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Home My WebLink AboutDELHI CENTER (13)City of Santa Ana - }Yx Clerk of the Council AGREEMENT TERMINATION FORM op p Please complete this form in its entirety when the attached agreement ar°d a amendments (if any) are no longer in effect. Dote: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreements) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30) . Call 647-1520 if you have any questions. The agreement with A-2(]22-1�33-Q1 N©. was completed on (List all amendments. Use space below if needed.) il�agreementsVormsVorm- agreement termination form —golden rod. doc COTC Office Use Only C 2oZ3 C- Y CLERK '. and final payment has been made. De part m en t: ��'LI �" l G--11 IV� ,� t�-�- l,e Phone/Ext.: f 5 L1 �i3 Signature: Date: /. INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES I I • 01- Z&11 A-2022-033-01 CLERK OF COUNCIL DATE: MAR 10 20221 AGREEMENT BETWEEN THE CITY OF SANTA ANA AND Q: „\ DELHI CENTER FOR USE OF G ^_r�WWVA �' C AMERICAN RESCUE PLAN ACT (ARPA) FUNDS This Agreement is hereby made and entered into this 1 st day of March, 2022, 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 Delhi Center, a California domestic nonprofit corporation ("CONTRACTOR"). RECITALS: A. The American Rescue Plan Act ("ARPA") was signed into law in March 2021. ARPA provides funding for a number of different programs, including the Coronavirus State and Local Fiscal Recovery Fund ("SLFRF"), to provide monetary support to local governments to respond to, mitigate, and recover from the COVID-19 public health emergency. B. On July 20, 2021, the Santa Ana City Council authorized the City Manager to utilize ARPA SLFRF funding from the United States Department of Treasury for the Revive Santa Ana Spending Plan, which includes five spending categories: recovery from the pandemic, direct assistance programs, public health and safety, critical infrastructure, and city fiscal health. C. CONTRACTOR has been selected by the CITY to receive ARPA SLFRF Funds in order to provide food distribution and/or food supply programs, in accordance with the Scope of Work attached hereto as Exhibit A and incorporated herein by reference ("said program"). CONTRACTOR represents that it is qualified and willing to operate said program and certifies that the administration of said program carried out with funds provided under this Agreement will meet ARPA's objectives to respond to, mitigate, and recover from this historic COVID-19 public health crisis. D. CONTRACTOR agrees that it will adhere to the tasks and services as indicated in Exhibit A for said program. Failure to follow the requirements and meet the stated expectations 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 CONTRACTOR 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 CONTRACTOR: ARPA PROGRAM PROVISIONS A. Scope of Work. CONTRACTOR shall be responsible for the specific tasks and services of said program, and agrees to administer said program in compliance with the tasks and services as described in the Scope of Work attached hereto 'as Exhibit A. CONTRACTOR's failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of funds for said program or termination of this Agreement. B. Term of Agreement. The term of said Agreement shall commence on the date first written above and continue through February 28, 2023 ("Term"), unless terminated earlier pursuant to the terms of this Agreement. This Agreement shall also cover any and all services provided by the CONTRACTOR to the CITY since the date the ARPA SLFRF Funds were awarded to the CITY. Additionally, the Term of this Agreement may be extended by a writing executed by the City Manager, or designee, and the City Attorney. C. Amount of Grant Funding. The total amount of funds provided for said program shall not exceed TWO HUNDRED EIGHTEEN THOUSAND FIVE HUNDRED SEVENTY-FOUR dollars ($218,574) ("ARPA SLFRF Funds") during the Term of the Agreement. CONTRACTOR agrees to use said ARPA SLFRF Funds to administer said program as outlined in Exhibit A. D. Disbursement of Funds. Said ARPA SLFRF Funds shall be disbursed by CITY to CONTRACTOR pursuant to the terms found in the Fee Payment Schedule attached hereto as Exhibit B, with payments subject to the submittal of invoices and other reporting requirements, as hereinafter more fully set forth. CONTRACTOR 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 ARPA SLFRF Funds, or return the entire request to CONTRACTOR, until such documentation and reporting has been received and approved by CITY. (1) Reduction in ARPA SLFRF Funding. The CITY reserves the right to reduce the amount of ARPA SLFRF Funds to CONTRACTOR, or to completely terminate this Agreement, in the CITY's sole discretion, if there is a reduction in ARPA SLFRF Funds provided to the CITY. (2) Reduced Distribution of Funds. The CITY reserves the right to reduce the grant application if the CITY's fiscal monitoring indicates that CONTRACTOR's rate of expenditure will result in unspent funds at the end of the program term. Amendments in the grant allocation will be made after consultation with CONTRACTOR. (3) Reversion of Assets. CONTRACTOR agrees that any and all funds received under this Agreement shall be utilized during the Term of this Agreement, and that any and all funds remaining as of the end of the Term, which have not been utilized, shall be returned by CONTRACTOR to the CITY within thirty (30) days of the expiration or earlier termination of the Agreement. No expense of CONTRACTOR will be reimbursed by CITY if incurred after the end of the Term of the Agreement. E. Grant Program Requirements. (1) CONTRACTOR acknowledges that the source of funding for said program is the federal ARPA, and that payments from the ARPA SLFRF Funds are only to be used to make necessary expenditures incurred due to the public health emergency with respect to COVID-19. (2) CONTRACTOR acknowledges that ARPA provisions allow the use of ARPA SLFRF Funds to respond to, mitigate, and recoverfrom the COVID-19 public health emergency, and will not use these funds for any other uses. (3) CONTRACTOR shall follow the process and determination of eligibility for participants in said program as outlined in Exhibit A. F. Performance Monitoring. (1) CONTRACTOR shall submit program performance information as often as requested by CITY, but no less than the submission of monthly reports and a final report to CITY with the information requested by and in the format acceptable to CITY. Each monthly report is due within thirty (30) days of completion of work for each month. The final report is due within thirty (30) days after the termination or expiration of this Agreement. (2) CITY will evaluate CONTRACTOR's management and operation of said program with respect to the project expectations as described in Exhibit A. (3) CITY will review the audit of the CONTRACTOR to ensure that grant funds are used for authorized purposes in compliance with laws, regulations, and the provisions of contracts or grant agreements under this Agreement, including attachments and exhibits. (4) If action to correct any substandard performance is not taken by the CONTRACTOR within a reasonable period after being notified by CITY, suspension or termination procedures may be initiated by CITY. (5) All performance shall be subject to review by the CITY or other regulatory agencies at all times. CONTRACTOR shall provide adequate cooperation to any inspector or other CITY representative to permit the same to determine CONTRACTOR's conformity with the terms of this Agreement. If any services performed by CONTRACTOR are not in conformance with the terms of this Agreement, the CITY shall have the right to require CONTRACTOR to perform the services in conformance with the terms of the Agreement at no additional cost. The CITY may also terminate this Agreement for default and charge CONTRACTOR for any costs incurred by the CITY because of CONTRACTOR's failure to perform. (6) CONTRACTOR shall establish adequate procedures for self -monitoring and quality control and assurance to ensure proper performance under this Agreement; and shall permit a CITY representative or other regulatory official to monitor, assess, or evaluate CONTRACTOR's performance under this Agreement at any time, upon reasonable notice to CONTRACTOR. G. Audit. (1) CONTRACTOR shall maintain complete and accurate records and supporting documentation to facilitate financial and/or program audits by CITY. This requirement shall apply to any records and documentation CITY shall reasonably require or as required to be maintained pursuant to the ARPA regulations. (2) The books and accounts, files, and other records of CONTRACTOR, which are applicable to this Agreement, shall be available for inspection, review, and audit during normal business hours by CITY to determine the proper application and use of all ARPA SLFRF Funds provided to or for the account or benefit of CONTRACTOR. (3) CONTRACTOR assumes responsibility for reimbursement toCITY asum of money equivalent to the amount of any expenditures disallowed should the CITY, or an authorized agency, rule through audit, exception, or some other appropriate means, that expenditures from funds allocated to CONTRACTOR for direct and/or administrative costs were not made in compliance with the applicable cost principles, regulations, or the provisions of this Agreement. (4) CONTRACTOR agrees to comply with the requirements of OMB Uniform Guidance 2 CFR Part 200. CONTRACTOR further agrees to provide CITY with a copy of completed independent auditors' report within thirty (30) days of CITY's request for such report. If the report contains instances of non-compliance with federal laws and regulations that bear directly on the performance or administration of this Agreement, CONTRACTOR shall provide CITY copies of responses to auditors' reports, a plan for corrective action, and auditors' response that the noncompliance has been resolved. All reports prepared in accord with the requirements of OMB Uniform Guidance 2 CFR Part 200 shall be available for inspection by representatives of CITY or the federal government during normal business hours. (5) All accounting records, reports, and evidence pertaining to all costs, expenses and the ARPA SLFRF Funds of CONTRACTOR and all documents related to this Agreement shall be maintained and kept available at CONTRACTOR'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, claims, 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 CONTRACTOR does not make the above -referenced documents available within the City of Santa Ana, California, CONTRACTOR 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. H. Ownership/Use of Materials. CONTRACTOR agrees that all materials, reports or products in any form, including electronic, created by CONTRACTOR for which CONTRACTOR has been compensated pursuant to this Agreement shall be the sole property of the CITY. The material, reports, or products may be used by the CITY for any purpose that the CITY deems to be appropriate, including, but not limit to, duplication and/or distribution within the CITY or to third parties. CONTRACTOR agrees not to release or circulate in whole or part such materials, reports, or products without prior written authorization of the CITY. I. Close -Out. CONTRACTOR agrees to comply with the closeout procedures detailed in 2 CFR §200.343, including the following: (1) CONTRACTOR 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 this Agreement; (2) CONTRACTOR 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 CONTRACTOR for use in other projects (See OMB Circular A-129 and 2 CFR §200.345); and, (3) CITY should complete all closeout actions for the Federal award no later than one year after receipt and acceptance of all required final reports. CONTRACTOR'S OBLIGATIONS A. Representations and Warranties. (1) Authority. CONTRACTOR is a duly organized and existing domestic nonprofit corporation in good standing and authorized to do business under the laws of the State of California. CONTRACTOR 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 CONTRACTOR has been fully authorized by all requisite actions on the part of CONTRACTOR. (2) Experience. CONTRACTOR is qualified to provide the administrator services for said program detailed herein. (3) Familiarity With Services Required. By executing this Agreement, CONTRACTOR warrants that: (i) it has thoroughly investigated and considered the administrator services to be performed and provided for said program as detailed in Exhibit A; (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. (4) No Conflict. To the best of CONTRACTOR'S knowledge, CONTRACTOR'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 CONTRACTOR is a party or by which it is bound. (5) No Bankruptcy. CONTRACTOR is not the subject of any current or threatened bankruptcy proceeding. (6) No Pending Legal Proceedings. CONTRACTOR is not the subject of a current or threatened litigation that would or may materially affect CONTRACTOR'S performance under this Agreement. (7) Proposal Veracity. All provisions of and information provided in CONTRACTOR's proposal submitted to CITY, including any exhibits, are true and correct in all material respects. (8) No Pending Investigation. CONTRACTOR 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, which would relate to or affect performance of the Agreement or provision of services hereunder. B. Licensing. CONTRACTOR agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. CONTRACTOR shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing CONTRACTOR's operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. C. Zoning. CONTRACTOR agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activities. Should CONTRACTOR fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and regulations relating thereto, CONTRACTOR shall immediately make good -faith efforts to gain compliance with local, state orfederal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. CONTRACTOR 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. CONTRACTOR 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. D. Separation of Accounts. All funds received by CONTRACTOR 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 2 CFR 200.302 requirements. CONTRACTOR is not required to maintain separate depository accounts for ARPA SLFRF Funds; provided however, the CONTRACTOR must be able to account for receipt, obligation, distribution and expenditure of ARPA SLFRF Funds pursuant to applicable 2 CFR 200.302 requirements. E. Audit Report Requirements. CONTRACTOR agrees that if CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000) or more in federal funds, CONTRACTOR 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. CONTRACTOR 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. F. Compliance with Law/Program Income. CONTRACTOR acknowledges that the funds being provided by CITY for said program are received by CITY pursuant to ARPA, and that distribution and expenditure of these ARPA SLFRF Funds shall be in accordance with ARPA and all pertinent regulations issued by agencies of the federal government, including, but not limited to, all regulations found at Title 24 of the Code of Federal Regulations. Any program income received by CONTRACTOR shall be returned to CITY, unless otherwise provided for in this Agreement. CONTRACTOR agrees to comply fully with all federal, state and local laws and court orders applicable to its operation and administration of said program, whether or not referred to in this Agreement. G. 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. CONTRACTOR must review and sign Exhibit D "Debarment", which is attached hereto and incorporated herein by this reference. CONTRACTOR shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board or Internal Revenue Service. Any change in the corporate status or suspension of CONTRACTOR shall be reported immediately to CITY. H. Confidentiality. Without prejudice to any other provisions of this Agreement, CONTRACTOR 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, CONTRACTOR shall submit to CITY or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by CONTRACTOR, costs incurred and services rendered hereunder. I. Independent Contractor. CONTRACTOR agrees that the performance of obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way an agent of CITY. J. Violation of Terms and Conditions. CONTRACTOR agrees that if CONTRACTOR violates any of the terms and conditions of this Agreement or any prior Agreement whereby ARPA SLFRF Funds were received by CONTRACTOR, or if CONTRACTOR reports inaccurately, or if on audit there is a disallowance of certain expenditures, CONTRACTOR agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If CONTRACTOR engaged in fraudulent activity to obtain and/or justify distribution or expenditure of the ARPA SLFRF Funds granted hereunder, CONTRACTOR shall be required to reimburse the CITY of all such funds that were obtained, distributed and/or spent under fraudulent circumstances. K. Fraud. CONTRACTOR shall immediately report all suspected or known instances and facts concerning possible fraud, abuse or criminal activity related to said program for the ARPA SLFRF Funds under this Agreement. L. Prohibited Use. CONTRACTOR hereby certifies and agrees that it will not use ARPA SLFRF Funds provided through this Agreement to pay for entertainment, meals or gifts, or other prohibited uses. M. Lobbying. CONTRACTOR certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, 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. CONTRACTOR shall sign a certification to that effect in a form as set forth in Exhibit E, attached hereto and by this reference incorporated herein. CONTRACTOR 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 CONTRACTOR 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, grant, loan, or cooperative agreement, the undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions (Exhibit E). N. Financial Interest. CONTRACTOR agrees that except for the use of administrative fees to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to administering said program 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 the administration of said program, may obtain a financial interest or benefit from said program, 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 CONTRACTOR. O. Labor Standards. The CONTRACTOR 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 CONTRACTOR agrees to comply with the Copeland Anti -Kick Back Act (18 U.S.C. 874 et seq.) and its implementing regulations of the U.S. Department of Labor at 29 CFR Part 5. The CONTRACTOR 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. P. Equal Employment Opportunities. CONTRACTOR shall make every effort to ensure that all projects funded wholly or in part by ARPA SLFRF Funds shall provide equal employment opportunities for minorities and women. Q. Women and MinoritV-Owned Businesses (W/MBE) CONTRACTOR will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance of this Agreement in accordance with the requirements of 2 CFR 200.321 "Contracting with small and minority businesses, women's business enterprises, and labor surplus area firms". As used in this Agreement, the term "small business" means a business that meets the criteria set forth in section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are African -Americans, Spanish-speaking, Spanish surnamed or Spanish -heritage Americans, Asian -Americans, and American Indians. CONTRACTOR may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. R. Drug Free Workplace. CONTRACTOR agrees to provide a drug -free workplace and to execute a certification as set forth in Exhibit F attached hereto and incorporated herein by this reference. S. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The following requirements and standards must be complied with: 2 CFR Part 200 et al. CONTRACTOR shall procure all materials, property, or services in accordance with the requirements of 2 CFR 200.318-326. III. CITY'S OBLIGATIONS A. Audit of Account. CITY shall include an audit of the account maintained by CONTRACTOR in CITY's audit of all ARPA SLFRF Funds in accordance with Title 24 of the Code of Federal Regulations and other applicable federal laws and regulations. B. Common Rule: Pursuant to 2 CFR 200.328(a), the CITY manages the day-to-day 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. C. Project Expectations: CITY shall monitor the performance of CONTRACTOR against goals and performance standards required herein. The CONTRACTOR shall be responsible to accomplish the project expectations as set forth in Exhibit A, and report such results to the CITY. If the CONTRACTOR estimates such goals will not be met, the CONTRACTOR 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 CONTRACTOR 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 CONTRACTOR in writing of its determination specifying in full detail the objections that it has to the CONTRACTOR's performance. If action to correct such substandard performance is not taken by the CONTRACTOR 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. IV. GENERAL PROVISIONS A. Non -Discrimination. 1. CONTRACTOR agrees to comply with Executive Order 11246, which requires that during the performance of this Agreement, CONTRACTOR 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. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the CONTRACTOR setting forth the provisions of this nondiscrimination clause. 2. CONTRACTOR agrees to comply with Title VI of the Civil Rights Act of 1964, which indicates that no person shall, on the ground of race, 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. 3. 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, be refused the benefits of, or otherwise be subject to discrimination in any activities, programs or employment supported by this Agreement. CONTRACTOR 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. 4. CONTRACTOR agrees to comply with the Age Discrimination Act of 1975, which requires that during the performance of this Agreement, CONTRACTOR 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. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the CONTRACTOR setting forth the provisions of this age discrimination clause. 5. CONTRACTOR agrees to comply with Section 504 of the Rehabilitation Act of 1973, which requires that no otherwise qualified individual with a disability in the 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. B. Conflict of Interest. Pursuant to the conflict of interest requirements set forth in 24 CFR 570.611 and 2 CFR 200.112, CONTRACTOR certifies that no member, officer, employee, agent or assignee of CITY having direct or indirect control of any ARPA SLFRF Funds granted to the CITY, inclusive of the subject ARPA SLFRF Funds, shall serve as an officer of CONTRACTOR. Further, any conflict or potential conflict of interest of any officer of CONTRACTOR 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 CONTRACTOR to CITY regarding any changes or modifications to its board of directors and list of officers. C. Special Certification for Religious Entities. If CONTRACTOR is a religious entity, CONTRACTOR hereby agrees that in connection with the provision of the services CONTRACTOR shall provide with ARPA SLFRF Funds, in accordance with 24 CFR 570.2000): 1. CONTRACTOR 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. 2. CONTRACTOR shall not discriminate against any person applying for the services CONTRACTOR 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. 3. CONTRACTOR 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 that this covenant is intended to and shall be construed for the limited purpose of assuring compliance with respect to the use of CITY funds by CONTRACTOR 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 CONTRACTOR. 4. 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. 5. Where the services to be provided under said program are rendered on property owned by the primarily religious entity CONTRACTOR, ARPA SLFRF 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 ARPA expenditure for rendering the services under said program. D. Prohibition of Nepotism. CONTRACTOR 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 an administrative capacity by CONTRACTOR. 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. E. 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 Daisy Perez Assistant to the City Manager City Manager's Office 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702-1988 TO CONTRACTOR: Delhi Center Jenny Rios, CEO 505 E. Central Ave. Santa Ana, CA 92706 714-481-9600 Jennyrios@delhicenter.org F. Assignability. None of the duties of, or work to be performed by, CONTRACTOR under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY. CONTRACTOR 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 CONTRACTOR pursuant to this Agreement. G. Indemnification/Hold Harmless. CONTRACTOR 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 CONTRACTOR, its officers, directors, employees, agents, subcontractors and suppliers arising out of CONTRACTOR's performance of this Agreement. H. Insurance. Contractor 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 and the results of that work by the Contractor, its agents, representatives, employees, or subcontractors. a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): 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 $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 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 0001 covering, Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non -owned), with limit no less than $1,000,000 (if program services includes transportation of youth, the limit shall be no less than $5,000,000) per accident for bodily injury and property damage. (Not required if an automobile is not required to fulfill 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 injury or disease. 4. Sexual Abuse or Molestation (SAM) Liability. If the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Contractor shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit no less than $1,000,000 per occurrence or claim. 5. If the Contractor 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 Contractor. 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: 1. Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor 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 Contractor's insurance (at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if a later edition is used). 2. Primary Coverage: For any claims related to this contract, the Contractor's insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 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 Contractor's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall state that coverage shall not be canceled, except with notice to the City. 4. Waiver of Subrogation: Contractor hereby grants to City a waiver of any right to subrogation which any insurer of said Contractor may acquire against the City by virtue of the payment of any loss under such insurance. Contractor 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. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the City. The City may require the Contractor 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 of Insurers: 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 A:VII, unless otherwise acceptable to the City. 7. Claims Made Policies: If any of the required policies provide coverage on a claims -made basis: 1. 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 -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Contractor must purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: Contractor 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 documents prior to the work beginning shall not waive the Contractor'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. 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. I. Termination. 1. This Agreement may be terminated on thirty (30) days' written notice by either party. In the event of such termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. 2. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by CONTRACTOR of Federal Laws governing the use of ARPA SLFRF Funds. In the event of such suspension or termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. 3. Pursuant to 2 CFR 200.340, in the event CONTRACTOR 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 CONTRACTOR, 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 further 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. 4. The grant of funds under this Agreement may be terminated for convenience by either the CITY or CONTRACTOR, 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 forwhich the award was made, the CITY may terminate the award in its entirety. 5. The grant of funds under this Agreement may be terminated due to the non-performance of CONTRACTOR and/or failure of SUBRECIPENT to perform the work described in Exhibit A. 6. The grant of funds under this Agreement may be terminated due to the failure of the CITY to receive sufficient or anticipated funding for the ARPA program for any term subject to this Agreement. 7. In the event this Agreement is terminated as set forth in subparagraphs I(1) through I(6), inclusive, CONTRACTOR agrees to immediately return to CITY upon CITY's demand and prior to any adjudication of CONTRACTOR's rights, any and all funds not used, and to comply with the Reversion of Assets requirements in this Agreement. J. Limitation of Funds. The United States of America may in the future place programmatic or fiscal limitations on the use of ARPA SLFRF Funds, which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting ARPA program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement, may limit the rate of CONTRACTOR's authority to utilize funds, or may restrict CONTRACTOR's use of uncommitted funds. Where CITY has been directed to implement a reduction in funding, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. If such a reduction in funding occurs, CONTRACTOR shall be permitted to de -scope accordingly. Where CITY has reasonable grounds to question CONTRACTOR's fiscal accountability 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 CONTRACTOR 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 CONTRACTOR 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 ARPA SLFRF Funds withdrawal guidelines. K. Exclusivity 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 ARPA SLFRF Funds by CONTRACTOR and contains all the covenants and agreements between the parties with respect to SUBRECIPIIENT's administration of said program. 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 CONTRACTOR. L. 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. M. Validity and Severability. 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. N. 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 parties 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. O. Federal Award Identification Information. CONTRACTOR's pertinent Federal Award Identification Information, including DUNS Number and Federal Award Identification Number (FAIN), as well as the applicable information for ARPA, are included in Exhibit C attached hereto and incorporated herein by this reference. P. Miscellaneous Provisions. 1. 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. 2. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 3. This Agreement must be signed below and may be signed in counterpart and delivered by fax, email as a PDF (Portable Document Format) file attachment, or by other means that displays the original or a copy of the signatures. Any subsequent amendments may be signed and delivered in the same manner. (Signatures on following page} IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year first written above. ATTEST: a. Clerk of the Council APPROVED AS TO FORM: SONIA R. Oi- }RVALV10 City Attome; i 11 ,f By: RYAN 0. HOr?GE Assistant',CLy AttoiT;ey CONTRACTOR: JENNY RIOS Chief Executive ;Offj er DUNS-## 088513563 CITY OF SANTA ANA KRISTINE RIDG--- City Manager EXHIBIT A DELH'ICENTER RFP 22-009A for Food Distribution programs REVISED SCOPE OF WORK The revised award amount of $218,574 for the RFP 22-009Afor Food Distribution Program at Delhi Center will be sufficient for the center to continue with its goal to increase its distribution of food from four hours once a week to twelve hours per day, 4-5 days per week, resulting in a significant increase in the number of residents that could be served. The registration, outreach and scheduling, and preparation and distribution functions will remain the same as originally proposed. The only difference in this process will be the reduction of the Customer Service Representative position from 40 hours per week to 29 hours per week (from 1.0 FTE to .725 FTE). This will be made possible by recruiting volunteers and by assigning existing staff to a few hours each week to assist with intake and registration, scheduling, and tracking demographics, which they have done in the past. Delhi Center will absorb the cost of printing, office supplies, and some of the smaller equipment items by making adjustments to other center expenses and making these a priority. Also, donations will be requested from partners and sponsors for specific items needed. Donations will also be sought for cleaning supplies as a result of the reduction in that budget line item. Food costs will be reduced from $300 per month to $200 per month and the truck rental will be reduced to only one time per month instead of twice a month as a result. Staff will work with partners to increase food drives and donations to make up for any food shortages. Finally, the cost allocated to space rental will be reduced from $30,000 to $20,525. All proposed program components will remain the same and the weekly food distribution strategy will continue. The expansion of the program will significantly increase the number of hours residents can access food, which will result in doubling the number of families served also as originally proposed. Delhi Center will dedicate 760 square feet of space for a permanent food pantry where food will be maintained and arranged much like a grocery store so residents can come in at greatly expanded time blocks to help feed their families consistently. In addition to the weekly food distribution, the food pantry could be open Monday through Thursday from 8:30 am to about 8:30 pm and possibly on weekends. Delhi Center will also continue to collaborate with a number of partners that provide a broad network of resources to improve service delivery to the community. This will help us recruit volunteers and secure donations of items that have been cut or reduced from the original budget. EXHIBIT B PERSONNEL COST DESCRIPTION Facility Manager (.50 FTE) 29,266 Coordinates scheduling of the facility and manages the master calendar; troubleshoots facility, equipment, and IT issues; assists with food collection and distribution Administrative Aide (.50 FTE) 22,328 Communicates with residents regarding weekly food distribution and special circumstances, tracks numbers served and submits reports to Second Harvest FT Custodian (.50 FTE) 22,542 Sets up and tears down tables and chairs for weekly food distribution, sanitizes and cleans the center daily, assists with stocking the food pantry and with food distribution Associate Director (.20 FTE) 20,326 Oversees center operations, manages volunteer recruitment, training, and supervision, manages grant compliance FT Customer Svc Rep (Vacant) 33,368 Conducts outreach, intake & registration, identifies resident (.725 FTE) needs, schedules residents for food pantry visits, tracks demographics and numbers served, provides customer service, maintains the panty fully stocked and assists with food distribution. PT Custodian (Vacant) (.75 FTE) 26,818 Assists with food collection, stocking the food pantry, cleaning and sanitizing on a daily basis, assists with food distribution TOTAL 154,648 ADMINISTRATIVE COST DESCRIPTION Scheduling App 240 $20 month Permits 320 Self -Serve Certificates ($10 per person x 7 staff); County of Orange food handling and storage feeding site permit ($250) TOTAL ADMINISTRATIVE $560 EQUIPMENT COST DESCRIPTION 1 single door refrigerator 14,000 Single door and double door refrigerators and freezers to 1 double door refrigerator maintain perishable food in the food pantry. Must be NSF or 1 single door freezer commercial grade and approved by the County of Orange 1 double door freezer Health Department 3 14" x 60" and 3 24" x 48" 1,577 NSF or commercial grade shelving units approved by the Chrome Shelf Kits with casters County of Orange Health Dept for food pantry storage Chrome Two Basket and One 752 Food pantry storage and display carts approved by the County Shelf Utility Cart 24" x 36" x 39" of Orange Health Dept for food pantry Flex Station "Fresh & Fast" 48" 816 - Food pantry storage and display carts approved by the County x 23" x 75 3/4" of Orange Health Dept for food pantry TOTAL EQUIPMENT $17,145 SUPPLIES COST DESCRIPTION Cleaning and Sanitation 875 Disinfectant sprays and wipes, hand sanitizer, cleaning Supplies supplies, gloves, masks, grocery bags/boxes, trash bins, bags, recycle bins Miscellaneous Supplies 500 Box cutters, protective eyewear, heavy duty work gloves, etc Equipment 850 Heavy-duty pallet jack for moving pallets of food TOTAL SUPPLIES $2,225 FOOD PURCHASES COST DESCRIPTION CAPOC Food Bank 2,400 $200 per month; 5,000 pounds of food @ .06 per pound Truck Rental 1,200 Rental once a month to pick food from the CAPOC food bank to stock the food pantry for 12 months TOTAL $3,600 SPACE RENTAL COST DESCRIPTION 760 sq ft @ 3.29 per sq ft/month for 12 months 20,525 Dedicated space for food pantry, for $1,710.42 per month; includes a two -room suite with storage cabinets and sink to comply with county health department TOTAL SPACE RENTAL $20,525 TOTAL DIRECT COSTS 198,703 INDIRECT COSTS (10%) 19,870 TOTAL REQUESTED 218,573 Reimbursement Schedule Delhi is to submit an invoice requesting reimbursement of program expenses, along with a report outlining all program outcomes and performance metrics to the City on a quarterly basis as follows: Q1: March 1, 2022 - May 31, 2022 Reporting/Invoicing Due: June 30, 2022 Q2: June 1, 2022 - August 31, 2022 Reporting/Invoicing Due: September 30, 2022 Q3: September 1, 2022 - November 30, 2022 Reporting/Invoicing Due: December 31, 2022 Q4: December 1, 2022 - February 28, 2023 Reporting/Invoicing Due: March 31, 2023 EXHIBIT C APPENDIX ATTACHMENT 3-5: STATUS DOCUMENTION Include a copy of DUNS Status https://www.dnb.com/duns-number/lookuLi.htrnl Include a copy of SAM.gov Status httpsj/ sa : ov content/home Include a copy of 501(c)3 Status Include a copy of State of Californla Status htt, os:!/businesssearch.sos.ca,c�ov./ City of Santa Ana RFP 22-009A Page 47 9, 5 11110121, 11:07 AM 1 Search Results D&B D-U-N-S Number Lookup See your company listed below? You can have your D-U-N-S Number emailed to you or view/update your company information. If you don't see your company's name in the search results, search again or request a new D-U-N-S Number by clicking the link at the bottom of the screen. DELHICENTER 505 E Central Ave, Santa Ana, CA 92707-3503 714 361-B866 SINGLE LOCATION I ACTIVE Don't see your organization listed? Get a New DdJ-N-S Number 0 httpa:IA w .dnb.com/duas numberilookup.html 1/1 AI ABY oor 0 ho ALERTf This entity is only available FOR OFFICIAL USE ONLY. Unique Entity ID Purpose of Registration All Awards Physical Address 505 E Central AVE Santa Ana, California 927073503 United States Doing Business as (blank) Congressional District California 46 MPIN ' 2019 SAM Unique Entity ID CAGE! NCAGE MQGSTJ7HPHW3 4GY81 Registration Status Expiration Date Active Jan 27, 2022 Melling Address 605 E. Central AVE Santa Ana, California 927073603 United States Division Name Division Number (blank) (blank) Stale l Country of Incorporation URL California I United States http:www.delhlwnter org Registration Dates Activation Data Submission Date Initial Registration Date Jan 29, 2021 Jan 27, 2021 Ju127, 2006 Entity Dates Entity Start Date Fiscal Year End Close Data Apr 1, 1970 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation In your business a organization's preceding completed fiscal year, did your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) receive both of the following: 1.80 percent or more of your annual gross revenues in U.S. federal Contracts, subcontracts, loans, grants, subgrents, and/or Cooperative agreements and 2. $25,000,000 or more in annual gross revenues from U.S. federal Contracts, subcontracts, loans, grants, subgrams, and/or Cooperative agreements? No Does the public have access to information about the compensation of the senior executives In your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) through periodic reports filed under section 13(a) or 1Sid) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 19867 Not selected Proceedings Questions Is your business or organization, as represented by the DUNS Number an this entity registration, responding to a Federal procurement opportunity that Contains the provision at FAR 62,209-7, subject to the clause In FAR 52,209.9 in a Current Federal contract, of applying for a Federal grant opportunity which Contains the award term and Condition described in 2 C.F.R. 200 Appendix XII? No Does your business or organization, as represented by the DUNS number on this specific SAM record, have current active Federal contrects and/or grants with total value (including any exemised/unexemised options) greater than $10,000,000? Not Selected Within the last five years, had fha business or organization (represented by the DUNS number on this specific SAM record) and/or any of Its principals, In connection with the award to or performance by the business or organization of a Federal Contract or grant, been the subject of a Federal or Slake (1) criminal proceeding resulting In a Conviction or other acknowledgment of fault; (2) civil proceeding resulting In a finding of fault with a monetary fine, penally, reimbursement. restitution, and/or damages greater than $5,000. or other acknowledgment of fault; and/or (3) administrative proceeding resulting in a FA Business Types EntityStrocture Corporate Entity (Tax Exempt) Profit Structure Non -Profit Organization Other Entity Qualifiers Minority Institution Hispanic Servicing Institution Educational Institution Entity Type Business or Organization Organization Factors (blank) Accepts Credit Card Payments Yes Debt Subject To Offset No Department Code (blank) EFT Indicator CAGE Code 0000 4GYB1 Electronic Funds Transfer Account Type Routing Number Lock Box Number Checking "0247 (blank) Financial Institution Account Number WELLS FARGO BANK NA ""10154 Automated Clearing House Phone (U.S.) Email Phone (non-U.S.) 7144819600 patdsia@dolhi"nter.org (blank) Fax (blank) Remittance Address rELHICENTER 5 E. Central AVE Santa Ana, California 92707 United States pr EIN Type of Tax Taxpayer Name '* '0952 Applicable Federal Tax DELHI CENTER Tax Year (Most Recent Tax Year) Namorrile of Individual Executing Consent TIN Consent Date 2019 Director Of Operations Jan 27, 2021 Address Signature 505 E Central AVE PATRISIA GONZALEZ Santa Ana, California 92707 M,. EM Accounts Receivable POO P. PATRISIA GONZALEZ, Director of Operations patrisia@delhlcenter.org 7144819600 ton"111arm/by Putru]u gn,,:ulw nn Jmr 22 2021 ut 05:24 PA! DFLHI CF.N7F.4 Electronic Business R 506 E. Central AVE. Patrlsla Gonzalez, Director of Operations Santa Ana, California 92707 patrisla@delhlcenter.arg United States 7144819600 Margarita Chavez 505 E. Conical AVE. margarita@)do111icenier.org Santa Ana, California 02707 7144819600 United States Government Business $ 505 E. Central AVE, Patrlsla Gonzalez Santa Ann, California 92707 patrlala@delhlcentinhorg United Slates 7144619000 Margarita Chavez 5a5 ERENTRAL AVE margadta@delhiunter.org Santa Ane, CNifomla 927m 7144619800 United Steles Past Performance P 505 E. Central AVE, Margarita Chavez Santa Ana, California 92707 margarita@dethicetner.org United States 714481960D Margarita Chavez 505 E. Central AVE margarita@delhimnier.org Santa Ana, California 92707 7144819600 United Slates n 611420 624120 624190 024210 624229 711130 Computer Training Services For The Elderly And Persons With Disabilities Other Individual And Family Services Community Food Services Other Community Housing Services Musical Groups And Attain arc. 1� �az� m• . �� s IGT Size Motion Annual Revenue (from all IGTs) (blank) Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 121) $7.00 11 Location Annual Receipts (in accordance with 13 CFR 121) Number of Employees (In accordance with 13 CFR 121) $7.00 11 Industry -Specific Bartels Capacity Megawatt Hours Total Assets (blank) (blank) (blank) hrgr:/Lvnnr.r,•nN uioJ0FA5115Y3irmeDnm7smms=AeRve Lon updaled by Pmdnv Gvnm1¢an Jvn 22, 2021 m 01:24 PAI DEMI CENIPA i a s `"A`x �x a� v a t�� / c } " 1 ,�..`y3xi .rt . !.�b ,'. :. @, "'a"C'4 .`e Eami4.. xThis enifty does not appear in the disaster response registry. �0 AnPxr/homgo�/vxl10�08'81f3593/ruePum7sma�a=Aclivx Internal Rovanua servioo MO.' Morch a, 2002 DONCentor Sob 6 Central Ave Santa Area, CA 02707 Deer Sir or Madam: Deparamnt or the Treasury P. o. Box 2508 Cincinnati, OH 4$201 person to Contact: Steve Brown Sl-07422 Customer Service R"MaM auve TOR Free TaMptwna lumbar: e:lsemtsasopavaar 077-szt-66op Fax Number 513.203376s Federal Identification Number, W2020052 This IeCerls In response to your request for a copy of yourorganizalion'a determination letter, This lebarwid take the place of the copy you requested. Our MOONS Indloate that a determination letter issued In April 1970 granted your wganizatlan exemption from federal Income lax under section 801(c)(e) of f1w Internal Revenue Code. That letter is and In affect. Based on Infcmpttkm aublocluenay subaAaod, wo Wassiflad your otyMOMIian as one that is not a private foundation w" the meaning of section 509(a) of the Code bemuse It Is an organbetion dasamed In seotiw" SO9(a)(1) and 170(15)(1)(Axv�. This dess'mcation was b aced on the assUMPI on that your aManisaft 'a operations would continue as stated n the appCoa%on. If year orpa lnatlo t'a aaU CbI of support or Its csraraaer, memod of oparadOne, or PxsPeses have ehanyed, pleaaa tot Ira imew as we can consider the affect of the change on the exempt status end roundatign ataxia 01 yaurorganization, Your wgallzedon Is rlsqulred to file Form M. Return of orgentzatlon Fxempt ham Income Tax, only ff its pose mosiPts each year M n0 mady more than 528,000. C s return is required, h must be Ned by the lath day of the fdlh month after the and of the otgaaizatbn`s anmad accounting padod The law imposes a partsHy of $20 a day, up to a ro"ImumAt 8ro,000, when a return is Clad late, unless there is reasonable cause for the delay. AA exempt orgar8zations (unless specfliarlly excluded) are liable for texas under the Fed" insurance Contributions Act (soClal amruity laxas) an wftwfW*t>drt of 8100 ar more paid to each employee dudng a calendaryear. Your organtudon is not liable for Inc tax Imposed under the, Federal Unemployment Tax Act (FUTA). Ownizatlons that are not Private foundations are not subJeol 10 the excise taxes under Chapter 42 of the Cade. However, Claw organizations are natautamaUrztly exempt from other federal excise taxes. Donors may deduct con"wtione to your w0mlzO on as provided In soction 170 of the Code. Bequests, RVacies, davlaos, transfers, or 0111s to yourorganik8tion Of for Its use ere deductible for (adarat estate end gift tax 1x "503 it they meet the APpdcable provisions of sections 2055, 2108, and 2522 of the Code. 51 Secretary of State Certificate of Status I, SHIRLEY N. WEBER, Ph.D., Secretary of State of the State of California, hereby certify: Entity Name: DELHI CENTER File Number: C0579643 Registration Date: 09/10/1969 Entity Type: DOMESTIC NONPROFIT CORPORATION Jurisdiction: CALIFORNIA Status: ACTIVE (GOOD STANDING) As of April 12, 2021 (Certification Date), the entity Is authorized to exercise all of its powers, rights and privileges in California. This certificate relates to the status of the entity on the Secretary of State's records as of the Certification Date and does not reflect documents that are pending review or other events that may affect status. No Information is available from this office regarding the financial condition, status of licenses, if any, business activities or practices of the entity. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of April 13, 2021. SHIRLEY N. WEBER, Ph.D. Secretary of State Certificate Verification Number: ZVKBLNY To verify the issuance of this Certificate, use the Certificate Verification Number above with the Secretary of State Certification Verification Search available at bebizRle os.ca, vpo lcertd6cefion/index. EXHIBIT D APPENDIX ATTACHMENT 3-1: NON -COLLUSION AFFIDAVIT CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR REVIVE: SANTA ANA FOOD SUPPLY/DISTRIBUTION PROGRAMS RFP NO.: 22.009A NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA CITY MANAGER'S OFFICE In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or Indirectly colluded, conspired, connived cr agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained In the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged Information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Organization VGlr11 Signed and Printed Name: Title,iG"GIj61Q l�lri Date '/Y! 7, 1 U� City of Santa Ana RFP 22-009A Page 42 A EXHIBIT E ATTACHMENT 3-2: NON -LOBBYING CERTIFICATION CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR REVIVE: SANTA ANA FOOD SUPPLY/DISTRIBUTION PROGRAMS RFP NO.: 22.009A The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: 1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering Into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. 2. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to Influence any officer or employee of any federal 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, grant loan, loan or cooperative agreement, the undersigned shall complete and submit a "Disclosure of Lobbying Activities". This certification is a material representation of fad upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Signed and Printed Name: Date City of Santa Ana RFP 22-009A Page 43 art 1_W.0I L3 DRUG -FREE WORKPLACE Certification Regarding Drug -Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Treasury in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Treasury, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about— (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. (e) Notifying the U.S. Department of Treasury within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - DRUG -FREE WORKPLACE Certification Regarding Druct-Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Treasury In awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Treasury, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about — (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. (a) Notifying the U.S. Department of Treasury within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a rederal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (a) and (f). B. The contractor shall insert in the space provided on the attached "Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (Including street address, city, county, state, and zip code) .the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Treasury immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Authorized Silture i Date WORKPLACE REQUIREMENTS The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract covered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): iitC-C�M/J CERTIFICATE OF LIABILITY INSURANCE DAT11/021EIMM2/22807 7 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. HM—POITT—ANT; "a contficate holder In an ADDITIONALIf SUBROGATION IS WAIVED, subject to the ttermsa and conditions oftheDl policy, es)must olio TIONAL INSUREDrsement. orbeendorsed. 1 p oy, certain mm nt(s).as may require an endorsement. A statement on this certificate does not confer rIDIHa to the certificate holden in lieu of such endoreement(S , PRODUCER SO Or NAME' 66N Cer00oate lance Team �.,. Comprehensive lnaurence Services PHONE UQ.M �0 . (949)709.8800 a 26429 Rancho Parkway South . M. Ir ADDRESS: y@thecomprehonslvelmumnce.cam (B49)709-i66B Suite 120 INSURIDUSIAFfORDIMOCOVEMGE -NAICB Lake Forest CA 92830 msUREan: Nonprofits Insurance Alliance of California 10023 INSURED MSURERa: StarNat Insurance Company - - 40046� Delhi Center INSURER a: 505 E, ContlalAVe, INSURER D: N8anE Santa Ana CA 92707 INSURER!: COVERAGES CERTIFICATE NUMBER: CL2111205495 REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L}R TYPE OPINSUMNCE I Ix ..R9.11 POUCYNUYBER MMNDIYYYY MOWN V, UMne GONMFRCIAL GENERAL UASWITY EACHOCWNRENCE S 1.000.000 CLAIM8•MAOE ® OCCUR PREM18E5mx nrb,nnnrwl f 500J000 A J Y 2021-01376 1110112021. 11ION2022 PERSONAL Nnpy INJURY 7,tl0D,000 OENLAGGRFOATE LIMITAPPLIES PER: GENERALAGGREGATE § 9.060,000 POLICY ® JECT ®LOC PRODUCTS-COMPIOPAGG § 3,C00,000 OTHER: $O Deductible AUTOMOBILE LWBILRY INW I Ee ectid § 1,000,000 ANYAUTO 9pDILYINJURY(P.pg ) § A OWNED BCHEOULED AUTOS ONLY AUTOS 2021-01376 11/01/2021 1110112022 aoDRYIWURY(P.,Z&nn § HIRED NO"MED AUTOS ONLY AUTOGONLY -s v..�. 0 Deductible UMBRELLA LOOP OCCUR EACH OCCURRENCE excess L1AB GlA1M6 Mn0F AGGREGATE DED - RETENTION $ § WORKERS COMPENSATION X PER $O DBdUCIIbIB AND EMPLOYERS' LUMILRY YIN STATUTE B ANYPROPRIEiORIPARTNERIEXECUMVE LNJ ppFflCEriMEMOCR EXCLUDED? NIA 13NUWC0152622 11/0112021 1110V2022 E.L. EACHACCIOEW II1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 r tMnndalNry to NH) _ nron.d.fte enggr DESCRIPTION OF OPEMTIONShBNw _ E.L. DISame-POR'"Le"n S 1,000,000 ServiceProfessionalConduct $$,000,000/1.000,Wo ABgregom Om1R. A ImpSocroper Improper Sexual Conduct Liability Liability 2021-01376 11101/2021 11101/2022 $1.000'000/1,O.OLCCO Aggregated0ccun. $D DadUoUble DESCRIPTION OF OPEANDONS I LOGATIDNS I VEHICLES (ACORD 101. AVVmond RnmvhA Saboduk, niW he MWah" It rune npnae In mqulmr0 City of SMIWAWU ONcere, agents, employees, end VOlmleum are named aS additionally Insured on this policy pursuant to written contrast, agreement, or memorandum of understanding per attached endomemant CG2026. Such insurance as is afforded by this policy shall be primary, and any insurance carried by Cary shall be excess and nonaonmbutory per attached endamement HAIG E61. 30 day notice of cancellation With 10 day notes, of cancellation for non-payment of premium per policy prevision. PPOTIFIr.ATC wen nwo SHOULD ANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORReD REPRESENTATIVE 20 CIVIC Center Plaza Santa Ana CA 92702 ®1955-ZUIB ACORD CORPORATION. All rights reserved. ACORD 25 (2010103) The ACORD name and logo are registered marks of ACORD An 1e Digitally signed a� or CERTIFICATE OF LIABILITY INSURANCE by ngle3/ozrzozzYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U H E h R. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED F.y THP��W^I=R BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT BETWEEN THE ISSUING INSURFA(S), AM2Q*3:07 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSUP617, provisions fir 116 01rdlerA If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services AIC NNo Ex : (949) 709-8800 FAD No: (949) 709-1668 26420 Rancho Parkway South poliRless: Jeremy@thecomprehensivelnsurance.com Suite 120 INSURERS) AFFORDING COVERAGE NAICn Lake Forest CA 92630 INSURERA: Nonprofits Insurance Alliance of California 10023 INSURED INSURER B: StarNet Insurance Company 40045 Delhi Center INSURER C: 505 E. Central Ave. INSURER D : INSURER E : Santa Ana GA 92707 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2111205495 RRVICIr1N NIIMRFR• 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDLSUBR INSD Me POLICY NUMBER POLICY EFF MMIDDIYYYV POLICY EXP MMNDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ®OCCUR CLAIMS -MADE PREMISES Ea occurrence)$ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL&ADV INJURY $ 11000,000 A Y 2021-01376 11/0112021 11/01/2022 GEN'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 3,OOD,000 ❑ PRO- FX—I POLICY JECT LOC PRODUCTS - COMPIOP AGG $ 3,000,000 OTHER: $0 Deductible $ LIABILITY COMBINE. SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per Person) $ ANYAUTO AOWNED SCHEDULE. UTOS ONLY AUTOS 2021-01376 11/01/2021 11/01/2022 4MOBI,LE BODILY INJURY Per accident I ) $ HIREDNON-OWNEDPR ONLY AUTOS ONLY DAMAGEUTO Per accident $ $0 Deductible $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESSLIAB CLAIMS -MADE 2021-01376 03/02/2022 11101/2022 DED I I RETENTION $ $ WORKERS COMPENSATION _ X STATUTE FIR $0 Deductible AND EMPLOYERS' LIABILITY YIN E.L. EACHACCIDENT $ 1,000,000 B ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? EE NIA BNUWC0152622 11/01/2021 11701/2022 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, descrlbe under E.L. DISEASE -POLICY LIMIT $ 1,O00,000 DESCRIPTION OF OPERATIONS below Social Service Professional Liability $3,000,000/1,000,000 Aggregate/Occurr. A Improper Sexual Conduct Liability 2021-01376 11/01/2021 11/01/2022 $1,000,000/1,000,000 Aggregate/Occurr. $0 Deductible DESCRIPTION OF OPERATIONS LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are named as additionally Insured on this policy pursuant to written contract, agreement, or memorandum of understanding per attached endorsement CG2026. Such insurance as is afforded by this policy shall be primary, and any insurance carried by Clly shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. Umbrella policy applies over and above General Liability coverage. 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 ArnR ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 3 ^_a Risk Management j Hf REVIEWED & APPROVED BY: lfi�ila r1r.11' A r"n ewk T Risk Management Spedalist' POLICY NUMBER: 2021-01376 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. I Information required to complete this Schedule, if not shown above, will be shown in the I A. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG20261219 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services office, Inc., 2012 Page 1 of 1 �. RlekMan�+anenEDlWelon ". i'`'% REMEwED//&�APPROVED BY: �1 f r12°d'_lQfRVF d Risk Management Specialist NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Msurance. A Heart for Nonprof@s. POLICY NUMBER: 2021-01376 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. SECTION II — WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named In the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. SECTION III — LIMITS OF INSURANCE is amended to include: B. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision AA above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance Is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 ��i�- wekManga,'emmt Division REVIEWED i& APPROVED BY: WRisk Management Spedalist NONPROFITS INSURANCE ALLIANCCOFCALIFORNIA A Head forJnsarance. A Heartfar Nonprofits. POLICY NUMBER:2021-01376 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described In paragraph b. below. b. Excesslnsurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work" (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I - COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE. (a) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. C. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. N IAC-E61 02 19 RWkManapmerLtDl*Ion z N ReA0V@D&APPROvac8r Risk Management Specialist NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance.. A Heart far Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org COMMERCIAL UMBRELLA POLICY DECLARATIONS PRODUCER: Comprehensive Insurance Services 26429 Rancho Parkway South Suite 120 Lake Forest, CA 92630 Item 1 NAME OF INSURED AND MAILING ADDRESS: Delhi Center 505 E. Central Avenue Santa Ana, CA 92707 Item 2 POLICY PERIOD: BUSINESS DESCRIPTION: FROM 3/2/2022 POLICY NUMBER: 2022-01376-UMB TO 11/112022 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE Resource & referral services IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: (premium includes Terrorism Coverage - Certified Acts: $33 but only for policies that indicate coverage on Schedule A - Schedule of Underlying Insurance) $434 Item LIMITS OF INSURANCE: a. Occurrence / Accident / Injury / Claim Limits (where applicable): ............................................ 1,000,000 i) Each Occurrence - Commercial General Liability and Products - Completed Operations Liability ii) Each Accident - Business Auto Liability iii) Each Injury- Liquor Liability iv) Each Claim - Employee Benefits Liability b. Each Claim - Directors and Officers Liability.......................................................................... Excluded C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... Excluded d. Each Claim - Social Service Professional Liability.................................................................. Excluded Item 5 Aggregate limits e. Commercial General Liability, Business Auto Liability, Products- Completed Operations Liability, Liquor Liability, and Employee Benefits Liability Aggregate (where applicable): .................................................................................................................. 1,000,000 I. Directors and Officers Liability Aggregate................................................................................ Excluded g. Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ Excluded h. Social Service Professional Liability Aggregate....................................................................... Excluded RETROACTIVE DATES - SEE SCHEDULE OF UNDERLYING INSURANCE FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): CU 2130 01 15, IL 09 99 12 20, NIAC-EO03 UMB 08 20, NIAC-E180 UMB 01 21, NIAC-E253 UMB 08 21, NIAC-E42 UMB 09 19, SCHEDULE A 01 80, UMB 231 06 16, UMB 232 06 16, UMB-100 05 21, UMB166 12 88, UMB61 05 13 ^pyou. ifYl �„`� -• � � RiskMmwgementDhtIon REV swoo& APPROppvE) BY; r'I714eV4�a M Risk Management Specialist NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head far Insurance. A Heart far Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org 17�- COMMERCIAL UMBRELLA POLICY DECLARATIONS PRODUCER: Comprehensive Insurance Services 26429 Rancho Parkway South Suite 120 Lake Forest, CA 92630 COUNTERSIGNED: 3/7/2022 BY POLICY NUMBER: 2022-01376-UMB &�e,,a. (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS, THE ATTACHED SCHEDULE OF UNDERLYING INSURANCE, TOGETHER WITH THE ATTACHED SCHEDULE OF FORMS AND ENDORSEMENTS, AND ANY FORMS AND ENDORSEMENTS WE MAY LATER ATTACH TO REFLECT CHANGES, MAKE UP AND COMPLETE THE ABOVE NUMBERED POLICY. Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Cc 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of Califo regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay ch becomes insolvent. NIAC - UMB /2-99 m.e Risk MawgemenlDhfilon i >-` REVIEWEDqq&APPR(O(.�VED Sr 8� PI��t4 rIE4//�tJ RBIs Management sped�rst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head far Insurance. A Heart for Nonprofits, NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org SCHEDULE A - SCHEDULE OF UNDERLYING INSURANCE POLICY NUMBER: 2022-01376-UMB CONTROL NUMBER: 01376 NAME OF INSURED: Delhi Center TYPE OF POLICY APPLICABLE LIMITS INSURER POLICY # APPLICABLE PERIOD (A) Automobile Bodily Injury and Property Damage Liability Combined Single Limit ........................................ N/A Business Uninsured/Underinsured Motorist N/A Auto ....................... (B) Commercial Each Occurrence Limit .................................. $1,000,000 NIAC 03/02/2022 to 11/01/2022 General General Aggregate Limit $3,000,000 2021-01376 ................................ Liability Products/Completed Operations Aggregate Limi $3,000,000 Personal & Advertising Injury Limit .................... $1,000,000 Damage to Premises Rented to You .................... N/A (any one premises) (Includes Terrorism Coverage - Certified Acts) (C) Social Each Occurrence Limit ................................... N/A Service Aggregate Limit Professional """"""""""""""""' N/A Liability (D) Standard Coverage B - Employers Liability Workers Compensation & Employers Bodily Injury by Accident ..................................... N/A Each Accident Liability Bodily Injury by Disease ..................................... N/A Each Employee Bodily Injury by Disease ..................................... N/A Policy Limit (E) Improper Each Occurrence Limit ...................................... N/A Sexual General Aggregate Limit ................................. N/A Conduct and Physical Abuse (F) Directors' Each Wrongful Act Limit ................................. N/A And Aggregate Limit .............................................. N/A Officers' (G) Liquor Each Common Cause Limit ............................ $1,000,000 NIAC 03/02/2022 to 11/01/2022 Liability Aggregate Limit $1,000,000 2021-01376 ................................................ (Includes Terrorism Coverage - Certified Acts) (H) Employee Each Employee ................................................ $1,000,000 NIAC Benefits Aggregate Limit $3,000,000 2021-01376 ................................................ Liability (Includes Terrorism Coverage - 03/02/2022 to 11/01/2022 Risk Manegemenmlfilon REVIEWEDq&APPRWm By. rr t I mp Aav44 Risk Management Specialist NONPROFITS INSURANCE ®� ALLIANCE OF CALIFORNIA. A Head for Insurance. A Heart for Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) INDEX OF FORMS ATTACHED TO THE POLICY POLICY NUMBER: 2022-01376-UMB-NPO NAME OF INSURED: Delhi Center UMBRELLA FORMS AND ENDORSEMENTS Cap on Losses for Certified Acts - Terrorism Coverage Disclosure Of Premium For Certified Acts of Terrorism Member Criteria Communicable Disease - Exclusion Workers' Compensation - Exclusion Nuclear, Chemical and Biological Hazard Exclusion Schedule A - Schedule of Underlying Insurance Privacy Liability and Cyber Coverage Exclusion Medical Payments Exclusion Commercial Umbrella Policy Unimpaired Aggregate Limits Endorsement (Non-Concurrency) Employers' Liability Exclusion This list of forms is not part of the actual policy, but is for your information only. Please refer to the policy(s) for actual limits, coverages and exclusions. www.insurancefornonprofits.org Page 1 FORM NUMBERIEDITION DATE CU 21 30 01 15 IL 09 99 12 20 NIAC-EO03 UMB 08 2 NIAC-E180 UMB 012 NIAC-E253 UMB 08 2 NIAC-E42 UMB 09 19 SCHEDULE A 0180 UMB 23106 16 UMB 232 06 16 UMB-100 05 21 UMB166 12 88 UMB61 05 13 ¢,w,, Rish Manegr LDMa[on REVIEWED^&APPROAVEDBY: �l a�L®®F �� F"fap A6,odd lab -�' Risk Management Specialist COMMERCIAL LIABILITY UMBRELLA CU21300115 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL LIABILITY UMBRELLA COVERAGE PART A. If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insurance Act exceed $100 billion In a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. B. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. CU 21 30 01 15 © Insurance Services Office, Inc., 2015 w .,, 3 RlekMana�mnitD[Wakm REVIEWED &APPRo^vm BY: q Risk Management specialist NONPROFITS INSURANCE �■ ALLIANCE Or CALIFORNIA A Head far tnsurdnne. A Heartfor Nonpraflks, COMMERCIAL UMBRELLA POLICY THIS POLICY PROVIDES COVERAGE ON A CLAIMS -MADE BASIS IF THE UNDERLYING INSURANCE PROVIDES CLAIMS -MADE COVERAGE. IF COVERAGE WITHIN THIS POLICY IS PROVIDED ON A CLAIMS - MADE BASIS, IT APPLIES ONLY TO CLAIMS MADE AGAINST AN INSURED AND REPORTED TO US DURING THIS POLICY'S PERIOD OR ANY EXTENDED REPORTING PERIOD THAT MAY APPLY. IF COVERAGE WITHIN THIS POLICY IS PROVIDED ON A CLAIMS -MADE BASIS, THIS COVERAGE APPLIES ONLY TO DAMAGES ARISING FROM AN ACT, ERROR OR OMISSION COMMITTED ON OR AFTER THE RETROACTIVE DATE SHOWN IN THE DECLARATIONS OF THE UNDERLYING CLAIMS -MADE POLICY(S) BUT PRIOR TO THE END OF THIS POLICY'S PERIOD, NOT INCLUDING AN EXTENDED REPORTING PERIOD. PLEASE READ THIS POLICY CAREFULLY TO DETERMINE YOUR RIGHTS AND OBLIGATIONS. Throughout this policy, the words "you" and "your" referto the Named Insured shown in the Declarations. The words "we," "us" and "our" refer to the Company issuing this policy. Other words and phrases that appear in quotation marks have special meanings found in Section 6 - DEFINITIONS. SECTION 1. INSURING AGREEMENT A. Excess Liability Insurance (Following Form) We will pay on behalf of an insured those sums in excess of the amount payable under the terms of any "Underlying Insurance" as stated in the "Schedule of Underlying Insurance" that an insured becomes legally obligated to pay as damages to which this insurance applies. This Excess Liability Insurance is excess insurance and follows the "Underlying Insurance" except as otherwise stated in this policy. This Excess Liability Insurance is subject to the same terms, conditions, warranties, agreements, exclusions, endorsements and definitions contained in the "Underlying Insurance" except as otherwise provided in this policy; provided, however, in no event will this insurance apply unless the "Underlying Insurance" applies or would apply but for the exhaustion of the applicable Limit of Liability in the "Underlying Insurance." B. Extended Reporting 1. Extended Reporting Periods If the "Underlying Insurance" provides coverage on a claims -made basis and this policy provides coverage on a claims -made basis, then we will provide an Automatic Extended Reporting Period as described in subparagraph 2 below and, if you purchase it, an Optional Extended Reporting Period as described in subparagraph 3 below, IF, a, this insurance is cancelled or not renewed for any reason other than non-payment of premium; or b. we renew or replace this insurance with other insurance that: i. has a Retroactive Date later than the Retroactive Date shown in the Declarations of this policy; or ii. does NOT apply to damage on a claims -made basis. If the "Underlying Insurance" does not provide an Extended Reporting Period then we will not offer and will not provide an Extended Reporting Period. 2. Automatic Extended Reporting Period If the "Underlying Insurance" provides coverage on a claims -made basis then an Automatic Extended Reporting Period, equal in length to the Automatic Extended Reporting Period provided in tt Insurance," is automatically provided, except when this insurance is cancelled or not UMB-100 05 21 Nonprofits Insurance AllianceTm and NONPROFITS OWN® are brand'. of Alliance Member ServicesTM (AMS). © AMS. All rights reserved. wu RleieManagolnentDW[on REVIEWED&APPROVED BY: I a �,�ta Acwaafe, RIA Management Specialist payment of premium. The Automatic Extended Reporting Period does NOT apply to a claim that is covered under any subsequent insurance you purchase, or that would be covered, but for exhaustion of the amount of insurance otherwise applicable to such claim. 3. Optional Extended Reporting Period a. If the "Underlying Insurance" provides coverage on a claims -made basis then an Optional Extended Reporting Period is available only by an endorsement and for an additional charge. The Optional Extended Reporting Period starts at the end of this policy, either by cancellation or expiration, and will be equal in length to the Optional Extended Reporting Period you purchase as to the applicable "Underlying Insurance." A "claim" first made during this Optional Extended Reporting Period will be deemed to have been made during the policy period of this policy, and will be subject to the Limits of Liability set forth in SECTION 2 - LIMITS OF LIABILITY. b. The Named Insured listed in the Declarations to this policy must give us a written request for the Optional Extended Reporting Period, together with payment of the appropriate premium, within 30 days after the cancellation or non -renewal of this policy. This additional premium shall be fully earned at the inception of the Optional Extended Reporting Period. c. We will determine the additional premium for the Optional Extended Reporting Period in accordance with our rates. d. The Optional Extended Reporting Period is excess over any other insurance available under a policy or policies in force after the Optional Extended Reporting Period starts. 4. How Optional Extended Reporting Period Applies a. The Optional Extended Reporting Period applies only to damages arising from acts, errors or omissions committed before the end of this policy period, but not before the Retroactive Date shown in the Declarations, and not including an Extended Reporting Period, The Optional Extended Reporting Period does NOT: i. extend this policy's period or change the scope of coverage provided; ii. reinstate or increase the Limits of Liability applicable to any "claim" or "suit" to which this insurance applies. 5. Notification of us of a Claim or Suit Notification of a "claim" or "suit" must be in accordance with Duties In The Event Of A Claim Or Suit as stated in Provision F.2. of SECTION 5 - CONDITIONS of this policy. Any insured's failure to comply with the Duties In The Event Of A Claim Or Suit as stated in SECTION 5 - CONDITIONS of this policy will void the Optional Extended Reporting Period coverage under this policy, and we will promptly refund any additional premium you paid for the Optional Extended Reporting Period . SECTION 2. LIMITS OF LIABILITY A. The Limits of Liability shown in the Declarations and the rules below fix the most we will pay regardless of the number of: 1. persons and organizations who are insureds under this policy; 2. coverages provided under this policy; 3. "claims" made and/or "suits" brought against any oral] insureds; or 4. persons or organizations making a "claim" or bringing a "suit". B. The General Aggregate as stated in Item 4.e. of the Declarations to this policy is the most we will pay for all damages to which this policy applies for Commercial General Liability, Business Auto Liability, Products - Completed Operations Liability, Liquor Liability and Employee Benefits Liability. C. The Directors and Officers Liability Aggregate as stated in Item 4.f. of the Declaration we will pay for all damages to which this policy applies for Directors and Officers Liat UMB-100 05 21 Nonprofits Insurance Alliance- and NONPROFITS OWN® are brands of Alliance Member Services"^ (AMS). © AMS. All rights reserved. ny, RukManag�mnrtDtwfon REVIEWED&APPRDvm BY: RiA Management spedaht D. The Improper Sexual Conduct and Physical Abuse Aggregate as stated in Item 4.g. of the Declarations to this policy is the most we will pay for all damages to which this policy applies for Improper Sexual Conduct and Physical Abuse Liability. E. The Social Service Professional Liability Aggregate as stated in Item 4.h. of the Declarations to this policy is the most we will pay for all damages to which this policy applies for Social Service Professional Liability. If the Limit of Liability of the "Scheduled Underlying Policy" as stated in the "Schedule of Underlying Insurance' has been exhausted by payments made on behalf of any insured by the "Underlying Insurer," this policy shall apply in the same manner as the applicable "Underlying Insurance," subject to all the terms and conditions of such "Underlying Insurance' and the terms and conditions of this policy. If the Limit of Liability of the "Underlying Insurance" as stated in the "Schedule of Underlying Insurance" has been reduced by payments made on behalf of any insured by the "Underlying Insurer," this policy will drop down to become immediately excess of the reduced limit of the "Underlying Insurance." G. The Limits of Insurance of the "Scheduled Underlying Policy" will be reduced or exhausted only by payments made on behalf of an insured for injury or damage to which this insurance would apply, but for the amount of such injury or damage. H. The Limits of Insurance of this policy apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations to this policy, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limit of Insurance. Any Extended Reporting Period will not increase the applicable Limit of Insurance. SECTION 3. DEFENSE PROVISIONS A. We will have the same defense obligations under this policy as are in the applicable "Underlying Insurance" when the applicable Limits of Liability of the "Underlying Insurance," plus the applicable limits of any other applicable insurance, have been exhausted by payments made on behalf of an insured. If the "Underlying Insurance' includes payments of "defense expenses' as part of its Limits of Liability, then when excess of such "Underlying Insurance," our payment of any "defense expenses' is within the applicable Limits of Liability of this policy and each payment we make for such "defense expenses" reduces the available Limits of Liability by the amount of the payment. 2. If the "Underlying Insurance" does not include payments of "defense expenses' as part of its Limits of Liability, but instead indicates that the payment of "defense expenses' will not reduce the Limits of Liability, then when excess of such "Underlying Insurance," our payment of "defense expenses' will not reduce the available Limits of Liability. 3. The "defense expenses' extended by this policy will be subject to the same provisions as the "defense expenses' extended by the "Underlying Insurance." B. We will not defend any "suit" or "claim" after we have exhausted the applicable Limit of Liability as stated in the Declarations. If we are prevented by law from carrying out this paragraph, we will NOT pay any "defense expenses' incurred without our written consent. C. In all circumstances for which paragraph A above is not applicable, we will NOT be obligated to assume charges or pay expenses for the investigation, settlement or defense of any "claim" made, or "suit' brought, or proceedings instituted against any insured. We will, however, have the right in our sole discretion to participate in the defense and trial of any "claim", "claims', "suits' or proceedings which may involve the coverage extended by this policy. If we avail ourselves of this right, we will do so at our expense. UMB-100 05 21 Nonprofits Insurance Alliance TM and NONPROFITS OWN® are brands of Alliance Member ServicesTM (AMS). © AMS. All rights reserved. ,y RlskManeganadDMaliz . i REVIEWED &APPROVE) BY: q `�--_---' Risk Management Specialist SECTION 4. EXCLUSIONS OR SUBLIMITS A. Each and every exclusion within the "Underlying Insurance' is incorporated by reference to this policy, with the same force and effect as though expressly set forth within this policy. As an example only, if the "Underlying Insurance" includes an exclusion for improper sexual misconduct and physical abuse, that exclusion in its entirety is incorporated within this policy as though fully set forth herein. B. Notwithstanding Provision A within Section 1, the coverage identified in the Declarations to this policy is the only coverage extended by this policy. If an "Underlying Insurance" includes exclusions with exceptions and specified sub -limits, this policy will not provide coverage in excess of the specified sub -limit, unless a separate sub -limit is identified specifically within the Declarations to this policy. If an "Underlying Insurance" includes Additional Coverages with specified limits, this policy will not provide coverage in excess of the specified Additional Coverage, unless a limit for that Additional Coverage is specifically identified within the Declarations to this policy. If an "Underlying Insurance" includes an extension of a specified coverage with a limit specific to that coverage, this policy will not provide coverage excess to that specified coverage unless a separate limit is specifically identified within the Declarations to this policy. SECTION 5. CONDITIONS /_1 IN Q Appeals We can appeal a judgment against any insured under this policy if: 1. the judgment is for more than the remaining Limits of Liability under the "Underlying Insurance"; and 2. the insured or the "Underlying Insurer' do not appeal it. If we appeal the judgment, we will pay the costs of that appeal and any interest on those costs. Those payments will be in addition to the Limits of Liability of this policy, unless the "Underlying Insurance" includes payment of expenses incurred in an appeal as part of its Limit of Liability, in which case the costs of the appeal and any interest on those costs will decrease the applicable Limit of Liability. Audit of Books and Records We may audit your books and records at any time during the term of this insurance or within three years after its expiration or termination. Financial Impairment Bankruptcy, insolvency, rehabilitation, receivership, liquidation, or other financial impairment of any insured or any insurer providing "Underlying Insurance" as stated in the "Schedule of Underlying Insurance," shall neither relieve nor increase any of our obligations under this policy. In the event there is a diminished recovery or no recovery available to any insured as a result of such financial impairment of any insurer providing "Underlying Insurance," the coverage under this policy shall apply only in excess of the Limits of Liability stated in the "Schedule of Underlying Insurance." Under no circumstances will we be required to drop down and replace the underlying Limits of Liability or assume any other obligations of a financially impaired insurer or an insured. Cancellation You may cancel this policy at any time by sending us a written request or by returning the policy stating the date of cancellation. 1. We may cancel this policy at any time by sending to you a notice of cancellation 30 days (10 days in the event of non-payment of premium) in advance of the cancellation date. Our notice of cancellation will be mailed to your last known address shown in the Declarations to this policy and will indicate the date on which coverage is terminated. 2. If cancellation is at your request, return premium will be computed at 90% of pro rata. If we cancel, return premium will be computed pro rata. If this policy insures more than one Named be affected by the first Named Insured in the Declarations to this policy for tl UMB-100 05 21 Nonprofits Insurance Allianceym and NONPROFITS OWN® are brands of Alliance Member ServicesTm (AMS). © AMS. All rights reserved. Rlefe Managemen ��y,��w. t Dlvislon yf/ - `0. REVIEWED & APPROVED BY: Risk Management Specialist Insureds. Notice of cancellation by us to such first Named Insured will be deemed notice to all insureds and payment of any return premium to such first Named Insured will be for the account of all insureds. 3. In the event that provisions of this condition conflict with any state law or regulation governing the cancellation/nonrenewal of this policy, then such law or regulation shall prevail and this policy is amended to conform with such law or regulation. E. Changes Notice to any agent or knowledge possessed by any agent or by any other person will not affect a waiver or a change in any part of this policy. This policy can only be changed by a written endorsement that becomes part of this policy. The endorsement must be signed by one of our authorized representatives. F. Duties in the Event of a Claim or Suit 1. You must see to it that we are notified as soon as practicable of an accident, occurrence, offense or event that may result in a "claim' or "suit." To the extent possible and subject to the requirements of Section 1 above, notice should include: a. how, when and where the activities which form the basis of any potential "claim" or "suit" took place; b. the names and addresses of any injured persons and witnesses; and c. the nature and location of any injury or damage arising out of the activities which form the basis for any potential "claim" or "suit." 2. If a "claim" is made or "suit" is brought against any insured, you must: a. immediately record the specifics of the "claim" or "suit" and the date received; b. notify us as soon as practicable and immediately provide to us written notice of the "claim" or "suit;" and c. if the "Underlying Insurance" is on a claims -made form, you must provide written notice to us in conformance with the applicable claims -made temporal conditions included within the "Underlying Insurance." 3. You and any other involved insured must: a. immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "claim" or "suit"; b. authorize us to obtain records and other information; c. cooperate with us in the investigation, settlement or defense of the "claim" or "suit"; and d. assist us, upon our request, in the enforcement of any right against any person or organization, which may be liable to the insured because of injury or damage to which this insurance may also apply. 4. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. G. Maintenance of Scheduled Underlying Insurance While this policy is in effect you agree to maintain the "Underlying Insurance" listed in the "Schedule of Underlying Insurance" in full force. This means that: 1. the "Scheduled Underlying Policy" or "Scheduled Underlying Policies" may not be cancelled or not renewed by either you or the "Underlying Insurer" without notifying us; 2, renewals or replacements will not be more restrictive in coverage than the "Underlying Insurance" listed in the "Schedule of Underlying Insurance"; 3. the terms, conditions and endorsements of the "Underlying Scheduled Insurance" will not materially change; UMB-100 05 21 Nonprofits Insurance AllianceTM and NONPROFITS OWN® are brands of Alliance Member Services'M (AMS). © AMS. All rights reserved. m.yR RlekManagonentDMaIM eXvA} REVIEWED&APPROVED B/Y.' I�t INA Management Specialist 4. the risk of uncollectibility (in whole or in part) of the "Underlying Scheduled Insurance" limit as listed in the "Schedule of Underlying Insurance," or replacements thereof, whether because of financial impairment or insolvency of an "Underlying Insurer' or for any other reason, is expressly retained by you and is not in any way or under any circumstances insured or assumed by us; and 5. limits of "Underlying Insurance' will not change except for any reduction in the aggregate limit or Limits of Insurance by payment of claims hereunder. Your failure and/or the failure of the "Underlying Insurer' to comply with this condition will not invalidate this policy, but in the event of such failure, we will only be liable to the same extent as if there had been compliance with this condition. H. Otherinsurance If other insurance applies to a "claim" or "suit' covered by this policy, the insurance under this policy is excess of such other insurance and we will not make any payments until the other insurance has been used up. This condition shall not apply if the other insurance is specifically written to be excess over this policy. Except to the extent stated in this policy, this insurance is not subject to the terms, conditions, or limitations of any other insurance except for "Underlying Insurance." Transfer of Rights of Recovery Against Others to us If any insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. Each insured must do nothing to impair these rights or the transfer thereof to us. Each insured must cooperate with us and, at our request, assist us in the pursuit and enforcement of those rights. If there is any money recovered, we will disburse that money, as follows: 1. first, we will be repaid to the extent of our actual payment; and 2. second, if any money remains, the insured or any "Underlying Insurer' will be repaid to the extent of their actual payment. If any expenses are incurred to recover money, we will share the expenses with the insured or any "Underlying Insurer" in proportion to the amount that each is repaid. If our recovery attempt is not successful, we will bear all of the recovery expenses. J. Premium The premium for this policy as stated in the Declarations is a flat premium and is subject to a minimum and deposit premium, if applicable. The premium is not subject to adjustment unless: a rate is shown in the Declarations; or an endorsement or endorsements are attached to this policy changing the Limit of Liability, adding or changing the "Underlying Insurance', changing the policy period, or because of an Extended Reporting Period. If a flat premium is charged, and a minimum premium is shown in the Declarations, then that minimum premium is fully earned as of the inception of this policy. K. Representations By accepting this policy, you agree that: 1. the statements in the Application for this policy and Declarations to this policy are accurate and complete; 2. those statements are based upon representations you made to us; and 3. we have issued this policy in reliance upon your representations in the Application for this policy and its Declarations. UMB-100 05 21 Nonprofits Insurance AllianceTm and NONPROFITS OWN® are brands of Alliance Member ServicesT" (AMS). © AMS. All rights reserved. Rlal¢ManagementDivialan 8 Y REMEWED&APPRWnmBY: Risk Management Specialist L. Titles of Paragraphs The titles of the varied Sections, Paragraphs, and Subparagraphs of this policy and endorsements attached to this policy, if any, are inserted solely for convenience or reference and are not to be deemed in any way to limit or affect the provisions to which they relate. M. Transfer of Rights and Duties Your rights and duties under this insurance may not be transferred without our written consent, except in the event of the death of an individual insured and then only to that individual's representative. N. When Loss is Payable This policy will not apply until an insured, or an insured's "Underlying Insurer," is obligated to pay the amount of the "Underlying Insurance" for damages which are also covered by this policy. When the amount of loss has finally been determined, we will promptly pay on behalf of the insured the amount of the damages which comes within the terms of this policy. SECTION 6. DEFINITIONS Except for the terms appearing in quotes within this policy, the terms within this policy have the same meaning as set forth in the applicable "Underlying Insurance." With respect to the terms appearing in quotes within this policy, the definitions below will apply. A. "Claim" or "Claims" means any demand, including a "suit," against an insured for damages to which this policy applies are alleged. B. "Defense expenses" means the fees, costs and/or expenses which an "Underlying Insurer" has an obligation to pay in the defense of a "claim," "claims" or "suit" pursuant to the terms and conditions of the "Underlying Insurance." C. "Schedule of Underlying Insurance" means the Schedule of Underlying Insurance included within the Declarations to this policy. D. "Scheduled Underlying Policy" or "Scheduled Underlying Policies" means the identified policy or policies within the "Schedule of Underlying Insurance." E. "Suit" means a civil proceeding in which damages to which this policy applies are alleged, including, without limitation: 1. An arbitration proceeding in which such damages are claimed and to which you must submit or do submit with our consent; or 2. Any other alternative dispute resolution proceeding in which such damages are claimed and to which you submit with our consent. F. "Underlying Insurance" means the policy or policies within the "Schedule of Underlying Insurance" applicable or potentially applicable to the "claim" or "suit." G. "Underlying Insurer" or "Underlying Insurers" means the entity or entities that issued the "Underlying Insurance. UMB-100 05 21 Nonprofits Insurance Alliance'^^ and NONPROFITS OWN® are brands of Alliance Member Services TM (AMS). © AMS. All rights reserved. ,n. PJAManaganadDMaron 81 ,It h REVIEWEDqq&APPRAO�VE�"D�'�B/Y'.'� RIBA Management Specialist NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head fbi Insurance. A Heartfor Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMUNICABLE DISEASE - EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY Notwithstanding any coverage extended within the Schedule of Underlying Insurance, the Commercial Umbrella Policy to which this endorsement is attached does not apply to, and we shall have no duty to defend any, 'claim", "suit', "damages" or "injury" which arises out of: 1. The actual or alleged transmission of a "communicable disease'; and/or 2. An act, error or omission by or on behalf of any "insured" or "Member" in: a. The supervision, hiring, employment, training or monitoring of any person who transmits, is infected with, and/or alleged to be infected with a "communicable disease; and/or b. Testing for a "communicable disease"; and/or c. The actual or alleged failure to prevent the spread of a "communicable disease"; and/or d. The actual or alleged failure to report a "communicable disease" to the authorities, including but not limited to the reporting or failure to report any person who is infected with or is alleged to be infected With a 'communicable disease", and/or any place where there is or is alleged to be a presence or spread of a "communicable disease'. "Communicable disease" as used in this endorsement shall mean any contagious disease, illness or syndrome which is or has been transmitted to a person or place by bacteria, virus, fungi, protozoa, a toxic agent or any combination of these. All other terms and conditions of the Commercial Umbrella Liability Policy to which this endorsement is attached remain unchanged NIAC-E180 UMB 0121 Includes copyrighted material of Insurance Services Office, Inc. with its permission. RIAMangacmterAD[r Im ,t �t REVIEWED(t&APPRO^VED BY: �--� Rhk Management Specialist POLICY NUMBER: IL 09 99 12 20 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. 1 . • .. i I 1 1 . . . . SCHEDULE SCHEDULE — PART I Terrorism Premium (Certified Acts) (A) Premium through end of year (12/311 ► $ (B) Estimated Premium beyond the date specified above $ (Refer to Paragraph D. in this endorsement.) This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies): All Coverage parts other than: Social Service Professional Liability Coverage Form Business Auto Coverage Additional information, if any, concerning the terrorism premium: SCHEDULE — PART II Federal share of terrorism losses 80 % Refer to Paragraph B. in this endorsement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. IL 09 99 12 20 0 Insurance Services Office, Inc., 2020 *Rh RiekMangga mdDMaran REVIEWED&APPROVEDBy: �,hg yQGeyp 1®� I f R15k Management Sped Mist A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under that Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B. Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C. Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rats allocation in accordance with procedures established by the Secretary of the Treasury. D. Possibility Of Additional Or Return Premium The premium for certified acts of terrorism coverage is calculated based in part on the federal participation in payment of terrorism losses as set forth in the Terrorism Risk Insurance Act. The federal program established by the Act is scheduled to terminate at the end of the year specified in Part I of the Schedule of this endorsement, unless extended by the federal government. If the federal program terminates or if the level or terms of federal participation change, the estimated premium shown in (B) in Part I of the Schedule may not be appropriate. If this policy contains a Conditional Exclusion, continuation of coverage for certified acts of terrorism, or termination of such coverage, will be determined upon disposition of the federal program, subject to the terms and conditions of the Conditional Exclusion. If this policy does not contain a Conditional Exclusion, coverage for certified acts of terrorism will continue. In either case, when disposition of the federal program is determined, we will recalculate the premium shown in (B) in Part I of the Schedule and will charge additional premium or refund excess premium, if indicated. If we notify you of an additional premium charge, the additional premium will be due as specified in such notice. Page 2 of 2 © Insurance Services Office, Inc., 2020 ,r/ „� w�k„enuoiwziio� REVIEWED&APPROVm BY: A(� Risk Management Specialist THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYERS' LIABILITY EXCLUSION This insurance does not apply to any liability for bodily injury, sickness, disease, disability or shock, including death at any time resulting therefrom, and, if arising out of the foregoing, mental anguish or mental injury sustained by: An employee of the insured arising out of and in the course of employment by the insured; or 2. The spouse, child, parent, brother or sister of that employee as a consequence of (1) above. This exclusion applies: Whether the insured may be liable as an employer or in any other capacity; and 2. To any obligation to share damages with or repay someone else who must pay damages because of the injury. UMB 6105 13 ,� RiekManggtmuntDtvieton REVIEWEDryry&APPR^W/,m: ��BY 1T "46 Risk Management Specialist NONPROFITS INSURANCE ALLIANCE OF CAW EORNIA A Head far Insurance, A Heart far Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MEDICAL PAYMENTS EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY This insurance does not apply to COVERAGE C MEDICAL PAYMENTS provided in any underlying Commercial General Liability Coverage Form or to any medical expenses for which COVERAGE C MEDICAL PAYMENTS are paid or payable. UMB 232 06 16 y, s..a RiekMmtagnneaxtDivielon REVIEWED&APPROVED BY: A "44 �=—� Risk Management Specialist NONPROFITS INSURANCE _s AWANCG OF CALIFORNIA A Head for Insurance, A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MEMBER CRITERIA This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY A named insured of the Nonprofits Insurance Alliance of California (NIAC) must meet at least the following criteria: is organized chiefly to provide or fund health or human services, but does not include a hospital; 2. is incorporated in California or qualified to do business in California and is an organization described in section 501(c)(3) of the Internal Revenue Code and exempt from tax under section 501(a), or any corresponding sections of any future federal tax code. Any member which receives a final determination that it no longer qualifies as an organization described in section 501(c)(3) of the Internal Revenue Code, or corresponding section of any future tax code, shall immediately notify the corporation of such determination and the effective date of such determination. NIAC-E003 08 20 n �� RleleManeglRtentUtvielon f x REVIEWEDrA &�APPRovm BY: 14 An�--�--�' RISRNIanagement Specialist NONPROFITS INSURANCE ALLIANCL^ OF CALIFORNIA A Head for Insurance. A Heartfor Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR, CHEMICAL AND BIOLOGICAL HAZARD EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY This insurance does not apply to any liability, loss, cost or expense of whatsoever nature directly or indirectly caused by, contributed to by, resulting from, arising out of or in connection with the use or release, or threat thereof, of any nuclear weapon or device or chemical or biological agent, regardless of any other cause or event contributing concurrently or in any other sequence to the loss. NIAC-E42 UMB 09 19 ,,�e..,s. z, RiskMaVwkentDW1= 'j RE4IEWED^&APPRO/�Vm BY: k AN, 'ju `MARM—WR Risk Management Specialist NONPROFITS INSUI2.ANCE ALLIANCII OF CALIFORNIA A Head for Insurance. A Neart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIVACY LIABILITY AND CYBER COVERAGE EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY A. This insurance does not apply to any of the following 1. "Identity theft". 2. "Loss of electronic data." 3. The disclosure, loss or use of "protected health information". For purposes of the liability coverages excluded by this endorsement, the following Definitions apply "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment "Identity theft" means fraudulent appropriation and use of a person's identification or personal information, including both "electronic data" as well as information contained in printed or written format. "Loss of electronic data" means 1. Damage to, loss of, loss of use of, corruption of, inability to access or inability to manipulate "electronic data;" and 2. "Identity theft." "Protected health information" means any information, whether oral or recorded in any form or medium: (1) That relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; (ii) That identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify that individual; and (ill) as defined within the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. §1320d- 1320d-8 ("HIPAA") or other similar federal, state or local laws or statutes. UMB 231 06 16 RIAMmagmtentD&Ision j REVIEWED&APPRoovm By., WNW Risk Management Spedlist B. This insurance also does not apply to any of the following first party coverages in the PRIVACY LIABILITY AND CYBER COVERAGE ENDORSEMENT: 1. Security Event Costs and Expenses 2. Cyber Extortion 3. Crisis Management and Reward Expenses UMB 23106 16 RIAMmagn LDMSIan 3 REVIEWED&APPROVEDBY: 'I s ) A AM4A Risk Managetnent Specialist THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNIMPAIRED AGGREGATE LIMITS ENDORSEMENT (NON-CONCURRENCI) It is agreed that the underlying aggregate limits, where applicable, as shown in the Schedule of Underlying Insurance, shall be unimpaired at the effective date of this policy and for the purpose of the insurance provided by this policy, only occurrences taking place during the term of this policy shall be considered in determining the extent of any exhaustion of the underlying aggregate limits. UMB166/12-88 RlekMmiaganenE4[vlelon REVIEWED & APPROVED BY: Risk Management Specialist NONPROFITS INSURANCE �■ ALLIANCE or CAtxroItNIA A Hood for Insurance. A Heart for Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION - EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA POLICY Notwithstanding any coverage extended within an "Underlying Insurance", the insurance extended within the Commercial Umbrella policy to which this endorsement is attached does not apply to, and we shall have no duty to defend, any "claim", "claims", "suit", or damages which arises out of: (1) Workers' Compensation benefits extended by statute which are subject to a Workers' Compensation policy (including but not limited to a Workers' Compensation and Employer's Liability Policy) issued to you; or (2) Any benefits that you are required to pay or provide under the Workers' Compensation law pursuant to which this policy shall be construed. All other terms and conditions of the Commercial Umbrella Policy to which this endorsement is attached remain unchanged. NIAC-E253 UMB 08 21 Nonprofits Insurance Alliances' and NONPROFITS OWN® are brands of Alliance Member ServicesTM (AMS). © AMS. All rights reserved �. PJA Mm WmentDhUlmt REVIEWEDqy&APPROVm BY: ®'r A,�u 44 �=--J Risk Management Specialist NOTICE OF COMPLIANCE ClY S IAFF PMN � � FHS PAGEAND QNCL DE l � u.0 AGNICIEM N I � G � FIE CLERI 4 Gomm � u IE COUNYQL Contractor Delhi Center Name: Project A-2022-033-01 Number: Project Agreement Between The City Of Santa Ana And Delhi Center Name: For Use Of American Rescue Plan Act (ARPA) 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 AUTOMOBILE LIABILITY 202201376 11/01/2023 09/06/2022 ACORD Form 20221025-132337.pdf GENERAL LIABILITY 202201376 11/01/2023 09/06/2022 ACORD Form 20221025-132337.pdf Delhi Center COI Exp IMPROPER SEXUAL CONDUCT LIABILITY 202101376 11/01/2022 03/02/2022 11-01-2022. pdf SOCIAL SERVICE PROFESSIONAL LIABILITY 202201376 11/01/2023 09/06/2022 ACORD Form IMPROPER SEXUAL CONDUCT LIABILITY 20221025-132337.pdf WORKERS COMPENSATION AND EMPLOYERS' BNUWC0152622 11/01/2023 09/06/2022 ACORD Form LIABILITY 20221021-154756.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 10/27/2022 11:54 AM