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HomeMy WebLinkAboutTALLER SAN JOSE HOPE BUILDERS (7)O=CDR co (l�\?c1fL) P- INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES i I.2091 CLERK OF COUNCIL DATE: A-2020-157-06 FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND TALLER SAN JOSE HOPE BUILDERS (24 CFR Parts 570) THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT is entered into this 10TH day of September 2021, by and between the City of ;::4 Santa Ana, a charter city and municipal corporation of the State of California ("City"), and o Taller San Jose Hope Builders, a California nonprofit organization ("Subrecipient"). co RECITALS UJ w ' A. On July 1, 2020, the City entered into Community Development Block Grant ("CDBG") Subrecipient Agreement #A-2020-043-20 with Subrecipient to provide CDBG Funds from the United States Department of Housing and Urban 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 II, 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-2020-157-06 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said Agreement the date and year first above written. ATTEST: r:em W—"T Clerk of the Council APPROVED AS TO FORM: Soniaarvalho City tt qy 0 I0 RECOMMENDED FOR APPROVAL: 7F�Q-- ��k- STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager &iuk Name: Shawna Smith Title: Executive Director Tax ID# 59-3816355 DUNS# 614473580 Francine R. 1111111yalanm by Fawdre R. Villareal Villareal _r"202tm.z9 1a;1652 Page 1 of 2 CERTIFICATE OF LIABILITY INSURANCE O05/21ATE I/2021Y) 05/21/2021 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 poilcy(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 endorsement(s). PRODUCER Willis (Bermuda) Ltd. Wellesley souse, 2nd Floor 90 Pitts Hay Road CONTACT Willie Towers Watecn Certificate Center NAME: qIC No; 1-888-467-2378 R.E.-877-995-7378 ApD Ecertificates@willis.com INSURERS AFFORDING COVERAGE NAICA Pembroke, MOB END INSURER A: American Unity Group Limited C0929 INSURED Taller San Jose Hope Builders INSURER B: 801 N. Broadway INSURER C: INSURERD: Santa Ana, CA 92701 INSURERE: NSURERF: COVERAGES CERTIFICATE NUMBER: W21008985 RFVISION NIIMRFP- 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBR LTft TYPE OF INSURANCE JHM WVD POLICYNUMBER OUCYYFF POLIC EXP LIMITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 X CLAIMS -MADE OCCUR DAMAGE TO RE TED PREMISES Ea occunenoe $ MED EXP (Any one erson) $ A y 1-14601-00-21 06/01/2021 06/01/2022 PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,000,000 K POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGO $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea eccldenl $ BODILY INJURY (Par Person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accldent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OF ICERIMEMS REXCLUDED?ANYPROPRIETORIPARTNEWEXECUTIVE ❑ NIA E.L. DISEASE EA EMPLOYEE $ (Mandatory In NH) If year dsacrlba under DESCRIPTION OF OPERATIONS below E, L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is requlred) If this Certificate of Insurance is for Professional and / or General Liability insurance this provides evidence of coverage for 1) amployeas while acting within the scope and during the course of their employment with Providence St. Joseph Health and /or 2) contracted parties for their acts, errors or omissions in rendering or failing to render Medical Services outlined by such contract with a Providence St. Joseph Health entity including the Insured identified on this certificate. HOLDER City of Sans. 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 PROVISIONS. AUTHORIZED REPRESENTATIVE JS_ ©1988.2016 AC ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Sa In: 21126221 BATON: 2103724 r RielrManagznlerdffivislon , $/'(r*IVs� REVIEWED & APtPRCVM BY. E( /19Yll1Yr9adHl.+vF+d Ruk ManageementAnalyst AGENCY CUSTOMER ID: LOC #: -`A�?p® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis (Bermuda) Ltd. - Taller San Jose Hope Builders 801 N. Broadway Santa Ana, CA 92701 POLICY NUMBER See Page 1 CARRIER NAIC CODE Sea Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 26 FORM TITLE: certificate of Liability Insurance City of Santa Ana, its officers, agents, representatives, employees and volunteers are included as Additional Insureds as respects to General Liability. - ACORD 101 (2008101) 72008 ACORD C The ACORD name and logo are registered marks of ACORD SR ID: 21126221 BATCH: 2203724 CERT: W21008985 sun Hlek Mmmgnmmt Drnalon u. 3fi �2 REVIEWED&APPROVED BY: , I�I Risk Management Hnalytt provisions of this policy relating to the Mowing: MIM I 5- Wain all rights, of au on agranst the cartftate holder, ft elected or appointed offida1w officers, employees, agents,..representatives and walunteers, when acting within the scope of their appointment or employment Issued 5,172021 N Primary Policy No, 1-14001-00-21 ts' REVIEWED CnIN A4 A *—I-filroa RrikManarie-MAnAYS1 Oe A� br CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDYYYY) 0810512020 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(ies) 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 endorsement(s). PRODUCER Marsh USA Inc. 13015th Avenue, Suite 1900 Seattle, WA 98101 ABm Jennifer Caudebec-206-214-3156 CONTACT NAME: lAnd No Exit- PHONE A/C No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE - NAIC If INSURER A: Safety National Casualty Corp. 15105 CNI 18985706�00000�XSWG19-22 INSURED Providence St. Joseph Health INSURER B:' INSURER C Slaters of St. Joseph Of Orange - 1801 Lind Ave SW #9016 Renton, WA 98057-9016 - INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003556843-09 REVISION NUMBER: 7 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HER LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY BEE POLIMM1DD/YEYY LIMITS COMMERCIAL GENERAL LABILITY CLAIMS -MADE ❑OCCUR EACH OCCURRENCE Is DAMAGE TO RENTED - PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY Is GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PECT RO ❑ LOC J OTHER: GENERALAGGREGATE Is PRODUCTS - COMPIOP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea ercl $ BODILY INJURY (Per person) $ BODILY INJURY(Peraccldorau $ PROPERTYDAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE OFFICIMMEMBEREXCLUDE09 (Mandatory In NH) Use describe under DESCRIPTION OF OPERATIONS below NIA SP4059664 SIR: $2,000,000 0 (012 0110112022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) SSJO doe Taller San Jose, Block Grant, SIO N. Poinaetta, Santa Ana, CA 92701. City of Santa Ana, officers, agents, employees, and volunteers are named as additionally Insured on this policy pursuant to written Contract, agreement, or memorandum of understanding. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jean Aguirre 988.2016 ACORD CI The ACORD name and logo are registered marks of ACORD � 1tiek7danagtmuntDlWaimt IIV � REVIEWED i& pAPP'RIOVEO BY 8 �lll� Risk Management Analyst WTW INS SVCS WEST 801 S FIGUEROA ST LOS ANGELES, CA 90017 1-213-607-6300 Certificate of Insurance PROb'REMIYAF COMMERCIAL Policy number: 08219302.2 Underwritten by: UNITED FINANCIAL CAS CO January 26, 2021 Page 1 of 2 Certificate Holder ................................................................ ,............. ............................... ...................... ............. :................. Additional Insured CITY OF SANTA ANA 20 CIVIC CFR PIL SANTA ANA, CA 92702 Insured ................................................................................................................................... Agent/Surplus Lines Broker ............ ... ........�.................................. TALLER SAN JOSE HOPE ES WTW INS SVCS WEST BUILDERS 801 S FIGUEROA ST HOPE BUILDERS CONSTRUCFIO LOS ANGELES, CA 90017 801 N BROADWAY SANTA ANA, CA 92701 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. ............................................................................................................................................................................ Policy Effective Date: Oct 31, 2020 Policy Expiration Date: Oct 31, 2021- Insurance coverage(s) Limits ..................................................................................................................................................................... BODILY INJURY/PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT UNINSURED/UNDERINSURED MOTORIST $1,000,000 COMBINED SINGLE LIMIT Description of Location/Vehicles/Special Items Scheduled autos only 994 6MC 4000 W4SO42 4KDB4B1A5R1001096 Stated Amount $32,552 MEDICAL PAYMENTS $5,000 COMPREHENSIVE $1,000 DIED COLLISION $1,000 DIED W/WAIVER . .................L............,.......,........'1GC.C' NE'...H'73'........................,............. ,........................,................................... 2017CHEVROLETSILVERADO C15001GCRCNEHSHZ358082 MEDICAL PAYMENTS $5,000 COMPREHENSIVE $1,000 DIED COLLISION $1,000 DIED W/WAIVER r lttskMana�muntl)wielon 0REmEWED&APPROVEOBr• V Risk Management Analyst Policy number: 08219302-2 Page 2 of 2 Certificate number 02621NET302 Please be advised that additional insureds and loss payees will be notified in the event of amid -term cancellation. 7( _ ,�Mi i Form 5241 (10102) IEwED & APPROlYimelo: �r REVIEWED&APPROVED BY: ® Risk Management Mtalyrt '