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HomeMy WebLinkAboutAIDS SERVICES FOUNDATION OF OC DBA RADIANT HEALTH CENTERS (2)City of Santa Ana Clerk of the Council I AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements ; E have been satisfied prior to signing the termination form." „ Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with Sv LS No. A-2020-043-01 was completed on (List all amendments. Use space below if needed.) i7agreementsWormslform- agreement termination form_goldenrod.doc COTC Office Use On OF 1-7 ;=v e� ' 30 '-71�and final payment has been made. Department: ,�5,—PA Phone/Ext.: �6 Signature: _r Date: INSURANCE ON FILE %ORK MAY PROCEEU U1171L INSURE EXPIRES CLERK O�OUNCIL A-2020-157-09 FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND AIDS SERVICE FOUNDATION OF OC DBA RADIANT HEALTH CENTERS (24 CFR Parts 570) O:Cok(D) (D0I1Xafi0rcS) THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK 1 fPf GRANT AGREEMENT is entered into this 10TH day of September, 2021, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"), and Aids Service Foundation of OC DBA Radiant Health Centers, a California nonprofit organization ("Subrecipient"). N RECITALS 0 N 00 A. On July 1, 2020, the City entered into Community Development Block Grant C%+ ("CDBG") Subrecipient Agreement #A-2020-043-01 with Subrecipient to provide w CDBG Funds from the United States Department of Housing and Urban V) Development ("HUD") to be used in the operation of a public service program for the youth of the City of Santa Ana ("said Agreement"). B. In accordance with the terms and conditions of said Agreement, the parties desire to amend said Agreement to report the current Catalog of Federal Domestic Assistance ("CFDA") Number and Federal Award Identification Number ("FAIN") for Subrecipient, and to report the current federal award date and amount of the award as required for pass -through entities. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except as herein modified, the parties agree as follows: 1. Recital A shall be amended to update the City's current CFDA Number to 14.218 and FAIN to B-21-MC-06-0508 in accordance with the requirements for pass -through entities outlined in 24 CFR 200.332. 2. Article I1, Section A, shall be amended to report the current federal award date of July 1, 2021, and update the amount of the award to be $5,640,635 in accordance with the requirements for pass -through entities outlined in 24 CFR 200.332. 3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. A-2020-157-09 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said Agreement the date and year first above written. ATTEST: air � /DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM: RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager SUBRECIPIENT: Name: e Title: Chief Executive Officer Tax ID# 33-0126481 DUNS# 189300031 Tori Pierson w°'e'e'nz;9oas10:027emnn. a— 1 AIU,StK-U1 JOHNSON pA7/19/OD/YYYYJ 7119/2021 AI 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 conditions 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 endorsements). PRODUCER License # 0827761 & EACT Sandra Johnson CalNonprofits Insurance Services PO Box 640 Capitols, CA 95010 PHONE FAX Alc, No, Ext): (213) 401A 014 (AIC, No): Xi%AIE . sandra@cal-insurance.org INSURERS AFFORDING COVERAGE NAIC# INSURER A: Nonprofits Insurance Alliance of California 10023 INSURED AIDS Services Foundation of Orange County dba Radiant Health Centers INSURERS: Service American Indemnity Company 39152 INSURER C INSURER D 17982 Sky Park Circle, Ste. J INSURER E: Irvine, CA 92614 INSURER F: COVERAGES CF_RTIFICATF NIIMRFR• Rclncrnkl KII IkaRRR. 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. ILSR TYPE OF INSURANCE ADUL p SUER WIVID POLICY NUMBER POLICY EFF POLICY EXP pp LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR X X 2021-08363 7129/2021 712912022 EACH OCCURRENCE $ 1,000,000 URMAISEULTU RENPEMS (Ea cure nce $ 500,000 MED EXP (Any one erson 20,000 PERSONAL &ADV INJURY 11000,000 AGGREGATE LIMIT APPLIES PER: POLICY 1:1wf LOC GENERAL AGGREGATE 3,000,000 GEN'L X PRODUCTS - COMPIOP AGG 3,000,000 OTHER: A AUTOMOBILE X LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS S�Wr p AUTOS ONLY AilT05 ONY 2021-08363 7/2912021 712912022 CEOMaBINED SINGLE LIMIT $ 1000000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PeOaccitlent AMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 2021.08363-UMe 712912021 712912022 EACH OCCURRENCE 2,000,000 AGGREGATE 2,000,000 DIEDX RETENTION$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN QAQN��Y PRO�PRIETORI EXCLUDRIEXECUTIVE (manCatolry in NH)EXCLUDED? DIf ESCRIPTION OF OPERATIONS below NIA SATIS0394900 11112021 1!1/2022 X PER H. STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 A PROF Liability 2021-08363 7/2912021 712912022 $lM/Event-Aggregate 3,000,000 A Abuse & Molestation 2021.08363 712912021 7/2912022 Ea. Claim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached If more space Is required) City of Santa Ana, officers, agents, employees, and volunteers are named as Additional Insured with respect to General Liability as required by written contract per forms attached.Coverage Is Primary & Non-contributory and Blanket Waiver of Subrogation applies. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVE"""" AUTHORIZED REPRESENTATIVE $'4j RE'lkFkD&APPRroyso8; 76v Pivnwu Risk Marwaemmt❑encilAide ACUKU Zb tZU10/U3f @ 1988.2015 ACORD C(V - 'J The ACORD name and logo are registered marks of ACORD ACORO7 16..� AGENCY CUSTOMER ID: AIDSSER-01 LOC #: 1 ADDITIONAL REMARKS SCHEDULE SJOHNSON Page 1 of 1 AGENCY alNonprofits Insurance Services POLICY NUMBER EE PAGE 1 License # 0827761 NAMED INSURED AIDS Services Foundation of Orange County dba Radiant Health Centers 17982 Sky Park Circle, Ste. J Irvine, CA 92614 Orange CARRIER NAIL CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certincate of Liability Insurance 2021 Cyber Liability NETWORK SECURITY & DATA PRIVACY LIABILITY Lloyds of London Policy #ESJ0028903601; EFF 02/26/2021-02126/2022 Retroactive Date: Full Prior Acts $1M Limits of Liability; $1M Aggregate $11M Network Security; First Party Privacy Breach Expenses $1M Media Liability including Defamation & Intellectual Property Rights $51K Deductible applies to each claim including costs and expenses Lloyds of London agree to pay on your behalf any reasonable sums necessarily incurred by you, or on your behalf, as a direct result of a cyber event first discovered by you during the period of the policy in compliance with policy form insuring clauses. =a�MW&APPW�ft AI VKV "IV tZUUDIU'If U2005 ACORD COR' L - "RalaM,r,uyenwiKleetu tAiue The ACORD name and logo are registered marks of ACORD I(- POLICY NUMBER: 2021-08363 Named Insured: Radiant Health Centers* COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 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 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 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. I 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 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 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 12 19 © Insurance Services Office, Inc., 2012 ��ll#�� 7arct lateuar _ �rraxma,uy""v,rci�caivae ®®NONPROFITS POLICY NUMBER: 2021-08363 FORM: NIAC-E2611 17 INSURANCE NAMED INSURED: Radiant Health Centers* ALLIANCE Of CALIFORNIA A Hoad for Insurance. A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. N IAC-E26 11 17 ortw�t f *f yy a 9ixtwEo&+/A�rveovm lip. 'aickhk,ucjerrmt OctimlNtk NONPROFITS INSURANCE ALLIANCE OR CAL1 roRN IA A Head for fnsuraoce. A Heart for Nonprofits. 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(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(s) 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. .u_1e=10141 MA <- RbkMc ugmu lto['N i 55Rewevr�6AarnavEURr ? iau:'iale l R¢kManagemmcMiu�lAi<ic ,- POLICY NUMBER: 2021-08363 Named Insured: Radiant Health Centers* COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 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 Organization(s): City of Santa Ana, Its Officers, Agents, Employees and Volunteers City of Santa Ana Risk Management 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 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. .�, Ridf 1Mdakn =.. y - t#werreo6�nMexrnmUv: = U :If ' 7asc p'aCWan ' FhkM19a,wr�enxix ClmiralNne. CG 20 26 12 19 © Insurance Services Office, Inc., 2012