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HomeMy WebLinkAboutLATINO CENTER FOR PREVENTION AND ACTION IN HEALTH AND WELFARE dba HEALTH ACCESS (2)DocuSign Envelope ID: Cl AG2826-DD4F-484E-86A3-1GFE7A848C82 A-2021-107-02A MAYOR !NSURANCEN�TOT ON FILE Vicente Sarmiento y'JONOT RK MAY PROLE MAYOR PRO TEM PCLERK OF COUNCI y hil Bacerra - COUNCILMEMBERS 11H, Johnathan Ryan Hernandez DATE: Jessie Lopez NeliAPR 0 7 2022 da Mendoza David Penaloza Thal Viet Phan CITY OF SANTA ANA CPA UP) COMMUNITY DEVELOPMENT AGENCY (Dot ' 61 20 Civic Center Plaza M-25 ) voir-Santa Ana, California 92702 www.santa-ana.org March 3, 2022 Latino Health Access Attn: Nancy Mejia, Chief Program Officer 450 W. 4th Street, Suite 130 Santa Ana, CA 92701 Re: Extension of Agreement #A-2021-107-02 Dear Ms. Mejia, CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section I.B. ("Term of Agreement") of Agreement No. A-2021-107-02 ("Agreement"), as amended, entered into by Latino Health Access and the City of Santa Ana dated August 1, 2021, the parties hereby agree to extend the Term of the Agreement for a six (6) month period through September 30, 2022. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Steven Mendoza Executive Director, Community Development Agency CITY OF SANTA ANA: Kristine City Manager APPROVED AS TO FORM: Sonia R. Carvalho City-4ttomey RyaV O.�Hodge Assistant City Attorney LATINO HEALTH ACCESS [Doeuftmal by: Nu; LUyia Nancy Mejia 182636 14DF2 67... Chief Program Officer ATTEST: Daisy Gomez Clerk of the Council SANTA ANA CITY COUNCIL Vicente Saimlento Phil Buena Thal Viet Phan David Penaloza Jessie Lopez JPhnaihan Ryan Hamann. Wida Mendoza Mayor Mayor Pro Tem. Ward 4 Ward1 Werd2 Want WaN5 Wnd6 vearmlenmtaaaPlaana.om Obacenaaljisanla-anaem bhan0..me-..em dPenabi.n.nmanae Lwhelooez(olsanteana Pnmendo teeantaanaem A-2021-107-02A ' 0i9ud11yaenednynancWR. Francine R.Vi l l a real VNa,nl QA-1°INLT1e"'30-a1"wOP ID: SD ,acoizo CERTIFICATE OF LIABILITY INSURANCE DATE 07128/2021 2812021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES. NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dufour Insurance Services, LLC 5611 Littler Drive Huntington Beach, CA 92649 CONTACT Stephanie Dufour PHONE 714.369.2998 Fax A No Ex A/C No E-MAIL Ste hanie dufourinsurance.com ADDRESS; P INSURER(S) AFFORDING COVERAGE NAIC9 INSURERA: Nonprofit Insurance 524210 INSURED Latino Center for Prevention and Action, dba Latino Health Access 450 W. Fourth Street Santa Ana, CA 92701 INSURER e:lnsurance Company of the West 27847 INSURER C: INSURER D: 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. LTR TYPE OF INSURANCE D POLICY NUMBER MMIODY EYYY MMIDDP XVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 500,00 A X COMMERCIAL GENERAL LIABILITY X X 2021.04261-NPO 07105/2021 07/05/2022 CLAIMS -MADE OCCUR MED EXP(Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,00 A X Professional 2021.04261- NPO 07/0512021 07/0512022 X Abuse GENERAL AGGREGATE $ 3,000,00 A 2021.04261- NPO 07/05/2021 07105/2022 GEN'L AGGREGATELIMIT APPLIESFER: PRODUCTS - COMPIOP AGO $ 3,000,00 POLICY PRO X Loc Deductibl $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO X X 2021.04261-NPO 07105/2021 07/05/2022 ALL OWNED X SCHEDULED NON -OWNED HIREDAUTOS AUTOS BODILY INJURY(Pereccident) $ PROPERTY DAMAGE PER ACCIDENT $ Deductible $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE X X 2021.04261-UMB-NPO 07/0512021 07/0512022 DEO I X IRETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERTLIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEY OFFICERIMEMBER EXCLUDED? (Mandatory In NH) - NIA WVE503936503 01/0112021 01/01/2022 OTH- WCSIN X TOY S ER —NLU E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYE $ 1,000,00 If he. describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Cyber Liability X X 2021.04261-NPO 07105/2021 07/05/2022 Per Occ 1,000,00 A Liquor Liability X X 2021-04261-NPO 07/05/2021 07/0512022 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sc h ad old, If more space Is required) The City of Santa Ana, 20 Civic Center Drive, Santa Ana, CA 92701, its officers, employees, agents and volunteers are named as Additional Insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary and any insurance carried by ity shall be excess and noncontributory. The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD COF ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD RtekManagemmtDlwslon %-ll a �. REvEWED&pAPLPRWm BY "RIslS MnnaOamentgn ltyst.= HOLDER CODE LA I IN-1 PAGE 2 NOTEPAD. INSURED'SNAME Latino Center for Prevention OP ID: SD Date 071Y8/2041 This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limit of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. With respect to the additional insured, this insurance shall not be canceled or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701. Scheduled events: „�- RlekMaYjpralt]Ek- Nk're`` I �° REVIEWED[ APP+�R,OVf 711 F4PF -oW P, Yl4 POLICY NUMBER: 2021-04261- NPO COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insured ("additional insured") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insured. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insured, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. (Completion of the following, includinacorm[ersignature is required to make this endorsement effectivr issued to Latino Health Access Counts rsi4ned by accent Stephanie Dufour CG 20 26 11 85 Copyright, Insurance Services Office, Inc., 1984 ,,, ltieleManagementl)tWslon _ y REVIEWED&AP+P+RLOVED BY 81 IIi6Wl� ~''1fi1l4z*L P,cNg (, Rukktana�,emenrAnalyF4 POLICY # 2021-04261- NPO PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): City of Santa Ana, its officers, officials, employees and volunteers Effective Date: 07/05/21 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule: This insurance Is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. y.. R6kMan%nv,usit Dhislm REVIEWED&APPROVED BY P — Rlxkktartage➢lnt Analyst 'M —