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HomeMy WebLinkAboutSALVATION ARMY (5)A-2021-106-02 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: SECOND AMENDMENT TO AGREEMENT BETWEEN ® THE CITY OF SANTA ANA AND THE SALVATION ARMY C� FOR USE OF EMERGENCY SOLUTIONS GRANT CORONAVIRUS (ESG-CV) FUNDS ® THIS SECOND AMENDMENT to the above -referenced agreement is entered into on January 18, w 2022, 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"). C)'- GOACi rl )(3)^) 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. The parties entered into a First Amendment to said Agreement No. A-2021-106-01 dated November 16, 2021, in order to extend the Term of said Agreement and to increase the maximum amount of Compensation for said Agreement. C. In accordance with the terms and conditions of said Agreement, the Parties desire to again 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, as amended, except as herein modified, the parties agree as follows: Section 11, Term of Agreement, shall be amended to extend the potential no later than end date of the Term of said Agreement from January 31, 2022, to February 28, 2022, subject to the termination provisions in the First Amendment to said Agreement. Recitals J and K, and Sections III and 111(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 one -million and forty thousand dollars ($1,040,000.00) during the Term of said Agreement, subject to the termination provisions in the First Amendment to said Agreement. 3. Except as modified by this Second Amendment, all terms and conditions of said Agreement, except as modified by the First Amendment, shall remain in full force and effect. Page l of 2 IN WITNESS WHEREOF, the Parties hereto have executed this Second Amendment to said Agreement on the date and year first written above. ATTEST APPROVED AS TO FORM SONIA R. CARVALHO City Artr�ri,�i By: Y/ RYA f DGE Assist nt City Attorney FOR APPROVAL STEVEN A. MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager THE SALVATION ARMY Name: Title: Page 2 of 2 HUGHES Francine Digdallysigned by Francine R. VillarealPage 1 of 2 r1 \ ien _ _ n.,. 9m1 In va IN. VI II AQICQI 08:30:55 -0T CERTIFICATE OF LIABILITY INSURANCE 0' DATE MMIDDflYYY) 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 Willis Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center PNCNE Ext: 1-877-945-7378 A/C No:1-888-467-2378 E-MAIL ADDRESS: om certificates@willis.c Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAICp INSURERA: Westchester Surplus Lines Insurance Compan 10172 IThe Salvation Army - Division 17 NSURED INSURERB: Greenwich Insurance Company 22322 INSURERC: XL Specialty Insurance Company 37885 30840 Hawthorne Blvd., Bldg D Rancho Palos Verdes, CA 90275 INSURERD: INSURERE: INSURER F: IEUVttXAUt5 GtR I1HGA IF NIIMRFR: W22.1Vbb H2 Dc\rICInu ulwoco. 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 Elm TYPE OF INSURANCE ADDL UBR POLICYNUMBER POLICY EFF IMNl1DDfYYM POLICY EXP (MMIDDrYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY CLX AIMS -MADE OCCUR EACH OCCURRENCE $ 2,000, 000 DAMAGE TO NTED PREMISES Ea ocomance $ 1,000, 000 X X MEO EXP (Any one person) $ 0 A Self Insured Retention: y G7183119A 002 10/01/2021 10/01/2022 $_1 000,000 PERSONAL &AOV INJURY $ 2,000,000 AGGREGATE UMITAPPLIES PER: POLICY D O- JEPRCT 1XI LOC GENERALAGGREGATE $ 4,000,000 GEN'L PRODUCTS - COMP/OP AGO $ 4,000, 000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEOULEO AUTOS ONLY AUTOS BODILY INJURY IPeracddent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LAB H OCCUR EACH OCCURRENCE $ AGGREGATE g EXCESS UAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABIUTY YIN ANYPROPRIETORNARTNERIEXECULVE ❑ OFFICERIMEMSER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS below B Excess Auto Liability - CA Y RAE500021811 10/01/2021 10/01/2022 Any Auto / CSL $3,000,000 Self-Insd Retention $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaxa�r - Y Santa Ana, CA 92702 � REVIEWET'J6 MPktT/®6Y: ©1988-2016 ACORD C 11M,c ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ' x Rhk Management Analyst SR ID: 21630631 HATcH: 2252947 AGENCY CUSTOMER ID: LOC #: A o oiz 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 D Rancho Palos Verdes, CA 90275 POUCYNUMBER See Page 1 CARRIER NAIC CODE Sae 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 NAIC#: 37885 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,GD0,000 CA EL Each Employee $1,000,000 Retention: $1,000,000 ADDITIONAL REMARKS: 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 101 (2008101) © 2008 ACORD C The ACORD name and logo are registered marks of ACORD Risk Management Analyst SR ID: 21630631 BATCH: 2252947 CENT: W22306682 SrAMW W IaAVA 09�M1 M1@!f M 1 p fOi iR IR E9 A Public Service Agency This is to certify that: CERTIFICATE OF SELF-INSURANCE The Salvation Army NAME OF SEI RINSURER 30840 Hawthorne Boulevard, Rancho Palos Verde, California 90275 ADDRESS. GT ,, 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 MAN ER Financial Responsibility Unit Department of Motor Vehicles SR 27 (REV. IQW) UH _ ""per. WekMnrgetlpttDMY°n -� REVIEWED&APPRovWBY: �' Risk Management Analyst STATE OF CALIFORNIA Edmund G. Brown Jr., Governor 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 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 and effective. Dated at Sacramento, California This day the 20th of April 2017 Lyn Asio Booz, Chief ORIG: Craig Nictes Director Of Claims Management The Salvation Army 180 East Ocean Boulevard, IOth Floor Long Beach, Ca 90802 e""x"s 1f� .RlakMdugpnadlJb{�bn tt {�_ nCYIEYt+ED&PJ�PROV®BY: Risk Management Analyst 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 O erations 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 endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Risk MwgmwRtln4im Rem exm&Mrxa mft. t a fAftz�e P, VtLG.tiaL Ruk Management Malyat NON-CONTRIBUTORY OTHER INSURANCE ENDORSEMENT Named Insured The Salvation Army Endorsement Number Policy Symbol Policy Number Policy Period Effective Date of Endorsement GLW G7183119A 002 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. RA mmig"eftaDW&M .8' p ftmeM 8 Prr2M BY: GLE0095 (07/10) ©Chubb. 2016. All rights reserved. y > j y j fV4161�K P, Ut" � RUManagement AnatIol