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HomeMy WebLinkAboutLATINO HEALTH ACCESS (2)INSURANCE ON FILE N WORK MA.' PROCEED N UNTIL INSU RANCE EXPIRES C, a Z o 5 2oti't- CLERK OF COUNCIL v DATE: A-2021-131-01 AGREEMENT FOR USE OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF d'. GA 0 (Or AD K.1,> �� k) � MINORITY HEALTH GRANT FUNDS This Agreement is hereby made and entered into this q1 h1 day of '> G _ _ 2021, by and between 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"), and Latino Health Access, a California nonprofit corporation ("SUBRECIPIENT"). RECITALS: A. The CITY, as an entitlement recipient and grantee ofthe United States Department of Health and Human Services ("HHS") Office of Minority Health ("OMH") Grant Fund Program, Funding Opportunity Number MP-CPI-21-006 and Federal Award Identification Number (FAIN) CPIMP211286, desires to enter into this Agreement with the SUBRECIPIENT for the expenditure of OMH FUNDS in accordance with the authority of 42 U.S.C. § 300u-6 (Section 1707 of the Public Health Service Act), 45 CFR Part 75 and the Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (P.L. 116-260) ("OMH REGS"). B. The SUBRECIPIENT is a private nonprofit corporation that has been selected by the CITY to receive OMH FUNDS and administer such financial assistance; and to provide the services described in Exhibit A, in accordance with the Schedule of Performance included therein, hereinafter referred to as "said program". SUBRECIPIENT represents that it is qualified and willing to operate said program and certifies that the activities carried out with funds provided under this Agreement will meet one or more of the HEAL-OC program's National Objectives. C. CITY and SUBRECIPIENT, along with other participating entities, executed a Memorandum of Understanding dated August 31, 2021, outlining the requirements of the HEAL-OC grant program and committing each entity to work cooperatively to adhere to the HEAL-OC grant program requirements. D. SUBRECIPIENT agrees that it will adhere to the performance measurements and outcomes as indicated on Exhibit A (Schedule of Performance). Failure to follow the measurements and meet the stated outcomes may constitute breach of contract that could result in termination of this Agreement or serve as reason for the City to recapture the grant funds awarded to SUBRECIPIENT pursuant to this Agreement. WHEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of this Agreement and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and SUBRECIPIENT: I. SUBRECH'IENT'S OBLIGATIONS A. Nonprofit Status - Representations and Warranties (a) Authority. SUBRECIPIENT is a duly organized and existing nonprofit corporation in good standing and authorized to do business under the laws of the State of California. SUBRECIPIENT has full right, power and lawful authority to accept the funding hereunder and to undertake all obligations as provided herein and the execution, performance and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions on the part of SUBRECIPIENT. (b) Experience. SUBRECIPIENT is a qualified provider of the services to be provided hereunder. (c) Familiarity With Services Required. By executing this Agreement, SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to be performed and provided hereunder, (ii) it has carefully considered how the services should be performed, and (III) it fully understands the facilities, difficulties and restrictions attending performance of the services under this Agreement, (d) No Conflict, To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement will not constitute a default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party or by which it is bound. (e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened bankruptcy proceeding, (f) No rending Legal Proceedings. SUBRECIPIENT is not the subject of a current or threatened litigation that would or may materially affect SUBRECIPIENT'S performance under this Agreement. (g) Application Veracity. All provisions of and information provided In SUBRECIPIENT'S application for funding submitted to CITY, including any exhibits, are true and correct in all material respects. (h) No Pending Investigation. SUBRECIPIENT has no knowledge that it is the subject of any current or threatened criminal or civil action investigation by any public agency, including without limitation a police agency or prosecuting authority, that would relate to or affect performance of the Agreement or provision of services hereunder. B. Amount of Gran = and Quarterly Disbursement. The amount granted to SUBRECIPIENT is $910,000 ("OMIT FUNDS"), for the two-year term from July 1, 2021 through June 30, 2023 for the program named; Health Equity and Literacy in OC (HEAL-OC). Such funds shall be expended by SUBRECIPIENT on or before June 30, 2023, The Term of this Agreement may be extended by a writing executed by theCity Manager, or his orher designee, and the City Attorney. The OMH FUNDS shall be disbursed by CITY to SUBRECIPIENT on a quarterly basis subject to and upon receipt and approval of a complete quarterly activity report from SUBRECIPIENT, with the final payment subject to the satisfaction of the condition precedent of submittal of complete reporting information due on or before July 15 of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the term, including, but not limited to, obligations with respect to indemnification, audits, reporting, data retention/reporting, and accounting. Failure to provide any of the required documentation and reporting will cause CITY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by CITY. The CITY reserves the right to reduce the amount of OMH FUNDS to SUBRECIPIENT, or to completely terminatethis Agreement, in the CITY's sole discretion, if there is a reduction in OMH FUNDS provided to the CITY for program year 2021.2022 or 2022-2023. The CITY reserves the right to reduce the grant application if the CITY's fiscal monitoring indicates that SUBRECIPIENT's rate of expenditure will result in unspent funds at the end of the program years, Amendments in the grant allocation will be made after consultation with SUBRECIPIENT. C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit A," attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of fiords CITY is otherwise obligated to pay to SUBRECIPIENT hereunder. D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before June 30, 2023, and to use said funds to pay for necessary and reasonable costs allowable under the federal law and regulations to operate said program. Said amounts shall include, but not be limited to, wages, administrative costs, and employee benefits comparable to other similarly situated employees, and indirect costs, Other allowable program costs are detailed in the budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income received from said funds only for the same purposes for which said funds may be expended pursuant to the terms and conditions of this Agreement. SUBRECIPIENT has the ability to adjust line item amounts in the budget with the written approval of the CITY's City Manager or designee, so long as the total budget amount does not increase. Pursuant to 45 CFR Part 75 the Indirect Cost Rate for the SUBRECIPIENT's award shall be, an approved federally recognized indirect cost rate negotiated between the SUBRECIPIENT and the Federal government, or, if no such rate exists, the de minimis indirect cost rate as defined in 2 CFR §200,414(b) Indirect (F&A) costs, For this agreement, the de minimis indirect cost rate of 10% will apply. E, Licensing, SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required Iicenses, registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should SUBRECRIENT fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make good -faith efforts to gain compliance with local, state or federal roles and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. SUBRECIPIBNT must make all corrections required to bring the facility/property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder, G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY pursuant to this Agreement shall be maintained in an account in a federally insured banking or savings and loan institution with record keeping of such accounts maintained pursuant to applicable 45 CFR Part 75 requirements. SUBRECIPIENT is not required to maintain separate depository accounts for HEAL-OC FUNDS; provided however, the SUBRECIPIENT must be able to account for receipt, obligation and expenditure of HEAL-OC FUNDS pursuant to applicable 45 CFR Part 75 requirements. H. Audit Report Requirements, SUBRECIPIENT agrees that if SUBRECIPIENT expends Seven Hundred Fifty Thousand Dollars ($750,000) or more in federal funds, SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in accordance with the standards as set forth and published by the United States Office of Management and Budget, SUBRECIPIENT shall provide CITY with a copy of said audit by April 1 of the year following the program year in which this Agreement is executed. I. RecordKeepinaJRepprting. SUBRECIPIENT shall keep and maintain complete and adequate records and reports on program participants to determine their initial and continuing eligibility for the program services being provided to assist CITY in meeting and maintaining its record keeping responsibilities under the OMH RBGS, including the following: (1) Records a, Documentation of the number of persons and/or families participating in or benefiting by the SUBRECIPIENT program. b. Household information shall include number of persons, identification of head of household, racelethnicity, and income verification of all household members ages 18 and over, a Documentation of all OMH FUNDS received from CITY, d. Documentation of expenses as identified in the Budget Proposal, including evidence of incurring the expense, invoices for goods or services, copies of any and all contracts or documentation pertaining to costs for subcontractors, plus all other invoices and proof of payment for which OMH FUNDS were expended, and any payments therefor. e. Any such other related records as CITY shall reasonably require or as required to be maintained pursuant to the OMH REGS. (2) Reports a. Payment Request, Concurrently with the submittal of each quarterly report, on or before the 15th day of October, January, April and July, SUBRECIPIBNT shall submit both; an original invoice/request for reimbursement and true copies of invoices, receipts, canceled checks, bank statements, credit card statements, procurement documentation for goods or services, tiniesheets, payroll records, benefit statements, agreements, contracts or documentation pertaining to costs for subcontractors, and/or other documentation supporting and evidencing how the OMH FUNDS have been expended during the applicable quarter, b. Quarterly Progress Report. SUBRECIPIENT agrees to keep records of all ethnic and racial statistics of persons and families benefited by SUBRECIPIEN'r in the performance of its obligations under this Agreement, including, but not limited to, new program information and year- to-date program statistics on expenditures, caseload and activities. Failure to provide any of the required documentation and reporting will cause CITY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by CITY. J. Access to Records. CITY and the United States Govermment and their representatives or auditors shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities and performance, to books, documents and papers, and the right to examine records of SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in regard to said program. CITY and the United States Government and their representatives or auditors shall also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants in said program and entering any premises or any site in which any of the services or activities funded hereunder is conducted or in which any of the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. 0 K. Location of Records2Nuired Length of Record Keeping. All accounting records, reports, and evidence pertaining to all costs, expenses and the OMH FUNDS of SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and thereafter for five (5) years from the date of Final payment under this Agreement. Records which relate to (a) complaints, claim, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY or any other governmental agency takes exception, shall be retained beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In the event SUBRECIPIENT does not make the above -referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. L. Compliance with Law/Program Income, SUBRECIPIENT acknowledges that the funds being provided by CITY for said program ate received by CITY pursuant to the ACT as amended and that expenditures of these funds shall be in accordance with the ACT and all pertinent regulations issued by agencies of the federal government, including, but not limited to, all regulations found at Title 45 of the Code of Federal Regulations. Program income received by SUBRECIPIENT shall be returned to CITY wiless otherwise provided for in this Agreement. SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement. M. Debarment. To protect the public interest and ensure the integrity of Federal programs, CITY may only conduct business with responsible persons and may not make any award or permit any award to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension". See also 24 CFR 570.609. SUBRECIPIENT must review and sign Exhibit C "Debarment", which is attached hereto and incorporated herein by this reference, SUBRECIPIENT shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue Service, Any change in the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY, N. Confidentiality. Without prejudice to any other provisions of this Agreement, SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided to it concerning participants in accordance with the requirements of federal and state law. However, SUBRECIPIENT shall submit to CITY and or OMH or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by SUBRECIPIBNT, costs incurred and services rendered hereunder, O. Independent Contractor. SUBRECIPIENT agrees that the performance of obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way an agency of CITY, P. Violation ofTerms and Conditions. SUBRECIPIENT agrees that if SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior Agreement whereby OMH FUNDS were received by SUBRECIPIENT, or if SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expendituues, SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof, I£ SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the OMH FUNDS granted hereunder, SUBRECIPIENT shall be required to reimburse the CITY of all such finds that were obtained and/or spent under fraudulent circumstances, Q. Egaipinart. SUBRECIPIENT agrees to maintain a record for each item of non -expendable personal properly acquired under 0ie terms of this Agreement. Said record shall be made available to CITY upon request. The tern "non -expendable personal property" shall include leased and purchased equipment. R. Prohibited Use, SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this Agreement to pay for entertainment, meals or gifts, or other prohibited uses. S. Lobbyine, SUBRECIPIENT certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 45 CFR Part 75, which provide that no appropriated funds may be expended by the recipient of a federal contract, giant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that effect in a form as set forth in "Exhibit D," attached hereto and by this reference incorporated herein, SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to SUBRECIPIENT under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grunt, loan, or cooperative agreement, the undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions (Exhibit D). SUBRECIPIFNT shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontractors, sub -grants, and contracts under grants, loans, and cooperative agreements), and agrees to take all actions necessary to ensure that all subrecipients shall similarly certify and disclose accordingly, T. Financial Interest. SUBRECIPIENT agrees that except for the use of OMH FUNDS to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to OMB. activities assisted under the terms of this Agreement, or who are in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a OMH-assisted activity of SUBRECIPIENT, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer, or elected or appointed official of CITY, or of any designated public agency, or the SUBRECIPIENT. U. Labor Standards The SUBRECIPIENT agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis -Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this Agreement, The SUBRECIPIENT agrees to comply with the Copeland Anti -Kick Back Act (I 8 U. S.C. 874 et seq.) and its implementing regulations of the U.S. Department of Labor at 29 CFR Part 5. The SUBRECIPIENT shall maintain documentation that demonstrates compliance with hour and wage requirements of this part. Such documentation shall be made available to the CITY for review upon request. V. Drug Free Work lace, SUBRECIPIENT agrees to provide a drug -free work place and to execute a certification as set forth in "Exhibit E" attached hereto and incorporated herein by this reference, H. CITY'S OBLIGATIONS A, Payment of Funds. On 7uly 20, 2021, the CITY was allocated $4,000,000 from the United States Department of Health and Human Services ("HI3S") Office of Minority Health Grant ("OMH") Program. Subject to the terms of this Agreement, CITY agrees to pay to SUBRECIPIENT when, if and to the extent federal :funds are received a sum not to exceed NINE HUNDRED AND TEN THOUSAND DOLLARS ($910,000) for SUBRECIPIENT'S performance in accordance with the Budget attached hereto as "Exhibit B" during the two-year period of this Agreement. Payments shall be made to SUBRECIPIENT through the submission of invoices/reimbursement requests. CITY shall pay such invoices/reimbursement requests within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been incurred and documented within the scope and provisions of this Agreement and that SUBRECIPIENT is in compliance with the terns and conditions of this Agreement. Failure to provide any of the required documentation and reporting will cause CITY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by CITY, Documentation may include, but is not limited to, true copies of invoices, receipts, canceled checks, bank statements, credit card statements, procurement documentation for goods or services, timesheets, payroll records, benefit statements, agreements, contracts or documentation pertaining to costs for subcontractors, and/or other documentation supporting and evidencing how the OMH FUNDS have been expended during the applicable quarter. B, Audit of Account. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's amoral audit of all HEAL-OC FUNDS in accordance with Title 45 of the Code of Federal Regulations and other applicable federal laws and regulations. C. Common Rule: Pursuant to 45 CFR Part 75, the CITY manages the day -today operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant program requirements and monitors grant and subgrant supported activities to assure compliance with Federal requirements. Such monitoring covers each program, function and activity and performance goals are reviewed periodically, D. Environmental Review: In accordance with 45 CFR Part 75, the CITY is responsible for undertaking environmental review and maintaining environmental review records for each applicable project. E. Performance Monitorink: CITY shall monitor the performance of SUBRECIPIENT against goals and performance standards required herein. The SUBRECIPIENT shall beresponsible to accomplish the levels of performance as set forth in Exhibit A and report such measures quarterly to the CITY. If the SUBRECIPIENT estimates such goals will not be met, the SUBRECIPIENT is to contact the CITY, at which time the CITY will determine if any adjustments to the grant award is appropriate. Substandard performance as determined by the CITY will constitute non-compliance with this Agreement. Should the CITY determine that the SUBRECIPIENT has not performed its obligations as stated in this contract in a satisfactory manner, or if the CITY determines that insufficient supporting information has been submitted, the CITY shall notify the SUBRECIPIENT in writing of its determination specifying in full detail the objections which it has to the SUBRECIPIENT's performance. If action to correct such substandard performance is not taken by the SUBRECIPIENT after being notified by the CITY, within a reasonable period of time as stipulated in the written notification, contract suspension or termination procedures will be initiated. III, NONDISCRIMINATION A. SUBRECIPIENT agrees to comply with Executive Order 11246 which requires that during the performance of this Agreement, SUBRECIPIENT agrees not to discriminate against any employee or applicant for employment because of race, religion, sex, color or national origin, Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer, rates of pay or other forms of compensation, and selection for training, including apprenticeship. SUBRECIPIENT agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the SUBRECIPIENT setting forth the provisions of this nondiscrimination clause. B. SUBRECIPIENT agrees to comply with Title VI of the Civil Rights Act of 1964 which indicates that no person shall, on the ground ofrace, color or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program of activity receiving federal financial assistance, C. No person shall, on the grounds of race, sex, creed, color, religion, marital status, national origin, age, sexual orientation, or physical or mental handicap be excluded from participation in, berefused the benefits of, or otherwise be subject to discrimination in any activities, programs or employment supported by this Agreement. SUBRECIPIENT is prohibited from discrimination on the basis of age or with respect to an otherwise qualified handicapped person as provided for under Section 109 of the Housing and Community Development Act of 1974, as amended, D, SUBRECIPIENT agrees to comply with the Age Discrimination Act of 1975 which requires that during the performance of this Agreement, SUBRECIPDW agrees not to discriminate against any employee or applicant for employment because of age. Such action shall include, but not be limited to the following: employment upgrading, demotion, or transfer, rates of pay or other forms of compensation, and selection for training, including apprenticeship. SUBRECIPIENT agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the SUBRECIPIENT setting forth the provisions of this age discrimination clause. E. SUBRECIPIENT agrees to comply with Section 504 of the Rehabilitation Act of 1973 which requires that no otherwise qualified individual with a disability in die United States, shall, solely by reason of his or her disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance or under any program or activity conducted by any executive agency or by the United States Postal Service. IV. CONFLICT OE INTEREST Pursuant to the conflict of interest requirements set forth in 45 CFR Part 75, SUBRECIPIENT certifies that no member, officer, employee, agent or assignee of CITY having direct or indirect control of any OMH monies granted to the CITY, inclusive of the subject OMII FUNDS, shall serve as an officer of SUBRECIPENT. Further, any conflict or potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its board of directors and list of officers. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection with the provision of the services SUBRECIPIENT shall provide with OMH FUNDS, in accordance with 45 CFR Part 75: A. SUBRECIPIENT shall not discriminate against any employee or applicant for employment on the basis of religion and shall not limit employment or give preference in employment to persons on the basis of religion. B. SUBRECIPBENT shall not discriminate against any person applying for the services SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and shall not limit such services or give preference to applicants for such services on the basis of religion, C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct any religious worship or services, or engage in any religious proselytizing, or exert any religious influence in the provision of the services in said program. The parties agree drat this covenant is intended to slid shall be construed for the limited purpose of assuring compliance with respect to the use of CITY fiords by SUBRECIPIENT with applicable constitutional limitations respecting the establishment of religion as set forth in the establishment clause under the First Amendment of the United States Constitution and Article I, Section 4 of the California Constitution, and is not in any manner intended to restrict other activities of SUBRECIPIENT. A. The portion of a facility used to provide public services assisted in whole or in part under this Agreement shall contain no sectarian or religious symbols, E. Where the services to be provided under said program are rendered on property owned by the primarily religious entity SUBRECIPIENT, OMH FUNDS may also be used for minor repairs to such property which are directly related to the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the OMH expenditure for rendering the services under said program, VI. PROHIBITION OF NEPOTISM SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in air administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VH, NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: City of Santa Ana City Manager's Office (M-31) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702-1988 TO SUBRECIPIENT: Latino IIealth Access 450 W Fourth Street, Suite 130 Santa Ana, CA 92701 Attention: America Bracho, President and CEO VM. ASSIGNABILITY None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY, SUBRECIPIENT must submit all subcontracts and other agreements that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal obligations of SUBRECIPIENT pursuant to this Agreement, IX. HOLD HARMLESS SUBRECIPIENT shall indemnify, defend and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all damages to or for loss of use of property and for injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and including attorney fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPIENT's performance of this Agreement. X. INSURANCE SUBRECIPIENT shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the SUBRECIPIENT, its agents, representatives, employees or subcontractors. a, MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall beat least as broad as: 1. Commercial General Liability (CGI): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CO 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2, Automobile Liability: Insurance Services Office Form Number CA 00 01 covering Code 1 (any auto), or if SUBRECIPIENT has no owned autos, Code 8 (hired) and 9 (non -owned), with limit no less than $1,000,000 per accident for bodily injury and property damage, (Not required if SUBRECIPIENT does not use an automobile to perform services.) 3. Workers' Compensation: insurance as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $ 1,000,000 per accident for bodily irjury or disease. (Not required if SUBRECIPIENT provides written verification it has no employees,) 4. Professional Liability (Errors and Omissions): insurance appropriate to the SUBRECIPIENT's profession, with limit no less than $1,000,000 per occurrence or claim, $2,000,000 aggregate. 5. If the SUBRECB'IENT maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the SUBRECIPIBNT. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other insurance Provisions — The insurance policies are to contain, or be endorsed to contain, the following provisions: 10 1. Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the COL policy with respect to liability arising out of work or operations performed by or on behalf of the SUBRECIPIENT including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the SUBRECIPIENT's insurance (at least as broad as ISO Form CG 20 10 1185 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if later revisions used), 2, Primary Coverage: For any claims related to this contract, the SUBRECIPIENT's insurance coverage shall be primary coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the SUBRECIPIENT's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City, 4. Waiver of Subrogation: SUBRECIPIENT hereby grants to City a waiver of any right to subrogation which any insurer of said SUBRECIPIENT may acquire against the City by virtue of the payment of any loss under such insurance. SUBRECIPIENT agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer, 5. SelfUnsured Retentions: Self -insured retentions must be declared to and approved by the City, The City may require the SUBRECIPIENT to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or City. 6. Acceptability oflnsurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M, Best's rating of no less than ANII, unless otherwise acceptable to the City. 7. Claims Made Policies: If any of the required policies provide coverage on a claims - made basis: I, The Retroactive Date must be shown and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work, 3. If coverage is canceled or non-ronewed, and not replaced with another claims - made policy form with a Retroactive Date prior to the contract effective date, the SUBRECIPIENT mast purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: SUBRECIPIENT shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required 11 documents prior to the work beginning shall not waive the SUBRECIPIENT's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time, 9. Subcontractors; SUBRBCIPIENT shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and SUBRECIPIENT shall ensure that Entity is an additional insured on insurance required from subcontractors. 10, Special Risks or Circumstances; City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances, XI. TERMINATION A. This Agreement maybe terminated on thirty (30) days' written notice by either party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Office of Minority Health Grant Funds. In the event of such suspension or termination, SUBRECIPIENT shall only be. entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. Pursuant to 2 CFR 200,340, in the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of this Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such notice, unless such default is cured before the effective date of termination stated in such notice, If terminated for cause, CITY shall be relieved of furdner liability or responsibility under this Agreement, or as a result of the termination thereof, including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any payments made for services not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining substitute performance. D. The grant of funds under this Agreement may be terminated for convenience by either the CITY or SUBRECIPIENT, in whole or in part, by setting forth the reasons for such termination, the effective date, and, in the case of portion termination, their portion to be terminated. However, if in the case of a partial termination, the CITY determines that the remaining portion of the award will not accomplish the purpose for with the award was made, the CITY may terminate tine award in its entirety. E. The grant of funds under this Agreement may be terminated due to the non-performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described in Exhibits A and B or failure to meet the performance standards and program goals set forth therein. F. The grant of funds under this Agreement maybe terminated due to the failure of iheCrfY to receive sufficient or anticipated finding from HHS for the OMH program for any year tern subject to this Agreement. 12 X1I, LIMITATION OF FUNDS The United States of America, through HHS, may in the future place programmatic or fiscal limitations on the use of OMH FUNDS which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting OMH program funding, br the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of both its uncommitted and its unspent funds. Where HHS has directed or requested CITY to implement a reduction in funding, in whole or as to a cost category, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and ef£ecdng such a reduction slid in revising, modifying, or amending the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days written notice to SUBRECIPMNT of its intention to so act, pending an audit or other resolution of such questions, In no event, however, shall any revisions made by CITY affect expenditures and legally binding commitments made by SUBRECIPIENT before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HHS cash withdrawal guidelines. XUL EXCLUSIVPI'Y AND AMENDMENT OF_AGREEMENT This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of CITY's OMH FUNDS by SUBRECIPIENT and contains all the covenants and agreements between the parties with respect to such employment in any manner whatsoever, Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and SUBRECIPIENT. XIV. LAWS GOVERNING THIS AGREEMENT This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XV. CLOSE-OUT The SUBRECIPIENT agrees to comply with the closeout procedures detailed in 2 CFR §200.343, including the following: 1. SUBRECIPIENT must submit, no later than ninety (90) calendar days after the end date of the period of performance, all financial, performance, and other reports as required by the terms and conditions of the Federal award; 2. Unless the CITY authorizes an extension, SUBRECIPIENT must liquidate all obligations incurred under the Federal award not later than ninety (90) calendar days after the end date of the period of performance as specified in the terms and conditions of the Federal award; 3. SUBRECIPIENT must promptly refund any balances of unobligated cash that the CITY paid in advance or paid and that is not authorized to be retained by SUBRECIPIENT for use in 13 other projects (See OMB Circular A-129 and 2 CFR §200.345); 4. SU13RECIPIENT must account for any real and personal property acquired with Federal funds or received from the Federal government in accordance with 2 CFR §§200.310-200.316 and 200.329; and, 5. The CITY should complete all closeout actions for the Federal award no later than one year after receipt and acceptance of all required fmal reports. XVL VALIDITY ANTI S�VI�RABILITY The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. Whenever possible, each provision of this AGREEMENT shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this AGREEMENT is held to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this AGREEMENT. XVIL WAIVER No delay or omission by either party hereto to exercise any right or power accruing upon any noncompliance or default by the other party with respect to any of the terms of this Agreement shall impair any such right or power or be construed to be a waiver thereof, A waiver by either of the parries hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition or agreement herein contained. XVLII, _MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. (Signatures on followingpage) 14 A-2021-131-01 IN WITNESS VVHEREOF, the pubes hereto have executed this Agreement as of the last date and year written below. ATTEST: DAISY GOMEZ) Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney `% for By: RYAN O. HODGE Assistant City Attorney SUBRECIPIENT: r4merics-B t-andd-E�A- Latino He th Access Tax ID: 33-0562943 DUNS # 938164811 CITY OF SANTA ANA iSTINE RIDGE City Manager fan2� a MPN ,M`nN•/ 15 DlgPallysyrietl byFnn,lne P. Francine R. Villareal vin.,ea LATIN-1 m,e:z"0P`lW'SW ,A14 R CERTIFICATE OF LIABILITY INSURANCE Dn011061202TE 2Y) ovos/2o2z 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 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 Dufour Insurance Services, LLC 5611 Littler Drive Huntington Beach, CA 92649 N0 fflr Stephanie Dufour (PAPNC NNo Ea:714-369-2998 aC No: EMAIL Stephanie@dufourinsurance.com ADDRESS: P @dufourinsurance.com INSURERS AFFORDING COVERAGE NAIC q INSURERA:Nonprofit Insurance 524210 INSURED Latino Center for Prevention and Action, dba Latino Health Access INSURER B:AmTrust INSURER C:Philadelphia lndemnity 18058 INSURER D: 450 W. Fourth Street Santa Ana, CA 92701 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 rypE OF INSURANCE DDL UBR POLICYNUMSER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR X X 2021-04261-NPO 0710512021 07/05/2022 PREMISES fEa cooper.) $ 500,00 MED EXP(My one person) $ 20,000 PERSONAL S ADV INJURY $ 11000,00 A X Professional 2021-04261- NPO 07105/2021 07/05/2022 X Abuse GENERAL AGGREGATE $ 3,000,00 A 2021-04261- NPO 07105/2021 07/0512022 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP ADS $ 3,000,00 POLICY PRO X LOC Deductibi $ AUTOMOBILE LIABILITY COMB EacidenINEOStINULL LIMIT ac 1,000,00 X BODILY INJURY (Far person) $ A ANY AUTO X X 2021-04261-NPO 07/0512021 07/05/2022 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY accident ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE PERACCIDEN $ Deductible $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE X X 2021-04261-UMB-NPO 07/0512021 0710512022 DEO I X I RETENTION$ 10,000 It B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYLIM ANY PROPRIETORIPARTNEMEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA SWC1374729 0110112022 01101/2023 X WC STATU- OTH IR E.L EACH ACCIDENT $ 1,000,00 EL DISEASE -EA EMPLOYEE $ 1,000,00 If We. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 C Cyber Liability X X PHSD1684193 12112/2022 1211212023 Per Occ 1,000,00 A Liquor Liability X X 2021-04261- NPO 07/0512021 07/05/2022 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) The City of Santa Ana, 20 Civic Center Drive, Santa Ana, CA 92701, its officers, employees, agents end volunteers are named as Additional Insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary and any insurance carried by ity shall be excess and noncontributory. The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92701 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 ©1988.2010 ACORD COB ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD n RMk1AAmgmlmtDaiefDn REVIEwED&APPROVm BY' , ®'I Risk Management Anatyst HOLDER CODE LATIN-1 PAGE 2 NOTEPAD: INSURED'SMME Latino Center for Prevention OP ID: SD Data 01106/2022 This insurance applies seperately to each insured against whom claim is made or suit is brought except with respect to the company's limit of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. With respect to the additional insured, this insurance shall not be canceled or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701. Scheduled events s. REAtc, r4mYh Z VibliIsl - Risk Management Analyst POLICY NUMBER: 2021-04261- NPO COMMERCIAL GENERAL LIABILITY 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 Person or Organization: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insured ("additional insured") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. 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 insured. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insured, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. (Completion of the following, including countersignature is required to make this endorsement effective.) Issued to Latino Health Access Countersigned by agent, Stephanie Dufour CG 20 26 11 85 Copyright, Insurance Services Office, Inc., 1984 _ Risk MamgemmtDiAsimi ' RENEWED S APPROVED BY: ��' Risk Management Malys[ POLICY # 2021-04261- NPO PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): City of Santa Ana, its officers, officials, employees and volunteers Effective Date: 07/05/21 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Al�.� R1ekMaragemadDWIM a f c, REVIEWED&,VPRovmar: p/md 90W, Risk hlana9ement Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description The City of Santa Ana, its officers, employees, agents Funding Contract and volunteers. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2022 Policy No. SWC1374729 Insured Latino Health Access (a Corp) Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84) Endorsement No. 0 Premium $ 60,773 Risk MowgowdD welnn REVIEwm&APPROVm By t fry 2. V.Cltiut ®'. - Risk Management Analyst NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Latino Center for Prevention and Action Name: Project A-2021-131-01 Number: Project Agreement For Use Of The United States Department Of Health And Name: Human Services Office Of Minority Health Grant Funds The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: EXPIRATION TYPE OF INSURANCE POLICY NUMBER COI DATE FILE NAME DATE CERT- City of AUTOMOBILE LIABILITY 202304261NPO 07/05/2024 08/25/2023 Santa Ana 2023 Updated.pdf CERT- City of GENERAL LIABILITY 202304261NPO 07/05/2024 09/29/2023 Santa Ana 2023.pdf CERT- City of PROFESSIONAL LIABILITY 202304261NPO 07/05/2024 09/18/2023 Santa Ana 2023 Updated.pdf CERT- City of WORKERS COMPENSATION AND EMPLOYERS' Santa Ana SWC1374729RENEWAL 01/01/2024 12/09/2022 LIABILITY 2022-23 updated (1).pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 10/5/2023 12:00 PM