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HomeMy WebLinkAboutLATINO HEALTH ACCESS (3)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and al amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) 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 L-a-t-)M 111 A-2022-033-03 r� No.ci.I-�`�- Gist ail amendments. was comp e e on Use space below if needed.] iAagreementsWormsVorm - agreement termination form_goldenrod.doc Department: COT'C Office Use Only C 2023 city 01 Santa Ana JAN 112014 city clerws Cff c and final payment has been made. VtA D Phone/Ext.: is L�LL$ Signature:qa'kA-P4� Date: l oUHANPE ON FILE WORK MAY PROCEEDA-2022-033-03 UNTIL INSURANCE EXPIRES I- S • 22- CLERK OF COUNCIL iATE: AGREEMENT BETWEEN THE CITY OF SANTA ANA AND CMO (1) LATINO HEALTH ACCESS FOR USE OF (WV z��)fa 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 Latino L— Health Access, 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 Aareement. 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 ONE HUNDRED NINE THOUSAND TWO HUNDRED EIGHTY-EIGHT dollars ($109 288 ("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-1 9. (2) CONTRACTOR acknowledges that ARPA provisions allow the use of ARPA SLFRF Funds to respond to, mitigate, and recover from 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 to CITY a sum 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-1 29 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. (I) 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 or federal 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/orjustify 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. 0. 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 Minority -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: Latino Health Access America Bracho, MPH, CDE President & CEO 450 W. Fourth Street, Suite 130 Santa Ana, CA 92701 714-542-7792 www.latinohealthaccess.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. 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. 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 for which 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 1(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} DocuSign Envelope ID: 71 E35225-1804-4E72-8896-35052FF82A49 A-2022-033-03 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year first written above. ATTEST: DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM: SONIA VAL 0 City om 1( U By: RY CONTRACTOR: IFdmac�SanF�evn AMERICA BRACHO, MPH, CDE President & CEO DUNS #: 938164811 CITY OF SANTA ANA KRISTINE RIDGE City Manager Latino Health Access Weekly Food Distribution Program RFP 22-009A REVIVE Santa Ana: Food Supply/Distribution Programs EXHIBIT A 1. Proposal shall include details of food supply and/or food distribution services to be provided, the tasks to be accomplished, duration of the program (proposals may be up to two years) and the deliverables to be provided. The Goal of Latino Health Access' Weekly Food Distribution Program is to mitigate food insecurity among working-class, Latinx residents of Santa Ana. Objectives: Within a two-year grant period, Latino Health Access will accomplish the following objectives: 1. Conduct 4,500 outreach contacts annually in working-class neighborhoods of Santa Ana to promote food distribution. 2. Provide a minimum of 46 food distribution events annually for City of Santa Ana residents. 3. Provide food supply to 800 Santa Ana residents per month through food distribution events. 4. Distribute at least 3,000 diapers per month to Santa Ana families. Program Description: Latino Health Access (LHA) promotores will continue to organize a weekly food distribution with a diaper distribution once a month at LHA's main facility (450 W. 4a' Street, Santa Ana, CA, 92701). This location is central to the city and has ease of access through public transportation, although a majority of residents are from the 92701 Zip Code. The weekly distribution will accommodate a walk-thru and drive-thru format to make it accessible for Santa Ana communities without a car. Activities: ® Outreach (Timeline: Ongoing, during the duration of the grant) —Occurring via door-to-door, in shopping centers and other community -based locations, through outreach, LHA Promotores are able to inform community members of the food distribution resource, as well as answer any questions or concerns (e.g. assure community members that LHA will not require legal immigration status, payment, or other requirement that may dissuade members of the community from utilizing this resource). During the COVID-19 pandemic, LHA expanded its presence in neighborhoods that lack infrastructure to deploy services and successfully reached and trained community leaders to assist in building such infrastructure for communication and action. LHA will continue to leverage these networks to conduct ongoing outreach to promote the food distribution and to informally assess needs related to food insecurity in these neighborhoods. LHA will also disseminate information via social media channels on Facebook and Instagram to widen our reach. Food (and Diaper) Distribution Events the food distribution begins at 12 noon with the first hour designed to accommodate walk-ins who do not have access to a car. From 2PM-4PM, the food distribution is set-up to accommodate distribution to individuals in vehicles. Registration occurs onsite for individuals attending the food distribution, and those who have previously attended other food distribution events are provided a voucher Latino Health Access Weekly food Distribution Program RFP 22-009A REVIVE Santa Ana: Food Supply/Distribution Programs to "check -in" rather than complete the registration process. The food distribution process is open to all Santa Ana residents, regardless of citizenship. LHA Promotores and volunteers set-up between 8AM-12 Noon in the parking lot of the LHA main facility, setting up different stations with fresh produce and other food staples. Prior to entering the food distribution, participants are provided a busic COVID-19 screening. All food distribution events also require significant infrastructure to set-up in a physically -distanced manner and to ensure that all COVID-19 safety protocols are being followed. Individuals and families go through the different stations to pick up their food, minimizing waste by increasing choice. When boxes are pre -packaged, volunteers help to place food boxes into personal carts or carrying equipment brought by participants. Participants who bring their vehicles are provided their food via no -contact methods to minimize risk of COVID-19 transmission. o Diaper Distribution--LHA receives a monthly supply of diapers size 0-5 from the CAPOC Diaper Bank. The second Friday of the month, a diaper distribution assembly is incorporated into the weekly food distribution allowing low-income families with young children to access this additional resource. Each month, LHA provides an average of 5,000 diapers to benefit approximately 80 families and over 100 children. 2. Proposal shall include details of the target population Latino Health Access will prioritize food distribution for working-class, primarily Latinx individuals and families living in the 92701 Zip Codes. However, our food distribution is open to all Santa Ana residents and has had participation from diverse demographics, given the economic impact of the COVID-19 pandemic, which is still felt in working-class communities. Our participants live in households that are foreign -born (93%) and have household incomes of less than $30,000 (88%). In addition, educational attainment among parents in these households is significantly less than their counterparts in more affluent areas of the city. Often, participants are single mothers who also experience housing insecurity and a range of other social determinants of health, creating additional economic burden that increases food insecurity. 3. Proposals Should Include Details of Unmet Need According to the OC Healthier Together Dashboard, Orange County has a food insecurity rate of 8.3%. Yet, marked by the darker green at the center of the map, Santa Ana Zip Codes (92701., 92703, 92707, 92704) experience food insecurity at higher rates (marked by a 5 on the food insecurity, index, the highest ranking, signaling the greatest food insecurity). Residents of these Zip Codes are working-class and were among the first affected by economic instability in the COVID-19 pandemic, the impact of which continues to limit families' abilities to address the 4 I r resulting social needs, including food insecurity. In addition, some families may not qualify for existing relief programs (e.g. SNAP) or do not have access to enrollers who can also address their z questions related to immigration and SNAP eligibility. Even ifthe COVID-19 pandemic ended V moms: o.aii¢. um..uao: a Latino IIealth Access Weekly Food Distribution Program RFP 22-009A REVIVE Santa Ana: Food Supply/Distribution Programs swiftly, addressing food insecurity that has been exacerbated during the pandemic will require additional support systems, including ongoing access to food supply for these families while simultaneously taking an approach to build systems change for the eradication of food insecurity over the long-term. 4. Proposal shall include details of collaborations with local organizations For its food distribution program, LHA collaborates with the following local entities: • Second Harvest Food Bank and OC Food Bank —manage securing the food supply and other resources that are distributed at LHA. They arrange pick-up times and LHA staff manage the entirety of packaging, transportation, and distribution. • Community Action Partnership of Orange Diaper Bank — LHA answered the call of the Diaper Bank at the onset of the COVID-19 pandemic to connect families in need to diapers, at a time when they and other partners had to pause direct services. The partnership has remained as there has been an ongoing need for diapers among the families served in the weekly food distribution. LHA receives approximately 6,000 diapers a month to distribute. • Downtown Family Resource Center, Local Schools, and Churches — LHA has a network of partners that refer families to the food and diaper distribution event each week. Flyers are shared regularly along with other educational information on services and partners disseminate with their constituency. This allows us to reach more families throughout Santa Ana. ICey partners include Downtown Family Resource Center housed at LHA, SAUSD FACE, and Scholarship Prep Academy. 5. Proposal shall include details of innovation in program/service delivery Latino Health Access prograrnming combines evidence -based practices with community expertise to best meet the needs of our community while strengthening community assets and enhancing capacity. Over the last year, LHA has collaborated with public health researchers to understand the impact of the pandemic. In an article published in the Harvard Journal of Hispanic Policy', we find that our communities experienced the economic impact of the pandemic first, especially immigrant communities who remained civically disconnected from health and social systems due to structural exclusion. In a subsequent article published in Preventing Chronic Disease, a CDC -sponsored journal'-, we analyze data from LHA's Emotional Wellness program pre and during the COVID-19 pandemic. Results show that while mental health/emotional wellness concerns do not disappear, there is a significant shift from our community toward seeking referrals and resources related to social needs, including those that will reduce increasing food insecurity. This research shows the interconnectedness of food insecurity, other social determinants of health, and overall mental health/emotional wellness of ' Montiel, G. I., Moon, K. J., Cantero, P. J., Pantoja, L., Ortiz, H. M., Arpero, S., .& Nawaz, S. (2021). Queremos Transformar Corranidades: Incorporating Civic Engagement as an Equity Strategy in Promotor-Led COVID-19 Response Efforts in Latins Communities. Harvard Journal of Hispanic Policy, 33, 79-102. 'Moon, K. J, Montiel, G. I., Cantero, P. J., & Nawaz, S. (2021). Peer Reviewed: Addressing Emotional Wellness During the COVID-19 Pandemic: the Role of Promotores in Delivering Integrated Mental Health Care and Social Services. Preventing Chronic Disease, 18. Latino Aealth Access weekly Food Distribution Program RFP 22-009A REVIVE Santa Ana: Food Supply/Dstribution Programs our communities. Lastly, in our most recent publication', we analyze the ways in which LHA promotores have worked at the center of direct services, community capacity -building and policy and systems change to improve our response to the COVID-19 pandemic and ensuing health and social needs. Across these different peer -reviewed publications, we have worked with Promotores on the frontlines of the COVID-19 pandemic to highlight the following innovations in our model, which includes the work of mitigating food insecurity: e Combination of direct services. LHA combines its food distribution with distribution of diapers, accessibility of information, among others. This limits the number of times that community needs to show up to our facility, which is most efficient given their limited availability. Our community is over -represented in low -wage essential services, which may not allow them to have time off to access multiple services if conducted on different days. o Combination of direct services with long-term policy, systems, and environmental change. While provision of food distribution services will alleviate immediate need, LHA's promotores also work with community members to understand data, to present data to relevant stakeholders, and to work collaboratively toward systems change that will address food insecurity as well as other social determinants of health. Throughout our food distribution program, LHA has also built community capacity to organize, to plan in accordance with safety protocols, and to innovate ways to expand food distribution to other neighborhoods (conducting pilots of neighborhood- and apartment complex -based distribution). LHA provides the opportunity for individuals who live in the communities that are most impacted by inequities to partner with us to lead solutions. SECTION 5• DATA COLLECTING, REPORTING AND COMPLIANCE Data Collection and Evaluation Process measures will be collected for all activities and will include: the number of individuals reached and engaged throughout each activity in our food distribution work. Where possible, LHA will collect demographics and types of services each participant received. LHA will track on a monthly basis the reach of each service and when significant shifts occur, LHA will conduct informal interviews with community leaders to better understand how to pivot to meet the community's emerging needs. 1. The proposal shall include details on how the organization will comply with the State and Local Fiscal Recovery Funds, Compliance and Reporting responsibilities for the following categories: 2: Negative Economic Impacts 2.1 Household Assistance: Food Programs ' Montiel, G.1., Moon, K., Bracho, A., Meiia, N., Cantero., P.J., Arpero, S., Pantoja, L. & Nawaz, S. (2021). La equidad en tiempos de pandemia: a case study of promotores on the frontlines of COVID-19 response in Latinx communities in Orange County, California. Border -lines Journal. Latino Health Access Weekly Food Distribution Program RFP 22-009A Rr VIVC Santa Ana: Food Supply/Distribution Programs By operating a weekly food distribution program and tracking services provided to working-class individuals in Santa Ana, Latino Health Access program staff and evaluation department is able to provide the required initial report that describes efforts to date to promote equity in the services to disproportionately impacted communities, as required by the Compliance and Reporting Guidance. Our program is intended to mitigate food insecurity in households within the City of Santa Ana and falls within the types of programs explicitly mentioned under the "Negative Economic Impacts" category. The guidelines also specify integrating strategies that advance racial equity. LHA's focus on Latinx and immigrant populations advance this goal. 2. The proposal shall include details on how the organization will service people in a Qualified Service Tract (QCT) (See link for below for map). If service is not in a QCT, how will the organization support their determination that the pandemic resulted in disproportionate public health or economic outcomes to the specific population, household, or geographic area served. Services proposed will primarily be implemented in the 92701 Zip Code and in similar Zip Codes in the City of Santa Ana, which include numerous QCTs. We have intentionally selected these geographic areas because they are those with the most social vulnerabilities that provide a context for food insecurity. The map shown (left) represents the primary service area and is inclusive of the geographic location of LHA's two service sites. The map shows the food insecurity index by Census Tract, where central Santa Ana's census tracts have higher food insecurity than in surrounding areas. 2. The proposal shall include details on how the organization will comply with 2 CFR part 200 (Uniform Administrative Requirements) Latino Health Access is experienced in managing public funds, including those that are granted by federal agencies. Fulfillment of the Uniform Administrative Requirements will be ensured by a team that includes the Chief Program Officer, the Program Coordinator, and the Director of Finance. LHA maintains an active System for Award Management account and has in place the appropriate policies and procedures to abide by the required fiscal guidelines and cost principles. LHA will conduct the required federal awards audit in a timely manner and maintain current staff training to ensure compliance. N M L Ui Ol a" '0 N N N E O > N 0)� C N c O p C > 0 C U! 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N 9 a) r r -00c En e 1-1a)G o ay " c CL u n3 O U) U 2 0 N M d J 0 oYaaa EXHIBIT C LATINO HEALTH HEALTH ACC-F55tM Jess Salgado <jsalgado@latinohealthaccess.org> Fwd: Your DUNS Lookup Request for Latino Center For Prevention & Action In Health & Welfare 1 message Iliana Coronado <iliana@latinohealthaccess.org> To: Jess Salgado <jsalgado@latinohealthaccess.org> DUNS Iliana Coronado Director of Finance Latino Health Access 450 West 4th Street, Ste 130 Santa Ana, CA 92701 (714)542-7792 Ext1065 LATINO I017 HEALTH ACCESS L . Mon, Feb 7, 2022 at 11:53 AM ---------- Forwarded message --------- From: Dun & Bradstreet <DandB@click.dandb.com> Date: Mon, Feb 7, 2022 at 11:42 AM Subject: Your DUNS Lookup Request for Latino Center For Prevention & Action In Health & Welfare To: <iliana@latinohealthaccess.org> Having trouble seeing this email? View it online dun bradstreet 02/07/2022 Iliana Coronado, The following is the Dun & Bradstreet D-U-N-S® number for Latino Center For Prevention & Action In Health & Welfare: D-U-N-S number:938164811 If this is YOUR COMPANY, take advantage of CreditBuilderTM, our next generation credit building solution. https://mail.google.com/mail/u/0/?ik=cdI d853850&view=pt&search=all&permthid=thread-f%3AI724136465846143412&slmpl=msg-f-/o3Al724135465... 112 2/7/22, 2:04 PM Latino Health Access Mail - Fwd: Your DUNS Lookup Request for Latino Center For Prevention & Action In Health & Welfare With tsreditHWilder' you earl: Get unlimited access to your business credit file Ensure you are always aware of the most current D&B information your banks, suppliers, competitors and customers are using to evaluate your business Get alerts when there are changes to your business credit file Benchmark your company's credit scores against your industry and key competitors Enhance your D&B credit scores and ratings by adding good payment history to your credit profile If you are looking for information on ANOTHER COMPANY, consider purchasing a Business Information Report'". Reduce the risk of unpaid bills by evaluating the credit risk of another company before doing business with them. With a Business Information Report you can: <_- Get a detailed snapshot of another company's credit report; available online for 6 months from initial access See a company's PAYDEX® score and other D&B® ratings Access a company's payment history View company history and background information on key employees Call 1-800-700-2733, Monday through Friday, 8:00 AM to 6:00 PM local time or contact us at Dun & Bradstreet support. Sincerely, Dun & Bradstreet Please add dandhQclick d, na db.com to your email address book to ensure delivery of our emails to your inbox. This is a notification regarding your product subscription with Dun & Bradstreet. If you have any questions, please contact Dun 4BnAgtree pport. Privacy and Terms of Service Notice: Your privacy is important to us; please see our Privacy_EgEgy and TeLms of Service; ©Dun & Bradstreet, Inc. 2022. All rights reserved. 1250 Valley Brook Avenue, Suite 102 Lyndhurst, NJ 07071 https://mail.google.com/mail/u/0/7ik=cdl d853850&view--pt&search=all&permthid=thread-f%3A1724135465846143412&simpl=msg-f%3A1724135465... 2/2 12/17121,10:15AM SAM.gov I Entity An official website of the United States government Here's how you know You have 2 new alerts Show / Hide Alerts Entity Registration Core Data Assertions Reps and Cents Exclusions Responsibility / Qualification LATINO CENTER FOR PREVENTION & EDCNS Unique Entity ll) 938164811 [S:AA� Unique Entity ID MU7ZHM6JVST7 CAGE/NCAGE 41NBI Registration Status Expiration Date Active J u n =3, 2022 Download 99 Follow N IN HEALTH& WELFARE https:llsam.govlentityl9381648111coreData?status=active&emrKeyValue=2387626-1622751602592937 12117/21, 10:15 AM SAM.gov I Entity Purpose of Registration Federal Assistance Awards Only Physical Address 450 W 4TH ST STE 120 Santa Ana, California 92701-4562, United States Mailing Address 450 W 4TH ST STE 130 Santa Ana, California 92701-4562, United States *The DUNS number is Version Current Record BUSINESS INFORMATION Doing Business As Latino Health Access URL (blank) State / Country of Incorporation California, United States Division Name (blank) Division Number (blank) Congressional District California 46 Registration Dates Activation Date Jun 4, 2021 Submission Date Jun 3, 2021 the official Unique Entity ID https:llsam.govlentityl9381648111coreData?status=active&emrKeyValue=2387626-1622761602502937 2/43% 12/17121, 10:15 AM SAM.gov I Entity Initial Registration Date Jul 1,2005 Entity Dates Entity Start Date Jun 20,1993 Fiscal Year End Close Date Dec 31 Immediate Owner CAGE (blank) Legal Business Name (blank) Highest Leve4Owner CAGE (blank) Legal Business Name (blank) Executive Compensation Registrants in the System forAward Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L.109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. Proceedings Questions Registrants in the System for Award Management (SAM) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2.C.F.R. 200 Appendix XII. Their responses are not displayed in SAM. They are sent to FAPIIS.gov for display as applicable. Maintaining an active registration in SAM demonstrates the registrant responded to the proceedings questions. SAM Search Authorization I authorize my entity's non -sensitive information to be displayed in SAM public search results: https:/Isam.gov/entity/938164811/coreData?status=active&emrKeyValue=2387626--1622761602692937 3/638 12117121, 10A5AM Yes SAM,gov I Entity ENTITYTYPES Business Types Entity Structure Corporate Entity (Tax Exempt) Organization Factors (blank) Entity Type Business or Organization Profit Structure Non -Profit Organization FINANCIAL INFORMATION Accepts Credit Card Payments Yes Debt Subject To Offset (What is this?) No Account Details EFT Indicator 0000 CAGE Code 41NB1 POINTS OF CONTACT Electronic Business 0 "* Gloria I Montiel, Ms. 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States https://sam.govlentityl938i648111coreData?status=active&emrKeyValue=2387626-1622761602592937 4/09 12/17/21, 10:15 AM SAM.gov I Entity Ginger Lee 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States Government Business 0 f* America Bracho 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States Ginger Lee 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States Past Performance O I'* America Bracho 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States Iliana Coronado 450 W. 4TH Street STE 130 Santa Ana, California 92701 United States Feedback Our Website Our Partners Policies https://sam.gov/entity/938164811 /coreData?status=active&emrKeyValLie=2387626-1622751602692937 INTERNAL REVENUE SERVICE District Director c/o McCaslin Industrial Park 2 Cupan1a. Circle Monterey Park, CA 97754 AttntEOC-4 Latino Center for Prevention Action in Health and Welfare 8161 E: Marblehead Way Anaheim, CA 92608 Dear Applicant. Department of the Treasury Date : 1JR 2 9 1993 Employer Identification Number: 33--0562943 and Case Number: 953168019 Contact Person: C. Tschopik Contact Telephone Number: (218) 725-7002 Accounting Period Ending, December 31 Foundation status Classification: 170(b)(1)(A)(vi) Advance Ruling Begins; June 10, 1993 Advance Ruling Period Ends: December 31, 1997 Caveat Applies: yes based on the information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section501(0)(3) of the Internal Revenue Code, Because you are a newly created organization we are not now making a final determination of your foundation status under section 509(a) of the Code, However, we have determined that you can reasonably be expected to be a publicly supported organizations described in section 5'09(a')(1) and 170(b)(1)(A)(vi). Accordingly, you will be treated as a publicly supported organization and not as a private foundation, during the advance ruling period, This advance ruling period begins on the date of your inception and ends on the date shown above, Within 90 bays after the end of your advance ruling period, you must submit to us additional information needed to determine whether you have met the requirements of the applicable support test during the advance ruling period, if you establish that you been a Page 2 Latino Center for Prevention and Action in Health and Welfare publicly supported organization, you wi11 be classified as a section 509(a)(1) .or 509(a)(2) organization as long as you continue. to meet the requirements of the applicable support test. If YOU do not meet the pubTic support requirements :during the advance ruling period, you will be classified as a private foundation for future periods. Also, if you are classified as a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not .a private foundation until 90 :days after the end of your advance ruling period. If you submit the required information within 90 days, grantors and :donors may continue to rely on the advance determination. until the Service makes a, final determination of your foundation status, If notice that you will no longer be treated as a publicly, supported organization is published in the Internal Revenue Bulletin, grantors and contributors may not rely on this determination after the date of such publication. Also, a grantor or donor may not rely on this determination if he or she was in part :responsible for, or was aware of, the act or failure to actthat resulted in your loss of status as a publicly supported organization or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a publicly supported organization. If your sources of support or your purposes, character or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. As of January 1, 1984, you are liable for taxes under the Federal Insurance contributions Act (social security taxes) on remuneration of �ioo or more you pay to each of your employees during a calendar year, You are not liable for the tax imposed under the Federal Unemployment, Tax Act (FUTA)• Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from the other excise taxes: If you have any questions about excise, employment, or other Federal taxes, please let us know. Donors may deduct contributions to you as provided in section 170 of the Code, Bequests legacies, devises, transfers or gifts to you or for your use are deductible for Federal estate and gift tax purposes, if they meet the applicable provisions of sections 2055, 2105 and 2522 of the Code, Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket purchases and similar payments in conjunction with Page 3 Latino Center for Prevention and Action in Health and Welfare fund raising events may not necessarily qualify as deductible contributions, depending on the circumstances, See Revenue Ruling 67-246, Published in Cumulative Bulletin 1957-2, on page 104, which sets forth guidelines regarding the deductibility, as charitable contributions, of payments made by 'taxpayers for admission to or other participation in fundraising activities for charity, You are required to file Form 990, Return of Organization Exempt from Income Tax; only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 590 package in the mail, please file the return even if you do not exceed the gross receipts test. If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return. If a return is required, it must be (tiled by the 15th day of the firth month after the end of your annual accounting period, A penalty of $10 a day is charged when return is filed late, unless there is reasonable cause for the delay, However, a maximum penalty charged cannot exceed $5,000 or 5 percent of your gross receipts for that year, whichever is less. This penalty may also be charged if a return is not complete, so please be .sure your return is complete before you file it. Youarenot required to file Federal income tax returns unless You are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt organization Business Income Tax Return. In this letter, we are not determining whether any of your prese.nt or proposed activities are unrelated trade or business as defined in section 513 of the Code, You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigneo to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service. Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If the heading of this letter indicates that a caveat applies, the caveat below or on the enclosure is an integral part of this letter. If you have any questions, please contact the person.whose name and telephone number are shown in the heading of this letter, Page 4 Latino Center for Prevention and Action in Health and Welfare Sincerely yours, .a 'Michael J. Quinn ~ District Director A DD E,'1 DtJM (CG1045) phis determination is based on evidence that your 'Funds are dedicated to the purposes listed in section 501(c)(3) of the Code. io assure your continued exemption, you should maintain records to show that funds are expended only for those purposes. If you distribute funds to other organizations; your records should show whether they are exempt under Code section 541(c)(3). in cases where the recipient organization is not exempt under section 50i(e)(3), there should be evidence that the funds will remain dedicated to the required, purposes and that they will be used for those purposes by the r,eci.pient. 09/11/2014 11: 01 916-653-0126 SECRETARY OF STATE PAGE 02/02 State of California Secretary of State CERTIFICATE OF STATUS ENTITY NAME: LATINO CENTER FOR PREVENTION AND ACTION IN HEALTH AND WELFARE FILE NUMBER: C1726454 FORMATION DATE: 06/10/1993 TYPE: DOMESTIC NONPROFIT CORPORATION JURISDICTION: CALIFORNIA STATUS: ACTIVE (GOOD STANDING) I, DEBRA BOWEN, Secretary of State of the State of California, hereby certify: The records of this office indicate the entity is authorized to exercise all of its powers, rights and privileges in the State of California. No information is available from this office regarding the financial condition; 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 September 08, 2014. DEE,RA ROWEN Secretary of State MP-25 (REV 112007) ALL EXHIBIT D APPENDIX ATTACHMENT 3-1 NON -COLLUSION AFFIDAVIT CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR y vjaW,_�W_MTRIBUTION PROGRAMS RFP •. _ 1 1.. t NON�COLLUSION AFFIDAVIT (Title23 United States Code Section 112 and. Public Contract Code Section 710,6) To the CITY OF SANTA ANA CITY MANAGER'S OFFICE in accordance with Title 23 United States Cade Section 112.and Public Oontraet Code 7106 the BIDDER declares that the bid Is not made in the interest of, oron 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, so! iclted any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put In a sham bid, orlhat anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or, indirectly, sought by agreement; communication; or conference with anyoneto fixthe bid price of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, orof thatof any other KIDDER, or tosecure 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, thatthe 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 e.ffectuate.a collusive or shard bid, Note; The above Non-ooilusion Afiidavitis part of the Proposal. Signing this. Proposal on the signature portion thereof shelf also constitute signature of this Non -collusion Affidavit_ BIDDERS are cautioned that making a false certification may sublact the certifier to criminal prosecutloh.r Organization 1�bno Signed and Printed Name. Title c- ,i, isofE city of Santa Ana RFP 22-009A Page 42 EXHIBIT E APPENDIX ATTACHMENT 3-2: NON -LOBBYING CERTIFICATION CERTIFICATIONS CiTY OF SANTA ANA REQUEST FOR PROPOSALS FOR REVIVE: SANTA ANA FOOD SUPPLY/DISTRIBUTION iPROGRAMS FP 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 snaking 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 otherthan 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 A01vities". This certification is a material representation of fact 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 falls 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 particlpant 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. Organization l " }i t� t7 1 (+�, A Signed and Printed Name: Title Data e,_ ' --+ i 'd-O?- ?- City of Santa Ana RFP 22-009A Page 43 EXHIBIT F 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 - DowSign Envelope ID: 71E35225-18044E72-8896-35062FFB2A49 (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 Federal, 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), (e) 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. L-4+i na k+ , *cuss I -_--. Authorize Slgnatur Date DocuSign Envelope ID; 71E3522&1804-4E72-8896-35052FFB2A49 -: - A - - 0 - Date: 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): LATIN-1 OP ID: CA1 Ate./ p® CERTIFICATE OF LIABILITY INSURANCE OA03/04/04/2022 V) 022 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Dufour Insurance Services, LLC 6611 Littler Drive Huntington Beach, CA 92649 Stephanie Dufour NONEACT Stephanie Dufour acNo •714-369-2998 Plc No: poD2ess: Stephanie@dufourinsurance.com dufourinsurance.com INSURER(S)gFFORDING COVERAGE NAICN INSURER A: Nonprofit Insurance 524210 _ INSURED Latino Center for Prevention and Action, Latino Healthh Access A INSURER 13:Security National Ills-AmTrust INSURER C:Philadel hia Indemnity18068 INSURER D: 460 W. Fourth Street INSURER E: Santa Ana, CA 92701 INSURER F : COVEKAGES CERTIFICATE NUMBER: REVISION NIIMRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR TYPE OF INSURANCE Ao oLsUBR POLICYNUMBER POLICY EFF POLICY EXP DDqyYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X 2021-04261-NPO 07/06/2021 07/06/2022 PREMISES Ea occurrence _ $ 500,00 MED EXP(Any one person) $ 20,000 A X Professional 202144261- NPO 07/06/2021 07/06/2022 PERSONAL a ADV INJURY $ 1,000,00 X Abuse GENERAL AGGREGATE $ 3,000,00 A 2021.04261-NPO 07/06/2021 07/0512022 GERL AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 PRO X LOC Deductibl $POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 11000,00 BODILY INJURY (Per parson) $ A X ANY AUTO 2021.04261-NPO 07105/2021 07/06/2022 AUTOS ALLOWNED X SCHEDULED AUTO BODILY INJURY (Per scalded) $ HIRED AUTOS NON -OWNED AUTOS OPERTY PRDAMAGE PER ACCIDENT $ Deductible $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE Is 5,000,00 A EXCESSUAB CLAIMS -MADE 2021-04261-UMB-NPO 07/0512021 07/06/2022 DED X RETENTION $ 10,000 § B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYEFL ANY PROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? NIA SWC1374729 01/0112022 01/01/2023 X TORV TATUS OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,00 (Mandatory In kin If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE -POLICY LIMIT $ 1,000,00 C Cyber Liability PHSD1684193 12/1212021 12/12/2022 Per Occ 1,000,00 A Liquor Liability 2021.04261-NPO 07/06/2021 07105/2022 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD tot, Additional Remarks Schedule, if more space Is required) The City of Santa Ana, its officers, officials, employees,& volunteers are to be covered as additional insureds & Waiver of Subro on the CGL 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 Insurance is Primary ad NonContributory City of Santa Ana ARPA funded food distribution Contractor 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010/05) 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 © 1958-2010 ACORD CO The ACORD name and logo are registered marks of ACORD ,� /w, RiakManaBnu¢ntDfwalon s7-� �� REVIEV%ED 6r APPROqVaED BV: �'---J RiskManagemenS Speoalis[ POLICY NUMBER: 2021-04261- NPO COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART, SCHEDULE Name of Person or Organization: The City of Santa Ana, its officers, officials, employees,& volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. � xmk�llM>Iwit . NWEWED/&�APPROVED Br. '° � FfF�GCU4�0 s , RISK ManagemcntSpeC1,05t POLICY # 2021-04261- NPO PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Santa Ana, its officers, officials, employees,& volunteers Effective Date: 07/05/21 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured, The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. o�� s w�kMsnagan�,tt)�wn REIAEWED & APPRovEDBY, rrfe (}eaua,�a RIA ManyyementSpenalist WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described In the Schedule. The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description The City of Santa Ana, its officers, employees, agents Funding Contract and volunteers. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2022 Policy No. SWC1374729 Endorsement No. 0 Insured Latino Health Access (a Corp) Premium $ 60,773 Insurance Company Security National Insurance Company Countersigned by v WekMunngemmEDWslm WC 04 03 06 flkv svuso&Ara Aav4y: ' Awe Auuuto (Ed. 04-84) Rislc management Specialist A n q I e Digitally siOA-Tg4_1 OP ID: CA1 ACC7R0 gle DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY TSUR A,adQ 106/28/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE JP(E)b ffHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CJVFP,,,y� QRDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRA TWEE'a THE SURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ' 20:14:18-07'00' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: CONTACT Stephanie Dufour Dufour Insurance Services, LLC PHONE 714-369-2998 aIc No 6611 Littler Drive vc No Ext Huntington Beach, CA 92649 or nQIF... Steohanie0clufourinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nonprofit Insurance 524210 INSURED Latino Center for Prevention INSURER B:Security National Ins-AmTrust and Action, dba INSURER c: Philadelphia Indemnity 18058 Latino Health Access 450 W. Fourth Street INSURER D 7 Santa Ana, CA 92701 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL WVDSUB POLICY NUMBER POLICY EFF MM DD YYYY POLICY EXP MM /DD YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X 2022-04261- NPO 07/06/2022 07/06/2023 DAMAGE TO RENTED PREMISES Ea occurrence $ 500 t)t)t) CLAIMS -MADE � OCCUR MED EXP (Anyone person) $ 20,000 PERSONAL & ADV INJURY $ 1,000,000 A X Professional 2022-04261- NPO 07/06/2022 07/06/2023 X Abuse GENERAL AGGREGATE $ 3,000,000 A 2022-04261- NPO 07/06/2022 07/06/2023 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 POLICY PRO X LOC JECT Deductibl $ 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1000000 $ e e BODILY INJURY (Per person) $ A X ANY AUTO 2022-04261- NPO 07/06/2022 07/06/2023 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE PER ACCIDENT) $ Deductible $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE 2022-04261-UMB-NPO 07/06/2022 07/06/2023 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A SWC1374729 01/01/2022 01/01/2023 X WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Cyber Liability PHSD1684193 12/12/2021 12/12/2022 Per Occ 1,000,000 A Liquor Liability 2022-04261- NPO 07/06/2022 07/06/2023 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its officers, officials, employees,& volunteers are to be covered as additional insureds & Waiver of Subro on the CGL 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 Insurance is Primary ad Noncontributory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. ARPA funded food distribution Contractor AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana, CA 92701 y�(a t w, w.,.��e"„�� rn Risk Dns ian REVIEWED & APPROVED BY: © 1988-2010 ACORD CO e Aezvaa ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD — Risk Management specialist POLICY NUMBER: 2022-04261- NPO COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: The City of Santa Ana, its officers, officials, employees,& volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. RAMuaigmadDlMsian E REVIEWED & APPROVED BY: e '�--'Risk Management Specialist POLICY # 2022-04261- NPO PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON—CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Santa Ana, its officers, officials, employees,& volunteers Effective Date: 07/05/22 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. RAMuaigmadDlMsian ZW REVIEWED & APPROVED BY. e eev'� 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: Dufour Insurance Services, LLC 5611 Littler Drive Huntington Beach, CA 92649 Item 1 NAME OF INSURED AND MAILING ADDRESS: POLICY NUMBER: 2022-04261-UMB RENEWAL OF NUMBER: 2021-04261-UMB-NPO Latino Center for Prevention & Action in Health & Welfare dba: Latino Health Access 450 West 4th St., Ste. 130 Santa Ana, CA 92701 Item 2 POLICY PERIOD: FROM 7/5/2022 TO 7/5/2023 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Health and nutrition education 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: $10,357 (premium includes Terrorism Coverage - Certified Acts: $498 but only for policies that indicate coverage on Schedule A - Schedule of Underlying Insurance) Item 4 LIMITS OF INSURANCE: a. Occurrence / Accident / Injury / Claim Limits (where applicable):...... 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 .................................... C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability d. Each Claim - Social Service Professional Liability ............................. Aggregate limits: Commercial General Liability, Business Auto Liability, Products- Completed Operations Liability, Liquor Liability, and Employee Benefits Liability Aggregate (where applicable): ........................................................................................................... Directors and Officers Liability Aggregate......................................................................... Improper Sexual Conduct and Physical Abuse Liability Aggregate ................................. Social Service Professional Liability Aggregate............................................................... Item 5 RETROACTIVE DATES - SEE SCHEDULE OF UNDERLYING INSURANCE 1,000,000 1,000,000 5,000,000 5,000,000 1,000,000 1,000,000 5,000,000 FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): CU 21 30 01 15, CU 21 33 a 01 15, CU 21 33 s 01 15, IL 09 99 12 20, NIAC-EO03 UMB 08 20, NIAC-E133 UMB 05 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, UMB61 05 13 Risk Memigment DlMsian E REVIEWED & APPROVED BY. e Aeevaa '�--'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: Dufour Insurance Services, LLC 5611 Littler Drive Huntington Beach, CA 92649 COUNTERSIGNED: 7/1 /2022 POLICY NUMBER: 2022-04261-UMB RENEWAL OF NUMBER: 2021-04261-UMB-NPO BY 1 (�' x. (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 E DMs� regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay cl _ ° REVIEWED&APPROVEDBY: becomes insolvent. e Aeevulo NIAC - UMB / 2-99 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 SCHEDULE A - SCHEDULE OF UNDERLYING INSURANCE POLICY NUMBER: 2022-04261-UMB CONTROL NUMBER: 04261 NAME OF INSURED: Latino Center for Prevention & Action in Health & Welfare dba: Latino Health Access TYPE OF POLICY APPLICABLE LIMITS INSURER APPLICABLE PERIOD POLICY # (A) Automobile Bodily Injury and Property Damage NIAC 07/05/2022 to 07/05/2023 Liability Combined Single Limit ........................................ $1,000,000 2022-04261 Business Uninsured/Underinsured Motorist ....................... N/A Auto (Does not include:Terrorism Coverage - Certified Acts) (B) Commercial Each Occurrence Limit .................................. $1,000,000 NIAC 07/05/2022 to 07/05/2023 General General Aggregate Limit ................................ $3,000,000 2022-04261 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 ................................... $1,000,000 NIAC 07/05/2022 to 07/05/2023 Service Aggregate Limit ................................ $3,000,000 2022-04261 Professional Liability (Does not include:Terrorism Coverage - Certified Acts) (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 ...................................... $1,000,000 NIAC 07/05/2022 to 07/05/2023 Sexual General Aggregate Limit ................................. $3,000,000 2022-04261 Conduct and Physical Abuse (Includes Terrorism Coverage- Certified Acts) (F) Directors' Each Wrongful Act Limit ................................. $1,000,000 NIAC 07/05/2022 to 07/05/2023 And Aggregate Limit $1,000,000 2022-04261-DO Officers' (Includes Terrorism Coverage- Certified Acts) (G) Liquor Each Common Cause Limit ............................ $1,000,000 NIAC 07/05/2022 to 07/05/2023 Liability Aggregate Limit $1,000,000 2022-04261 (Includes Terrorism Coverage- Certified Acts) (H) Employee Each Employee ................................................ $1,000,000 NIAC 07/05/2022 to 07/05/2023 Benefits Aggregate Limit $3,000,000 2022-04261 Liability (Includes Terrorism Coverage- —\ µ.ow M RideMuaigmad DlMsian iREVIEWED & APPROVED BY. e eev� Risk Management Specialist WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description The City of Santa Ana, its officers, employees, agents Funding Contract and volunteers. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company WC 04 03 06 (Ed. 04-84) 1/1/2022 Policy No. SWC1374729 Latino Health Access (a Corp) Security National Insurance Company Countersigned by Endorsement No. 0 Premium $ 60,773 Ride DlMsian E o N,`0' REVIEWED & APPROVED BY: e Aeevaa '�--'Rfsk Management Specialist NOTICE OF COMPLIANCE Contractor Latino Center for Prevention and Action Name: Project A-2022-033-03 Number: Project Agreement Between The City Of Santa Ana And Latino Health Name: Access 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 Latino Center COI AUTOMOBILE LIABILITY 202104261NPO 07/05/2023 06/28/2022 Exp 7-5-23 RMD07252022.pdf GENERAL LIABILITY 202104261NPO 07/05/2023 06/28/2022 CERT city of Santa Ana generic .pdf SEXUAL ABUSE 202204261NPO 07/05/2023 07/28/2022 CERT- City of WORKERS COMPENSATION AND SWC1374729RENEWAL 01/01/2024 12/09/2022 Santa Ana 2022-23 EMPLOYERS' LIABILITY updated (1).pdf ............... Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 12/14/2022 6:02 PM