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Home My WebLink AboutORANGE COUNTY CHILDRENS THERAPEUTICS ARTS CENTER (4)City of Santa Nna Clerk of the Cc._acil 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 grgnt retention requirements 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 A-2020-043 15 COTC Office Use On FiNq CITY CLERK ? 133'23 PM3:5 eialhbwY�'Grw-A _ C � n-r'c r No. A was completed on �7 -i and final payment has been made. (List aff amendments. Use space below if needed.) Department: Phone/Ext.: Signature: Date: 1:lagreementsVormsVorm- agreement termination form_goldenrod.doc INSURANCE ON FILE WORK MAY PROCEED UNIIL INSURANCE 51PIRES _►aa�� CLERK OF COUNCIL A-2020-043-15A D: CDo CD) DATE: (D-"^'r S Vim— SECOND AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND ORANGE COUNTY CHILDREN'S THERAPEUTIC ARTS CENTER (24 CFR Parts 570) THIS SECOND AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK 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 o ("City"), and Orange CountyChildren's Therapeutic Arts Center, a California nonprofit organization ("Subrecipient"). r RECITALS A. On July 1, 2020, the City entered into Community Development Block Grant ("CDB(Y") Subrecipient Agreement #A-2020-157-01 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 H, 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 fall force and effect. A-2020-043-15A IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said Agreement the date and year fast above written. ATTEST: / '- Y" i' I APPROVED AS TO FORM: RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager SUBRECIPIENT: Name: Dr. Ana JimenezZmi Title: Executive Director Tax ID# 33-0930891 DUNS# 014317940 Digitally signed by Francine R. Francine R. Villareal Villareal A60Rb® CERTIFICATE OF LIABILITY INSURANCE °AT YY) L. r-' 412212DY 04/22/z021 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 CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services AIC NNO Ezt; (949)7C9-8800 FAIL No: (949)709-1668 26429 Rancho Parkway South AODRE33: leremy@thecomprehensiveinsurance.com Suite 120 INSURERS AFFORDING COVERAGE NAIC N Lake Forest CA 92630 INSURERA: Nonprofits Insurance Alliance of California 10023 INSURED INSURER B : State Compensation Insurance Fund 35076 Orange County Children's Therapeutic Arts Center INSURER C 2215 N. Broadway INSURER D INSURER E : Santa Ana CA 92706 INSURER F: CERTIFICATE NUMBER: ULZU THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUUL INSO bUbirt MD POLICYNUMBER POLICYEFF MMIDDNYYY POLICYEXP MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccunence $ 500,000 CLAIMS -MADE OCCUR MED EXP Any one person $ 2Q000 PERSONAL &ADV INJURY $ 1,000,000 A Y 2020-09201 12/21/2020 12121/2021 GEN'L AGGREGATE LI MIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑ JEC LOD PRODUCTS -COMPIOPAGO $ 2,000,000 OTHER', $0 Deductible $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea saddlent $ 1,000,000 BODI LV I NJURY(Per person) $ ANY AUTO A OWNED scHEOULED AUTOS ONLY AUTOS 2020-09201 12/21/2020 12/21/2021 BODILY INJURY Per accident ( ) $ HIRED X NON-0WNED X PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY(Per ... Want) $ $0 Deductible $ UMBRELLALIAB O CCUR EACH OCCURRENCE $ AGGREGATE $ E%CESS LIAB CLAI:MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- X STATUTE ER $O Deductible AND EMPLOYERS' LIABILITY YIN E.L. EACHACCIDENT $ 1,000,000 B ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA 9255171-2021 06/15/2021 06/15/2022 E.L. DISEASE - EA EMPLOYEE $ 11000,000 (Mandatory In NH) describe under E.L. DISEASE-POLICYLIMIT $ 1,000,000 Ees, SCRI PTION OF OPERATI DNS below Social Service Professional Liability $1,000,00011,000,000 Aggregate/Occurr A Improper Sexual Conduct Liability 2020-09201 12/21/2020 12/21/2021 $1,000,000/1,000,000 Aggregate/Occurr $0 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attach ad If more space Is required) The City of Santa Ana, Its officers, employees, agents, volunteers, and representatives are included as Additional Insured per attached endorsement CG2026. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such Insurance as Is afforded by this policy Is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional Insureds per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. 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 PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD a a 1tIslxMan�gnnentD[Watpn < REVIEWED&APPRI BY � <S Risk Management Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head jar Insurance, A Heartfor Nonprofits, POLICY NUMBER: 2020-09201 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 Name of Person or Organization: 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.4. 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 :S REVIEWED&APPROV Risk Mar1,19e1writ Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for lasuran[e. A Heart forNonproflm POLICY NUMBER: 2020-09201 (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 loss 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. (a) 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 csm s RAMamgrmwrtD[Welon REVIEWED&APPROVED BY: Risk M aoagemeet Apalyst