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The Grantee attests to the fact that it is an independent non-profit 501(c)(3) public benefit corporation <br /> incorporated under the laws of the State of California, that its programs and administrative functions <br /> are managed by its independent board of directors and staff, and that the Grantee and the agents and <br /> employees of the Grantee shall act in an independent capacity and not as officers, employees, or <br /> agents of UWBA. <br /> The Grantee shall indemnify and hold harmless UWBA, its directors, officers, employees and agents <br /> against any and all liability, loss or expense imp�sed er clairrzsd, including attorney's fees and other <br /> legal expenses arising directly or indirectly from any act or fail�are to act by Grantee or Grantee's <br /> assistants, employees or agents, including all claims relating to the injury or death of any person or <br /> damage to any property. <br /> USA PATRIOT ACT CERTIFICATION OF COMPLIANCE <br /> ❑ I hereby certify on behalf of '<��L������`�-1 .�1��� (P�EasE PR�Nr <br /> YOUR ORGANIZATION NAME, a requirement for release of f nds) that all United Way funds and <br /> donations will be used in compliance with all applicable anti-t�rrc�rist financing and asset control laws, <br /> statues and executive orders. <br /> This MOU shall be signed and returned to UWBA l�y 6/�1/2012, and shall remain in effect until <br /> 5/31/2013 unless terminated by UWBA as provided herein. No pavments will be released until <br /> (1) the sipned Memorandum of Understandinq (MOU) is returned to UWBA, (2) a copv of the <br /> oraanization's certificate of insurance naming UWBA as an additional insured is returned to <br /> UWBA, and (3) anv special conditions requested bv UWBA are met. <br /> ❑ We hereby certify that the foregoin� is a full, true, and correct copy of the MOU duly and <br /> regularly adopted on the � day of 5��, 20��:t by th� Grantee's board of directors. <br /> � J �`'� � _ C�� 1��'�� � � �. <br /> ign ture Print Name Date <br /> Grant e Chief Volun er Officer <br /> (Board Chair, Board President) <br /> City of Redwood City <br /> - ., , /• � - , <br /> ,- <br /> ��/ /t � (f �._ , l� ry �, �;���-�-.• f- � /` _1�', "L <br /> T �� f � � r�: �:� , , __ r <br /> Signature Print Name 1�'�f�f Date <br /> Grantee Chief Professional Officer <br /> (Executive Director, CEO, President) <br /> City of Redwood ity <br /> � �. <br /> Lo eedle D te <br /> C ef ommunity Investment Officer <br /> Unite Way of the Bay Area <br /> Payments will be delayed if any of the following is missing: <br /> • Name of your organization must be printed under the USA Patriot Act Certification(above) <br /> • Date your board adopted this MOU must be entered(above) <br /> • An updated copy of your Certificate of Liability Insurance poticy naming UWBA as an additional insured,as <br /> outlined in the MOU.Providing proof of insurance is not sufficient.Grantee must contact insurance broker <br /> to amend coverage to include UWBA as an additional insure�,which must be stated on the Certificate.This <br /> certificate must provide coverage for the full grant period. <br /> FYi2 Community School Initiative Page 3 <br />