course of care. Many life -enriching, supportive activities are offered by HOV's 243 active volunteers, such as companionship, emotional support, reading, singing, holding a hand, caregiver relief, running errands, shopping, meal preparation, housekeeping, and legacy DVD interviews and recordings. HOV helps people fulfill their dying wishes by helping them find closure, validating the deep meaning of their life's purpose, helping them to accomplish all they wish before they die, and assisting in preserving their dignity. Temecula's population of 90,000 is growing at a very fast rate - an astounding 57% increase in the past 10 years. The number of people over the age of 65 grew approximately 24% over the same timeframe. The poverty rate in Riverside County is estimated at 12.6%, having increased significantly since 2005. Even those in our community that do not live in poverty are struggling to make ends meet. In 2011, approximately 50% of all Americans are underinsured and 15% have no coverage at all. For those with health insurance, all are finding their insurance no longer covers all the costs related to medical treatment. Many families are over -burdened with huge bills on top of having to face a terminal illness. Annually, HOV serves approximately 457 adults with terminal illness and a life expectancy of 6 months or less. 92% of the patients served are age 61 and over. Many come with no insurance, limited insurance coverage, or lack the resources to pay for the full cost of hospice care. HOV's goal is to ensure no one is turned away or provided limited hospice care due to inability to pay. In 2010 alone, through the generous support of donors and community partners, HOV was able to provide $75,604 in charity care — a significant feat considering the drastic reduction in non-profit organizations' ability to raise funds due to the ailing economy. HOV is requesting grant monies to benefit the citizens of Temecula and surrounding areas who are near the end of their lives through their Senior Assistance Program. The project objectives are to 1) increase access to hospice care for those with limited or no funding source; 2) enhance the experience of patients and families at end -of -life by providing tangible support and assistance in meeting their unique needs; and 3) further HOV's mission to "foster reverence for life, relief of suffering and compassion in loss." The monies provided by the Temecula Community Service Funding Program Grant will be used to extend our ability to pay for more patients to receive unreimbursed medications, durable medical equipment and medical supplies essential to provide the highest quality comfort care. The Senior Assistance program exemplifies our long-term commitment to meeting the needs of our community. As a responsible steward of public funds, we continue ongoing efforts to strategically fundraise, work to grow and nurture our donor base, build new funding relationships and raise awareness for meeting the vital needs of patients and families at end -of -life in the Temecula Valley. Budget - Hospice of the Valleys' spends an average of $25 per day for each patient to receive the following services: medications, durable medical equipment and medical supplies. Full funding from the City of Temecula Community Service Funding program will pay for direct costs only, enabling us to provide these vital services for 200 patient days for those who are underinsured or non-insured. In 2010, total HOV patient days were 33,647 and our funding request would cover 0.67% of total patient days. Although this is a small percentage, this grant would make a significant impact in the lives of our community members facing life's end. Thank you for your kind consideration of this proposal. 25240 Hancock Ave., Suite 120, Murrieta, CA 92562 • 951-200-7800 • www.hospiceofthevalleys.org PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. A/c / a/y,?-e,'64 b-' Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: (��`% 7.Cc, , �� � NAUt and TITLE (Please Print or Type) SIGNATURE: T -e encl 4 Z -t. L ORGANIZATION NAME: f+b S�)i (e. os MAILING ADDRESS: dl 5? ` A vt Cv c k- / v c n -Li C1) 5 k (2 - AAAA, NA, u. (4 7 .- (v TELEPHONE: q - c) O v — "0 E -Mail Address: ( %v v' S c , 0 r `' DATED THIS t of S.P.D+, , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judv.mcnabb(cr�citvoftemecula.ora 951-694-6479 Application — Page 5 12:01 PM 09/08/11 Accrual Basis Hospice of the Valleys Profit & Loss Budget Overview January through December 2011 Ordinary Income/Expense Income 3610 • Physician Visit Revenue 3000 Medicare -Ben Routine 3010 • MCD -Ben Routine 3020 • Commercial Benefit 3060 • Charity Income Jan - Dec 11 83,820.00 5,304,242.00 294,600.00 56,000.00 0.00 Total Income 5,738,662.00 Gross Profit 5,738,662.00 Expense 4000-1 • Salaries, Benefits & Related Ex 4,081,504.00 5000-1 • Patient -Related Expenses 964,352.00 6000-1 • Facility -Related Expenses 146,772.00 6500-1 • Admin. Expenses 340,818.00 6950 • Depreciation Expense 131,040.00 Total Expense 5,664,486.00 Net Ordinary Income 74,176.00 Other Income/Expense Other Income 7040 • Bequests 0.00 7000-2 • Support 42,850.00 7200-1 • Fundraising 97,350.00 7700-1 • Interest & Investment Income 3,000.00 Total Other Income Net Other Income Net Income 143,200.00 143,200.00 217,376.00 Page 1 2:12 PM 09/08/11 Accrual Basis Hospice of the Valleys Balance Sheet As of July 31, 2011 ASSETS Current Assets Checking/Savings 1040 • WF Investment 1030 • Wells Fargo Relationship 1004 • Commerce Bank Relationship 1008 • Rabobank MMA 0500 • Petty Cash 1018 • PayPal 1700-1 • Investments Total Checking/Savings Other Current Assets 1303 • Bequests & Donations Receivable 1300 • AR Patient Accounts 1302 • AR Room & Board 1330 • Other Receivable 1550 • Deposits 1501 • Prepaid Insurance 1500 • Prepaid Expenses Jul 31, 11 250,036.12 194,263.56 213,159.85 226,162.33 350.00 4,581.69 464,562.87 1,353,116.42 30,000.00 618,500.83 38,839.71 2,718.38 13,887.47 12,813.85 49,232.02 Total Other Current Assets 765,992.26 Total Current Assets 2,119,108.68 Fixed Assets 1900-1 • Fixed Assets 359,885.75 Total Fixed Assets 359,885.75 TOTAL ASSETS 2,478,994.43 LIABILITIES & EQUITY Liabilities Current Liabilities Accounts Payable 2000 • Accounts Payable 147,802.56 Total Accounts Payable 147,802.56 Credit Cards 2500 • Commerce Bank Visa 2,571.22 Total Credit Cards 2,571.22 Other Current Liabilities 2009 • Accounts Payable --Accrued 29,775.94 2110 • Accrued Payroll 86,375.98 2200 • Accrued Payroll Ben Liabilities 74,269.68 2301 • BancLease - ESI Phone System 8,795.12 2400 • Deferred Rent 11,654.37 Total Other Current Liabilities Total Current Liabilities Total Liabilities Equity 2920 • Temporarily Restricted 2901 • Retained Eamings—Undesignated Net Income 210,871.09 361,244.87 361,244.87 11,275.00 1,940,762.82 165, 711.74 Total Equity 2,117,749.56 TOTAL LIABILITIES & EQUITY 2,478,994.43 Page 1 1:42 PM Hospice of the Valleys 09/08/11 Profit & Loss Accrual Basis January through July 2011 Ordinary Income/Expense Income 3750 • Medical Records 3610 • Physician Visit Revenue 3000 • Medicare -Ben Routine 3010 • MCD -Ben Routine 3020 • Commercial Benefit 3060 • Charity Income Jan -Jul 11 0.00 44,154.09 3,134,645.24 141,874.06 143,882.87 0.00 Total Income 3,464,556.26 Gross Profit 3,464,556.26 Expense 4000-1 • Salaries, Benefits & Related Ex 2,446,236.54 5000-1 • Patient -Related Expenses 595,681.31 6000-1 • Facility -Related Expenses 86,307.92 6500-1 • Admin. Expenses 196,515.80 6950 • Depreciation Expense 72,340.00 6999-1 • Unclassified 0.00 Total Expense 3,397,081.57 Net Ordinary Income 67,474.69 Other Income/Expense Other Income 7040 • Bequests -1,469.91 7000-2 • Support 19,584.18 7200-1 • Fundraising 68,798.17 7700-1 • Interest & Investment Income 11,324.61 Total Other Income Net Other Income Net Income 98,237.05 98,237.05 165,711.74 Page 1 • +�rial Revenue Service District Director Date: JUN 2 ° .1983 Hospice of Sun City Incorporated 27851 Bradley Rd. Sun City, CA 92381 Department of the Treasury E ployer Identification Number: Accounting �tti December 31 Foundation Status Classification: 509(a)(1) and 170(b)(1)(A)(vi) Advance Ruling Period Ends: December 31, 1984 Person to Contact: I. Hill Contact Telephone Number: (213) 688-4889 Dear Applicant: Based on information.supplied, and assuming ydur operations will be as stated in your application for recognition o tip we have determined you are exempt from Federal income tax'under sec on 501(c)(3) of the Internal Revenue Code. . Because you are a neWly create dorganization, we are not now making a final determination of your foundation status under section 509(a) of the Code. However, we have determined that you oan reasonably be expected to be a publioly supported organization described in section 509(a)(1) and 170(b)(1)(A)(vi). 'Accordingly, you will be treated as a publicly supported organization, and not. as a private foundation, during an advance ruling period, This advance ruling.period begins on the date of your inception and ends on the date shown above. Within 90 days after the end of your advance ruling period, you must submit to us information needed to determine whether.you have met the requirements of the applicable support test during. the advance ruling period. If you establish that you have been a publioly supported organization, you will be olassifi.ed as a section 509(a)(1) or 509(a)(2.) organization as long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, you will be classified as a private foundation for future periods. Also, if you are olassified as'a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940, Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your. advance ruling period. If you submit the required information within the 90 days, grantors and donors may continue to. rely on the advance determination until the Service makes a final determination of your foundation status. However, if notice that you will no longer be treated as a section 509(a)(1)** organization is published in the Internal Revenue Bulletin, grantors and donors may not rely on this determination after the date of such publication. Also, a grantor or donor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in your loss of section 509(a)(1)** status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from • classification as a section 509(a)(1)** organization.. P.O. Box 2350, Los Angeles, Calif. 90053 ** and section 170(b)(1)(A)(vi). (over) Letter 1045(D0) (6-77) Ph: (951) 200-7800 25240 Hancock Avenue, Suite '120 • Murrieta, CA 92562-5991 Fx: (951) 973-7760 Judy McNabb City of Temecula Community Service Funding Program 41000 Main Street Temecula, CA 92590 September 15, 2011 Dear Judy, Please accept the enclosed two copies of Hospice of the Valleys' grant proposal for the Community Service Funding Program. We are requesting funding for our Senior Assistance Program to benefit patients and families who are uninsured or under -insured in our community and experiencing end -of -life. We are hopeful that you will find this project worthy of funding and look forward to working with you in the near future. Sincerely, e vvy L Terry Azkoul Executive Director Serving Southwest Riverside County Since 1982 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 19 CITY OF TEMECUI.A FISCAL YEAR 20 1 1.12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) urs, Program ember 1; ubm ssiton Deadline; originel,�plu PROJECT INFORMATION Amount Requested: $ 6000 (Maximum allowable $5,000) Project Name: Project Start Date: (' cy\ber 2611 Project End Date: Uc i kSr 2.0 \2. ' lam: i. -Lc )C¼4- �csn ,�1ct1 ORGANIZATION INFORMATION Name of Organizati n: Contact Name: C ,,v, e. ,‘A\5erTitle/Position; cci Mailing Address: l.` Ct aJ �`�C\e C~ lit k - 2 m-e.CA.LAQ C-rt�1Q 9O Telephone: Ct5\ D"{?)33149 E -Mail Address: (° v a1.65exi c .� Ll ad i Ickec1 Year Organization Founded: 1 Cn tD Geographic Area(s) Served: J L.1.4► j an Number of Paid Staff: Number of Volunteers: Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 1°1(316 —1(316 if "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: Ma ut 1-7 I 1(19_5 Federal identification number: 3 -- u ") I a.? LA j State identification number: If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application -- Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT See attached Mission Statement, financial statements, budget, previous audit, and letters from the community Institute for Children's Aid (ICA) DBA began in 1990 with its principle office in Temecula, California, and is a non-profit 501(c) 3 organization. ICA was built on the foundation of Hospitality and Sanctuary seeking to be a voice for those who cannot speak for themselves believing that all life is sacred. There are several programs involved with the Institute to include adoption, foster care, unaccompanied minors, fair trade, immigration, humanitarian aid, and hosting programs. However, ICA is seeking funding for their Children's Peace Exhibit. The Children's Peace Exhibit is a one of a kind exhibit, not duplicated anywhere. It is the result of over 30 years of research, traveling and experience discovering the needs of children worldwide. It is registered as a children's museum with several associations because of its uniqueness. Please see the Project Description for further details. The purpose of the Exhibit is to educate others as to the plight of children worldwide and ways in which each one of us can make a difference. It has interactive stations as well as fantastic artwork. Some exhibits are from other museums around the country displaying a refugee camp, the Holocaust, child soldiers and other child rights challenges rarely seen or talked about. The Temecula Valley has already benefited from the Mobile Peace Exhibit and has made the following comments: "I am shocked at the things happening to children in our own community and in other countries. I hope I can make a difference someday." -Jason 16 years old, Temecula Resident "Why doesn't anybody talk about these problems happening? I can't believe that we don't even see or hear about it." - Student Paloma Valley High School, freshman "This exhibit motivates me to do something that makes a difference with my life." - Melissa 17 years old, Student Calvary Chapel Christian School "I'd been exposed to some levels of information but had not "walked" in a child's shoes as I did during my visit." -Vanessa Vazquez, Supervisor Olive Crest Other Exhibit viewers include: Former Mayor Mary Ann Edwards, Tamra Middlecamp, City Managers Office, Cal Baptist professors, several Pastors and church leaders in the community, NACSW California Chapter Glenda Gordon, International delegates from the Philippines, Azusa Pacific Professors, and Temecula Girl Scout Troup 785. ICA is COA and ECFA accredited for quality management and fiscal responsibility. We have annual audits and consult with Nigro & Nigro as our controllers. We have a diverse staff and devoted to serve all persons in the community. We collaborate and have long working relationships with a wide range of organizations, including local Native Indian tribal organizations, orphan care organizations, and county social services. We are a faith based organization; however we are not affiliated with any church or denomination. Our services are free from religious discrimination and political agenda. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) The funding that is awarded to Institute for Children's Aid will be allocated to the Children's Peace Exhibit, specifically for the development of the Mobile Exhibit. Participants in the Children's Peace Exhibit experience the issues facing children today, i.e. child trafficking, bullying, child abuse and neglect, discrimination, homelessness; all through the eyes and ears of a child. The Exhibit is specifically designed with DVD's, games, hands-on experiences, and arts and crafts to reach young people and adults on many levels. The exhibit concludes with a Hope center which gives several ways that they too can make a difference and displays artistic photos of children who need to find loving families. Many schools, clubs and organizations due to the decrease in their budget are not able to go on outside fieldtrips or provide enrichment programs for their students and young people. Through the mobile peace exhibit ICA is able to go into the Temecula community to provide education and enrichment to schools and other community programs. We have and want to be considered a community resource and educational center that provides life changing results for our youth today. The mobile exhibit is part of a full curriculum provided to educators and community leaders that they can choose to take part in. ICA provides professional staff that loves children and can relay information about how they can help youth in their own community and world wide. Temecula valley is growing in diversity and the Children's Peace Exhibit can provide an excellent resource. ICA's goal in the next year is to reach Temecula Valley's high schools (public, private, and charter), a variety of service clubs, and children through the county foster system to offer education through classroom presentations and the mobile exhibit to bring awareness about children's rights. Our goal and anticipated schedule of activities include: monthly educational conferences for educators/social services/lawyers, at least one group (school, community, church, etc.) per week scheduled for the exhibit, and ongoing educational services provided to the community. We currently have five volunteers that are committed to helping the development of the exhibit and its education. We offer community service hours to high school students and college units/internships to college students. A TTACHMENTS: Section One 1. Mission Statement Section Two 1. 501(c)3 verification letter 2. State of California Licenses 3. COA Accreditation Section Three 1. Project Budget Sheet 2. ICA Organization Budget Sheet 3. 2009-2010 Audit Section Four 1. ICA 2010-2011 Annual Report 2. Letters of Support 3. Newspaper Article Application — Page 3 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. 1� -1 PREPARED BY: C' �'�� �t% \���� 1P 4'l (� )(Co r,i��1`� aJ l re(' -Vor d NAME and TITLE SIGNATURE: Print or Type-) a.t PRESIDENT or AUTHORIZED OFFICER: 4--4(A-14.13( 1/ ! �r 7C� SIGNATURE: NAME and TITLE (Please Print or Type) ORGANIZATION NAME: 111-"\"\ tU?r UC C `1 \\A\ CP `1sgi)\C\ MAILING ADDRESS: LI \;�J ul vy-v ec UAAa c ot2`.9 0 TELEPHONE: C\ --i (). E -Mail Address: C S-Dat-A_ke\:\ « Clark 01.6 DATED THIS 1 5 of SegArn\OeC , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judy.mcnabb@cii<yoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 Mobile Children's Peace Exhibit Equipment Needed/replacement/maintenance Cost Portable DVD players for 12 stations $1000 Headphones (12) $360 Stands for DVD players and information (12) $480 24in flat Screen TV's (2) $800 Art and Screen Printing for mobile stations $1500 Easels and Materials for Children's Hope Center and Gallery (displays photos of children who need homes) $150 Teachers Curriculum Materials $1000 Children's Fair Trade Supplies $1000 Total $6290 Institute for Children's Aid Budget Ordinary Income/Expense Jul '11 - Jun 12 Jubilee Exchange 2,250.00 Coffee Shop 120.00 Peace Exhibit* 8,600.00 Sinai Immigration 10,800.00 Total 21,770.00 Expense Advertising 600.00 Ad/Marketing Mobile Exh. 2,400.00 Auto 600.00 Exhibit supplies 240.00 Postage 1,200.00 Rent 8,400.00 Staff Expense 240.00 Telephone 300.00 D and 0 Insur 780.00 Liability 1,200.00 Medical Insurance Workers Comp Insurance 168.00 Electric Utility 300.00 Gas Utility 48.00 Wages 4,800.00 Payroll Taxes 480.00 Total Expense"' 21,756.00 Net Income 14.00 *Anticipate $5000 grant from City of Temecula for Mobile Exhibit **Anticipating additional expenses for Mobile Exhibit after grant International Christian Adoptions Supplemental Schedule Institute For Children's Aid Peace Exhibit June 30, 2010 During the year ended June 30, 2010 the Organization rented additional space which was renovated to create a Children's Peace Exhibit and Fair Trade store. The Organization plans to use the Exhibit as an outreach in order to bring awareness to the local community of children's plights around the world. The Exhibit is opening in August 2010, and various events have been planned during the upcoming year for the entire community. In addition to the Exhibit, a conference center is available to be used for training and educational camps for professionals, schools, community groups, lawyers, and social service providers. The Exhibit will also have a store, which will feature fair trade certified products from artisans around the world. All of the organizations whose products are available in the fair trade store have a direct relationship to the causes demonstrated in the Exhibit. Although International Christian Adoptions has set up and funded this Exhibit, the goal is for the exhibit to become self-sustaining and assist the Organization in finding interested people to further its mission. Expenses related to the Exhibit for the year ended June 30, 2010 are as follows: Children's Global Jubilee Sinai Peace Children's Exchange Immigration Exhibit Conference Fair Trade Store Aid 2010 Education & training $ 310 $ 607 $ 917 Equipment/tools $ 6,158 $ 2,850 1,201 10,209 Peace exhibit 1,040 1,040 Office expenses 101 101 Postage & delivery 16 16 Rent 1,500 1,500 Utilities 115 115 Total $ 8,930 $ 310 $ 2,850 $ 1,808 $ 13,897 S-2 Vander Spek & Corsello CPAs - A Professional Corporation INDEPENDENT AUDITOR'S REPORT To the Board of Directors International Christian Adoptions We have audited the accompanying statement of financial position of International Christian Adoptions, a nonprofit organization, ("Organization") as of June 30, 2010, and the related statements of activities, changes in net assets, functional expenses, and cash flows for the year then ended. These financial statements are the responsibility of the Organization's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards and provisions require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of International Christian Adoptions as of June 30, 2010, and the changes in net assets and its cash flows for the year then ended in conformity with accounting principles generally accepted in the United States of America. In accordance with Government Auditing Standards, we have also issued our report dated September 10, 2010, on our consideration of International Christian Adoptions' internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the result of our audit. Our audit was conducted for the purpose of forming an opinion on the basic financial statements taken as a whole. The accompanying supplementary information is presented for the purpose of additional analysis and is not a required part of the basic financial statements. Such information is the responsibility of management and was Members of American Institute of Certified Public Accountants and Califomia Society of Certified Public Accountants 350 W. Fifth Avenue, Suite 300 Escondido, California 92025 Voice 760-741-2659 Fax 760-743-7428 12631 E. Imperial Hwy., Suite 117E Santa Fe Springs, California 90670 Voice 562-864-2504 Fax 562-864-1109 www.VanderSpekCPAs.com derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the information is fairly stated in all material respects in relation to the financial statements. The prior year comparative information has been derived from International Christian Adoptions' 2009 financial statements and is presented for purposes of additional analysis. In our report dated September 2, 2009 we expressed an unqualified opinion on those financial statements. Escondido, California September 10, 2010 6,,LtelkCP� INTERNAL REVENUE SERVICE DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 Date MAY 1 7 1995 INTERNATIONAL CHRISTIAN ADOPTIONS C/0 LAURA DUKE 41745 RIDER 2 . TEMECULA, CA 92590-4826 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 33-0412343 Case Number: 955130011 Contact Person: TYRONE THOMAS Contact Telephone Number: (213) 894-2289 Our Letter Dated: November 26,. 1990 Addendum Applies: No This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 501(c) (3) is still in effect. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Code because you are an organization of the type described in section 509(a)(2). Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a) (2) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a) (2) organization. Aa of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes} on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). You are required to file Form 990 only if your gross receipts each year are normally more than $25,000. For guidance in determining whether your gross receipts are "normally" more than $25,000, see the instructions for Form 990. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return im filed late, unless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $5,000 or 5 percent of your gross receipts far the year, whichever is less. This penalty may also be' charged if a return is not complete, so please be sure your return is complete before you file it. If we have indicated in the heading of this letter that an addendum Admili.a, an& addandt mr .n.lor.d La an inb.Sral pub of Shia l.t sw. Letter 1050 (DO/Ca) -2 - INTERNATIONAL CHRISTIAN ADOPTIONS r Because this letter could help resolve any questions about your private foundation status, .please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, Richard R. 0rosco District Director Letter 1050 (DO/CG) 101011511111,111111111113111211*. State of California Department of Social Services Facility Number: Effective Date: 330600007 12/14/93 Total Capacity: In accordance with applicable provisions of the Health and Safety Code of California, and its rules and regulations, the Department of Social Services, hereby issues this License to INTERNATIONAL CHRISTIAN ADOPTIONS to operate and maintain a FOSTER FAMILY AGENCY Name of Facility INTERNATIONAL CHRISTIAN ADOPTION FFA 41745 RIDER WAY, #2 TEMECULA CA 92590 This License is not transferable and is gg�ranted solely aeon the following PLACEMENT AND SERVICES FOR CHILD`r4EN THROUGHOUT THE STATE OF CALIFORNIA Client Groups Served: CHILDREN Complaints regarding services provided in this facility should be directed to: SANTA ANA DISTRICT OFFICE (714) 558-4563 MARTHA LOPEZ Deputy Director, Community Care Licensing Division c.% rIt < <l%Z:14Zllly1,x--7 Authorized Representative of Licensing Agency 0 C ZC ;IA {19d) Facility Number: 330600006 Effective Dale: 12/14/1990 In accordance with applicable provisions of the Health and Safely Code of California, and its rules and regulations; the Department of Social Services, hereby issues INTERNATIONAL CHRISTIAN ADOPTIONS INTERNATIONAL CHRISTIAN ADOPTIONS 41745 RIDER WAY, #2 TEMECULA CA 92590 This License is not transferable and is granted solely upon the following: FULL SERVICE ADOPTION AGENCY PROVIDING ADOPTION SERVICES UNDER THE AGENCY ADOPTION PROGRAM THROUGHOUT CALIFORNIA. ALSO, FULL SERVICE ADOPTION STATEWIDE FOR INTERCOUNTRY AND DOMESTIC ADOPTIONS. Client Groups Served: CHILDREN Complaints regarding services provided in this facility should be directed to: MARTHA LOPEZ Deputy Director, Community Care Licensing Division Authorized Reprns of Licensing Ager C10.1)18111 11, • I? f1.l.H1 tv • AT:IIII;%I M1\T Richard Kfarberg President & Chief Executive Officer Sister Ann P. Conrad Chair. Board of Trustees Sponsoring Organizations AIliaric:e for Children and Families Association of Jewish Family and Children's Agencies Catholic Charities USA Children's Moine Society oI Arnerica Chid We:fare League of America Foster FamityBased Treatment Association Joint Council on International Children's Services l utheran Services in Arnerica National Council For Adoption National Foundation fur Credit Counseling National Network for Ycuth National Organization of State Assert rations for Children Volunteers of Arnerica Council on Accreditation 120 Wall Street 1 l th f Iorr' New York, NY 1(X)05 212 797.3000 Fax 212 797 1428 www.coanet.org November 3, 2009 Dear Sir/Madam: I am pleased to write to you in support of International Christian Adoptions, located at 41745 Rider Way #2, Temecula, CA. 1 am certain that you will be as proud to work with this organization as we were in accrediting them. International Christian Adoptions is currently Hague accredited through May 31, 2012 by the Council on Accreditation (COA). COA is an independent not-for-profit international accreditor of the full continuum of community-based behavioral health care and social service organizations for 30 years. The Department of State has designated COA as a national accrediting entity to accredit and approve adoption service providers pursuant to the Hague Convention, the Intercountry Adoption Act, and the regulations set forth in 22 CFR Part 96. Hague accreditation is an objective and reliable verification that organizations such as International Christian Adoptions qualify for your confidence and support. The Hague accreditation process involves a detailed review and analysis of an agency's administrative operations ---including financial practices ---and its service delivery practices. All are "measured" against the standards set forth in 22 CFR Part 96. These standards emphasize services that adoption services are provided ethically and in accordance with all applicable foreign, federal and state requirements. An additional endorsement of COA and the value of its accreditation process are reflected in it being named the only national accreditor designated by the U.S. Department of Defense to develop accreditation standards and processes for human service programs provided to military personnel and their families. To achieve Hague accreditation, international Christian Adoptions first provided written evidence of compliance with the standards. Thereafter, a group of specially trained volunteer Evaluators confirmed compliance with these standards during a series of on-site interviews with trustees, staff and clients and a review of case files and other records. (.I l I Icr, 111 \r OI i; 30 l r I:• r ri SI is\ it 1 November 3, 2009 Page 2 Based on their findings, our volunteer -based Accreditation Commission voted that international Christian Adoptions had successfully demonstrated substantial compliance with the standards and met the criteria for accreditation. At this time, we have no reason to believe that International Christian Adoptions has made any significant changes to their policies and/or procedures that would justify our reconsidering their accreditation status. We will be pleased to provide you with any additional information that you may require as you review International Christian Adoptions' request. Please feel free to contact ane either by email at rl<larberg1coanct.org or by telephone at 212.797.3000, extension 260, if you have any questions. Sincerely, Richard Klarberg President and Chief Executive Officer C;ri I %I I \C. 0% III 30 1.1..11:, SI. I(\ r ACCREDITATION w 0 H U H U is in Substantial Compliance with the provisions of Title 22 of the Code of Federal Regulations, Part 96 and is Hague Accredited fi ,O fi A.44 ks • g ca •w a • ,o V V fi '� 4 v O 000 tsi INSTITUTE FOR CHILDREN'S AID A Voice, of if ( OP for Ch : re.v W ortd/wLde- MISSION STATEMENT Institute for Children's Aid (ICA) dba began in 1990 with its principle office in California. ICA was built on the foundation of Hospitality and Sanctuary seeking to be a voice for those who cannot speak for themselves believing that all life is sacred. ICA's mission is to: • Promote and secure the emotional, spiritual and physical welfare of children who have been victimized, abandoned or persecuted; found in the streets, war zones, government run institutions, refugee camps or family homes. • Actively engage in providing immigration and refugee resettlement services to those fleeing persecution, war, oppression and poverty. • To provide an environment of peaceful and humanitarian exchange to foreign students and those who go abroad. • To offer an environment where hard working artisans can be paid a fair wage and be given the dignity of self determination through fair trade. • To provide opportunities for orphans to experience culture and sense of family with camps to America and in their country. • To widen the horizons of Americans by sending them to foreign countries to experience differing cultures through a myriad of work projects, camps and activities. • Maintain a Hague compliant licensed child placement agency under a different name in accordance with the laws of the State of California in order to provide temporal foster care and adoptive placement. • Maintain several programs to enhance ICA's mission which is not limited to but includes immigration and refugee resettlement services; foreign student exchange program; fair trade; cultural camps; mission programs and tours, and other social service programs. 41745 Rider Way, #2 Temecula CA 92590 1 951.695.3336 1 951.308.1753 1 info@4achild.org 1 www.4achild.org r• _i A. ' C INSTITUTE FOR CHILDREN'S AID me \ Voice of HOPE' for Children Worldwide i 410. 1� 7 41745 Rider Way. 111 Temecula. CA 92590 Tet: (951) 695-3336 F: (951) 308-1753 E:infoQ4achild.org W:www.4a �1lMC?N STATEMENT Institute for Children's Aid (ICA) dba began in 1990 with its principle office in California. ICA was built on the foundation of Hospitality and Sanctuary seeking to be a voice for those who cannot speak for themselves believing that all life is sacred. Institute for Children's Aid mission is to: • Promote and secure the emotional, spiritual and physical wel- fare of children who have been victimized, abandoned or per- secuted; found in the streets, war zones, government run insti- tutions, refugee camps or family houses. • Actively engage in providing immigration and refugee resettle- ment to those fleeing persecution, war, oppression and pov- erty. • To provide an environment of peaceful and humanitarian ex- change to foreign students and those who go abroad. • To offer an environment where hard working artisans can be paid a fair wage and be given the dignity of self determination through fair trade. • To provide opportunities for orphans to experience culture and sense of family with camps to America and in their country. • To widen the horizons of Americans by sending them to for- eign countries to experience differing cultures through a myr- iad of work projects, camps and activities. • Maintain a Hague compliant licensed child placement agency under a different name in accordance with the laws of the State of California in order to provide temporal foster care and adoptive placement. • Maintain several programs to enhance ICA's mission which is not limited to but includes immigration and refugee resettle- ment services; foreign student exchange program; fair trade; cultural camps; mission programs and tours; and other social service programs. TME cIElLw;REN's PEACE EXHILT Institute for Children's Aid presents the first registered museum of it's kind to the Temecula Valley in Southern California... The Children's Peace Exhibit offers an interactive journey for children and adults of all ages, where they travel through the complexity of contemporary issues affecting children on a global scale. Children and Adults start their journey with their own exhibit passport and work through 14 exhibits tackling problems that many children face such as child abuse, child slavery, child labor, war, refugees, homelessness, hunger, education and others. Each exhibit is designed to equip and inspire its visitors to learn the facts, identify the problem and become an important advocate for change. To complete the journey, children will enter the Hope Center where they can discover how to help other children and families through available local and global organizations and other resources! In 2010-2011, the Children's Peace Exhibit was visited by a variety of junior high, high school and college students, youth groups, at -risk kids, church leaders, local profes- sionals, human rights advocates, visiting foreign dignitaries, and several city leaders. Children and adults who were moved with compassion and left cards on the Exhibit's Hope Tree, expressing their reflections and hope for change. Ate Lc1C v.l)n�jy5 ) 1014,... 1-1 o P E God gill3vs sfe»'{ -fl, iD reach oGi nude LAO Sir aorJYdc to $ .tl,r Keie ,, WC. 4<ai fu 14. (t MR - /114 savior. OB1LE PEACE ExHIBrr CHI LL RIGHTS The Mobile Peace Exhibit was purposely made to carry forth the mission to educate and equip the communities and bring these children's issues to the public. As a miniature sampling of the Children's Peace Exhibit, it carries vital statistics, descriptions and short video/audio presentations to educate its' numerous viewers. It made it's debut appearance at St. Lucy Priory School in Glendora in April 2011 as the girls were being educated about human trafficking. Nearly 2,500+ adults and children have walked through the Mobile Exhibit since it's creation in April 2011. It was also happily received and walked through by several donors, funders, students and families at a fundraising event combating Human Trafficking at Azusa Pacific University as well as a Global Mis- sions Initiative at Calvary Chapel Murrieta in May 2011. The Mobile Exhibit inspires its visitors to invest their resources in local and global organizations which support children, families and communities by pur- chasing fair trade products associated with these social justice issues from ICA's Jubilee Exchange Store. . dirt 3s i_ -ya h ir: %AY2 in stppc ii p nn• organizations.'etlurehes within the surroundipg . r r '-; fQre'n ces. events:arid-seminars advocating for. children's weiftar'q and social justice. • •._. r - JUBILEE EXCHANGE A New & Ethical Marketplace! The Jubilee Exchange store is a wholesale retailer oa fair trade products. Seeking to "jump on board" with the dynamic fair trade movement that is rapes, or ing in precedence worldwide, it promotes connecng producers and consumers in etilicek rading part gar- ships. Jubilee Exchange brings many fun and inction gifts and products by partnering with a vast network of fair trade organizations such as Equal Exchange, SERRV, Divine Chocolate, UPAVIM (Guatemala), Bridge for Africa, and Native Harvest (USA), to name a few. Ntjorrti a kan&-ovf, iF s a 0404 'or wide. io ktip ptoett. Por fkt, iottlg—ttrnc, The sales from the Jubilee Exchange store are used to do good and make a positive difference in the lives of children, families, and communities worldwide. Su PPLEMENTAL CHARTS 7000 6000 5000 4000 3000 2000 1000 Income and Expense by Month July 2010 through June 2011 .v PpQc Q• ti he' 04c p, til til ti C) Q2o a's `�yti ti~ ti �1` QQ 43> 1J ti 2% ■ income ■ Expense Expense Summary July 2010 through June 2011 ■ Rent ■ Cost of Goods Sold ■ Office • Equipment • Bank Fees/Bank Card Charges • Licensing Fees • Utilities Shipping/Handling Auto. Membership Fees HUMANLTARLAN AID Each child that participates in an adoption camp called "Welcome Home" is provided two 50 Ib. bags of humanitarian aid items. Several churches in the Riverside and San Diego counties par- ticipate in sponsoring events, announcing and inviting families and individuals to participate in the events or in donating Hope Paks in support of the children. This year, Humanitarian Aid was distributed to children in Mexico and the Philippines and foster children in California. Additionally, for the 2010-2011 year, My Stuff Bags Foundations generously granted ICA 500 duffle bags filled with travel -sized hygienic products, blankets, toys, books/puzzles for distribu- tion to the many foster care children and foster care agencies in the California counties. They were distributed to care children in Tulare and Riverside Counties. • nf, 01 .. Child Welfare Services (00111.1001 • AO09(b %r U{mAM: i Ways to Give: • • Hope Paks (Humanitarian Aid Gifts) • Gift of Life Fund I • Child Sponsorships • Gift Shoppe Items I • Family Sponsorship Fund • Monetary Donations/Gift Cards PALOMA VALLEY HIGH SCHOOL To Whom It May Concern, 31375 Bradley Road Menifee, California 92584 (951) 672-6030 September 13, 201 1 The Institute for Children's Aid (ICA) has become a great resource to educators. ICA's staff is very active in bringing their eye-opening cause to schools. They have taken part in conferences at colleges by leading seminars on International Adoptions and also Fair Trade Products. ICA sent staff as a guest speaker to my high school to speak to my students about Fair Trade products and Human Trafficking. I teach AP Human Geography, which focuses on many global issues including human rights and economic development. Many students in my class were inspired that a local non-governmental organization was actively seeking to help improve the lives of children around the world. ICA seeks to bring their message to many students around Southern California, but they also offer a unique experience to those who visit them. At iCA's main office in Temecula is a new exhibit dedicated to children's rights. The Children's Peace Exhibit does a wonderful job of exposing students to the plight of many disadvantaged youth across the world. ICA's staff has done an excellent job of developing lesson plans that teachers can utilize to prepare students for a field trip as well as for debriefing. There are lesson plans that cover all levels, from elementary to high school and that last for one day or multiple days. The Children's Peace Exhibit does a great job of providing multiple ways of appealing to many different students with their various modalities: from music to visual arts to hands-on interactive displays to multimedia presentations. ICA has taken the time to make sure their Children's Peace Exhibit can accommodate many different educators and their specific needs. On top of all this, this exhibit is free. America today, especially Southern California, is notoriously unaware and in denial about many problems that children face today, both home and abroad. Globalization is powerful, as seen in many events from terrorist attacks to the banking crisis to new emerging markets in Asia, has created a huge need for today's youth to be aware of world issues. The same technology that allows this globalization to take place also allows many Americans to isolate themselves in their own worlds through I -Pods, cell phones and Facebook. ICA's unique efforts to raise awareness on these global issues put them in a great position to help educators to open their students' eyes. Sincerely, Andrew Paulsen September 15, 2011 Jim Jenson Institute for Children's Aid 41745 Rider Way #2 Temecula, CA 92590 Dear Jim, I wanted to thank you and your organization for the wonderful experience my Girl Scout Troop had at the Children's Peace Exhibit. My daughters and their fellow Girl Scouts came away from the exhibit inspired to help children in the world less fortunate then themselves. Our troop contacted World Vision and received information about how we could help other children. We raised money and through World Vision purchased a goat, 2 ducks, and a well for a needy family in Africa. I have told our Girl Scout Southwest Region leaders about your exhibit and our positive experience. They are going to add it to their list of activities for troops in our region. I liked the fact that the exhibit could be adjusted for most age groups such as juniors, cadettes, and senior Girl Scouts. Thank you again. Your exhibit has left a lasting impression on all of us. Sincerely, Claire Smith oz_c4x,u)S,1-a--0 Leader of Troop 785 Southwest Region, San Gorgonio Council SEP -14-2011 10:00 FROM: " tL�. V , C o-"6 fb 6/ lEIL- September 14, 2011 Tt1:9 ,2)R1 75 P.2'2 I would like to offer my support of a great organization in our valley called ICA. I have had the opportunity to visit their fair trade store, go through their children's exhibit, and help advertise the various opportunities to foster children. risk in our world, I love what they stand for and what they're doing, There are so many children at through their exhibit, they as well as in our own valley. They not only create awareness the safety speak at various conferences and forums to promote of children. When I personally went through their exhibit, I was at a loss for words. My heart was stirred and broken. Although I was already aware of the many ways children in the world are being exploited by being stripped of their basic human rights, the exhibit made it even more real. One of the most significant things about the Peace Exhibit was the hands-on aspect of it. You actually take part in each station and try to imagine what it would be like to have no water, or live on the street, or even be a child soldier. I have recommended that many people go on a field trip to ICA, from individuals to youth groups to home school groups. I know the exhibit would make a major impact on them, whether they are a child or an adult. It's the only one of its kind. I believe that every teacher in our valley should take their children through this exhibit to expose them to the important information that it provides. Not only would it provide education and awareness, it hope -fully will stir many hearts into action to become involved in some way and help make a difference. Our society often needs to be reminded that the "world" isn't just about "us," and many countries don't share the same advantages and blessings that we in the west are privileged with. The fair trade store that they run is also fantastic. It's the only fair trade store in the community. They have worked hard to make the community aware of what's happening globally and offer opportunities to help people all over the world earn fair wages, send their kids to school, and make better lives for those in developing countries. Although I know they are mostly known for their adoption work, they do so much more. They care about all children, all over the world, and will help in any way they can. I enthusiastically support and love the work of ICA and would love to see this organization grow and become more well-known in the community. It supports one of the greatest causes in this world; our basic human rights. Sincerely, Kelly Bell Women's' Ministry Director, Calvary Chapel Murrieta 24225 Monroe Ave. - Murrieta, Ca. 92562 - Phone 951.677.5667 - Fax 951.698.4896 FRANK BELLINO RE PRESS -ENTERPRISE Kacie Macdonald with Institute For Children's Aid in Temecula demonstrates what kids have to do as part of child labor at the Children's Peace Exhibit. THROUGH THE EYES OF KIDS Temecula exhibit focuses on the plight of disadvantaged children BY TIFFANY AUSTIN-SUNIGA SPECIAL TO THE PRESS.EATEAPRISE When the Institute for Chil- dren's Aid began in 1990, It was built on a foundation of hospitality and sanctuary, with the intent to be a voice for those who could not speak for themselves. Now, 21 years later, the Temecu- la -based organization continues to educate young people about the plight of less fortunate children around the world through the Children's Peace Exhibit. The exhibit is geared toward children ages 10 and olderand features interactive stations and artwork. Led by a docent, participants begin by choosing a role tolay SEE CHILDREN/C5 CHILDREN CONTINUED FROM Cl throughout the exhibit. Ev- ery station includes a video and activity unique to the role the participant has cho- sen to play. It begins by discussing children's rights worldwide, demonstrating the rights that children ideally should pos- sess. Then, according to Kacie Macdonald, assistant director for international social ser- vices, it addresses issues such as child abuse, child soldiers, trafficking, war, refugees, gen- ocide, the Holocaust and child labor. It concludes by discuss- ing a child's right to a family, education and play. After the going through the exhibit, children are encour- aged to join in a drum circle, including a discussion and ac- tivities that help them formu- late solutions to end mistreat- ment of children worldwide. Macdonald said the exhibit, FRANK BELLINO/TNE PRESS-ENTIRPRISE Kacie Macdonald stands next to some of the Children's Peace Exhibit that shows the plight of children worldwide. though not intended to disturb the children, can be very emo- tional for some due nature of the information and how it is depicted. Macdonald added it is age appropriate. "The goal is to raise aware- ness about these issues and help people move towards ac- tion. We don't want people to feel overwhelmed by the enor- mity of the problems, but em- powered by knowledge and by the ways they can make a difference," Macdonald said. The Children's Peace Exhib- it is open Monday -Friday 9 a.m.-5 p.m., but the Institute is willing to accommodate groups that cannot fit .that schedule. The exhibit is at 41745 Rider Way, unit 2, Temecula. Information: www.institu- teforchildrensaid.org• Tiffany Austin is a Press -Enterprise correspondent. Reach her at tiffa- ny.au§tin®rocketmail.com September 15, 2011 INSTITUTE FOR CHILDREN'S AID City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 A Voice of HOPE for Children Worldwide RE: Community Service Funding Program Application Dear Ms. McNabb, CxYofTemecula SEP z 5 zO» Finance NM. I Please accept the attached application for consideration of the Temecula Community Service Funding Program. We have been honored to be part of the City of Temecula for over 20 years and serving the people within this valley. Please consider our proposal for the Mobile Children's Peace Exhibit and the education of the community in several diversified areas. If you have further questions or need additional documentation, please don't hesitate to contact me. Thank you, Ch 4'lo to leen, M W Executive Director Institute for Children's Aid 41745 Rider Way #2 Temecula, CA 92590 951-695-3336 www.instituteforchildrensaid.org Enclosures 41745 Rider Way, tt2, Temecula, CA 92590 1 T: 951.695.3336 1 F: 951.308.1753 I www.instituteforchildrensaid.org 1 info®4achild.org City of Temecula 2011-12 CS Funding Program APPLICATION NO. 20 City of Temecula CITY OF TEMECULA AUG0 4 2011 FISCAL YEAR 201 1.12 Finance Department COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 Project Name: ALCOHOL/DRIVING/UNDERAGE CONSUMPTION/EDUCATION Project Start Date: Project End Date: 12/31/2012 (Maximum allowable $5,000) ORGANIZATION INFORMATION Name of Organization: JONBOY'S INC. Contact Name: EDWARD J VARELA Title/Position: PRESIDENT Mailing Address: 31805 TEMECULA PARKWAY# 812 Telephone: 888-956-6269 E -Mail Address: EVARELA@jonboysinc.com Year Organization Founded: 7 Geographic Area(s) Served: N.COUNTY/SOUTHWEST RIVERSIDE Number of Paid Staff: 0 Number of Volunteers: 23 Is this organization incorporated in California as a non-profit organization? Yes n No [1 Effective Date: 01/11/2010 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 01/11/2010 Federal identification number: If "no": 27-1869532 State identification number: 03270748 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee J L Board of Directors Application — Page I Members -at -Large n FINANCIAL, STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. OUR MISSION IS TO STOP DRUNK DRIVING. WE PROVIDE FREE TRANSPORTATION TO ANYONE THAT MAKES THE CHOICE NOT TO DRIVE AFTER CONSUMING ALCOHOL. TO DATE WE HAVE REMOVED 1266 RESONSIBLE INDIVIDUALS FROM OUR STREETS. WE ARE ALSO VERY ACTIVE IN OUR COMMUNITY EDUCATING YOUNG AND OLD ON THE IMPORTANCE OF SOBER DRIVING. WE ARE ANNUAL PARTICIPANTS IN THE EVERYFIFTEEN MINUTE PROGRAM: 2011 TEMECULA VALLEY HIGH SCHOOL AND VISTA MURRIETA HIGH SCHOOL. YOU WILL FIND US PROVIDING SUPPORT AT MANY DUI CHECK POINTS. WE FREQUENT ESTABLISHMENTS WHICH SERVE ALCOHOL, ENSURING THE AVAILABILITY OF ALTERNATIVE TRANSPORTATION CONTACT INFORMATION. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) ATTACHED Application - Page 3 The Baker to Vegas Relay is the most "positive" event offered to law enforcement officers today. It gives them a reason to maintain a physical fitness program so as to help them better perform their duties. Over the 20+ years the Challenge Cup/Baker to Vegas Relay has been run hundreds of thousands law enforcement personnel have tread across the desert. The original ideals of the race continue: teamwork, camaraderie, physical fitness and competition. The event has expanded in many ways — most notably in entries and categories. The number of teams has grown 14 fold from the first 19 teams in 1985. The number of teams is now limited to 260. Categories have grown to include Probation Officers, District Attorneys, US Attorneys and full time civilian police personnel. As a result of this growth the race has flourished. Today it is the largest law enforcement event of its kind in the World with teams participating from Calgary Canada, RCMP both men and women, Berlin and Hamburg Germany and law enforcement teams throughout the United States. The Challenge Cup/Baker to Vegas Relay is truly a National and International event. The Annual Challenge Cup/Baker to Vegas Relay is scheduled to take place (depending on Las Vegas accomodations) over a weekend from late March to early April. The course begins 25 miles north of Baker CA. on Highway 127 to Shoshone CA; then northeast on Highway 178, across the state line into Nevada on Highway 372 to Pahrump NV., then southeast on Highway 160 to the finish inside the Hilton Hotel Convention Room in Las Vegas. Teams are scheduled to run in eleven flights, depending upon their ability, with flights starting hourly from 9:00 am to 5:00 pm. On Sunday, eight hours after the last team finishes, an Awards Ceremony is held in the Hilton Hotel Convention room for over 6000 runners and support personel; several thousand family members and friends; and almost a thousand race volunteers. The festivities began with a most impressive Opening Program providing entertainment for all. Over 145 VIP law enforcement dignitaries, chiefs of police, agents—in—charge and sheriffs are introduced to the crowd. During the ceremony and throughout the hotel conversation is continually in a roar with the most common phrase and pledge, "Wait till next year"! We would like to commit to one of our local agencies to supply a support vehicle during this competition. This event will allow JONBOY'S Inc. to share the news; The City of Temecula has provided the key component for existence, AND WILL BE NOTICED. (BANNERS, FLYERS, WATER LABELS, ETC..) CHP, TEMECULA PD, BORDER PATROL, ABC, ALCOHOL BEVERAGE CONTROL OR RIVERSIDE COUNTY PROBATION. WE WILL DETERMINE WHAT ORGANIZATION WILL BENEFIT ONCE AWARD IS GIVEN. THANK YOU PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 SIGNATURE PAGE We hereby certify tl_irifomTyion contained in this application is true to the best of our knowledge and belief. / PREPAf2ED BY: Edward j Varela SIGNATURE.: NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Edward j Varela • NAME and TITLE (Please Print or Type) SIGNATyjRE ORGANIZATION NAME: JONBOY'S INC. MAILING ADDRESS. 31805 TEMECULA PARKWAY #812 TENIECULA, CA 92592 TELEPHONE: 8$8-956-6269 E -Mail Address: DATED THIS 08 EVARELA@JON BOYSINC. COM of AUGUST , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person. E -Mail Address. City of Temecula Community Service Funding Program Attn. Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 Ldy.mcnabb(cr�cityofternecula orq Facsimile: 951-694-6479 Application — Page Form 990 -EZ Oepa tment of Ire Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(ax1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ► Sponsoring aeart,zations of donor mhsted funds. animations that operate ono or mad hospital facilities. and certain Controlling organizations as defined in section 512(b)(13) mutt -tile Flim 990 (son mstructiats) AI(0ewi.o.ganitallare with gross receipts less than $200.000 and total asseIS less than $500.000 at the end of the year may use This form. ► The organization may have 10 use a copy or MIS return to satisfy state reporting requirements OtAB N.1 1545. 1 t `:0 2010 Open to Public Inspection A For the 2010 calendar year, or tax year beginning , 2010, and ending B Check if applicable. Address change Name change India; return Terminated Amended relum Application pending c JONBOYS INC 1363 CORTE SAGUNTO TEMECULA, CA 92592 D Employer Identification number 27-1869532 E Telephone number 951 296-1698 F Group Exemption Number G Accounting Method: 0 Cash U Accrual Other (specify) 1 Website: ► N/A J Tax-exempt status (ek only one) — (T501(c)(3) 1 1501(c) ( I< Check Jif the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50.000. A Form 990 -EZ or Form 990 return is not required though Form 990-N (e -postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return. L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, line 25. column (8) below) are $500,000 or more, file Form 990 instead of Form 990 -EZ... ... ... a" $ 9, 984 . LPart l -1 Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part l.) Check if the organization used Schedule 0 to respond to any question in this Part I X1 9,984. ) vs (insert Ito.) 1 4947(a)0) or H Check P. 0 if the organization is not required to attach Schedule B (Form 527 990, 990•EZ, or 990 -PF). R E v E N u E X ti s E s 1 Contributions, gifts, grants, and similar amounts received 2 Program service revenue including government fees and contracts 3 Membership dues and assessments 4 Investment income 5a Gross amount from sale of assets other than inventory I 5a1 b Less: cost or other basis and sales expenses f 5b c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) 6 Gaming and fundraising events a Gross income from gaining (attach Schedule G if greater than $15,000).... b Gross income from fundraising events (not including $ from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000). 6 b c Less: direct expenses from gaming and fundraising events. 6c 2 3 6 al of contributions d Net income or (loss) from gaming and fundraising events (add tines 6a and 6b and subtract line 6c) 7a Gross sales of Inventory, less returns and allowances b Less: cost of goods sold c Gross profit or (loss) from sales of inventory (Subtract line 7b frorn line 7a) 8 Other revenue (describe in Schedule 0) 9 Total revenue. Add lines 1. 2, 3, 4, 5c 6d, 7c, and 8 10 Grants and similar amounts paid (list in Schedule 0) 11 Benefits paid to or for members 12 Salaries, other compensation, and employee benefits 13 Professional fees and other payments to independent contractors 14 Occupancy, rent, utilities, and maintenance 15 Printing, publications, postage, and shipping 16 Other expenses (describe in Schedule 0) SEE . SCHEDULE 0 17 Total expenses. Add lines 10 through 16 118 Excess or (deficit) for the year (Subtract line 17 from line 9) 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end•of-year E s figure reported on prior year's return) T T 20 Other changes in net assets or fund balances (explain in Schedule 0) s 21 Net assets or fund balances at end of year. Combine lines 18 through 20 ► BAA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 -EZ (2010) Tal 7b 6d 7c 8 ► g 9, 984. 10 11 12 13 91. 14 15 16 297. 13,622. ► 17 14,010. 18 - 4,026. 19 0. 20 21 - 4,026. TEEA0eo3L 02110/1 Form990•EZ(2010) JONBOYS INC 27-1869532 Paget (Paii.l1 j Balance Sheets. (see the instructions for Part I1.) Check if the organization used Schedule 0 to respond to any question in this Part II n (A) Beginning of year 1 (B) End of year 73. 22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) ) 25 Total assets 73. 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 ) 4,099. 27 Net assets or fund balances (line 27 of column (8) must agree with line 21) 0. —4,026. [Partin ( Statement of Program Service Accomplishments (see the instrs for Part 111.) Expenses Check if the organization used Schedule 0 to respond to any question in this Part 111 n (Required for section What is the organization's primary exempt purpose? S .E SCHEDULES 501(c)(3) and 501(c)(4) organizations and section Describe what was achieved in carrying out a orgarnza ions exempt purposes. In a,elear arld concise manner, 49470)(1) trusts; optional describe the services provided, the number_of persons benefited, and other relevant information for each for others.) program title. 28 PROVIDED TRANSPORTATION FOR 106 INDIVIDUALS THAT WERE CHEMICALLY ] IMPAIRED IN 2010. ALSO PARTICIPATED INTHE "EVERY 15 MINUTES PROGRAM" WITH THE TEMECULA VALLEY UNIFIED SCHOOL DISTRICT. r� (Grants $ ) If this amount includes foreign grants. check here 1-I u 28a 29 22 23 24 0. 0. 25 26 27 30 1 12,010. (Grants $ ) If this amount includes foreign grants, check here. ►D 29a 30 a (Grants $ ) If this amount includes foreign grants. check here 31 Other program services (describe in Schedule 0) ..... (Grants $ ) 0 this amount includes foreign grants, check here. s.32 Totalprogram service expenses (add lines 28a through 31 a) LPart IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated (see the instructions for Par iV.j— __..__ . , c ,. a.ae n r� .ne,.,,n,i in ani nupclinn in this Pari IV h n 31 a 32 12,010. 4necx 11 tiro Vryarncauv,,. uocu w„c........+ (a) Name and address w ....,r.,.w ......., (b) Title and average hours per week devoted to position 7--^'-- -- --- - - - - - - - (c) Compensation Of . (d) Contributions to not paid, enter -0-.) I employe n� compensation delerred (e) Expense account and other allowances EDWARD 3.VARELA 1363 CORTE SAGUNTO TEMECULA, CA 92592 PRESIDENT 0 0.' 0. 0. MATHEW E. VARELA 1363 CORTE SAGUNTO TEMECULA, CA 92592 SEC & TREAS 0 0. 0. 0. JENNIFER IBOLD 1363 CORTE SAGUNTO TEMECULA, CA 92592 DIRECTO 0. I 0. 0. GARY WHITE 1363 CORTE SAGUNTO -. TEMECULA, CA 92592 DIRECTO' 0. O. 0. 0 LORI WHITE 1.363 CORTE SAGUNTO_ _ _ - TEMECULA, CA 92592 DIRECTOR O. O. 0. 0 — - — i BAA TEEAO81a 02)18/11 Form 990•EZ (2010) JONBOYS INC 27-1869532 Page 3 [Part V•j Other Information (Note the statement requirements in the instructions for Part V.) SEE SCHEDULE 0 Check if the organization used Schedule 0 to respond to any question in this Part V r t^L. Yes No 33 Did the organization engage in any activity not previously reported to the IRS? If 'Yes; provide a detailed description of 133 X each activity in Schedule O 34 Were any significant changes made to the organizing or governing documents? If 'Yes,' attach a conformed copy of the amended documents if they reflect X a change to the organization's name. Otherwise, explain the change on Schedule 0 (see instructions) 35 11 the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990•T, explain in Schedule 0 why the organization did not report the income on form 9904. a Did the organization have unrelated business gross income of $1,000 or more or was it a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements? .... 35a X b If 'Yes,' has it filed a tax return on Form 990•T for this year (see instructions)? 35 b 36 Did the organization undergo a liquidation. dissolution, termination, or significant disposition of net assets during the X year? If 'Yes,' complete applicable parts of Schedule N 36 X 37a Enter amount of political expenditures, direct or indirect, as described in the instructions. '1 37a1 0 - b Did the organization file Form 1120-POL for this year? 37 b _ _ X 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? 38a X b If 'Yes,' complete Schedule L, Part II and enter the total 38b 4, 099. amount involved — 39 Section 50I (c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 39a N/A bGross receipts, included on line 9, for public use of club facilities 39b N/A 40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ► 0 . ; section 4912 P. 0 . ; section 4955 ► 0 . b Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990 -EZ? If 'Yes; complete Schedule L, Part I c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If 'Yes,' complete Form 8886-T 41 List the states with which a copy of this return is filed ► CA 42a The organization's books are in care of ► JODY D. NOTTINGHAM„ CPA Located at ► 43460 RIDGE PARR DRIVEL STE 240 TEMECULA CA 0. 40 b 40e X Telephone no. ► 951 296-1698 ZIP +4► 92590 b At any time during the calendar year, did the organization have an interest in or a signature or other authorityover a financial account in a foreign country (such as a bank account, securities account, or other financial account)? If 'Yes,' enter the name of the foreign country:.. ' Sec the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report o1 a Foreign Bank and Financial Accounts. c At any time during the calendar year, did the organization maintain an office outside of the U.S If 'Yes,' enter the name of the foreign country:.. Yes 42 b No X 42c X 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990•EZ in lieu of Form 1041 — Check here. ' ❑ N/A and enter the amount of tax-exempt interest received or accrued during the tax year ►I 43 I N/A No 44a Did the organization maintain any donor advised funds during the year? If 'Yes,' Form 990 must be completed instead of Form 990•EZ b Did the organization operate one or more hospital facilities during the year? If 'Yes,' Form 990 must be cornpleted instead of Form 990 -EZ c Did the organization receive any payments for indoor tanning services during the year? d If 'Yes' to line 44c, has the organization filed a Form 720 to report these payments? If No,' provide an explanation in Schedule 0 BAA Yes 44a X 44b 44c X X 44d 1EEA08121 02/18111 Form 990 -EZ (2010) Form•990.EZ (2010) JONBOYS INC 27-1869532 Page 4 Yes No 45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? 45 X a Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)7 If 'Yes,' Form 990 and Schedule RR may need to be completed instead of Form 990 -EZ (see inst.) 45a _ X 46 Did the organization engage, directly or indirectly. in pollticai campaign activities on behalf of or in opposition to candidates for public office? If 'Yes, complete Schedule C, Part I 46 X [Part VI J Section 501(cX3) organizations and section 4947(aX1) nonexempt charitable trusts onlyAll section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52, and complete the tables for lines 50 and 51. Check if the organization used Schedule 0 to respond to any question in this Part VI No 47 Did the organization engage in lobbying activities? If 'Yes,' complete Schedule C, Part 1l 147 X 48 Is the organization a school as described in section 170(b)(1)(A)0i)? If 'Yes,' complete Schedule E. 49a Did the organization make any transfers to an exempt non•cliarilable related organization? b If 'Yes.' was the related organization a section 527 organization? 49b1 1 50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none. enter 'None.' (b) Title and average (c) Comperisatior, (d) Contributions to employee r t and (a) Expense (a) Name and ode than 5100000 employee pard devoted pe. position ( deterred 1 compenonll on °thee nd allowances 48 49a NONE c 1 Total number of other employees paid over $ 00,000. 51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none enter 'None.' (a) Name and address of each independent contractor paid more than $100,000 (b)Type of service --1 (c)t:omp008al011 NONE dTo(l number of other independent contractors each receiving over $100,000 52 Did the organization compleie Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1) nonexempt � charitable trusts must attach a completed Schedule A o• I^I Yes I n t No under penalties of pe.rury,1 ifegSlefe that I have examined Ilea return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is hue. Correll, and compete. OG:laratien oh paperer new/ Oman °mice() is based on all Information of whim preperer has any knowledge --- — I /! Sign Here IP- S.gnatiamei officer EDWARD -J. VARELA Date PRESIDENT Type or print name and (iib. Paid Preparer Use Only PnnliType prenarei s name JODY NOTTINGHAM CPA V Fimnis name ' NOTTINGHAM & ASSOCIATES Frmn•saddress ► 43960 RIDGE PARK DR, STE 240 TEMECULA, CA 92590-3600 ate Check fl d self employed PTIN N/A Fmrm'SEtN N/A Plroneno. (951) 296-1698 May the IRS discuss this return with the preparer shown above? See Instructions..... .. ► X Yes No Form 990 -EZ (2010) BAA TEEEA0812L C2/18/11 SCHEDULE A (Forth 990 or 990 -EZ) Public Charity Status and Public Support Complete if the organization onexempt charitable trust. zatlon or a section Intee nrnai el Me Treasury 0 -Attach to Form 990 or Form 990•EZ. I- See separate instructions. InRent nue Service Name of the organization ( Employer identification number JONBOYS INC 27-1869532 'Pant! '!Reason for Public Charity Status (All organizations rnust complete this part.) See instructions. The organization is not a private foundation because it Is: (For lines 1 through 11, check only one box.) 1 A church, convention of churches or association of churches described in section 170(b)(1XAXi). OME3 No. 1545.0047 2010 Open to Public Inspection 2 r A school described in section 170(bX1XAXii). (Attach Schedule E.) 3 r_ A hospital or a cooperative hospital service organization described in section 170(b)(1XAXIII). 4 A medical research organization operated in conjunction with a hospital described in section 170(bX1XAXili). Enter the hospital's name, city, and state: 5 ri An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(bX1XAXiv). (Complete Part II.) 6 A federal, state, or local government or governmental unit described in section 170(bX1XAXv). 7 ' An organization that normally receives a substantial part of its support from a governmental unit or from the general public described [11 in section 170(bX1XAXvi). (Complete Part IL) 8 A community trust described in section 170(b)(1XAXvI). (Complete Part 11.) 9 rXi An organization that normally receives: (1) more than 33.113% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions — subject to certain exceptions, and (2) no more than 33-1130 of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after _ June 30. 1975, See section 509(aX2). (Complete Part 111.) 10 ` An organization organized and operated exclusively to test for public safety. See section 509(aX4). 11 An organization organized and operated exclusively tor the benefit of, to perform the functions of, or carry out the purposes of one or "— more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(aX3). (..heck the box that describes the type of supporting organization and complete lines 11e through 11b. a EIType I b JType II c Q Type Ill — Functionally integrated d Type III — Other e By checking this box, I certify that the organization is not controlled directly or Inairectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). f If the organization received a written determination from the IRS that is a Type I, Type 11 or Type III supporting organization, check this box g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? (1) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below, the governing body of the supported organization? (ii) A family member of a person described in (i) above (iii) A 35% controlled entity of a person described in (i) or (ii) above? LI19 (iii) h Provide the followin• information about the supported organization(s). (A) (i) Name �l of supported (ii) EiN (iii) Type of organization (described above 01 RCsection (see instructions)) (C) (D) (E) Total (iv)10 the (v) Did you noliy organization in the organization ,n column (1) listed in column (1) of your (Ovenung your support? document? Ni)Is the organization in column (i) organized 10 the u.s.? Yes No 11 g (I) 11gCi) Yes No (vii) Amount 01 support BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule A (Form 990 or 990 -EZ) 2010 TEEA04011. 12J23/10 Schedule A (Form 990 or 990 -EZ) 2010 JONBOYS INC 27-1869532 Page 2 Part II I Support Schedule for Organizations Described in Sections 170(bX1XAXiv) and 170(bx1XAXvi) organrzel on faiif ls to qualifykunndeethe tests box on rne lited be ow, please complete Pari IIIor 8 of Part I or if the ) tion faded to qualify under Part Ili. If the Section A. Public Support Calendar year (or fiscal year beginning in) 1 Gifts, grants, contributions, and membership fees received. (Do not include unusual grants.) . 2 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 3 The value of services or facilities furnished by a governmental unit to the organization without charge 4 Total. Add lines 1 through 3 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (0 6 Public support. Subtract line 5 from line 4 Section B. Total Support (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total Calendar year (or fiscal year beginning in) 0. 7 Amounts from line 4 ..... ... 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources 9 Net income from unrelated business activities, whether or not the business is regularly canned on 10 Other income. Do not include gain loss of capital apitalassets (Explain in Part IV.).. . Total support. Add lines 7 11 through 1 (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total 12 Gross receipts from related activities, etc (see instiuclions) 13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) n organization, check this box and stop here Section C. Computation of Public Support Percentage 14 Public support percentage for 2010 (line 6, column (f) divided by line 11, column (f)) L15 Public support percentage from 2009 Schedule A, Part II, line 14 15 16a 33-113% support test - 2010. If the organization did not check the box on line 13, and the line 14 is 33.113% or more, check this box and stop here. The organization qualifies as a publicly supported organization b 33-113% support test - 2009. If the organization did not check a box on line 13 or 16a, and line 15 is 33-1/3% or rnore, check this box ❑ and stop here. The organization qualifies as a publicly supported organization 17a 10%facts and circumstances test - 2010. If the organization did not check a box on line 13, 16a; or 16b, and line 14 is 10% 12 or more, and if the organization meets the 'facts -and -circumstances' test, check this box and stop here. Explain in Part IV how the organization meets the 'facts -and -circumstances' lest. The organization qualifies as a publicly supported organization b 10%•facts-and-circumstances test - 2009.1f the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the 'facts -and -circumstances' test, check this box and stop here. Explain in Part IV how the — organization meets the 'facts-and•circumstances' lest. The organization qualifies as a publicly supported organization _ 18 Private foundation. If the organization did riot check a box on line 13, 16a, 16b, 17a. or 17b, check this box and see instructions . o' BAA Schedule A (Form 990 or 990 -EZ) 2010 -o TEEA0402L 12/23/10 Schedule A(Form 990 or 990 -EZ) 2010 JONBOYS INC Part Ip 1 Support Schedule for Organizations Described in Section 509(aX2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) 27-1869532 Page 3 We(:.MM M. r uuna, ,Pwt,N.., a (a) 2006 (b) 2007 (c) 2008 (d) 2009 - (e) 2010 (1) Total ;alendar year (or fiscal yr beginning in)► 1 Gifts, grants, contributions and membership fees received. (Do not include any 'unusual grants.') 2 Gross receipts from admis- sions. merchandise sold or services perforrned, or facilities furnished in any activity that is related to the organization's tax-exempt purpose 3 Gross receipts from activities that are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf 5 The value of services or facilities furnished by a governmental unit to the organization without charge 6 Total. Add lines 1 through 5 7a Amounts included on lines 1, 2, and 3 received from disqualified persons bAmounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year cAddlines7aand7b 8 Public support (Subtract line 7c from line 6.) .... .... 0. 0. 9,984. 9,984. 9, 9g4, 9, 984. 0. 0 0. 0. 0 0. 0. 0. 0. 0 0. 0. 0. 0 . 0. 0. 9, 984. 9,984. 0 0 0 • 0 . 0 , 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0. 0. 0. 0. 0. 0. 9,984. Section B. Total Support Calendar year (or fiscal yr beginning in)► 9 Amounts from line 6 10a Gross income from interest, dividends, payments received on securities loans, lents, royalties and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 c Add lines 10a and 10b 11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on 12 Other income. Do not include capital assets (Explain in of Part IV.) 13 Total support. (Add ms 9,100, 11, and 12) 14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here Section C. Computation of Public Support Percentage 15 Public support percentage for 2010 (line 8, column (f) divided by line 13, column (f)) 15 16 Public support percentage from 2009 Schedule A, Part III, line 15 f 16 Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2010 (line 10c, column (f) divided by line 13, column (f)) 17 18 Investment income percentage from 2009 Schedule A, Part III, line 17 18 19a 33413% support tests — 2010. If the organization did not check the box on line 14, and line 15 is more than 33-1/3%, and line 17 is not more than 33.1/3%. check this box and stop here. The organization qualifies as a publicly supported organization b 33-113% support tests — 2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33.113%, and line 18 is not more than 33.1/3%, check this box and stop here. The organization qualifies as a publicly supported organization 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions BAA TEEA04031. 12/29/10 Schedule A (Form 990 or 990 -EZ) 2010 (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (1) Total 0. 0. 0. 0. 9,984. 9,984. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 9,984. 9,984. -n % Schedule A (Form 990 or 990•EZ) 2010 JONBOYS INC 27-1869532 Page 4 [Part IV j Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, Zine 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions). BAA TEEA0404L 09108110 Schedule A (Form 990 or 990•EZ) 2010 SCHEDULE 0 (Form 990 or990-EZ) Department of the Treesrny !Memel Revenue Service SuppiementaI Information to Form 990 or 990 -EZ Complete to provide information for responses to specific questions on Form 990 or 990 -EZ or to provide any additional information. b. Attach to Form 990 or 990 -EZ. OMB No. 1545 OC4/ 2010 Open to Public Inspection Naine of the organization Employer identification number JONBOYS INC 27-1869532 _ _F RIV1_990-EZ,.PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE _ TO PROVIDE TRANSPORTATION FOR INDIVIDUALS WITHIN SOUTHWEST RIVERSIDE COUNTY WHO ARE UNABLE TO SAFELY OPERATE A VEHICLEL IN ORDER TO MINIMIZE ALCOHOL RELATED DEATHS AND TO EDUCATE COMMUNITY RESIDENTS OF THE POTENTIAL DEVISTATING ISSUES SURROUNDING DRINKING AND DRIVING. FORM 990•EZ, PART V - REGARDING TRANSFERS ASSOCIATED WITH PERSONAL BENEFIT CONTRACTS (A) DID THE ORGANIZATION, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT? NO (B) DID THE ORGANIZATION, DURING THE YEAR, PAY PREMIUMS, DIRECTLY OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT/ NO BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. TEEA49011 10/26/10 Schedule 0 (Form 990 or 990 -EZ) 2010 2010 SCHEDULE 0 - SUPPLEMENTAL INFORMATION PAGE 2 JONBOYS INC 27-1869532 FORM 990 -EZ, PART 1, LINE 16 OTHER EXPENSES AUTO EXPENSE $ 2,942. BANK CHARGES 40. DONATIONS 60. DUES 62. INSURANCE 3,928. MEALS 617. OFFICE EXPENSES 793. PENALTIES. 175. REPAIRS & MAINTENANCE 83. SUPPLIES. 161. TELEPHONE 2,878. TRAVEL. 352. WEB DESIGN 1,520. WEBSITE 11. TOTAL $ 13,622. FORM 990 -EZ, PART 11, LINE 26 TOTAL LIABILITIES PAYABLE TO OFFICERS, DIRECTORS, ETC.. _B)JGzNNING._ _ ENDING $ 0. $ 4,099. TOTAL $ 0. $ 4,099. TAXABLE YEAR California Exempt Organization 2010 Annual Information Return FORM 199 Calendar year 2010 or fiscal year beginning month day A First Return Filed? X Yes 1 B Type of organization INo Corporation/Organization Name JONBOYS INC Address 1.363 CORTE SAGUNTO year , and ending month Exempt girder Section 23701... D (insert letter) IRC Section 4947(a)(1) tryst .. day year CORP a 3270798 FEIN 27-1869532 C.y TEMECULA CA 92592 C Amended Return? Slate ZIP Code D Are you a subordinate/affiliate in a group exemption?. • Yes a Is this a group filing for affiliates? See General Instruction L b If 'Yes,' enter the number of affiliates c Are all affiliates Included? .. ... .. (if 'No; attach a list. See Instructions.) d Is this a separate return filed by all organization covered I, by a group ruling? 0 Yes LJ No e Federal Group Exemption Number f Is a roster of subordinates attached? J Yes 0 No E Final return? • Dissolved • 0 Surrendered (Withdrawn) • Merged/Reorganized (attach explanation) If a box s checked, enter date • F Check the box d the organization filed the following federal forms or schedule: 1 • 0 990T 2 • 0 990PF 3 • I (Schedule 11) 990 G If organization is exempt under R&TC Section 23701d and is exclusively religious, educational, or charitable, and is supported primarily (50% or mote) by public No Yes LI No Yes No H contributions, check box. See General Instruction F. No filing fee is required • _ Accounting method used... 1 Cash 2 0 Accrual 3 Other If exempt under R&TC Section 23701 dr has the organization during the year: (1) participated in any political campaign or (2) attempted to influence legislation or any ballot measure, or (3) made an electron under R&TC Section 23704.5 (relating to lobbying by public charities)? If 'Yes,' complete and attach form FTB 3509, Political or Legislative Activities by Section 23701d Organizations • 0 Yes kj No J Did the organization have any changes in its activities, governing Instrument, articles of incorporation, or bylaws that have not been reported to the Franchise Tax Board? If 'Yes; complete an explanation and attach copies of revised documents • 0 Yes L j Ne K Is the organization exempt under R&TC Section 23701g? • EI Yes L� No If 'Yes,' enter amount of gross receipts from nonmember sources $ L Is the organization under audit by the IRS or has the IRS audited in a prior year? • M Is the organization a Limited Liability Company? • N Yes Yes X No X No Did the organization fileForm 100 or Form 109 to n report taxable income3 • n Yes ,1n1 No Part I Complete Part I unless not required to file this form. See General nstructions B and C. 1 Gross sales or receipts from other sources. From Side 2, Part 11, line 8 2 Gross dues and assessments from members and affiliates 3 Gross contributions, gifts, grants, and similar amounts received 4 Total gross receipts for filing requirement test. Add line 1 through line 3. This line must be completed. If the result is less than $25,000, see General Instruction B 5 Cost of goods sold • T-5 6 Cost or other basis, and sales expenses of assets sold... • 6 7 Total costs. Add line 5 and Zine 6 8 Total gross income. Subtract line 7 from line 4 Receipts and Revenues Expenses • I 2 • ' 3 1 9984. 9, 984 . 7 • I 8 9, 989 .. 9 Total expenses and disbursements. From Side 2, Part II. line 18 . • 9 10 Excess of receipts over expenses and disbursements. Subtract line 9 from line t3 ..... .... • i 10 14,010. -4,026. Filing Fee 11 Filing fee $10 or $25. See General Instruction F 11 12 Total payments 12 13 Penalties and Interest. See General Instruction J 13 14 Use tax. eneral In`s uclion K 15 Balance due. Add line 1 line 13, and line 14 Then subtract line 12 m the result • 14 10. 15 1.0. Sign Hero Paid Preparers Use Only Under penalties of perjury. 1 de ieie that I have examined this return including accompanying schedules and statements. and to the bnsl.ol my knowledge and belief. it is tare. correct. and complete. DecIa af,on of prepare( (other Ilan taxpayer) is based on all information of which prepare( has any rurowledge. Signature ► SIDENT Of officer- r Tulle PItE Preparerslgst. ,• signaluuo1 ; 1 �11OTTINGHAM '& ASSOCIATES Frm ante ufs• yotxs. ► 43460 RIDGE PARK DR, STE 240 (or H selt•employed) and address TEMECULA, CA 92590-3600 Date • telephone 951 296-1698 Check • • Preparer's PTIN/SSN it self. ► n P00168412 employed • FEIN 20-2082681 • Telephone (951) 296-1698 May the FTB discuss this return with the preparer shown above? See instructions For Privacy Notice, get form FTB 1131. 77713651104 rte_ CACA11121_ 12/21/10 Form 199 C1 2010 Side 1 JONBOYS INC 27-1869532 Part II Organizations with gross receipts of more than $25,000 and private foundations regardless of amount of gross receipts — com .tete Part II or furnish substitute information. See Specific Line Instructions. 1 Gross sales or receipts from ali business activities. See instructions 2 Interest 3 Dividends 4 Gross rents 5 6 7 8 Receipts • from Gross royalties • Other Sources Gross amount received from sale of assets (See Instructions) • Other income. Attach schedule • Total gross sales or receipts from other sources. Add line 1 through line 7. Expenses and Disburse- ments le 1 Enter here and on Side 1, Part I, line 1 8 9 Contributions, gilts, grants, and similar amounts paid. Attach schedule • 9 10 Disbursements to or for members • 10 11 Compensation of officers, directors, and trustees. Attach schedule .. SEE. STAT.EMENT..1 • 11 12 Other salaries and wages • 12 13 Interest • 13 14 Taxes • , 14 0. 15 Rents • , 15 16 Depreciation and depletion (See Instructions) • , 16 17 Other. Attach schedule SEE. STAT.EMENT..2 • 17 18 Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 18 L Balance Sheets Beginning of taxable year End of taxable year 14,010. 14,010. 1 Cash 2 Net accounts receivable 3 Net notes receivable. Attach schedule 4 Inventories. 5 Federal and state government obligations 6 Investments in other bonds. Attach sch 7 Investments in stock. Attach schedule....... .... 8 Mortgage loans (number of loans ) Liabilities , • • • • • • • 9 Other investments. Attach schedule 10 a Depreciable assets b Less accumulated depreciation. 11 Land 12 Other assets. Attach schedule 13 Total assets and net worth 14 Accounts payable . . . 15 Contributions, gifts, or grants payable 16 Bonds and notes payable. Attach schedule..... 17 Mortgages payable 18 Other liabilities. Attach schedule 19 Capital stock or principle fund 20 Paid -in or capital surplus. Attach reconciliation 21 Retained earnings or income fund 22 Total liabilities and net worth • • • 73 . • '10 • 4 , 0 99 . l , • • — 4, 026 . • • 7 3 Schedule M-1 Reconciliation of income per books with income per return Do not complete this schedule if the amount on Schedule L, line 13, column (d), is less than $25,000 1 Net income per books 2 Federal income tax 3 Excess of capital losses over capital gains 4 Income not recorded on books this year. Attach schedule 5 Expenses recorded on books this year not deducted in this return. Attach schedule 6 Total, Add line I through line 5 • • 7 Income recorded on books this year not included in this return. Attach schedule 8 Deductions in this return not charged against book income this year. Attach schedule 9 Total. Add line 7 and line 8. 10 Net income per return. Subtract line 9 Irom line 6 Side Form 199 Cl 2010 7797 3652104 r- CACA1i+2L 12/21/10 2010 CALIFORNIA STATEMENTS PAGE 1 JONBOYS INC 27-1869532 STATEMENT 1 FORM 199, PART 11, LINE 11 COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES CURRENT OFFICERS: NAME _AND ADDRESS TITLE AND CONTRI- EXPENSE AVERAGE HOURS COMPEN- BUTION TO ACCOUNT/ PER WEEK DEVOTED SATION EBP & K OTHER EDWARD J. VARELA PRESIDENT $ 0. $ 0. $ 0. 1363 CORTE SAGUNTO 0 TEMECULA, CA 92592 MATHEW E. VARELA SEC & TREAS 0. 0. 0. 1363 CORTE SAGUNTO 0 TEMECULA, CA 92592 JENNIFER IBOLD DIRECTOR 0. 0. 0. 1363 CORTE SAGUNTO 0 TEMECULA, CA 92592 GARY WHITE DIRECTOR 0. 0. 0. 1363 CORTE SAGUNTO 0 TEMECULA, CA 92592 LORI WHITE DIRECTOR 0. 0. 0. 1363 CORTE SAGUNTO 0 TEMECULA, CA 92592 TOTAL � 0. $ 0. $ _ 0. STATEMENT 2 FORM 199, PART II, LINE 17 OTHER EXPENSES AUTO EXPENSE $ 2,942. BANK CHARGES. 40. DONATIONS 60. DUES ... 62. INSURANCE 3,928. MEALS 617. OFFICE EXPENSES 793. OTHER FEES 91. PENALTIES 175. POSTAGE AND SHIPPING 297. REPAIRS & MAINTENANCE 83. SUPPLIES 161. TELEPHONE 2,878. TRAVEL 352. WEB DESIGN 1,520. WEBSITE 11. TOTAL $ 14,010. IN MAIL TO: Registry of Charitable Trusts P.O. Box 903447 Sacramento, CA 94203-4470 Telephone: (916) 445-2021 WEBSITE ADDRESS: http:Uag.ca.govichariticsl ANNUAL REGISTRATION RENEWAL FEE REPORT TO ATTORNEY GENERAL OF CALIFORNIA Sections 12586 and 12587, California Government Code 11 CaI. Code Regs. sections 301-307, 311 and 312 Failure to submit this report annually no later than lour months and fifteen days alter the end of the organization's accounting period may result In the loss 01 lax exemption and the assessment of a minimum tax of $800, plus interest, andror linos or filing penalties as defined in Government Code Section 12586.1. IRS extensions will be honored. State Charity Registration Number JONBOYS INC Name of Organization 1 363 CORTE SAGUNTO Check if: Change of address Amended report Address (Number and Street) TEMECULA, CA 92592 , City or Town State ZIP Code Corporate or Organization No. 327 0'/ 4 8 Federal Employer ID No. 27-1869532 ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 CaI. Code Regs. sections 301-307, 311 and 312) Make Check Payable to Attorney General's Registry of Charitable Trusts Gross Annual Revenue Fee Gross Annual Revenue Fee Gross Annual Revenue Fee Less than $25,000 0 Between $100,001 and $250,000 $50 Between $1,000,001 and $10 million 5150 Between $25,000 and $100,000 $25 Between $250,001 and $1 million $75 Between $10,000,001 and $50 million $225 During this reporting period, did the organization receive any governmental funding? If so, provide ari attachment listing the name of the agency, mailing address, contact person, and telephone number. • 7 During this reporting period did the organization hold a raffle for charitable purposes? If 'yes,' provide an attachment indicating the number of raffles and the date(s) they occurred. R Greater than $50 million $300 PART A — ACTIVITIES For your most recent full accounting period (beginning 1 / 01 / 10 ending 12/31/10 )list: Gross annual revenue $. __- 9, 989•_ Total assets $ 73 . PART B — STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT Note: If you answer 'yes' to any of the questions below, you must attach a separate sheet providing an explanation and details for each • 'yes' response. Please review RRF•1 instructions for information required. 1 During this reporting period, were there any contracts, loans, leases or other financial transactions between the organization and any officer. director or trustee thereof either directly or with an entity in which any such officer, director or trustee had any financial interest. Yes No ❑ Dr, , U n 1^L J X 1 2 3 During this reporting period, was there any theft, embezzlement, diversion or misuse of the organization's charitable property or funds? n During this reporting period. did non -program expenditures exceed 50% of gross revenues? ❑. ❑ 4 During this reporting period, were any organization funds used to pay any penalty, fine or judgment? If you filed a Form 4720 with the Internal Revenue Service, attach a copy. 5 During Iles reporting period, were the services of a commercial fundraiser or fundraising counsel for charitable purposes used? If 'yes,' provide an attachment listing the name, address, and telephone number of the service provider. ❑ n a In� I I^J 6 During this reporting period, did the organization receive any governmental funding? If so, provide ari attachment listing the name of the agency, mailing address, contact person, and telephone number. • 7 During this reporting period did the organization hold a raffle for charitable purposes? If 'yes,' provide an attachment indicating the number of raffles and the date(s) they occurred. R 8 Does the organization conduct a vehicle donation prograrn? If 'yes,' provide an attachment indicating whether the program is operated by the charity or whether the organization contracts with a commercial fundraiser for charitable purposes. ri 1111 9 Did your organization have prepared an audited financial statement in accordance with generally accepted accounting principles for this reporting period. n n Organization's Organizatt9 area_cndeand.telephone number 951 296-1698 e-mail address 4 I declare under penalty of pe ' ry that I have examined this report, Including accompanying documents, and to the best of my knowledge and belief, it is true, corre and complete. EDWARD J. VARELA PRESIDENT <-'lam _ iii Signalure of authorized officer Printed Name CAVA9801L 08/16/05 J RRF-1 (3.05) City of Temecula 2011-12 CS Funding Program APPLICATION NO. 21 CITY OF TEMECULE! City of Temecula SEP 14 2011 FISCAL YEAR 201 1.12 COMMUNITY SERVICE FUNDING PROGRA e , f 'E/QN (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 1,000.00 Project Name: Children's Health Care Fund Project Start Date: November 1, 2011 (Maximum allowable $5,000) Project End Date: October 31, 2012 ORGANIZATION INFORMATION Name of Organization: Neighborhood Healthcare Contact Name: Tracy Ream Mailing Address: 425 Date Street, Escondido, CA 92025 Telephone: 760-520-8375 Year Organization Founded: 1969 Geographic Area(s) Served: Temecula Title/Position: CEO E -Mail Address: TracyR@nhcare.org Number of Paid Staff: 402 Number of Volunteers: 110 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 1972 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: October 25, 1972 Federal identification number: 95-2796316 State identification number: D-6679350 If "no": Name of sponsoring organization: n/a Federal identification number: n /a State identification number: n/a This application has been authorized by the organization's: Executive Committee X Board of Directors Application - Page 1 Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Neighborhood Healthcare (NHcare) is a private, non-profit community health system that has offered quality health and behavioral care since 1969. NHcare operates 10 health care centers located in Temecula, Escondido, Pauma Valley, Lakeside and El Cajon. Our mission is to provide quality health care and promote wellness to everyone in our communities, focusing on those most in need. Services are available to all ages, ethnicities and genders and no one is denied service due to inability to pay. Locally. at Neighborhood Healthcare -- Temecula. we serve 14.000 patients annually in over 32.000 Services provided include adult and pediatric medicine acute and chronic care, women's health , family planning, HIV/AIDS testing, preventive services and community -focused services through outreach and health promotion programs . Currently staff is working with Temecula schools to provide flu vaccines for children and school staff at no cost. NI-lcare is Temecula's only local option for the under -insured and un -insured. There are no County public health facilities with the exception of one for emergency mental health services. Neighborhood Healthcare and its health center in Temecula meet all the criteria of importance to the Temecula City Council. NHcare serves the entire community without discrimination. There is strong executive leadership with a commitment to the organization as evidenced by the length of time these staff have been with the organization (10-25 years). Services are patient -focused, assuring a high degree of customer service and satisfaction. Evaluation tools include patient satisfaction surveys, patient flow studies and appointment access surveys. Financial statements are prepared monthly and reviewed by the 11 member volunteer Board of Directors. The Board includes clinic patients, and mirrors the ethnic mix of patients. Expenses are monitored according to the annual budget. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Funds from the City of Temecula will pay for medications and medical treatment for children whose parents cannot afford care and have no health insurance. The average cost of a medical visit for a child is $125. For the approximately 500 children who are uninsured. Neighborhood Healthcare receives. on average. $48 from the child's family for these visits, leaving Neighborhood Healthcare responsible for the remaining $77 or about $38,500 annually. The most common medications needed are for treatment of asthma, ear infections, dehydration, and other bacterial infections that require antibiotics. Neighborhood Healthcare provides many medications to families at a lower cost than retail, but the reduced cost may still be beyond the parent's means, especially if the illness is sudden or unexpected or the parent has more than one child ill at the same time. From a medical point of view. it is critical that the child use the medication to avoid potentially more serious problems that could result in emergency room care or hospitalization. In infants and very young children, a relatively simple illness like the flu can become life threatening. A funding level of $1,000 will assist at least 50 needy children with basic health care and medication. Families are screened for ability to pay at the time of visit. Those without health insurance are helped by a Certified Application Assistor to determine eligibility for public health insurance plans such as Medi -Cal and Healthy Families. For all families, health care visit fees are based on a sliding -scale. Those families without health insurance or ineligible Cor public health insurance and who cannot pay the sliding -scale fee for their child's visit and/or pay for medication would be able to have their fee covered by the Children's Health Fund sponsored by the City of Temecula. In these difficult economic times with high unemployment rates, these funds are greatly needed. Project Budget: Expenses: Cost of care for 500 visits = $62,500 Income: Cost of care paid by client through a sliding fee scale = $24,000 City of Temecula = $1,000 Other sources - $37,500 Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. N/A Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Lorna Hardin, Director of Grants �, NAME and TITLE (Please Print or Type) SIGNATURE: C 7'i PRESIDENT or Tracy Ream, CEO AUTHORIZED OFFICER: NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Neighborhood Healthcare MAILING ADDRESS: 425 Date Street, Escondido, CA 92025 TELEPHONE: 760-520-8375 E -Mail Address: TracyR@nhcare.org DATED THIS 12th of (Date) September (Month) , 2011. Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: Ludy. mcnabbacityoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 Cash & Cash Equivalents Accounts Receivable: Self Pay Medi -Cal Medicare Public Insurance (BCSP, FPACT, EAPC, CMS, etc.) Private Insurance Managed Care Grants & Contracts Pharmacy Other Vendors Total Accounts Receivable Prepaid Expenses Inventory Deposits Fixed Assets: Land & Building Leasehold & Building Improvements Furniture & Equipment 728 E. Valley Parkway -- bldg. shell w/Tls pending Construction -in -Progress -- Poway Construction -in -Progress -- Temecula Winchester Total Fixed Assets TOTAL ASSETS Accounts Payable Accrued Payroll Advanced Funds (Deferred Revenue): Health Promotion Grants Federal 330 Grant PPH -- Hospitalist/SNF Program Total Advances (Deferred Revenue) Deferred Revenue (Mgd. Care Rec's, Molina, CI) Line of Credit (Union Bank/Edward Jones) Deposits on Hand CPCA Loan (Poway Land) Mortgages Payable: Valley Parkway (Ivy) 728 East Valley Parkway Dickenson Wellness Center Elm Street Clinic Peds./Prenatal Center Lakeside (paid off June 2004) El Cajon Grand (Union Bank and CHFFA) Temecula -- Enterprise Circle Total Mortgages Payable TOTAL LIABILITIES Beginning Fund Balance Excess Revenue Over (Under) Expense TOTAL FUND BALANCE TOTAL LIABILITIES AND FUND BALANCE Neighborhood Healthcare Balance Sheet Period Ending 7/31/11 @ 7/31/11 ASSETS 8,563,139 0 1,762,764 722,147 1,365,884 138,085 231,170 989,087 93,597 5,000 @ 6/30/11 ASSETS 8,280,141 0 2,953,696 718,700 1,165, 395 161,359 267,734 1,202,449 89,196 5,000 @ 6/30/10 ASSETS 9,049,833 Note 1 0 2,313,768 490,363 775,696 325,439 123,349 535,500 97,142 3,528 5,307,734 443,648 14,020 40,967 11,211,351 9,500 1,023,425 1,041,676 89,345 2,031,752 6,563,528 344,165 14,020 40,967 11,237,011 9,500 971,286 1,041,676 89,345 2,031,752 4,664,784 342,751 168,611 38,166 11,469,322 9,500 826,243 889,377 39,985 0 15,407,047 15,380,569 13,234,427 29,776,555 30,623,390 27,498,573 LIABILITIES 865,309 2,169,920 143,442 0 0 LIABILITIES 950,287 2,302,040 153,359 0 0 LIABILITIES 630,635 2,119,041 26,433 0 0 143,442 574,027 1,212,122 245 221,704 87,110 1,261,538 328,787 458,122 471,412 0 188,696 562,095 1,265,895 153,359 574,027 1,715,002 275 231,914 90,485 1,264,397 331,350 459,069 472,399 0 190,981 564,912 1,270,948 26,433 919,137 0 0 352,221 132,379 1,294,684 361,129 469,706 483,470 0 217,959 598,037 0 4,623,655 4,644,542 3,557,364 9,810,424 10,571,446 7,604,831 20,051,944 (85,814) 19,893,743 158,201 16,487,277 3,406,466 19,966,130 20,051,944 19,893,743 29,776,555 30,623,390 27,498,574 Notes: I, Cash & Cash Equivalents for the cun•ent month includes $6,538,944 in Edward Jones general fimd, 51,044,315 in restricted investments ($1,020,455 endowment, 523,860 Pauma), $972,624 in checking and savings accounts, and 57,255 in Petty Cash. y C 97 7 > A H u A • d REVENUE: 0 0 gze 0 0 0 0 CO00 CO O CMO LM 0 0) N CO O) I- LA 0 0) I- t` O) - N 0 CO M 0) 0) 0) M �- M 0 r M � I•••• LA CO 0 CA LA L0 O O CO CA M co r Lf) CO cc; c6 • C O (0 co N- al O 40 O N N . O M M .- 00 I-. T. (0 T cM h M 0 0) s- LA 0 r I) CA 10' ID N (A COv O N CO LA CS) N N t` CA I-- CO N N... N %%... .N...0.. O r r CO CO N 0 I's 0 CO 0) 0 CO CO CO 00 MLD N CA CO 10 I- O LA OA CJe (0 (0 r N 00 O O ct (O et LA O (M CD (00 0) NN. sem- 0 LA N N N- 0 I� r CO LA M LA O N CO N- 0 (0MN.O~)000 0)CO-0 0) O (7 0 r (V O) M (V ef L6 co co 40N CCOO sN- CO r CO CO r M co co LA O N O ,- o O I- co O) N r N. Lf) (O CO N O 0 0) CO r (O (M CA r N O) CM N LA 'M- 1 co M N- T(0 ' CO CO 0 a w 1- 0Q ca a v) a 0 u) co0 U L 0 C 0 i 12 D NUUm ern CO 2 c c p 0 N O f6 w C U U a)fs0 to '73 (p 0 0 O •c (0 L- .0 O a22aa2C9aa ti ti CO CO N O LA ti M a CO M 1C) N (O 0 C1) N M (O O CA M O N (O L0 ti O) CO CO N EXPENDITURES: Salaries and Benefits: O 0 O COO0. O co N LA LOf) CO O d0' N 0 N CO OLA CO co<07 M N O co N O0) O N N 0 co Ln co CO LA N C71 O) M r In O CA LOA N co co O N M N N c m m ch as • 73 CO m CA 0 O 0 0 0 0 0 0 0 0 0 0 0 O O Lf) CO 0) r 0) a) N Io 0 CO CO CO N CO CO N (fl a) (q co (fl 0 IS 0 r (O CA CA d 00 W N ✓ O) LA 0) 0 N U) L() LA �t 0 r CO r O M O o0 00 M 00 N 0) �- Lsn. 0 eee-�t r (fl O) O) I� r r Q) N (O 0M0 Ct N O s7 M e coM OM) O I� 00 r Is T T r 0 I- N 0 0) CO 0 0 0 N 0 N O) CO LA CO CO 0 N CON N M M d' 0 0 C0 M I- et Nei r N CO o rL CO CO LC) CO LA O) r N I- O �t ✓ O) N L!) CO I� N (0 "I CA CO O) CA NI '- (0(0 • r r co co co co MLA 0�0 M 0 0 0Lr L( ID CO co. O M 1 N r r I'- r O N N r r M 00 I.. 0 r sr r et co r r (O M r r CO (O CO CO CO O LA r r r 0) (00 • N. 0) et M CO LLj N- N. CO_NV N Is 0 er- et s- d0' co sN- sr- r coMM r r Contract Services - Patient O CA ti O O O O M O 1` M M C7) O CO O O co co O M O ti co N CA N C 4) CD c a O I.= C N o Z It O d E d O N Q N r3+ U O o ea .6 O c C C O .r U O O CU N U CO c CU c> C 1 C. 0. 1.1 d O_ E N C V t.) W w cw Q. E ) 2= Es c d N d (0 0 C -� U cOUH W li ctt<OOi- M CO N co M '1 Revenue Over (Under) Expense .4- Nts. NC * The annual budget assumes 251 workdays per year and the monthly budget is based on # of workdays in the month. Internal Revenue Service Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Date: August 3, 2002 Person to Contact: Steve Brown 31-07422 Customer Service Representative Neighborhood Healthcare Toil Free Telephone Number: 425 N Date St 8:00 a.m. to 6:30 p,m. EST Escondido, CA 92025 877-829-5500 Fax Number: --- - ----513=263=3756— - - -- Federal Identification Number: 95-2796316 Dear Sir or Madam: This is in response to the amend.merit to your organization's Aiiicies of Incorporation filed With the state on March 18. 2002. We have updated our records to reflect the name change as indicated above. Our records indicate that a determination letter issued in July 1973 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is riot a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10.000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar year Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Coae. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts :o your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sec:ions 2055, 2106, and 2522 of the Code. -2 - Neighborhood Healthcare 95-2796316 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Fomi 990-T, Exempt Organization Business Income Tax Retum. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you to make your organization's annual retum available for public inspection without charge for three years after the due date of the return. If your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records_ If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, John E. Ricketts, Director, TEJGE Customer Account Services City of Temecula 2011-12 CS Funding Program APPLICATION NO. 22 CITY OF TEMECULA FISCAL YEAR 20 1 1.12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) PROJECT INFORMATION Amount Requested: $ 2,500 (Maximum allowable $5,000) Project Name: Oak Grove Center Arts Program (1)c rfor;,: :;t; Arts & Visual Arts) Project Start Date: September 7 , 2011 Project End Date: June 30, 2 012 ORGANIZATION INFORMATION Name of Organization: Oak Grove-Gn.t- iee : ___Kdacla_:_>n- anent and" the Ar-ts Contact Name: Tammy Wilson Title/Position: CIE Mailing Address: 24275 Jefferson Ave. , Murrieta, CA 92562 Telephone: 951-677-5599 E -Mail Address: tammywOoakgrovecenter.orq Year Organization Founded: 1989 GeographicArea(s) •:±: Number of Paid Staff: 283 Number of Volunteers: 61 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: _t_29j, _ If "yes" (Must provide a copy organization's 501( fl nn-. ► :ft status form): Date of incorporation as a non-profit: septembe r 1 s 9 Federal identification number: 33-0470446 State identification number: r1 S7a925 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application - Page 1 Members -at -Large as FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION, FINANCIAL STATEMENTS AND FOOTNOTES (it does not require a CPA's audit, but please submit if available.) However, if financial statements are not available, this page must be cornpleted. MISSION STATEMENT Briefly describe the goals and objectives of your organization a, id community services it provides. Describe the ways your organization meets the criteria listed on page 2. Oak Grove's mission is to "rebuild the lives of at -risk children and their f,,sriiiie:. through educating, healing, restoring relationships, building character and instilling hope': We believe u;at "The work we do today builds a better tomorrow." Oak Grove, a nonprofit educational and residential center, serves 175 children including 76 who receive 24-hour residential treatment services. Children come t:::,; with :1 variety of psychological, social, emotional, behavioral and academic problems. They suffer from physical and/or sexual abuse, emotional abuse, neglect, or other traumas. Oak Grove was founded in 1989 and altho.,c:'» it oris i !! served only the children who lived on campus, over the years there was more of a need to serve children fror;; :;; iocal community that live at home. We now provide a nonpublic school setting for an additional :) youth th,.; ::-e transported from the local areas daily. Two years ago we opened two classrooms for children a:::! :-out!: with ::utism , followed by athird classroom this past year. These children all receive case managclnent services, Stroup therapy or family therapy depending on their needs. We also operate a second satellite campus in Perri';. " Grove at the Ranch. This is a nonpublic school only with 50 students are enrolled. This includes s:U<1 n r : e Temecula area along with foster children living at Rancho Damacitas. These students have alsc l cn invr.• ' in our arts program. Our Temecula population of students is growing. Our Tema •.!;: stn:!e:: • ! :: been involved in arts at Oak Grove as well as in the community. As part of a previous grant, students were ir:-; olved in various aspects of the arts including rock band, a performance team (choir), singing lessen, r•ritar lef• • : Drumestra and dance as well as visual arts. The Drumestra has been a great addition for our s:;::' •nt; .`•1:: ': le with anger management issues as well as self-expression. We included more of our develop:- • • • r'y 'le': • ° 'Indents including those with autism given our increase in census. We would like to continue to a-':' +'':: ' Working in conjunction with the Boys and Girls Club, Ternec:u':: Live Plc! :•"'.•' r•r l other nonprofit organizations has provided our at -risk population the opportunity to not only he e•n..-iclv'd ! .r,-, Arts but to be exposed to the community in a positive manner that has fostered connections that c:. ' o n:. •.:•.! after discharge to their local public schools. We believe that this provides for a stronger transit iorr ;t_, as they have been exposed to positive influences within the community and are therefore more 1 i) r'. ::::r;., ;.:t • . cse connections and new-found interests along with their sobriety, in the case of those who were treat!..! for adli-' H '-sues. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and wh . Include a detailed .budget and a schedule of significant activities related to this project fP14,1 r! `�°? . k clot jiief i.._rii f,. • n��' .. rk. �.rr ,.�:.„, '� �"��'� •:��� typewritten page of information. (Please type or print legibly.) Similar to FY 2009-2010, our organization will use the funding to deliver services related to the Performing, Literary and Visual Arts, prioritizing Temecula students and providing opportunities for them to become fain iliar with resources the city offers and to ease the transition following discharge from Oak Grove back into the con unn n ity. We have a very positive track record with our students who are consistently returning, after graduating from the program, letting us know how they are doing, how important the arts are to them. They are also asking to be involved even after graduation which speaks to how important the program is to them and how important the arts have become. The Arts Program is multi -faceted including exposure to music, song -writing, drama, film, drumming, performing and job skills training. The students will be involved in writing, rehearsing and performing for Senior Citizens and peers within their community. In addition to "giving back", they are also learning Ieisure skills and social skills. . This past year we again expanded services to provide arts programming to day students from Temecula. We provided services to students who were placed by the Temecula School District. The number of local students has grown in the last several years and we are expecting higher enrollment this year. The students are able to earn credits while in the Arts program, but even more importantly are earning self-esteem and self-respect. As part of the grant, we provided field trips and experiences designed to "reintegrate" the students into the community. This was designed to facilitate a smooth transition back into the community at the end of the academic year. Similar to the design last year, there will be experiences involving r11:ing students from Temecula into the community to various art venues including the Boys and Girls Club Teen Idol Search, Poetry, Art and Photography exhibits, exposure to the Temecula Music Festival and Youth Film Festival, etc. These field trips not only will stimulate their artistic ability but facilitate their transition back into the community from which they had been placed. As part of our socialization and integration with these Temecula Students, we want them to have more access to the programs that Temecula is offering so in addition to the Arts, a field trip to the Boys and Girls Club and Community Recreation Center. Many c)t Gut at -risk youth have not previously accessed what the community has to offer. If we expose them to what is positive in the comm nr r ity, it's more likely after discharge that they will be more likely to remain sober, remain connected to others and maintain the progress that they have made while in treatment. Additionally, with the expansion of our Autism program we plan to offer art:, phot=ramming to these special needs students, this allows positive ways that these youth can connect with others and be "include.”" Lr programming. Given that this group of students lives in the community, another aspect of the l:ro;ct will be to involve them in either participating and or volunteering at a Benefit for the Arts being produced by'1'crr: cc n la Live, 1: •1:! at the Temecula Theatre on Jan 27 and 28, 2011. We again will involve our local students in working on I earn job skill:: n ca.nbination with artistic skills by learning how to be involved artistically on visual, performing and literary and vocational levels. This will expose them to marketing and promotion, teaching a job skill but in a manner that supports arai encourages involvement in the arts. The visual artists will also work on work that can be displayed at Temecula Live or Ever ';; Under tl: Oa'.s for a student exhibit. We will involve artists from the community to work with our students, preparing then r for tl i:: ever:;. 'I i:e more we increase familiarity and comfort with the local community, the greater the success of transitioning back into the l oca i c: c., n r; nunity in a positive, productive manner. We have added a third class to the two classes added two years ago for cl r i Idren and : •o, tt h with autism, comprised of local children. There is a lack of resources and enrichment activities for this special neees pope iLtt ion [.o the plan is to involve more of these youth in the arts program as well. inclusion is very therapeutic for thes., sti d uts r:-:.' e:. ly increases their self-esteem. Application — Pagt; 3 Oak Grove Arts Budget Temecula Students Field Trips -Community Integration Therapeutic Drumming $1055 costs related to transporting Temecula Students to a variety of outings, venues in the local community to assist in bcc ini.u; familiar with community resources 2 Sessions, 8-10 students @ $650 = $1300 (Oak Grove's fundraising efforts will provide seed mont:y for this endeavor with a goal of submitting student films, goal oriented documentaries, videos and film—Oak Grove is committed to raising funds for an additional $815 for a third session or <. additional students. $1055 Fine Arts Classes $1300 Materials and supplies, paints, canvas, chalk ; a:>tels Pur a. c :.;asses at Oak Grove, both a Special Needs (Developmentally disabled and autism) as well as an at -risk class for Middle and I lifyl School Students. 3 classes at $500 each Class taught by local artists from Temectd:t ior semesters Performing Arts = $5855 $1500 $2000 Requested grant amount $2500 Oak Grove plans on involving Angels for Oak Grove, our Vol ;ntl:: r C;1 )1.:, [o help us in supporting the arts program, assisting as volunteers and providing additional support. Last year there were at least 30 volunteers that helped on various aspects of the program, finding value in the ;o:.; ; if PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Oak Grove Center did not receive funding for Fiscal Year 2010-11 Oak Grove Center did receive funding for Fiscal Year 2009-2010 Temecula Community Service Funding Program with the award of $1,000 to be used for Performing and Visual Arts Program. There was approximately 50 hours spent in the community for the Temecula Live! Production in January and the Gospel Fest in September both held at the Old Town Temecula Community Theater. Additionally, there were also many trips into the community by the Oak Grove performance teams to local church groups, senior centers and community service organizations that provided opportunities for our students to perform in their community, be exposed to various aspects and populations within the community as well as having ttie opportunity to 'give back". Some of our students involved in the Arts program are part of the Meals on Whe& is 'jcct, ing lunches to Seniors. We took our youth on outings to see the Youth Talent show put on at the theater, other cornmunity events including musical performances at the Promenade Mall. A more intensified Dru liming pr-ograri r began at Oak Grove, which is very helpful for youth with depression and problems expressing their feelings. Vi6ual arts instruction continued and photography and film was introduced. Our outcome studies of students wno have graduated substantiate that the students involved in the arts program are doing well after discharge, Thank you or your support of our community and our youth. Application — Page 4 SIGNATURE 1'AGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Tammy Wilson, LMFT, CEO NAME and TITLE (Please Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: Tammy Wilson, LMFT, CEO NAME and TITLE (Please Prim o; type) ORGANIZATION NAME: Oak Grove Center MAILING ADDRESS: 24275 Jefferson Ave. Murrieta, CA 92562 TELEPHONE: 951-677-5599 DATED THIS .3 / of L1. ,,t r , 2011. (Date) gmonth) E -Mail Address: t:ammyw@oakarovecenter.org Submit Application by September 16, 20 .1 .t : Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judv.mcnabb(citvoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 Oak Grove Center for Education, Treatment Proposed Operating Budget CYE December 31, 2011 & The Arts Description 2010 Budget 2010 Actual 2011 Budget S Ii,c/(Dec) over '10 Actual %of Inc/(Dec) over '10 Actual Revenue Mental Health 4,601,370 6,483,692 5,186,954 ; 1,296,738) -20.00% Adoptions 109,991 90.937 72,750 (18187) -20.00% DSS 223,618 229,283 183,426 (45,857) -20.00% Probation 1,881 104,231 83,385 (20,846) -20.00% Wraparound - - 309,465 309,465 100.00% Managed Care & Private Pay 389,987 348,468 348,466 - 0.00% Interest Income - Res'I 19,140 36,680 20,174 (16,506) -45.00% Residential Education Revenue 1,765,132 1,897,674 1,859,721 (37,953) -2.00% Gain/(Loss) on Investments - 5,617 ,6%0 33 0.60% Day Student Revenue 3,277,597 3,528,670 3,'1''1,^16 '7C,573)` - -2.00% WorkAbllityGrant 80,000 89,148 a=.,1.18 0.00% Intensive Outpatient 27,275 2!,275 - 0.00% Adolescent Partial 63,068 79,965 7.7,995 • 0.00% Nutrition Program Revenue 116,066 110,199 :,1:39 - 0.00% Interest Income - Day Program 19,910 24,000 37,852 93,308 2^,619 100,000 (17,033) -45,00% Donations In -Kind 6,692 490 7.17%1 0.61% Donations - Cash 25,000 80,510 0 r • " Grants 25,000 18,008 1, , "t' - 0.00% Special Events 100,000 147,942 1r'1,(80 (47,942) -32.41% Fundraising - 11,033 •',C'.;0 (5,933) -49.72% Mise Income : ,5 '8 63 0.67% ENINIMIIIIIIMEEM) W9,437 Expenses - ADL (Res. Allowances) 12,365 :1I,1;.!: ' " 534 4.00% Amort Loan Orig 1,626 " ' ' - 0.00% Auto Repair 22,572 " ' 781 4.00% Bank Charges 7,424 i, ,.:Y 5 339 4.00% Books/SubscriptIons/Wkbks 16,442 1:',' t5 498 4.00% Building Rent 97,920 /,1 I 1,150 16.91% Clothing 1,385 1,672 , r e 67 4.00% Computer 35,482 ''3,909 •,' t, c. 1,756 4.00% Conference/Workshop 25,092 71,:1" • ' . ' " _ 3,67,1 17.25% Contractors 298,242 34"' 3 ' 13,884 4.00% Dairy 29,465 . .. 1,1',1 4.00% Damages/Repairs 21,662 "' ' " 1,6'':. 4.00% Dental Benefits 10,862 7 1,8':'! 15.00% Depreciation Building 198,886_ 'i' • 1,6;1 1,7 to 4.00% Depreciation Computer 39,977 a ': 1 4.00% Depreciation F, E & F 37,137 4.00% Depreciation Vehicle 52,908 I t, 0.00% Dietary Servicei _� 4.00% EAP Benefits 6,218 ' I 25.00% Electricity 126,093 1; , I 1 1 1 ,. 21,1,:,: 4.00% Equipment 18,691 t.1' 4.00% Equipment Rental 81,895 ._ . I 50.00% Flex Benefits Disab. 622 . . 25.00% Food Supplies 200,094 2 2 ' . 10.00% Forms 9,967 , ; ''iG 4.00% Fuel 73,472 tit. I I +t,!;02 • 10.00% Fundraising 64,946 7 : ' I 0.00% Ptt,1:: ;' h its $ over '10 ;.clual % of Inc/(Dec) over '10 Actual 19,710 -100.00% 1,024 4.00% 17 2,640 45.00% 1-5 8,015 231 •t64 • .'36 '28 194 :i r7 711 10.00% 4,839 10.00% 29,507 9.01% 0.00% 0.00% 559 14 50 913 4.00% 4.00% 4.00% 10.00% 136 227 5`:,704 10.00% 4.00% 15.00% 177 2,067 2,.153 10.00% 10.00% 4.00% 0.00% 0.00% 4.00% 719 4.00% 4.00% 3,'148 4.00% 1.;'78 1 4.00% 29.::64 5.96% 17 4.00% 3,t 4.00% 10.00% 10.00% 106 .1. 1,, 4.00% 4.00% 4.00% 7.03% 514.18% 21.37% 4.00% 4.00% 100.00% 4.00% 4.00% 100.00% 0.00% 0.00% 10.00% 4.00% 10.00% 100.00% 4.00% ikaarial Oak Grove Center for E. 't ':..'on, .1. Proposed .p: .',..ting B! CYE Dec.:0.0r 31, Description 2010 Budget ;;;;; .,tt,,;;! 1, Gain/Loss of Fixed Asset Dispose - (15,710) Housekeeping 31,336.'uT Inservice 8,358 - 7 Insurance - Facility 98,670 8r.,1rt, Insurance - Transportation 50,291 4!:. 192 Insurance - Workers Comp. 276,937 ::27,;;67 Interest Mort. 166,678 , .: ,7:16 LOC Interest ' • 28 License/Permits/Fens 12,5519 : ' 441 Linens 277 , Maintenance - Transportation1,501 1 - 1 Marketing & P/R 25,901 I,; .1',',• Meals 1,101 ;,1•.,: Med. Supplies 6,194 Medical Benefits 406,301 Medications 7,585 1 7 '•: Memberships/Dues 23,701 21 " Mileage 47,976 4 52 -• Minnesota Life Benefits 13,200 vi • 1 Miscellaneous ! — Natural Gas 8,239 11 ' i Office Supplies 7,311 Outings 19,923 I ______.. Outside Services 73,506 •,, Payroll Processing 32,654 ,' - 1• Payroll Taxes 495,349 4: i,;. 1 ,; Pers. Res. Exp. - r. Postage 10,100 10,5'• Prof. Services - Attorney 5,000 Prof. Services - Auditors 31,330 Property Tax 14,537 Recruiting 6,197 Rewards 32,565 , Salaries 6,852,244 6,7 Sales & Use Tax Staff Awards - Benefits 50,000 Storage Rental 4,673 Supplies 93,131 k, 1 Supplies - Donated 46,366 , 5 11; Telephone 50,358 4: Trash -21,082 2 Travel__ 13,000 Uncollectible A/C's 116,844 191:,4: it.,. Unemployment Benefits 97,101 10 : 1i, WorkAbillty & Special Programs 6,510 1 Water/Sewer 29,230 2 _ Work/Study 1,651 2 Wraparound Exp (less salaries) H 401k Retirement Plan Benefits 52,888 . 49 lir,R:.Ile :.f ' 111 '1:i... ":.. i'1=1i1i1: tolnrl •iY1.i;.: A !: QS P art, Y i; #,; ; ,. Ptt,1:: ;' h its $ over '10 ;.clual % of Inc/(Dec) over '10 Actual 19,710 -100.00% 1,024 4.00% 17 2,640 45.00% 1-5 8,015 231 •t64 • .'36 '28 194 :i r7 711 10.00% 4,839 10.00% 29,507 9.01% 0.00% 0.00% 559 14 50 913 4.00% 4.00% 4.00% 10.00% 136 227 5`:,704 10.00% 4.00% 15.00% 177 2,067 2,.153 10.00% 10.00% 4.00% 0.00% 0.00% 4.00% 719 4.00% 4.00% 3,'148 4.00% 1.;'78 1 4.00% 29.::64 5.96% 17 4.00% 3,t 4.00% 10.00% 10.00% 106 .1. 1,, 4.00% 4.00% 4.00% 7.03% 514.18% 21.37% 4.00% 4.00% 100.00% 4.00% 4.00% 100.00% 0.00% 0.00% 10.00% 4.00% 10.00% 100.00% 4.00% ikaarial Oak Grove Institute F uncdakon Balance Sheet (Compared t1 'rior Ye...') 6/30/2011 Un..udited Assets Current Assets Cash and 10001-99 10100-99 10101-99 10200-99 10201-99 10210-99 10220-99 10300-99 10400-99 10900-60 10900-99 cash equivalents Cash - PWB - Gen Che: ':incj Cash - B of A - Payroll Cash - PWB - Payroll Checking 7,315.91 Cash - B of A - Int. Maximizer :)2,795.21 Cash - PWB - Int Maximizer :.:bi's,342.85 Cash - Merrill Lynch CM \ 417,006.3 Cash - Merrill Lynch SDP - Cash - CD Restricted 50,192.00 Cash - Money Market D 53,980,40 Petty Cash 900.00 Petty Cash 4,000.00 :urrent Year 73,771.78 Cash and cash equivalei,ts Accounts Receivable 11000-40 Accounts Receivable 11000-60 Accounts Receivable 11000-99 Accounts Receivable 11050-60 Allowance for Bad DeUs 11050-99 Allowance for Bad Debts 11500-99 Accounts Receivable - Accounts Receivable Other current assets 13000-99 Prepaid Expenses 13220-99 Prepaid Insurance : or n. nor cial 14200-99 Deposits - Workers Con y Other current assets Total current assets Other assets 15000-99 Loan Origination Cons Total other assets Fixed assets 8/30/2011 3:32 PM Buildings 16000-20 16100-20 16100-99 16150-20 16150-99 Construction In Progress Buildings Buildings Accum Depr - Buildinc;s Accum Depr - Buildings Buildings Computers 16200-10 Computers - 4 yr 16200-20 Computers - 4 yr 16200-60 Computers - 4 yr (4,55f;.00 .J.,251.40 22,016.10) .0,73EL0O •'.713 7 Prior Year 226,803.59 335.81 4,211.88 3,784,741.47 345,583.67 50,650.00 56,587.67 1,434,406.95 900.00 3,300.00 5,907,521.04 285,427.44 2,133,887.77 (62,668.83) (204,666.62) 38,414.93 2,190,394.69 26,265.54 19,865.36 65,665.00 111,795.90 8,209,711.63 7,586.07 7,586.07 10,000.00 843,906.33 7,134, 837.93 (26,271.61) (3,006,278.04) 4,956,194.61 14,279.27 107,541.92 28,674.20 c.3 4CE SHEET 06-30-11 (unaudited) Oak Grove Institute F Balance Sheet (Compared ti 6/3J/2011 Unaudited 16200-99 16250-10 16250-20 16250-60 16250-99 16270-20 16270-99 16290-20 16290-99 Computers - Accum Depr. Accum Depr. Accum Depr. Accum Depr. Computers - Computers - Accum Depr Accum Depr Computers 4 yr - 4 yr Coo iputer - 4 yr Com; uter - 4 yr Co:, .utar -4 yr Cornouter 7 yr 7 yr - 7 yr Computers - 7 yr Computers Furniture and Equipment 16300-10 Furniture, Equip., & Fixi:.,es 16300-20 Furniture, Equip., & 16300-60 16300-99 16350-10 16350-20 16350-60 16350-99 Vehicles 16400-10 16400-20 16400-60 16450-10 16450-20 16450-60 Furniture, Equip., & Fixtures Furniture, Equip., & Fixtures Accum Depr - F,E & F Accum Depr - F,E & F Accum Depr - F,E & F Accum Depr - F,E & F Furniture and Equiprr:'1: Vehicles - 4 yr Vehicles - 4 yr Vehicles - 4 yr Accum Depr - 4 yr Vehic; :s Accum Depr - 4 yr Vehic! Accum Depr - 4 yr Vehi^1 ” ; Vehicles Land 16900-99 Land Land Total fixed assets Suspense Suspense 19000-99 Suspense 19200-99 Suspense- P/R Marival/V.;ia cks Total suspense Total non-current assets Total assets 8/30/2011 3:32 PM 1 1 7 7 17, :.: ;ion r) Prior Year 238,309.09 (13,907.33) (67,436.72) (17,273.19) (199,497.90) 8,027.83 11,265.25 (8,027.83) (11,265.25) 90,689.34 293,424.84 98,977.98 8,175.18 396,396.03 (243,006.40) (57,625.32) (2,943.58) (313,009.75) 180,388.98 24,773.70 476, 855.69 103, 802.33 (24,773.70) (440,067.63) (91,363.80) 49,226.59 1,750,000.00 1,750,000.00 7,026,499.52 (1,000.00) ,295.42 295.42 7,034,381.01 15,244,092.64 2 of 3 ,CE SHEET 06-30-11 (unaudited) Oak Grove Inst;cute F : ion Balance Sheet (Coirupared tc 6/30/2011 Unaudited Liabilities and Net Income (Equity1 Current liabilities Accounts payable and trust 20000-99 A/P - Trade 20500-99 A/P - Other 21000-99 Cash Held in Trust 21500-99 School Nutrition Trus; 22500-99 Note Payable Total accounts payable and trust Accrued expenses 23100-99 23200-99 23300-99 23400-99 23600-99 23700-99 Accrued 401(k) Benefits Accrued Interest Expensr: Accrued Payroll Accrued Payroll Taxc:s Accrued Unemploy; iiont Accrued Garnishmon: 23800-99 Accrued Vacation 23900-99 Accrued Expenses Total accrued expenses Total current liabilities Long-term liabilities 24000-99 Mortgage Total long-term liabilities Total liabilities Net income.(equity) 30000-10 30000-20 30000-30 30000-60 30000-95 30000-99 Current earnings (Ic.s:;) Ret Earnings - RTC ;r1,: r`.ata Ret Earnings - Sch `.Lurk- to Ret Earnings - Medi -cal tv urrie Ret Earnings - Sch Perris Ret Earnings - Vista Ret Earnings - Muir icta Total net income (equity) Total liabilities and net income (equ;t,; 8/30/2011 3:32 PM 2 2 4, 3 13 17 rr Prior Year 129,389.86 378,438.77 (1,468.55) 68.48 33,214.81 539,643.37 5,124.87 12,953.33 201,815.12 64,361.01 110,487.60 1,422.68 215,448.47 12, 000.00 623,613.08 1,163,256.45 3,269,944.96 3,269,944.96 4,43:;,201.41 1,809,730.01 (684,918.21) 6,469,131.51 635.51 706,230.36 (5IL,956.16) 3,286,038.21 10, 810, 891.23 15,x . •.,092.64 JCE SHEET 06-30-11 (unaudited) Internal Revenue Service Date: March 23, 2005 OAK GROVE INSTITUTE FOUNDATION INC % THOMAS LESTER 24275 JEFFERSON MURRIETA CA 92562-7285 Dear Sir or Madam: Department of the Treasury P, O, Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Regina Parker 31-07403 Customer Service Specialist Toil Free Telephone Number: 8:3u a.rri. io 5:30 p.m. ET 877-629-5500 Fax Nuts.bur: 513-263-375(5 Federal identification Number: 33-0470446 . This is in response to your request of March 23, 2005, regaruing your organization's tax- exempt status. In September 1992 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your ornnnization Is currently exempt under section 501(c)(3) of the Internal. Revenue; Cc du. Our records indicate that your organization is also clncssif:d i:s a public charity under section 509(a)(2) of the Internal Revenue Code. Our records indicate that contributions to your organization aro deductible under section 170 of the Code, and that you are qualified to receive tax deductibic bequests, devises, transfers or gifts under section 2055, 2106 or 2522 oi :i:;: ,:uvenue Code. If you have any questions, please call us at the telephone nu;nber sisown in the heading of this letter. Sincerely, Janna K. ;)i;,;;;,o;, i-E/GE CustornerAcco;.rst Survic City of Temecula 2011-12 CS Funding Program APPLICATION NO. 23 CITY OF TEMECULA City of Temecula FISCAL YEAR 20 I 1-1 2 SEP 15 2011 COMMUNITY SERVICE FUNDING PROGRAM APF'IIi,,l T ION (Please Print or Type) 2011-12 Program Submission Deadline:. Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5.r On 0 (Maximum allowable $5,000) Project Name: aAe- Jtc c'sc61tool A.)cst`-1 .q2r�Afi1\S Project Start Date: kt Vtcri'lo Project End Date: WA ORGANIZATION INFORMATION Name of Organization: Cod - Contact Name: HA/W_ AV' Sv"U Title/Position: Mailing Address: 3\'-{e\ 3 e QU cU L - Telephone: qS-k 3O3 qk 3 a- E -Mail Address: Year Organization Founded: 200 S' Geographic Area(s) Served: Number of Paid Staff: ‘t (4,0 .c; (uacc:„L0.(Cer-`lam octti'\ONr- GA -AA -IL ,c_briN 1 € \lw Number of Volunteers: \00 + • Is this organization incorporated in California as a non-profit organization? Yes i< No Effective Date: If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: Federal identification number: State identification number: If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application — Page 1 Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. b csz-rv; c_.s2 S CeA \ elm u • l s er o 1 `fin \\P � d Svc . G ,, r a rvi")_0_, Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) c PleaAr N0,--,) ct-) (\- t��l' d.J ire.-. i•IJ:G,� �v�►��,G�� �-' t r�r�-��r- ��>� C:1.�'l ,'-�J --� <�'�l. cY�� ttc- f l t- i �h �� �� i n k---; �. �.j{L� r �Z3 ) (.c 3 k COe o L $ E t - k \ \ - e kk- , of c. F ketc_N 3e , oAl I 1A_ C U lads b- oc, \1 o< - n Ciel 74- e,..r6„ -' rk AP C•+'� .� C/' (11�'� &n-.v/� 1)U' C,c;4�t (S A7) Ci\C" c" Pc.i<PN-0-r-c 'We 0 (-1- (-1";.\2,-ev, (n;ex‘ 2Sk/ e 5 - c,.aoL)\ Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. V,a,}e, i \Aa4`v\ CV- ect.5 i1 -fid 4, 0 ai `�(,.� ' G A -Dol s --e\. VSO �'(4a.fl,..- ` I � t;.% \\p�� U�-� 1,��= \(,C ri-C-})Ct 5 - - -1- L j eUZ- 1't r 0,^ (Cu r- c d - v.j1/4/12ZC 0/`P -JC S rr:oc,)✓t0-5 '1)4 ( 1/ \cams .Q,nr.› Q[ k2 UJ'c r Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: 14(LK- 11*' S r D \I V f, Pre," ,. *- NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: ORGANIZATION NAME: NAME and TITLE (Please Print or type) ke-4TO CPT R.C4se\A--1 MAILING ADDRESS: 3( 4`13 e - t -3G \D fol./.;Lo TELEPHONE: qn3o3'(31-3 DATED THIS (2 of (Date) E -Mail Address: \ --v\-11/4)1 t -N -J Fes` Ci a-'\ u fie_/ , 2011. (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: judy.mcnabbacityoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 24 CITY OF TEMECUL4 FISCAL YEAR 20 1 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) SLI 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 (Maximum allowable $5,000) Third Grade Education Program at the Santa Rosa Plateau Project Name: Frngl ng; cal RPSPrvP Project Start Date: September 2011 Project End Date: June 2012 ORGANIZATION INFORMATION Name of Organization: Santa Rosa Plateau Foundation Contact Name: Ginger Greaves Title/Position: Executive Director Mailing Address: P.O. Box 941, Murrieta, CA 92564 Telephone: 951-696-5967 C11j1 ;'E -Mail Address: Year Organization Founded: 2003 Number of Paid Staff: 0 ginger@srpf.org Geographic Area(s) Served: Southwest Riverside County Number of Volunteers: 25+ Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: May 2003 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: May 2003 Federal identification number: 71-0946697 State identification number: 2531858 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee X Board of Directors X Members -at -Large Application - Page 1 FINANCIAL STATEMENTS (PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS BALANCE STATEMENT AND INCOME STATEMENT.) It is does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on Page 2 of the CS Funding Policy. Mission Statement — Santa Rosa Plateau Foundation (SRPF): To inspire and motivate students to learn and care about the natural world. We accomplish this by providing programs and projects at the Santa Rosa Plateau Ecological Reserve (SRPER). Criteria A. Is the organization currently non-profit? Yes. Since May 2003 the SRPF has had and continues to have, a 501 (c) 3 federal tax exemption. B. Does the organization provide a service to the overall community? Since 2003, the SRPF has focused on providing funding to help educate third graders living in Southwest Riverside County about the natural world. The SRPER provides an ideal outdoor classroom in an environment rich in natural and human history. To date, this education program has benefited approximately 77,000 students from eight (8) area school districts, including the Temecula Valley Unified School District (TVUSD). Of the 77,000 students, approximately 22.300 students came from TVUSD. It is SRPF's belief that the entire community benefits when children are educated about their natural environment, inspiring the next generation to ensure preservation of all natural places, including the SRPER, a unique natural asset to the Temecula Valley area. In addition to funding costs associated with the classrooms coming up to the SRPER, the SRPF funds a Title 1 Outreach pro ect taking the outdoor program to the low -to -moderate income schools in the area. It also funds a middle school (6`" 7thand 8' grade) research project. The funds requested in this grant will cover ALL the costs for the TVUSD buses used to transport TVUSD students to the program. B. Is the size and make-up of the organization equipped to provide the program/service to the overall community? Approximately 30 volunteer Docents led by Rob Hicks, the SRPER Interpreter for Riverside County Regional Parks and Open Space District (an "essential partner"), teach the curriculum which meets the State of California Board of Education Science Content Standards. Each Docent has attended and graduated from a 10 -day training course. These courses are held annually in order to prepare new Docents serve/replace Docents due to attrition. The courses also serve as refresher courses for experienced Docents and include education regarding the flora, fauna, geology and geography of the SRPER. A significant proportion of Docents participating in the third education program are retired school teachers continuing to give back to their community. New docents are required to "shadow" those with experience prior to independently leading a third grade class. C. What is the public reaction to the group? The SRPF has established itself as a credible, effective organization in the Temecula Valley. SRPF is a member of the Temecula Valley and Murrieta Chambers of Commerce, and the Temecula Valley Convention and Visitors Bureau. The TVUSD and Murrieta Valley Unified School District (MVUSD) have both honored the SRPF in 2009 and 2010. The MVUSD entered into a Memorandum of Cooperation (MOC) to assist the SRPF promote its education programs and fundraising projects. Scott Bangle, General Manager of Riverside County Regional Park and Open -Space District endorsed the SRPF's Third Grade Program (see attached letter) in February 2011. Major financial supporters include the offices of Supervisors Jeff Stone and Bob Buster, Ace Hardware, Pechanga Band of Luiseno Indians, the Roripaugh Family Foundation, the Verizon Education Foundation and the Coeta & Donald Barker Foundation. D.Does the organization have a high quality of fiscal management? The accounting firm of Nottingham and Associates and their predecessor Doughtery and Nottingham of Temecula, have provided accounting services since the SRPF's inception. They prepare all tax returns and monthly P&L and balance sheets. Their records are reconciled by the SRPF's treasurer each month who is a retired real estate analyst/commercial real'bstate appraiser with a degree in accounting. Monies required to produce fundraising events are raised and/or committed in advance of the event with no monies being used from the general fund. SRPF fundraising events include an annual art show, garden tour, a Cowboy Jubilee, and community education classes related to nature. E.Is the group well organized to ensure longevity in the City of Temecula? The Board of Directors is comprised of thirteen (17) individuals. Two are charter members and the remaining members have served terms of one to four years. Longevity is ensured by a succession plan for key officers. F.Is there evidence of satisfactory service provided to the City's Citizens? The success of the program undergoes constant evaluation from the third grade teachers who accompany their classes to the SRPER. They rate the teaching manual, the effectiveness of the classroom experience, the knowledge of the Docents and the enthusiasm of their students. Students are pre- and post -tested to validate what they have learned. Results are tabulated and shared with the SRPF and the Riverside County Parks' staff. G. Is the organization free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion or political affiliation? Yes. H. Does the organization require attendance or participation in any political, religious or social activity? No. I. Can the organization provide financial statements (prepared using an appropriate method of accounting) to demonstrate sound financial management? Yes. Current P&L and Balance Sheet attached. Application — Page 2 J. Can the organization provide a budget for the fiscal year of request demonstrating cost-effectiveness? Yes. Attached. K. Does the organization make its services available to all? Yes. L. Does the organization possess ongoing program evaluation tools? Yes. For the third grade program, a pre- and post-test was developed and implemented to evaluate and measure what the students learn after their participation in the program and to ensure that they are achieving an increased level of knowledge about the natural sciences. In addition, each teacher evaluates the program in written form. All the information is recorded, tracked, and provided to the SRPF, SRPER staff and the Riverside County Parks Department for ongoing review and evaluation. Application — Page 3 r PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) "The Santa Rosa Plateau is a secluded refuge in the Santa Ana Mountains — a place of rare beauty .... The plateau is a treasured keepsake of untrammeled Southern California. It blends the region's largest expanse of native grasslands with wetlands, coastal sage scrub, chaparral and dramatic stands of rare Engelmann oak" - The Nature Conservancy. Additionally, vernal pools provide habitat for the Santa Rosa Plateau Ecological Reserve (SRPER) fairy shrimp and migrating birds. Natural watering holes across the SRPER sustain 50 dwelling species of plants and animals, including mountain lions, burrowing owls, and southwestern pond turtles. The original ranch's adobes are the two oldest buildings in Riverside County, providing visual testament to an era of the area's natural history. Archeological locations and artifacts provide further educational opportunities regarding earliest indigenous Indian life. Using this incredible outdoor classroom for its setting, the third grade {included a Title I Outreach program) and 6, th, and 8`" grade education programs funded by the Santa Rosa Plateau Foundation {SRPF) provides a unique teaching environment for 7,000 to 8,000 students each year. Teaching materials, including sections on habitats, plants, animals, geology and human history, are sent at the beginning of each school year to each participating third grade teacher to be utilized in lesson planning prior to the day trip to the SRPER. A very successful outreach program to Title 1 schools was added in 2008-09 by volunteer docents focusing on these third graders, many of whom have never been to an undeveloped open space. Irrational fears are allayed and anticipation is built, optimizing the on-site program for when the students arrive at the SRPER. Upon arrival, Rob Hicks — Riverside County Parks Interpreter, and his staff of 20+ volunteers, lead the students on an illuminating hike through various habitats. The students experience first-hand their natural environment, walking back through time to an older, more pristine California. It allows them to learn by experiencing nature's beauty and variety directly so that they may appreciate its wonder and fragility. Additionally, the SRPF believes that it is through education of the community, especially the children, that preservation goals can be realized. The Temecula area has experienced one of the highest growth rates in California, with a Riverside County population reaching over 2 million. The subsequent results have been a loss of habitat and historical buildings. The SRPF believes that meeting the basic needs of employment, housing and services for humans while preserving our environment can be achieved through educating children about the habitats that sustain the flora, fauna and native peoples of the area. The SRPER provides a unique outdoor classroom for that education. The cost of this education program is approximately $120,000 per year. The SRPF has an annual funding commitment of $45,000 to continue this vital program. The remaining costs are paid by one of our essential partners, the Riverside County Park and Open Space District. The current economic climate and resulting budget cuts along with rising transportation costs represent a negative impact on any off -campus school activity. The SRPF third grade program is the only off-site education program that is written and implemented to augment the schools/districts' elementary science requirement. A testing tool has revealed an average 32% pain in natural science knowledge by students participating in the program. Art, music, PE, and other portions of normal school curriculum have become expendable in the push by school districts to save money. Third graders from the Temecula Valley Unified School District (TVUSD) can continue to participate in the third grade natural history and science program with the SRPF's continued financial support aided by a $6,000 grant from the City of Temecula. Please see the following transportation costs for the TVUSD's schools participating in the program during the 2010-11 school year. Application — Page 4 PAST PROJECT BENEFITS If your organization has received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. While the City of Temecula has not yet funded the Santa Rosa Plateau Foundation's request for grant monies since 2006, Temecula third grade students have continued to benefit from the educational program along with other third graders in Southwest Riverside County. Below documents our continued request for funding: FY 2006-07 $3,500 FY 2007-08 $4,000 FY 2008-09 $5,000 FY 2009-10 $2,500 FY 2010-11 $5,000 Application — Page 6 From: 9516778096 Page: 2/2 Date: 10/24/2011 10:46:35,AM r•� SIGNATURE PAdE We hereby certify the information contained in this applicatioh is true to the best of our knowledge and belief. PREPARED BY: Ginger SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: Greaves . Px4 eut• i ve Lai r'ec-tor NAME and TITLE (Please Print or Type) EEL- -' f Virginia Hyde Precti runt NAME andTITLE(Please Print or Type) .tel/ SIGNATURE: :e GCS ORGANIZATION NAME: MAIUNG ADDRESS: Fanta Price Plateau Pm) dation P.O. Box 941, Murrieta, Ca 92562 TELEPHONE: 909-732 .2209 E -Mail Address: gingeresrof.org DATED THIS J 6 64' of CL_p2� (Date) (Month) Submit Application by September Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 iudy.mcnabb aecityoftemecuia.orq 951-694-6479 Application — Page 5 , 2011. 5, 2011: BUDGET Temecula Valley Unified Schools Transportation Costs FY 2010-11 SCHOOL NO. X COST OF TRIP TOTAL COST PER SCHOOL Alamos Elementary 3 X $250 $750 Crown Hill Elementary 1X $250 $250 Helen Hunt Jackson Elementary 1X $250 $250 Joan Sparkman Elementary 1X $250 $250 Pauba Valley Elementary 2 X $250 $550 Rancho Elementary 3 X $250 $750 Tony Tobin Elementary 3 X $250 $750 Vail Elementary 2 X $250 $500 Vintage Hills Elementary 2 X $250 $500 Ysabel Barrett Elementary 2 X $250 $550 Grand Total 20 X $250 $5,000 The $5,000 grant request from the City of Temecula will assist the Santa Rosa Plateau Foundation to defray the ever-increasing costs of this vital educational program. Application — Page 5 SRPF OPERATING EXPENSES - 2011 - (Annus Budget) Exclusive of specific projects, i.e. Concerts, Garden Tour, Art Show, Etc. Expenditures through EDUCATION PROGRAMS 3rd Grade Co. Parks Donation Education Assistant Outreach/Wildlife Day Middle School Proj Buses Print Newsletter Print Plant Book Print Membership Info. Postage - Newsletter Postage - Plant Book Postage - Membership Mailings Website Mgmnt. Newsletter Format Supplies - Plant Book Supplies - Membership Signage - Membership Party Equipment - Membership Middle School Proj Tools Etc Cronberg - Photo/Nature Classes Curriculum Materials TOTAL EDUCATION PROG'S. ADMINISTRATION/MGMNT. Accounting Fees CPA - Monthly Statements Federal & State Tax Prep Misc. Tax Filing Liability/ D&O Insurance Office Supplies /Utilities Supplies Stationary/Bus Cds 800# P. 0, Box Rental General Postage TOTAL ADMIN. MARKETING/PROMO Constant Contact Local Chambers of Commerce CoII. Materials - Membership Col. Materials - Special Events Annual Meeting Volunteer Lunch TOTAL MKTG. PROMO ANNUAL OPERATING BUDGET Non -Budgeted Expenses 45000 10000 1500 1500 2772 2070 760 1560 250 100 1150 825 100 50 100 275 1500 1825 1200 72537 2400 675 250 1285 1000 1000 300 60 200 7170 360 650 1000 2000 650 200 4860 84567 ?age - 7 8:41 AM 08/22/11 Cash Basis Santa Rosa Plateau Foundation Balance Sheet As of July 31, 2011 ASSETS Current Assets Checking/Savings Commerce Bank First Citizens Bank -2793 TVB - Trail Maintenance - 7... TVB CD #4 - 0245 TVB CD#6-2612 Total Checking/Savings Total Current Assets Fixed Assets Machinery & Equipment Accumulated Depreciation Total Fixed Assets TOTAL ASSETS LIABILITIES & EQUITY Equity Unrestrict (retained earnings) Net Income Total Equity TOTAL LIABILITIES & EQUITY Jul 31, 11 5,877.91 9,076.84 4,016.01 64,146.82 5,431.36 88,548.94 88,548.94 5,248.51 -2,579.00 2,669.51 91,218.45 111,603.73 -20,385.28 91,218.45 91,218.45 Page ' FOR MANAGEMENT PURPOSES ONLY SANTA ROSA PLATEAU FOUNDATION PROFIT AND LOSS REPORT FOR THE MONTH ENDED July 31, 2011 INCOME: Membership Income Individual Contributions < $250 Individual Contributions $250-$5,000 Art Show - Gift Portion Art Show - Artist's share Art Show Tickets Plant Book Interest income TOTAL INCOME EXPENSE: Art show expense Bank charges Dues & subscriptions Meeting expense Membership expense Office supplies Photo class Plant book expense Postage Professional fees Telephone Third Grade Program TOTAL EXPENSE NET INCOME BEGINNING RETAINED EARNINGS ENDING RETAINED EARNINGS $ 835.13 130.00 1,000.00 957.40 1,545.60 1,491.45 240.00 54.46 6,254.04 610.87 76.32 70.00 12.93 200.00 217.25 150.00 362.50 44.00 200.00 30.42 45,000.00 46,974.29 (40,720.25) 131,938.70 $ 91,218.45 FOR MANAGEMENT PURPOSES ONLY Page 9 E E 1 S I l COUNTY i', 'L- iona1;4rid Open -Space District _.cn;..r. IA•,+r! • lli.rr.,,l. 1"t !l?:i(19-1;8.i4 • itxr,111.i.i:i--1..111 • I... (WM Cri:i.-{.i(Li February 8, 2011 Third Grade and Outreach Docents Santa Rosa Plateau c/o Virginia Hyde Santa Rosa Plateau Foundation, President P.O. Box 941 Murrieta, CA 92564 Dear Third Grade and Outreach Docents of the Santa Rosa Plateau, >! (11 1 i,1\rrl1. The Riverside County Regional Park and Open -Space District is pleased to endorse the efforts of the Santa Rosa Plateau Foundation to sustain and help fund the children's education programs at the Santa Rosa Plateau Ecological Reserve. The Foundation continues to support the causes that the Parks industry has embraced and recognizes the similarities of mission between the educational community and those who support outdoor Learning. While continuing to provide the much needed funding to support transportation for 3,4 grade school programs at the Plateau, the Foundation has launched a plan to build a sustainable program that will ensure success for years to come. The Parks industry has long claimed that parks and open space play an important role in building .self-esteem, leadership, personality, and interpersonal relations ainong our youth. Recently, scientists have studied the effects of nature on populations and provided empirical evidence that supports the notion that access to nature alters the overall well being and functioning in trademark domains: social, psychological, and physical health. Yet, knowing that nature will have an immediate and positive impact on youth is not enough. Taking the research to the next level, the Foundation has launched an aggressive program to determine what level of knowledge is transferred between our interpreters and the students when they visit our program. The first year results are promising. Building pre and post visit tests that coincide with the California State Elementary Science Standards, we learned that a 32% increase in knowledge was obtained by visiting our outdoor classroom over a typical brick and mortar program. So, it is with great enthusiasm that 1 write on behalf of our "essential partner" in asking your support. We have a robust relationship with the Foundation that transcends typical public/private partnerships. Ours is one built on "out of the box thinking" and metric -based reporting that continues to support the call for classroom exposure to nature. The Foundation's foresight in inviting the educational community to the table makes perfect sense as we all work to improve the quality of life for generations to come. S"n erely, Scott Bangh• General Manager c. Bob Grady, Chair, District Advisory Commission Cois Byrd, District Advisory Commissioner, District Itl William Hartford, District Advisory Commission, District I Keith Herron, Nancy Wenzel, Rob Hicks, Park District Virginia Hyde, President; Ginger Greaves, Executive Director, Santa Rosa Plateau Foundation "-Ave- ID INTERNAL REVENUE SERVICE P. O. BOK. 2508 CINCINNATI, OH 45201 Date: 1P, ft',; Ew`•, SANTA ROSA PLATEAU FOUNDATION C/O VIRGINIA GREAVES 39400 CLINTON KEITH ROAD MURRIETA, CA 92562-0000 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 71-0946697 DLN: 604077034 Contact Person: GERALD HOLLAND Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31, Foundation Status Classification: 509(a) (1) Advance Ruling Period Begins: May 10, 2003 Advance Ruling Period Endo: December 31,2007 Addendum Applies: No ID# 95031 Based on information you supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue. Code as an organization described in section 501(c)(3). Because you are a newly created organization, we are not now making a final determination of your foundation status under section 509(a) of the Code. However, we have determined that you can reasonably expect to be a publicly supported organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). Accordingly, during an advance ruling period you will be treated as a publicly supported organization, and not as a private foundation. This advance ruling period begins and ends on the dates shown above. Within 90 days after the end of your advance ruling period, you must send us the information needed to determine whether you have met the require- ments of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, we will classi- fy you as a section 509(a)(1) or 509(a)(2) organization as long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, we will classify you as a private foundation for future periods. Also, if we classify you as a private foundation, we will treat you as a private foundation from your beginning date for purposes of section 507(d) and 4940. Grantors and contributors may rely on our determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you send 14s the required information within the 90 days, grantors and contributors may continue to rely on the advance determination until we make Letter 1045 (DO/CG) ?age - la. FRANCHSE TAX BOARD PO BOX 1286 • RANCHO CORDOVA CA 95741-12d6 In reply refer to 755:6 :SIK September 25, 2006 THE SANTA ROSA PLATEAU FOUNDATION PO BOX 941 MURRIETA CA 92564-0941 Purpose • Code Section • Form of Organization • Accounting Period Ending: Organization Number EDUCATIONAL 2370Id Corporation December 31 2531858 You are exempt from state franchise or income tax under the section of the Revenue and Taxation Code indicated above. This decision is based on information you submitted and assumes that your present operations continue unchanged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect on your exempt status. Any change of name or address must also be reported. In the event of a change in relevant statutory, administrative, judicial case law, a change in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon which this opinion is based, this opinion may no longer be applicable. It is your responsibility to be aware of these changes should they occur. This paragraph constitutes written advice, other than a chief counsel ruling, within the meaning of Revenue and Taxation Code Section 21012(a)(2). You may be required to file Fora 199 (Exempt Organization Annual Information Return) on or before the 15th day of the 5th month (4 1/2 months) after the close of your accounting period. Please see annual instructions with forms for requirements. You are not required to file state franchise or income tax returns "Page'o Santa. Rosa Plateau FOUNDATION www.srpf.org COVER PAGE / INDEX Grant Submittal City of Temecula September 13, 2011 09-14-11A11:23 CVD 09-15 22822-1-9CEDL DESCRIPTION PAGE Application Cover 1 IRS Exemption la FTB Exemption 1 b Application 2-3 Project Description 4 Project Budget/Grant Request 5 Past Project Benefits 6 Organization Budget 7 Organization Bal Sheet 7/31/11 8 Organization P & L 7/31/2011 9 Letter — Riverside County Regional Parks & 10 Open Space District City of Temecula 2011-12 CS Funding Program APPLICATION NO. 25 CITY OF TEMECULA FISCAL YEAR 201 1.12 COMMUNITY SERVICE FUNDING PROGRAM (Please Print or Type) Clty of Telnecti,w SEP 13 2011 Finance Dept APPLICATION :t?I PROJECT INFORMATION Amount Requested: $ 5,11(10 (Maximum allowable $5,000) Project Name: Senior Citizen Service Center Food Bank Project Start Date: 2/1978 Project End Date: On Going ORGANIZATION INFORMATION Name of Organization: Senior Citizen Service Center of the Temecula Rancho Area Inc Contact Name: Rose Vaccarino Title/Position: President/Director Mailing Address: 91 538 Eastman Drive., Unit B, C, Murrieta CA 92562 Telephone: 951-600-9557 E -Mail Address: scscl 1 @Verizon. net Year Organization Founded: 19 78 Geographic Area(s) Served: Number of Paid Staff: -0- Number of Volunteers: 37 Is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: 2/1978 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 2/1972 Federal identification number: 95-1214774 State identification number: C-0838119 If "no": Name of sponsoring organization: Federal Identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application- Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit If available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The Senior Citizen Service Center and Food Banks mission is to solicit, warehouse, and distribute food products in support of Southwest Riverside County low income seniors, families, and the homeless. Established in 1978 as a 501(c) non-profit corporation this public charity is equipped to provide services to Temecula and its surrounding areas. Our public acceptance is ov''r wh@lming, as seen by our continuos growth and longevity, having been a reliable source of food for over 33 years, is evident of the satisfactory services provided to all the city's citizens regard - ]cats of rare, rnlnr, r.rPPfl, nai-innality, Px, marital Gtatus, di ahi l i ty, religion or potif-icaJ afftli ati on, and regardlecs of partisipation in any political, religious or social activity. Our fiscal management is closely monitored by a Certified Public Accountant with over 20 years in the industry, providing us with year-end audited filanciak statements using appropriate account- ing methods, which we also use for budgeting and forecasting. • . 0 0 I- • •. 9 •1 0. s. . .- 0 - place. On going program evaluation methods are also in place as a tool for recognizing number of partisipants, effectiveness, costs, statistics, and areas of improvement, as we continue to reach out to the community. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Funding provides for food for over 13,000 low income seniors and families, refrigeration, and maintenance/repairs for refrigeration as needed. Over the past years, incl with tho economy, the Senior Citizen Service renter has ,axpanded previouo efforts to encompass the entire comm»ni-y and arcac of Couthwest Riverside County, including Temecula, Murrieta, Wildomar, Aguanga and Winchester picking up the Clark from other community centers continuing to provide food, as well as hygieno supplies, and holiday baskets, and toys. Its primary objective to feed the homeless and less fortunate families and senior riti7ens regardless of race, creed, nationality, sex, marital status, disability, religion, or pnlitiral affiliation. The organization currently has six food programs: Bread, Cnmmndities, Sham, Brown -Bag, Emergency Food, and Holiday Baskets which provide homeless and low income families and seniors with a nutritional and reliable method of obtaining food and is looking to add an addtional program "Lunch Box" Program making sure no schnnl child goes hungry. The food bank operates without any pair? staff_ Tho programs are facilitated by a dedicated staff of over 35 volunteers and managed by a Board of Trustees comprised of several retirees from the community, including some who have previously taken part in the programs. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. The Senior Citizen Service Center was formed by Buel Pettit in 1978 as an outreach to serve the community with food. Over all, The Senior Citizen Service Center and Food Bank program is efficient, cost effective, and easy to administer. In the past years it has had a tremendous impact within our community. Budget cuts by the Federal Government, negative change in the economy, including continuing job losses for the area are up three times what it was four years ago, have subsequently led to a rise in the number of people that are homeless or with substan- tial less income and in need of food assistance. Temecula residents and surrounding areas benefited by having a reliable method of obtaining food within the community. In the prior year the fend hank serviced over 1,200 clients a month with approyimate1y c% of thnsP hPing new partisipants, including rRferrals from the County Department of Social Services, This year WP saw "lumbers reach close to 1,800 a month with F,% of those bQing nPw partisipants, and we continue to see growth. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: Roselie Vaccarino President/Director NAME and TITLE (Please Print or Type) Jann Hannan Secretary/Grant Writer NAME anci TITLE (Please Print or Type) ,t G/(G�7t/ SIGNATURE: A-4-`2-'4441- Senior Cltizen Service Center of the Temecula ORGANIZATION NAME:—Rancho Arca, MAILING ADDRESS: P.O. Box 987 Temecula CA 92590 TELEPHONE: 951-600-9557 E -Mail Address: scsc1 1 (averizon, net DATED THIS 30 of August , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabb(c�citvoftemecula.org 951-694-6479 Application - Page 5 FINANCIAL INFORMATION: beginning date July 1, 2011 Proposed Project Budget FUNDS TOTAL ACTIVITY/PROJECT BUDGET 1. Personnel A. Salaries and Wages B. Fringe Benefits C. Consultants & Contract Svcs $ N/A $ N/A $ N/A 2. Non -Personnel A. Space Costs $ 30,000 B. Rental, Lease, Purchase Equip. $ C. Insurance $ 1,200 D. Office Expense $ 2,571 E. Telephone $ 2,000 F. Repairs and Maintenance $ 1,285 G. Emergency Food and Aid $ 13,000 H. Other $ 200 SUB -TOTAL $ 50,256 3. Architectural/Engineering Design $ N/A 4. Acquisition of Real Property $ N/A 5. Construction/Rehabilitation $ N/A 6. Indirect Costs $ N/A TOTAL: $ 50,256 Winifred A. Samstag, CPA 16198 SW 14th Avenue Road Ocala, FL 34473 (352) 693-4958 or (877) 797-7630 Telephone (352) 693-4959 Fax Email:�iinsamstaaaea ohm To the Board of Directors Senior Citizens Service Center of the Temecula Rancho Area, Inc. Murrieta, California Independent Auditor's Report I have audited the accompanying statement of assets and liabilities of the Senior Citizens Service Center of the Temecula Rancho Area, Inc. as of June 30, 2011 and the related statements of support, expenses and changes in fund balances and cash flows for rthenuefiscal year then ended. These statements are the responsibility of the Organization's Board of Directors. My responsibility is to express an opinion on these financial statements based on my audit. I conducted my audit in accordance with generally accepted auditing standards. Those standards re tost obtain reasonable standaassurards equired that I plan and perform the audit about whether the financial statements are free of material misstatement. An audit includes examining, test basis, evidence supporting the amount and disclosures in eon a financial statements. An audit also includes assessing the accounting principles used and significant estimates made by the Board of Directors, as well as evaluating the overall financial statement presentation. I believe that my audit provides a reasonable basis for my opinion. In my opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Senior Citizens Service Center of the Temecula Rancho Area, Inc. as of June 30, 2011 and the results of its operations and its cash flows for the fiscal year then ended in conformity with the cash basis method of accounting. September 6, 2011 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. STATEMENT OF ASSETS AND LIABILITIES JUNE 30, 2011 ASSETS Cash in banks Furniture and equipment Rent deposit and prepaid rent Equipment Total Assets LIABILITIES AND FUND BALANCES Sales tax payable Total Liabilities Fund Balances Undesignated Total Fund Balances UNRESTRICTED RESTRICTED TOTAL FUND FUND FUNDS $ 31,363 5,781 2,000 $ 39,144 $ 31,363 5,781 2,000 - $ 39,144 $ 673 $ 673 673 - 673 38,471 38,471 38,471 - 38,471 Total Liabilities and Fund Balances $ 39,144 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida $ 39,144 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. STATEMFNT OF SUPPORT, REVENUE, EXPENSES AND CHANGES IN FUND BALANCES FOR THE FISCAL YEAR ENDED JUNE 30, 2011 PUBLIC SUPPORT AND REVENUE Public Support: City CDBG Community Grant Donations UNRESTRICTED RESTRICTED TOTAL FUND FUND FUNDS 9,252 Total Public Support 9,252 $ 12,543 5,000 $ 12,543 5, 000 9, 252 17,543 26,795 Revenue: Interest income 13 13 Thrift store sales 7,697 7,697 Trip income (net of expenses) 4,937 4,937 Total Revenue 12,647 12,647 Total Support and Revenue 21,899 OPERATING EXPENSES Emergency food and aid Insurance 1,152 Office expense and miscellaneous 2,472 Rent and utilities 14,957 Repairs and maintenance 1,236 Telephone 1,954 Total Expenses 21,771 17,543 39,442 5, 000 12,543 5, 000 1,152 2,472 27,500 1,236 1, 954 17,543 39,314 Excess of public support and revenue over expenses 128 - 128 Fund balance, beginning of year Fund balance, end of year 38,343 - 38,343 38,471 - 38,471 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. STATEMENT OF CASH FLOWS FOR THE FISCAL YEAR ENDED JUNE 30, 2011 CASH FLOWS FROM OPERATING ACTIVITIES Excess of public support and revenue over expenses UNRESTRICTED RESTRICTED TOTAL FUND FUND FUNDS $ 128 $ 128 Adjustments to reconcile net cash provided by operating activities Increase in sales tax payable 673 673 Net Cash Flows Provided (Used) by Operating Activities CASH FLOWS FROM INVESTING ACTIVITIES Purchase of refrigerators Net Cash Flows Provided (Used) by Investing Activities Net Increase (Decrease) in cash Cash - Beginning of Year Cash - End of Year 801 - 801 (2,100) (2,100) (2,100) (2,100) (1,299) - (1,299) 32,662 32,662 $ 31,363 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida $ 31,363 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. NOTES TO FINANCIAL STATEMENTS JUNE 30, 2011 Note A - Summary of Significant Accounting Policies The Senior Citizens Service Center of the Temecula Rancho Area, Inc. was incorporated as a non-profit organization under Internal Revenue Code Section 501(c)(3). The Service Center assists area needy senior citizens with by distributing government commodities to the poor and needy in the local area. The Center also provides social and recreational facilities and activities for senior citizens. Accounting Method The organization maintains its books generally on a modified cash basis of accounting. Expenses and capital expenditures are paid as incurred. Revenues are generally recorded as income as received. Fund Accounting To insure observance of limitations and restrictions placed on the use of certain resources available to the Service Center, the accounts of the Service Center are maintained in accordance with principles of fund accounting. This is the procedure by which resources for various purposes are classified for accounting and reporting purposes into funds established according to their nature and purpose. Separate accounts are maintained for each fund. The assets, liabilities and fund balances of the Service Center are reported in self -balancing groups as follows: Unrestricted funds represent the portion of expendable funds that is available for support of the Service Center's operations. Restricted funds represent resources restricted for facility rent and emergency food and medical assistance to senior citizens. During the fiscal year ended June 30, 2011 restricted funds were received from Riverside County EDA to be used for facility rent. SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. NOTES TO FINANCIAL STATEMENTS JUNE 30, 2011 Donated Services and Materials A substantial number of unpaid volunteers have made significant contributions of their time in conjunction with the Service Center programs and services. These contributions have not been included in these financial statements, as no objective method of valuation has been determined. In addition to volunteer time, most of the food distributed has been donated by various agencies. No record has been kept of the value of these donated items, therefore they are not included in these financial statements. All contributions are considered to be available for unrestricted use unless specifically restricted by the donor. Support donations are recorded as they are received. A11 items sold in the Thrift Store have been donated. NOTE B - Federal Income Tax The Service Center is an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. While the Service Center is generally exempt from income taxes, it is subject to taxes on unrelated trade or business income and on excess lobbying expenses. For the year ended June 30, 2011, the Service Center did not incur any tax liability for unrelated trade or business, or lobbying activities. NOTE C - Facility Lease The organization is operating in a facility under a five year lease, with payments of $2,500 per month, which will expire in May, 2014. Internal Revenue Service Date: June 29, 2007 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA INC PO BOX 987 TEMECULA CA 92593-0987 Dear Sir or Madam: Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Geoffrey T. Rash 17-19328 Customer Service Representative Toll Free Telephone Number: 877-829-5500 Federal Identification Number: 95-3214774 This is in response to your request of June 29, 2007, regarding your organization's tax- exempt status. In September 1978 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your organization is currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records indicate that your organization is also classified as a public charity under sections 509(a)(1) and 170(b)(1)(A)(vi) of the Internal Revenue Code. Our records indicate that contributions to your organization are deductible under section 170 of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055 2 106 or 2 522 of the Internal Revenue Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, Michele M. Sullivan, Oper. Mgr. Accounts Management Operations 1 OFFICE OF THE SECRETARY OF STATE CERTIFICATE -OF-STATUS DOMESTIC CORPORATION 1, MARCH FONG EU, Secretary of State of the State of California, hereby certify: That on the 2nd day of February , 19 78 . , SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA became incorporated under the laws of the State of California by filing its Articles of In- corporation in this office; and That no record exists in. this office of a certificate of dissolution of said corporation nor of a court order declaring dissolution thereof, nor of a merger or consolidation which terminated its existence; and • That said corporation's corporate powers, rights and privileges are not suspended on the records of this office; and That according to the records of this office, the said corporation is authorized to exer- cise all its corporate powers, rights and privileges and is in good legal standing in the State of California; and That no information is available in this office on the financial condition, business ac- tivity or practices of this corporation. That said corporation is organized under the General Nonprofit Corporation Law. SEC/STATE FORM CE -112 (REV. 7-87) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this 29th day of July, 1993 Weack Secretary of State 87 45931 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 26 CITY OF TEMECULA City of Temecula FISCAL YEAR 2011-12 SEP 13 WI COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) Finance Departmen )gir�lrrt `Sl MIsstc n. eadline;' PROJECT INFORMATION Amount Requested: $ 5,000 (Maximum allowable $5,000) Project Name: Sports training and competition programs for athletes with intellectual disabilities in the City of Temecula January 1, 2012 December 31, 2012 Project Start Date: Project End Date: ORGANIZATION INFORMATION Special Olympics Temecula -Valle j Name of Organization: �t �4'tt v 1'� �� <tl� Cf1C' Contact Name: Stacy Fish Title/Position: Area Director Mailing Address: 27475 Ynez Road, Suite 174, Temecula, CA 92591 Telephone: (951) 296-3624 E -Mail Address: sfish@sosc.org Year Organization Founded: 1969 Geographic Area(s) Served: Temecula Valley Number of Paid Staff: 0 Number of Volunteers: 250 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 1995 If "no": Federal identification number: 95-4538450 State identification number: 189240 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors , x Members -at -Large X Application — Page 1 r�w FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Through Special Olympics, individuals with intellectual disabilities receive opportunities for increased physical exercise, positive socialization, and heightened self-esteem. Athletes train year-round at neighborhood schools and community facilities in the City of Temecula under the supervision of volunteer coaches. Training focuses on sports rules and fundamentals to prepare athletes for competition and increase their overall level of fitness. Coaches reinforce values such as teamwork, sportsmanship, safety, self-discipline, and self-reliance. Athletes attend competitions held throughout the year which allow athletes the opportunity to showcase their athletic skills and celebrate accomplishments with family, friends, and the community. Special Olympics aims to serve individuals with intellectual disabilities in Temecula by providing quality programs in Olympic -type sports which result in increased physical activity, heightened self-esteem, and a healthy, more active lifestyle for our participants. The following measurable objectives determine if our expected outcomes are met: • Provide year-round sports training opportunities for 200 athletes with intellectual disabilities in Temecula and form teams based upon age and ability level. • Host 4 Special Olympics competitions for athletes to showcase their skills throughout fhe year. • Screen and train 100% of new volunteer coaches to lead local teams and Maintain a I :4 coach to athlete ratio in accordance to Special Olympics guide lines, pairing new coaches with veteran coaches to provide an additional layer of support during the first year of coaching. • Provide each athlete with a minimum of 50 hours of physical exercise each season. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of Information. (Please type or print legibly.) Monies received from the City of Temecula will be used to fund our sports trainings and competitions held in 2012. We have more than 200 athletes in our programs who have the opportunity to train and compete in 12 Olympic -type sports. Costs associated with the project include facility rentals, sports equipment, uniforms, meals, medals, event supplies, and personnel. Special Olympics is the only organization in the City of Temecula which provides sports training and competition programs to persons with disabilities of all abilities free of charge to all participants. Over 80% of our athlete's live at or below the poverty level, working part-time jobs and receiving government assistance to subsidize neves sary living expenses such as food and rent. Most persons with intellectual disabilities could not afford costs associated with participation in sports programs if fees were assessed. As a result, Special Olympics covers all program related expenses for both training and competition, including facility rentals for train- ings and competitions, sports equipment, uniforms, games fees, transportation, and training for coaches. Special Olympics could not exist without the energy, commitment, and enthusiasm of 200+ volunteers in Temecula. As a grass-roots organization, Special Olympics relies on volunteers to ensure that every athlete is offered a quality sports training and competition experience. Volunteers are involved with every aspect of our programming and often serve as coaches, tournament volunteers, and other key leadership roles. We are proud to boast ongoing involvement from Temecula -based volunteer groups, including Knights of Columbus, Riverside County Sheriffs Department, and Temecula Police Department. Application -- Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. We are so grateful for the City of Temecula's on-going support for our programs and athletes. In 2011, Special Olympics Temecula Valley received a grant to fund its sports training and compet- tion programs. Funds were used to purchase much needed uniforms for several sports teams. This allowed Special Olympics to expand the programs offered in Temecula so that more athletes could benefit. We are so thankful for grants, such as the one provided by the City of Temecula allow us to offer our prams to athletes with intellectual disabilities in Temecula free of charge. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Stacy Fish SIGNATURE: i M�iierfTLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Stacy Fish - Area Director SIGNATURE: LE (Please Print or Type) ORGANIZATION NAME: Special Olympics Temecula Valley MAILING ADDRESS: 27475 Ynez Road, Suite 174 Temecula, CA 92591 TELEPHONE: (951) 296-3624 E -Mail Address: sfish@sosc.org DATED THIS 1st of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: .mcnabbCr7citvoftemecula.orq Facsimile: 951-694-6479 Application - Page 5 TEMECULA VALLEY AREA SPECIAL OLYMPICS Balance Sheet As of: January 31, 2011 ASSETS Cash & Investments Petty Cash Wells Fargo Area Account Wells Fargo Crisis Account 0.00 289,027.13 0.00 Total Cash & Investments 289,027.13 Accounts Receivable NR - SOSC A/R - OTHER 0.47 0.00 Total Accounts Receivable 0.47 Other Current Assets Other Prepaid Expenses 0.00 0.00 Total Other Current Assets 0.00 Fixed Assets Autos & Vans A/D - Autos & Vans Computers & Software A/D Computers & Software Furniture & Equipment A/D - Furniture & Equipment Sports Equipment A/D - Sports Equipment 0.00 0.00 0.00 0.00 856.58 (856.58) 0.00 0.00 Total Fixed Assets 0.00 Other Assets Total Other Assets 0.00 Total Assets 289,027.60 LIABILITIES & FUND BALANCE Liabilities Accounts Payable Due to SOSC Accrued Payroll -Related Expenses Deferred Lease Liability 510.05 0.00 0.00 0.00 Total Liabilities 510.05 Fund Balance Fund Balance Beginning 2009 Balance Forward Current Year Activity 256,048.09 33,079.51 (610.05) Total Fund Balance 288,517.55 Total Liabilities & Fund Balance 289,027.60 Preliminary UNAUDITED - FOR INTERNAL USE ONLY PRINTED 3/30/2011 Internal Revenue Service Date: June 20, 2000 Special Olympics Southern Califomia, Inc. % Richard L. Vankirk 6071 Bristol Pky. Ste. 100 Culver City, CA 90230-6634 Dear Sir or Madam: Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Sheila Schrom 31-02836 Customer Service Representative Toll Free Telephone Number: 8:00 am. to 9:30 p.m. EST 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 95-4538450 This letter is in response to your request for a copy of your organization's determination letter. This letter will take the place of the copy you requested. Our records indicate that a determination letter issued in May 1996 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vr7. This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Retum of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a retum is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a retum is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts .to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Special Olympics Southern California, Inc. 95-4538450 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Retum. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you to make your organization's annual retum available for public inspection without charge for three years after the due date of the return. You are also required to make available for public inspection a copy of your organization's exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual retum). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, John E. Ricketts Director, TE1GE CAS vai[s�zuun 1Y:Yb rnn STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 1286 RANCHO CORDOVA CA 95741-1286 In reply refer to 755:6 :EMM August 13, 1998 SPECIAL OLYMPICS SOUTHERN CALIFORNIA INC STEVEN ZELMAN 6071 BRISTOL PKWY STE 100 CULVER CITY CA 90230-6601 Purpose : CHARITABLE Code Section 23701d Form of Organization : Corporation Accounting Period Ending: December 31 Organization Number 1898240 a 002/003 You are exempt from state franchise or income tax under the section of the Revenue and Taxation Code indicated above. This decision is based on information you submitted and assumes that your present operations continue unchanged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect on your exempt status. Any change of name or address must also be reported. In the event of a change in relevant statutory, administrative, judicial case law, e change in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon which this opinion is based, this opinion may no longer be applicable. It is your responsibility to be aware of these changes should they occur This paragraph constitues written advice, other than a chief counsel ruling, within the meaning of Revenue and Taxation Code Section 21012(a)(2). You may be required to file Form 199 (Exempt Organization Annual Information Return) on or before the 15th day of the 5th month (4 1/2 months) after the close of your accounting period. Please see annual instructions with forms for requirements. You are not required to file state franchise or income tax returns unless you have income subject to the unrelated business income tax under Section 23731 of the Code. In this event, you are required to 0.1003/003 August 13, 1998 SPECIAL OLYMPICS SOUTHERN CALIFORNIA, INC. Entity ID 1898240 P•g• 2 file Form 109 (Exempt Organisation Business Income Tax Return) by the 15th day of the 5th month (4 1/2 months) after the close of your annual accounting period. Please note that en exemption from federal income or other taxes and other state taxes requires separate applications. A copy of this letter has been sent to the Registry of Charitable Trusts E DIALA EXEMPT ORGANIZATION SECTION PROCESSING SERVICES BUREAU Telephone (916) 845-4171 E0 s Ar Special Olympics Southern California Temecula Valley 27475 Ynez Road, Suite 174, Temecula, CA 92591, Tel: (951) 296-3624 Web Address: http://www.sosc.org September 6, 2011 City of Temecula Community Services Funding Program CIO Judy McNabb PO Box 9033 Temecula, CA 92589-9033 Dear Ms. McNabb: On behalf of the athletes, families and volunteers of Special Olympics Temecula Valley, we thank you for the opportunity to submit the enclosed proposal to the City of Temecula in support of our local sports programs. Through your previous funding, Special Olympics Temecula Valley has provided sports training and competition to athletes with intellectual disabilities the past three years including athletes with stories such as Maci's. Maci would swim 365 days a year if her mother would allow it. She has been working on perfecting her strokes through her involvement in Special Olympics over the past 2 years, winning several medals along the way. In addition to weekly practices with her teammates, Maci trains almost daily in the backyard pool, increasing her skill level for competition. The time in the pool has strengthened her health. Maci use to go to the doctor twice a month. Since she has participated with Special Olympics, her check-ups have decreased to once in six months. Special Olympics has improved Maci's health and fitness, leading her to an enhanced sports experience and improved well-being. Throughout Temecula Valley, more than 200 athletes with intellectual disabilities just like Maci find opportunities for improved health, fitness and social interaction through their involvement in Special Olympics. Founded on the belief that people with intellectual disabilities can learn, enjoy and grow from participation in individual and team sports, Special Olympics provides the structure and encouragement critical to their success. Through the mastery of sport, our athletes achieve new levels of self-confidence in their physical, mental, and social abilities. We respectfully request $5,000 from the City of Temecula to support our sports training and competition and programs in the city. Your support will allow Special Olympics Temecula Valley — and athletes like Maci— to grow and thrive. On behalf of the athletes, families and volunteers of Special Olympics Temecula Valley we would like to thank you for making opportunities such as the one presented by the City of Temecula available to assist organizations like ours achieve our goals. Stacy Fish Area Director City of Temecula 2011-12 CS Funding Program APPLICATION NO. 27 CITY OF TEMECULA City of Temecula FISCAL YEAR 201 1-12 SEP 1 5 2011 COMMUNITY SERVICE FUNDING PROGRAM P�LIC TION (Please Print or Type) p-InancAe eta t 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5 CO Project Name: HM &UEEf\/ OF _A— s.r (Maximum allowable $5,000) p Project Start Date: CRR€t'.JY Project End Date: LTFIN. i 1 20(3 ORGANIZATION INFORMATION Name of Organization: �'t-f!� �/�T f.2 T- OF G € E C• LI Contact Name:LTEPCLC) DIQ OF BANC� Mailing Address: 3255 )EC -e HoLtiorAl PAi2t4wAs/ Telephone: (95)2i'41 -6945o -Exr, 323E -Mail Address: 13 ih SI LA Year Organization Founded: 2.004. Geographic Area(s) Served: TEfV1ECULA Number of Paid Staff:., pre -1 Number of Volunteers: i Cr)4NIVU1L AV3 Is this organization incorporated in California as a non-profit organization? Yes V. No Effective Date: If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: Ni�}t/ 2o, 229-4-'f Federal identification number: 2.0/!-- / / 27 e80 State identification number: If"no": CT- /27379 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application - Page 1 Qri COM FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. 1EA5E SEE THE RE VE5 c�Vov Pi -e,t5 E NV OTE _ "GQAl54 (JMbi u� AT-111---7=CCo-CL, t2 !c n- G)$2tc:x Jps) Application - Page 2 The Spirit of Great Oak High School Band & Guard London New Year's Day Parade 2013 The London Committee The Spirit of Great Oak Band & Guard is honored to receive the prestigious honor of being 1 of 25 Marching Bands selected world wide to participate in the January 1, 2013 New Year's Day Parade in London England. The parade is in celebration of Her Majesty Queen Elizabeth the second's Golden Crown Jubilee. The popularity of the parade in Europe is equivalent to America's "Macy's Thanksgiving Day Parade," in N.Y. City. The parade is viewed worldwide by an estimated 220 million people on the BBC Network, and attended by over 1 million spectators. The Parade begins at Trafalgar Sq. and concludes as each unit passes by the Royal Box near the Big Ben Tower. The parade concludes with a mass band performance of Sir Edward Elgar's "Pomp & Circumstance." The intent is to travel with 80-100 Performers, and an additional 50- 75 "Band Fans," on a weeklong tour of London and vicinity culminating in the Parade. Several Parent volunteers will be on hand as chaperones. Overall we expect to travel with an entourage of approximately 150-200. Funding provided by grants and sponsors would be utilized to offset the cost for the performers. Specifically the funding would be utilized to help offset the costs of a new parade banner, instrument overseas shipping, and ground transportation to and from the Airports. Please see the attached budget specific to this trip for further understanding of the costs incurred. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) ( Pt -k c i(N,„ Application - Page 3 The Spirit of Great Oak High School Band & Guard London New Year's Day Parade 2013 The London Committee Mission Statement This is a once in a lifetime honor and invitation from the HM Queen of England and the Lord Mayor of London for our students to represent California and the United States of America in one of the largest and most viewed parades in the world. This honor will broaden our student's view of the world, teach history and geography "hands on", provide a premier performance opportunity and connect our talented students from Temecula to the worldwide community. We want all students participating in Great Oak High School music program to have the opportunity to attend the London trip despite family income level. The estimated trip cost per student is $3,200. To help facilitate each family we hope to collectively fundraise 15% or more of the cost of the trip for each student and chaperones. Opportunities will be available to students to do additional fundraising to help reach the remaining 85%. With our collective fundraising efforts we hope the cost for each student will come down below $2,750. We will send email updates as we achieve fundraising goals. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. -S/ =e_z-7- OoV 14/7� VP, OF 2010 --0/14 Jar's e Ar!. ry C'ovN�z�. 0 IF Application — Page 4 SIGNATURE PAGE We hereby certify the belief. PREPARED BY: information contained in this application is true to the best of our knowledge and lE� RC)LJ E T I DJEC� �c )1 DJ RECTOR NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: ORGANIZATION NAME: MAILING ADDRESS: L0i 5 /11 6d / d Z 1 (5PC/`e.--74cs/' NAME and TITLE (Please Print or Type) G (G' .i1/t,L ,2-7:5-5. 7 -E77 /iS 7/ 17g— TELEPHONE: ("57)76e E -Mail Address: 73 r Ci)A7 11 C:2, DATED THIS f (Month) , 2011. Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabb@cityoftemecula.org 951-694-6479 Application - Page 5 LONDON TRIP Notes BUDGET Income Trip Fee 275,000.00 100 travelers @ $2,750 each Donation 5,000.00 I Sponsorship Program 100,000.00 Fundraising - NET PROFIT Lessons for London $1,200 (To be applied to individual student accounts) Pennies for Parade 2,000.00 Bottles for Britain 2,000.00 Buckets for Britain Let's Make a Deal Game Show 4,000.00 Auto Club Speedway 3,000.00 _ _ _ Parry I 3,000.00 Scenty Party 1,000.00 Park Lane Jewelry 500.00 Tamale Sales Special Band Event Concessions Direct Mail Total Fundraising - NET PROFIT 15,500.00 Total Income 395,500.00 Expense I Travel Cost 320,000.00 100 travelers @ $3,200 each Fundrals ng Expense Fliers 200.00 Posters 200.00 Stickers 50.00 Buckets 50.00 Baskets 100.00 Food 300.00 Postage 100.00 Reservations (Morgan Hill Security) 300.00 Total Fundraising Expense 1,300.00 Total Expense 321,300.00 ENDING BALANCE 74,200.00 0MOQ Door triaD'4 N En r N CO r o a a O Total Checking/Savings a V o N Total Current Assets (D (D N (D N, CO O) O 0 (D If N N O O N N d N (0 CO CO O ('7 L7 P) N N N rn N N (D m ED CO N CO. 0 f7? w 1+ O.-.- )� CTI h CO N N fD (O (D W W d iA O) 0) N N a0 (D m N 0 6 1- O) N a0 ? O N O) f� O 1'- U7 (D N O_ A N co O (o N (0 ('I N N N 1- 47'4 O CO l0 'Q N N O) V (D N N NI N (7 o (9 (o (7 - tl) O) O mr O N O CI N (n N M O) DD (D N N a0 En N In Cr) v N (7 N ('7 O O) N 0) V N N N N r N 0 N r C 0 Y C u u e a 0 m U a m c C C = q L 0 5 a U _ Y N Q= O O n m m - 3� C f- $ to m w i0 1A 0VoovmcoliceLL;Eo,Pl(?dn_f Eutoilam en w �gymvJ�S��i(?mg=.teyroco a E om0uo Vl — ;p.a.:M mmmmmmu00000LL U' ( QU' U' (. ' �2ZCNN Q.4 J_ 0Z F qW O 3 0 O O CO .- to C1 V <t U7 07 (O (O t0 Q r N Cp O CO co n O) f7 Q) NN n 0)n o) .- Total Net Assets N N N 0 N City of Temecula 2011-12 CS Funding Program APPLICATION NO. 28 CITY OF TEMECUTA FISCAL YEAR 20 11.12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) Clty of Temecula 9 SEP 072011 Finance Dept. PROJECT INFORMATION Amount Requested: $ Project Name: 7-4,9n.7 ' Vex/6E4 /ea. ,/9=,--27--",1 (Maximum allowable $5,000) Project Start Date: 7— -7/ - // Project End Date: l - V,2.- ORGANIZATION INFORMATION 1/9,2 /046 as�-i -.57 r.� /72i,z� ,ei�.�s Name of Organizatior ,Q� �,.! �� ��(� — c�/ /P?/1 l i�?/l1i�y )447/7 Contact Name:/j1, /E f1//MY4S' itle/Position: OZ:7./ Mailing Address: c2'2 —3 ! c ,Z, Telephone:frC�7' E -Mail Address: , Year Organization Founded: J,7 7,7 Geographic Area(s) Served: Number of Paid Staff: Number of Volunteers: 5O --z`-- Is this organization incorporated in California as a non-profit organization? Yes X No Effective Dater? —/% /7?7 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: / 957'7' If "no": Federal identification number: „57— b / D 7D State identification number: / 7 /7 ,5:>-) Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee _ Board of Directors Application — Page 1 Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Application — Page 2 MISSION STATEMENT TEAM Evangelical Assistance Ministries, DBA Temecula -Murrieta Community Pantry is a non-profit organization located in Old Town Temecula since 1987. We provide assistance to the homeless and low-income families in Temecula-Murrieta-Anza-and Aguanga. 90% of the families we serve live in Temecula. We are open Monday, Wednesday and Friday for the distribution of donated food from food drives, surplus foods from local markets, donated clothing and household goods. Our goal is to help our clients with their immediate needs in all areas. We refer to community outreach programs, dental and medical services, as well as state agencies. When funds are available, we assist with temporary housing, bus passes, gas cards, etc. The Pantry welcomes all who come to our door, regardless of race, sex, marital status, disability, religion or political affiliation. Clients are asked for contact information and need requirements. We ask for the number of people in the household and a photo I.D. We also are asking for proof of income, although no one is turned away if they can't furnish that information. This information is needed for some grants. The Pantry is operated by dedicated volunteers and all expenses are kept to a minimum. The day-to-day management is provided by Margie Hammersley who has been the director since the Pantry's inception. She has received a salary for the past five years. A Board of Directors, many long acquainted with the pantry, meet quarterly to evaluate the needs of the Pantry. A member of the Board is on the premises every day the Pantry is open. Accounting is done on-site with an off-site backup. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be speclflc. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Application - Page 3 PROJECT DESCRIPTION If the Pantry receives this funding we would like to use it to help pay overhead so we can use other donated funds to increase our food purchases. We carry liability insurance with the City shown as Additional Named Insured, that costs $2,000.00 a year. The gas, electric and water cost $2,900.00 a year. The water is over $100.00 a month as we have at least 10 homeless who take showers each day. They can shower and do one load of wash each visit. Our telephone bill runs $2,820.00 a year. We want to increase the items we purchase to distribute daily. Unfortunately, our donations have gone down in the past three years by $20,000.00. We are now operating on less than $60,000.00 a year. We have had many churches drop their monthly support as they are barely able to meet the needs of their congregations. In the last 6 months we lost monthly support from 5 churches. Also, our business donations have gone down as they struggle in this economy. At the same time we have had an increase of families coming in for food boxes from 50 to 70 families a month. We have gone from 50 families receiving fresh foods Monday, Wednesday and Friday, to over 70 each day. We are still trying to accumulate enough cash to purchase a much needed walk-in freezer. We would really like to have the freezer before the Holidays. We are only $2,000.00 short of having enough to purchase it. We were recently given the money to buy a commercial refrigerator. It has made a big difference in the way we can store and distribute our fresh deli items and produce. Also we can now store milk and eggs. We have over 400 low-income families and seniors just in Old Town who rely on us. These are our neighbors and we want to give them as much fresh items as we can. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. i p. Application — Page 4 PAST PROJECT BENEFITS We used the funding from 2010/2011 toward rent on the mobile office the City rented for our use. The first of November we moved into the house and barn on Pujol Street. The City is providing this facility for our use and we are most grateful for it! What a blessing this arrangement has been for us as we were able to continue with our food distributions with no cut in our service in any way, and actually can now serve more people, more efficiently. We set up our offices in the house and all the food is distributed from the barn. We served, in the last year, over 1,500 families and 4,600 individuals with food boxes containing groceries sufficient to feed their family for 8 days These families were referred to us by Social Services, churches, law enforcement agencies, and other outreach programs. The food in these boxes is from food drives but we do have to purchase some items to make sure there are three meals a day for 8 days. We distributed fresh food to over 200 families a week. Last year we served 5,715 families with bread, bakery good, produce and deli items. These items are donated by local stores, restaurants and growers and are picked up for us by " special needs "adults from Care Rite. We have an average of 16 volunteers from Care Rite a day who help pack and give out food. We usually have about 30 people volunteering at any one time. In addition to the above, we distributed Thanksgiving and Christmas food boxes to 350 families each Holiday and gave out 2,500 toys to the neighborhood children. At Easter we distributed over 100 Easter Boxes and 100 Easter Baskets for the children. The cash value of all items distributed, except clothing, was over $400,000.00 for the year. We keep track of our clients by computer. Our accounting is done on- site and a back-up is kept off the premises. A CPA does the yearly tax return. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: NAM and TI E (P Print or Type) NAM - nd TI E (Plea : Print or Type) SIGNATURE: ORGANIZATION NAME: 27/ .' —775,,7e.."424- ` /&7 loll{17v e)/ 7 7-{%,�y MAILING ADDRESS: o �J� i"�� r� / TELEPHONE: %— E -Mail Address: `/.;<2 (1-, /9-4/ 6,7, 2 DATED THIS %z of rSe 775,7 ,7.(, 2011. (Date) (Month Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judv.mcnabbftitvoftemecula.ora 951-694-6479 Application - Page 5 TEMECULA-MURRIETA COMMUNITY PANTRY 2011 BUDGET INCOME: CHURCHES $ 14,000.00 BUSINESSES 10,000.00 GRANTS 21,000.00 INDIVIDUALS 15,000.00 EXPENSES: ADMINISTRATIVE: SALARY $ 22,000.00 PAYROLL TAXES 2,000.00 INSURANCE 2,000.00 FACILITIES: INSURANCE -LIABILITY $ 2,500.00 TELEPHONE & UTILITIES 5,000.00 MAINTENANCE 1,500.00 OFFICE EXPENSES 2,500.00 AUTO & GAS 6.000.00 MINISTRY: FOOD PURCHASES $ 15,000.00 LODGING 500.00 TRANSPORTATION 500.00 SPECIAL NEEDS 500.00 $ 60,000.00 $ 26,000.00 $17,500.00 $ 16,500.00 TOTAL ALL EXPENSES $ 60,000.00 10:18 AIN TEAM EVANGELICAL ASSISTANCE MINISTRY 00101111 Balance Sheet Accrual Basis As of June 30, 2011 ASSETS Current Assets Checking/Savings Bank of America Total Checking/Savings Total Current Assets Jun 30, 11 16,017.24 16,817.24 16,817.24 Fixed Assets 1640 • Furniture, fixtures, & equip 2,000.00 Total Fixed Assets 2,000.00 TOTAL ASSETS 18,817.24 LIABILITIES & EQUITY Liabilities Currant Liabilities Other Current Liabilities 2112 • Accrued Payroll -State 80.53 2130 • Accrued payroll taxes 650.24 2132 • Accrued FIT 427.60 Total Other Current Liabilities Total Current Liabilities Total Liabilities Equity 3001 • Opening Bal Equtty 3010 • Unreetrict (retained earnings) Net Income Total Equity TOTAL LIABILITIES & EQUITY 1,158.27 1,150.27 1,150.27 8,701.28 9,142.75 1,814.54 17,658.97 10,817.24 raga 1 10:19 AM 08/01/11 Accrual Basis TEAM EVANGELICAL ASSISTANCE MINISTRY Profit & Loss July 2010 through June 2011 Ordinary Income/Expense Income 4 • Contributed support 4010 - Indiividuals 4210 • Business Donation 4230 • Grants 4420 • Churches Total 4 • Contributed support 5 • Eamed revenues 5310 • Interest-savings/short-tern inv Total 5 • Eamed revenues Total Income Expense 4000 • Reconciliation Discrepancies 7000 • Grant & contract expense 7050 • Specific assistance - ind Total 7000 • Grant & contract expense 7200 - Salaries & related expenses 7210 • Officers & directors salaries 7250 • Payroll taxes Total 7200 • Salaries & related expenses 7500 • Other personnel expenses 7580 • Insurance -Workman's Comp Total 7500 • Other personnel expenses 7582 • Insurance -Medical 7584 • Insurance -Auto 8100 • Non -personnel expenses 8110 • Office Supplies 8120 • Groceries 8130 • Telephone & telecommunications 8140 • Postage, shipping, delivery 8150 • Supplies 8170 • Backpack Ministry 8180 • Books, subscriptions, reference Total 8100 • Non -personnel expenses 8200 • Occupancy expenses 8210 • Rent, parking, other occupancy 8220 • Utilities 8230 • Real estate taxes Total 8200 - Occupancy expenses 8300 • Travel & meetings expenses 8310 • Gasoline 8320 • Conference,convention,meeting Total 8300 • Travel & meetings expenses 8340 • Car Allowance 8500 • Misc expenses 8510 • Interest expense - general 8520 • Insurance 8590 Other expenses 8500 • Mlsc expenses - Other Total 8500 • Misc expenses Jul '10 - Jun 11 15,156.99 10,354.90 16,466.64 16,588.00 58, 566.53 1.21 1.21 58,567.74 -0.06 884.47 884.47 20,350.00 1,556.71 21,906.71 913.00 913.00 5,807.78 300.00 939.66 8,928.40 3,273.04 44.00 2,363.47 740.16 72.59 16,361.32 4,400.00 2,228.53 273.68 6,902.21 2,456.50 162.33 2,618.83 5,395.00 2.50 -16.24 2.50 0.00 -11.24 Page 1 10:19 AM 08/01/11 Accrual Basis TEAM EVANGELICAL ASSISTANCE�iiyyMINISTRY Prat 't JOly.. 1) through June 2011 8600 • Business expenses 8670 • Organizational (corp) expenses Jul '10 - Jun 11 75.00 Total 8600 • Business expenses 75.00 Total Expense 61,153.02 Net Ordinary Income 2,585.28 Net Income -2,585.28 Page 2 tate of La1ffnrtha Serr2f of State TATEMENT BY DOMESTIC NONPROFIT CORPORATION P.O. Bax 2030 Sacramento, GA 95012 Phone: (916) 445-2020 THIS STATEMENT MUST BE FILED WITH CALIFORNIA SECRETARY OF STATE (SEC1IONS 6210, 8210, 9660 CORPORATIONS CODE) 13919 DO NOT DUE DATE: 2--19-07 TEAM EVANGELICAL ASSISTANCE MINISTRIES OF RANCHO--TEMECULA-MURRI ETA VALLEYS ALTER PHEPRUQTEC1 NAMtI. IF .TEM PLEASE TYPE 1 12 BLANK PLEA= Eh1YLER CORFORAig MAbE DO NOT WRITE IN TN 'SPACE PLEASE HEAD INSTRUCTIONS ON BACK •OF FORM. QR USE BLACK INK WHICH WOULD BE SU11 ABLE FOR MICROFILM/NG. FEL FOR FILING THIS STATEMENT - $2,50. 14E CORPQRAI ION NA .4 D HEREIN, ORGANIZED UNDER THE LAWS OF THE STATE OF CALIFORNIA. MAKES TUC FOLLOWING 'STATEMLNT: R. ■ITR:ET ADDRriy ow rsimr.swAI. 6Pa•IClf to, STN. CUH/LETE 'J.SEj 41945 Fifth St. (DO NOT USE P.o. Box NO.] .7.{,34.61 AnDREBn tCr<TIONA,( 41945 Fifth SL. &UITY OR ROOM 2A. 13UR2 OR R001.1 3A. Temecula, CA CITY AND STATE Temecula, CA CRY AND STATE 2.. 92390 ICI. CODE aR. 92390 NAMES OF THE FOLLOW?NI3 OFFICERS Attic: 1. John H. Stanley cw1S� OoECUttvY oFFtcE71 T_J, Mercer DECRETA„r Roger Brewer CHEEP IRNANG1AL OPFICFR AGENT Fon sEHVICe of PTIOCE44: 4A. ZIP CODE 27895-i, Diaz Rd. a:aiNESS OR RESIDENCE ADDRESS (DO NOT USE PA_ Dox) SA. 28030 Del. Rio Rd. DUIJINes9 OA RESEDE:NCE AODkhyS (DO NOT USE P.O. COX) OA. 29141 Valle -in Ave. QUSINESS OR RESIDENCE ADDRESS (DO NOT USE P.O_ BO)Q John H. Stanley 41, Temecula, CA CRY ANU STATC 9239C Sa_ Temecula, CA BD. GTT. AND STATE Temecula, CA CITY AND STATE 9239C ZIT CQD6 EC. 9239C Ar Cone 27895-L Diaz Rd. Temecula, CA 92390 .•,- 'FORNu 2171;74E33 OR RESIDENCE ADDRESS IP AN INDIVIDUAL IDO NOT USE P.O. 60X) ONLY ONE AGETET CAN BE NA►(GD. DO NOT INCLUDE AUDB ESS IP AQ91T A CORPORATION. • I DECLARE THAT 1 HAVE EXAMINED THIS STATEMENT AND TO THE REST OF MY XNOWLSDGE AND DEUEF, IT 13 TRUE. CORR6 AN". COMP!E. INTERNAL REVENUE SERVICE DISTRICT DIRECTOR 2 CtJPANIA CIRCLE MONTEREY PARK, Cl 91755-7406 Date: OCT 28 MI - TEAL EVANGELICAL ASSISTANCE MINISTRIES OF RANCHO-TEMECUZA- L4URRIETA VALLEY P 0 BOX 1002 TEMECULA, CA 92593 DEPARTMENT OF TNS i'.REMUR Employer Identification Number: 33-0210704 Case Number: 953266046 Contact Person: TERRY I ZUNI Centact Telephone Number: (213) 725-6619 Accounting Period Ending: December 31. Form 990 Required: yes Addendum .Applies: Di ar Applicant: : Delved an information eupplied, and assuming your operations will he as stated in your application for recognition of exemption, We have determined exempt from Federal income tax under section 501(a) of the Interna, code as an organization described in section 501(e)(3). you are Revenue We have further determined that you are not a private founciatien within the meaning of section 509(a) of the Code, because you are an organization described in sections 509(a) (1) and 170(b) (1) (A) (vi) , If your sources of support, or your purposes, character, or method of nperaeion change, please let us know so we can consider the effect of the change on your exempt status and foundation status. In the case of an amend- ment to your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you should inform us of ail changes in your name or address. As of Januar ]., 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $149 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FiiTT.) . Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other Federal excise taxes. If you have any questions about excise, employment, ox other Federal taxes, please let us know. Grantors and contributors may rely on this determination unities the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a) (1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a)(1) organization_. Letter 947 (DO/CO) -2 - TEAM EVANGELICAL ASSISTANCE Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket pur- chases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which seta forth guidelines regarding the deductibility, as chari- table contributions, of payments made by taxpayers for admission to or other' participation in fundraising activities for charity: In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated. you are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receiptn test. If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally 325,000 or less, and sign the return. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return is filed late, unless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $5,000 or 5 per- cent of your gross receipts for the year, whichever is less. This penalty may also be charged if a return is not complete, so please be sure your return is complete before you file it. You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service. If we have indicated in the heading of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. Letter 947 {DO/Ca) -3 - TEAM EVANGELICAL ASSISTANCE If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter_ Since, yours, Richard R. Oros District Director Letter 947 (DO/CG) City of Temecula 2011-12 CS Funding Program APPLICATION NO. 29 From: 9516959326 Page: 2/11 Date: 9/1/2011 3:31:12 PM N•` CITY OF TEMECULA FISCAL YEAR 20 1 1.1 2 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION cc Amount Requested: $ t C an l,� air1'\. I ► (Maximum allowable $5,000) Project Name: h 0 1Fa IN) l ! i,) C< 1 G< 5 C.74 C Kb Y-0 Y-0 S Project Start Date: :10-1/1e 2 G l l Project End Date: 3t,(- - Vi { 2 G 1 2. �4-kt 0(11 `4 l C ORGANIZATION INFORMA'T.ION Name of Organizatio • kr ({ Ct,\— rC:.lrvt t L ;r� i A Y7 (1-f- Cr, 5 c,' c • Contact Name: N c 1- K t y 1 t' L. Title/Position: C a_iV\ ko D; aft.: r Mailing Address:..t1)') V t u Vann 2 tit i �Y1 t.2 .. -r Vv1 t_ C'.. i Il Ci � (. L . cT s-ci C.' Telephone: G S 1 i,;i S- l3'� (c, E -Mail Address:1+.N0Y\ � , •i t I< vn 's Y t � c` <.zt s� a r1 in t�Z ••. n oC,ct ‘f ertvs-- ccrf_.- , C Ono Organization Founded: t Lie Cc v a Geographic Area(s) Served: i•evine:c Le--( Lirt. It v` Number of Paid Staff: Number of Volunteers: Is this organization incorporated in California as a non-profit organization? Yes 't No Effective Date: If "yes" (Must provide a copy organization's 50t(c)3 non-profit status form): Date of incorporation as a non-profit: C 1'L:S t' 00-C ( C t°t u•'r Ch Federal identification number: (4S `r?- 2 State identification number: If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorize by the organization's: Executive Committee `J' Board of Directors Members -at -Large Aoolication -- Page 1 This fax was received by GFI FAXmaker fax server. For more information, visit: http:l/www.gfi.com From: 9516959326 Page: 3/11 Date: 9/1/2011 3:31:12 PM FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. R b Li CLQ 3'GZ,Vn*c (, k 16(5 i S a 5(k_On I,-vkt,-. CCS virl p cies c� vl Eel �. '! r (kVf rein v -"L1 C�+ �r'\ a v -e e e,i:') Gt��'ii Sc%r,1 fti1(0Y t1e r 1-e C + & SC jr- itis czt L'e ' ' r Ca v' e S 9 S:k--C' vv) -+) (. ( v v p -17 pil)d ! e 1 C'\/4? bO- � ) ell1aut k -141-6 r 11 '- u3 ru l• Lt d 1-{- -e re v‘ c e ! \. e C a t1'l � l `� I� (,� I'� `� J �U \ ,t_ v'1 ke ' v j J . ;cis r( vl CGT (A a v c TLzi, - r ---V1 l 1� ,)`�"t le( v'e sJc- C'i t \ cI,� C .�tc� i o c;` C._ cL ii . Aoolication — Paae 2 This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com • From: 9516959326 Page: 4/11 Date: 9/1/2011 3:31:13 PM __ r• PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) • .0 - o pixyx.. ? C pef'3 -f - Camp „ 11,1-e ek ce - i1 --E f:4 Ca -ivy p e Ver 10.54-L10 11/1 e ribs ('% lr c . 15 C G'N COL VIA 6' v (�' ZWVLe S Ott (7)(L. 6-0 a C't4 Lv.-ft v c CVS' 9nieriiRo c •CQ`'a- vt.e c&-- ( ru. y' ec e. 0.110 1)) LL VI."e V S Irt__l. U °VC v • € ic.)(4) vb 1 w i:/1 €rte . V L 7 e c r V- .---f1 re.e. ( 3 Keca.L %( cL (• C ,�5� C-'11--j>Le) i Y"`\ ivy c 1,1Cj �4J�111,1 v c (A V ' a I\ u 0-e () ci 11 del Lt. e,J. Ld-I-1-b rts • 11.81. r, X () l e f/, C- t (.'4;:z V' (Y7 Cc.._ 4 ' 1° 1' 11. P_ rj._F yy\ P. `11 A c v l e5 '( e fry.fpUytok-e 04 _ c�C s��rY \C'4'. -Zt �5o'c 0'h i f:C3 C 04-11 Ian,r�l> �, (� C �`� nnlii-atinn -.. Pano This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com From: 9516959326 Page: 5/11 Date: 9/1/2011 3:31:13 PM •••••••••••---1-*..... .......... ....•...1 v. vvv vvs..v N•� PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. rye kdo_4 .4 ,00n 2051 fr LOe uocu_ mak C �� rt— (� r 4 qtr (D cel l `r - tr 71J -Al C11- 201.2_ I C:d rvv e L9c.4-- ire(e (tc%c( -e. e ex() evk 5r? s -1-b11-h 6-15 /� ���� �;� x err (�C �nl i� �� 1t7� '� �.�� �)c)2( ris � 3 COC) •r%in ea.s2c Uo 1 p r rte. - i 5 C C2Ctikl ; V es -1. A nniin!siinn ., Dono G This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com From: 9516959326 Page: 6/11 Date: 9/1/2011 3:31:13 PM vv{• V I • I vv.w,. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. , PREPARED BY: 1 �{ i�.. ' l1-4..to5('e L- J CjitittiCrec.1��r NAME and TITLE (Please Pri yor Type) SIGNATURE'/ Icoh-Qa 1/.Likkae_.) PRESIDENT orj� ,,_j AUTHORIZED OFFICER: t�� - / �� �' l �C-�{ ( V c ve( l nr- NAME and TIIT`LLE�(Please Print or Type} SIGNATURE(idZQ -Q o I 12Qf ORGANIZATION NAME: R U( 5 (C r 1 S 5 fic0MAILING ADDRESS: t- 7S) ) ((l (Aft -a. C A q2'90 TELEPHONE: 5 5 " (015 `95 E -Mail Address: 1 "ar\ L ir7a eacedruktkier Coy() DATED THIS of .t .et ^,2V , 2011 (Mbnth) (Date) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judo. mcnabb@citvoftemecula.orq 951-694-6479 n.,..lineiinn — Dona This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com Run Date 7/14/2011 Time 15:09:50 535 ROYAL FAMILY KIDS From: 9516959326 Page: 7/11 Date: 9/1/2011 3:31:14 PM CrossRoads Church 28763 Via Montezuma Temecula CA 92890 Fiscal Year Beginning 1/1/2011 Income 8 Expense Statement for Period 07 July 001 GENERAL FUND Current Y -T -D °ln RFK INCOME 535/47105 5k Walk -A Thon .00 .00 13,592.37 48.30 535147115 Camp Petty Cash 50.00 100.00 50.00 .18 535/47125 Corporate Donation .00 .00 1.500.00 5,33 535/47135 Dinner/Auction Income .00 .00 7,646.38 27.17 535/47145 Golf Tournament Income .00 .00 .00 .00 535/47300 Ministry Offering .00 .00 5,350.91 19.02 535/47315 Private Donations .00 .00 .00 .00 535/47325 RFK Corp. Income .00 .00 .00 .00 535/47335 Sponser Income .00 .00 .00 .00 TOTAL RFK INCOME 50.00 100.00 28,139.66 100.00 RFK EXPENSE 535/61015 5k Walk-A-Thon Expense .00 .00 252.37 .90 535/61025 Activity Center Expense 125.13 250.26 1,075.13 3.82 535/61035 Bible Story Supplies .00 .00 .00 .00 535/61045 Birthday Party Expense .00 .00 1,774.10 6.30 535/61055 Camp Petty Cash Expense .00 .00 800.00 2.84 535/61065 Camp Supplies Expense 327 6.54 10,829.22 37.77 535/61075 Dinner/Auction Expense .00 .00 953.72 3.39 535/61085 Directors Enrichment Expense .00 .00 1,474.04 5.24 535/61095 Drama Supplies .00 .00 .00 .00 535/61105 Golf Tournament Expense .00 .00 .00 .00 535/61115 Memory Books Expense .00 .00 .00 .00 535/61125 Ranch Expense .00 .00 20,000.00 71.07 535/61135 Registration Supply Expense 35.52 71.04 35.52 .13 535/61145 RFK Corp. Expense .00 .00 850.00 3.02 535/61155 Staff/Counselor Development Exp. .00 .00 913.53 3.25 535/62040 Supplies .00 .00 834.77 2.97 535/62045 Welcome Home Dinner Expense .00 .00 137.44 .49 TOTAL RFK EXP. 163.92 327.84 39,729.84 141.19 COMBINED TOTAL ROYAL FAMILY 113.92 227.84 11,590.18 41.19 This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com N•' Page 1 From: 9516959326 Page: 8/11 Date: 9/1/2011 3:31:14 PM ..vv v .•vv.�vp. ..... ......w......� ,. ., ..vv vv._v N•" 1850769 ENDORSED FILED ARTICLES OF INCORPORATION OF Temecula Valley Christian Center lo the offico of the Secretory of Stoic of Out Stool of Coilomio DEC 3 11992 o FONG Eli, Secretary id State The name of this corporation is Temecula Valley Christian Center II. A. This corporation is a religious corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Religious Corporation Law exclusively for religious purposes_ B. The specific purpose of this corporation is to operate a church that is affiliated with the Southern California District Council of the Assemblies of God, Inc. III. The name and address in the State of California of this corporation's initial agent for service of process is: Leonard Nipper 2525 Newport Blvd., Costa Mesa, CA IV. A. This corporation is organized and operated exclusively for religious purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com From: 9516959326 Page: 9/11 Date: 9/1/2011 3:31.14 PM �_ N " ' Page Two V. N"' The property of this corporation is irrevocably dedicated to religious or charitable purposes, and no part of the net income or assets of this corporation shall ever inure to the benefit .of any director, officer or member thereof, or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall he distributed to Southern California District Council of the Assemblies of God, Inc., which is a nonprofit corporation organized and operated exclusively for religious or charitable purposes, and which has established its tax-exempt status under section 501(c)(3) of the Internal revenue Code; provided that the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc., elects to receive such distribution. In the event the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc., does not elect to receive such distribution or in the event the Southern California District Council of the Assemblies of God, Inc., is not then exempt under section 501(c)(3)of the Internal Revenue Code, the assets shall be so distributed to another nonprofit fund, foundation or corporation which is organized and operated exclusively far religious or charitable purposes and which bas established its tax-exempt status under section 501( c 3 of the Internal Revenue Code. The written consent of the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc, is required to amend this article. VL These articles of incorporation may not be amended without the written consent of the Southern California District Council of the Assemblies of God, Inc. Leonard Nipper, or This fax was received by GFI FAXmaker fax server. For more information, visit: http://www,gfi.com From: 9516959326 Page: 10/11 Date: 9/1/2011 3:31:15 CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION Timothy M. Buttrey and Jack Bigpond certify that: ENDORSED - FJLED in the office of the Secretary of State of the Staie of California JUN 1 3 2000 B1LL JONES, Secretary of State 1. They are the president and the secretary, respectively, of Temecula Valley Christian Center, (#C1850769) a California Corporation. 2. Article One, of the Articles of Incorporation, is amended to read as follows: The name of this corporation is Crossroads Church of the Assemblies of God. 3. The foregoing amendment of articles of incorporation has been duly approved by the board of directors. 4, The foregoing amendment of articles of incorporation has been duly approved by the required vote of members. We further declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true an correct of our own knowledge. Date: .3/2 c/o -rJ othy M. Buttrey, Prudent ack Bigpond, Secretary This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com From: 9516959326 Page: 11/11 Date: 9/1/2011 !/ Department of the T'easury Internal Revenue Service FRESNO, CA 93888 TEMECULA VALLEY CHRISTIAN CENTER TIMOTHY M BUTTREY 6468 CARTER ST CHINO CA 91723 Cr 575 DATE OF THIS NOTICE: D4-25-90 EMPLOYER IDENTIFICATION NUMBER: 95-6256287 TAX PERIOD ENDING: N/A 8916606071 0 For assistance you may call us et: 1-800-424-1040 Or you may write to us at the address shown at the left. It you write, be sure to attach the bottom part of this form. TAX FORMS YOU MUST FILE: Notice of New Employer Identification Number Assigned Thank you for your Form SS -4, Application for Employer Identification Number (EJN). The number assigned to you is shown above. This number will be used to identify your business account and related tax returns and documents, even if you do not have employees. 1. Keep a copy of this number in your permanent records. 2. Use this number and your name exactly as shown above, on alt Federal tax forms. 3. Use this number on all tax payments and tax related correspondence or documents. Any variation used when filing tax returns, making FTD payments or subsequent payments may result in improper or delayed posting of payments to your account and/or the assignment of more -than one EIN. The filing requirement(s) and tax period shown above have been established for your account based on information contained on your Form SS -4. If you are a trust, your tax year generally must be a calendar year, unless you are exempt from taxation under section 501 (a) of the Internal Revenue Code or a charitable trust described in section 4947(a)(1 ) of the Code. To help you to determine your required tax year, you may obtain Publication 538, Accounting Periods and Methods. This publication is available at most 1 RS offices for more information. Piease note that the assignment of this number does not grant tax-exempt status to nonprofit organizations. Any organization (ether than 3 private foundation) hating annual gross receipts normally of S5,000 or less is exempt by sta'nite if it meets the requirements of Section 501(c)(3) of the internal Revenue Code. These organizations are not required to file Form 1023 (Application for Recognition of Exemption) or file Form 990 (Return of Organization Exempt from Income Tax). However, if the organization wants to establish its exemption with the Internal Revenue Service and receive a ruling or determination letter recognizing its exempt status, it should file Form 1023 with the key district director. For details on how to apply for this exemption, see IRS publication 557, Tax -Exempt Status for your Organization, available at most IRS offices. Thank you for your cooperation. Kopp this part for your records. This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com CP 575 (Rev. 10-89) From: 9516959326 ..,,r..• .. r ••.v.%.••...,,• ....,•, Page: 1/11 Date: 9/1/2011 3:31:12 PM y`� a_c\(\‘. 6/\,c J COYR.vuunL‘ vtc_ T't un MAY) 66131 01-1-17 1 �a r•• --OseLSY Ca. t4-1,\ nu) nts cx Cmc ex -y-6 lfwi cjnn J This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com City of Temecula 2011-12 CS Funding Program APPLICATION NO. 30 CITY OF TEMECUI.A City of Temecula SEP 1 4 2011 FISCAL YEAR 201 1-12 COMMUNITY SERVICE FUNDING PROGRAP4 M WC ION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 1, 100.00 Project Name: Temecula Valley Flower and Garden Show Project Start Date: Apr] l 1, 2012 (Maximum allowable $5,000) Project End Date: May 5 , 2012 ORGANIZATION INFORMATION Name of Organization: Temecula Valley Garden Club Contact Name: Jeanine Newhouse Title/Position:Grants/Donations-Comm. Chair Mailing Address: P.0. Box 1526 Temecula, CA 92593-1526 Telephone: 858-442-5145 Year Organization Founded: 1984 E -Mail Address: guavaj am5Camsn . com Geographic Area(s) Served: Temecula Val ley Number of Paid Staff: 0 Number of Volunteers: 152 members Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 2002 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 2002 Federal identification number: EIN 71-0869568 State identification number: If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee X Board of Directors Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Established in 1984, the Temecula Valley Garden Club (TVGC) is open to all persons and organized for community charitable and educational purposes. TVGC is a non-profit organization whose objectives are to encourage interest in all phases of home gardening, to promote better horticultural practices and conservation of natural resources and to aid civic organizations wherever possible. The TVGC seeks, where possible to partner with other local non-profit organizations, schools and businesses to maximize resource gathering efforts for education and other community service projects. The TVGC has implemented a number of community programs including the Children's Garden at the Temecula Library. We have renovated the existing garden with new plantings. For the second phase of the program we are looking to finish it with art work sculpture. The garden is also used for a program of service dogs being used by children who practice reading by reading to the dogs. The TVGC has also run the Grow It and Give It Program since 2009. By that program we grow produce in our gardens and donate a portion to local food pantries. We had also incorporated this into a youth program; whereby students create gardens and grow vegetables from seed. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) The TVGC places a great emphasis on community programs and projects. A key approach to provide public education and introduce them to the array of service opportunities is through our annual Flower Show. With an overall theme of "Growing Gardens / Growing Friendships" the annual Flower Show provides an opportunity to have master gardeners meet with attendees to effectively develop and maintain organic gardens, display and provide information regarding the key plants that grow in our region, assist in education on water -wise gardening and landscaping, teach attendees in the art of floral design, and display youth gardening projects and other exhibits. The flower show is also a key major event in the region. All entrants whether by members or the public are judged by National Garden Club accredited judges. The show has Horticulture, Design and Special Exhibits; featuring youth, educational exhibits and artistic crafts. The requested amount is to be used to offset increasing costs we have at the City of Temecula facility, tables/chairs rental and cost of publicity. We expect that the use of these funds if granted would be $500 for facility rental, $300 for tables/chairs and $300 for publicity. Through using these funds and holding this key regional gardening event our community members will learn the advantages of water wise gardening and landscaping, the benefits of growing ones' own vegetables, how to improve the community in terms of floral design and beautification, and the education of our youth in these areas. Application - Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Our organization did not receive funding in the previous year. Application - Page 4 SIGNATURE PAGE We hereby certify t ormatio ned ' this application is true to the best of our knowledge and belief. AAL PREPARED BY: Jeanine Newhouse, Grants/Donations Committee Chairperson NAME and TITLE (Please Print or Type) SIGNATURE: Sally Kirby, Flower Show Chairperson, signing for J. Newhouse PRESIDENT or AUTHORIZED OFFICER: Judy Dermody, President NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Temecula Valley Garden Club MAILING ADDRESS: P. 0. Box 1526, Temecula, California 92593-1526 TELEPHONE: 858-442-5145 DATED THIS S E -Mail Address: guavajam5@msn.com (Date) ' (Month) 2011. Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: Judy.mcnabb(a cityoftemecula.org Facsimile: 951-694-6479 Application - Page 5 2:48 PM 08/10111 Cash Basis From: 951 301 9716 Page: 2/6 Date: 10/20/2011 3:18:55 PM Temecula Valley Garden Club 2011-2012 Budget 2007 - Web Site Total 2000 Operating Expense 4000 • Flower Show Expense 4001 • Facility Rental 4002 Facility insurance 4003 - Award ribbons 4004. Banners and Signs 4005.Opportunity Drawing 4006 • Office Supplies 4007 • Judges Travel Expenses 4008 • Publicity 4009 • Permits for banners and signs 4010 • Plant Sale 4011 • Hospitality Members 4012 • Youth Division 4013 • Printing 4014 • Hospitality Judges 4015 • Staging 4018 • TabielChair Renta/ 4020 • Labor Total 4000 • Flower Show Expense 4050 - Community Service Expense 4052 • Youth Gardening 4070 • Community Service Projects 4075 • Petals for Patriots Total 4050 • Community Service Expense 6000- Workshop Expenses 6004. otleer Workshop Total 6000 • Workshop Expenses 0050 • Hospitality Expense 6054 • Monthly Meetings Total 8050 • Hospitality Expense 6076 • CGCI Expense 6076 • Palomar District Dues 8077 • Luncheon 8078 • Penny Pines Certificate 6079 • CGCI Membership Dues Total 8075 - CGCI Expense 8000 • Programs Expense 8001 - Speakers Fee 8002 • Tours 8003 • Installation Total 8000 • Programs Expense 8076 • Sunshine 8090 • Scholarships 1,000.00 Total Expense1� 6 00 Net Income -2,454.00 Budget 444.00 3,114.00 1,500.00 20.00 400.00 200.00 150.00 75.00 200.00 150.00 59.00 25.00 100.00 200.00 500.00 150.00 300.00 300.00 200.00 4,520.00 100.00 1,000.00 200.00 1,300.00 200.00 200.00 400.00 400.00 300.00 100.00 800.00 350.00 1,550.00 1,100.00 500.00 200.00 200.00 Page 2 of 2 From: 951 301 9716 Page: 3/6 Date: 10/20/2011 3:18:56 PM 2:48 PM 08110x11 Cash Basis Income 100 • Membership 101 • Name Badges 102 • Membership Dues Total 100 • Membership 120 • Flower S1tow Income 121 • Donation 122 • Food & Beverage 123 •Opportunity Ratfle 125. Plant Safe Total 120 - Flower Show Income 130 • Program Income 131 - Tours Total 130 • Program Income 140 • Friends of NGC 150 - Workshops Income 153 • Workshops Total 150 • Workshops Income 170 • Ways & Means Income 172• Cookbooks 173 • Holiday Boutique 174 • Fall Plant Sales 175 • White !Elephant Sale 176 •Opportunity Tickets 179 • Iris Sates Total 170 • Ways & Means Income Temecula Valley Garden Club 2011-2012 Budget Budget 250.00 4,200.00 4,45E1.00 200.00 150.00 600.00 640.00 •w 1 500.00 500.00 1,000.00 200.00 200.00 900.00 200.00 450.00 500.00 3,000.00 200.00 , 5 502.00 180 • CGCI Income 100.00 181 - Luncheon 182 • District Mtg. Sales 200.00 184 • Penny Pines800.00 Total 180 • CGCI Income ,100.00 190 - Dividend & Interest Earned 150.00 14,400.00 DO Total Income Expense 1000 • Newsletter Expense 120.00 1011 • Postage ,20.00 1013 - Office supplies Total 1000 • Newsletter Expense 220.00 1020 • Ways & Means Expenses 1022 • Opportunity Expense 1023 • Fall Plant Sale Total 1020 • Ways & Means Expenses 1075 • Membership Expenses 1076• Badges 1077.Office Supplies 1078 • Membership Book Printing 1079 • New Members Annual Brunch Total 1075 • Membership Expenses 2000.Operating Expense 2001 • insurance 2002 • Storage 2003 • Meeting Facility 2004 - PO box Rental 2005 • Miscellaneous Office Supplies E 1,250.00 100.00 , 1350.00 250.00 100.00 700.00 150.00 1,200.00 400.00 950.00 1,000.00 70.00 250.00 Page 1 of 2 2:55 PM 10/20/11 Cash Basis From: 951 301 9716 Page: 4/6 Date: 10/20/2011 3:18:56 PM Temecula Valley Garden Club Balance Sheet As of October 20, 2011 ASSETS Current Assets Checkl ng/Savings 5005 • Chase 5010 • petty cash Total CheckIng/Savings Total Current Assets Oct 20, 11 16,518.85 50.00 16,568.88 16,568.88 TOTAL ASSETS 16,568.88 LIABILITIES & EQUITY Equity 3000 • Opening Bal Equity 6,223.25 3900 Retained Earnings 7,303.14 Net Income 3,042.49 Total Equity 16,568.88 TOTAL LIABILITIES & EQUITY 16,568.88 2:53 PM 10/20/11 Cash L3asis From: 951 301 9716 Page: 5/6 Date: 10/20/2011 3:18:56 PM Temecula Valley Garden Club Profit & Loss July 1 through October 20, 20.11 Income 100 • Membership 101 • Name Badges 102 Membership Dues Total 100 • Membership 130 - Program Income 131 • Tours Total 130 • Program Income 170 • Ways & Means Income 172 • Cookbooks 216.00 174 • Fall Plant Sales 245.00 176 • Opportunity Tickets 606.00 179 • Iris Sales ; 14.00 Total 170 • Ways & Means Income 1,081.00 180 • CGCI Income 181 • Luncheon 0.00 184 • Penny Pines 196.00 Total 150 • CGCI Income 195.00 190 • Dividend & Interest Earned - 150.00 Total Income 6,008.00 Expense 1000 • Newsletter Expense 1011 • Postage 68.00 Total 1000 - Newsletter Expense 88.00 1020 • Ways & Means Expenses 1022 • Opportunity Expense 76.96 1023 • Fall Plarrt Sale 69.23 Total 1020 - Ways & Moans Expenses 146.19 1075 • Membership Expenses 1076 • Badges 64.13 1077 • Office Supplies 36.47 1078 • Membership Book Printing 707.11 Total 1075 • Membership Expenses 807.71 2000 • Operating Expense 2003 • Meeting Facility 2005 • Miscellaneous Office Supplies E Total 2000 • Operating Expense 4000 • Flower Show Expense 4001 • Facility Rental Total 4000 - Flower Show Expense 4050 - Community Service Expense 4075 • Petals for Patriots Total 4050 - Community Service Expense 6000 • Workshop Expenses 6004 • Gardening Workshop 51.00 Total 6000 • Workshop Expenses 6050 • Hospitality Expense 6054 • Monthly Meetings _ 79.57 Jul 1 - Oct 20, 11 280.00 4,151.00 4,431.00 150.0D 150.00 480.00 96.52 576.52 150.00 150.00 261.57 261.67 51.00 Total 6050 • Hospitality Expense 6075 • CGCI Expense 6676 • Palomar District Dues 6079 • CGCI Membership Dues 79.67 260.00 321.75 2:53 PM 10120111 Cash Basis From: 951 301 9716 Page: 6/6 Date: 10/20/2011 3:18:57 PM i er scuta Valley Garden Clu13 Profit & Lass Jay 1 throughOctobe'i ,2011 Tots OM 0.00Peaossioe. '- Programs EXpanse o1 - Speakers Fee TotN1 BODO • Programs Expense Sionshine WO Jul 1 - Oct 20, 11 607.75 150.00 150.00 47.00 2,965.51 Mot Ingqnw 3,042.49 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: Imam TEMECULA VALLEY GARDEN CLUB C/O CAROL J HUDSON 31492 CORTE SALINAS TEMECULA, CA 92592 1t. DEPARTMENT OF THE TREASURY Employer Identification Number: 71-0869568 DLN: 17053126033042 Contact Person: DENNIS SAYERS Contact Telephone Number: (877) 829-5500 Accounting Period Ending: August 31 Form 990 Required: ,No Addendum Applies: No ID# 52486 _ Dear Applicant: Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3). We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 509(a)(2). If your sources of support, or your purposes, character, or method of operation change, please let UB know so we can consider the effect of the change on your exempt status and foundation status. In the case of an amend- ment to your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you should inform us of all changes in your name or address. An of January 1, 1984-, you are liable for taxes under the Federal Insurance Contributions Act (social secsecurity es)conerem remuneration f $100 or more you pay to each of your employeesg y are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, if you are involved in an excess benefit transaction, that transaction might be subject to the excise xcisettaxes of section 4958. Additionally, you are not automatically exempt federal excise taxes. If you have any questions about excise, employment, or other federal taxes, please contact your key district office. __ $rantor$._an contributors _m_ay_rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a)(2) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the Letter 947 (DO/CG) -2- TEMECULA VALLEY GARDEN CLUB part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a)(2) organization. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket pur- chases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which sets forth guidelines regarding the deductibility, as chari- table contributions, of payments made by taxpayers for admission to or other participation in fundraising activities for charity. In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receipts test. If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $20 a day is charged when a return is filed late, unless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $10,000 or 5 percent of your gross receipts for the year, whichever is less. For organizations with gross receipts exceeding $1,000,000 in any year, the penalty is $100 per day per return, unless there is reasonable cause for the delay. The maximum penalty for an organization with gross receipts exceeding $1,000,000 shall not exceed $50,000. This penalty may also be charged if a return is not complete, so be sure your return is complete before you file it. You are required to make your annual information return, Form 990 or Form 990 -EZ, available for public inspection for three years after the later of the due date of the return or the date the return is filed. You are also required to make available for public inspection your exemption application, any supporting documents, and your exemption letter. Copies of these documents are also required to be provided to any individual upon written or in person request without charge other than reasonable fees for copying and postage. You may fulfill this requirement by placing these documents on the -Internet. Penalties maybe imposed for failure to comply with these requirements. Additional information is available in Publication 557, Tax -Exempt Status for Your Organization, or you may call our toll free number shown above. Letter 947 (DO/CG) -3- TEMECULA VALLEY GARDEN CLUB You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt Organization Bwainess Income Tax Return. In this letter we are not determining Whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that nyer on all returns you file and in ail correspondence with the Internal Revenue Service. In accordance with section 508(a) of the Code, the effective date of this determination letter is July 29, 2002. This determination is based on evidence that your funds are dedicated to the purposes listed in section 501(c)(3) of the Code. To assure your continued exemption, you should keep records to show that funds are expended only for those purposes. If you distribute funds to other organizations, your records should show whether they are exempt under section 501(c)(3). In cases where the recipient organization is not exempt under section 501(c)(3), there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient. If distributions are made to individuals, case histories orregarding ds, the hener recipients should be kept showing names, addresses, purposes of selection, relationship (if any) to members, officers, trustees or dA ::• = ` •�`�-`ter` funds to you, so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service. (Revenue Ruling 56-304, C.B. 1956-2, page 306.) If we have indicated in the heading of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. -4- TEMECULA VALLEY GARDEN CLUB If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, C' m f 7 7 4 e • -t Lois G. Lerner Director, Exempt Organizations City of Temecula 2011-12 CS Funding Program APPLICATION NO. 31 City of Temecula CI"I'Y OF TEMECULA AUG 2 4 2011 FISCAL YEAR 2011-12 COMMUNITY SERVICE FUNDING PROGRAM API p1WRON (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one PROJECT INFORMATION Amount Requested: $500.00 (Maximum allowable $5,000) Project Name: 2011 CARE TO SHARE HOLIDAY PROGRAMS Project Start Date: SEPT 1ST, 2011 Project End Date: JAN 30; 2012 ORGANIZATION INFORMATION Name of Organization: TEMECULA VALLEY PEOPLE HELPING PEOPLE Contact Name: DENNY MIGHELL Title/Position: PRESIDENT / CEO Mailing Address: 37887 SPUR DRIVE, MURRIETA, CA 92563 Telephone: 951-757-5212 E -Mail Address: tvphp@verizon.net Year Organization Founded: 1992 Geographic Area(s)Served:, Temecula & South Riverside County Number of Paid Staff: 0 Number of Volunteers: 200 Is this organization incorporated in California as a non-profit organization? Yes Effective Date: 1997 If "yes" (Must provide a copy organization's 501 (c)3 non-profit status form): Date of incorporation as a non-profit Sept. 6-1996 Federal identification number: 33-0754195 State identification number: 1978608 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee (X) Board of Directors (X) Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. MISSION STATEMENT Our mission, as a nonprofit charity and information service, is to actively serve the people of Riverside County by building permanent charitable capital, and providing services that contribute to the health and vitality of the community. Through collaboration with other service organizations, city and government officials, and other caring individuals, TVPHP will continue to unite resources, experience, and effort to work towards a mutual goal in assisting those in need in our community. Vision TVPHP will be Riverside County's premier knowledge resource; and a recognized leader in assisting individuals, families, and children in need. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Temecula Valley People Helping People in 2011 Care to Share Holiday Program Temecula Valley People Helping People (TVPHP) is a 501-C3, 509-A1, 170 -B -1-A and V I non-profit organization. TVPHP has assisted many organizations, children, families and other non-profit groups to raise money, gifts, toys, food and other items for those in need. TVPHP provides services with dignity while reaffirming the self-worth of each individual and assisting that person in reaching his or her greatest potential for the past 19 years. In 2011 our figures could reach over 20,000 plus children. seniors and families, due to the economy time we are in. We try to bring smiles on children faces and also on the parent/parents or grandparent faces as well. There is nothing sweeter than to give to someone and receive a big hug or that beautiful smile, being that it comes from a child, mother, father, grandparent or whomever! If TVPHP receives the grant approval, the funds will go help the children, families and seniors in Temecula area. As the City of Temecula has been working TVPHP for the past 19 years and knows our reputation and what we can do and what we done. PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Temecula Valley People Helping People In 2010 TVPHP Group and partners , Care to Share Holiday Programs handle between 16,000 to 17,000 children, seniors and families. This can only happen when we all work together and support our communities, can these numbers be taken care of.. TVPHP believes it takes a Village to Raise Child! With this in mind the economy that has hit Southwest Riverside County & Riverside County very hard as well as the country. This effects millions of families, seniors and children with unbelievable hardships I n their lives and it is only getting worst. So many non -profits groups, food banks, churches and so many other organizations have been trying their best to handle/help those in need. In this gloomy sad state of mind, so many (millions) suffering from depression, emotional rejection and withdrawal. So many are looking for help, because of loss of jobs, homes, business and the worst, the lost of families. Society in general is has a very big heart. Americans goes out of their way to help so many in the world; but at times we seem to forget those at home. As our elected officials cannot seem to overcome so many issues we have today in our state and our country, the people of the community needs to step up and help. Our tax dollars are not going where they are needed. So many important programs are being cut out/drop to help those in need. It's all about money and the mismanagement across the board and everyone pointing the finger at each other. We as a community can make a difference by working together, every little bit helps. Today fundraisers, grants and donations are in short supply. Many businesses and supporters are feeling the rough time and cannot help like they have in the past. Many businesses either have cut backs, or just closed the doors, look around and can see for yourself! TVPHP has a working partnership with forty non-profit groups, organizations, schools, churches and many more for the past "NINTEEN AND HALF YEARS". This can only happen when we all work together and support our communities, can these numbers be taken care of.. These number can only reflect what is happening in our community today and the need to help and support each other. We no longer turn our heads away and not look at what is happening to the families in our community, the "HOMELESS", families living in the street, cars, camp grounds and I am not talking about the men living in the and camping in the street, I mean woman with children, whole families, seniors. These were people living home, apartment and condo's. Temecula Valley People Helping People "NEEDS YOUR HELP", WE CANNOT DO IT WITH OUT YOU. We are receiving calls and emails daily for help, asking for food, clothing, shoes, rental help, gas cards, car repairs, utility help with electric, gas and water and many other organization are the same and many talk to each other about these issues. TVPHP has a few families (like a mother and 3 children & others families like this) that need help to get into home, apartment or help to move back to another state where they have family and we need money to help with these issues. Thank you and God Bless; SIGNA'T'URE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY: DENNY MIGHELL - PRESIDENT / CEO NAME and TITLE (Please Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: DENNY MIGHELL - PRESIDENT / CEO NAME and TITLE (Please Print or Type) ORGANIZATION NAME: TVPHP GROUP - TEMECULA VALLEY PEOPLE HELPING PEOPLE MAILING ADDRESS: 37887 SPUR DRIVE, MURRIETA, CA 92563 TELEPHONE 951-757-5212 E -Mail Address: tvphp@verzion.net DATED THIS 22nd of Aug. , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: iudy.mcnabb(c�cityoftemecula.orq Facsimile: 951-694-6479 People Helping People Estimated Annual Budget 2011 Inflows Cash donations In kind contributions (clothing, toys, etc.) 116,650 1,200,000 Total inflows 1,316,650 Outflows Auto & Fuel 15,900 In kind contributions (gifts for children & elderly) 1200,000 Gifts (not received through inkind contributions) 35,000 Facility rent (christmas program) 48,000 Supplies 1,800 Dues & memberships 1,000 Professional services 9,600 Telephone 3,600 Travel 750 Bank fees 250 Postage 250 Licenses & permits 500 Total outflows 1,316,650 Net inflows (outflows) Prepared by Denny Mighell 009072 I�7 ``� Department of the Troasury IJ Internal Revenue Service OGDEN UT 64201-0038 004072.866221.0021.001 1 AT 0.365 540 III IIIIIIllrrrl llrrIiIrIIrliIr.11111lrrlrl1111111111111111111Ilrl TEMECULA VALLEY PEOPLE HELPING PEOPLE PEOPLE HELPING PEOPLE 37887 SPUR DR MURRIETA CA 92563-4784 CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF THIS PAGE IF YOU ARE MAKING A PAYMENT, EVEN IF YOU ALSO HAVE AN INQUIRY. The IRS address must appear in the window. 0438058212 BODCD-TE INTERNAL REVENUE SERVICE OGDEN UT 84201-0038 III.IiuII,IruI,�II IlIlrrrll IIII a Illllrll Use for payments Letter Number: LTR4168C Letter Date 2011-07-01 Tax Period 000000 IBI III 1111 0V *330754195* TEMECULA VALLEY PEOPLE HELPING PEOPLE PEOPLE HELPING PEOPLE 37887 SPUR DR MURRIETA CA 92563-4784 330754195 RL TEME 00 2 000000 670 00000000000 004072 IRSDepartment of the Treasury Internal Revenue Service OGDEN UT 84201-0038 TEMECULA VALLEY PEOPLE HELPING PEOPLE PEOPLE HELPING PEOPLE 37887 SPUR DR MURRIETA CA 92563-4784 In reply refer to: 0436058212 July 01, 2011 LTR 4168C 0 33-0754195 000000 00 00034651 BODC: TE Employer Identification Number: 33-0754195 Person to Contact: Shannon Ingraham Toll Free Telephone Number: ---877=829-5500 Dear Taxpayer: This is in response to your June 22, 2011, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 501(c)(03) of the Internal Revenue Code in a determination letter issued in May 1997. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irs.gov/eo for information regarding filing requirements. Specifically, section 6033(j) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(7) of the Code on our website beginning in early 2011. 0438058212 July 01, 2011 LTR 4168C 0 33-0754195 000000 00 00034652 TEMECULA VALLEY PEOPLE HELPING PEOPLE PEOPLE HELPING PEOPLE 37887 SPUR DR MURRIETA CA 92563-4784 If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, RitcLa_,Abz__, Rita A. Leete Accounts Management II Form W-9 (Rev. November 2005) Department the Treasury2005)Identification Internal Revenue Service Request for Taxpayer Number and Certification Give form to the requester. Do not send to the IRS. Please print or type See Specific Instructions on page 2. Name (as shown on your income tax return) Business name, if different from above. TVPHP Group - Temecula Valley People Helping People Exempt from backup ❑ Other ❑ withholding Check appropriate Individual/► box: ❑ Sole � Corporation ❑ Partnership proprietor Address (number, street, and apt. or suite no.) 37887 SPUR DRIVE Requester's Name and address (optional) City, state, and ZIP code MURRIETA CA 92563 - List account number(s) here (optional) Part 1 Taxpayer Identification Number (TIN) Ente your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note: If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social Security number or Employer identification number 33 - 0754195 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Here Signature of U.S. person ► Date P. 01 / 01 / 2011 Purpose of Form A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. In 3 above, if applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. For federal tax purposes you are considered a person if you are: • An individual who is a citizen or resident of the United States, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or • Any estate (other than a foreign estate) or trust. See Regulation sections 301.7701-6(a) and 7 (a) for additional information. Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received: a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. 00-42-0035NSBW 03-2006 Cat. No. 10231X Form W-9 (Rev. 11-2005) City of Temecula 2011-12 CS Funding Program APPLICATION NO. 32 CITY OF TEMECULA FISCAL YEAR 20 1 1-12 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) Finance Departmen City of Temecula SEP 14 2011 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ .5, Q(`(' . (Maximum allowable $5,00 ) Project Name:f frIC't/(41(/ !�1/ �( 1noo`r lical, jc -16 /� Project Start Date: � ofI / Project End Date. if Crk51.5 - ORGANIZATION INFORMATION Name of Organization: Iu it t fit& Il Contact Name: riff l ..). • MO !Q 0 . Title/Position: Mailing Address: Ti! . L ) 51 Ala rri P•/ l of Telephone: !, 5/ - c' (-, --/.yqj E -Mail Address: rj j t ('yy 6/4/A_ i(, , CW) Year Organization Founded: ) 7 GeographicArea(s) Serve > RV/ / k. .. it I - "a l( c'ne 1 trtr11C��c�-c�o,- Number of Paid Staff: Number of Volunteers: '4 &) Is this organization incorporated in California as a non-profit organization? Yes %( No _ Effective Date: 4,97�'P If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: J/47/'()0~7 Federal identification number: c4 - 5 ,38--z-N5-7 State identification number: U'qL/L(% L(( If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee iC Board of Directors Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed,on page 2 of the CS Funding Policy. and, �r_hcgl �� ��rt--76-inguA1ahz-e't C(-lrt>(Y)s. 70 Amora0 -41 4)5 11p m514-3-1-114), ,SGS 01 51-anhard --rhe I__Iyitperrencv vol I) (14-erS (14r -e 'Avni7 ahe 31�� )6.y‘) a year --mien hL±Th 15(.t cid c ou�rn,+rrneict � - �,Pr Mak ,"Ti) i f VoIc li1 -CY" Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) /I UO (1) Of if/14(AA � �) ‘Prn vi * 4cnijyaioq / f atd ctiiV latIc* real ,$i,+D -pie C` +)z'fl '5 (F --P. 0:1- cc «nit_c !r Q3 kx We 5iice ) _ as 11 1 Ail 'JI i. ... iia s, 4 /I' .r..v i►'_r, 4r. _ A / ■ sr., - ' f.,1 . ciiillr• -act A :r 4 .1 7a% rest 1 di I I• /I teDCf1c tPn-E-- min ()Er: VUluari-ir� Low CM7iue`r- he.� i�Q nF Oro( -42 111-CrtAilfratki - I n -tkes tr-reai-clryl Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. 7Fr \ec MITh mod Crnn tylf (3-7-2 l i) c ) / (� , 4 ntrii-j-Cry) (y1 r cAtv,10 clorzicire 'lane) ) 7 t r c`.I 1 0rf -5 1 J ofFr, ,iia Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: 90/&'' NAME and TLE (ase Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: MR+J -T74 —EoA✓th evrroy2,c, NAME and TITLE (Please Print or Type) SIGNATURE: -�— ORGANIZATION NAME: T .l ft i —/--t 1 l n1 I S kw ,31ci e • =rte MAILING ADDRESS:x Ma rrleh TELEPHONE: gb7' () 5 E -Mail Address: 9rrJn1 rceGi j DATED THIS of51rik-9(4hOrr- , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judv.mcnabb(c�citvoftemecula.orq Facsimile: 951-694-6479 Application — Page 5 FROM : FAX NO. Sep. 14 2011 08:10AM P1 Form 990. Return of Organization Exempt From Income Tax Under section 501(c), 627, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Department of the Treasury of this return to sell;+ state reporting requirements. baern,l Cleverly° Staff/10eIIP "The organization may have to use a copy 2009 and ending JUNE n 0 A . For the 2009 calendar year, or tax year beginning JULY 01 g Check It Please C Name of organization TRAUMA INTERVENTION PROGkAMS IN 110 Employer Identification number ..applicable: use IRS P0-53894577 Adorer.a uneiloe label or Doing Business Ae print or Numbor end ;treat (or P.Q. boa 11 moll Ir. nui dellvnrcd to street addre66) I rigmIn/ E Telephone dumber tw See' 0 BOX 585 (951) 698-2453 e Specific Inetruc- tlona. OMB No. 1545-0047 2009 , 2010 Name nhenge Initial return Terminated Amended return Application nnndlng City or town, state or country, and ZIP + 4 URRIETA CA 92564-0585 F Nacre and address of principal officer: 1 Tex -exempt status, X1501(c)(3 ) (insert no.) l 14947(8)(1) or J Website: ► WWW , SWRCTIP . ORG K Form of urganl2dlinn: X) Corpnr61J°n Trust Association 627 Ducar ► G Groes recolpts $ 51,256 H(a) Is tins a group return for effillote67 Yes No H(b) Are ail affIlintesIncluded7 Yes No 11 "No,"attach a Hat. (see Instr,rotiuns) H(o) Ciroup asemntIon number ► 54 03 L Year of formation: 2007 FM State 01 cepa) domicile: CA e— ^^< Summary 1 Briefly deeerIbe the organIzation's mission or Most significant activities: LSEE ATTACHMENT #1 A cG T I V V TR N E A S N C 2 Cheek this box ► j' the organization discontinued Its operations or disposed of more than 25% of its not assets. 3 Number of voting rr.embers of the governing body (Part VI, line 1a) 3 4 Number of Independent voting members of the governing body (Part VI, lire 1 b) 6 Total number of employees (Part V Ilne 2a) . . . . ..... . ....... .................. s Total number ot•volurttoels (estimate if necessary) 7a Total gross unrelated buelness revenue from Part VIII, column (C), Ilne 12 b Net unrelated business taxable Income from Form 900-T, line 34 E V E N U E E X P E N S E S 5 5 1 e 45 7a 7b e Contributions and grants (Part VIII, Ilno 1 h) 9 Program service revenue (Pail VIII, lino 2g) 10 Investment Income (Part VIII, column (A), linos 3, 4, and 7d) 11 Outer revenue (Pan Vlil, column (A), !Ines 5, rad ac:, 9c, 10e, and 110) 12 Total revenue -- add lined a through 11 (must equal Pen VIII, column (A), lino 12) . 13 Grants and trlmaar amounts paid (Part IX, column (A), linea 1-3) 14 Benefits paid to or for members (Pan IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Pen IX, column (A), lines 5-10) . - • 16a Professional fundraising fees (Pali IX, column (A), Ilne 110) b Total fundraising expanses (Pan IX, column (0), Ilno 25) ► 17 Othor expenses (Part IX, column (A), Ines 17 a -aid, 111-241) 18 Tvital oxpenaee. Add limes 13-17 (must equal Pait IX, column (A), line 25) 19 Revenue less expenses. Subtract line 10 Prom Ilno 12 20 Total assets (Pan X, line 10) 21 Total IlabIlfdas (Part X, lino 20) 22 Net assets or fund balances, Subtract Ilne 21 from line 20 Prior Year Current Year 0 29. 550 29,761 881 130 19, 510 2,351 49,941 32,242 500 46,353 32,596 �+• :531,s^?Q t; • 1 _ 17,024 22,562 63,377 55,658 -13,436 -23,416 Scultmlngof Current Year 87,177 End of Year 63,732 393 364 86,784 63,366 J( Signature Block Under wallies( of perjury. I deci8ro that havn csaromed tnic return, Including accompaeyiup 8c11r doles end etatnniente. and to the best of my knoWledoo and enlist. 11 i6 two, cureet, and complete. Declaration n1 preperer(other than 7ffioerl iia based on all Information of which properer har any knowiedgn. Dale Sign Here Signature of officer Typearer's pate ep p t nacos an• Check it Prarpi'g Irinn til sing fiUmbcr (too ineL .l Preparernn11- 01 14-201 dem�l°sed it. 9mgnature Paid ANDERSON PROFESSIONAL SERVICES EIN IPPreparers Fn' lr,e name (or0u y1 e Use Only It eell-e mploynd), :17 6 2 0 GRAND AVENUE Phone no. ► (9 51) 678-216,5 LAKE ELSINORE CA 92530 '`'l addreae, and ZIP�i� � r � 1 Yga ti<1) NO ............ May Iho IRS discuss this return w th the proparer shown obovc4 (t;ee Instructions ...... Furm 990 (2009) For Privacy Act and PaperworK Reduction Act Notice. sea the separate Instructions. ,1V4 09 99012 1Wr 15583 Copyright Forir (SottwarrOnly). 21100 T: FROM : FAX NO. : Sep. 14 2011 OB: 10AM P2 Form 990 (2009) TRAUMA INTERVENTION PROGRA 20 -53 89457 Page 2 �(. Statement of Program service Accomplishments ---� 1 Briefly describe the organization's mission: TO PROVIDE IMMEDIATE, ON -SCENE EMOTIONAL AND PRACTICAL SUPPORT TO EMOTIONALLY TRAUMATIZED CITIZENS. TO ACCOMPLISH THIS, THEY MEET THE SAME.HIGH STANDARDS AS THE EMERGENCY RESPONSE' SYSTEM ITSELF. AVAILABLE 24/7, 365 DAYS A YEAR. 2 Did the organization undertake any significant program services during the year wtitch were not listed on Yea ®No Me prior Form 990 or 99o -EZ? i1 "Yes," describe these new services on Schedule 0. 3 Did the organization cease conducting, or make significant changes in how R conducts, any program Yea No sservices?U iceB? u It "Yes," describe these changes on Schedule O. 4 Describe the exempt purpose achievements for each of the organization's throe largest program services by expenses. (1) and �allocaations to ottws, the total organizations ponies, end revenue, if ny )for eacheprogram required are amount of grants service reported. 4a (Code: ) (Expenses * 54 , 80B ',lowing grant. of S ) ( Revenues 31 4 0 0 SEE ATTACHMENT #2 ) 4b (ecce: (capeneee $ Including Brenta of $ ) ( Revenue $ 4c (Godo: ) (Expenr:na $ 4ncluding grants of $ ) ( Revenue E 4d Other program sarviceti. (Describe In Schedule 0,) (Expenses $ including grants of $ ) (Revenue $ ) 4e Total program service expenses I. $ 54 , 8 08 Form 990 (2009) 1vn 09 99012 1'WF3339n Copyright Fume (Software Onry)-2009TVJ FROM : FAX NO. : Sep. 14 2011 08:11AM P3 Form 890 2000 TRAUMA INTERVENTION PROGRA 2 0 - 55 3 8 9457 Checklist of Required Schedules 1 Is tee organization doncrlbed In section 501(c)(3) or 49470)(1) (outer than a private foundation)? if "Yee," complete Schedule A 2 Is the organization requited to complete Schedule B. Schedule of Contributors? 3 Did the organization engage In direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Patti 4 Section 601(c)(3) organlzattone. Did the organization engage In lobbying activities? It "Yes," complete Schedule C. Pail II 6 Section'501(ox4), 501(0)(6), and 501(c)(6) organizations. I91he organization subject to the section 6033(e)'notice N/A and reporting requirement and proxy tax? 11 "Yes.' complete Schedule C, Part III 6 Did the organization maintain any donor advised funds or any similar tunds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? 11 "Yes," complete Schedule D, Part 1 7 Did the organization receive or hold a conservation easement, including casements to preserve open space, the environment, historic land areas, or historic structures? It "Yes," complete Schedule 0, Part 11 8 Did IM organization maintain collections 01 works of art, historical treasures, or other similar assets? if'Yes," complete Schedule D, Part III 9 Did the organization report an amount In Part X, lino 21; serve as a custodian for amounts not lteted In Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," compiete Schedule D, Part IV 10 Did the organization, directly or through a related organization, hold meta In term, permanent, or quasi-ondowments? If "Yes," complete Schedule D, Part V 11 Is the organization's answer 10 any 01 the following queallons "Yee"? 11 so, complete Schedule 0, Parts VI, VII, Vill IX, or X as applicable • Did the organization report an amount for land, buildings, and equipment In Part X, line 10? If "Yes,' complete Schedule 0, Pari VI. • Did the organization report an amount for investments -- other securities in Part X, lino 12 that le 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule 0, Part VO, • Did the organization report an amount tor Investrnente -- program related In Pail X, line 13 that is 5% or more of its total assets reported In Part X, line 16? If "Yes,' completo Schedule D, Part VIII, • DId the organization report an amount for other assets In Part X, line 15 that Is 5% or more of Ile total assets reported in Part X, line 16? 11 "Yes," complete Schedule D, Part IX. • DId the organization report an amount for other liabilities In Port X, line 25? If "Yes," complete Schedule D, Part X. • Did the organization's separate or consolidated flnancial statements for the tax year Include a footnote that addresses the organization's liability for uncertain tax positione under FIN 48? It "Yes,' complete Schedule 0, Part X. 12 Old the organization obtain eepefeto, independent audited financial statements for the tax year? if "Yes," complete Schedule D, Parts XI, XiI. and X111. 12A Was the organization included in coneolidetod, independent audited financial :statements for the fax year? If "Yea," completing Schedule 0, Parts XJ, XII, and XIII is optional 12A X i3 Is the organization a school deecrlbod in section 170(b)(1)(A)(1i)? If "Yes," complete Schedule E 140 Did the organization maintain an office, employeee, or agents outside of the United States? b Did the organization have aggregate revenues or expenses of more than $10.000 from grantmaking, fundraising, business, and program cervico activities outside the United States? If "Yeas" complete Schedule F, Part 1 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located ouleide the United States? If 'Yes," complete Schedule F, Pen 11 18 DId the organization report on Part IX, column (A), line 3, more than $5.000 of aggregate grunts or aseletance to individuals located outside the United States? 11 "Yes," complete Schedule F, Part 111 17 Did the organization report a total of more than $15,000 of expenees for professional fundraising services on Part IX, column (A), linea 6 and 11e? It "Yee,' complete Schedule G, Parti 18 Did the organization report more than $15,000 total of fundraising event groan income and contributions on Part VAI, lines lc arid Ba? 1f "Yea,' complete Schedule C,, Parr!! 19 Did the organization report more than $15,000 o1 gross income from gaming activities on Part Vill, line 9a? 11 "Yes:' complete Schedule Co, Part III X 20 Did the organization operate one or more hospitals? II 'Yes,' complete Schedule H Form 990 (2000) ,NA 09 99034 TWF33s9& CopyrightFor mz Mort w,rCOnty)•-2n09TW FROM : Form 990 (2009 Checklist of Required Schedules (continued) 21 Did the organization report more Than $5,000 01 grants and other assistance to govonhmente and organizations in the United States on Part IX, column (A), lino 17 If "Yes," complete Schodule 1, Parts 1 and II 22 Did the organization report more than $5,000 of grants and other assistance to Individuals In the Untied States on Part IX, column (A), line 27 If "Yes," complete Schedule I, Parra I and 11I 23 Did the organization answor "Yee" io Part VII, Section A, hne 3, 4, or 5 about componsallon ofe rg? iIf zYesn's ccurrent and former officers, directore, trustees, key employees, and highest compensated employees? cornplote Schedule J 24a Did the organization have a tax-exempt bond Issuo with an outstanding principal amount of more than $100,000 es of ' the teat day of the year, that wee Issued after December 31, 2002? 11 "Yes," answer lines 24b through 24d and complete Schedule K. r1 "NO," go to line 25 b Did the organization Invest any proceeds of tax-exempt bonds beyond a temporary poriod exception?, , , , , , , .. NSA c Dld tho orgariI atlon maintain an oscioW account other than e refunding escrow at any time during the year to dete ae any lox-oxempi bonds? d Did the organization act as an "on behalf of" Issuer for bonds outstanding at any time during the year? N/A 26a Section 601(0)(3) and 601(C)(4) organizations. Dld the organization engage In an oxca8B benefit iransaoflon with a disqualified person during the year? If "Yes," complete Schedule L, Part 1 b Is the organization aware that it engaged In an excHB3 benefit trarteaCtlon with a disqualified person in a prior year, and that the transaction heti not boon reported on any of the organization's prior Forms 980 or 990-Q7 I1 "Yee," complete Schedule L, Part I 26 Was a loan to or by a current or former officer, direcior, trustee, Key employee, highly compensated employee. or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part 11 27 Did tho organization provide 8 grant or other assistance to an Weer, director, truetee, key employee, substantial Contributor, or grant selection committee member, or to a pereori related to ouch an Individual? If "Yee," complete Schedule L, Pari III 28 Was Me organization a party to a busineue transaction with one of The follow ng parties (see Schedule L, Part IV insirucllons for applicable filing throsholds, conditions, and exceptions)' a A current or former officer, director, trustee, or key employed? If "Yes," complete Schedule L, Pen IV b A family member of a current or former officer, director, trustee, or key employee? If "YeB," Complete Schedule L, Part V o An ontity of which a current or former officer, director, trustee, or key employee of the organization (or a family memoer) was an officer, director, truffles, nr diroct or indirect owner? If "Yes," complete Schedule L, Part IV 29 Did the organization receive more than $25 000 In non-cash contributions? If "Yee;' complete Schedule M 30 Did the organization receive contributions of art, historical lreeeures, or other similar assets, or qualified conservation contributions? 11 "Yea," complete Schedule M 31 Dld the organization liquidate, terminate, or dissolve and cease operations? if "Yes," complete Schedule N, Parti 32 Did the organization sell, exchange, dispose of, or transfer more than 25% ol Its net tweets? 11 "Yes," complete Schedule N, Part 11 33 Did the organization own 100% of an entity disregarded ae separate from the organization under Regulations 0ect ons 301.7701-2 and 301.7701-3? If "Yee," complete Schedule R, Part 1 34 Was the organization related to any tax-exempt or taxable entity'? II 'Yes," complete Schedule R, Parte II, III IV, and V, line 1 35 is any related organization a controlled entity WIMP) tho moaning of section 512(b)(i3)? If "Yes," complete Schedule R Pon V, line 2 38 Section 501(8)(3) organizations. Did the organization slake any transfers to en exempt non -charitable related organization? If "Yea," complete SehedLJle R, Part V, line 2 37 Did the o'ganizatlon conduct more than 5% of its activities through an entity that is not a rotated organization and that le treated ee a partnership for fedora) income Lax purposes? If "Yes," compute Schedule R, Pari VI, .... .. 38 Did tho organization complete Schedule 0 and provide explanation; In Schedule 0 for Part VI, lines 11 and 19? Note: All Form 990 filers are required to complete Schedule O J''A 09 09034 ran- .A23613 CnpyriphtFoin' ftwere0nlyl-71IU61V✓ FAX ND. : Sep. 14 2011 08:11RM P4 TRAUMA INTERVENTION PROGRA 20-5389457 Pae4 Yes N 21 22 23 X 24a X 24b 248 24d 25b 26 27 X 28a 28b 2Bc 29 30 31 32 33 34 35 36 37 38 X Form 990 (2009) FROM : FAX NO. : Sep. 14 2011 08:12AM P5 Form 990 (2009) TRAUMA INTERVENTION PROGRA 20-5389457 NW Statements Regarding Other IRS Filings and Tax Compliance la Enter the number reported in Box 3 oI Form 1098, Annual Summary and Transmittal of U.S. Information Returns. Enter -0- If not applicable 0 �� b Enter the number of Forms W -2G Included In lino ia. Enter -0- if not applicable tb c Did the organization comply with backup withholding rules for reportable paymente to vendors and reportable gaming (gambling) winnings to prize winners? N/A lc 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return 12a b If it least one I8 reported on line 2a; did the organization' lire all required federal employment tax returns? Note. If the surn 01 lines to and 20 Is greater than 250, you may be required to e-flte this return. (see Inattuctions) 3a DId the organization have unrelated business gross income of $1,000 or more during the year covered by Page 5 this return? . , , b If "Yes,' has It flied a Form 990-T for this year? If "No,' provide an explanation In Schedule 0 N/A 3b 4a At any tlmo during the calendar year, did the organization have an Interest in, or a signature or other authority over, a financial account In a foreign country (such es a bank account, eecurides account, or other financial account)? b if "Yes,' enter the name of the foreign country: a. See the Instructions for exceptions and tiling requirements for Forin TO F 90-22.1, Report of Foreign Rank and Financial Accounts. 60 Was the organization s party to a prohibited tax Shelter transaction at any tirne during the tax year? b DId any taxable party notily the organization that it was or Is a party to a prohibited tax shelter transaction? c If "Yes," to line 5a or 5b, did the organization file Form 8888-T, Disclosure by Tax -Exempt Entity Regarding N/A be Prohibited Tax Sheller Transaction? 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization 8o110 any contributions that were not tax deductible? 6a b 11 "Yee," did the organization include With every eolICltalion an express statement that such contributions or N/A gifts were not tax deductible? 7 eta Organizations that may receive deductible contributions under section 170(4 !7 j a Did the organization receive a payment In excess of $75 'nada partly as a contribution and partly for goods and 7a and servicers provided to the payor? b if "Yes," did tho organization notify the donor of the value of the goods or services provided? N/A 7b c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to lila Form 0282? d PI "Yeo," indicate the number of Fonts 0282 tiled during the year 7d e Did the organization, during the year, iocelVe any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e f Did the organization, during the year, pay premitrina, directly or indirectly, on a personal benefit contract? 7f g For all contributions of qualified intellectual properly, did the organization filo Fenn 8909 as required? 7g h For contributions of cars, boats, airplanes, and other vehicles, did the organization file o Form 1098-C as required? 7h 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by s sponsoring organtzation, have excess buetness holdings at any time during the year? 9 Sponsoring organizations maintaining donor advised funds. a Did the organization make any taxable distributions under section 4988? b Did the orgartizatlon make a distribution to a donor, donor advisor, or related person? 10 Section 501(cX7) organizations. Enter: a Initiation lean and capital contributions included on Part VIII, line 12 1oa b Grose receipts, Included on Forth 990, Part VIII, line 12, for public use of club facilitie8 10b 11 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholders 118 b Gross Income from other sources (Do not net amounts clue or paid to other sources 11b against amounts due or received from them.) 12a Section 494700(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu 01 Form 1041? b 1f "Yes." enter the amount of lex-oxem•1 Intoreet received or accrued during the ear 12b JVA 09 99056 TWF33347 CnpyrlAntForme. (Software Onlyt-20U9TW FROM : FAX NO. : Sep. 14 2011 08:12AM P6 Form 990 (2009) TRAUMA INTERVENTION PROGRA 20-5389457 page 6 yjMaj Governance, Management, and Disclosure For each "Yee" response to Tinea 2 through 7b below, and for a "No" response to line ea, 8b, or lob below, describe the circumstances, processes, or changes In Schedela 0. See instructions. Section A. Governing Body and Management is Enter the numbor of voting members of the governing body la b Enter the number of voting members that are Independent ib 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? 3 Did the organization delegate control over management duties customarily performed by or tinder the direct 'supervision of officers, directors or trustees, or key.employeee to a maneg'emenf companyer other person? 4 Dld the organization make any algntflcam changee to Its organizational documents since the prior Form 990 was flied? 6 Did the organizatlon become aware during the year of a material diverelon of the organization's assets? 6 Does the organization have members or atockhoiders? la Doee the organization have members, stockholders, or other persons who may elect one or more members of the governing body? b Are any decisions of the governing body subject to approval by members, elockhoideis, or other persons? e Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? b Each committee with authority to act on behalf of the governing body? 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If "Yee," provide the name° and addresses in SehedUle 0 Section B. Policies (Thie Section B requeele Information about policies not required by the Internal Revenue Code.) 10a Doe9 the organization nave local chapters, branches, or affiliates? b if "Yes;' does the organization have written policies and procedures governing me activities of such chapters, affiliates, and branches to unsure their operations are consistent with those of the organization? N/A 11 Hae the organization provided a copy of this Form 990 to ail members of its governing body before filing the form? 11a Describe in Schedule 0 the process, 11 any, used by the organization to review this Form 990, 12a Doee the organization have a written conflict of Intereat policy? if "No," go 10 line 13 b ,ore ottieere, directors or tru9tee9, and key employees required to disclose annually intereats that could give rise to conflicts? c Does the organization regularly and cnnelatently monitor and enforce compliance with the policy? If "Yes," describe in Schedule 0 how this is done 13 Does the organization have a written whlatteblower policy? 14 Doee the organization have a written document retention and destruction policy? 15 Did the process for determining compensation of the following persons inrdlude a review and approval by Independent persons, comparability data, and contemporaneous substantiation of the deliberation and declelon: a The organization's CEO, Executive Director, or top management official? b Other ofticere or key employees of the organization? If "Yea" to line 159 or 15b, describe the process in Schedule 0. (See instruction.) 16a Did the organization invent In, contribute assets to, or participate In a loirrt venture or similar .arrangement with a taxable entity during the year? b If "Yes;' has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in Joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organIzatlon's exempt Status with respect l0 ouch errangemente? N/A Yee No 2 3••. 4 5 6 X X X 7a 7b X x 8a 8b X 9a X N/A N/A Section C. Disclosure 17 List the elates with which a copy of this Form 990 is required to be filed CA 18 Section 0104 requires an organization to make its Forms 1023 (or 1024 If applicable), 090, and 990-T (501(c)(3)s only) available for public Inspection. indicate how you make those available. Check all that apply. Uown websito a Another's website ® Upon request 19 Describe in Schedule 0 whether (end if so, how), the organization makes its governing documents, conflict of intertest policy, and financial staterooms available to the public. 20 Slate the name, physical address, and telephone numbor of the person who poeoensos the balite and records of the organizatlon: te SEE ATTACHMENT #3 Yes No 10a X 11 12a 12b 12c 13 14 JVA 09 99056 TWF 33a09 Cop yrloht Fur Mb(9ottwgro Only)- 2009 I.W Form 900 (2009) FROM FOX NO. Sep. 14 2011 08:13AM P7 Farm 990 (2009) TRRT.JMA INTERVENTION PROGRA 2 0- 5 3 8 9 4 5 7 Page 7 :PAW Compensation of Officers, Directors, Truetees, Key Employees, HIyhe9t Compensated Employees, and Independent Contractors Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the orgenIzallon's tax yoar, Use Schedule J-2 If addltlonal npace.is needed. • List all of the organization's current officers, directors, trustees (whether individuals or organizations): regardless of amount of compensation. Enter -0- In columns (D), (E), and (F) if no compensation was paid. • List all of the organization's current key emptoyoos. See Instructions for definition of "key employee." • List the organzation's live current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compeneatlan (Box 5 ul Form W-2 and/or Box 7 01 Form 1009-MISC) of more than $100,000 from the organtzatlon arid any related orgentzations. • List all of the organlzatIon's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organizaton arid ary related organizations, • List all of the organization's former directors or trustees that received, ;n the capacity as a former director or trustee of the organization, more than 1310,000 of reportable compensation from tho organl2allon and any related organizations. List persons In the following order; Individual trustees or directors; Institutional trustees; office's; key employees; highest compensated employees; end former such persons. to an alrtant officer dlroctor ar trustee i I Check this box vine organ za11on (A) Name and Title did not comperes (B) Average y (C) Position (check all that apply) (0) Roportaole compensation from the organization (W-2/1099-MISC) (E) Reportable compensation from related organizatiuns (W-2/1000-MISC) (F) Estimated amount of other compensation from the Organization and related organizations hours per Week 1 T 0 N n LI U R I S E V T C I E T F 0 U R U A 0 L R 1 T NR ' U T 9 1 T T E 11 E r 1 u N A 0 F F 1 C E R K E EM V P L O V E E 11 C E IoM 0 M P H P L E 0 3 N v T S E A E T E o F 0 R M E n T()M TISDALE CHAIRMAN 4. 00 X 0 0 0 KIM COUSINS FINANCIAL OFFICER 4.00 X 0 0 0 LINDA MEJIA SECRETARY`i...00 X 0 0 SHELBY BARAN DIRECTOR x.00 X 0 0 0 GINA MAGEE CRT SIS TEAM MANAGER 30.00 X 30,000 0 n ,..— eon r rine JVA 09 99079 TWF 3AA3J Copyright Fume (Pohw>,rc O(.ly)- 200P TW FROM : FAX HO. : Form 990 (2009) TRAUMA INTERVENTION PROGRA [Now �" Section A. Officers Directors, Trustees, Key Employees, and (A) (B) (C) Average Position (chock all that apply) Nome and lltle hours per weak Sep. 14 2011 08:13AM P8 20-5389457 Highest Compensated Employees (continued) I T 0 N R • U R 8 E ✓ T C i E T D E U R A 0 L n I 1' N H 5 U T " I T F. U E 0 N A 0 F c K E Y E M L 0 Y E E H r E OMP H P L E E 0 • N Y T E A E 0 0 R M F1 (0) Roporlflble compensation from the organization (W-2/1099-MISC) lb Total 2 Total numbor of individuals (including but not limited to 'hose listed above) who rocaivod more thon $100,000 In reportable compensation from the organization ► (E) Reportable compensation from rotated organizations (W-2/1099-MISC) Page 8 (F) Estimated amount of other compensation from the organization and related organlzatione ► 30000 0 0 3 Did the organization Ilst any former officer, director or 1lusle°, key employee, or highest compensated employee on lino 1 a7 It ''Yes," complete Schedule J for such Individual 4 For Ony individual Ilalod on line le, Is tho sum of reportab e conpenaation and otter compensation iron the organization and related organizations greater than $150,0007 II "Yes," complete Schodulo J for such individual . 5 aid any person Ilstod on line 1e recoive or accrue coniperlsallon from any unrelated organization for servIcoo rendered to the organization? If "Yes," comploto Schedule J for such person ................. . xstifg, w,10, 4 X 5 X Section B. Independent Contractors 1 Complete this table for your live hlghost compenretod independent contractors that received more than $100,000 of compensation hum the organization. (A) Name and business address (B) Dencrlpton of servIcaa (C) Compnnsotion 2 Total number 01 Indoperldent contractors (Including but not limited to those lieled above) who roceived moro than $100,000 In compensation from the organization ► JVA 09 981178 T1WWF33400 Copyright Porn,. (Sof twareOnly) -2009TW FROM : FAX NO. : Sep. 14 2011 08:14AM P9 Form 990 2009) TRAUMA INTERVENTION PROGRA 20-5389457 ithifiVi* Statement of Revenue ?Q(:.• .' �� x ojsktt w r CG OTH N TSP R RG I R 1 IIA Pf T T A I n OAA NNM 5 DT s P 0 S 2a GE b p RR AVE MCE EN U E 1e Federated campaigns b Membership duos c Fundraising events d Related organizations e Government grants (contributions) , f All other contributions, gills, grants, & similar amounts not included above, g Nancash contribulfon:, included In IIneD la -if: h Total, Add lines is -1f , 0 T H E R E V E N u E JVA 0 d 0 la Page 9 5a, Total revenue 1b 10 ld 1e 25343 1f 4418 f All other program service revenue g Tota,. Add lines 2a -2t 3 Investment income (Inoluding dividends, Interest, and other simile!' amounts) 4 Income from inveelment of tax-exempt tend proceeds 5 Royaitlee Business Code Related or exempt function revenue Unrelated business revenue Re0) venue excluded flVM tex undo'. ael.'tiuna 512.W, or 614 • .. Jtb?c<.: i y :•�ytt •.'.?F t `� Yx Ti •: 't 'hSl�'�X°4•i':•'.•�9,a ea Groes Rents b Loss: rental expenses c Rental income or (loss) d Nat rental Income or (loss) 7a Gross amount from sales of assets other than inventory b Les.,: cost or other basis and sales expenses , , , o Gain or (lose) d Not gain or (loan) ea Gross Income frorrl fundraising events (not including $ 19856 of contributions reported on line lc). Soo Pan IV, line 1a a b loss: direct expenaes b c Net Income or (lord) from fundraising events 93 Grose Income from gaming activities. See Part IV, line 19 a .b Leos: direct expenses b c Net income or (loss) from gaming ac 1vltles 100 Gross sales of inventory, less returns and allowances b Less: cost of goods sold b c Net Income or (loss) Irom sales of inventory (1) Real 130 130 Mlscallanoous Revenue 11a MISCELLANEOUS/REIMBURS b _ 0 d Ali other revenue e Total. Add lines 11a -11d 12 Total revenue. See Instructions 09 9909 TWF 53401 Copyright farms (Software Only)- 200e TW FROM : Form 990 2009 ITTANN FAX NO. : Sep. 14 2011 08:15AM P10 TRAUMA INTERVENTION PROGRA 20-5389457 Statement of Functional Expenses Section 501(0X3) and 501(oU4) organization must complete all columns. Page 10 A11 other organizations must complete column A) but aro not required to oomplete columns (B), (C), and (0). (( )) Fundrratslnq expenses Do not Include amounts reported on lines 6b. 7b, eb,11b, and 10b of Part VIII. Total expense) Program service expenses Management and .eneral ex.enses 1 2 3 4 5 6 7 0 9 10 11 a b c d e• f g 12 13 14 16 18 17 18 19 20 21 22 23 24 a b c d e f Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 Grants and other aseielance to tndivlduels In the U.S. See Part IV, lino 22 Grant) and other assistance to govornmoMs, organlzatlone, and Individuals outside the U.S. See Part IV, lines 15 and 16�; Benefits paid to or for members Compensation of current officers, directors, trustees, and key employee) Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and parsons described in section 4958(c)(3)(B) Other ealariee and wages Pension plan contribution) (include section 401(k) and section 403(b) employer contribution) Other employee benefits Payroll taxes Fans for eervicea (non -employees): Management Legal Accounting Lobbying Professional fundraising services. See Part IV, lime 17 Investment management fees Other Advertising and promotion Office expenses Information technology Royalties Occupancy Travel Payments oI travel or entertainment expenses for any federal, state, or local public officials Conferences, conventions, and meetings Interest Payments to affiliates Depreciation, depletion, and amortization Insurance Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.) TELEPHONE EXPENSE , '`: • • z sY �A .. '"1'"l`,' 4i,'' c� °' 500 510-•• . x + ` : ,• A ''� N:',,t �„m . ;yo...� �� •.'"' ' Y . �: ; ,:'r.'.•r�. :x�. - ��' • '' . ' s �ifa'66 w ttw�t �S 30000 30000 2596 2596 1382 1382 _`' ''' . ' . !° 2175 2175 ...r 6027 01)27 1948 1948 :. e ti: �;•... , .. • r. • A I'd e`. ' - ek ,y h ai��,f�°e�; w .,.aA., a; ' t;,, � ) •. x .b , :.:..:N 2794 , y . ilii •.t. axe , - ..44":., ,. = .•a<�Z•,• �oy. 1< <e4 -4.i � r: •.. •.Yoh>e kse � w • ' ' .q. ;,'..t•A• ,e,y;+xow Tek +5`vc: a. ,... 2794 SUPPLIES 1661 1661 PRINTING 1594 1594 RADIO & PAGING 1348 1348 DUES & SUBSCRIPTIONS 1:120 1320 All other expenses 444.. Total functional expenaes. Add lines i through 24f 2313 2313 . - 55658 55658 25 26 Joint oosts. Check hero ► flu following SOP 90-2. Complete this line only if the organization reported In column (B) pint coats Irom a combined educational camoaigrr and fundraising solicitation JVA 09 99010 TWP 554412 Copyright Farms (Software ONO- ZOU9 TW arm FROM : FAX NO. : Sep. 14 2011 08:16AM P11 Form 900 (2009) TRAUMA INTERVENTION PROGRA 2 0- 5 3 8 94 5 7 Page 11 . A S S E T t3 (A) Beginning of year (B) End of year .� 1 Cash -- non-Intereet bearing 2 Savings and temporary caeh inveelments 3 Pledgee and grants receivable, net 4 Accounts receivable, net 5 Receivables from current and former officers, directors, employees, and highest compensated employees Schedule L B Receivables from other dlsquafilied persona (as defined 4960(0(1)) and persona described In section 4958(c)(3)(B). Part II 01 Schedule L 7 Notes and loane receivable, net a Inventories for Bale or uee 9 Prepaid expenses and deterred charges 10a Land, buildings, and equipment: COAL or other basis. Complete Pett VI 01 Schedule D b Less: accumulated depreciation 11 Investments -- publicly traded eecurltlea 12 Investments -- other securities. See Part IV, line 11 13 Investments -- program -related. See Part IV, line 14 Intangible assets 16 Other assets. See Part IV, line 11 18 Total easels. Add lines 1 through 15 (must equal line IrueleeR, Complete /0a Key Part II of .. • •-• -... under section Complete 8 7 , 177 1 6 3 , 732 2 3 4 R..m..x;,... x• <._ t , ; :.,; ''' •s . •; .•: x.. ,-... - • -. .... any rk2+x. :'" .0 •4"t - h .. " ` .. i.. ;;. fl fa,.% R@, • ; S, x: • a �" " x 7 8 s ;- `"Y r q >' , . ar-z:•• ��"" $; . w;' 10c <, p. ,.... .. ?- �Y"y x�- '6.i • "r lob 11 34) 11 12 13 14 16 87 , 177 18 63 , 732 L I A 8 L T E1 S 17 Accounts payable and accrued expenses 18 Grants payable 19 Deterred revenue 20 Tax-exempt bond Ilabilllles 21 Escrow or custodial account liability. Complete Part IV of Schedule D 22 Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and dl»quatifled persons. Complete Part 11 of Schedule L 23 Secured mortgagee arid notes payable to unrelated third pertlea 24 Unsecured notes and loans payable to unrelated third parties 26 Other liabilities. Complete Part X of Schedule 0 26 Total Ilabllitl08. Add linea 17 through 2b 393 17 364 19 19 20 21 „� �, .... .tN- ,:, f„ jy .•....,::,,-:.��,.�',.�� , .. �` t`S. ;•., 22 yy ,: ;�:.. jv.3. i per, ;� '���;;;•?"..; :�'�`•.�` 23 24 Z5 _. 393 26 364 (V F T N A D S 9 S E T N S c 0 E !i S Organizations that follow SFAS 117. chock here ► U and complete lines 27 through 29, and lines 33 and 34. 27 Unrestricted net assets 29 Temporarily restricted net aeeets 29 Permanently restricted net aeeete Organizations that do not follow SFAS 117, check here ► and oomptete linea 30 through 34. 30 Capital stock or trust principal, or current fund:. 31 Paid -in or capital surplus, or land, building, or equipment fund 32 Retained oarninge, endowment, accumulated income. or other funds 33 Total net assets or fund balancer 34 Total IlabIlltles and not assets/fund balances ..x.... *� s• • �.es:... 86,784 = 27 }`°" ,„„.',54t.,..:.:::. •`/t: c' ... . 63,368 R ,. 28 29 F: • ' .� �`�,�,�} fth&W.: v`:.. "% ° ' m 30 _•y, „ •,..,, •,.., :w w o •� t' :: ' �«« s -X 3 g «. ' y H".: • '; 31 32 86 , 784 33 63 , 368 B7,177 34 63,732 JVA 09 99011 TWF 33403 cop yrl00tForms (•3oftwaroOnly) -2000TW Forrn FROM Form 890 (2009) iNftqf Financial Statements and Reporting FAX NO. Sep. 14 2011 08:16AM P12 Page 12 1 Accounting method used to prepare the Form 990: Cash 0 Accrual U Other If the organization changed its mothod of accounting from a prior year or chocked "Other," explain in Schedule 0. 2a Wore the organlzallon's financial statements Compiled or reviewed by an independent accountant? b Were the organization's financial statements audited by an Independent accountant'? c If "Yes" to lines 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, rovlew, or compilation of its financial statements and selection of an indopondent accountant? N/A Me organization changed olther its oversight process or selection process during the tax year, explain In Schedule 0. d 11 "Yes" to line 2a or 2b, check a box below to indicate whether the financial otatemonts for the year were issued on e consolidated bade, separate basis, or both: Separate basis U Consolidated basis L I Both consolidated and separate baths 3a As a resell of a federal award, was the organization required to undergo an audit or audtta as set forth in the Single Audit Act and OMB Circular A-133? b 11 "Yes," did the organization undergo the required audit or audits? If the organization did rot undergo the required audit or audits, oxplaln why in Schedule 0 and describe any steps taken to undergo such audits N/A 3b Jvn 09 99012 99011 TWF 33421 CopyrIght Form= (9cftwve Only)- 2008 TW Form 990 (2000) No 2a X X X Pc.a 2944744 State of California Secretary of State 1, DEBRA BOWEN, Secretary of State of the State of California, hereby certify: That the attached transcript of / page(s) has been compared with the record on file in this office, of which it purports to be a copy, and that it is full, true and correct. Sec/State Form CE -107 (REV 1/2007) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of JAN 2 7 2007 DEBRA BOWEN Secretary of State :�? OSPO6 99734 2944744 ARTICLES OF INCORPORATION ENDORSED - FILED In the office of the Secretary of State of the State of California DEC2006 The name of this corporation is Trauma Intervention Programs of S. W. Riverside County, Inc. I I A. This corporation is a nonprofit PUBLIC BENEFIT CORPORATION and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for charitable purposes. B. The specific purposes of this corporation is to ensure that victims of traumatic events receive the emotional and practical support they need immediately following a traumatic occurrence by training citizen volunteers to provide on scene crisis support III The name and address in the State of California of this corporation's initial agent for service of process is Name: Rosann Orewyler Address: P 0 Box 585 City: Murrieta State CALIFORNIA Zip: 92564-0585 IV A. This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for office. V The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of the organization shall ever inure to the benefit of any director, officer, or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment of, or provision for payment of, all debts and liabilities of this corporation, shall be distributed to a nonprofit fund, foundation, or corporation which is organized and operated exclusively for charitable purposes and which has established its tax-exempt status under Section 501(c)(3) of the Internal Revenue Code. Rosann Orewyler, Incorporator Exhibit "A" Territory (Description of Affiliate's Geographic Boundaries) (Section 1.3) // � 1. t Os S (9a. iff ( u.ct Ebi t h,2 140 rtt : &-cr x �,,,� O 6 )r cc a 2 bSS Qat U� � P i s tr: L et.ke Pani �c�Sf `�t D'ric L.c Ll� r' LC - i vt, ilie 17(121//ac.cd Remo 1444 , se-ciAztr £a-4 da&t , L J &4t,;(_cit, cuLdt, Vet Lake_ gcu‘L 404 Ow, E La -A alac6:4'11.Q. A-1 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 33 CITY OF TEMECIJLA FISCAL YEAR 20 1 1-1 2 COMMUNITY SERVICE FUNDING PROGRA APPaf Th (Please Print or Type) City of Temecula SEP 15 2011 2011-12 Program Submission Deadline: Thursday, September 15, 2011(original, plus one) PROJECT INFORMATION Amount Requested: $ 5,00(Maximum allowable $5,000) Project Name: Medical Outreach Services Program Project Start Date: May 2011 Project End Date: Services provided ongoing ORGANIZATION INFORMATION Name of Organization: Urban Community Action Projects Contact Name: Eddie Estrada Title/Position: Executive Director Mailing Address: 3727 McCray Street Riverside, CA 92501 Telephone: (951) 534-9963 E -Mail Address: eestrada4polministries.net Year Organization Founded: 2010 Geographic Area(s) Served: Riverside County Number of Paid Staff: 9 Number of Volunteers: 40 Is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 5/15/2010 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 5/15/2010 Federal identification number: 04-3656147 State identification number: 2395923 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee — Board of Directors X Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Urban Community Action Projects (UCAP) is a 501 (c) (3) organization that provides medical outreach services to homeless individuals and medically indigent adults, children and families. Dedicated to its mission "to improve the health status and well-being of Riverside County's homeless by providing quality, affordable, patient centered health care", UCAP serves clients at fixed site locations and via the mobile medical van throughout Riverside County. With an annual operating budget of $821,160.00, UCAP works in partnership with homeless service providers to establish a medical "home" that provides comprehensive health care including primary care, medications, case management, health education and referrals to speciality care, substance abuse and mental health services. UCAP believes in a holistic approach that looks at all aspects of health with an emphasis on prevention, community outreach and education, empowerment, self-management and reducing barriers to care. A 2006 San Diego study (Dunford, James. et. al. "Impact of the San Diego Serial Inebriate Program on Use of Emergency Medical resources) found that over a 3 year period, 529 homeless individuals in the City of San Diego amassed $17.7 million in medical costs including ambulance transportation, emergency room visits and hospital admissions. With the 2011 County of Riverside Homeless. Survey showing a 134% increase in the number of homeless in the City of Temecula, UCAP believes that providing health education, preventative care and chronic disease management can help reduce the cost burden to local hospitals and emergency rooms frequented by the uninsured/under insured that do not have a medical "home". During the period 1/2011 through 7/2011 UCAP has provided 945 medical visits, filled over 2,000 prescriptions , re£errod 450 individuals and secured over $329,000 in in-kind services. UCAP remains ono of only ;, few f,,e clinics in Riverside County dedicated to caring for the indigent and homeless. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) The state of the economy, poverty, lack of affordable housing, domestic violence, mental illness and substance abuse coupled with decreasing resources due to Federal, State and local funding cuts has precipitated an alarming increase in the number of homeless in Riverside County. Many homeless individuals have one or more serious disabling health conditions and may delay seeking medical care because their food and shelter needs take precedence over their health needs. To address this issue, Urban Community Action Projects (UCAP) partnered with Project Touch in May 2011 to provide medical services once a week to homeless individuals in the City of Temecula. Services include but are not limited to basic routine physicals, treatment of chronic illness, chronic disease management, cancer screenings, laboratory services, prescription assistance, health education and referrals to speciality care. The goals of this program are accomplished through the following three objectives; (1) Providing comprehensive health services to 300 unduplicated individuals over a 12 month period; (2) Providing supportive services, case management and referrals to individuals accessing services; (3) Reducing unwarranted emergency room visits for services more appropriately handled in an outpatient setting. On site supervision is provided during all operating hours by one or more of UCAP's healthcare team. In addition, volunteer physicians and nurses accompanied by general service volunteers are present at each session. All volunteer, licensed professionals credentials (medical license, DEA license, professional malpractice liability insurance, volunteer applications and background checks) are stored off site at UCAP's business offices and are available for review if requested. Funding requested for the City of Temecula's Community Service Funding Program will pay for basic medical supplies (sterile dressings, Band-Aids, ACE wraps, Isopropyl Alcohol, gloves, etc.) and prescription medications for those clients who do not qualify to receive prescription assistance through any other program. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. ,, ` PREPARED BY: Edd i .tr- tf dA / E Xe -C &(.+A/C. V i r•e.c- f NAME and TITLE (Please Print or Type) SIGNATURE: PRESIDENT or 1 AUTHORIZED OFFICER: L- fits(r G-sf�'u-�/'-!��/ X e- 12-+ U� S/r l���-T D ✓ NAME and TITLE (Please PCInt or Type) SIGNATURE: i':;64;c ,:=;;-7;.;;?, ORGANIZATION NAME: Urban Community Action Projects MAILING ADDRESS: 3727 McCray Street Riverside, CA 92501 TELEPHONE: (951) 534-9963 E -Mail Address: eestradaftpolministries .net DATED THIS / of g f )1 JY) ('/" , 2011. (Date) (Month) Submit Application by September 15, 2011; Mall Applications: Deliver in Person: E -Mail Address: Facsimile: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 Judy. mcnabb(a?citvoftemecuia.orq 951-694-6479 Application - Page 5 O J U W RI I- 0 o O O (1. 0 0 O O J) 0 O 100 (`. c l 0 O N l) 0 O O On co 0 O O co 0 O (n OO 1./) 60 V cmc) oi (0 137 CO (/) 0 0 O -3 (!3 0 0 Cr co 0 0 N N N 0 0 10 V) 0 0 L0 N 0 0 CO N O 1.0 M N OO - r N_ v) 0 0 N (9 0 0 N .- 4/) 0 (A N V) 0 O (0 . - V) 0 C) (0 (f) 0 (O N (0 O O 0 r- V) O 0) O V) U) 1.0 C9 0) C9 69 ,i' 0) CO ,- 0) N M O (n> Other Sources 0 O 0' 69 0 O O E9 S 12,00C 1 O CD O Op (i) O O O 0)(0 9(!) (!) O C) (0 4.') O 09 (0 (1) $ 400 $ 500 500 $ 300 O (l) CO E9 O ,r N 09 O O V N 4/) pH' i. s 1 O (0 N (f) O O (!) a- CO I $ 500 C7 a) N- (A C) 0 O - U) O 0) 60 O V) O N (0 (0 th $ 6,652 N N. M (D tel C Y ' (Y) 0 0 O O 0Cn 43i $ 17,500 1 U> $ 12,000 1 CD O ([-) (/) (f> Imo- CC (J) (0 N 60 (f) $ S 1..200 $ $ $ 69 69 (F) (A 69 (9 09 Et> (f> O O N .(- 69 $ 47,415 S 4,742 Is - in N 49 City of Temecula Request 03 69 (1> (9 4/) (1) 09 (0 (A ( D 0 V1 O O (/) (3 (%) V) d> (/) V) V) (f) (3) 69 V) ((,) 5,000 CD O O (1) `0 Budget O O O (Zj 69 $ 20,000 $ 17,500 $ 12,000 S 8,000 O 0 O N (/) O 0 LO CO (/) $ 13,345 1 in V' COO • u) O O (`J (/3 $ 2,400 $ 3.200 $ 500 500 $ 300 O In ('3 FA 1,240 $ 2400 1 $ 1,200 0 L0 N 69 0 O (I) r (f) 0 O (!) (/) 0 (f) i- (n 0 O O ` () S 22,090 1.0 M O) aM— T 69 ch O) r) .— (0 S 125,3291, (0 Cr)WI $ 180,000 O C7 0 o N (fl O C7 O o r- 4/) $ 24.000 $ 32,0001 $ 24.000 $ 410.000 O O I--- 0) (0 cs) O O ts 0) I'- (i) W L L) 0 O 0.25 1 (n (V 0 O (C) 0 (n (V 0 0 (f) 0 o Co W Z c UJ UJ EL CID Np�� 0 � V 0 a c v) ? w Q G u) Q 0 0 1Volunteer Coordinaior;Medical Case ManaGer 1 ( u) ; g _ • ; ';--,.7.: i u -a TOTALI IFrinoe Benefits (.17% per FTE) Personnel Total l '0 ore' a O Medications Lab Work & Supplies Medical Supplies Office Supplies Radiology Waste Removal • Computer Software & Network Maintenance Medical Equipment Computer Equipment - U N !Wireless Connection u (3 m 11 co _2 1Client Travel and Outreach 1Conference & Staff Travel Technical Assistance (program evaluation) Total Operations Total Operating Budget Indirect Cost TOTAL PROJECT COST UCAP Organization Budget 2011 REVENUE Individual Donor $ 15,000 !n -Kind $ 371,160 Private Foundations $ 435,000 Total Income $ 821,160 EXPENSES PERSONNEL Salaries (9 FTEs) $ 558,000 Fringe Benefits (.22% per FTE) $ 122,760 Personnel Total $ 680,760 OPERATIONS Medications $ 32,000 Lab Work & Supplies $ 4,800 Medical Supplies $ 4,800 Office Supplies $ 4,800 Client Outreach $ 2,400 Waste Removal $ 3,600 RV Parking $ 2,400 Computer Software & Network Maintenance $ 10,000 Membership Dues and Clinic Licenses $ 1,500 Medical Equipment $ 2,400 Computer Equipment $ 2.400 Misc $ 500 Wireless Connection $ 3,600 Outsource Accounting Services $ 4,800 Rent $ 18,000 Utilities $ 6,000 Mal -Practice $ 18.000 Conference & Staff Travel $ 6,400 Technical Assistance $ 12,000 Operations Tota! $ 140,400 Total Operating Budget $ 821,160 INTERNAL REVENGE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DntA: 'SEP 0 2 all ORtAN COMMUNITY ACTION PROJECTS 3727 MCCRAY ST RIVERSIDE, CA 92501 Dear Applicant: DEPARTMENT Or THE TREASURY Employer Identification. Nuumber: 04-3656147 DLN: 1705320037800/ Contact Person: DIANE M EC/CARP Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: May 15, 2010 Contribution Deductibility: Yes Addendum Applies: Yes It## 31394 we are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 5o1(c)(3) of the Internal Revenue Code. Contributions to you aro deductible under section 170 of the Code. YOu are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(0)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(e) listed in the heading of thin letter. Please see enclosed publication 4221 -PC, Compliance Guide for 501(0)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/Co) -2- [3RBA? CO.TY ACTION PROCBCTS we have sent a copy of thio letter to your representative as indicated in your power of attorney. Enclosure: Publication 4221 -PC Sincerely, Lois G. Lerner Director, Exempt organizations Letter 947 (Do/CG) • _3- URPAN COMMUNITY ACTION PROJECTS we considered and approved your request for retroactive reinstatement under Notice 2011-43. Letter 947 (DO/CG) TOTAL P.004 Judy McNabb From: Eddie Estrada <eestrada©polministries.net> Sent: Thursday, September 15, 2011 11:30 AM To: Judy McNabb Cc: Eddie Estrada Subject: Community Service Funding Program FY 2011-2012: Urban Community Action Projects (UCAP) Attachments: UCAP_Temecula_CSFPP_Grant_Final.Pdf Mrs. Judy McNabb, The Urban Community Action Projects (UCAP) respectfully requests a total of $5,000 for a one year period to improve access to primary care for our county's vulnerable population: the homeless, uninsured, and low-income residents of Temecula. A grant in this amount will ensure UCAP delivers free, non -judgmental health care and social services to the homeless. The critically needed funds will be used for medications and medical supplies. Thank you for your time and consideration of this request. Please call me should you wish to discuss this proposal at (951) 786-9048. Sincerely, Eddie Estrada Executive Director 1 City of Temecula 2011-12 CS Funding Program APPLICATION NO. 34 Ctty of Temecula 11 CITY OF TEMECUI.A FISCAL YEAR 201 1-12 SEP 15 2011 COMMUNITY SERVICE FUNDING PROGRAM API21ON (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested:j$ Jr! 00 0 D p (Maximum allowable $5,000) Project Name: Ve 71-&(.0145 o f 7 & re-t)(1/V. GJR-/2S Project Start Date: j"9/4 020 /Z. Project End Date: oZ O/A., ORGANIZATION INFORMATION Name of Organization: V fW -Pod 0:) Contact Name: /pni 2)(. l? e./ Title/Position: Ct3/7/ /) Mailing Address: 2 PO %5 -2),' 97_ c ,, 7rhece 4 ` C,44 Telephone: 4/9 re - b.L/5) E -Mail Address: L "O1l> we. aCe. Year Organization Founded: / 9 Geographic Area(s) Served: �m ale ci Number of Paid Staff: 0 Number of Volunteers: 9� ilrrA i1 1Q/cam l Is this organization incorporated in California as a non-profit organization? O� y� n Yes L- No Effective Date: 7 -02 s"^ "e If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: Federal identification number: 13 - 0 o State identification number: SW g 02I 799 et, If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors Members -at -Large Application — Page 1 Mission Statement To actively assist veterans and families, families of POW/MIA's, troops and their families who reside in Temecula Valley; with monthly food boxes, newborn baby supplies, job placement, eligible medical and disability compensation, support of school programs, scholarships, troop supplies and troop events, holiday baskets of turkeys and food items, gently used clothing and linens, to show support and gratitude for their sacrifices for the United States and its communities. Our goals are to continue the above named proiects. For example, the monthly food boxes; we have been conducting this program for 4 years and both the Ladies Auxiliary and the VFW donate monies to this project and carry it out each month. A total of 1,743 meals were donated this year as of January 2011. We also will be participating in throwing a baby shower in partnership with Operation Showers of Appreciation, wherein 20 families will be present to accept gift baskets to help with their newborn's arrival. As always, we award annual scholarships to Voice of Democracy and Patriot's Pen winners. This program is conducted through the schools of Temecula. We heavily support the troops of Temecula and participate in the program Adopt A Unit, in addition to awarding a $200.00 grant plus monies from National VFW to a troop member to put his car in working order. Holidays are always difficult and we try our best to give as many food baskets as we can to those in need. Our goals do not change from year to year, except to expand our programs and increase the amount of monies or donations we are able to give others. (c) VFW Post 4089 has over 400 total members, with 40 hard-working volunteers dedicated to carrying out the above-named projects within the community. (d) We have had several articles in the papers over the last 3 years reflecting on the accomplishments of the Post 4089 comrades and Ladies Aux. We are well liked by the public and often invited to participate with other organizations in their projects. (e) Both the VFW Post 4089 and the Ladies Aux., each have a Quartermaster and Treasurer, respectively, which handle all finances, produce monthly reports and are audited every quarter by trustees. As a non-profit we must meet national accounting standards and guidelines. (f) We have been chartered in Temecula Valley since 1981 and we hope to remain for many more years an active group in Temecula Valley. (g) All of our recipients have been most gracious for the work we carry out each and every month. We do try to keep names, addresses and phone numbers confidential, so as to protect their privacy. (h) Absolutely, it is in our by-laws that we cannot discriminate based on race, color, creed, nationality, sex, marital status, disability, religion or political affiliation. (i) We do encourage members to attend our monthly meetings, but we do not require attendance or participation in any political, religious or social activity. (j) Yes, we can provide monthly financial statements and are so required to do so at each monthly meeting. (k) While we do not do a formal budget, as a group we are always looking for the best possible place(s) to purchase our donations to give to others. If one avenue does not work out or is too costly, we immediately switch to another vendor or supplier. All monies have to be approved each month to spend on each and every project, so we are very watchful of every penny. (1) Our organization has a main focus of veterans, troops and families residing within Temecula Valley, but we assist our communities and all their citizens if asked, because they assist us. (m) Each program is evaluated yearly, one to see if we have funds to carry out the project again the following year, was the program beneficial, did we receive the gratitude due our organization and do we have the volunteers to carry it out again. Project Description: to carry out our monthly food box project, which feeds approximately 16 families a month, cost of $28.00 each, total monthly expenditure equals $448.00. Annual cost for 12 months equals $5,376.00. A team of 5 volunteers carries out this project, phone calls to families, purchasing of goods, delivery of goods and administrative paperwork. In addition, if we have extra monies available,we purchase additional food baskets for the holidays. Past Project Benefits: Yes, we received a check for $5,000.00 this year in late Feb or March, and immediately applied the funds to the Food Box program. A simple spreadsheet is attached showing quantities of food boxes/meals delivered. More detailed spreadsheets are kept in our records as they contain confidential information, but may be reviewed by a city official if required. Since this program has been in effect for 4 years, our veterans, troops and families have come to depend on our assistance each month and we provide it, whether we have obtained public funding or not. We take this project seriously, as we care about our veterans, troops and families within Temecula Valley. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: SIGNATURE: L_e PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: 7671e,-(5---0/ci NAME and TITLE (Please Print or Type) vow /✓ /Y110/9-.Ade.2- NAME and TITLE (PleaslPrint or Type) ORGANIZATION NAME: !/ t /i/ Y O6Py MAILING ADDRESS: 6C) 7$ 1'19-2- 4?Z VA-444-7(,etry e TELEPHONE: (0! 7'V-' OA -35 E -Mail Address: /DoJoo_. Chi ( Cel/ 9S7 -- 7/9- 4.2JJ C h / DATED THIS /. ' 1'1of , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: Deliver in Person: E -Mail Address: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 judy.mcnabb(a�cityoftemecula.org Facsimile: 951-694-6479 Application - Page 5 neth TRUSTEES' REPORT OF AUDIT OF The Books and Records of the Quartermaster and Adjutant of Department of Califomia • 23 / Riverside / 4089 (District / County / Post No.) for the Fiscal Quarter ending JUNE 30, 2011 Oct 1toDec 31 FUNDS Net Cash Balances at Beginning of 10. Quarter Receipts During Quarter 11 Expenditures During Quarter 12. Net Cash Balances at End of Quarter 6 1. National and Department Dues (Per Capita Tax) $ 63.80 $ 83.00 122.00 ; 24.80 2. Admission or Application Fees (Department) $ 69.80 $ 0.00 0.00 $ 69.80 3. Post General Fund $ 237.21 $ 2,585.34 2,311.04 $ 511.51 4. Post Relief Fund (Poppy Profits, Donations, etc.) $ 1,269.98 $ 0.00 0.00 $ 1,269.98 5. Post Dues Reserve Fund (See Sec. 218, Manual of Procedure) $ 514.64 $ 834.00 56.50 $ 1,292.14 6. National Home 8 90.00 $ 79.00 0.00 $ 169.00 7. Post Canteen or Club Fund $ 5,088.08 $ 9,027.11 10,071.36 $ 4,043.83 8. Post Home or Bu$ding Fund (Including Savings but Not Real Estate i 0.00 $ 4,272.00 542.10 $ 3,729.90 9. Accruals $ 0.00 $ $ 0.00 $ $ $ $ $ $ 9. Bonds and Investments Not Credited to Funds $ $ $ 14. TOTALS: $ $ 16,880.45 13,103.00 $ 11,110.96 7,333.51 18. OPERATIONS Have required payroll deductions be . Have payments been made to the proper State and Federal agencies U . Have sales taxes been collected an . Are club employees bonded Amount of outstanding bills Value of Real Estate Amount of liability insurance N/A X $ N/A $ N/A $ 1,000,000.00 Owed on mortgages and loans $ N/A Value of personal property $ _ Amount of property insurance $ N/A 17. RECONCILIATION OF FUND BALANCES Checking Account Balance Less Outstanding Checks Actual Balance Savings Account Balance Cash on Hand Total Bonds and Investments (cost value) Total 11,110.961 11,110.96 11,110.96 11,110.96 20,000.00 18. TRUSTEES' AND COMMANDER'S CERTIFICATE OF AUDIT Date 7/092011 2011 This is to certify that we (or qualified accountants) have audited the books and records of the Adjutant and Quartermaster of 23 / Riverside / 4089 for the Fiscal Quarter ending 30 JUN 11 in accordance of the National By -Laws and that this Report is a true and correct statement thereof to the best of our knowledge and belief. All vouchers and checks have been examined and found to be properly approved and checks properly countersigned: Post Quartermaster DENNIS PETERSON 28075 Diaz Road Temecula . CA 92590 (Address) This is to certify that the Office of the Quartermaster is bonded with the amount of $ 19,000 until August , 2011 and belief. Signed: Trustee Signed: Trustee Signed: Trustee Traveler's Casualty & Surety Co. of America in , and that this audit is correctly made out to the best of my knowledge Signed: Commander (Total 1 rD n OZ 0 r,7 Sep Aug Jul May Apr Mar Feb d 7 UJ (0 -P Ol VI -4, -P -P T 0) B F-` O N O O O I" N I--, 000 I --s N I 140 I 112 I- N I- N I-, N I -s N Meals per lD UJ l0 10 LO l0 I- 0 I- I --s I- F-, I- NJ I - N N (D Z.O al Ul I--, O O O 63 -I O Ol W Q1 W �I O 77 77 84 84 Meals per F -s �l WO O O O 1--, Ui N 00 1 , VI N W N N I� � l0 I-, 00 0 I--, Ol I� w Ol Total ?a/ , e( r6t- ) City of Temecula 2011-12 CS Funding Program APPLICATION NO. 35 CITY OF TEMECULA City of Temccul., SEP 15 2011 FISCAL YEAR 201 1-12 Finance Dept. COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5000.00 Project Name: Circle of Care Food Ministry Project Start Date: September 1999 Project End Date: On-going (Maximum allowable $5,000) ORGANIZATION INFORMATION Name of Organization: VNW-Circle of Care, Inc. Contact Name: Tem Keim Title/Position: Director Mailing Address: P.O. Box 218, Temecula, CA 92590 Telephone: 951 973-3582 E -Mail Address: wecare@vnwcircleofcare.org Year Organization Founded: 1999 Geographic Area(s) Served: City of Temecula Number of Paid Staff: One Number of Volunteers: 100 is this organization incorporated in California as a non-profit organization? Yes X No Effective Date: 10/30/2003 if "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit: 10/30/2003 Federal identification number: 73-1691246 If "no": State identification number: 2527781 Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application — Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Vnw-Circle of Care's goals and objective are to tangibly help those in need. Established in 1999, a 501c3 non-profit, Temecula based organization, have been tangibly helping our Temecula neighbors every week for 12 years with groceries, used & new furniture, baby items, used clothing, every day necessities as well as gifts for children at the Holidays. We serve all that call on us for assistance to the best of our ability with the resources we have. Circle of Care is listed on 211, families are referred to us by the Social Services, WIC, Riverside County case workers, hospitals, churches, school teachers, other non -profits, and word of mouth. We serve all without discrimination to race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. There are no demands made on the recipients to participate in any political, religious or social activity. Currently we have four Food Distribution locations in the City of Temecula, serving about 200 families each week, which equals 860 people, in which 500 are children. We also have an additional five Food Distribution Sites in the surrounding Cities; total number of families served each week is 350. In the four Food Distribution Sites in Temecula we have approximately 40 volunteers working each week to serve their neighbors. Many of these volunteers have been with our organization for many years. May of this year, we conducted a survey of our recipients. We had about 55% participation, the survey was done anonymously. Over 95% of the results stated that the benefits for our recipients were very helpful in their ability to have nutritious meals on a regular basis and the money not used for groceries went to paying their rent and or utilities. We have a good working relationship with different sectors of our Community and partner with other non -profits to better serve the "whole" of the family's needs. We make it a point to interact with our recipients and ask how effective our organization is to their family, we take those remarks to heart to both fuel our passion and to expand our capacity. Circle of Care uses Quick Books for all our accounting, we have an accountant, Cheryl Silva, that does all the entries each month, she also gets the books ready for the 990 tax forms each year and does our end of year donation statements. We have CPA, Derek Thomas, which prepares our 990 tax forms. We can provide financial statements and budgets to demonstrate sound financial management. Application — Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a =Aim= of one double-spaced typewritten page of information. (Please type or print legibly.) If awarded this grant we would use the funds to help keep our capacity for service. The funds would be used for the purchase of new equipment that would give us more versatility and allow us to be more efficient and effective. We currently have a 45' refrigerated trailer for bulk perishable storage. This piece of equipment is older, but still works, it needs to be serviced on a regular basis and a new fan motor for better temperature control. The amount of funds we would put aside for this equipment would be $2200.00. Then we need to replace a standard freezer for inside our 2000 square foot warehouse. Our largest and oldest freezer just recently stopped working. We need to replace this piece of equipment as we use several smaller refrigerators & freezers inside the warehouse for smaller quantities of product, this is cost effective and it is easier to manage product. The cost on replacing the nonfunctioning freezer will be about $600.00. We are located in an older industrial building that is not wired for internes, wiring this building would be very expensive, so we've used air cards in the past for our internet. We are now in need of a Mobile Hot Spot device and a new desk top computer. The cost on these two pieces would be about $1000.00 and then $50.00 per month for the Mobile Hot Spot. The balance of $600.00, would be used to offset grocery transportation expenses, i.e., fuel. This new equipment and additional funds for the refrigeration would keep us operating at the our current pace and the Mobil Hot Spot & new computer would increase our capacity to increase our volunteer office staff, which in turn will gives us the ability to pursue more product and be more efficient on a daily basis. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. VNW-Circle of Care has been a recipient of this grant every year since 2002, with the exception of 2010 as I was incapacitated due to illness and missed filing our application. The benefits to the City of Temecula through Circle of Care have been positive. We were the Food & Warehouse Facility for the Wild Fires of 2007. All four of the evacuation sites were feed each meal and snack for every evacuated family for the entire time of the evacuation through the efforts of Circle of Care as we networked with City of Temecula, the Red Cross, grocery stores, restaurants, business, churches and individuals to take care of the emergency and we stand ready to help again. On average we distribute about 700,000Ibs of groceries into our local communities. We are helping grocery stores, restaurants and packing houses to be sustainable and "green" in their operations. We are networking with new business consistently to obtain greater quantities of resources. The biggest resource we have to bring to families in need is hope, we dispense hope every day. When a mom does not have food for her children and she shows up at one of our Food Distribution Sites, she picks the groceries out that she will bring home to her family. She is filled with hope and she knows she live in a community that cares and looks that out for the well being of its citizens. We have been very gratefully for the years past funding and it is a vital part of our organization. We appreciate that the City of Temecula recognizes our efforts. We are privileged to assist our neighbors and our passion has not waived in all these years. The needs have gotten larger and the demands are greater. In 2009 we used the funds for daily operations. Since 2001, and every year since, our financial donations have decreased. In the past ten years there have been many disasters of one kind or another. The people of our community are very generous and when those disasters happened, many of our regular supporters felt the need to give to the those situations. Hunger in a community such as ours is not a disaster that you see in such drastic pictures, its quiet, it's easy to put out of our minds. Recently our Country is understanding the impact hunger has and its effects. Thank you for being a part of our organization and we look forward with hope to be funded yet again with this Grant. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Tem Keim, Director SIGNATURE: NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Charles P. Keim, Executive Director NAME and T1TLE (Please Print or Type) SIGNATURE: ?‘tL ORGANIZATION NAME: VNW-Circle of Care, Inc. MAILING ADDRESS: P.O. Box 218, Temecula, CA 92590 TELEPHONE: 951 973-3582 E -Mail Address: wecareAvnwcircleofcare.org DATED THIS 14th of September , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person: City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address: :....... :... :.:: Facsimile: 951-694-6479 Application — Page A B C D E F G F! 1 DEBT 11/2011 12/2011 1/2012 2/2012 3/2012 4/2012 5/2012 2 3 Salaries $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 4 Book Keeper $120 $120 $120 $120 $120 $120 $120 5 Rent includes Utilities 6 South West Traders 51,175 51,175 $1,175 51,175 51,175 51,175 $1,175 7 Fan Motor Refrigerator Trailer 51,200 8 Trailer Maintenance 5160 $160 $160 $160 9 Diesel Refrigerator Trailer 5250 $250 $250 $250 $250 $250 $250 10 Propane for Forklift $30 $30 $30 $30 $30 $30 $30 11 Envoy (food transportation) $300 5300 $300 $300 $300 $300 $300 12 Insurance 13 Liability $189 $189 $189 5189 $189 $189 5189 14 Workers Comp $240 $240 $240 $240 $240 $240 $240 15 E& O $125 $125 $125 $125 $125 $125 $125 16 Utilities 17 Telephone Mobile $230 $230 $230 $230 $230 $230 $230 18 Mobil Hot Spot Purchase $50 19 Mobil Hot Spot monthly cost $50 $50 $50 $50 $50 $50 $50 20 Web Fee $30 $30 $30 $30 $30 $30 $30 21 Misc Monthly Costs $100 5100 $100 $100 $100 $100 5100 22 Office Supplies $50 $50 $50 $50 $50 $50 $50 23 Copies $50 $50 $50 $50 $50 $50 $50 24 Postage $10 $10 $10 $10 510 $10 510 25 Purchase of New Computer Programs included $950 26 Holiday Spirit 2011 Costs 52,000 27 (SUBTOTAL DEBT $7,309 $6.949 $5,109 54,949 $5,1.09 $4,949 $5,109 28 INCOME 29 Grant - City of Temecula Community Funding Project 52,410 $259 $259 $259 $259 $259 $259 30 Grant - CDGB City of Temecula 2012-2013 Projected 31 Grant-CDBG City of Temecula 2011-2012 Awarded $1,000 51,000 $1,000 51,000 51,000 51,000 510,000 32 Pechanga Annual Donation 52,000 33 Monthly Donations $500 $500 $500 $500 $500 5500 $500 34 $5.00 Suggested Donation from Families (serve 1500 fam per/mo) $3,500 $3,500 $3,500 53,500 $3,500 $3,500 $3,500 35 SUBTOTAL INCOME $7,410 $7,259 $5,259 $5,259 55,259 55,259 $5,259 36 Projected Profit/Loss $101 $310 5150 $310 $150 5310 $150 37 I J K L M 1 6/2012 7/2.012 8/2012 9/2012 Totals 2 3 $2,000 $2,000 $2,000 $2,000 $22,000 4 $120 $120 $120 $120 $1,320 5 6 $1,175 $1,175 $1,175 $1,175 $12,925 7 $1,200 8 5160 $160 $960 9 $250 $250 $250 $250 $2,750 10 $30 $30 $30 $30 $330 11 $300 $300 $300 $300 $3,300 12 13 $189 $189 $189 $189 $2,079 14 $240 $240 $240 5240 52,640 15 $125 $125 $125 $125 $1,375 16 17 $230 $230 5230 $230 $2,530 18 19 $50 $50 $50 $50 $550 20 $30 $30 $30 $30 $330 21 $100 $100 5100 5100 $1,100 22 $50 $50 $50 $50 $550 23 $50 $50 $50 $50 $550 24 25 $10 $10 $10 $10 $110 $950 26 27 $4,949 $5,109 $4,949 $5,109 559,599 28 29 $259 $259 $259 $259 $5,000 30 $1,000 $1,000 51,000 $3,000 31 $1,000 $8,000 32 33 $500 $500 $500 $500 $5,500 34 $3,500 53,500 $3,500 $3,500 $38,500 35 $5,259 $5,2.59 $5,259 $5,259 562,000 36 5310 5150 $310 $150 $2,401 37 :...71ZNAT : -z". '`is l 3i SERVICE ?oz 2508 : ;:::::=': 'TI. OR 43203 ... r v.'ti.. A 0 >s 3klv .7Ng CZR(Cli.E. OF CARE INC 218 .,...'• ':''VLA:. CA 92593 Dear Apel icax2t . DERARINEXT OF TRE TREASURY Employer Identification Number: 73-1691246 1705_3157090016 Contact Person: EMARO S SCEL ACR II 3136 Contac. Telephone NUMber: (877) 829-5500 Accounting ing Per.:. od Ending: Decatber 31 Public Charity Status: 1'70(b) (1.) €A3 :vis Form 990 Required: les Effective Date of Exertion: October 30, 2003 Contribution Deductibility: 'ens We are pleased to .inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section Svi (c) ( 3) of the Internal Revenue Code. Contributions to you are deducts ale under section 1/0 of the Code. You are also quaiifi.ed to receive tax deductible bequests, devises. transfers or gifts under section 2059, 23.06 or 2522 of the Code. Because this letter could help resolve any questions regarding yo.xr exempt status, you should keep it in your perManent records. organizations exempt sander section 501(c) €3) of the Code are further classified as either public charities or private foundations. . Re determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Information for Exempt Organizations Under Section 501(c;(3) for some helpful iaformation about your responsibilities as an exempt organization. Sincerely, Lois G. Lerner Director, wept Organizations Rulings gs and Agreements Enclosures: information for Organizations Exempt Under Section 501(c)(3) Letter 94? (DO/CG) PO B:'( 12288 RANCHO COR IA CA 95741-1284 l: July 27, 2007 VNW CIRCLE OF CARE INC PO 80X 218 TEPECULA CA' 92593-0218 _Purpose. .. . Code Section Form of Organization Accounting Period Ending: Organization Number - CHAR -i T:A.E 2371 1d Corporation December 51 2527781 In reply refer to 755:6 xDI You are exempt from state franchise or income taxunder the section of the Revenue and Taxation Code indicated above. This decision is based on information you submitted and assumes that your present operations continue uncharged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization mast be reported immediately to this office so that we may determine the effect on your exempt status. Any change of nage or address oust also be reported. In the event of a change in relevant statutory, administrative, judicial case law, a chane in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon which this opinion is based, this opinion may no longer be applicable. It is your responsibility to be aware of these changes should they occur. This paragraph constitutes written advice, other than a chief counsel. ruling, within the meaning of Revenue and Taxation Code Section 21012(a)(2). You may be regtdred to file Fors 199 (Exempt pt Organization Annual, Information Return) on or before the 15th day of the 5th month (4 1/2 months) after the close of your accounting period. Please see annual instructions with forms for requirements. You are not required to file state franchise or income tax returns City of Temecula 2011-12 CS Funding Program APPLICATION NO. 36 MT OF r lJMECU:LA City of Temecula 2-ati FISCAL YEAR 201 1-12 Finance Department COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) 2011-12 Program Submission Deadline: Thursday, September 15, 2011 (original, plus one) PROJECT INFORMATION Amount Requested: S 5 , 000 Project Name: Pink Ribbon Assistance Program (M:axirnur' allowable .$5.000) Project Start Date: January uary 1, 201.2 Project End Date: °''x:e 3°, 0 1 -' OR(.;ANIZ TION INFORMATION 1 Name of Organizati Contact Name: f` - e Hen Beast Cancer i esouvice C:ente. ) ougla Title/Position: Executive Director Mailing Address: 27645 Jefferson Avenue, Suite 117, Temecula,. CA. 92599 Telephone: 951-304-1280 Year Organization Founded: 2°0° E -Mail Address: 1. e: c -,'I c;' . o,: q Geographic Area(s) Served: Southwest RiveLS:.cle c_ouUIl:_• Number of Paid Staff: 4 Number of Volunteers: 350 is this organization incorporated in California as a non-profit organization? Yes x No Effective Date: Nove a ex 4 , 2000 If "yes" (Must provide a copy organization's 501(c)3 non-profit status form): Date of incorporation as a non-profit November 4, 2000 Federal identification number: 33-0951216 State identification number: 2267780 If "no": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors :X Members -at -Large Application - Page 1 FINANCIAL. STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT EMM NT 1 Briefly describe the goals and objectives of your organization and community services it provides Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Please see attached. Application - Page Mission Statement. (Michelle's Place is a non-profit organization located in Temecula, providing breast health services. support and esoui't;C•s to women. As the only non-profit organization serving women's breast health needs in southern Riverside County. Michelle's Plate Ser\ es any women needing access to quality sereenings. treatment and support. Our nnis,ion stanelnenl k to. pro\ide emotional and educational support to those touched with breast canker and iae'ilitate beret i healih cafe sc ry ices. As a non-profit agency. our organization relies on donations. grants and sponsorships to provide our sem ice, at no cost to our clients. Local support from individual private donors. businesses and local governments Inas historic:llly funded our pruurauns. indicating a high level of public support. Michelle's Place is a fiscally sound orgatnivation conservative business practices designed fine long-term program and agency sustainability. Our or•gauiiatiun has completed an audit. which had no findings. and we have successfully irnpletnented projects since our inception a decade ago Oiir agency develops an annual operating budget to guide our progratuts and plan for servict•s iii ilei upeomiII t•t are a Iaich we ha\ e attached lir the City's review. Our agency is governed by a Board of Directors made up of business professionals. community leaders. etita.ator;. health ptufessionals and cancer survivors. Their breadth of experience. community involveluetit and guidance hall developed kliehclle's Place into an agency that is prepared and able to serve women needing breast health set\ ire's. Irl:ddiiic it. our 1_..xee'utive Director. Kien Goodnough. manages the day to Clay operation; as well .i +eulales partnerships. Iimdil1. and relationships to steer the agency towards the future. Our program stall, which includes Janine t('hely I I.et+o\\it/. and Carrie Linden itnplements our programs, directly serve our clients and handle the. administrative tasks necessary to illake our 8!Cl1Cv' rtltt smoothly. ;Michelle's Place has grown significantly over the past few years, demonstrating hod t our community's heed aur quality breast health services and our community's positive response to our agency. In 2010, Michelle's Place pi, ,\ idetf uver 6.400 services to nearly 1.700 women. a 1O% increase over 2009. Each year more women ancf families are seeking thaongtt Michelle's Place because they have no other option. With a rising: une'lnplo m nt rate of over 15"i, i►i Riverside 1'ounty. we expect the number of women needing services to continue to rise. and our ag tt \• is commit lI1nlltled 1t+ itiuring that every woman \\ ho has been touched by breast cancer. or who suspects breast eancer has access to hte'a-.t lleahh services. regiirdless of Iter ability to pay. Midwife's Place does not discriminate based 011 race. color, creed. nationality . ,ex. marital status, disability. religion 01' political affiliate. nor does our agency require attendance or participation in any political. religious or social activity. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services thrat would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) Please see attached. Application — Page 3 I'rujcct Description ivl,tny es( ih . women wlio are diaen&Sed With breast cancer and are seeking 3erviceN at Michelle': Plate have !amities that rely on their income and experience financial strain btbile undergoing treatment. Several women ate soli` providers for their la+rates and once treatments start. are left in a position that they are not able to provide aur their families. complicating .ut already stressful sitnatiuu. In an effort to serve these women and their families Michelle's Place prc+t ides direct financial assistance. support and encouraging events in addition to access to medical services through our Pink Ribbon Assistance: Program. the proposed project that we are requesting funding from the City of 1'ci weiila. Last years• Lahr Pink R.ihbon Assistmice Program provided 50 titntilies with over $422.0t0O worth of financial or in- Lind support such as direct financial assistance, food supplies tbra thanksgiving* meal. and a holiday party complete ccitli _ills tiit•each family member. In 2012, the expect to serve 80 families with over $70.000 worth oi'!ienelits. i o expand nn seek ices to families struggling through Lancer and financial need. Michelle's !'lar: he_a ii Pali) iii the Park three ears ago. This event is free to families participating in the Punk Ribbon Assistance Pruigain. a tinaiicia! ai,istancc program. and Kids Konnceted which is a monthly support group for children providing friendship. lull rsiailing_ education and support to kids who have a parent with cancer or who have lost a parent lo cancer. Party in tate Park was designed to bring families together to develop friendships in which they can learn from and support one another. All of the women participating in this event are currently undet•goirtg treatment. and itt need of financial .lc,ist:lnt:c•' o there is a common ground afshared experiences and struggles that leads to �upporlive family 1elationslrips. I),:r:rte_ tate e; cm. which is held at the cmcl of siunnler at a local park. families can participate in .ites and crafts, ctijoy piz_ra and getting acquainted with other families. In addition. all of the children receive backpacks tilled c} ith a hci::l 'I) )t e's and a lunch batt weeks before school starts. other times throughout the vcar ('amities participating in the Pink Ribbon Assistance Prugraiu receive :tssi-aank.e. oul�icic of t!tc usual. day-to-day support, groups. staff resource assistance and patient navigation. In Ntovetnhet. each PRA family receives a 1•tianksg.tving food basket to help you prepare for a day o!' thanks. The food basket includes a El whey. potatoes. canned goods and a pie. In 1)ecettiher• families' are invited to a local pizza restaurant for a festive, holiday piri:i party _ ;t t i'. t from Santa. and a gift for each member of the family. Michelle's Plan: is seeking funding front the City of Temecula to support the Pini. Rihhurt Assistance Program. Specifically. to support direct financial assistance and events for to women undergoing hi cast cancer treatment. and Mei] families. A detailed project budget has been attached. L PAST PROJECT BEN IS ITI'y If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Please •see attachccd. - Application - Page 4 i'ast Project Lienefits Michelle': Pince received 1,>.UO►U la:t. liar \\hich „ci cd ((t „omen i!n.ougIi our I3reait 1\r,�; la1 )11t1\ itlnh Iiha\ int di t4?nt»1it' imagining ,t'r\•ices (mammograms. IIIII:1.otnds. etc.). 1 ;11.1y detectioi1 •,•:nl it;• 111.. l:ili:'lllitll:"_' factor in itn-\ 1\1'11. au1Cl IIII';i \\Ouien \\t\tlld not have Other\\ Ise' had access lo t11a.'n;litlt 1\ Iti Intv icier based in l eniecuia. the inajorii of women seeking services through tvliehelle': Place are local re,id nt.. lloINc• cr \\i do not limit services 'lased on ��eo::rall)11km! locaticllt. Any woman seeking ser‘ ice: at Michelle': Place ICt il\ 4 s ilii\ lee :lila >t'r\-itt•>. when n ed,,tl. SIGNATURE PACE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Kim Goodnou.cj.h., Executive Direct:oz- NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Kim ('ooduOugh , Execut i.ve lair ec:to:i. NAME and TITLE (Please Print or Type) SIGNATURE:I •\, 'I. ORGANIZATION NAME: r Michelle s ,'.Place MAILING ADDRESS: 27645 Jefferson Avenue, Suite 117 Temecula, CA 92590 TELEPHONE: 951-304-1280 )- ooduoucIa'r7-m _c e11.eespLace.O 9 E -Mail Address: DATED THIS 1:3th of Sept ember , 2011. (Date) (Month) Submit Application by September 15, 2011: Mail Applications: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589-9033 Deliver in Person- City of Temecula Community Service Funding Program Attn: Judy McNabb 41000 Main Street Temecula, CA 92590 E -Mail Address::Lc./ :1Wi i 6{l,')Cit-;01i'r'r1i Facsimile: 951-694-6479 Application - Page 5 t:Veuse Item Michelle's Place Pink Ribboi Assistance Program Budget 2011/2012 Total Anu►imt Requested from City of Temecula Easter Event. $2.00 Y; 7.;0 Party in tht' Park Event $5,000 $ 75() 1 hanhsei'ving thanks Event $1.500 Christmas Event $7M00 Financial Assistance: $25.000 $ 3.50(1 Program Coordinator $27.736 Styptic, $1.000 $ Mai k 'i ini&Bros attics $1.500 'i; S70.936 S 5.0(11) Nlichelles Place 2011 Budget 9/ I 5/20 11 1 Homan 10111 Riverside County CBOG Comnitunly F,,unc1.211,x1 ttorntri 111!", Hamer Ad ininititrative 600(1(41810y (Grants) (Grantz) (Grates) {(irants) (Grants) (taittc Minds) TC (AI. ia •••, , 0.000.00 .., loco iNs ,,..1 00 • 60 000 00 0.1140 00 80.000 00 E10,000.00 1 500.00 1 T03.1.53 (.• :, .....,. :,.. o. 1— 000 to; -; f, 0001)0. II i., 900 00 — 1,, owl 0,4 ...,---.1 ' imm0.00 mention' Tot.•!! Gral Tottinantent 3,1,500.00 34.5116.00 (. :•il 51 .15.• 2,) • • • 1 ,es 100 elf 14 :)b 4') 0)100 th, )',,)31 0'' 13 0,100 . r•,,,,,..,..,7 , .9,0100,0 1101) 11 Itaai Grant Incornt 24,806.00 10,000.00 3,333.1)0 84306.40 6,400.00 0(10 17 Intsros1.111(0010 6.000.00 6,000.00 Ne.W6i010 EriV..i0p0 3,000 00 3.0)30 00 Chlor Evontr... it,c000, 60,000 00 00.000 00 4310k,P.ar,0.1 .--.,,,,,-....- Ft, ?• ..• III:,0).1111L.:111 ',..:511C.;;,ii, I J 01)0 01) r..0041•;41 rini. rs.r...111 /,',.,. 1 .. 11 .10 • , ill. i 0 IMO 00 _II i,,1. 113)i11. , . , i rt..:Ir,o,i I 8,000.00 9.000 00 15 )4)0 01) , 5 000 110 7 )o 00 't 4:00 (1t) it,•.•1 ft 'I ; I DM 110110 /41,404 (1t) V. :ItI,wit•:•...),,• •t , I 13 000 00 ';11:041:S1 lcl.V. Span ruiuttalsyr 50,000.00 ________ 50,000 00 6,000.00 I 237,000.00 24.806 00 10,000.00 3 232 on 84,330.45 0400.00 000 371,374 45 1 1 1 1 5,00 Mk ; ..:: i'0 1! :111aciut,1 I 4.800 00 11)1,4)1' . 1'..,:l (4)05$4: 0.00)10o (. ow) 11 1 l',..1:•,' 1.000.00 1 ono 00 Total Gott Totona00.0t Expanse 12,500.00 12 500.00 Wit., )3,.. ,>. :. 1 \-.9- h ,• ..- i,....,1;,, ,.: ,i, 1 ,;,..,..,,s 'oil ......--__s___- 1 , • • tro 1 ':()(119 I-:1:1(1.1 .- i•.0.: 0,1 2 000,00 1 • :...., , ,". :....:+11:,i'l 1 5o0 00 ."1 ....1 .11,....„.,.,,,,.;::,:11.., 500101 I ..,, rio,..., 1 035 WI . I lit,. .. , - t.:ii t• 1.332 00 .1 'It :,....,. 1 1,:s7"t OD 372.00 114 '.....01.4 i • 0)10000 ry•••ii. ,i... l',.,.1, VI 101100 00 1 IVA, 1) ' '11..1 N, .:... h• Mt' • 4 !JD) (N) I 11:P 3 ',....10 N, . ,. , 1 ' (41 '. m•-.. -II ' i ., : . 1(701 ' ti.3I)0 I ) '.',130 Lb ' '0) 'NI :: : . : .e. 4 .( WO 00 klt3/0 ail N.-.1 „, Cl ,....7.;t01,: t. 5t81 00 I 4,))) 'J.) :', : • com i, 4 ,,Llt) 00 1 .1 "011 3.. .1,,.).„„, .1 (.100 00 2603) 14 •.0t, 111 .v.2 .;/ l'!'..,,:i I.,1 ,: ' 1.,1,,10%tt .... 10 51.10 00 1 Michelle's Place 2011 Kml_c•t 9/1512011 Rtvrrslda Community I Page 2 1 Komori 10111 (Grants) 1,980,00 10.111111111 1 County -09X6 (Grants) 0.001 Fourxiatron Kamen 11.112 Kaiser (Grants) (Grants) (Gt,(n1S) (M1((0 Granla) 'ICTAL �— Administrative Fundraising' 0.001 51.051 0,, ano I . 0.00, 93,/61,90 10,000.00 Oil OInes Er1, nc'vs 02.900 001 0.00, 1( UIlu^ ElTi,t:< 10.000.00 . 1'.' 1 i.:00 00 1 1 M : iint1 00 '.:1.1).1(1 .IiiV 1 1800.00 C.1. 1 0110 00 500.00 2,300.00 —1 2.700,001 2.700.001 1 0,19110 :1.01(411 - 6.800 00 — 1 . , .1.,, ..ui 2 010 00 1 : , l ;2,00 632.00 � 1,;r, „ _.. - .':/01.11 5 1 it ••I . , • „ .;1, n!VW.d,cn11E1l;.r, Z.(Y);rlp)1 4000.00! 1 .1:032:00 .1 200 001 ' WTI 00 ,,,. ■ 1 ! . 1 , ((!:11)1 r,, M / 110 00 - ---- 1"0 CO i• 001 . ;.: „1. 1 - ---- „1 Q°•'i(!t1ph 2=1 5.,),5 (19 3,Ut 81.9;1 10,907.00 0.00 .. .._ .'.._ C' 0,2 (til 1' -'i y 1 111 tttait 1 3,332,00 53792.5 11,400.001 000 131i.41110 • lots 0el.01111; Corr 39,000.00 20,000.00 t:,,.,.,. 1 �• ,'I'I. ..,..It 1.1,111; 10 224 00 ,3,000 00 III� :'1/1(1(1 ...I.: 1' . ' 53 (;+100 I— ' 1 - i. ,� :d 419100 _ 1G I0'I):i • t 1 . 1 .t ,.i; ; •.. •- 1. ,... 0 4111 1 —1 .; 1 K.,v .,,'„ (h. ,l 71147)0 —, 4.37!100 2204.00 .. ..UU 00 .1, 1..00 :!1;t'I.1GI. 10 (i'1 -1 I 9,639,60 1 7,300.001 1 11 1 , . 1 10) 00 -■ 0.00 21050 3 00 0.00 17'1.•12 .i1 ,1 ; S.11111 •.2231431 (1.00 1, ■ I 1 ' ,;1,.l i ,,, 2, 1 L00.ou 2.(410X01 _,: .,:,1 1 ,„,,,,,,L . .___ .. 10 009.1101 Tan: Spr109 E+' n1 1 1,000.00* I15.000.00 1 24,206.00 0.00 1 1,:,1:1::: I ;,0011 011 10.:10065 0.011 3 000 CO, Volui l,, r 0xpi,ni" Total Expense 3.000,00 266.542.,311 1 57,500.001 3,332.00 54,336.45 6,40000 0.00 '152.01(.1(,1 0.001 0011 000 ,;a0 111/. 7..; 1/. t 1741,500.0) Page 2 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) b- The u i)liii23lien nl v toile to en 3 copy UI iills feI!11n to sit,-:iy ii(; ? lop(:t IIH! n. lUlrviukill<. nAirr tv 1 ,..'01 2010 Open to Public hlspe(.tiorl For tl:e 2010 1 alto -Mai year, or tax year beginning - , 2010, enol ending. t 1 ?k 1 I.:.gb• ,u •r,naum Women's Breast: Caucet. 11esoureE 2.645 Jefferson St #117 Temecula, CA 92590 Q rr„plovarlJrnhilC. U'! 1II ie•r 3'3709.51216 E who, G i.;:• F N:inY :1. F:.,. )!,•F• 41;:.if:r.i;.a1 a I ; Same As C I{t)OVe 171c :'LII(• ( )4.(111100oo) 1 Id':•",(,.)(1)ur U:;::1 1 _ 1Ne_bs!te• • N/PiI hA .,.,r • • . 1 •. ......i CA it I Jk:1 ---T.: 71 ?1.C.aI:;J Sailer» IL •o::, , .' ,°I,171i.;. Part 1 - i Summary, 1 1.3n,::!'; p•ribr: the organization's mission ur nrnst ',iqi ificanl activities: To_takutvid,§_s ah2ar.r.-):f(_-'r =c t_uil'> t_r i3):'( slv_Qa.11rer,...T )_ia i0(11Pdes brg.s1St. cCtar_eI_sc 'c1t njog13,_ t-SBr(a1.c,. 1 uppD (_.,•.a..'0- 1i5atsi.aro e_i1'1-I;iie_1:('.S:S?Y('.7:.y ?_rDae s,.. - - - --- -- -•-- 2 Ci:c'1. I)'i': trim ' .1 .1 if the urq;:•niza•Iion (Irsconiinucd its operations lir disposed al more Hien 75;, of its noel ;- 3-= "5. E� 3 Number of voting nvi(:`n!bers 01 ti -e ucverning body (fail VI, line la) ... 3..I._—•—_ 4 P)t! .It:: ! '.)i inclr I> :n(!e ni voting mm of the governing body (Fait JI. lino 1b(r_4. 1 5 Tol: Iiund i I (•i i;,tiivl(iu:: s employed in calendar year 2010 (Part V, .lit ; 2a) ... .. . G j.%.G TortinunIb.•I (•1':uluntcr-,_;('slnrrrtei!ner tirss:sry)._-. . . •,•• - •• • -. • -- --- -- 7a '11)11 I unrelfile.1 burin rss ite:xtn 1 from Fart VIII, column (C), lire: 12:.. 71) A _____—_ _ b Not Irnt� I-.teti besi(:*i s. t�rrable income Pruni Foam 990-T, line 34 . . . .......... ... . ...—..--.— Prior Year Current Year �A(y, IG%1 . 3.1`1. L'5.. •% 8 Cc,rrl!ibut,(:ns and rim nts (Part 1/111, line 110.. .. s)'), (I6f3 . _ ---- — 9 )'nrlll;;nl :; rvlc revenue (Fart VIII, ling 7_c} .... .... ... 88 . c rl, ryb2 . 10 Invd-t.tine rl me zinc' (Part \1111, rnlunir1 (A), tineas 3, '1, and -id) .... .. . Cf. 11 1)111.1. 1A•rei'tie. (13ial VIII, :':)lunlri (A), linea 5, 64, 13c, 9C, 10c, and 11e) . -��, �'.Lrl ( 'Illi'. I? . , • e. 12 T r,i�4i r. v^.ilu:i — 4:ud 1,1!C! 8 RH012 h 1 1 (Hurst t>.rl al fart \ Ili, c'f,lumu A. , ... — 13 Cii .•))s :.,ntr tonidsr rslnour is paid (Pari IX, r:olurm (A), liners 1.3) HO) I., 1:.... ,,::.. n..: . :119 , 8 1 . Ivo. 1X;80 , r.:•.. �_�ri, 1 0 a G F- sT 14 I' i,(iil•, paid!) in !or r.lambers (Purl IX, column (A), lire 4) , , . 15 '..?•:iiaii,Nt. 1)Mier rr)tlilrr;!t,ation, employee benefits (fieri IX, column (A). linos 5.11)) , 16a F'IoI>-.': ;inn l fundraising lees (Part IX, column (A), line 11:.') b Toted iundr.ul'sing oxpc'fSf'e> (Part IX, column (0). litre 25) ► 56,240, 17 Other (-xprwes (Part IX, coll,unri (A), line 11a•11d. 111-241) ........ • . •. 18 Totid -p-'i (rs P.(id linos 13-17 (mils! equal Pail IX, column (A). Zine 25) 19 i-::•vi:nue tits.> evponSes Subtract line 18 Iron) line 12 20 TohI ;iVf'.h (F;at X. Zine I6)..... ..... 21 ii;,8ilibes (Part X. Ince 26) . , . . . . co k)rn.l balances. Subtract line 21 frorri rine 20 rPart 11 Signature Block 1,59, 1:1.7 . 7:1,.259. 230, 376. 1.13,038 . Beginning. of Current Yeti 1.93, 09.1 . 0. 193, (19) . —. ri l 01:i. -3I,1Ci: _End of Year - 81,926 1.fr1 ... , I ,. . r-„,,,,,,.....1.11,:, r: Inrn ,r• Iuir7 „ '•lbup b nh) :• h --Jules ..4.1 ,,,,,,,,,,o,:. ac4 I" 1.,. 1, -al v) my h,,r.,•,;; :,!•• ..r -, 1. 1' 1. '1 ..:... f • , I : .; o.. ..r1 r. t..:.. n..)/ 11� ,1 rnoldn, 1 nm_n i n ,-n1•r X16 1y'. ilI uual;;i ,r. Sign C; :C Here- K..met)' (,-oodnol Git A„ :':.era:ci',, i.1;,al:uc �C,•u (.,..o, !v I ., IUI -- t s ' on Jack .1' Ferguson , Paid Jf�i(:1,. '1' 'erc�u;• Prepares r ,:. s' JIkCK T. FERC( SON CPA Ir Use Only r,... s,,,:_: °.31` 69 Canyon Estates Di: Ste 112 4 1,AJ(E F::LSI ORE, CA 92532. r.,,,,,; .,•, (95i) 'Hi -2700 Yes No Mi,' 11',' IRS (Jlz.rusy�. Ibis return with the preparer shown above,.? sec instructions). .. Form 990 (20ii)j 1rEc:(01 Vzil '. 'li1r10 n...: «Ira 1. 13M For Paperwork Reduction Act Notice, see the separate instructions. i 1 1 Ai 1 Forel 990 (20 l.0) Women' s Bast Cancer Resource 33-095111(; Part UIJ Statement of Program Service Accomplishments chock 11 Schedule 0 contains o response to any question in this Pt ill 1 th•:, eiganizatarres mission: To_pLov.ide_support for victims of. breast cancer. This ineludes _breast. cancer sc!.eenin_gs, 1.1osit-surgical_svport, and assistance in ne recovery. prOCoSs.- 2 Did ilk, owaiiinition undertake any significant prop am services during the year which weri, riot tistd on the prior Fiini '190 .), 090-2? ill Yes ry.f N9 if *Y04,. dt-,csilre ill new se'vices on Schedule 0 :ii tecono.., too ccaz.:e eondocliny, or inat<e significant changes in tiow it conducts, any procirani SPIVIC:•.-,?.. 11 yos Inc No .lz.,,,ctity, Li se Changes oil Sehedule 0. 4 liesci lee ;lit- exeropt puicx,se achievements for eoch of the ufganization's three !oiliest program seivicPs by expfinss. St.•.finri arid 3U1(c)(4) oi ganizatioi is and section 4947(a)(1) trusts ;No required le r..,port Ihi.? amount of grants L'ild• allocation.; blICi revunue, if any, for k.`.3(.i) program service ieported. •- (no _ $ 138,711. inoluciing giants $ ) vel r ur.tiLideci Iite.,clical er xaminations fowomen who have or are at: risk for breast ciricet.-- 4h (C(nc. PEOVi tied • (Expenses $ 96,599. including t'aCi ity for su2port meetinqs -a9spport services. grants of $ ) (Ftovri art: $ -_______ _ and counsel:pig, f2u reas _ .§11P.119lit- AIL L _ . 4c ;C.:00 ) (F...>•pensm $ 30,343. !minding grants of $ ) rfievenie; $ P01i i ormation relating to breast cancer to_patients and to_the_commnni L'cle 4d Otliut nio!p.!u! ,orvices. (Describe. in Scheditle 0.) including ,gretrit's of S. 265,6G3. IEEA01021. itc Total program set vice expenses BAA lei061111 )_Fevertue 900 ;:,(}10...., :=ia1,r 900 i(1-0) �jonieri' s Breast Cancer Resource iii IPart IVV Checklist of Required Schedules 1 Is the organization described in section 501(c)(3) or 4947(x)(1) (other than a private foundation)? if 'Yes,' corn.•&ale schedule 4 . 2 !s the ole?mxe:tiva required to coirn)fele Schedule B, Schedule of Contributors? (sole instructions) • • 3 Did th'- i :n :nixatiorl engage in direct or indirect political campaign activities on behalf of or in opposition to candidates Col I'i.t>I.i; oily. t;? iI ') r -s,' 4r- aurae Schedule (.. Par; 1 ... . . .. . • • • • ... . . • 4 Section 501(c)(3) organizations Did the olganiz_stion engaage in lobbyirig activities, cr have ai section 501(h) :Jet dot. it] elle( t dor log the falx year? if 'Ye..-:.' complete Sch,ydirlu G, Part If .... 1: the nr,larlization a section 501(c)(4), 50I (c)(5), or 501(c)(6) organization that receives membership dues.;arrl 111. . <i•,eismii -lis, ;>r simile, amounts as defined in Revenue Procedure 98-19? if 'Ye5;' tuniprr�f . Sr/i,'c;tr1 C, - 6 i)uf the rroaniz_llion maintain %try donor advlsc J funds or any similar funds or acccounts where donors have the: right o provide ntivire on the distribution or investment of amounts in such funds or accounts? If 'Yes,' comp/vie Scheditte 0. ,`-'r:r i l . .... ......... ..... ....... . 7 UIrI lire acu.:nizalien recc;vee ni hold a conservation easement. including easements to preseIve open spaice. lir- 7 :::rviroru•nc nt. historic. land eaves or historic structures? If 'Yes,' Gonplf,'te Schedule 0, Awl 11 . .. • . . • 8 Del lie nrpanixaatlon maintain vollections of works of %lrt, historical tI'easuies, or rather similar assets? II '(. _, i4 C011plra(c! SC110(111 1). Pad 111 .... . ...... .................. ..... . .... ... ... _ . ... 9 lair)di.: organiz ttion report an amount in Part X, tine 21; 5011/() as a custodian for (11nocrnis nul listc•,i in Rirl X, or provide credit counseling, debt management, credit repair, or debt negotiation services? 1i 'Yes.' complete q SC(:c: dole 0. Par f !l! . . ......... . ...... . ... . 10 Did the: nrgsalizahor.. dii.sctly or through a related organization, hold assets in term. permanent, 01 quasi -endowments? 1�13 'Ye ' cYvnl.)Inlr: Schedule 0, Pad .. ... - .. ' . 11 1; ilk'. oro iiiizetio r:::tnSavc;t lc any of the following questions is 'Yes', thea? complete Schcdcilc: l), Parts VI. VII, V111. IX, or X as 2f>plic.sl>Ir;. a Did the ero..mizolicnl report en amount for land, buildings and equiptne'nl in Part X, line 10? if ') es.' complete 5ched!'l - r), Pari VI ........ ... .: • ...•... ........... .... ..... .. 11_2 b Did the aya;nli:afion report an amount for investments— other securities in Part X, pint; 12 that 1s 5 or aline of its lots] 11 b ;warts ler:oi ter) ir: Part X, Zine 16? if 'Yes,' ruri)plel;: Schedule 0, Pad Vit - ---- c I)iil li.e ot;)icnieetioil 11 pill l an amount for investments— program related in Part X, Ili10 13 that es 5% or ttiore. 01 iI; i:it.,i ,..c.i ; re0oiI" li `o fart Y. Zine 16? i( 'Yes,' complete Schrfclirin. 0. Mot VIiI. d i)nt ii::• :)i:ornizzlio:> import •'n amount for other assets in Part X, line 15 that is 5';, of mole ni its Iola! r:ss.e ; Ic•itr>rted 11 d .ii f'r;i X, line Icy' If 'Yes,' eo•nplele SrLedtrle 0. Part IX. ....... . . . . .. .. .. .. e hid Ill nrr;.',.rli: Miori report earlslmo:ant for othei liabilities in Pall X. line 25? 1('Yes.'conipl::i:� :it li'rhilrl l.), i-'.:ri A 'll e 1 Diii the urtt:inizatiol:s stearate or consolidated bnaancial statements for the tax year inciuri i a fovinot•: tli::r edrIr.:-s"-, the organization's liability for oncertrin t•ax positions under FIN 48 (ASC 740)? /1 'Yes,' complete.; Sc bode!, 0. I• -'<:i t X. _111 . ____ 12:i 1)nl ihc: ••rr:ani; anion ui,le+in separate., independent audited financial statements tor the far year? 11 'Yet-:, : r,,n)i)lr., Ila Sca,dule b. Pi -31;5.;1. X1i, and Xlll. - b A1'r• the nil.;lnizti0rl included in consolidated, independent audited financial statements for ilii' tar viae? f('Yes,' and (i Oa: r .!,nl;.'•'iiun answered 'No' to Ione 12a, then completing Schadvle 0, Paris Xi, XI!, :InJ XiII rs vi rtic•rrat ... 13 Is illy oi1idniz:ation a school described in section 170(b)(1)(A)(ii)? if 'Yes,' complete Schedule E. ... .. 14a I)i'i the organization maintain an office, employees, or agents outside of the United Stales' 33-095;.216 P;ste 3 1 • 1 1 1 1 1ta 5 Yes _No 2 6l --X b Did the organization have aggregate revenues or expenses of more than $10,000 frorn grantmakin, furu1i. ising, business, arid program service activities outside the United Stites? 1i 'Yes.' complete Schedule F. -arh 1 and Ito. .. 11; 15 IJiif the oro„riiz ii.i0n report or. Part IX. column (A), line 3. more than $5,000 of greIi'Iis Of irs$istZinee 10 any wormy -1110;i c1I entity located autsirle the United States? If 'Yes,' complete Schedule F. Parts 11 and i1/.... . Ili (lir) Il,r rtcl<.u1:;-: JLI•;li r••,pert or. Part IX, column (A), liner 3, more: Ihlc.rl $5.000 of orJrti :jafe (perii:. or 'issia,lr:; ,.. i> 1G i?•twirl:•:._ for:edea c iitSic the United Slates? If 'Yes,'rornple;e Schedule I=, Putts Ni pVend,. 17 I).d tin: .-11- oi::.ptioil tepolt tl total of mot -9 than $15,000 of expenses for professional tundliaisin9 services :%r, F'i•t1 I%.. 1 7 c.?=..•neap (A.). IIIl' 6 and 11e? I1 ')es.' complete Schedule G. fart I (sae instructions). 18 Dirt !tic wtpinizatinn report more than fi 15,000 total of fundraising event gross Income end c:n.ril;uiiuns o'i Part�,il`. ;8 hilt.,,• 1r• and f;..4? If ')'e5,' Ct�nplct.^ Schedule G, Pad 11 19 Did 1110 run:• 1:e: ither Iepor( more than $15,000 of gross income from gaming activities 011 Nal ;'III. Iii,.: ;'. ? 11 Y. II, cAmj.Ik .'N:iisclulr' G. roll Ili .. .. .. . - - - • .. 20 aU:c: iii:• urr; -ni? .tre,i operate one or Inst;, hospitals? 11 'Yes.' con:pie1e .. • • ... • Schedule H...... . . b like' that c�preette nnetor more hospitals arrust-attactitach its tauditefinancial finrancial slatetinents (sera instruction):1Seiler loon nc U a()AA (FLAIIIIOI• 1)271;10 12h 13 14a A Yt ,„ v 14b 15 . ,9 [20 20 b f'o? 990 2010) :7-ir:e Form 990 (2010).Women' s Breast Cancer 'Resource 33-0951.216 4 ;Part IV I Checklist of .Ret 1,iitchedttles (contirltted). — Yes -r No 21 Did the or garria.ltirri report more Clan $5,000 of grants and other assistance to governments ..incl ornaniz-ihorts in tIrr Urrilod St.le.s oil Part IX, r obi Oi I (A), line 1? if 'Yes.' complete Schack*, 1, Parts 1 and 11 21 22 'Did the organizationn report more lhan $5,000 of grants acid oilier assistance to individuals in the United ,S.'tate, oi• I '., I • IX, column (A). line 2? if •Yes.' compiefe Schedule I, Parts I and 111 22 23 Did the organization answer 'Yes' to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current 24a Did. lire erg:mlion have. a lax -exempt. 0ond issue with an outstanding principal ellYIOLIO .. ' ' 00,000 'Is of 234 „,,„ 101 Wel. officers, directors. trustees, key employees, and highest compensated employees? It 'Yes.' complete .. . . .... . .47 Sclaytele 1 .. . .... .. A_ U le Iasi tioy of filo year. and that was issued after December 31, 2002? If 'Yes,' answer fines ;MU through 2441 and compkle Schoch*11 'No.'uo to line 25 0 DO th,-.• orglnization invest any proceeds of tax-exempt bonds beyond a temporary period eym.. .. ptiori? . 7.22441L:. : it' • . " • • ' • • A C Did the organizaton maintain art escrow account other than.a refunding escrow al any time dining the year t!e!C ally to)-(FflPt burp's? 24r - d Did the organization act as :1.1 'on behalf of issuer for bonds. outstondino at any time during the year? .. .... • 24d 25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a rrisgur.iiiied poisen during the year? it 'Yes,' complete Schedule L, Pert 1 —, 25a X _ 0 Is ilio ouraor aim-) aware ihat il engaged in an excess benefit transaction with a disqualified person in n rir ior year, arid 11,Imos.:•‘-tion has not hoen reported on any of the organization's prior FOOT* 990 or 990 -EZ? if "cos,' co!irpi,dr :,,rrii.: L t'...i/ CliSql) zdifien1 pOt z,.(.111 01 AA:3116110 Fsti of the end of the organization's lex year? It 'Yes,' compiew ;,-;eirairrie c, !-';ii /I 26 ....;.„,. __ 26 'vvr,..,-, :-. hall ro ei oy cm (Cr, i ur foirner officer. director, trustee, key employee, hiohly compensated ertlpiOyer., u' 27 DO 111:-: organization pi oyide a grant or 001C -N. riS5i$LEIOCO 10 wt officer, director, trustee. key employee. substantial I.:0111(111,1..01, 01 it grant selection cominittee member. or to a pr() srarc elated to h an individwil? II 'Yes.' i orlif.,1•?1,.. S. i Ici l!,hy L. 11t1/1 27 ,i. 28 W..F. the oroanization a party to a business transaction with ono of the fallowing parties (see Schedule I... Pail IV ir•snia.t;(ris tor applic able filing thresholds, conditions, and exceptions): a A run frit. 01 roriner office(, director, tnistee, or key employee? If 'Yes.' complete Schedule L, Port IV ........ . .. I) ••:., family irintaber 01 a current or fennel Officer, director, trustee, or key employee"' 1; 'Yes,' eon inteie- Sitertric. L, Pcd i IV .... ..... .... ..... . • . .. „ ... ...... .... ...... , . .... ....... .... . .. . . .. 2411 _ ;,..,_ c An entity oi which a current or Winter officer. director, trustee, or key employer (0r a 'family member thereot) wc, an offieer directoi, trustee. or dried or indirect owner? if 'Yes,' compieie Schedule L, Part IV .. ... . .. ..... . ... . :2a(; - 11 29 Did tl it. organization recnrive snore than $25.000 in non-cash contributions? If 'Yes,' cninpkqe Seta:11(11c. M. . 29 30 DO tho 01L11 u11 receive cord' ibutions of art, historical treasures, 01 other •_;irriilar ossets. ot qualified conservr-tion crs:lribi filo.' is 7 It 'Y 8 S , ' CO/ Vole Sc A4 . . ' • _0. 3' !iv I ilk. oigniiiniion lirluiriate. terminate. or dissolve and cease operations? If 'Yes,',7ompiele Schack*? N. Part 1 31 32 1)11' tiw oignorzi,tion sell. exchange. dispose ot, or transfer more than 25% of ils rpit sr Is? if 'Yi:,;.' nvo!dore Si.i.t.sfitde N. Piyi II - " • • • __Ye _I_ .x. 33 Did Ow ofro,nixation own 100% ot an entity disregarded as sepiirate from Itis organization limier Heat socoons 301 77012) mid 'Art .7 /01.3% If 'Yes,' complete Schedule R, Part i . • • , 33 —..— 34 Wa:t the organization related 10 any tax•exempt or taxable entity? 1! Yes.' curepleie Schedule, R. Paris II, ill. it,. :110 1,r1:1 1 "• ______ --.. * t 35 .s ory iektert orgarii11on n controllerr entity within the mooning of section 512(1)1(13)?. .. , , _______ . 35 1. a Did li:o orwirizalion receive any payn rent from or er.gaoe in any transaction with a conlrolled entity ,--, _. within the meaning or section 512(b)(13)? if 'Yes.' complete Schedule R, Part V, lino 2. ... . . . . ... Li Yes IX] No 36 Section 501(c)(3) organizations. Did the oroanlzation make any transfers to an exempt non -charitable related organizatioir? If 'Yes,' complete Schedule R. Part V, line 2 37 Ditl the oroanizntion conduct more than 5% ot its activitiesh anentitythat is not a relateci organiz.ation am! that is treatee as a gartnei ship for federal inc.orne tax purposes?If 'Yes,' complete Schedule ft, Pad VI . .. , . 37 38 r:ii!ii-; organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines I I and 19? Nob'. All Form 990 liters Pro. required to complete Setterlrile 0 ...... .. .... . ... ... . . . 38 it --- ;-111 990 •:i0101 CAA 2%. . ruAorWa l/?!ii) 1 1 1 1 1 1 1 1 Form 990 (2(110) 1,1c»nerl' s Breast Cancer Resource (Part V 1 Statements Regarding Other IRS Filings and Tax Compliance ( I,, F1. li `.iciiedule 0 contains a fesponse to any question, in this art V. L 1 1) 1 a i=nt<�r Il,=.+ n,:nG•:a ..>':rir:rl in &»: 3 of Form 1096. Enter •(!• if not applicable..applicable..}-,a 0 h Eni.:i Ili. :iniube i ':i i.:.i i s W -2G included in line 1a. Enter -0- if not applicable.. I. 1 0 C I);;p ihr: o niiization comply with bturnip withholding rules for reportabie payments to vendors and Irpcnl:a,le gamin; (c :iniblincl) wiirniriv. io prize. +';ii+rlels?. 2a Enter Hr-• number of einplovees reported on Form W.3, Transmittal of Wage and Tax Stale- I n lents. filed for the calendar yea tar ending with or within the year covered by this return . 2a . b If ot lei..st one is reported on line 2a, did the organization file all required federal eniployine+ t lax returns? • - Note. If the ;urn of pines la and 2a is greater than 250. you may be required to a -file. (see instructions) 3a Ord the +>i„.ani:::tion have unrelated business gross income of $1,000 or more during the year? .......• . ..• - 0 li .,.' i.,,; ii i Ic d a Form 990-T for this year? It No,' provide in, r.xplonation in Schedule U 421 ;'.l i?ily lion:: ;I.irrie, ti in calendar year, did the organization have an interest iri. or a signature or other .authority r.Yiir i• iir::il i :Ic» :': t 000.1 1 1 a foreignrountiy (such :is a bank account. �ecurihes account, or other financial account).' h Ii 'Yes.' ante i the rranv of fie: foreign country: Sea Hisir.icberis for filing regirirtarientr+ for Form TO F 90.22.1, Report of Foie'it)n Bank and Financial Accounts 5a',^r' >, Ihrr nrg imi et:on %a party to ;: prohibited tax shelter transaction r.t any time during the ta:. Nal ? . - • • • 1,00 .IP/ taxabte party notify the organization that it was or is as party to a prohibited tax Sheller transui:lion?..... . . c. If '.'•rs,' to line al., or 1.31), slid ilia +)ryaniz• limn file Form as3r. t7 • Ga LP:•,: lir., tutiaarli'..Gun leve, unnusrm {,Foss receipts that .aa normally gi mici than $100.000, and did i1e rnttanir:.lrc.ri .4.11, !i 'a:y'.:on4itw horns 111nt were mel tat. rle:+.lu+.+ible? ..... .. . . .. ... . . . . • • .. . . . I: it '.".,:z.' cad 91c orcp,nixeii;in ri .lode oath ('\''i r 50ltrt.ilfoli an Px rnss '1. 1crrrant that seta cenlrtaitio s.. iv grit, cr.'r : not t_:,. iJeiJiicl:bl=: ' . ... .... . ... . 7 Organizations that may receive deductible contributions under section 170(c). a Did the orllanixotion i eceive a payment in excess of $75 made partly as a corftribulton and pal ily lot g0odk, ;:r+d se:^;i,:r: provided to the payr:r7 0 0 'Yrs,' did the oreanizatior+ notify the donor of the value of the goods or services provided? ... . c Did the orgerilzaalion sell. exchange. or alherwise dispose of tangible personal properly tor which il was required to GI.) Farm r,):1',)? tp it "res ' orric:fie the number of Fo::ns )2E2 Fled during the year., - o Di:l liar nr cI'ri?'itiOrl receive; -my fluids, directly or indirectly, to pay premiums Uel a personi;l t+':nerit :'nrllr.:ad"a f Crit the 01;i-ni jtion, during the year, pay premiums, directly or indirectly. on a personal benefit contract? . g IL Itie n:gr:nl talion received a contirbution of qualified iniellectuaf properly, did the organization file Four. Z.1d99 €r If Ur' c r.ranizatior :eceivec1 o conlrihulion of cars. boats, airplanes, of ether vehicles, aid the organization file ,+ Feint In.,rg-c7. .. . ...... .. .. ...... .. . ....... .. . .... E Sponsuring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did +ler f g 1 "5't••rai l'I''j c:rrisru;::.Iion. ca: �+ donor advised fund maintained try 0sponsoring nrgtini::.,hon. f:;svr• P ,::r•c!; ht!.. Iry I„ Inrtnl:+ :•1 {.rig li,:'i; durirlci the year? . ........ ..... 9 Spinisoring organizations maintaining clonor advised funds. a Did the !)l i ri:ralion make any laxabl: distributions under section 4965? .... . h Did ihn organization intalu+ r:, distribution la a donor, donor advisor, or related person?. . 10 Section 501(cX7) organizations. Enter: a Initiation feels and capital contributions included on Fart VIII, fine 12....... .. pal b Gloss r)cc'rpts, included on Form 990, Part VIII, line 12. for public use of club facilities.:. 1.f)b 11 Section 501(c)(12) organizations. Enter: a Gross ns:r,nie rror;i rnc,rnbr•,rs or shareholders... . . ........ ......... ... . •11a O C.r;+•.s irn.r.)me horn other source- (1)0 not net amounts due or pard to other sources 11 b .:yanist :411o!!ats clue or received 1-om thorn.)...... 12a Section 4947(0(1) non.exempt charitable trusts. Is the organization tiling Form 990 in lieu of Fo!ni 104 l ?... . b If 'Yc's.' enter the a mou!il of tax-exempt interest received or r::ccrued during the yr.;:r . ... 120 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a 0' live organization licensed lo issue qualified health plans in i'oore than one :stale? .... ........ .... Note. Sr'=: 'ti !e Instructions for <,.ddilidnal information the organization must report 011 Schedule 0 11 Fr (:1 the iia Fiord of reserves the organi!_ation is required to maintain by the states in 13h which Fie ',ionization is licensed to issue clue lined health plans ............... ... .. . 1_ c 1= ni i>r iht• •srnau:•ir of rr,5r.'1 vet on hand .. .. .... ' 13c 14a I')rr the ralgani2%,tien receive any payments for indoor 'arming services ciuriny the lax year? .. . . . b ii "', e:5.' !i=s if filed ti Form 720 to report these payments? It 'No.'provide ail explarr,tirigrr in Sdu.'mi'iI,, r).. . BAA 'frzeniosi i ir:(vir, 33-1))5..21(, P.V,' L?Yeti No. 1c 2h :S 3;i 30 4,a 9 a 50 5 '. `ria 6b 71 70 /c 70 7t 70 . 90 140 onl 990 .:010) Form 991U10).Women' s Breast .Cancer Resource 33-0951216'•,,:: G :Part VI Governance, Management and Disclosure For each 'Yes' response to lines 2 through 7b below. � t)c! to! - ;) 'Pio losl)oftse to litre 8n, 8b, or 10b below. describe the circumst4nces. processes. oi' i'lr.;lio:'5 tr; Sr.irec/ulr. D. Sean instructions. Gleet, i' Srfiledole 0 contain.,:: response t•, any graestr0n in this Part Vi... Section A. Governing Body and Management Yrs No _(i 1a Enter tii:' number of voting members of the governing body at the end of tate tax year.. 1 a —8 b Enter the number of voting rnemhers included in line la, above, who are independent .... 1 2 ;et an,• uffic- i, erector, trustee, or key employee have a family relationship 01 :a business relationship-eelli any other z ,fice)r, director, trustee or key employee' .' 3 Dui Vie ,eaniz=ilio+' de1egete control over management duties customarily performed by or under Ilia i)ii cl su11..1..1,1:ar .,. ,)iii+., Is, directors of trustees, or key employees to a management COriipetly 01 other perkon? .... 4 Did the c•u1ariiza.trun make ;.coy significant changes to ifs ylovemin9 documents :,irU.4- the prior Fenn 990 woe, filed? " ...... . 5 Did the orn nut lion become ;aware during the year of <i significant diversion of 'he urgarri ,,Bee's asset.:.? 6 goes: ire ui anizaiinn have members or stoCt,holders?... .... .... ................. ....... .... ... 7a r.Jes 51 a orri,nivitinn have eteinbers, stockholders, or other persons who may eieet one or more n•reniber5 of ih;' owe' nirirl I "ly? . _ , . ... . . . . ... • b 1'.r'• 7riv der i' -ion • of Itio go'.c•'rriin0 body subject to approval by members, stockholders, ,.e.+,thee NI -oris.' . 713 13 C).,1 Ili.• orcesnizr.tion col itemooraneousdy document the meehnes held) or written actions tindeit;iken derive iiie Vic;.::: , the loll:. i,r0' 8a;.1 M,• lass..:::ming body? . . h F .:''h r omi'Ii11C0 wen authority to ec1 on behalf of the governing body? .. .... . • ... • . .. ... .. . .- 9 IS 111rlr• iely officer, director c;r trustee, or key err1)IUyee listed in Part Vit, Section A, •' i)u c::11:1 ht: 1.a<4 Iloilo! iiie r n;,:. r:::::,1 on's orlilint .idche'.s'? I! Yr .' prgvrde the names and i,r,uresses in Schc 'ii/.> 0 ) Section L',. Policies (17tis Scclion 0 tequtsts informatonab!iut poheitis mit fequlted by the Mier 1?evenurr Orel_ :Ua 1::!*:-: lite of it uzR;nil iinvi'. local choptr;l 5. branches. or irffiliale5?.. .. • . .... • • • .. . I, it 'Yes,' does the cr.g•'inizaliCf hs,ve v;riiten policies arid procedures governing the acii'i•;it::, u1 s- K.1i 0i1:ilier.i. a iii'•'... 1011 _ oNei 1)15'Ich0. to 111isures their operations are consistent with those of the organization?.... . . .. ..... "1 a Ha the orga organization provided a copy of this Form 990 to all members of its governing body before filing roe l Miro.. .. ` 11a X b Describe in `• cnedule 0 the process. if any. used by the organization to review this Form 990 See ScIte.dule 0 _.. 12<') Doe; lire ;)cgauriz<ainn hive a written conflict of interest policy? 11 'No,' go to line 13 .... ... .. .. • . . 12a b M:^ oi!irers.. aiicrc•lors or trustees, .:nd kw employees required to disclose annually iirtorest.r that cauk div,; ri,:: lu (nonfat .r . ... . . ... . .. . ....-. . . ... c DIY:S 13i1 oirj.r!i/. iion regularly ,)rd consistently monitor arid enforce compliance with the policy? 1r '1, <.' d.: s(•r).' ,.• ,rile,•;111:. 0 noxi' itu< (5 (trio:. . ... .. . .. . . 13 Oar ; llie ofgenizf,lion leave .3 written wilislleblo. cr policy?.. . .. .. • - 14 Does tire al.lar:izatiun have a written c!oeurrient retention end destruction policy? ... .. • • .. . • . • 15 Dirt II -ie t)ror^,:, tar determining compen eIion of the following persons include a review and approval by i'0rl:-;',•n:i-•rii j,ar<.;oes, rnnimr-4bility data, and contemporaneous substantiation or the deliberation and decision? a Tire oroeni•c�?!ficin': CID. Executive Director, or top management o(lic:ir•ii.. See . Schedule. 0 h otirei ,1 ircee of fa:y oeiploy:es of the utcasrii,_ation , 1' 'Yei:' Ir. lino 1!;-. or 15b, dpacrihe the process in Schedule 0. (See instructions.) )fia1):rr'he ;,iri;,ni. -ti invest in, ronlributeascr:'ls1u.(II participate in«joint venture or similar ..n;i1v31mra':r:lh:f i.::.i,lr. -'nlity during tire ye -<i ? .. ... .. . .... ... ... . . ..... . . - . ..... . • • written re iring e zetion to b G Yes,' has tireilirre in jr1iil venture arrangerrntion adopted aents under app Iicr_blerfodre.ral tax law. alnd takenisteps to s� e'quealltiii „r•aarie• tion'~ ex'-'oipl .Sia tus with respect to such arranger encs" 16I) .3 7a X 126 IJiI 756 r No Section C. Disclosure 17 _ist the slates with which a copy of this Form 990 is required lo be filed ► iskine _ - _ - . - - - -- - - - 113 :5,N:14,111,104 requires an organization to make its Forms 1023 (or 1024 it applicable), 990, and 990• (301(c)(3)'- 1)11!") ;;'rcirroble .,,, ride'.... hit; -:1 tori. lridlr•S13 I'iow you make these available. Check ail that apply. IA,riolher's website IXI Upon request Ui,ii trFli5ll(? 1-1 _ 19 Dem., i..: in Scireciukl U whether (and if so, how) the organization makes its governing docurtrants, (,01111 1 of interest 1,08, y. a:i•• irri:,tl '::I .t- t:»nr• :iiF-^vail•.iif' to the peblic See Schedule 0 20 Slate the refer, i-hysicai address, and telephone number of the person vain possesses the honks and records of the oie.eie- a on. b-Mar•xJ._In R S atson 41.85 Elm St Murrieta Ca 92562 ,(951.) 304-120(1 I3AA I,_CA0l0'i. t2i_Ur0 Ilea 990 (:'flit!) ■ l• Yi 111 1 Form 990 (7010) Women's Breast Cancer Resource. 33-055127 6 Patio 7 LPart II Compensation of Officers, Directors, Trustees, Key Etnployees, Highest Compensated Employees, and independent Contractors r i r l ,cure ()r,vr I, a .'.: response: to any.r1uesfion in this Port VII .... Section A. Office)s1Director's, Trustees Key Employees, and Highest Compensated Employees + a l;r mill• 1: i:! : for all pe icons reuniter) to he listed. Report compensation for the a ilurider yea' c:,adut:7 with .,r wtItul l ;: . crty rii;.: on's I.'x year • List all of the organization's current office's directors, trustees (wheiiier individuals or organizations), rcpm(lles, u, i i•.ul't rl. o,?nsatuwn. 3:•nt i -(:- in columns (I)). (E), and (t-) if no compensation was paid. 0 .all of the (,rganizaathori s current key employees, if any. See instructions fol definition of 'key employee.' O +. ;', ;' :.nl•I+ I --aims tier, current highest compensated employees (other than an officer, director, liu_:t.:», oI ka', ciiii:toyec) .Alo on=ali:m tI3ox 5 of Form WI andira, Box 7 of Form 1099-MISC) of ntoro Ih ri $100.000 firm, Ito crgan,7:eti^.0 ::r,(I "r"r' G 1.11;1 II r,: 11 ,r: nru<.rriz%,tiun's former officals. key employees, and highest compensated employees .'.ho tecetved us:,; ;I.nrl C100,000 of , ilei'!, II'II^. U, 0:Thizetiuh and any 'elated orwmizations. O Lost a:U of th.: omaniz:;lfor's former directors or trustees that received, in Out cztpacity as :I forrarerr.f ilI' .'::ium, mote II I::ri '100,000 id Iepu(t31 1c compensation from the organization tirid an.r rel ti (f ' i0.1nirr:ai(:n= I_ S! '<.'i on° in the l)Ik, wI11 or(IEI: individual Itustees or Jirectni : institutional trustees; oflict:Is; key (:1111.2» )cs: 3 iiol1'•>°t cow:- .1 '•t: oml>!(+yees; and tonna, :uch poisons. Check Ihis arx if neither the organization nor any relator! (i1rl, uizatlora sompensalEd r.rty ruri ni office' r1; .'clor, or hitsioo (0) (D) (r_) (i) ft". ,,i.1Ili!^ — l(i) �'a0., yil !, f Prt>S,.dc ;Ale": t- . VJ_"c I'OPSide'i t La)_ Waynew?:i L son >r ( H- (5) Cincler. oont _ _ 1)i' rCto! 4 Di rector 10 i _(7) FI„ .'.LrD Di illlaC.io _ I -,Director 3 _(0)_Kipberly__Gpodno_ujh _.--- ):•rec-l:fr. ive al. r.ec 50 l 0. () . 0. 1 e) 0. . 0. 0. 52,849. 0 . I) . 0 . l 0. 0 . 0. 0. 0 . s12) lr_EA11111i 12121/1/) I:,iiII: 990 (-'01:1) 1 Form 990 (2010) Women' s Breast Cancer Resource 33 -0 51 211 C• Par;,-. 8 •K E to ees Ind Highest Con�ensated F rltpioyees �x1r1fl Part'V11 i Section A. Officers, Directors, Trustees, ey mp y 11 r:a Jq =ir1 - (o) r: ,�i. ... (E) I:. I IP:..r i..,,,..; A1.1'..• 0'7.'411 Y 7A1't.t (F) >4 :r '• . b,,: .. I. (A) (a) A: 1.0.... I. (c) Ft•5ilin,: it itN.Ic (18) (19) _- ---- - -------' (20) (21) (L2) - ---- ----- - (t3) (?4) — - -• -----•------- --- (25) - - - -. (2.6) ---- --__ (?7). -- ---- -- - - - _ (28) (29) --- -- 1 b Siih-total c 1'ot. I tiom continuation sheets to Part VII, Section A; . • :: r 0. 57.. Q 9. 0 0. rE Total (;1441 1rxts 117 and I c) 2 1 ot,1 number of individual; Occluding lr)I not limited to those listed i.:bove) who received more Than $100,000 in reirrn l.:':! I:f;l-1 lE r r�rcrerlizatiou P" 0 3 raid tl•r; olvaiiizalion list any former officer, ((hector or trustee, key employers, or highest compensated employee on tint! la. 11 'Yea, • complete Schedule .1 for such individual.. .... ..... ... . . 4 for any irutividu, I listed on Zine In. is the suin of ,n sortable c.ompensatian and other compensation 'root the orcarli ation and Ielaal1)d organizations greater than $1 50,000? 1f 'Yrs' complete Schedule .l fur a'K'11 rri,livitl'1t'-1 .. - . ... . , .... ..... • . ... . 5 Dir) 71n)' I1or?011 IIleri on line 1£, re(.eiv,, or accrue compensation front any unrelated n: zilizatron or lilcrri:i.i,:;`I lilt sus vi(' -:'i i ra'1''J.I l lo the Atli itiz•.1hon? If 'Yo:;.' complete Schedule .1 Io: Sikh /Ic rwn • • Section B. Independent Contractors 1 (;ornpb!P llitis 1:11 4!. for your five: iitlhAst can111onsate i indrin_nrloni contractors that received more th m.l00,001) (1' coni. r rs.diun Inn11 the orowiiz:iirctl,. Yes 3 4 I .0 5 Name and business address 1)esc:riptioti of :2r vices (C) (.rlulr:r'11: •.Ilr!ti 2 1'o1::.I n,:ntber of independent contractors (including but not limited to those listed above) who received more than $100.000 sn wmp ensalion Iron'' the organization ► 0 CAA TFRA010.';L 12121ttu 1 ca•rn 990 (%(::'1) s'd Fon., 990 c(10) Women ' s Breast Cancer R8S011rce !P;!rt Vill Statement of Revenue Ft.iterated campaigns . b Pliernbei4iip dims. ,,,, c Fontlraising events (1 Reii:Icd digy:lizatioi . O 11e: frik t !.- 01:s, Mid 51111114 01:101 altiej;: g affair-Altars:uiirlp iSins 1r1•11: $ h Total. Add lines la- If ............. ijsiius Code 1a lb lc 1 d le if 33-09512'6 9 (A) iOI rcvonue (B) Related Or exerni-.1 foxtrot IVVCrILIC: (C) JIH 168,766. 21'1,087 h - • to 2 V 1 All other pi °grain service revenue . III 0 (..1 h. Total. Add Iiiies e 3 lov-stment inconi(inc!uding dividends, interest and 2;1•2U other similar arrow ils) 4 Inceine Irom investment ot tax-exanipt bond proceeths d5 Royal ileS . . .. . . .............. ... . /'` ;.1 I: 1! (11 379,853. (p) h srt,n r j A , ,i, LI 6a Gloss 'tents b ie.ntal evenses. c iitoA income: (Io) . . . ti Nei rental income or iIiTIii 7a fir rz,.. rriiievrit ; 01;0 invoireiy.. b 1 Ord ri • .:11.,,• C C I Ji (Jil! A :•,111 or Voss) .. 8a Crossincome from tundiais,ing events (not Including. $ of contributions reported ort line 1c). See Rad IV, line 18 a b Less. direct expenses c Nr.:1 or (loss) troin iundraisino events. 90 Gross income fron: gaming activities. Sir- Pan IV. line 19. . " b Less: direct expenses .. . b c Net income or (loss) from gaming activities.. .. ... 10a Gross s:iles of inventory. less returns and alloi,vances b Less-- of goods sold . c 11.r1 income. ie (loss) from szleS of inv nicey 1.• - Nioines5 Code 11 _ d All other rovenue ....... „ e Total. Add lines I1a• ........ 12 Total revenue. See instructioi is. . . .379,853. O. 0. C'011!. 10ii1/10 0 l')rrei 9911 (.()1(r`i 1 1 3]-0��121S r�,m 3]-0��121 990 (•:-.01(1) Women'x Breast Cancer Resource F enses '~'^`~ _tf tio*�nctional 'W�a��/�Vm���n��;��,� All ^ox,*rom��".nv"m,,"v,="^ ..-~----- (A)R Tom|ex/»:�^ - m��� expenses (C) n� m,10mlvnc/ev^ V8 /u�wp� "w',"'' 70 not include amounts reported on lines 9b, 7011 of Part V1Y. -'_- ;b, 7b..3b. and _-�~_-- ___-' ___-----.____' z u^» /./�,.viosi^"^ to w.m*,k..` o°11... F''�*xtIV, !i'p22 ' n m�as."ym/ wno"o'^�~ outside ,= ». -_-_- ---- — :�.*���xm|�r /Saw ... — 4 s*uvts',m1*mw"members .. s cw w�.w«nmomvmces.«ir*x»"s, �2 84g. _ 0. 52 849. �� V. v'«~~'. ",^.�prwon*yr,x, ....�� x* to 0�l�on1:11t��»1rsmodesoihru °^ O. ---' �,s»"/^9S�;�uG � � 7 omw ,u"oo^mawnne, ... contrib. 0��� � scri,v wWu,tmn4.030* a1T1^ov.`,vnoxxxm151. . . , — . . • 9 Oilwr '.. y'�:s ~., .... ��� 10 onu n ,.',^, '"we*('"n+mpm,':,): ^ �`,^` "*./ � � ^'.~+ . c*r:mu'n . ��� «/owvnp • •'• '• en�*=/..a,:i;luny ;`ao`�Pail. IV, rine //' / /.�+.m^.xo*v.,o*^r" me,. ..• • • • v/wm � � . � /x �°.te�fau'"omx.a_____ `a /x�m ''xx�«� � �_ 14 '"^.'u.^^�u**`n' . `� :^�^n,s 16 w�vranY . . '.. 17 fi^vp . . . . m 1• m =" `-�� fpe/aistate, mlocal public""°" . '' .' � ^vg, . � p"*. .n/n;^^n,.mx a° 19 t�m~no 20 �'`:,:^ � ��� ' 21 /``�...o/��om/w" � . . �. � ' ' 22 n�**`^ow.oe�wx*��,\*o,mcmmn . 23 /.ew`*'` .. ot lio...k. lio..^ 241 �''column — t line `°~~' '�������� �)-''� ��� Cun'�c �6 OO5 . oo�. yu'_ ]'6OV. --_ _ ' — ____ ___ _- l.ZUO.______-_--__ ----- 1,43.5. L. ---- --- _____ ___ __ 6,445. ____� _-6�`.___________ ___ -- _-� -__ _ 3 2 311. 33,3] � . --'-- _______ %2,Jl5. ---- 22 �lS , . �__° ____ .____ ___ ------ ______________ ________ __�____ ----' ________� 6 ]85 , . 8�385� ___ ------- ----- _____ Il2 2�7 ^ ^4 2% O3l 112,247. __ --- ,Ki!.' oDc�l�ce -- eo uri(5a��i��ev(!:���eoa 8ven� . lS 246 , . ____ |�����. �� �^ . _ �i�'� Lerno� 49 34 449. 34., � ' 1.1' 96.3.?gu����n�e�Qernle /^�oU�/�`p'n:s� � ' � ' •'� •� Imes I iiacatuti 24125 11 963 ^-''-�' --------------�3,7�7. *0V '---'-- 09 1l5 .26 �6^��V� , 411,0I8.. 265,663. Total functional axpemos..M0; Joint costs. Check hei 0 IP H if followingSOr 05.2 (ASC 95S-720). Canplete this linecoiny if 11:.,: in woulniliun repcutei in column `=^w� novp ;'off 1 990 W010Y WOMen art.X 1 Balance Sheet Breast Cancer. Resource A s 1 Cash -- non -interest -healing '' • . 2 F,,svri igs arlti tr.mrpor ar y . .. 3 Plechies aid grants rc-weiyable, net 4 Ac, receivable, net .. " " 5 Ret.eivabli..q from cut i111 and former officers, directors, trustees, key einployees, 4riti comirPr1sa1••,q1 employees. Complete Part It of Schedule L.... ...... 6 Iteeeryab:esrroin other clisqualilied persons (as refined under section 4958(1)(1)), '.periojits de'•:cribr.,1 in -section 4953(c)(3)(B), and contributino employers arid Sporiserin9 erg,nizations cr 6eCtion 501(0(0) voluntary emuIrryeas* beneficiary limpriizatioos (see instr uctIons) 7 Moles :Bid is receivable, Del 13 Inventories tor sale or use " ....... • • ' "' 9 Pic:paid ee,penses and deferred charges, 1 10a Land buildings, .../nd etluipment: cost or other basis. ' Complete Part VI of Snaile D .. .. ..... 101 83,984. b Lr',1: Pwcuinulaleti depreciation. ... • . . 10b 23,874. 11 .riA:stioc11tt5 - „tubridy iia•led securities.. ... 12 invoinents - other securities See Fart IV, 13 Inve,triwnt.e. - prograni•I elated. See Part IV. line 11 '14 Inta‘sible asse.,s.... ... .......... ......... .... . 15 Other r•issets. Se:? Part 1V. rine 11... ... , . .... ... . • • • • 1G Total assets. A;fil lines I itire(iqn I 5imust -equal-. lin'• 34).• 33-0951216 r to,,: 11 (A) Beginninu of war 126,860, 1 (13) Eiv; e! /0:ir 1 01., 81.6. 2 3 4 5 6 7 9 66,223. 10c, 60, 10„. 11 12 13 14 15 17 Acc,,,H;14 lovatile and accro,:d expenses .. • • • • • • 18 Gr.4113 pay;)blc., . • , "9 Dr:rem:ft revenue li 20 1',..y•exervipt bond ...... • ....... ...... . ........ fi 21 ay: or custodial account Iiability. Complate Parl IV of Schedule . . 22 P'•vables to ciarent and fernier officers, directors, trustees, key employees, Holiest r•erriperisated employees, anrl disqualified persons. Complete Part i of S.iiver, 23 1,11)itgages and notes payable to unrelated third parties 24 tlosscuied nolc:, and loans payable lo unrelated third [req.. 25 Other iiabiblies Complete Parr X of Schedule D . ..... 26 Total liabilities. Add fines 17 through 25 ... ... . Organizations that follow SFAS 117, check here IP LI and complete lines 27 through 29 and lines 33 and 34. • 27 Unrestricted net ascets... . ..... . , • • 20 re:ropolarily iestrictert net assors ....... 29 Pfl?IIeotIy ix:stricter:1 net e.ssets . ........ ...... . Organizations that do not follow SEAS 117, check here and complete lines 30 through 34. 30 Carta' slcrIr or trust ptincipal, oi current kinds . 31 Prwi-ir or C.:LPitd surplus. or land. building, or equipment fund A LA' 32 endoyvment, accumulated irIN1ITIrI. or other funds.. C 33 Toll oet assets or fund balances_ - - . • . • 34 Tot.,.:1 1,:thilities a )d net ass:,31i/turd balances. #3/1A VEEP.0,111 ;2/4:1/11) :1,93,091.16 17 18 19 20 21 22 23 24 25 0. 26 27 28 29 242,055,. 30 or' 0 31 -48,964 , n2 -16, 21.8. 193,091, n t61, 926. 193,091. 34 161,926, firla 990 (41101 .1 Rom 990 (2010) Women's Breast: Cancel: Resource 1Part Xl I Reconciliation of Net Assets Ck.c.1( if Schedule 0 contains a response to any question in this PfL X1.. .. ...... . 1 Tat f*. Ver1110 (Mils; equal Pal t VIII. uoluion (A). line 12) ......... . 2 lelal empens (must equal Pad IX, column (A), line 25)... _ . . • • _ 3 lzkvenve Ies expens. Subtract lint, 2 item lino 1 . ..... 4 Net assots or kind balances at beginning of year (must equal Part X, line 33, column (A)). 5 Oho &engem in net assets or lund balances (explain in Schedule 0) 6 Is! -ti or lind bulanrxs %..tt end of ye . r.fiCombine lines 3, 4, and 5 (most equi Part X. line 33. ()hon:in ....... • • . • • • . . • ....... ...... . iPayt 1 Financial Statements and Reporting chec:: if i;r:1-Kciitle 0 G of ilains a response lu any -question in this Part Xit . • • • • • .. • .• I" 'Accounting reethott used lo prep -are the Form 990: Li] Cash Accrual Other li the organization changed its method of accounting from a prior year or chocked 'Othet,' explain in 9(1u:chile 0. 2a Wer ihe organization's fine.ncial statements compiled or reviewed by an independent accountant?..... ... • .. • b Vie organization's filiancial statements audited by an independent accountant? 1., lin, or 2;.:. the: orgailization have a committee that ac.sunics responsibility for oversight ol the audit. 1.1 compilation of it-, financial sIdements :-;nd selection or :In independent accountant? . ..... . • tinitiitt.ii Pittitn its i;vdisi9Itt proCeSs or Selection JI ocess (hiring Ilio tax year, e7p1,:in int'.1. 1 :di* 0 dll to lin 2a or 2b, check a box blow to indicate whether Lite linantial statements oi Itis yiiweire tsru”dort $epat ate W.1:;i.s. consolidated basis, or both: . . 1 I Separate basis [1 Consolidated basis 0 Both consolidated and separate basis 3a As a ir suit of s !etteral awatd, was the Organization required to undergo an audit ot audits as set forth 11 thcc Sitioi.: Audit Ad and OMB Circular A-133? ...... • ...... .... . .. • • . • b 11 ".'es.' clid enetitii.alion undergo the required audit or audits? If the organization did net undorqo the requited 31.tiii • wit? lit Si 0 and descrtly: r:iity steps taken Io undergo sorb • ....... 33-0951216 2 3 4 f15 3 . 111., 193,09j, 6 925. 13AA 1Et.101121. 12i2inu 3h1 runt 990 , Internal Revenue Service [ t€: November 8, 20O WOME1 BREAST CANCER RESOLJRC MARILYN R WATSON 41538 E A'-'31 IVIAN UI 6viir�iis,l=€,� CA 92562 Department of the Treasury P. 0. Box 2508 Cincinnati, OH 45201 Person to Contact: Steve Brown 31-0742:2 Customer Service Specialist Toll Free 'Telephone Number, 8T/4329-6500 Federal Identification Number ; ;33.0951216 i‘; In response to your request of November 6, 2005, regarding your organization's tax•-exeropt states. in peci tuber 2001 we issued a determination letter that recognized your organization as exempt from federal Income tax, our records Indicate that your organization is currently c: xerrrpt under section 501(r4(3) of the Internal Revenue Code. Our records indican: that your organization is also classified as a public charity under Mctiran 509(a)(2) of the internal Revenue Corte. Our re:"'unix iros iva Fr that contributions to your organization are deductible under section 1-i0 of the Cods, and that you are qualified to receive tax deductible bequests, devises, transfers or gifts rsrndcir S8000112055, 2106 or 2522 of the Internal Revenue Coda. is you i'tavF! any questions, please mai us at the telephone number shown in the heading of this letter. Sincerely, AleA44'7:161i64) Janna K 3hufra, Director, TGE Customer Account Services Judy McNabb From: Goodnough, Kim <kgoodnough©michellesplace.org> Sent: Thursday, September 15, 2011 3:43 PM To: Judy McNabb Subject: Michelle's Place Grant Application Attachments: Grant App 1.pdf; Grant App 2.pdf; Grant App 3.pdf Hi Judy, Here is our grant application. Please confirm receipt. Thank you, KLvw Executive Director Michelle's Place, Breast Cancer Resource Center 27645 Jefferson Ave. #117 Temecula, CA 92590 951-699-5455 www.michellesplace.org DEPARTMENTAL REPORTS Item No. 26 Approvals City Attorney Director of Finance City Manager ffiief-- OcL CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Shawn D. Nelson, City Manager DATE: December 13, 2011 SUBJECT: City Council Travel/Conference Report - November 2011 PREPARED BY: Sue Steffen, Executive Assistant RECOMMENDATION: Receive and file BACKGROUND: On November 2, 2011 Mayor Ron Roberts traveled to Los Angeles, California to attend the Southern California Association of Governments Executive/Administration Committee, Regional Council, and Joint Meeting of the Regional Council, Community, Economic & Human Development, Energy & Environment and Transportation Policy Committees. On November 8, 2011 Mayor Ron Roberts and Council Member Jeff Comerchero traveled to Phoenix, Arizona to attend the National League of Cities Congress of Cities Conference. In addition, Mayor Roberts attended the National of Cities Transportation Infrastructure and Services Policy & Advocacy Committee Meeting and Council Member Comerchero attended the Community & Economic Development Steering Committee Meeting. ATTACHMENT: Meeting Agendas SOUTHERN CALIFORNIA ASSOCIATION of GOVERNMENTS Main Office 818 West Seventh Street 12th Floor Los Angeles, California 90017-3435 t (2131236-1800 ((213)236-1825 wwwscag.ca.gov Officers President Pam O'Connor, Santa Monica First Vice President Glen Becerra, Simi Valley Second Vice President Greg Pettis, Cathedral City Immediate Past President Larry McCallon, Highland Executive/Administration Committee Chair Pant O'Connor, Santa Monica Policy Committee Chairs Community, Economic and Human Development 1318 Jahn, Big Rear Lake Energy & Environment Margaret Clark, Rosemead Transportation Paul Glaab, Laguna Niguel MEETING OF THE EXECUTIVE/ADMINISTRATION COMMITTEE PLEASE NOTE TIME Thursday, November 3, 2011 9:00 a.m. — 9:30 a.m. SCAG Main Office 818 W. 7th Street, 12th Floor Board Room Los Angeles, CA 90017 (213) 236-1800 If members of the public wish to review the attachments or have any questions on any of the agenda items, please contact Deby Salcido at (213) 236-1993 or via email salcido(,7scaq.ca.gov Agendas & Minutes for the Executive/Administration Committee are also available at: www.scaq.ca.qov/committees/eac.htm SCAG, in accordance with the Americans with Disabilities Act (ADA), will accommodate persons who require a modification of accommodation in order to participate in this meeting. If you require such assistance, please contact SCAG at (213) 236-1928 at least 72 hours in advance of the meeting to enable SCAG to make reasonable arrangements. To request documents related to this document in an alternative format, please contact (213) 236-1928. The Regional Council is comprised 01 84 elected officials representing 191 cities, six counties, six County Transportation Commissions and a Tribal Government representative within Southern California. 7.1.11 EXECUTIVE/ADMINISTRATION COMMITTEE AGENDA NOVEMBER 3, 2011 The Executive/Administration Committee may consider and act upon any of the items listed on the agenda regardless of whether they are listed as information or action items. CALL TO ORDER & PLEDGE OF ALLEGIANCE (Hon. Pam O'Connor, Chair) PUBLIC COMMENT PERIOD — Members of the public desiring to speak on items on the agenda, or items not on the agenda, but within the purview of the Committee, must fill out and present a Public Comment Card to the Assistant prior to speaking. Comments will be limited to three (3) minutes per speaker provided that the Chair has the discretion to reduce this time limit based upon the number of speakers. The Chair may limit the total time for all public comments to twenty (20) minutes. REVIEW AND PRIORITIZE AGENDA ITEMS EXECUTIVE DIRECTOR'S REPORT (Hasan Ikhrata, Executive Director) CONSENT CALENDAR Approval Items 1. Minutes of the October 6, 2011 Meeting Attachment 1 Page No. 2. SCAG Sponsorship of Annual Events: 1) Los Angeles County Attachment 7 Business Federation ($25,000); 2) California Transit Foundation Transportation Education Symposium ($1,200) 3. Development of a "Local Control" Approach to Amtrak Pacific Surfliner Attachment 9 Services on the Los Angeles — San Diego — San Luis Obispo (LOSSAN) Rail Corridor 4. Contracts/Purchase Orders and/or Amendments Between $5,000 - $200,000 Attachment 11 CFO MONTHLY FINANCIAL REPORT Attachment 35 (Wayne Moore, Chief Financial Officer) FUTURE AGENDA ITEMS Any Committee member or staff desiring to place items on a future agenda may make such a request. ANNOUNCEMENTS ADJOURNMENT The next regular meeting of the Executive/Administration Committee will be held on Thursday, January 5, 2012 at the SCAG Los Angeles Office. SOUTHERN CALIFORNIA i ASSOCIATION of GOVERNMENTS SOUTHERN CALIFORNIA ASSOCIATION of GOVERNMENTS Main Office 818 West Seventh Street 12th Floor Los Angeles, California 90017-3435 t (213) 235-1800 ((213)236.1825 www.swg.ca.gov Officers President Pain O'Connor, Santa Monica First Vice President Glen Decors, Simi Valley Second Vice President Greg Pettis, Cathedral City immediate Past President Larry McCallon, Highland Executive/Administration Committee Chair Pam O'Connor, Santa Monica Policy Committee Chairs Community, Economic and Human Development Bill Jahn, Dlg Rear Lake Energy & Environment Margaret Clark, Rosemead Transportation Paul Glaab, Laguna Niguel No. 533 MEETING OF THE REGIONAL COUNCIL PLEASE NOTE TIME Thursday, November 3, 2011 10:00 a.m. - 10:30 a.m. SCAG Main Office 818 W. 7th Street, 12th Floor Board Room Los Angeles, CA 90017 (213) 236-1800 If members of the public wish to review the attachments or have any questions on any of the agenda items, please contact Deby Salcido at (213) 236-1993 or via email at salcidoRscaq.ca.gov. In addition, regular meetings of the Regional Council may be viewed live or on -demand at www.scaq.ca.gov/scagty Agendas & Minutes for the Regional Council are also available at: www.scaq.ca.qovicommittees/rc.htm SCAG, in accordance with the Americans with Disabilities Act (ADA), will accommodate persons who require a modification of accommodation in order to participate in this meeting. If you require such assistance, please contact SCAG at (213) 236-1928 at least 72 hours in advance of the meeting to enable SCAG to make reasonable arrangements. To request documents related to this document in an alternative format, please contact (213) 236-1928. The Regional Council is comprised of 84 electecl officials representing 191 cities, six counties, six County Transportation Commissions and a Tribal Government representative within Southern California. 7.1.11 REGIONAL COUNCIL AGENDA NOVEMBER 3, 2011 The Regional Council may consider and act upon any of the items listed on the agenda regardless of whether they are listed as information or action items. CALL TO ORDER & PLEDGE OF ALLEGIANCE (Hon. Pam O'Connor, President) PUBLIC COMMENT PERIOD — Members of the public desiring to speak on items on the agenda, or items not on the agenda, but within the purview of the Council, must fill out and present a Public Comment Card to the Assistant prior to speaking. Comments will be limited to three (3) minutes per speaker provided that the Chair has the discretion to reduce this time limit based upon the number of speakers. The Chair may limit the total time for all public comments to twenty (20) minutes. REVIEW AND PRIORITIZE AGENDA ITEMS PRESIDENT'S REPORT Page No. 1. New Committee Appointments EXECUTIVE DIRECTOR'S REPORT (Hasan Ikhrata, Executive Director) COMMITTEE REPORTS/ACTION ITEMS Executive/Administration Committee (EAC) Report (Hon. Pam O'Connor, Chair) Community, Economic and Human Development Committee (CEHD) Report (Hon. Bill Jahn, Chair) Regional Housing Needs Assessment (RHNA) Subcommittee Report (Hon. Bill Jahn, Chair) 2. Final RHNA Allocation Methodology Attachment 1 Recommended Action: Approve the Final RHNA Allocation Methodology. Energy and Environment Committee (EEC) Report (Hon. Margaret Clark, Chair) Transportation Committee (TC) Report (Hon. Paul Glaab, Chair) Legislative/Communications and Membership Committee (LCMC) Report (Hon. Judy Mitchell, Chair) � 4 SOUTHERN CALIFORNIA 111, ASSOCIATION Of GOVERNMENTS 1 REGIONAL COUNCIL AGENDA NOVEMBER 3, 2011 CONSENT CALENDAR Approval Items 3. Minutes of the October 6, 2011 Meeting 4. SCAG Sponsorship of Annual Events: 1) Los Angeles County Business Federation ($25,000); 2) California Transit Foundation Transportation Education Symposium ($1,200) 5. Development of a `Local Control" Approach to Amtrak Pacific Surfliner Services on the Los Angeles — San Diego — San Luis Obispo (LOSSAN) Rail Corridor 6. Amended Memorandum of Understanding (MOU) regarding the Southern California Inland Corridor Group (SoCal ICG) 7. 2012 Proposed Regional Council and Policy Committee Meeting Schedule Receive & File 8. Contracts/Purchase Orders and/or Amendments Between $5,000 - $200,000 9. November 2011 State and Federal Legislative Update INFORMATION ITEM 10. CFO Monthly Report FUTURE AGENDA ITEM(S) ADJOURNMENT Page No. Attachment 21 Attachment 27 Attachment 29 Attachment 31 Attachment 45 Attachment 47 Attachment 65 The next regular meeting of the Regional Council will be held in conjunction with the Transportation, Sustainability & Economic Summit on Thursday, December 1, 2011 at the Wilshire Grand Hotel, 930 Wilshire Boulevard, Los Angeles, CA 90017. SOUTHERN CALIFORNIA ASSOCIATION or GOVERNMENTS ii SOUTHERN CALIFORNIA ASSOCIATION of GOVERNMENTS Main Office 818 West Seventh Street 12th Floor Los Angeles, California 90017-3435 t (213) 236-1800 f(213)236-1825 www.scag.ca.gov Officers President Pam O'Connor, Santa Monica First Vice President Glen Becerra, Simi Valley Second Vice President Greg Penis, Cathedral City Immediate Past President Larry McCallon, Highland Executive/Administration Committee Chair Pam O'Connor, Santa Monica Policy Committee Chairs Community, Economic and Human Development Bill Jahn, Big Bear Lake Energy & Environment Margaret Clark, Rosemead Transportation Paul Glaab, Laguna Niguel JOINT MEETING OF THE REGIONAL COUNCIL, COMMUNITY, ECONOMIC & HUMAN DEVELOPMENT ENERGY & ENVIRONMENT AND TRANSPORTATION COMMITTEES PLEASE NOTE TIME Thursday, November 3, 2011 10:30 a.m. — 1:30 p.m. SCAG Main Office 818 W. 7th Street, 12th Floor Board Room Los Angeles, CA 90017 (213) 236-1800 If members of the public wish to review the attachments or have any questions on any of the agenda items, please contact Deby Salcido at (213) 236-1993 or via email at salcido(c�scaq.ca.gov. In addition, this meeting may be viewed live or on -demand at www.scag.ca.gov/scagty. SCAG, in accordance with the Americans with Disabilities Act (ADA), will accommodate persons who require a modification of accommodation in order to participate in this meeting. If you require such assistance, please contact SCAG at (213) 236-1928 at least 72 hours in advance of the meeting to enable SCAG to make reasonable arrangements. To request documents related to this document in an alternative format, please contact (213) 236-1928. The Regional Council is comprised of 84 elected officials representing 191 cities, six counties, six County Transportation Commissions and a Tribal Government representative within Southern California. 7.1.11 JOINT MEETING OF THE REGIONAL COUNCIL, COMMUNITY, ECONOMIC & HUMAN DEVELOPMENT ENERGY & ENVIRONMENT AND TRANSPORTATION COMMITTEES AGENDA THURSDAY, NOVEMBER 3, 2011 10:30 a.m. — 1:30 p.m. CALL TO ORDER & PLEDGE OF ALLEGIANCE (Hon. Pam O'Connor, Chair) PUBLIC COMMENT PERIOD — Members of the public desiring to speak on items on the agenda, or items not on the agenda, but within the purview of the Council, must fill out and present a Public Comment Card to the Assistant prior to speaking. Comments will be limited to three (3) minutes per speaker provided that the Chair has the discretion to reduce this time limit based upon the number of speakers. The Chair may limit the total time for all public comments to twenty (20) minutes. CONSENT CALENDAR Approval Item Pate No. 1. Minutes of the October 20, 2011 Joint Regional Council and Policy Attachment 1 Committees Special Meeting Receive and File 2. Draft Program Environmental Impact Report (PEIR) for the 2012 Regional Transportation Plan and Sustainable Communities Strategy ACTION ITEM Attachment 11 3. Recommendation by the Community, Economic and Iluman Development Attachment 15 Committee; Energy and Environment Committee; and Transportation Committee to the Regional Council that they Release for Public Review the Draft 2012 Regional Transportation Plan/Sustainable Communities Strategy (RTP/SCS) Recommended Actions (for Policy Committee members only): Direct staff to prepare and finalize the Draft 2012 RTP/SCS document based upon the preferred alternative described in the staff report, and recommend that the Regional Council release the Draft 2012 RTP/SCS for formal public review and comments in December 2011. ADJOURNMENT SOUTHERN CALIFORNIA ASSOCIATION of GOVERNMENTS co 7 w I- o • co (1-) n E a� 0 NATIONAL LEAGUE OF CITIFY Tuesday, November 8 g I. 1 i I! E OO OQO Co � 01m •-.-•-.-.-.-.-.-.-NJNJ „�o re�iMS o r9aaaaaaaaaaaaaaaa m O44O NJ rnrni.ainInla o o OQ C unnao 8 NATIONAL LEAGUE OF CITIFY Thursday, \ovembe Thursday. November 10 Time Leadership Training I Governance Meetings `Committees, Councils and I Constituency Group I Exposition jLContere^, a Wide Events] Mobile Workshops State League Activities ` Registration Institute I Panels Meetings f Meetings and Events g. 0 M t. g SML Pres/ED Brkfst 7:00 am - 8:30 am I O c fl o v k O o 1 1 1 g.111 1 Welcome Reception 6:30 pm - 8:00 pm g. 8 Q E ro 0 01 I 8:30pm - Midnight 8 Board and Advisory Council Meetings Noon - 8:00 am Board and Advisory Council Lunch Noon - 1:30 pm Resolutions Committee 1:30 pm -4:00 pm Nominating Committee IHeanng 6:30 pm - 8:OOpm Seminars 9:00 am - Noon Luncheon Noon - 1:30 pm Leadership Training Council' 1 2:00 pm -3:30 pm 8:00 a.m. 8:30 a.m. E E A A' O O O co Ol Ql 10:00 a.m. 10:15 a.m. 10:30 a.m. 11:00 a.m. 9 a O 0 0, O .. N ,_ ,_ 12:30 p.m. E O. 0 O _ 1:30 p.m. 2:00 p.m. 2:30 p.m. E E Q. Q n 0 C O N M 3:30 p.m. 4:00 p.m. 4:30 p.m. 5:00 p.m. 5:30 p.m. 6:00 p.m. 6:3D p.m. 7:00 P.m. J E E 6.6. 0 0 C1 0 f: CO E,E a, Q „9,8 W'i Cr; E E Q 0 0 0 th O Q1 NATIONAL LEAGUE OF CITIES Cr) z 1-O U� - O "' L1J X Lil zn oz UQ J L J Oo Zcv Friday, November 11 Registration E a 0 itiE co O 0 State League Activities League Receptions 5:00 pm - Midnight Conference Wide Events Concurrent Sessions 8:00 am - Noon Concurrent Sessions 1:30 pm -5:00 pm Exposition Exhibit Hall Open 10:30am-2:OOpm Lunch in hall Noon - 1:30 Constituency Group Meetings and Events 5:00 pm - Midnight Govemance Meetings a) _,E a E E o off; U m E 47, co c O E O o 2 E 18:00 a.m. E C O m 00 E ca O 0 61 19:30 a.m. E cv O O— O .— E Ln O .— 10:30 a.m. E „a 0 0 .— 11:30 a.m. E a 0 0 N — 112:30 p.m. E a 0 O .- 11:30 p.m. 2:00 p.m. 2:30 p.m. E a Ln V N 13:00 p.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. E a O O Cr; 15:30 p.m. 6:00 p.m. 6:30 p.m. 7:00 p.m. 7:30 p.m. 8:00 p.m. NATIONAL LEAGUE OF CITIES 07 UQ Zr J w Q ZT_cN Saturday, \ovembe NATIONAL LEAGUE OF CITIES r Z J L -Li 0 Z1N Saturday, November 12 c0 IP E a N 0 M Conference Wide Events Concurrent Sessions 8:00 am - Noon Closing Lunch and General Session 12:30 pm - 2:00 pm Annual Business Meeting 2:30 pm - 4:30 pm Phoenix Host City Closing Event 9:00 pm - 6:00 pm Constituency Group Meetings and Events 8:00 am - Noon Committees, Councils and Panels Meetings 8:00 am - Noon Time O o 00 18:30 a.m. ca O O 6') 19:30 a.m. cv o O— 0 ca Ln 0 ,- ca 0 m 0.L I- ca 0 O r- 111:30 a.m. a 0 off) N e- a 0 N 11:00 p.m. 1 1:30 p.m. 2:00 p.m. 2:30 p.m. 2:45 p.m. 3:00 p.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. E a O O Lr) [5:30 p.m. 6:00 p.m. 6:30 p.m. E a" O O I` 17:30 p.m. 8:00 p.m. NATIONAL LEAGUE OF CITIES r Z J L -Li 0 Z1N NATIONAL LEAGUE of CITIES FEDERAL RELATIONS COMMUNITY AND ECONOMIC DEVELOPMENT POLICY AND ADVOCACY COMMITTEE MEETING CONGRESS OF CITIES AND EXPOSITION PHOENIX, AZ Meeting Phoenix Convention Center Room 230 Wednesday, November 9, 2011 1:00 p.m. — 4:00 p.m. Presiding Gilbert Lopez, Chair Vice Mayor Coolidge, AZ NLC Staff Michael Wallace Program Director (202) 626-3025 wallace(a),nlc.org COMMUNITY AND ECONOMIC DEVELOPMENT POLICY AND ADVOCACY COMMITTEE MEETING AGENDA 1:00 p.m. WELCOME, INTRODUCTIONS AND MEETING OVERVIEW • Gilbert Lopez, Chair Vice -Mayor, Coolidge, AZ 1:10 p.m. CHAIR'S REPORT • Gilbert Lopez, Chair Vice -Mayor, Coolidge, AZ The Chair will update the Conunittee on the Steering Committee's work and its recommendations for policy amendments and resolutions. 1:30 p.m. PRESENTATION AND DISCUSSION ON THE CONSUMER FINANCIAL PROTECTION BUREAU (CFPB) • Representative Consumer Financial Protection Bureau The CFPB, created under the Dodd -Frank Wall Street Reform and Consumer Protection Act of 2010, is the nation's central authority for writing and enforcing federal consumer financial protection rules. CFPB representatives will discuss federal regulatory impact on consumer lending, new mortgage protections, and the general accessibility of CFPB officials. 2:00 p.m. ECONOMIC DEVELOPMENT RESEARCH AND RESOURCES FOR LOCAL OFFICIALS • Katie Seeger McConnell, Senior Associate, Finance and Development NLC Center for Research and Innovation 2:15 p.m. 2:45 p.m. CED REGULATORY SUBCOMMITTEE - UPDATE AND DISCUSSION • Stephanie Crandall, Principal Associate NLC Center for Federal Relations FEDERAL LEGISLATION AND ADVOCACY - UPDATE AND DISCUSSION • Gilbert Lopez, Chair Vice -Mayor, Coolidge, AZ • Michael Wallace, Program Director for CED NLC Center for Federal Relations 3:15 p.m. PROPOSED RESOLUTIONS AND AMENDMENTS TO NATIONAL MUNICIPAL POLICY The Committee will consider the Steering Committee's proposed recommendations for renewing or amending resolutions, or incorporating them into existing policy. Proposals for additional resolutions or policy amendments will also be in order. 3:30 p.m. LOOKING AHEAD TO 2012: Discussion of potential community and economic development federal policy priorities. 4:00 p.m. ADJOURNMENT 3 NATIONAL LEAGUE of CITIES FEDERAL RELATIONS TRANSPORTATION INFRASTRUCTURE AND SERVICES POLICY AND ADVOCACY COMMITTEE MEETING CONGRESS OF CITIES AND EXPOSITION PHOENIX, AZ Meeting Phoenix Convention Center Room 231A Wednesday, November 9, 2011 1:00 p.m. — 4:00 p.m. Presiding David M. Sander, Chair Council Member Rancho Cordova, California NLC Staff Leslie Wollack Program Director (202) 626-3029 wollack@n1c.org TRANSPORTATION INFRASTRUCTURE AND SERVICES POLICY AND ADVOCACY COMMITTEE MEETING AGENDA 1:00 p.m. WELCOME, INTRODUCTIONS AND MEETING OVERVIEW David Sander, Chair Council Member, Rancho Cordova, California 1:10 p.m. 1:20 p.m. 1:30 p.m. CHAIR'S REPORT David Sander, Chair Council Member, Rancho Cordova, California The Chair will update the Committee on the Steering Committee's work since the March meeting and recommendations for policy amendments and resolutions. VICE CHAIR'S REPORT Lee Dunlap, Vice Chair Mayor Pro Tem, Plano, Texas FEDERAL RELATIONS UPDATE Leslie Wollack Program Director for Infrastructure and Sustainability 1:45 p.m. POSITIVE TRAIN CONTROL Discussion of current mandate for railroads to update their signals and prevent crashes 2:15 p.m. PROPOSED RESOLUTIONS AND AMENDMENTS TO NATIONAL MUNICIPAL POLICY 3:15 p.m. The Committee will consider the Steering Committee's proposed recommendations for renewing or amending resolutions, or incorporating them into existing policy. Proposals for additional resolutions or policy amendments will also be in order. NLC 2011 INFRASTRUCTURE TOUR Julia Pulidindi Senior Associate, Infrastructure , Research & Innovation LOOKING AHEAD TO 2012: Patsy Kinsey, Vice Chair Council Member, Charlotte, NC Discussion of potential transportation federal policy priorities. 4:00 p.m. ADJOURNMENT 3