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HomeMy WebLinkAboutSALVATION ARMY (4)INSURANCE ON FILE N'VoRK MAY PRocFFo A-2021-106-01 ID . 01 ZOZZ c G FIRST AMENDMENT TO AGREEMENT BETWEEN THE CITY OF SANTA ANA AND THE SALVATION ARMY FOR USE OF EMERGENCY SOLUTIONS GRANT CORONAVIRUS (ESG-CV) FUNDS 11' GDR (Mticeile patl(i "i1 T-T THii°�S111FIRST AMENDMENT to the above -referenced agreement is entered into on November 16, 2021, by and between The Salvation Army ("Subrecipient"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement No. A-2021-106, dated June 15, 2021, by which Contractor agreed to use ESG-CV funds to administer and operate the Hospitality House to temporarily house clients referred by the City and Street Outreach teams (`Agreement"). B. In accordance with the terms and conditions of said Agreement, the Parties desire to amend Section II —Term of Agreement, to extend the Term of said Agreement, and Section III — Disbursement of Funds, to increase the maximum amount of Compensation for said Agreement. 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: Section II, Term of Agreement, shall be amended to extend the end date of the Term of said Agreement through the date upon which the City decides in its sole discretion to complete the transfer of City guests at the Hospitality House to the new Carnegie Navigation Center, which shall be no later than January 31, 2022, unless terminated earlier in accordance with Section 15. City shall provide Contractor with fourteen (14) day written notice of the final date of transfer of City guests to the new Camegie Navigation Center, which date shall serve as the end of the Term of this Agreement. If necessary, the Term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney. 2. Recitals J and K, and Sections III and III(a), Disbursement and Funds, shall be amended to increase the maximum amount of compensation by one hundred and thirty thousand dollars ($130,000.00), such that the total sum to be expended under said Agreement shall not exceed nine hundred and ten thousand dollars ($910,000.00) during the Term of said Agreement. Contractor shall not be limited to a maximum amount of compensation per month, so long as Contractor remains within the total not to exceed amount of compensation during the Term of said Agreement. This total not to exceed amount of compensation is not guaranteed to Contractor. Rather, Contractor will only be paid for sufficient services provided during the Term of said Agreement. Once said Agreement is terminated, or the Term is ended as detailed in section II above, the City shall not be responsible for any further payments to Contractor other than payment for services provided by Contractor during the Term of the Agreement. Page 1 of 2 3. Except as modified by this First Amendment, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the Parties hereto have executed this First Amendment to said Agreement on the date and year first written above. ATTEST DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM SONIA Fe�grVA O City torn l Is City RECOMMENDED FOR APPROVAL STEVEN A. MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA K I 1NE RIDGE City Manager THE SALVATION ARMY Name: J. Ko ; Captain Title: Divisional Secretary for Business Page 2 of 2 A-2021-106-01 FIRST AMENDMENT TO OPERATING AGREEMENT WITH THE SALVATION ARMY TO OPERATE THE HOSPITALITY HOUSE SHELTER THIS FIRST AMENDMENT to the above -referenced agreement is entered into on November 16, 2021, by and between The Salvation Army ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"), RECITALS A. The parties entered into an Agreement dated June 15, 2021, by which Contractor agreed to administer and operate the Hospitality House to temporarily house clients referred by the City and Street Outreach teams ("Agreement'). B. In accordance with the terms and conditions of said Agreement, the Parties desire to amend Section 2 — Effectiveness and Tenn of Agreement, to extend the Term of said Agreement, and Section 3 — Compensation, to increase the maximum amount of Compensation for said Agreement. 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: Section 2(b), Effectiveness and Term of Agreement, shall be amended to extend the end date of the Term of said Agreement through the date upon which the City decides in its sole discretion to complete the transfer of City guests at the Hospitality House to the new Carnegie Navigation Center, which shall be no later than January 31, 2022, unless terminated in accordance with Section 15. City shall provide Contractor with fourteen (14) day written notice of the final date of transfer of City guests to the new Carnegie Navigation Center, which date shall serve as the end of the Term of this Agreement. If necessary, the Term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney. 2. Section 3, Compensation, subsections (a) and (b), shall be amended to increase the maximum amount of compensation by one -hundred and thirty thousand dollars ($130,000.00), such that the total sum to be expended under said Agreement shall not exceed nine -hundred and ten thousand dollars ($910,000.00) during the Term of said Agreement. Contractor shall not be limited to a maximum amount of compensation per month, so long as Contractor remains within the total not to exceed amount of compensation during the Term of said Agreement. This total not to exceed amount of compensation is not guaranteed to Contractor. Rather, Contractor will only be paid for sufficient services provide during the Term of said Agreement. Once said Agreement is terminated, or the Term is ended as detailed in section 2(b) above, the City shall not be responsible for any further payments to Contractor other than payment for services provided by Contractor during the Term of the Agreement. Page t of 2 3. Except as modified by this First Amendment, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the Parties hereto have executed this First Amendment to said Agreement on the date and year first written above. ATTEST CITY OF SANTA ANA )� AISY GOME�Z K_ I�STINE RIDGE Clerk of the Council City Manager TO FORM THE SALVATION ARMY SONIA City A} RYAN RECOMMENDED FOR APPROVAL STEVEN A. MENDOZA Executive Director Community Development Agency �� r Name: J. Koe ; aptain Title: Divisio Secretary for Business Page 2 of 2 Francine ,'. Digitally signed by '. Francine R. VillarealPag s 1 of 2 _i nnto 9n9i in?R r4N R. R[� VIIIcIICc1108:30:55-07'0' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIVYYy) 09/29/2021 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 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 Willie Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-737B FAX 1-888-467-2378 EMAIL ADDRESS: -certificates@willis. corn INSURERSAFFORDINGCOVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: Westchester Surplus Lines Insurance Compan 10172 INSURED The Salvation Army,- Division 17 30840 Hawthorne Blvd., Bldg D INSURER B: Greenwich Insurance Company 22322 INSURER C: XL Specialty Insurance Company 37885 INSURER D: Rancho Palos Verde., CA 90275 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W22306682 REVISION NUMBER: 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 OF INSURANCE AODTYPE INSD MID POLICY NUMBER MM/POLDDIYYYY EFF MMIDDY FXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE I OCCUR DAMAGEExcED PREMISESS a occurrence $ 1,000,000 X MED EXP(Any one person) $ 0 A Self Insured Retention: X $1,000,000 y G7163119A 002 10/01/2021 10/01/2022 PERSONAL &ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 GERL POLICY PRO- ECT LOC PRODUCTS-COMPIOP AGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea eccldent $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per eccldent $ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMB REXCLUDED?ANYPROPRIETOWPARTNEWEXECUTIVE ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, docents under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $ B Excess Auto Liability - CA y RAE500021811 10/01/2021 10/01/2022 Any Auto / CSL $3,000,000 Self-Insd Retention $2,OOD,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Location Code: 17-145-10-01-01 - Santa Ana Hospitality House Shelter CA -Business Auto is fully Self -Insured per the attached State Certificate. SEE ATTACHED 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 A�� ©1988-2016 ACORD Ci ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sa m: 21630631 uI 2252947 9 e RlekManagmnentDkislon ss RREmEWED&pAPPROVED BY:: Risk Management Analyst AGENCY CUSTOMER ID: LOC M A & ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Insurance Services West, Inc. The Salvation Army - Division 17 30840 Hawthorne Blvd., Bldg n Rancho Palos Verdes, CA 90275 POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance FOR USE OF EMERGENCY SOLUTIONS GRANT CORONAVIRUS (ESG-CV) FUNDS. TERM:. From: June 15, 2021 through December 31, 2021 The City of Santa Ana, its officers, officials, employees, and volunteers are included as an Additional Insured as respects to General Liability and Auto Liability as required by written contract or agreement. General Liability policy shall be Primary and Non -Contributory with any other insurance in force for or which may be purchased by Additional Insureds as required by written contract or agreement. Waiver of Subrogation applies in favor of Additional Insureds with respects to Workers Compensation, as permitted by law. INSURER AFFORDING COVERAGE: XL Specialty Insurance Company POLICY NUMBER: RWE500047506 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Workers Compensation E.L. Each Accident $1,000,000 CA EL Each Employee $1,000,000 Retention: $1,000,000 ADDITIONAL REMARNS: Excess Workers Compensation Policy No. RWE500047506 provides coverage in the state of CA CA -Workers Compensation is fully Self -Insured per the attached State Certificate © 2008 ACORD C The ACORD name and logo are registered marks of ACORD SR ID: 21630631 BATCH: 2252947 CERT: W22306682 NAIC#; 37885 RiekMmuganrnfDivislan REVIEWED&APPROVED BY: ' Risk Management Analyst 5YAIEW4LLFOYJAA OFPIII, WWItl! ACAEN A Public Service Agency This is to certify that: CERTIFICATE OF SELF-INSURANCE The Salvation Army NAME OF SELF -INSURER 30840 Hawthorne Boulevard, Rancho Palos Verde., California 90275 ADDRESS, CITY, STATE, ZIP has been approved as a Self -Insurer under the California Compulsory Financial Responsibility Law and assigned Self -Insurance # 202 pursuant to Section 16053 of the California Vehicle Code for the period August 19, 2021 through August 18, 2022 wam' MAN ER Financial Responsibility Unit Department of Motor Vehicles SR 27 (REV. W199) UH �r �, RtekMatw.ganenEDtWelon B�IS/Qo, REVIEWED&APPRavED By., �`1;; �aa4tYM�f � ffNAad.� �� Rtsh Management Analyst STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS OFFICE OF SELF-INSURANCE PLANS 11050 Olson Drive, Suite 230 Rancho Cordova,CA 95670 Phone No. (916) 464-7000 FAX (916) 464-7007 Edmund G. Brown Jr., Governor CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION TO WHOM IT MAY CONCERN: This certifies that Certificate of Consent to Self -Insure No. 0566 was issued by the Director of Industrial Relations to: The Salvation Army under the provisions of Section 3700, Labor Code of California with an effective date of November 15, 1933. The certificate is currently in full force slid effective. Dated at Sacramento, California This day the 20th of April 2017 Lyn Asio Booz, Chief ORIG: Craig Nicles Director Of Claims Management The Salvation Army 180 East Ocean Boulevard, 1 Oth Floor Long Beach, Ca 90802 c,yo liteleMwwgemenGDlviefon /R�BAEwEo&{p}A�P+,,} P+RIovmr. B p`4AZ.ptrh¢ 6v Y or Rink Managem€nt MnaQasi POLICY NUMBER: G7183119A 002 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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) Locations Of Covered Operations As required by written contract signed by both parties prior to loss. 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. 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 endorsemen applicable Limits Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 t shall not increase the of Insurance shown in the "Mamgen aDlvlelon 4 REVIEWED&APPRavm By: Rh Manogeinent Analyst NON-CONTRIBUTORY OTHER INSURANCE ENDORSEMENT Named Insured The Salvation Army - Endorsement Number Policy Symbol Policy Number Policy Period - Effective Date of Endorsement GLW G7183119A002 10/01/2021 To 10/01/2022 10/01/2021 Issued By (Name of Insurance Company) _ Westchester Surplus Lines insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph 4. c. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted in its entirety and replaced by the following: c. Method of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method unless you are required by written contract to provide insurance that is primary and non-contributory, and the contract has been signed by you prior to any loss. Where required by such a written contract, this Insurance will be primary and non-contributory only when and to the extent required by that written contract. However, under the contributory 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 of the other insurance 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. All other terms and conditions remain unchanged. GLE0095 (07/10) ©Chubb. 2016. All rights reserved. TuskManagenvmtDrvuWn ,f Va REVIEWED&APPROVrDBY' 1Lq�a1n•.m� �ndn�i�+�t �.. �eRrWA� oe RukManagement Analyst