HomeMy WebLinkAbout2-1-1 ORANGE COUNTY (3)A-2019-088-05
INSURANCE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: JUL 2 2. 2010
D� coA 0)
EMERGENCY SOLUTIONS GRANT
SUBRECIPIENT AGREEMENT BETWEEN
THE CITY OF SANTA ANA
AND
211 ORANGE COUNTY
(24 CFR Parts 91 and 576)
THIS GRANT AGREEMENT, is hereby made and entered into this , 2019, by and between the City
of Santa Ana, a charter city and municipal corporation of the State of California, herein called the "CITY", and 211
ORANGE COUNTY, a Califorua nonprofit organization, herein called the "SUBRECIPIENT".
RECITALS:
1, The CITY is the recipient of Emergency Solutions Grant ("ESG") funds from the United States
Department of Housing and Urban Development ("HUD"), pursuant to subtitle B of title IV of the McKinney-Vento
Homeless Assistance Act [42 U.S.C. 11371-1.1378], for the rehabilitation or conversion of buildings for use as emergency
shelter for the homeless, for the payment of certain expenses related to operating emergency shelters, for essential services
related to emergency shelters and street outreach for the homeless, and for homelessness prevention and rapid re -housing
assistance. Catalogue of Federal Domestic; Assistance ("CFDA") 14.231 and Federal Award Identification Number
(FAIN) E-1.9-MC-06-0508.
2. The CITY has approved the provision of federal ,funds under the ESG to be used in the operation of an
emergency solutions program ("program") for the homeless or at -risk of homelessness of the City of Santa Ana as further
described by Exhibit A, Scope of Work, attached hereto and by this reference incorporated herein.
3. The SUBRECIPIENT represents that it has the requisite qualifications, expertise, and experience in the
provision of emergency solutions programs for the homeless or at -risk of homelessness and is willing to use said federal
funds to operate said program.
4. The SU3RECIPI:F",NT agrees to assist individuals and ,families that are homeless or at risk of
homelessness in obtaining appropriate supportive services including, but not limited to: temporary and permanent
housing, relocation and stabilization services, rapid re -housing assistance, medical and mental health treatment,
counseling supervision, and other services essential for achieving independent living.
5. The SUBRECIPIENT has agreed to be reimbursed for the above services in an amount not to exceed
$20,750 in grant funding for Shelter, Outreach Services, Rapid Re -Housing or Homeless Prevention,
6. This AGREEMENT is contingent upon the award of Emergency Solutions Grant funds from the United
States Department of Housing and Urban Development.
The CITY and the SUBRECIPIENT have duly executed this AGREEMENT for the expenditure and
utilization of said funds.
NOW THEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of
this AGREEMENT and the following terms and conditions are approved and together with all exhibits and attachments
hereto, shall constitute the entire AGREEMENT between the CITY and the SUBRECIPIENT:
I.
II.
SCOPE OF PROGRAM
A. General Administration
The SUBRECIPIENT agrees to implement this activity as set forth in detail in Exhibit A, Scope of Work, which
shall provide a description of each activity, including the services to be performed, the person or entity providing
the service, the estimated number of recipients of the service, and the manner and means of the services.
B. Levels of Accomplishment — Goals and Performance Measures
The SUBRECIPIENT shall be responsible to accomplish the levels of performance as set forth in Exhibit A and
report such measures quarterly to the CITY. If the SUBRECIPIENT estimates such goals will not be met, the
SUBRECIPIENT is to contact the CITY, at which time the CITY will determine if any adjustments to the grant
award is appropriate.
C. Staffing
The SUBRECIPIENT shall ensure adequate and appropriate staffing is allocated to each ESG activity. Nothing
contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or establishing
the relationship of employer/employee between the parties.
TERM OF AGREEMENT
This AGREEMENT shall take effect on July 1, 2019, and shall terminate on June 30, 2020, unless otherwise
cancelled or modified according to the terms of this AGREEMENT.
DISBURSEMENT AND FUNDS
The City was allocated $493,582 in Emergency Solutions Grant funds under the McKinney-Vento Homeless
Assistance Act for fiscal year 2019-2020 from the Department of Housing and Urban Development. CITY agrees
to pay to SUBRECIPIENT when, if and to the extent federal funds are received under provisions of the Act a sum
not to exceed $20,750 for SUBRECIPIENT'S performance in accordance with the Budget attached hereto as
"Exhibit B" during the period of this Agreement. Said sum shall be paid after CITY receives invoices submitted
by SUBRECIPIENT as provided hereinabove.
A. Amount and Expenditure End Date
The CITY agrees to reimburse the SUBRECIPIENT a maximum amount not to exceed $20,750 from Emergency
Solutions Grant (ESG) funds, as outlined in Exhibit B, Final Budget, and such funds shall be expended by the
SUBRECIPIENT on or before June 30, 2020. SUBRECIPIENT has the ability to adjust line item amounts in the
Budget with the written approval of the CITY's Executive Director of the Community Development Agency, so long
as the total Budget amount does not increase.
B. Invoicing Procedures
The SUBRECIPIENT shall submit quarterly invoices (on or before the 15'11 day of October, January, April, and
July) in a form prescribed by the CITY, detailing such expenses. Such schedule may be modified with the
approval of the CITY.
C. PaymenC
Payment is subject to the receipt and approval of such invoices and quarterly activity reports, as hereinafter more
fully set forth below under Reporting, with the final payment subject to the satisfaction of the condition precedent
of submittal of complete invoicing and reporting information due on or before July 15 of the applicable funding
year. The CITY shall pay such invoices within thirty (30) days after receipt thereof, provided the CITY is
satisfied that such expenses have been incurred within the scope of this AGREEMENT and that the
SUBRECIPIENT is in compliance with the terms and conditions of this AGREEMENT. The thirty (30) day
period will discontinue if the reimbursement request is determined to be incomplete and will restart the thirty -day
timeline once the remaining required elements have been submitted.
Failure to provide any of the required documentation and reporting will cause the CITY to withhold all or a
portion of a request for reimbursement until such documentation and reporting has been received and approved by
the CITY.
D. Use of Funds
The SUBRECIPIENT agrees to use said funds pursuant to this AGREEMENT to pay for necessary and
reasonable costs allowable under federal law and regulations to operate said program only. Said amounts shall
include and will be limited to, street outreach, emergency shelter, homelessness prevention, rapid re -housing
assistance, housing relocation and stabilization services, short-term and medium -term rental assistance, and
Homeless Management Information Systems ("HMIS") data contribution as set forth in 24 CFR § 576.101 — §
576.107. Allowable program costs are detailed in the Budget, as set forth in Exhibit B, attached hereto and by this
reference incorporated herein. The SUBRECIPIENT'S failure to perform as required may, in addition to other
remedies set forth in this AGREEMENT, result in readjustment of the amount of funds the CITY is otherwise
obligated to pay to the SUBRECIPIENT pursuant to the terms hereof. The SUBRECIPIENT agrees that the
homeless shelter/services under said program shall be available for the entire period during which said funds are
provided.
E. Condition of Funding
(1) The CITY advises the SUBRECIPIENT that a significant change in entitlement funding may result in a
change in the current process utilized by the CITY to determine funding allocations. The SUBRECIPIENT
acknowledges that the obligation of the CITY is contingent upon the availability of Federal, State or Local
government funds, which are appropriated or allocated for the payment of such an obligation. If funding levels are
significantly affected by Federal budgeting or if funds are not allocated and available for the continuance of the
function performed by the SUBRECIPIENT, this AGREEMENT may be terminated by the CITY at the end of
the period for which funds are available. At the earliest opportunity, the CITY shall notify the SUBRECIPIENT
of any service which may be affected by a shortage of funds. No penalty shall accrue to the CITY in the event this
provision is exercised and the CITY shall not be liable for any damages as a result of tertnination under this
provision of this AGREEMENT. Nothing herein shall be construed as obligating the CITY to expend funds in
excess of appropriations authorized by law.
(2) The SUBRECIPIENT shall allow representatives of the CITY or HUD to inspect facilities which are used
in connection with the AGREEMENT or which implement programs funded under this AGREEMENT.
F. Matching
The SUBRECIPIENT is required to make matching contributions to supplement the ESG program in an amount
that equals or exceeds the amount of ESG funds provided by HUD through the CITY. Such contributions shall be
entirely consistent with the Matching Requirements as outlined by 24 CFR § 576.201. The anticipated source and
amount of all matching funds contributed by the SUBRECIPIENT will be enumerated in Exhibit B, Final
Budget.
G. Program. Income
(1) Definition. Program income means, as provided by 2 CFR 200,80, gross income received by the
SUBRECIPIENT directly generated by a grant supported activity, or earned only as a result of the grant
agreement during the grant period. For purposes of ESG, program income will also include any amount of a
security or utility deposit returned to the SUBRECIPIENT.
(2) Use. The SUBRECIPIENT shall use all income received from said funds only for the same purposes for
which said funds may be expended pursuant to the terms and conditions of this AGREEMENT.
(3) Counts toward Matching. Costs paid by program income may count toward meeting the matching
requirements, provided the costs are eligible ESG costs that supplement the program.
H. Separation of Accounts
All funds received by the SUBRECIPIENT from the CITY pursuant to this AGREEMENT shall be maintained
separate and apart from any other funds of the SUBRECIPIENT, or of any principal or member of the
SUBRECIPIENT, in an account (the "Account") at a federally insured banking or savings and loan institution with
record keeping of such Accounts maintained pursuant to applicable legal requirements. The SUBRECIPIENT shall
keep all records of the Account in a manner that is consistent with generally accepted accounting principles. No
monies shall be withdrawn from the Account except for expenditures relating to essential services, homeless
prevention, and/or operations costs, as authorized hereunder. All disbursements from the Account shall be for
obligations incurred in the performance of this AGREEMENT and shall be supported by contracts, invoices,
vouchers, and other data, as appropriate, evidencing the necessity of such expenditure. The CITY may withhold
payment allocation requests if the SUBRECIPIENT fails to comply with the above requirements until such
compliance is demonstrated.
Expenditure of Funds
Much like how HUD requires the CITY, pursuant to 24 CFR 576.203, to expend all of the grant 'funds for eligible
activity costs within 24 months after the date that HUD signs the grant agreement with the CITY, it is a
requirement for the SUBRECIPIENT to expend all of the grant funds for eligible activity costs within the
aforementioned period. For the purposes of this paragraph, expenditure means either an actual cash disbursement
for a direct charge for a good/service or an indirect cost, or the accrual of a direct charge for a good/service or an
indirect cost. Failure to expend said funds within said timeframe can result in a reallocation of funds.
Prohibited Use
(1) Generally. The SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this
AGREEMENT to pay for meals for persons other than those identified as homeless or at risk of homelessness. Said
funds shall not be used for entertainment purposes or for gifts. The SUBRECIPIENT certifies that it will not use said
funds for illegal or dishonest conduct, rather, fund use will remain in compliance with all applicable federal, state, and
local laws, including applicable laws not outlined in this AGREEMENT.
(2) Lobbying. The SUBRECIPIENT certifies and agrees that it will comply with federal law (31 U.S.C. 1352)
and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient
of a federal contract, grant, loan, or cooperative agreement to pay any person for influencing or attempting to
influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of
IV.
V.
Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into
any cooperative agreement and the extension, renewal, amendment, or modification of any federal contract, grant,
loan, or cooperative agreement. The SUBRECIPIENT shall sign a certification to that effect in a form as set forth in
Exhibit C, attached hereto and by this reference incorporated herein. The SUBRECIPIENT shall submit said signed
certification to the CITY prior to performing any of its obligations under this AGREEMENT and prior to any
obligation arising on the part of the CITY to pay any sums to the SUBRECIPIENT under the terns and conditions of
this AGREEMENT. If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan,
or cooperative agreement, the undersigned shall complete and submit a 'Disclosure Form to Report Lobbying," in
accordance with its instructions (see Exhibit D).
NOTICES
The SUBRECIPIENT and the CITY agree that all notices required by this AGREEMENT shall be made in writing
and delivered via mail (postage prepaid); commercial courier; personal delivery; or sent by facsimile or other
electronic means (provided that receipt is confirmed). Any notice delivered or sent as aforesaid shall be effective
on the date of delivery or sending. All notices and other written communications under this AGREEMENT shall
be addressed to the individuals in the capacities indicated below, unless modified by subsequent written notice.
Communication and details concerning the AGREEMENT shall be delivered to the office of, and directed to, the
following representatives:
CITY
Terri Eggers
Sr. Community Development Analyst
City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, CA 92702-1988
(714) 647-5378
(714) 647-6549 FAX
tcauesia santa-ma.org
GENERAL CONDITIONS
A. Coordination with Continuum of Care
SUBRECIPIENT:
Karen Williams
Executive Director
211 Orange County
1505 E. 171' Street, Suite 108
Santa Ana, CA 92705
714-288-4007 ext. 1116
The SUBRECIPIENT must work with the Continuum of Care (" CoC") to ensure the screening, assessment, and
referral of program participants are consistent with the CYIY's written standards for providing ESG assistance as
described in its consolidated plan. The SUBRECIPIENT must keep documentation evidencing the use of, and
written intake procedures for, the centralized or coordinated assessment system(s) developed by the CoC in
accordance with the requirements established by HUD. See 24 CFR 576.400.
B. Evaluation of Program Participants Eligibility and Needs
The SUBRECIPIENT must conduct evaluations and re-evaluations to determine the eligibility of each individual
or family's eligibility for ESG assistance in accordance with 24 CFR 576,401,
C. Terminating Assistance
If a program participant violates program requirements, the SUBRECIPIENT may terminate the assistance in
accordance with a formal process established by the SUBRECIPIENT that recognizes the rights of individuals
affected. See 24 CFR 576,402
D. Shelter and Housing Standards
The SUBRECIPIENT certifies that shelters and housing supported by ESG funds and used by ESG beneficiaries
will conform to 24 CFR 576.403.
E. Homeless Involvement
The SUBRECIPIENT certifies that it will involve, to the maximums extent practicable, homeless individuals and
families in constructing, renovating, maintaining, and operating facilities assisted under the ESG program, and in
providing services for occupants of these facilities. See 24 CFR 576.405(c) and 42 USC 11375(d).
F. Independent Contractor
Nothing contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or
establishing the relationship of employer/employee between the parties. The SUBRECIPIENT and its
subcontractors shall at all times remain independent contractors with respect to the services to be performed under
this AGREEMENT. The CITY shall be exempt from payment of any Unemployment Compensation, FICA,
retirement, life and/or medical insurance and Workers' Compensation Insurance as the SUBRECIPIENT is an
independent contractor.
G. Subcontracts
(1) Content Requirements. The SUBRECIPIENT will include all relevant provisions of this AGREEMENT
in all subcontracts entered into as part of the activities undertaken in furtherance of this AGREEMENT
and will take appropriate action pursuant to any subcontract upon a finding that the subcontractor is in
violation of regulations issued by any federal agency. The SUBRECIPIENT will not subcontract with any
entity where it has notice or knowledge that the latter has been found in violation of regulations under 24
CFR Part 135 (Economic Opportunities for Low- and Very Low -Income Persons) and will not allow any
subcontract unless the entity has first provided it with a preliminary statement of ability to comply with
the requirements of these regulations.
(2) Submission to the CITY. The SUBRECIPIENT must submit all subcontracts and other agreements that
relate to this AGREEMENT to the CITY.
II. Licensing
The SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation, and inspections
from all agencies governng its operations. The SUBRECIPIENT shall ensure that its staff and subcontractors shall
also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing
the SUBRECIPIENT's operations hereunder. Such licensing requirements include obtaining a City business license,
as applicable.
I. Responsibilities Toward Employees
The SUBRECIPIENT accepts full responsibility for payment of any and all unemployment compensation,
insurance premiums, workers' compensation premiums, income tax withholdings, social security withholdings,
and any and all other taxes or payroll withholdings required for all employees engaged in the performance of the
work and activities authorized by the AGREEMENT. The SUBRECIPIENT accepts full responsibility for
providing workers with proper safety equipment and taking any and all necessary precautions to guarantee the
safety of workers or persons otherwise affected.
J. Insurance and Bonding
(1)Generally. The SUBRECIPIENT shall maintain liability and property insurance to cover actionable legal
claims for liability or loss which are the result of injury to or death of any person, or damage to property
(including property of Grantee) caused by the negligent acts or omissions, or negligent conduct of the
SUBRECIPIENT, its employees, agents or subcontractors, to the extent permitted by law, in connection with the
activities pursuant to this AGREEMENT.
The SUBRECIPIENT shall comply with the bonding and insurance requirements of 2 CFR 200.427, and 2 CFR
200.447.
The SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a policy or policies of
commercial general liability insurance, or equivalent form.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents, employees and volunteers as additional
insureds; (2) be primary with respect to insurance or self-insurance programs maintained by the CITY; (3) contain
standard separation of insureds provisions; and (4) give to the CITY prompt and timely notice of claim made or
suit instituted arising out of the SUBRECIPIENT's operations hereunder.
(2) Limits. The SUBRECIPIENT shall maintain, at all tunes, the following minimum levels of Insurance, and
shall, without.in any way altering its liability, obtain, pay for, and maintain insurance for the coverages and amounts
of coverage not less than those set forth below:
a. Workers' Compensation. Amount must comply with State and Federal Laws
b. Comprehensive General Liability. $1,000,000 combined single limit of liability for bodily injuries,
death, and property damage resulting from any one occurrence, including the following coverages:
Premises and Operations; and
ii. Broad Form Commercial General Liability Endorsement to include blarnlcet contractual
liability (specifically covering, but not limited to, the contractual obligations assumed by the
SUBRECIPIENT); Personal Injury (with employment and contractual exclusions deleted); and
Broad Form Property Damage coverage.
C. The SUBRECIPIENT's self -insured retention or deductible per line of coverage shall not exceed
$25,000 without the permission of the CITY.
(3) Proof of Insurance. The SUBRECIPIENT shall furnish the CITY's Clerk of the Council with an insurance
certificate from insurance carrier certifying that it carries such insurance and that the policy shall not be canceled
nor the coverage reduced except upon thirty (30) days prior notice to the CITY.
The SUBRECIPIENT shall, prior to exercising any right under this AGREEMENT:
a. furnish properly executed certificates of insurance and additional insured endorsement to the CITY
which shall clearly evidence all coverage required above;
b. provide that such insurance shall not be materially changed or tenninated except on thirty (30) days
prior written notice to the CITY;
c. maintain such insurance for the period covered by this AGREEMENT; and
d. replace such certificates for policies expiring prior to the expiration of this AGREEMENT.
(4) Company Rating. All insurance coverage shall be written with a company having an A.M. Best Rating of "A"
or better and financial size of VIII or larger.
(5) Failure to Comply. In the event of any failure by the SUBRECIPIENT to comply with these provisions,
the CITY may, after notice to the SUBRECIPIENT, suspend the program for cause until there is full compliance.
K. Zonine.
The SUBRECIPIENT agrees that any facility/property used in furtherance of said program shall be specifically zoned
and permitted for such use(s) and activity(ies). Should the SUBRECIPIENT fail to have the required land entitlement
and/or permits, thus violating any local, state, or federal rules and regulations relating thereto, the SUBRECIPIENT
shall immediately make good -faith efforts to gain compliance with local, state, or federal odes and regulations
following written notification of said violation(s) from the CITY or other authorized citing agency. The
SUBRECIPIENT shall notify the CITY immediately of any pending violations. Failure to notify the CITY of
pending violations, or to remedy such known violation(s), shall result in termination of grant funding hereunder. The
SUBRECIPIENT must make all corrections required to bring the facility/property into compliance with the law
within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shalt result in
termination of grant fimdung hereunder.
L. Displacement and Relocation.
The SUBRECIPIENT must assure that it has taken all reasonable steps to minimize displacement of persons.
Relocation must be consistent with requirements as set forth in 24 CFR § 576,408.
M. Provisions Required by Law Deemed Inserted.
Each and every provision of law and clause required by law to be inserted in this contract shall be deemed to be
inserted herein and the AGREEMENT shall be read and enforced as though it were included herein, and if
through mistake or otherwise any such provision is not inserted or correctly inserted, then upon the application of
either party the contract shall forthwith be physically amended to make such insertion or correction.
VI. ASSURANCES AND CERTIFICATIONS
A. Non -Profit Status
The SUBRECIPIENT certifies that:
(1) The SUBRECIPIENT is a duly organized and existing non-profit corporation in good standing and
authorized to do business under the laws of the State of California and in possession of required non-profit status
under the United States Internal Revenue Code [for example, 26 USC § 501(c)(3)]. The SUBRECIPIENT has full
right, power, and lawful authority to accept the funding hereunder and to undertake all obligations as provided
herein and the execution, perfornance, and delivery of this AGREEMENT by the SUBRECIPIENT has been
fully authorized by all requisite actions on the part of the SUBRECIPIENT.
(2) If the SUBRECIPIENT's non-profit status changes at anytime during this AGREEMENT, it will advise
the CITY within 15 days.
(3) If the SUBRECIPIENT is a private non-profit, it hereby agrees that the members of its Board of Directors
will receive no compensation, directly or indirectly, other than reimbursement for expenses, from any funds
generated from or because of the ESG program, for their services.
(4) As a non-profit, the SUBRECIPIENT acknowledges that administration of its operation and services are
subject to the requirements as established in 2 CFR 200.
B. Adherence to Federal State and Local Laws and Regulations
(1) General. The SUBRECIPIENT agrees to comply with all requirements of the ESG program and
applicable cross -cutting Federal, State, and Local requirements.
(2) Economic Opportunities for Low- and Very Low-income' Persons. The SUBRECIPIENT shall ensure that
employment and other economic opportunities generated by the Program shall, to the greatest extent feasible, be
directed to low- and very low-income persons, particularly those who are recipients of government assistance for
housing. Section 3 of the Housing and Urban Development Act of 1968, 12 U.S.C. 1701u, and regulations at 24
CFR part 135 apply, except that homeless individuals have priority over other Section 3 residents in accordance
with § 576.405(c).
(3) Civil Rights. The SUBRECIPIENT agrees to comply with Title VI of the Civil Rights Act of 1964, as
amended, Title VIII of the Civil Rights Act of 1968, as amended, Section 109 of the Title I of the Housing and
Community Development Act of 1974, Section 504 of the Rehabilitation Act of 1973, the Americans with
Disabilities Act of 1990, the Age Discrimination Act of 1975, and 41 CFR Chapter 60.
(4) Nondiscrimination and Equal Employment Opportunity. During the performance under this
AGREEMENT, the SUBRECIPIENT shall not discriminate against any employee or applicant for employment
based on race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status,
familial status, sexual orientation, or any other basis prohibited by applicable law.
The SUBRECIPIENT shall take affirmative action to ensure that all applicants and employees are treated without
regard to race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status,
familial status, and sexual orientation.
The SUBRECIPIENT shall comply with all provisions of Executive Order 11246, Equal Employment
Opportunity, as amended by Executive Orders 11375 and 12086.
(5) Nondiscrimination and Equal Opportunity in Participation. The requirements in 24 CPR part 5, subpart A
are applicable, including the nondiscrimination and equal opportunity requirements at 24 CFR 5.105(a). The
SUBRECIPIENT shall not discriminate against any participant on the ground of race, color, creed, religion, sex,
age, handicap, disability, ancestry, national origin, marital status, familiar status, sexual orientation, or any other
basis prohibited by applicable law. The SUBRECIPIENT shall, through affirmative outreach, make known that
use of the facilities, assistance, and services are available to all on a nondiscriminatory basis. The
SUBRECIPIENT must take appropriate steps to ensure effective communication with persons with disabilities.
(6) Americans with Disabilities Act. The SUBRECIPIENT agrees to comply with any federal regulations
issued pursuant to compliance with the Americans with Disabilities Act which prohibits discrimination and
ensures equal opportunity for persons with disabilities in employment, State and Local government services, and
public accommodations.
(7) Fair Housing. Under section 808(e)(5) of the Fair Housing Act, IIUD has a statutory duty to affirmatively
further fair housing. HUD requires the same of its funded sub -recipients. The SUBRECIPIENT has a duty to
affirmatively further fair housing opportunities for classes protected under the Fair Housing Act.
C. Falsification of Information
The SUBRECIPIENT represents and warrants that it has made no false statements to the CITY in the process of
obtaining this award of the ESG Funds.
D. Drug Free Workplace
The SUBRECIPIENT represents and warrants that it has established the following drug -free workplace policy:
(1) The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace for any employee involved in a federally funded program.
(2) As an employee working in conjunction with a federally funded program, the employees of the
SUBRECIPIENT will be required to:
a. Abide by the terms above in statement (1), and
Notify the appropriate SUBRECIPIENT authorities and CITY officials of any criminal drug
statute conviction for a violation occurring in the workplace. Such notification shall be made no
later than five (5) days after conviction.
(3) The CITY and the United States Department of Housing and Urban Development will be notified within
10
ten days after receiving notice of any such violation.
(4) Within thirty (30) days of receiving such notice, appropriate personnel action will be taken against such
employee, up to and including termination.
(5) Each such employee shall be required to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State or Local health, law enforcement,
or other appropriate agency.
E. Religious Organization
The SUBRECIPIENT may not engage in inherently religious activities, such as worship, religious instruction, or
proselytization as part of said program or services. If the SUBRECIPIENT conducts such activities, the activities
must be offered separately, in time or location, from said programs or services, and participation must be
voluntary for the program participants.
The SUBRECIPIENT shall not, in providing program assistance, discriminate against a program participant or
prospective program participant on the basis of religion or religious belief.
If the SUBRECIPIENT is a religious organization, it retains its independence from Federal, State, and Local
governments, and may continue to carry out its mission, including the definition, practice, and expression of its
religious beliefs, provided that the religious organization does not use direct ESG funds to support any inherently
religious activities.
The SUBRECIPIENT agrees that rehabilitation of structures by the religious organization in connection with said
program must be in sound accord with the provisions under 24 CFR § 576.406.
F. Additional Terms between the CITY and HUD
The SUBRECIPI,ENT agrees further that it shall be bound by the standard terms and conditions used in the Grant
Agreement between HUD and the CITY and such other rules, regulations, or requirements as FIUD may
reasonably impose in addition to the aforementioned assurances at or subsequent to the execution of this
AGREEMENT by the parties hereto.
Where employees are engaged in activities not covered under the Occupational Safety and Health Act of 1970,
they shall not be required or permitted to work, be trained, or receive services in buildings or surroundings or
under working conditions which are unsanitary, hazardous, or dangerous to the participants' health or safety.
H. Hatch Act
The SUBRECIPIENT agrees that no funds provided, nor personnel employed under this AGREEMENT, shall be
in any way or to any extent engaged in the conduct of political activities in violation of the Hatch Act, 5 U.S.C.
Section 1501 et seq.
11
I. Davis -Bacon Act
All laborers and mechanics employed by contractors or subcontractors in the performance of construction work,
including alterations and repairs, in excess of $2,000.00, financed in whole or in part with federal funds shall be
paid wages at rates not less than those prevailing on similar construction in the locality as determined in
accordance with the Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction
contract shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are required to be
maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No payment, advance, grant, loan
or guarantee of funds shall be approved by the federal agency unless there is on file with the agency a certification
by the contractor that the contractor and its subcontractors have complied with the provisions of 29 C.F.R. §5.5. A
breach of the contract clauses in 29 C.F.R. §5.5 may be grounds for temunation of the contract, and for debarment
as a contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations shall be
made as necessary to assure compliance. See 29 C.F.R. §5.6(a)(3).
V11. ADMINISTRATIVE REQUIREMENTS
A. Generally
The following requirements and standards must be complied with: 2 CFR Part 200, et al. SUBRECIPIENT shall
procure all materials, property, or services in accordance with the requirements of 2 CFR 200.318-326.
B. Procurement
(1) Compliance. The SUBRECIPIENT shall comply with current HUD and CITY policies concerning the
procurement of equipment, goods, and services, and shall maintain inventory records of all non -expendable
personal property as defined by such policy as may be procured with funds provided herein. The
SUBRECIPIENT shall report to the CITY all program assets (unexpended program income, property, equipment,
etc.), and upon the CITY' S request, such assets shall revert to the CITY upon termination of this AGREEMENT.
(2) Pursuant to 2 CFR 200.331 (a) (4), the Indirect Cost Rate for the SUBRECIPIENT's award shall be an
approved federally recognized cost rate negotiated between the SUBRECIPIENT and the Federal government, or,
if no cost rate exists, the de minims indirect cost rate as defined in 2 CFR 200.414(b) Indirect (F & A) costs shall
be used. For this agreement, the de minims indirect cost of 10% will apply.
(3) Use and Reversion of Assets. The use and disposition of equipment under this AGREEMENT shall be in
compliance with the requirements of 2 CFR Part 200.
C. Reporting
Reporting requirements must conform to the policies and procedures as established by the CITY and 24 CFR §
576,500. The SUBRECIPIENT shall submit to the CITY, on or before the 15" day of October, January, April,
and July, as part of the Quarterly Report:
(1) Payment Request. An original request for reimbursement and true copies of invoices, receipts,
agreements, or other documentation supporting and evidencing how the ESG Funds have been
expended during the applicable quarter.
12
(2) Quarterly Activities and written cumulative (year-to-date) reports of activities, program
accomplishments, new program infonnation, and up-to-date program statistics on expenditures,
caseload and activities. Failure to provide any of the required documentation and reporting will cause
the CITY to withhold all or a portion of a request for reimbursement until such documentation and
reporting has been received and approved by the CITY.
(3) Matching. Quarterly certification of match, plus documentation of match source.
(4) Any other such reports as the CITY (or HUD) shall reasonably require and/or request, including but
not limited to the following information: monthly records of all ethnic and racial statistics of persons
and families benefited by the SUBRECIPIENT in the performance of its obligations under this
AGREEMENT.
D. Record Keeping
Sufficient records must be established and maintained to enable the CITY and HUD to determine whether the
ESG requirements are being met. Record keeping requirements must conform to the policies and procedures as
established by the CITY. All accounting records, reports, all evidence pertaining to costs, expenses, and ESG
Funds of the SUBRECIPIENT, and all documents related to this AGREEMENT shall be maintained and kept
available at the SUBRECIPIENT'S office or place of business for the duration of the AGREEMENT and
thereafter for five (5) years post -completion of an audit in conformity with the ESG requirements, except as
hereinafter provided relating to retention of any records or documentation existing, created, or maintained in
compliance with Lead -based Paint regulations, which likely require longer retention as outlined below. Records
which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of
this AGREEMENT, or (b) costs and expenses of this AGREEMENT to which the CITY or any other
goverrunental agency takes exception, shall be retained beyond the five (5) years until complete resolution or
disposition of such appeals, litigation claims, or exceptions. All said records must be retained for the greater of the
aforementioned duration or the periods specified in 24 CFR 576.500(y). All records relating to, or created or
maintained in compliance with, the Lead -Based Paint regulations shall be retained and maintained by the
SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure statement(s), and
clearance report(s). Copies made by microfilming, photocopying, or similar methods may be substituted for the
original records. The CITY, HUD and auditors shall have the right to access all the SUBRECIPIENT records for
as long as the records are retained by the SUBRECIPIENT. In the event the SUBRECIPIENT does not make the
above -referenced documents available within the City of Santa Ana, California, the SUBRECIPIENT agrees to pay
all necessary and reasonable expenses incurred by the CITY in conducting any audit at the location where said
records and books of account are maintained.
The SUBRECIPIENT agrees to meet the requirements set forth in 24 CFR § 576.500.
E. Homeless Management Information Systems (HMIS)
(1) Generally. The SUBRECIPIENT must ensure that data on all persons served and all activities assisted
under ESG are entered into the applicable community -wide HMIS in the area in which those persons and
activities are located, or with the express knowledge and written consent of the CITY, a comparable database, in
accordance with FIUD's standards on participation, data collection, and reporting under a local HMIS.
(2) HMIS Agency Agreement, The SUBRECIPIENT shall have an agreement in place with the HMIS lead
agency to participate in the regionally HMIS system. A copy of the SUBRECIPIENTS agreement with the HMIS
lead agency shall be attached to this agreement as Exhibit F. In the case of Domestic Violence service providers
13
or other agencies prohibited from entering data into HMIS, documentation from the HMIS lead agency certifying
that the SUBRECIPIENT is using a comparable database shall be attached to this agreement as Exhibit E.
(3) HMIS Interagency Data Sharing Agreement. The SUBRECIPIENT shall enter into an Interagency Data
Sharing Agreement with the HMIS Lead Agency where the SUBRECIPIENT agrees to share FIMIS data with
other ESG funded agencies regarding clients that are served in ESG funded programs, unless prohibited by law.
A copy of such agreement shall be attached as Exhibit F-1.
(A.) The SUBRECIPIENT agrees to provide 2110C with all required data needed to complete
data analysis regarding project perforniance, data timeliness, or data quality.
F. Audit Report Requirements
The SUBRECIPIENT agrees that if the SUBRECIPIENT expends Seven Hundred Fifty Thousand Dollars
($750,000.00) or more in federal funds, the SUBRECIPIENT shall have an annual audit conducted by a certified
public accountant in accordance with the standards as set forth and published by the United States Office of
Management and Budget (2 CFR 200.501a), The SUBRECIPMNT shall provide the CITY with a copy of said audit
by April 1 of the year following the program year in which this AGREEMENT is executed. Further, the
SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable provisions of the
Lead -Based Paint Regulations as further detailed below.
VIII. EVALUATION AND MONITORING
A. Generallv
The CITY will monitor the performance of the SUBRECIPIENT against goals and performance standards as
required herein. The SUBRECIPIENT shall provide the CITY all necessary reporting information as required by
the CITY in the administration and review of the Program. Substandard performance as determined by the CITY
will constitute noncompliance with this AGREEMENT. If action to correct such substandard performance is not
taken by the SUBRECIPIENT within a reasonable period of time after being notified by the CITY, contract
suspension or termination procedures will be initiated.
B. Access to Records
The SUBRECIPIENT gives the CITY and MUD, including their authorized representative, access to and the right
to examine all records, books, papers, items, emails, and documents, both physical and electronic, relating to the
program.
C. Audit
The CITY shall have the right to audit and monitor any program income as a result of an ESG activity. Upon
request by the CITY and for audit purposes, the SUBRECIPIENT further agrees to provide all files, records, and
documents pertaining to related activities and clientele demographic data.
IX. LIABILITY
A. Generally
14
Each party to this AGREEMENT acknowledges that it will be liable for its own negligent acts or negligent
omissions by or through itself, its employees, agents, and subcontractors. Each party further agrees to defend
itself and themselves, and to pay any judgments and costs arising out of such negligent acts or omissions, and
nothing in this AGREEMENT shall impute or transfer any such liability from one to the other. In other words, the
SUBRECIPIENT agrees to be fully responsible for its negligent acts or omissions, or any intentional tortuous acts
which result in claims or suits against the CITY, and agrees to be liable for any damages proximately caused by
said acts or omissions. Nothing herein shall be construed as consent by a State or CITY agency or subdivision to
be sued by third parties in any matter arising out of any contract, and nothing herein is intended to serve as a
waiver of sovereign immunity where sovereign inununity applies.
B. CITY not Liable for Funds
The SUBRECIPIENT further acknowledges that the source of the ESG Funds is a federal pass -through grant to
the SUBRECIPIENT. The CITY shall have no obligation to advance or pay the SUBRECIPIENT with any funds
other than the ESG Funds the CITY receives from HUD.
C. Hold Harmless
The SUBRECIPIENT shall defend, indemnify and save harmless the CITY, its officers, agents, employees,
representatives, volunteers, and student externs from and against any and all damages to property or injuries to or
death of any person or persons, including property and employees or agents of the CITY, and shall defend,
indemnify and save harmless the CITY, its officers, agents, employees, representatives, volunteers, and student
externs from and against any and all claims, demands, suits, actions or proceedings of any kind or nature,
including, but not by way of limitation, workers compensation claims and attorney fees/expenses for litigation or
settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of the
SUBRECIPIENT, its officers, directors, employees, agents, subcontractors, and suppliers arising out of the
SUBRECIPIENT's performance of this AGREEMENT.
X. ENVIRONMENTAL CONDITIONS
A. Generally
ESG activities are subject to environmental review by HUD under the environmental regulations in 24 CFR 50.
The SUBRECIPIENT, or any contractor of the SUBRECIPIENT, may not acquire, rehabilitate, convert, lease,
repair, dispose of, demolish, or construct property for a project under this part, or commit or expend HUD or local
funds for eligible activities under this part, until HUD has performed an environmental review under 24 CFR part
50 and the recipient has received FIUD approval of the property.
The SUBRECIPIENT agrees to comply with all applicable environmental requirements insofar as they apply to
the performance of this AGREEMENT, including but not limited to the Clean Air Act, the Federal Water
Pollution Control Act and the Flood Disaster Protection Act. If applicable, the SUBRECIPIENT also shall comply
with the Historic Preservation requirements of National Historic Preservation Act of 1966.
B. Lead -based paint remediation and disclosure
The Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4821-4846), the Residential Lead -Based Paint
Hazard Reduction Act of 1992 (42 U.S.C. 4851-4856), and implementing regulations in 24 CFR part 35, subparts
A, B, H, J, K, M, and R apply to all shelters assisted under ESG program and all housing occupied by program
participants that were built before 1978.
15
C. Assignment of Responsibilities
By this AGREEMENT, the SUBRECIPIENT will accept assignment from the CITY of all responsibilities set
forth in Subpart K of 24 CFR 35.
D. Compliance with Subpart K
The purpose of Subpart K is to establish procedures to eliminate as far as practicable lead -based paint ("LBP")
hazards in a residential property that receives Federal assistance under certain HUD programs for acquisition,
leasing, support services, or operation. In connection with the grant funds under this AGREEMENT, the CITY
requires that the SUBRECIPIENT comply and show evidence of compliance with all applicable subparts of 24
CFR 35, and especially, Subpart K ("LBP Regs").
The SUBRECIPIENT shall conduct the following activities for the dwelling unit, cotmnon areas servicing the
dwelling unit, and the exterior surfaces of the building in which the dwelling unit is located:
A visual assessment of all painted surfaces in order to identify deteriorated paint;
(2) Paint stabilization of each deteriorated paint surface, and clearance, in accordance with §§ 35.1330(a) and
(b), before occupancy of a vacant dwelling unit or, where a unit is occupied, immediately after receipt
of Federal assistance; and
(3) On oing lead -based paint maintenance activities into regular building operations, in accordance with §
35.1355(a), if the dwelling unit has a continuing, active financial relationship with a Federal housing
assistance program, except that mortgage insurance or loan guarantees are not considered to
constitute an active programmatic relationship for the purposes of this part.
(4) And, notice to occupants in accordance with §§ 35.125(b)(1) and (c), describing the results of the
clearance examination.
E. Notification of LBP Hazard
The SUBRECIPIENT shall provide to all occupants of housing:
(1) In accordance with Section 35.130 of the LBP Regs - the LBP hazard information pamphlet. The
pamphlet shall be the EPA/HUD/Consumer Product Safety Cormnission lead hazard information
pamphlet or an EPA -approved equivalent.
The current form and version of the pamphlet can be found at:
http://www.hud.gov/offices/lead/ library/enforcement/fs-discl.pdf
(2) In accordance with 24 CFR 35, Subpart A, all available information and knowledge regarding the
presence of LBP and LBP hazards prior to leasing a housing unit.
f
(3) In accordance with 24 CPR 35, Subpart A, notification in writing of the results of the presumption of LBP
and/or LBP hazards, results of any lead hazard evaluation, and any lead hazard reduction work.
F. LBP Information Summary
For purposes of information only and in no respect intended to be a representation or warranty of the provisions of
the LBP Regulations, the CITY has caused to be prepared an information summary relating to the LBP
Regulations and Application to dwelling units that may be occupied by recipients of services and/or funding from
the SUBRECIPIENT under this AGREEMENT. CITY staff will cooperate with and be available to the
SUBRECIPIENT to assist in implementation of compliance with the LBP Regs as to residential dwelling units to
be assisted by the SUBRECIPIENT. The parties acknowledge and agree the CITY shall not be liable or
responsible for the accuracy of such surmnary, and the SUBRECIPENT is directed to the LBP Regulations and
implementing guidance published and provided by HUD relating to compliance with such LBP Regulations.
G. Exemptions
Section 35.115(a) provides exemptions from Subparts B through R. For example, lead -based paint requirements
do not apply to housing assistance if the assistance lasts less than one hundred (100) days.
XL CONFLICTS OF INTEREST
The SUBRECIPIENT shall comply with 2 CFR 200.112 with respect to the use of program funds to procure
services, equipment, supplies, or other property. With respect to all other decisions involving the use of program
funds, the following restriction shall apply: No person who is an employee, agent, consultant, officer, or elected
or appointed official of the SUBRECIPIENT and who exercises or has exercised any functions or responsibilities
with respect to assisted activities, or who is in a position to participate in a decision making process or gain inside
information with regard to such activities, may obtain a personal or financial interest or benefit from the activity,
or have an interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under,
either for himself or herself, or for those with who he or she has family or business ties, during his or her tenure or
for one (1) year thereafter.
The SUBRECIPIENT agrees to abide by the ESG Program's Conflict of Interest provisions as expressly detailed
in 24 CFR § 576.404 regarding Organizational Conflicts of Interest and Personal Conflicts of Interest. All
contractors of the SUBRECIPIENT must comply with the same requirements that apply to the SUBRECIPIENT
under this section.
XII. ASSIGNABILITY
None of the duties of, or work to be performed by, the SUBRECIPiENT under this AGREEMENT shall be
subcontracted or assigned to any agency, consultant, or person without the prior written consent of the CITY. The
SUBRECIPIENT must submit all subcontracts and other agreements that relate to this AGREEMENT to the
CITY. No subcontract or assignment shall terminate or alter the legal obligations of the SUBRECIPIENT
pursuant to this AGREEMENT.
XIII. EXCLUSIVITY OF AGREEMENT
This AGREEMENT supersedes any and all other agreements, either oral or in writing, between the parties hereto
17
XIV
XV
with respect to the use of the CITY's ESG Funds by the SUBRECIPIENT and contains all the covenants and
agreements between the parties with respect to such ESG Funds in any manner whatsoever. Each party to this
AGREEMENT acknowledges that no representations, inducements, promises or agreements, orally or otherwise,
have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no
other agreement or amendment hereto shall be effective unless executed in writing and signed by both the CITY
and the SUBRECIPIENT.
AMENDMENTS OR MODIFICATIONS
The SUBRECIPIENT shall not obligate, encumber, spend, or otherwise utilize program funds for any activity or
purpose not included or not in conformance with the budget as apportioned and as submitted to the CITY unless:
(1) The SUBRECIPIENT has received explicit written approval from the CITY to undertake such actions, or
(2) Budget changes may be made among approved program activities and among approved budget categories
so long as the specific project activity has been approved, there is no change to the total grant amount,
and the changes to the budget are documented.
Any program modification request by the SUBRECIPIENT must be requested at least forty-five (45) days prior to
the end of the term of this AGREEMENT. No modification to this AGREEMENT shall be binding by either party
unless in writing and signed by both parties.
In the event that the CITY approves any amendment to the funding allocation, the SUBRECIPIENT shall be
notified in writing and such notification shall constitute an official amendment.
The CITY may, at its discretion and upon provision of proper notice to the SUBRECIPIENT, amend this
AGREEMENT to conform with changes in Federal, State, and/or the CITY laws, regulations, guidelines,
directives, and objectives. Such amendments shall be incorporated by written amendment as a part of this
AGREEMENT.
VIOLATION OF TERMS AND CONDITIONS
A. Termination
If, due to any cause, the SUBRECIPIENT fails to comply with the terms, conditions or requirements of this
AGREEMENT, or any prior AGREEMENT whereby ESG funds were received by the SUBRECIPIENT, whether
stated in a Federal statute or regulation, an assurance, a State plan or application, a notice of award, or elsewhere,
the CITY may terminate or suspend this AGREEMENT in accordance with 2 CFR 200,339 and in accordance
with 2 CFR 200.340 by giving written notice, and the CITY may request in writing that all or some of the grant
funds be returned even if the SUBRECIPIENT has expended the funds.
If the SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, the
SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay the CITY all amounts
spent in violation thereof. If the SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure
of the ESG. funds granted hereunder, the SUBRECIPIENT shall be required to reimburse the CITY of all such funds
that were obtained and/or spent under fraudulent circumstances, and the CITY reserves the right to take other
remedies that may be legally available.
18
The SUBRECIPIENT agrees to return all funds as requested by the CITY under this section within thirty (30)
days of receipt of the written request.
Any objections regarding terminations or suspensions shall be made by the SUBRECIPIENT in writing and
mailed to the CITY pursuant to the above NOTICES section.
XVI. CLOSE-OUT
The SUBRECIPIENT agrees to comply with the closeout procedures detailed in 2 CFR 200.343, including the
following:
1. SUBRECIPIENT must submit, no later than ninety (90) calendar days after the end date of the period
of performance, all financial, performance, and other reports as required by the terms and conditions
of the Federal award;
2. Unless the CITY authorizes an extension, SUBRECIPIENT must liquidate all obligations incurred
under the'Federal award not later than ninety (90) calendar days after the end date of the period of
performance as specified in the tenns and conditions of the Federal award;
3. SUBRECIPIENT must promptly refund any balances of rnobligated cash that the CITY paid in
advance or paid and that is not authorized to be retained by SUBRECIPIENT for use in other projects
(See OMG Circular A-129 and 2 CFR 200.345);
4. SUBRECIPIENT must account for any real and personal property acquired with Federal funds or
received from the Federal government in accordance with 2 CFR 200.310-200.316 and 200,329; and,
5. The CITY should complete all closeout actions for the Federal award no later than one year after
receipt and acceptance of all required final reports.
XVIL VALIDITY AND SEVERABILITY
The invalidity in whole or in part of any provision of this ARGREEMENT shall not void or affect the validity of
any other provision of this AGREEMENT. Whenever possible, each provision of this AGREEMENT shall be
interpreted in such manner as to be effective and valid under applicable law, but if any provision of this
AGREEMENT is held to be prohibited by or invalid under applicable law, such provision shall be ineffective
only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this
AGREEMENT.
XVIII. LAWS GOVERNING THIS AGREEMENT
This AGREEMENT shall be governed by and construed in accordance with the laws of the State of California,
and all applicable federal laws and regulations.
XIX. WAIVER
No delay or omission by the CITY hereto to exercise any right or power accruing upon any noncompliance or
default by the SUBRECIPIENT with respect to any of the terms of this AGREEMENT shall impair any such right
or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants,
conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding
breach thereof or of any other covenant, condition, or agreement herein contained.
19
XX. AGREEMENT DOCUMENT EXHIBITS AND ATTACHMENTS
All of the attaclunents and exhibits attached to this AGREEMENT are deemed incorporated by reference. This
document may be executed in three (3) counterparts, each of which shall be deemed to be an original.
Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind thew
respective parties to each of the terms of this AGREEMENT, and shall indemnify the CITY fully, including reasonable costs
and attorney's fees, for any injuries or damages to the CITY in the event that such authority or power is not, hi fact, held by
the signatory or is withdrawn.
IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT on the date and year first above
written.
ATTEST: CITY OF SANTA ANA
a municipal corporation
rem"mil W
✓j DAISY GOMEZ
CLERK OF THE COUNCIL
APPROVED AS TO FORM:
RECOMMENDED FOR APPROVAL:
ST'EVEN A. MENDOZA
Executive Director
Community Development Agency
City Manager
SUBRECIPIENT:
211 Orange County
Karen Williams
Executive Director
Tax ID: )32H33goD72?
DUNS #' } 3300 3573-.1,
m
City of Santa Ana
Scope of Work
Name of Organization People for Irvine Community Health DBA 2-1-1 Orange County (211OC)
Name of Funded Program HMIS
Annual Accomplishment Goal
I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the
funded program, named above, during the 12-month contract period.
NA Persons
II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month
contract period.
NA Persons
Program and Funding Description
III. Description of Work - In the space below, describe the program to be funded during the 12-month contract period.
What specific activities will be undertaken during the contract period. Please be concise in your response. Only the
viewable space will print.
'11OC will facilitate HMIS coordination, communication, training, and technical assistance of Santa Ana ESG
ub-recipients to ensure adherence to data quality, supporting the City's efforts to fully comply with the
Act of 2009. 211OC will:
provide user meetings,
perform site visits,
provide training/technical assistance,
run data quality reports to post and make available online (www.21loc.org)
lete project set-ups,
update the dashboard created for the Mercy House Link on a monthly basis
Schedule of Performance
Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12-month
contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in
quarter 1 do not count them again in quarter
Quarter 1:
July 1 - September 30
Quarter 2:
October 1 - December 31
Quarter 3:
January 1 - March 31
Quarter 4:
April 1 -June 30
Persons
Persons
Persons
Persons
Total unduplicated Santa Ana Residents to be served.
Schedule of Invoicing
Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis.
Quarter 1: July 1 - September 30
Quarter 2: October 1 - December 31
Quarter 3: January 1 - March 31
Quarter 4: April 1 -June 30
K20750.00
Total Grant
Exhibit A
ESG Funded Personnel
Name of Organization: People for Irvine Community Health DBA 2-1-1 Orange County
Name of Program HMIS
Program Staff
Position Title
(only list funded positions)
Budget
Category
Amoral
Salary
Hourly Rate
Approximate
# of Hours per
month serving
Santa Ana
Total Amount Requested
Director ofCoCData & Operations
Salaries
$ 85,000
$ 40,97
17.05
$ 8,363.12
HMIS Data Analyst
Salaries
$ 49,920
$ 24.00
23.50
$ 6,768.00
HMISData Analyst
Salaries
$ 49,920
$ 24.00
13.50
$ 3,898.00
President & CEO
Salaries
$ 150,000
$ 72.12
2.00
$ 1,730.88
Total ESG Requested
$ 20,750.00
ESG Final Budget
Organization Name People for Irvine Community Health DBA 2-1-1 Orange County (2110C)
Program Name HMIS
Expenditures
Ezpens�g;Fuiied
llilfHousing
Expenses Funded
Total Program
Organizational
Categoryk`$r
�a, t1 Ana
by Other Sources
Budget
Budget
Relocation and Stabilization Services
Financial Assistance
Rent Deposit
$
Rental Application fees
t..
$
Utility Deposit
ram' u,
$
Utility
.�
$
Moving Costs
is
$
Service Assistance
Hsg Search & Placement
$
Case Management
$
Mediation
$
Legal
W�
$
Credit Repair
�`_
$
Rental Assistance
Rent,>�
� tom. ,,�
$ -
Other
Salaries
$u _48 864
$ 450,407
$ 469,271
$ 2,400,000
Facility & Equipment's
$ 25,972
$ 25,972
$ 126,000
Other Expenses
p
MINIMS
$ 144,000
$ 144,000
$ 256,000
Indirect Cost
tRVA- 0 86
$ 46,192
$ 48,078
$ 464,000
x
$
V T �i
�
$
wMM
Total
����ljn�
�w20r
$ 666,571
$ 687,321
$ 3,246,000
LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED
(Total Funds for Program must equal Total Program Budget above)
Source Amount
Santa Ana
$
20,750
City of Anaheim
$
10,935
City of Garden Grove
$
5,061
HUD HMIS
$
499,646
HUD HMIS Expansion
$
150,929
Total Funds for the Program
$
687,321
Exhibit B
Page 1 of 1
Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published
as Part VII of the May 26,1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION -
Attached)
(1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that
neither it nor its principals are presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by ary federal department or
agency.
(2) Where the prospective recipient of federal assistance funds is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this
proposal.
Name and Title of Authorized Representative
Signature Date
EXHIBIT C
Page 1 of 2
INSTRUCTIONS FOR CERTIFICATION
By signing and submitting this proposal, the prospective recipient of federal assistance funds is
providing the certification as set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed
when tlis transaction was entered into. If it is later determined that the prospective recipient of
federal assistance fiends knowingly rendered an erroneous certification, in addition to other remedies
available to the Federal Goverrnnent, the Department of Labor (DOL) may pursue available
remedies, including suspension and/or debarment.
3. The prospective recipient of federal assistance funds shall provide immediate written notice to the
person to which this proposal is submitted if at any time the prospective recipient of federal
assistance funds learns that its certification was erroneous when submitted or has become erroneous
by reason of changed circumstances.
4. The terns "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered
transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and
"voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and
Coverage sections of rules implementing Executive Order 12549. You may contact the person to
which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily
excluded fiom participation in this covered transaction, unless authorized by the DOL.
6. The prospective recipient of federal assistance funds further agrees by submitting this proposal that
it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and
voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier
covered transactions and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded
from the covered transaction, unless it knows that the certification is erroneous. A participant may
decide the method and frequency by which it determines the eligibility of its principals. Each
participant may, but is not required to check the List of Parties Excluded from Procurement or Non -
Procurement Programs.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge and
information of a participant is not required to exceed that which is normally possessed by a prudent
person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a
covered transaction knowingly enters into a tower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in
addition to other remedies available to the Federal Government, the DOL may pursue available
remedies, including suspension and/or debarment.
EXHIBIT C
Page 2 of 2
Certification Regarding Lobbying
Certification for Contracts Grants, Loans, and Cooperative A>_reemcnts
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated finds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Grantee/Contactor Organization Program Title
Name of Certifying Officer Signature Date
EXHIBIT D
Page I of 2
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
constriction in the locality as determined in accordance with the Davis -Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development fiends, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT D
Page 2 of 2
Change County COO
Inter -Agency Data Sharing Menictrant3um of Agreement
The agency agrees to share client data among participating
agencies via the LA/OC HMIS (Homeless Management Information System) for the purposes outlined below. Each
participating agency must complete and comply with the Agency Agreement. Each individual HMIS user must complete
and comply with the HMIS User Agreement. This document is available on the OCHMIS website
http I/Www.ochmis.oro.
Uses of HMIS Data:
• Coordinate housing services for families and individuals experiencing homelessness or facing a housing crisis in
Orange County
• Understand the extent and the nature of homelessness in Orange County
• Evaluate performance and progress toward community benchmarks
• Improve the programs and services available to Orange County residents experiencing homelessness or a
housing crisis
• Improve access to services for all Orange County homeless and at -risk populations
• Reduce inefficiencies and duplication of services within our community
• Ensure that services are targeted to those most in need, including "hard to serve" populations
• Ensure that clients receive the amount and type of services that "best fits" their needs and preferences
• Pursue additional resources for ending homelessness
• Advocate for policies and legislation that will support efforts to end homelessness in Orange County
Client Protection:
• Informed consent must be given by clients in order for their identifying information to be entered into HMIS and
shared among agencies in the LA/OC HMIS (see Orange County HMIS participating agencies on OCHMIS.org).
Non -identifying client information may be entered in the system for all clients regardless of whether they give
their informed consent and regardless of their domestic violence status.
• Only non -identifying information will be entered for clients currently fleeing or in danger from a domestic
violence, dating violence, sexual assault or stalking situation.
• Identifying client information will only be shared arnong agencies that have signed this agreement. At the time of
informed consent, and at any point after, the client has the right to see a current list of the OC HMIS
participating agencies.
• Additional agencies may join the LA/OC HMIS and will be added to the list of HMIS participating agencies. As
part of the informed consent process, clients must be informed that additional agencies may join the
collaborative at any time and will have access to their information.
• HMIS Users will maintain HMIS data in such a way as to protect against revealing the identity of clients to
unauthorized agencies, individuals, or entities (see the "OC HMIS Client Consent Form," and the "Client Rights
Brochure OC" available on the OCHMIS.org website).
• Clients may not be denied services based on their choice to withhold their consent.
Each party to this memorandum of agreement shall defend, indemnify, and hold all other parties harmless from any and
all claims arising out of that party's negligent performance of this agreement. Any loss or liability to third parties resulting
from negligent acts, errors, or omissions of a LA/OC HMIS user while acting within the scope of their authority under this
Agreement shall be borne by that user exclusively.
Agreed to and signed by the following agency representative:
Printed Name
Signature
GREATER Los ANGELES & ORANGE COUNTY
HOMELESS MANAGEMENT INFORMATION SYSTEM (LA/OC HMIS)
■z. .4 ��11 1
I. Purpose
The HMIS is a HUD -mandated information technology system that is designed to capture client -level information
over time, on the characteristics and service needs of homeless persons. Client data is maintained on a central
server, which will contain all client information in an encrypted state. HMIS integrates data from all homeless
service providers andorganizations in the community and captures basic descriptive information on every person
served. Participation inLAIOC HMIS allows organizations to share information with other participating
organizations to create a morecoordinated and effective delivery system.
The LA/OC HMIS is the secured electronic database for the Greater Los Angeles and Orange Counties and is a
valuable resource for local communities. The LA/OC HMIS Collaborative consists of four separate Continuums of
Care (CoC). The continuums are: Los Angeles City and County; Santa Ana/Anaheim/Orange County; Glendale; and
Pasadena.
The LA/OC HMIS Collaborative's goal is to provide a comprehensive case management system to advance the
provision of quality services for homeless persons, improve data collection, and promote more responsive policies
to end homelessness in the Greater Los Angeles and Orange Counties.
II. Agreement and Understanding
This Agreement authorizes this Participating Organization (Organization) to designate HMIS Users (User). A User is
a staff person entrusted to enter Protected Personal Information (PPI) into the LA/OC HMIS, on behalf of this
Organization. In order to allow a User to access the LA/OC HMIS, a User Agreement must be signed by the User,
the HMIS Administrator, and this Organization's Authorized Representative.
Confidentiality and Informed Consent
Confidentiality: This Organization must require all Users to abide by its organization's policies and procedures;
uphold all privacy protection standards established by the LA/OC HMIS Collaborative Policies and Procedures; and
comply with all relevant federal and State of California confidentiality laws and regulations that protect client
records. Except where otherwise provided for by law, this Organization shall ensure that confidential client records
are released with the client's written consent.
Written Consent: To obtain written consent, prior to each client's assessment, each client must be informed
that the client's information will be entered into an electronic database called HMIS. The terms of the Consent to
Share Protected Personal Information form must also be explained to each client. Clients who agree to have
their PPI entered into the LA/OC HMIS must sign the Consent to Share Protected Personal Information form.
Verbal Consent: Verbal consent to enter PPI into the LA/OC HMIS may be obtained during circumstances such
as phone screenings, street outreach, or community access center sign -ins. Each client must be informed that his
or her information will be entered into the HMIS database. The terms of the Consent to Share Protected
Personal Information form must also be explained to each client. The client's written consent must be obtained
once the client appears for his or her initial assessment.
Version 1.5 Page 1 of 3 Modified 1012112015
IV. Client's Rights
The client has a right to receive a copy of this notice at the time of request.
Each client has the right to receive the following, no later than five (5) business days of a written request:
• A correction of inaccurate or incomplete PPI
• A copy of his or her consent form
• A copy of his or her HMIS records
• A current list of participating organizations that have access to HMIS data
V. Data Use
This Organization must protect HMIS data by ensuring that:
• A link to the Privacy Notice is accessed from the Organization's website.
• LA/OC HMIS is not accessible to unauthorized users
• LA/OC HMIS is only accessed by computers approved by the Organization
• HMIS Users are trained regarding user responsibilities and conduct
• HMIS Users sign and comply with the LA/0C HMIS User Agreement
• HMIS Users forward a copy of a client's Revocation of Consent to the HMIS Administrator within 24 hours of
receipt.
VI. Responsibilities
This Organization is responsible to ensure that:
. The Notice Regarding Collection of Personal Information is posted at each intake desk or comparable
location.
• HMIS Users do not misuse the system
• Clients are notified if a breach of their PPI is discovered
• Any HMIS User who finds a possible security lapse on the system is obligated to immediately report it to the
HMIS Administrator.
• A signed copy of the Consent to Share Protected Personal Information is retained for a period of seven
(7) years after the PPI was created or last changed.
VII. System Use
Computer equipment and services provided by a CoC are intended only for LA/OC HMIS-related activities.
Prohibited uses include, but are not limited to: malicious or illegal activities; unauthorized access; the creation,
sending and/or storing of fraudulent, threatening, harassing, or obscene messages; inappropriate mass mailing
(spamming, flooding, bombing); denial of service attacks; and the creation or intentional distribution of computer
viruses, worms, and/or Trojan horses.
Equipment, if applicable: All CoC-provided computer equipment including, but not limited to,
printers, scanners, laptops and monitors, were provided through grant funds from HUD. The maintenance
and upgrades of these devices are subject to the requirements and funding limitations of the HUD grant.
Maintenance and/or upgrade costs to equipment, incurred after the HUD grant funds have been
exhausted, become the sole responsibility of this Organization.
Software, Licenses, and/or Services, if applicable Coc-provided services to each organization
may include, but are not limited to, purchasing and installing Anti -Virus Software and licenses, Firewall
software and licenses, Windows software updates and High -Speed Internet Connections. The software
and/or services are provided for HMIS purposes through HUD grant funds. The maintenance, upgrades
and license purchases are subject to the requirements and funding limitations of the HUD grant.
Additional maintenance, upgrades and license purchases, incurred after the grant funds have been
exhausted, become the sole responsibility of this Organization.
Version 1.5 Page 2 of 3 Modified 1012112015
Memorandum of Understanding (MOU)
bet►veen
and
The City of Santa Ana W101R1If Center
PARTIES: The parties to this Memorandum of Understanding (MOU) are
Santa Ana W/O/R/K Center ("Work Center"),
2. PURPOSE: The Work Center, in conjunction with
and the City of
endeavors to establish a
cooperative working relationship between the parties in order to provide program beneficiaries with
information about Work Center opportunities to find better jobs and careers. The MOU serves to establish
the framework for providing services to employees, job seekers and others needing workforce services. The
goal is to ensure that all program beneficiaries have been provided an opportunity to connect with the Work
Center and be assisted with the tools and knowledge necessary to enter the workforce or obtain a higher-
payingjob.
3. RESPONSIBILITIES:
A) The Work Center shall perform the following:
1) Accept referrals to the Work Center.
B) shall perform the following:
1) Provide Work Center information to participants and their families; and,
2) Refer participants in need of employment, training, or career counseling to the Work Center utilizing
the referral form attached hereto as Attachment 1 and incorporated herein by reference.
4. DURATION: This MOU shall commence on July 1, 2019, and shall remain in effect through June 30,
2020.
5. AMENDMENTS: Either party may propose amendments to this MOU at any time by providing written
notice to the other party. Amendments to this MOU shall require the approval of the City Manager, or
her/his designee ("City Manager"), on behalf of the Work Center.
6. CONFIDENTIALITY: If
receives information, which due to the nature of
such information is reasonably understood to be confidential and/or proprietary, such information shall not
be used or disclosed except in the performance of this MOU, and agrees
to exercise the same degree of care it uses to protect its own information of like importance, but in no event
less than reasonable care. "Confidential Information" shall include all non-public information. Confidential
information includes not only written information, but also information transferred orally, visually,
electronically, or by other means. Confidential information disclosed to either party by any subsidiary
and/or agent of the other party is covered by this MOU. The foregoing obligations of non-use and
nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources;
(b) is, through no fault of disclosed in a publicly available source; (c) is in rightful
possession of without an obligation of confidentiality; (d) is required to be disclosed
by operation of law; or (e) is independently developed by _without reference to
information disclosed by the City of Santa Ana.
ATTACHMENT
7. ACCESSABILITY: ORGANIZATION NAME will assure that its services and premises are accessible to
persons with disabilities pursuant to the requirements of the Americans with Disabilities Act,
8. HOLD HARMLESS CLAUSE: Each party to this MOU agrees to indemnify and hold harmless the other
parties, their officers, agents, employees, and volunteers from and against any and all loss or damage, and
from any and all suits, actions and claims Fled or brought by any person or persons arising out of acts or
omissions of the party or its officers, agents, employees or volunteers in the performance of this MOU.
9. DISPUTES: The parties shall first attempt to resolve all disputes informally. Any party may call a meeting
of all parties to discuss and resolve disputes. Should informal resolution efforts fail, the dispute shall be
referred to the City Manager to act as mediator, to attempt to resolve the dispute by holding an informal
hearing with presentations by both parties. If the City Manager's resolution efforts fail, any patty may file a
grievance with the City Manager for review and hearing. The parties agree to be bound by the final
determination resulting from that procedure. Each party to bear its own costs associated with any grievance
procedures.
10. DISCRIMINATION: shall not discriminate because of race, color,
creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined
and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, tennination
or other employment related activities. affirms that it is an equal
opportunity employer and shall comply with all applicable federal, state and local laws and regulations.
11. SEVERABILITY: If any part of this MOU is found to be null and void, or is otherwise stricken, the rest of
this MOU shall remain in force.
12. JURISDICTION: Jurisdiction over any disputes arising under this MOU shall reside in Orange County,
California.
13. AUTHORITY AND SIGNATURES: The individuals signing this MOU or its attacturrents have the
authority to commit the party they represent to the terms of this MOU, and do so commit by signing.
ATTACHMENT
SANTA ANA
W(c
CENTER
in,
Whether you are looking for A JOB or to LEARN A NEW SKILL,
the WORK Center can help!
• Find a Job
• Upgrade Skills
• Get Career Counseling
• Access to Community Services
Attend the My Next Move Workshop and connect with us!
Workshops take place on Mondays at 9:OOAM to 10:00 AM,
Name:
Referring Organization:
Workshop Date:
Time:
Santa Ana WORK Center ♦ 801 West Civic Center, Santa Ana, CA 92701
714-565-2600
ATTACHMENT
21100-0000 HBCT04
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CERTIFICATE OF LIABILITY INSURANCE �
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT; If the certificate holier is Sn ADDITIONAL INSURED, the Policy(les) must have ADDITIONAL INSURED provisions orb* endorsed,
If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not co_nf_e_r ri hts h> the certificate holder In fieu of such endorsomont(s),
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(and
on General Liability policy per the attac hod endorsement, If required.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Santa And
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Community Development Agency.
ACCORDANCE WITH THE POLICY PROVISIONS.
Administrative Services Division M-29
AUTHORIZED REPRESENTATIVE
20 Civic Center Plaia
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ACORD 25 (2015/03) R11988,2015 ACORD CORPORATION. All rights reserved.
'rho ACORD name and logo are registered marks of ACORD
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POLICY NUMBER: 2019-03104
Named Insured: People for Irvine Community Health`
COMMERCIAL GENERAL LIABILITY
GO 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED _ DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL. LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organlzatlon(s):
Any person or organization that you are required to add as an additional Insured on this policy, under a written
contract or agreement currently in effect, or becoming effective during the term of this policy. The additional
Insured status will not be afforded with respect to liability arlsing out of or related to your activities as a real
estate manager for that person or organization.
I information required to complete this Schedule, Knot shown above, will be shown In the Declarations. I
A. Section it - Who Is An Insured is amended to
include as an additional Insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily Injury", "property
damage" or "personal and advertising injury"
caused, In whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
Insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 04 13
�. With respect to the insurance afforded to these
additional Insureds, the following Is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured Is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of Insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
O Insurance Services Office, Inc., 2012
Page 1 of 1
4�1
POLICY NUMBER: 201 a-03104
Mh!i)NPROFII'S
UNI INSURANCE
ALUANCi et CAUt,JRNIA
A NyuU/qr tnfurvnae G tr®arttpr Nonpra/1(s.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR
LESSORS OF PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designation Of Premises (Part Leased To You):
Name Of Person(s) Or Organizations) (Additional Insured):
Any person or organization acting as a manager or lessor of a promises that you are required to name as an
additional Insured on this policy, under a written contract, lease or agreement currently in effect, or becoming
effective during the farm of this policy.
Additional Premium: included
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section if — Who Is An Insured Is amended to Include as an additional insured the porson(s) or
organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership,
maintenance or use of that part of the promises leased to you, and only with respect to liability for °bodily
injury', "property damage", or "personal and advertising injury", caused, in whole or in part, by your acts or
omissions, or the acts or omissions of those acting on your behalf, subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you cease to be a tenant In that premises.
2. Any offense which constitutes "personal and advertising injury" which is committed after you case to
be a tenant In that promisee; or
3, Structural alterations, now construction or demolition operations performed by or on behalf of the
persons) or organizations) shown in the Schedule.
However.
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contractor agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the
contract or agreement to provide for such additional insured.
S. With respect to the insurance afforded to these additional insured, the following is added to Section III -
Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional Insured Is the amount of Insurance:
1, Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations,
NIAC-E67 08 17
Page 1 of 1
�Po
POLICY NUMBER: 2019-03104
MP+IoN PPiOFITS
uni INSURANCE
AtLIANCLOf CAIItQKN1A
ANaadjar ln54rCnGR Akeurt jor Ntrnpro%rts.
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
This endorsement modifies Insurance provided under the following:
SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM
SCHEDULE
Name Of Additional Insured Person(s) Or Organizatlon(s):
Any person or organization that you are required to add as an additional insured on this policy,
under a written contract or agreement currently In effect, or becoming effective during the
term of this policy. The additional insured status will not be afforded with respect to liability
arising out of or related to your activities as a real estate manager for that person or
organization.
Section 11 -- Who Is An Insured is amended to include as an additional Insured the person($) or
organizatlon(s) shown In the Schedule, but only with respect to liability for "damages" caused, in whole or in
part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of
your ongoing operations.
The insurance extended by this endorsement Is primary coverage when you have so agreed in a written
contract or agreement and will be considered non-contributory with the additional insured(s) own Insurance.
NIAC E02 01 17
Page 1 of 1
2110E-00e0
DATE 02(MM/2019 l
o2toB/zols
�1CORC�" CERTIFICATE OF LIABILITY INSURANCE
�---�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditlons of the policy, certain policies may require an endorsement. A statement on
this Certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
ns
PRODUCER 41C0e # 0564249 &a cT
Heffernan Insurance Brokers - PNONE aX
18004 Sky Park Circle, Suite 210 (EAIC,1p, NI,a Ext)1 1 (949) 771-3400 arc, No):(949 771$401
Irvine, CA 92614 ! AliOfiEss:
INSURERS AFFORDING COVERAGE NAIC4
INSURERA: Nonprofits Insurance Alliance of California 01184
INSURED ; INSURERB:QBE Insurance Corporation
39217
2-1-1 Orange County 'INSURER C:
1505 E. 17th Street
Suite 100 Ia�R D:
Santa Ana, CA 92705 IN URE E;
_
INSURERP
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WF11CH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE Or INSURANCE
Hap
SUSR
Wv0
POLICYNUMBER
MMIDaIYYVYI POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [X] OCCUR
Improper Sexual Cond
X
201903104NPO
02/0112019
02/01/2020
EACH OCCURRENCE
S 1,000,000
DAEAGET MISSeaENTED
500,000
X
GEHL
MED EXP (Anyo e arson
20,000
PERSONAL&ADV INJURY
1,000,DOO
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ ypior - LOC
OTHER,
GENERALAGGREGATE
„�
2,000,000
PRODUCTS-COMPIOPAGO
�_ 2,000,DOO
SOCIALSERVICE
$ 1,000,909
_A
AUTOMOBILE
X
LIABILITY
ANYAUTO
OWNED BCHEOULED
AUTOSONLY AUTOS
HIREp X NON S%NEO
AUTOS ONLY AUTOS ONLY
201903104NPO
02/01/2019
02/01/2020
COMBINED SINGLELIMIT
Ca nds t
1,000,000
BODILY INJURY Per ema,)R
_
BODILY INJURY Perawltlent!$
PPROPERdV DAMAGE
(Perawl ant _
$
A
X
LMoREL1-A0Aa
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
201903104UMBNPOQOOTE
02/01/2010
02/01/2020
EACH o0CURRCNCE
$ 2,000,000
AGGREGATE
�2,000,D00
DED I RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' uABILITY YIN
�MYPPERO/MEIETOFUPPAARTNCWEXSCUTIVE I--�
(M6IIG6tory 111 Nlij L.
If yes, doscrlbe under
DEBCRIPTION OF OPERATIONS below
NIA
PER : OTH-
ER
E.L, EACH ACCIDENT
E. L. DISEASE -EA EMPLOYEE
$
--
E.L. DISEASE - POLICY LIMIT
B
A
Disabllky-AD&D-Trav
Professional Llablll
201903104ACC
201903104NPO
02/01/2019
02/01/2019
02/01/2020
02101/2020
)Aggregate
1,000,000
1,000,000
DESCRIPTION OP OPERATION$ / LOCATIONS / VEHICLES (ACORD 101, Addleonal RbM014 Sohodula, mayy ba ANAchad 0more ap0w le mgWmd)
Re: As Per Contract or Agreement on File with Insured. City of Santa Ana, Community Development Agency is included as an additional Insured (and Primary)
on General Liability policy perthe attached endorsement, If required.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLED BEFORE
Cityof Santa Ana
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Community Development Agency.
Administrative Services Division M-25
AUTHORIZED REPRESENTATIVE
20 Civic Center Plaza
Santa Ana, CA 92701
/// / --
ACORD 25 (2016103) O 1988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 2019-03104
Named Insured: People for Irvine Community Health"
COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifles Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization (a):
Any person or organization that you are required to add as an additional Insured on this policy, under a written
contract or agreement currently in effect, or becoming effective during the term of this policy. The additional
insured status will not be afforded with respect to liability arising out of or related to your activities as a real
estate manager for that person or organization.
Information required to complete this Schedule, If not shown above, will be shown In the Declarations.
A. Section II — Who Is An Insured is amended to
Include as an additional Insured the person(s) or
organization(s) shown In the Schedule, but only
with respect to liability for "bodily injunf', "property
damage" or "personal and advertising Injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you,
However:
1. The Insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
IS. With respect to the Insurance afforded to these
additional insureds, the following Is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional Insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown In the Declarations;
whichever Is less.
This endorsement shall not Increase the
applicable Limits of Insurance shown in the
Declarations.
CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 2019�03104
MNONPROFIT"
lINSURANCE,
A1,11ANCSt 4f C:ALI
rT Nucrr,fsr riio-areaca.>m ti�mt jne luveyrtp(tts:
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR
LESSORS OF PREMISES
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designation Of Premises (Part Leased To You):
Name Of Porson(s) Or Organization(s) (Additional Insured):
Any person or organization acting as a manager or lessor of a premises that you are required to name as an
additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming
effective during the term of this policy.
Additional Premium: Included
Information required to complete this Schedule, If not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured Is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership,
maintenance or use of that part of the premises leased to you, and only with respect to liability for "bodily
Injury", "property damage", or "personal and advertising injury", caused, in whole or in part, byyour acts or
omissions, or the acts or omissions of those acting on your behalf, subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you cease to be a tenant in that premises.
2. Any offense which constitutes "personal and advertising Injury" which is committed after you case to
be a tenant in that premises; or
3. Structural alterations, new construction or demolition operations performed by or on behalf of the
person(s) or organization(s) shown in the Schedule.
However:
1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional Insured will not be broader than that which you are required by the
contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insured, the following is added to Section III -
Llmlts Of Insurance:
If coverage provided to the additional Insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured Is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less.
This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations.
NIAC-E67 08 17 Page 1 of 1
3�
POLICY NUMBER: 2019.03104
NONPROFIIS,
INSURANCE
IIIA,OCEOf CAUrblkNiA
Aff¢ ajarWnrom A waplpr Naflatropts,
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY -
FOR DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies Insurance provided under the following:
SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM
SCHEDULE
Name Of Additional Insured Person(s) Or Organizatlon(s):
Any person or organization that you are required to add as an additional insured on this policy,
under a written contract or agreement currently in effect, or becoming effective during the
term of this policy. The additional insured status will not be afforded with respect to liability
arising out of or related to your activities as a real estate manager for that person or
organization.
Section II — Who Is An Insured is amended to include as an additional Insured the person($) or
organization(s) shown in the Schedule, but only with respect to liablllty for "damages" caused, In whole or in
part, by your acts or omisslons or the acts or omissions of those acting on your behalf In the performance of
your ongoing operations.
The insurance extended by this endorsement is primary coverage whan you have so agreed In a written
contract or agreement and will be considered non-contributory with the additional Insured(s) own insurance.
NIAC E02 01 17
Page 1 of 1 K
2110C-0000 HBC
CERTIFICATE OF LIABILITY INSURANCE D07131/2019ATE Y)
07f31/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les). must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in Hen of such endorsement s).
PRODUCER LIOenSa # 0084249k2aEACT
Heffernan Insurance Brokers
18004 Sky Park Circle, Suite 210
Irvine, CA 92614
PHONE �— Ai „No : 949 771.3401
AIc.Na,Ext�1._(949�,771_340U �.1.... �_�..._..
..........._.,.._........
E. IL
ss:......�_..._......W............�._._...__.......___.__.._.............s__ ._.._
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...............INSURE..Rtai.Al?FOROINQ...QbYPeCLAGE
IN B :Non roffta Insurance Allis a of California
011 4
INSURED
SURE .�__....
URERC:
2-1.1 Orange County
150$ E. 17th Street
SuiteIDS
....___...............�e...._..........-_.__................._._........�...
NSUR D:
......_.....___......._....-s.._.....�.e..._.._.,,........._.....
Santa Ana, CA 92705
INSU ERR fii......_.._...............-__..............__._........_....._.......�...___..
INSURER F:
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCEJNM
ADOL
SUBR
Me
POLICY NUMBER
Duey PF
POLICY EXP
02/01/2020
LIMITS
Lm
A
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
improper Sexual Cond
X
201903104NPO
02101/2019
GH OCCURRENCE
11000,000
DAMnoE TO RENTED
00, 00
MEDFXPnvo"udQ.ld.
s 20,000
X
PE ONAL bV N RY
S 11000,000
bEN'L AGGREGATE LIMITAPP IES PER:
POLICY O j�a M LOG
tlTHE`
AUTOMOBILE LIABILITY
RA E
2,000,000
PR DUCTS -CO IO AGG
2,000,000
SOCIAL SERVICE
60MBINE —SINGLE LIMIT
$ 1,000,000
1,000,000
S
AApNNWYNNAUTO
201903104NPO
02/01/2019
02/0112020
ODI YI JURY P ar
ODI YINJURY Peraucidarrt
AUTOSONLYNLY SCHEAUTDULED
X Ai1T090NLY X ALIT05 ONNErD,
Parreociatlenl AMAGE
S
A
X
UMBRELLA LIAR
Excess OAS
X
OCCUR
CUIMS-MADE
201903104UMSNPO
02101/2019
02101/2020
EA HDCCURRENC
2,000,000
RED TE
2,000,000
DEp RETENTIONS
ZNEKMRSOOEMSNIAALONY
ANY PROPREIETOERRIPARTNERIEXECUTIVE
iandato, In NJH)EZGlUOSof LJ
NIA
FER ERH
L.
i4,�v
E.L pISEASE- MPLOYE
E,pISA--Y—LIM-IT
_,,,,��
—
u gsC, Rdescribe
N under P RATIONS below
...--
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101, Additional Romarka Schedule, may be attached If more space Is required)
Re: As Per Contract or Agreement on File with Insured. City of Santa Ana, its officers, agents, employees, representatives, and volunteers are included as an
additional Insured (primary and noncontributory) on General Liability policy per the attached endorsement, if required, The Cancellation notice endorsement
has been requested for the General Liability policy from the insurance company and if approved will be forwarded when received. this certificate replaces and
supersedes all previously issued certificates.
REVIEWED & APPROVED
By RISK ANAgEMENT DIVISION
City of Santa Ana
Risk Management Division
20 Civic Center Plaza, 4lh floor
Santa Ana, CA 92702
OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
M. LAMBE TTHB EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
n lnRR.41111N ACORD
The ACORD name and logo are registered marks of ACORD
Aunts reserved,
POLICY NUMBER: 2019.03104
Named Insured: People for Irvine Community Health*
COMMERCIAL GENERAL LIABILITY
CO 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided underthe following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
MU
Name Of Additional Insured Person(s) Or Organization(s):
Any person or organization that you are required to add as an additional insured on this policy, under a written
contract or agreement currently in affect, or becoming effective during the term of this policy. The additional
insured status will not be afforded with respect to liability arising out of or related to your activities as a real
estate manager for that person or organization.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations l
A. Section 11— Who Is An insured is amended to
Include as an additional Insured the person(s) or
organizations) shown in the Schedule, but. only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The Insurance afforded to such additional
Insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following Is added to
Section III — Limits Of Insurance:
If coverage provided to the additional Insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured Is the
amount of insurance:
1. Required by the contractor agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not Increase the
applicable Limits of Insurance shown in the
Declarations.
j�/ltfG/ �
CG 20 26 0413 d 1 aur�ce .,vices Office, Inc., 2012
Page 1 of 1
POLICY NUMBER: 2019.03104
NONPROFITS
I. N V [i€ N C. L:
ALUANCt Of i, kU rOWIA
A trtadfarfoxor#ncC ANxart.�trr Jtts
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- PRIMARY AND NON-CONTRIBUTORY -
FOR DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies Insurance provided under the following:
SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM
SCHEDULE
Name Of Additional Insured Person(s) Or Organization (a):
Any person or organization that you are required to add as an additional Insured on this policy,
under a written contract or agreement currently in effect, or becoming effective during the
term of this policy. The additional Insured status will not be afforded with respect to liability
arising out of or related to your activities as a real estate manager for that person or
organization.
Section II — Who Is An Insured is amended to include as an additional Insured the person($) or
organization(s) shown In the Schedule, but only with respect to liability for "damages" caused, in whole or In
part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of
your ongoing operations.
The Insurance extended by this endorsement Is primary coverage when you have so agreed in a written
contract or agreement and will be considered non-contributory with the additional Insured(s) own insurance.
NIAC E02 0117 Pago 1 of 1
CERTHOLDER COPY
SP
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 07-30-2019
CITY OF SANTA ANA SP
RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLZ FL 4
SANTA ANA CA 92701-4058
GROUP:
POLICY NUMBER: 9023428-2018
CERTIFICATE ID: 29
CERTIFICATE EXPIRES: 09-01-2019
09-01-2018/09-01-2019
THIS CERTIFICATE SUPERSEDES AND CORRECTS
CERTIFICATE # 27 DATED 10-1$-2018
This Is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period that will expire or did
expire as indicated above.
This certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any .requirement, term Or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein Is subject to all the terms, exclusions, and conditions, of such policy.
/F�7%'Fi5'U' / U(/ct, � I�v"" ✓ j V NL�9sr+'^ �.P4A'Lf+'4��
Authorized Representatives President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-07-30 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #2005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-07-30 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF SANTA ANA
EMPLOYER
PEOPLE FOR IRVINE COMMUNITY HEALTH (A SP
NON-PROFIT CORP.) DBA: 2-1-1 ORANGE COUNTY
1505 E 17TH ST STE 108
SANTA ANA CA 92706
& APPROVED
1CtEM£NT L)IVI510N
M. LAMBERT
[SCM,CNI
PRINTED : 07-30-2010
(REV.7-2e14)
POLICYHOLDER COPY
R O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 07-30-2019 GROUP;
POLICY NUMBER: 9023428-2018
CERTIFICATE 10: 29
CERTIFICATE EXPIRE5:09-01-2019
09-01-2018/09-01-2019
THIS CERTIFICATE SUPERSEDES AND CORRECTS
CERTIFICATE # 27 DATED 10-18-2019
CITY OF SANTA ANA SIP
RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLZ FL 4
SANTA ANA CA 92701-4058
This is to certify that we have issued a valid Workers' Compensation Insurance policy In a form approved by the
California Insurance Commissioner to the employer named below for the policy period that will expire or did
expire as Indicated above.
This certificate of insurance Is not an Insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of Such Policy.
r�zL2�?<G- fl..f/et +'Zr�1/f L'ca..ri+.^ .x✓`T ..esru��..,
Authorized Representative/ President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,.000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-07-30 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-07-30 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF SANTA ANA
EMPLOYER
PEOPLE FOR IRVINE COMMUNITY HEALTH (A SP
NON-PROFIT CORP.) DBA: 2-1-1 ORANGE COUNTY
1505 E 17TH ST STE 108
SANTA ANA CA 92705
(SCM,CNI
PRINTED : 07-30-2019
IREV.7-2014)
Enclosed is your copy of a certificate of insurance on which the certificate holder
required a waiver of subrogation:
1. Please be advised that a waiver of subrogation requires that a 3% surcharge
will be applied by State Fund ONLY to the premium assessed on the payroll
of your employees earned while engaged in work for that certificate holder
who requested the waiver. (Note: if you have no employee payroll on that job,
then there is no charge.)
2. To apply the 3% surcharge, you must also agree to maintain accurately
segregated payroll records for employees engaged in work on job/s for the
certificate holder who has the waiver. The payroll records are subject to
verification by an auditor.
Example:
Payroll for job:
Sample Rate:
Regular Premium equals:
Surcharge:
Additional Waiver charge:
Total premium equals
$S,000.00
13.30%
$ 665.00
3.00a
$ 19.95
$ 684.95 (665.00 + 19.95)
POLICYHOLDER COPY SP
RO. BOX 8192, PLEA ANTON, CA 94588
OMMUM CERJ __ 1*
RIPA
COMPENSATION INSURANCE
I
ISSUE BATE: 09-01-2019 WL
aGROUP: a POLICY NUMBER: 9023428-2019
�t �
CERTIFICATE ID: 29
CERTIFICATE EXPIRES: 09-01w2020
09-01--2019109--01-2020
CITY OF SANTA ANA SP
RISK MANAGEMENT DIVISION
20 CIVIC CENTER PL,Z FL 4
SANTA AAA CA 92701-405S
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the amptoyer,
We vvill also give you 30 days advance notice should this policy be cancelled prier to its normal expiration.
This certificate of insurance is not an insurance policy and does not .amend. extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to ail the terms, exclusions, and conditions, of such policy.
Authorized Representative President and CEO
EMPLOYER'S LLABILITY LIMIT LNCLUDING DEFENSE COSTS: $1,000,O00 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-07-30 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY NAME OF ADDITIONAL .INSURED:
CITY OF SANTA AA
ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-202 IS
ATTACHED TO AND FORMS A PART OF THIS POL10Y,
ENDORSEMENT #2570 ENTITLED WAIVER OF SLIBROGATION EFFECTIVE 2019- 9-01 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, THIRD PARTY [SAME:
CITY OF SANTA ANAL
EMPLOYER
PEOPLE FOR IRVINE COMMUNITY HEALTH (A SP
NON-PROFIT CORP.) DSA: 2-1--1 ORANGE COUNTY
1505 E 17TH ST STE 108
SANTA ANA CA 92705
PRINTED : 08-15-2019
(REV.7.2014)
M0409
POLICYHOLDER COPY SP
P.O, BOX 8192, PL EASANTON, CA 94588
SOMMENIM DER I �C?� .:'COMPENSATION INSURANCE
ISSUE RATE: 09-01-2019
-& t POLICY NUMBER: 9023428-2019
CERTIFICATE 0. 29
CERTIFICATE EXPIRES:-01-2020
09-01-2019/09-01-2020
CITY OF SANTA ANA SP
RISK MANAGUMENT DIVISION
20 CIVIC CENTER PLZ FL
SANTA ANA CA 92701-4058
This is to certify that we have issued a valid Workers' Compensation insurance pcsiicy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cani�sliatlon by the =und except upon go days advance written notice €o tine employer.
We will also give you �O days advance notice should this policy he cancelled prior to its normal expiration.
This certificate of insurance Is not an insurance policy and does not amend. extend or niter the coverage afforded
by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be Issued or to which it rhay pertain, the insurance
afforded by the poiic;y described herein is subject to all the terms, exclusions, and conditions, of such policy.
;ro�e W�,_
Autharizecl Representative €srasicient and CEO
EMPLOYEPIS LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER QC RRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2 €19-07-S0 IS
ATTACHED TO AND FORM$ A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 SS
ATTACHED TO AIR FORMS A PART OF THIS POLICY.
ENDORSEMENT #2570 ENTITLED WAIVER OF SUB O ATION EfFWTIVE 2019-PS 01 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF SANTA ANA
APPROVED
igEMENT DtvJSI N
09 2019
EMPLOYER
PEOPLE FOR IRVINE COMMUNITY HEALT 4 (A SP
RON-PROFIT CORP,) RSA: 2-1-1 ORANGE COUNTY
1505 E 17TH ST STE 109
SANTA ANA CA 92705
€ 0400
IRE.v,7-2€114I PRINTED : 08- 16 -2019