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HomeMy WebLinkAboutDELHI CENTER/ PUBLIC LAW CENTERCity of Santa 0 na Clerk of the Cou.,cil AGREEMENT TERMINATION FORM 5A 1 Ole Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination farm. / 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 L A-2020-067-03 No. was completed on (List all amendments. Use space below if needed.) i7agreementsUormslform- agreement terminafion form _goldenrod.doc COTC Office Use Only LIF THE CC€ NUL 12 '23 P142:25 "/ � — � and final payment has been made. Department: l�j ✓y/ 7 Phone/Ext.: I �� Signature: Date: INSURANCE ON FILE A-2020-157-05 JORK WAY PROCEED SEP 2 g 2021 UNTIL INSURANCE EXPIRES 11-1:& 1 CLERK OF COUNCIL DATE: FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND p DELHI CENTER /PUBLIC LAW CENTER t PA CO CpA"Va horc5 (24 CFR Parts 570) THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT is entered into this LOTH 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 Della Center/Public Law Center, a California nonprofit organization ("Subrecipient"). RECITALS A. On July 1, 2020, the City entered into Community Development Block Grant ("CDBG") Subrecipient Agreement #A-2020-067-03 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. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said A-2020-15 7-05 Agreement the date and year first above written. ATTEST: of the Council APPROVED AS TO FORM: RECOMMENDED FOR APPROVAL: N.- STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager 481 19041191"01 Ii oiyi.Nnr%le��e or:4�m R.0 Jenny Rios°R� mYRuaama^= .k7nyRlos®EtlNcm�x.wg C =115 0 = f OeIM1i LaMp� Oem: 2021.W.131B:M:42-0B'BB' Name: Jenny Rios Title: Chief Executive Officer Tax ID# 95-2620952 DUNS# 088513593 l 1 Francine R. Villareal ViOaelal �Ianea by"�°`�na". Dee: 2021.01.261638:55-08'00` AC"Ril CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYi L.� 01/12/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 poll 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). PRODUCER CONTACTCert8 cate Issuance Team Comprehensive Insurance Services PHONE (949) 709-8800 F x (949) 709-1668 Est) lANo 26429 Rancho Parkway South E )eremY@thecomprehensiveinsurance.com MANo Suite 120 ADOREss: INSURERS) AFFORDING COVERAGE NAIC 9 Lake Forest CA 92630 INSURER A: Nonprofits Insurance Alliance of California 10023 INSURED INSURER B: StarNet Insurance Company 40045 Deihl Center INSURER C: 605 E. Central Ave, INSURER D: INSURER E : Santa Ana CA 92707 INSURER F: 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 LTR TYPE OF INSURANCE AUULbUUK INSO MO POLICYNUMBER POLICYEFF MM/DDIYYVY ICY EXP MMDGYVYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X RE ED CLAIMS -MADE OCCUR PREMISES Ee occurrence $ 500,000 MEO EXP (Any one person) $ 20,000 PERSONAL a ADV INJURY $ 1,000,000 A Y 2020-01376 11/01/2020 11/01/2021 GEN'LAGGREGATE UMITAPPLIES PER: GENERALAGGREGATE $ 31000,000 ❑ PRO- 7X -COMPfOPAGG 3,000,000 POLICY JECT LOGPRODUCTS$ OTHER: $0 Deductible $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT an, accident 11000,000 $ BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEUULED AUTOS ONLY AUTOS 2020-01376 11/01/2020 11/01/2021 BODILY INJURY Per ( Al) HIRED x NON -OWNED x PROPERTYDANIAGE AUTOS ONLY AUTOS ONLY Peraccidenf $ $0 Deductible $ UMBRELLA'IJI OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED -RETENTION $ $ WORKERS COMPENSATION v PER oTH- $0 Deductible AND EMPLOYERS' LIABILITY YIN /� STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 B ANY PEIRIME TOW PARLUDEDXEDOTIVE ❑ EXCLUDED? NIA BNUWC0152622 11/01/2020 11/01/2021 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mendatoryin NH) (MandatoryIn NH) yes, describe under E.L. DISEASE - POLICYLIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below Social Service Professional Liability $3,000,00011,000,000 Aggregate/Occur,. A Improper Sexual Conduct Liability 2020-01376 1 //0112020 11/01/2021 $1,000,00011,000,000 Aggregate/Occurr. $D Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I 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 additionally Insured on this policy pursuant to written contract, agreement, or memorandum of understanding per attached endorsement CG2026. Such Insurance as Is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 Rish ManagermanE➢Mn aco aM.w� ©1988.2015 ACORD 1.y '��� REVIEWED&APPROVEEr# ,MHNGwM3 Vi�f.Fne4C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I i Risk Management Analyst POLICY NUMBER: 2020-01376 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 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. A. Section II — Who Is An Insured 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 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. © ISO Properties, Inc., 2012 Page 1 of 1 a z litak MangmmetttDniafon `��, F RENEWED& APPROVED BY. .r ,3 l� � �Rtf•CKN2 Fv�"++Gi'e3MaRE frisk Management Analyst NONPROFITS INSURANCE M ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2020-01376 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. SECTION II —WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. 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, B. SECTION III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.A. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 xsG sl il~ ll ' WekManegemeaEDiroiafon_ APPROVED BY. F u r..�D.z k k&"At Risk Management Analyst ,... _.... o. NONPROFITS INSURANCE ■ ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2020-01376 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is Insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the toss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I - COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE. - (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. C. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 F RIsk Mmwgumnoi Division J REVIEWED&APPROVMrIY E - RISK Management Analyst DELHICENTER xmiaoy ee.un..nw.a n January 25, 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92701 RE: Contract #A-2020-067-03 Auto Insurance Requirement Release of Liability Dear Staff of the Risk Management Division: This letter regards provision X.2 of Contract #A-2020-067-03 for services performed under a CBDG funded grant issued by the City of Santa Ana. The Delhi Center does not own or operate any motor vehicles. The Delhi Center employees, participants, or other agents working under this Agreement utilize their own automobiles in the performance of this agreement. As per provision X.2 (page 12), The Delhi Center secures and maintains on file self -certification of automobile insurance coverage from all such employees, participants, or agents who work under this agreement. 2. Automobile Liability Coverage SUBRECIPIENT shall also obtain and maintain, during the effective period of this Agreement, broad form automobile liability coverage with a $1,000,000 limit unless reduced by CITY, which applies to both owned/leased and non -owned automobiles used by SUBRECIPIENT employees or participants in the performance of this Agreement, or, in the event that SUBRECIPIENT will not utilize such owned/leased automobiles but intends to require employees, participants or other agents to utilize their own automobiles in the performance of this Agreement, SUBRECIPIENT shall secure and maintain on file from all such employees, participants, or agents as self -certification of automobile insurance coverage. Governmental entities may provide proof of self- insurance. The Delhi Center hereby releases the City of Santa Ana of Automobile Liability. If you have any questions, please do not hesitate to contact our Director of Operations, Patrisia Gonzalez at gatrisia@delhicenter.org Sincerely, Patrisia Gonzalez Director of Operations The Delhi Center is a 501(c)(3) nonprofit organization. Tax ID # 95-2620952 505 E. Central Avenue., Santa Ana, Ca 92707 www.delhicenter.org u. RieleMawgtmenfDtWston ;:. afi�t� I'I �° REVIEWED&APPROVED BY Y 81 ill}.11) y r. '. Risk Management Analyst �T