HomeMy WebLinkAboutContracts & Agreements_178-2017 LETTER OF AGREEMEN C
KAISER FOUNDATION HOSPITALS, FONTANA
COMMUNITY BENEFIT CHARITABLE CONTRIBUTIONS PROGRAM
I his letter of Agrec.rrri.nt (hereinafter Agreement ) is entLrLd into b1' and
(iet€ LLn Kaiser I-oundation floSpitals a Cahfornia nonprofit public benefit wrporatiotl
(hereinaltet KI I I ) and CIh' of Redlands a charter city or�ganired ir1 the StatL of
California and not subject to federal or state Income tai
I his A��rcenlent sets forth the undcrStandmg of the parties hereto as to thL
terms and Londition,, under which KI 11 shall donate Hinds iii the arno€int of S5,000.00 fol
a one vear funding period beginning,Ju1, 2017 through JuIN 1, 2015 for Thrix ing
Farmers' ,Market SLILh terms and Lnnditions areas lollo%�s
1 Ia\ I acmntion StMUS Grantee represent,, that at all tithes relevant herein it is a
elmartel city Oq aniied In the State of California and not subjCU to federal of state incnnmL
tai
2 Puroose of Grant GI-antee shall use entire Grant 10 support the. spcLlfie goals
Object'%es acti%ities and outc.ames as stated in the Grant Summar}
I \,ncnditure of funds 7 his Grant(togethci «rth ani rrIL0ML earned upon
InNe,,tmctlt Of L?rarlt funds) is madL 101 the purpose Outlined to the Grantee S Work flan
and IllaN not be expended lot ani other purpose %sithoLit KI I I s prior MAtiLn approval
4 Prohibited Uses 111 leo L\Gilt shall GranILL u,,c anN of the f unci,, 11-0111 tilts Grant to
(a) support a political campaign (b) S€1ppOrt of atterllpt to influence ani government
lc4atslattOrl eu ept making mailable the result,, of non-partisan analysis Study of
re,,earLll or (c) grant an a%xard to another part) or for ani purpol e other than one
SpeLrf€ed In Section i 70(c)(2)(b) of the Internal Re%cnue (ode of 1986 as amended
Retur'rl Of I Lind, KFII reserves tile rr(,ht to drcontinue modrli or �Nltllhold
pa,mLnts to be InaclL under this Agreenment or to require a total or partial rLturn of ani
funds €nc.luding an} unc\pended tunds under the fOIIOX%ttlg Londittclns
(a) If KI l I in its sole discretion determines that the (nalltee has not pet fOrmLd In
aLLordallLL %�ltll thi,, Agreement or Ilas IMI (I to Lonlply Mth anN tont or
condition of this A(,rccment
(11) It Grantee IOSCS ItS s41t€1-s as '111 ell�41rble Gran-i- under Paragraph I abo%c
(L) -1n% portion of the f ands is not used 1`61 the:approx cd purpose
(d) SLILh XtI0I1 I,, necessary to comply N�lth the rt gUirements of am I w or ri-gulation
applicable to Grantee or to Iii I I or to this Grant
G RU orris .-audits and Site Vi Its KI 11 is authorved to COMILILt audit,, includirit,
oil-,,rte audit,, at ani tine during the term of this Grant and .\Itllln lour Near,, aftLi
completion of lite Grant Grantee shafl allo%% KI'l I and its repre5entatnes cit its roque,,t
to ImL rLasonable IC(-Ls,, during- buSincSS t10Lars to GrantLL ,, files reLOrds
aLLountS 1x.rsonnel and. LIILnt or other bencliciariLS for the pLlrposc of m rknlg ,,uLh
audits %erlfILatlons or program e%aluations as KI 11 deerins nLccssan of appropl IatL
ccmnLernirm4a this Gr•lnt Grantee Shall maintain accOLInting records 'Alf frLtcnt to tdL1111l4 L111-
f'oN11111milI Beneftl- l effel of ftC"l edit nt
hanc 1 11 uc kutt,,Intal bei j(t, lhi s gg aw clommorl r, 206)-089 1 of 4
Grant and to «horn and for what purpose such funds are expended tot at least four(4)
nears after the Grant has been expended
7 No Assi-snnlent of Delealation Grantee tna� not assign or othermse traristet ani
r Oits or delegates an) of Grantee s obligations under till,, Agm-ment «ithout prior
\4ritten appro-af fratrl K1 11
8 Record,, and Renorts Grantee shall submit %%ritten progress report(s) to KI 1 I In
accordance �N ith the due dates stated on the Grant SummarN (Attachment)
Cit•antee shall be primarily responsible for the corltc.nt of the c�aluatton rCpoi-t 11 K1 I I
dc.tCrrntnes IRI3 apprOA ai IS ne(,essar} as part of the etaluatton process Grantee shall
follot� KI-I I IRIS approN al processes and procedures
9 Rectuired Notification Grantee is required to prof ide KI-II ti�ith immediate
%�ritten notification of art) charige in Grantee s tax exempt state,,or when Grantee is
unable to expend the grant funds for the approNed purposes described in the Wotk Plan
10 Identification of KI-I I Grantee shall idt.ntily KI I Itis a Supporting or�.iativation til
all published mateiial relating to the subject matter of tills Grant Whene',er possible and
appropriate Graniee shall publiel) acknom1edge K1' 1-1 for this Grant
I I Fatial Lnmlo%ment Gnuortuntt� Grantee agrees to comply v,ith and be bound bN
the nondiscrimination and affrrmam e action elau,,es contained in I- xec ells t. ()rder
11246 as amended relame to equal opllortttnit\ tot all persons without regard to race
color rclt4�ion sex of national origin the Vo€.ational Rehabilitation Act of 197' as
am-ndcd relalt�c to then CntploymCtlt of qualtficd hatteltCappeel indi%iduals NW1101.1t
discrimination bawd upon then physical or mental handicaps the Victnam Ira Veterans
Readjustment A,,sistance Act of 1974 as amended re_latr�e to tale ernplo%nlent of
disabled xeterans and xeterans of the Vietnam I ra and the implementing rules and
rcgulatton,, pre,,cribcd by the Secretary of Laboi In i tie 41 Part 60 of the C ode of
1 ederal Regulations (( ER)
I2 Immt-ration Act RcGtrrrc.rtlents Grantce shall comply during the Lei-III of tills
A!�reerrtent N%ith the pro%isions of the Immigration Retonn and Contra] ACt of 1986 and
ani rCgulattons promulgated therCunder Grantee herebN Certifies that it has obtains-d a
proper-]% Completed 1_mploynlcnt Lligibilt) CertlilCate (INS Iornl 1-9) fol each mkt-i
pettarmmg SL IAILes related to the proo ram described rel the Work flan
1 L iCensinf7 and CrCdentials Grantee aoi-LeS to maintain to full torc.e and ettec.t all
rt quir'cd ��a�s:rnmerltal or professtc>nal lceitses and credentials fat itself It', lac tltttCs anti
for its empimees and all other persons engaged in "ork in Cniljune.tton \Neth tilts Grant
14 Pax ment of Grant I rrst paNment b� KI I I kNill be writin�gent upon a signed
'agreement bett%con KF-II and Grantee Subsequent paNments (tfam ) -ire Contin1jent upon
compltance Mth tills Agreement Including timely receipt of reports a,, outlined to
Part�t,raph 8 abox e ~
Nl_SS ak 1{1_R1.O1 the parties hereto ha.e executed this
�grcenlutt a, of the elate, first above "rittett
C ottmtttttttt 13cttelit - 1 etfr) ()/ f-tCrntrFu
l(Mel Ilctchhtll turn11?el /rlr tltts tytcrttt tiomitton is 2005-t)89 ? 014
Kaiser Foundation Hos ttals
(T tsh I ope/ Q Date
AR-d gal Ulli�ei
ra ntee r
B\ /
Paul Barich
Date
Mayor Pro Tem
City of Redlands
ATTEST. j1
anne Donaldson, City Clerk
on1111 mill 1jC'1TC'fi! - 1 effel o/ Icrl NC'Inew
11"Ise1 Im this 1'1 H21 (Ionafion iN 00 "089
3 u/-1
[ I- I 1 LIZ Of A(jfZI-I \1l. N7
:Attachment
GRAN I SUAIMARY
GRANT Nl`tiIUR 206�,7089 DA rE AUT I-IORIICD lune 19 2017
GRAN rFI h xivIF ( 11% of IZ(dland, � ;kNIOUNT S5 OUO 00 o%et 12 month~
1 ( ON I AC I TIT 1 I %Irs Mt-ulian \leadc Project Manauer _—
Z ELI 1 1IO\I (9[19) 79S-762Q ( I AX (909) 792-871 ;
CR PROJECT MAN AGER Martha Valencia Communll� f3en(.trt I1(alth klana(7cl
Phone (909) -127-�269 rmad nlartha r N alencla a kp ori!
GRAM PURPOSI, I hm 1n,, I irmcrs' .Marku
i
GRAN 1 013.11- Cl 1\ rS --�
1 o 1 rale imarrne;, anlon1,
12 ()61 low income C011111]lII]ltl to rcdcull ')N,\P/r I3 1 \\ IC' and
Senlul \till Itton N otichcr5 at the C rte of I:c(llancl, I artllcrs' \iarkel 2) LOI)du(.t I Icalthlct C h(m(-Cs
C ooklng Demoiistrat1011S uSlrmu larmcrS' nwrket I)R)C!(I(.e to Clra1\ tal`ttt ])0I)ul'1t1011 to [)()[]I imuketti
1'arucl])ant5 arc able to tr',c their I t3 l and %ouchcrl, at both I llurSda-Ns C ertlfHcd I arnicr,,' Nlarkct
MR[ at S uurda\ Mornul,; Cer"ttlle(I 1 arlllus' 1'l ukt,t to ])IIr'Ch<l5c n(Itr'ItlOt1S lICSh ioc.alk ,r(mil
I?loducc.
% "I F N I ION. ) oul ofalll/1110I1 r5 Ie.CUlred tO tittbllllt G month nIId-N1a1 -
t() date ,t,ItLHS Update on
the ])rogrc>s of the pI-oLramrSelnlec lundc(I I\hitt he and \NLIJ Mlttcn (0 LOII\c\ Inlpac,t
((luantrlau\c an(1 (luaht,ltl%c outu)nle,) Ctuc 11011daN, .JdntjarN 8 2018 to Include (ori-lant/Lit On name
I.I'MIt 1111OLin1 deSel'11)tlf)n (11 ]pl'O�<CI'Se'I'\1ec retiult, to (late) 1 he ol�_cl It Iti for
`ubmrtun�l the mid star lll)Clat(. on time h\ cinad to,tilartha r ialenm a kn om, A lrnal re1)or•t «III he
due fulN 11, 2018 (online)
GR 1N I PI RIO1)
')tart date 7'112017 i I I'd Date 7/1/2018 —
N 1RR MN'h AND I INANC I AL 1ZI POR I S I)UI-
l:cclum-ment Due Date - - --- — — -
1111,11 Report -- ;lurau5t 1 --
(R% it Redl lrkl
Ii( r Int S rmnmr•.
4 o1 4
Check Date Aug/0812017 Vendor Number 100022581 0012255146
Invoice Number Invoice Date Voucher ID Gross Amount Discount Taken Paid Amount
95011 7ul/2112017 40904527 5 000 00 0.00 5 000.00
THRIVING FARMERS MARKET
Total Total Total
Check Number Date Cross Amount Discounts Paid Amount
0012255146 Aug/0812017 55.000.00 $0.00 $5 000 00
I
KP FINANCIAL,SVCS OPS CITIBANK,N A 0012255146
75 N Fair Oaks Avenue 4th Ft One Penn's Way
Pasadena CA 91103 New Castle DE 19720 Date 2017-08-08
62-20/311
Pay Amount $***$ate 00
Pay ****FIVE THOUSAND AND XX/100 DOLLAR
To The CITY OF REDLANDS
Order Of 35 CAJON ST
REDLANDS,CA 92373
Authorized Signature
Authorized Signature
11200 1 2 255 It.6tin 1:03 1100 2091. 38 ?8 L009 In
'� KAISER PERMANEW
Kaiser Foundation Hospitals
2017 Acknowledgement of Cash Contribution from Kaiser Foundation Hospitals
Information Requested Records Show Corrections
1)Organization's Legal Name City of Redlands
2)Organization's Tax ID 95-6000766
3)Organization's Tax Exempt Government or Public Agency
Status-
4)Fiscal
tatus•4)Fiscal Agents only The
name of the benefiting orq
CASH CONTRIBUTION FROM KAISER FOUNDATION HOSPITALS
5)Brief description of project Thriving Farmers' Market
6)Check amount. $5,00000
7)Check number. 12255146
8)Check date 8/8/2017
GOODS AND SERVICES
9)Goods or services provided to Kaiser Foundation Hospitals and/or its representatives for the
contribution listed above.
a)Type(s)of goods or services provided ® NONE ❑ Meal ❑ Advertisement ❑ Event Ticket ❑ Booth
❑ Other
b)Quantity of goods or services provided (for example, 10 dinner seats)
c) Fair market value of goods or services provided (for example, $50 per seat, totaling$500)
10) Signature Item 9 above must be completed before sianina)
aul Barzch Mayor Pro_ Tpore
Name&Title(ty a or rmtt --- ----__..
Siignature '
z
e G
INTERNAL USE ONLY
11)Tracking Number 20657089 12)Payment Number 195011
13)Medical Center Service area Fontana DOCUment Rev 1211014
Instructions: Please return the signed document within five (5) days of check receipt to
scal.mc.grants@kp.org.
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