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HomeMy WebLinkAboutORANGE COUNTY CHILDRENS THERAPEUTICS ARTS CENTER (3)City of Santa la COTC Office Use Only - Clerk of the Council 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination form. ( / Is the agreementSANTO, ANA CITY CLERKs) a permanent record? Yes Nov :SAP 13'23 PM3:4f3 Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with ON A-2020-043 No. -161A was completed onC4 c? and final payment has been made. (List all amendments. Use space below if needed.) Department: Phone/Ext.:�/� Signature: Date: 15� —t " 9 J 0agreemen1sgormslform agreement termination form_goldenroddoc INSURANCE ON FILE . IOPK MAY PROCEED UNTIL INSURANCE EXPIRES 18.2-I• 9-1 CLERK OF COUNCIL DATE: A-2020-043-16A O. (.()R W) SECOND AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK Cw\\A'PMQ GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA rIp" 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 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 Orange County Children's Therapeutic Arts Center, a California nonprofit 0 organization ("Subrecipient"). N RECITALS v A. On July 1, 2020, the City entered into Community Development Block Grant ("CDBG") Subrecipient Agreement #A-2020-157-02 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 full force and effect. A-2020-043-16A IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST: N • I APPROVED AS TO FORM: Sonia R. Carvalho City �r y By: (((R O. ODGE Assistan ity Attorney RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA 725-�- L=L- KRISTINE RIDGE City Manager SUBRECIPIENT: 6"Q!:.-�= � - Name: Dr. Ana AmVez-HiGli Title: Executive Director Tax ID# 33-0930891 DUNS# 014317940 Digitally signed by Francine R. Francine R. Villareal vlimeal ACORH CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 1 `.,./ 04/22/2021 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 poiicy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub)ect 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 suchendorsement(s). _ PRODUCER CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services PHONE (949) 709-8800 FAX (949) 709-1668 Ext AIc, No 26429 Rancho Parkway South E mAILa Jerem lhecom ADOREss: Y@ prehensiveinsurance.com Suite 120 INSURER(S)AFFQRDING COVERAGE NAIC # Lake Forest CA 92630 INSURERA: Nonprofits Insurance Alliance of Californla 10023 INSURED - - INSURERS: State Compensation Insurance Fund - 35076 Orange County Children's Therapeutic Arts Center INSURERC: 2215 N. Broadway INSURER D: INSURER E : Santa Ana CA 92706 INSURER F: CERTIFICATE NUMBER: Ul THIS IS TO CERTIFYTHATTHE 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 AUULIbUHN INSD WVD POLICY NUMBER POLICY EFF MM/DD/VYYY POLICY EXP MM/DDNYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 11000,000 19 CLAIMS -MADE OCCUR PREMISES Ea occu rence $ 500,000 I EXP (Any one person $ 20,000 PERSONAL &ADV INJURY $ 11000,000 A Y 2020-09201 12/21/2020 12/21/2021 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- � PRODUCTS $ 2,000,000 POLICY JECT LOC $0 Deductible $ OTHER: - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ - ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 2020-09201 12/21/2020 12/21/2021 BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY X PROPERTY DAMAGE Peraccldent $ $0 Deductible $ UMBRELLA LIAR OCCUR - EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE -DED RETENTION $ $ WORKERS COMPENSATION PER OTH- X STATUTE ER $O Deductible ANDEMPLOYERS'LIABILITY YIN E.L. EACH ACCIDENT $.1,000,000 B ANY PROPRIETORIPARTNEWEXECUTIVE OFFICEWMEMBER EXCLUDED? NIA 9255171-2021 06/15/2021 06/15/2022 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below - E.L. DISEASE -POLICY LIMIT $ 1,000.000 Social Service Professional Liability $1,000,00011,000,000 Aggregate/Occurr A Improper Sexual Conduct Liability 2020-09201 12/21/2020 12/21/2021 $1,000,00011,000,000 Aggregate/Occurr $0 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City of Santa Ana, Its officers, employees, agents, volunteers, and representatives are included as Addltlonal 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. 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 yszr. ,mac xy� R1ekManegemenEDlWelon r�����r2 REVIEWED dr APPROVETI BV: 01988.2015 ACORD 'rA-4gc+at v ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORDRisk MznagelTlent Analyst POLICY NUMBER: 2020-09201 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): I 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. I Information required to complete this Schedule, if not shown above, will be shown in the 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. CG 20 26 12 19 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 06, RiskManegemadDMalon REVIEWED & APPROVED BY: ®tre �' `-� Risk ManagementAnalyet pNONPROFITS INSURANCE ALLIANCE OP CALIIORNIA A Head for lasuranoe. A Heart for Nonprofits. 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: 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 iBsk Manegenwait➢IWaton REVIEWED&APPROVED BY: F P, Y �' Rislc ManagcinFnl sVnafyrt