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HomeMy WebLinkAboutSALVATION ARMY (8)INSURANCE WORK A-2022-055 WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL THIRD AMENDMENT TO OPERATING AGREEMENT WITH DATE: THE SALVATION ARMY TO OPERATE THE HOSPITALITY HOUSE SHELTER o:C101C'Ierf (7x) 3 THIS THIRD AMENDMENT to the above -referenced agreement is entered into on April 5, 2022, by and between The Salvation Army ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of cv California ("City"). Q RECITALS A. The parties entered into an Agreement dated June 15, 2021, by which Contractor agreed to administer and operate the Hospitality House to temporarily house clients referred by the City and Street Outreach teams ("Agreement"). B. The parties entered into a First Amendment to said Agreement No. A-2021-106-01 dated November 16, 2021, in order to extend the Term of said Agreement and to increase the maximum amount of Compensation for said Agreement. C. The parties entered into a Second Amendment to said Agreement dated January 18, 2022, in order to again extend the Term of said Agreement and to increase the maximum amount of Compensation for said Agreement. D. in accordance with the terms and conditions of said Agreement, the Parties desire to again amend Section 2 — Effectiveness and Term of Agreement, to extend the Term of said Agreement, and Section 3 — Compensation, to increase the maximum amount of Compensation for said Agreement. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, as amended, except as herein modified, the parties agree as follows: 1. Section 2(b), Effectiveness and Term of Agreement, shall be amended to extend the potential no later than end date of the Term of said Agreement to June 30, 2022, subject to the termination provisions in the First Amendment to said Agreement. Said extension shall apply to any and all services provided under said Agreement since February 28, 2022. 2. Section 3, Compensation, subsections (a) and (b), shall be amended to increase the maximum amount of compensation by four hundred thousand dollars ($400,000.00), such that the total sum to be expended under said Agreement shall not exceed one -million four hundred and forty thousand dollars ($1,440,000.00) during the Term of said Agreement, subject to the termination provisions in the First Amendment to said Agreement. 3. Except as modified by this Third Amendment, all terms and conditions of said Agreement, as modified by the First and Second Amendments, shall remain in full force and effect. Paget oft IN WITNESS WHEREOF, the Parties hereto have executed this Third Amendment to said Agreement on the date and year first written above. ATTEST 4 r+ DAISY GOMEZ , vWClerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Atttprh5� 0 RY Attorney RECOMMENDED FOR APPROVAL STEVEN A. MENDOZA Executive Director Community Development Agency Page 2 of 2 CITY OF SANTA ANA KIS Jc KR TINE RIDGE City Manager THE SALVATION ARMY L Name: i Title: f TERRY HUGHES SECRETARY Francine Digitally Signed by Francine R. VillereelPage 1 of 2 Date: 202Li ACO)!s',P� CERTIFICATE OF LIABILITY INSURANCE rea 08:30:55-0T 0' DAT9 2IY21 29 09/29/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: .—,- Willis Towers Watson Insurance Services West, Inc. PHONE FAQ—'-' c/o 26 Century Blvd -IAA 1. 1-877-945-7378�i IAIC NoJ: 1"888-167-2378 P.O. Box 305191 E•MAII certiflcate4willis,com OD ESS: _ Nashville, TN 372305191 USA _ INSURERLLAFFORDING COVERAGE NAIC N _ IN5URERA; Westchester Surplus Lines Insurance Compan 10172 INSURED The salvation Army - Division 17 INSURERB; Greenwich Insurance Company 22322 INSURERC: XL Specialty Insurance Company 37885 — 30840 Hawthorne Blvd., Bldg D Rancho Palo. Verdes, CA 90275 INSURERD: _ _ INSURER E: ._--- - INSURER F; - COVERAGES CERTIFICATE NUMBER- W22306682 0=1110VFJ Au mnnve,. 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 DL SUBR -----� POLICY EFF POLI'YEXP -'-- TR TYPEOFINSURANCE D o POLICYNUMBER IDDIYYYY) (MMiDD?YYYYl LIMITS X COMMERCIALGENERAL LIABILITY EACHOCCURRENCE $ 21000,000 _ 8 1,000,000 JCLAIMS-MADE OOCCUR -GAM�TSREffiE�- PREMIS'S Ea occ rrancei_- X MED EXP. Any onopersen) ,__ $ i0 A Self Insured Retention: X $1,000,000 Y G7183119A 002 10/01/2021 10/01/2022 _PERSONAL &AOVINJURY 5 2,000, 000 GENT. e AGGREGATE LIMITAPPLIES PER: POLICY�X-11LOC GENERAL AGGREGATE $ 4,000,000 Ir PRODUCTS -COMPIOP AGG $ 4,000,000 $ OTHER: AUTOMOBILEUABILITY CO BI. INGLE LIMI $ - (Ea acclden0 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Par accident) -.-- $ AUTOS ONLY AUT05 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ROPEkhart) AGG 1Per acdtl¢ntl ------ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S Excess LIAR CWMS.MAOF. DEDT1 RETENTION$ _ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER YIN EAC .L. EACHCIDENT ---- $ AhIYPROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBEREXCLUDED? NIA E.I.DISEASE-CA EMPLOYEE -- $ (Mandatory lnNH) If yea, doecdbe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below a Maness Auto Liability - CA Y RAM500021811 10/01/2021 10/01/2022 Any Auto / CSL $3,000,000 I I Self-Insd Retention $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Location Code: 17-145-10-01-01 - Santa Ana Hospitality House Shelter CA -Business Auto is fully Self -Insured per the attached State Certificate. SEE ATTACHED City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2016/03) 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 The ACORD name and logo are registered marks of ACORD as tu: 21630631 aA'TCH: 2252947 Wait MAsm621hed1XVIefon ����i RBV1EViE.3 & FIMPaR',OpV�ED liY: 8�•181f.W9':l:) d6YtY%d� P, YmLSf ,4t �' Risk Management Analyst AGENCY CUSTOMER ID: LOC 8: `�� � ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Willis Towers Watson Insurance Services West, Inc. The Salvation Army - Division 17 30890 Itawtho cno Blvd., Bldg D PO Rancho Palos Verdes, CA 90275 Seee Page age I CARRIER See Page 1 NAIC CODE See Page 1 EFFECTIVEDATE: Sae Page 1 Page 2 of 2 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:. 25 _ FORM TITLE: Certificate of Liability Insurance FOR USE OF EMERGENCY SOLUTIONS GRANT CORONAVIRUS (ESG-CV) FUNDS. TERM: From: June 15, 2021 through December 31, 2021 The City of Santa Ana, its officers, officials, employees, and volunteers are included as an Additional Insured as respects to General Liability and Auto Liability as required by written contract or agreement. General Liability policy shall be Primary and Non -Contributory with any other insurance in force for or which may be purchased by Additional Insureds as required by written contract or agreement. Waiver of Subrogation applies in favor of Additional Insureds with respects to Workers Compensation, as permitted by law. INSURER AFFORDING COVERAGE: XL Specialty Insurance Company NAICI6: 37685 POLICY NUMBER: RWE500047506 EFF DATE: 10/01/2021 EXP DATE: 10/01/2022 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Workers Compensation E.L. Each Accident $1,000,000 CA EL Each Employee $1,000,000 Retention: $1,000,000 ADDITIONAL REMARKS: Excess Workers Compensation Policy No. RWE500047506 provides coverage in the state of CA CA -Workers Compensation is fully Self -Insured per the attached State Certificate nFlle'WTO&AFPRtivEDSY: ACORD 101 (2008/01) 0 2006 ACORD C Wti' The ACORD name and logo are registered marks of ACORD __!' Ruk Manage"ni Analyst Re TO: 21630631 RATCR 9252g47 CGPT. W221nrrA9 STATE OI- CALIFORNIA Edmund G. Drown Jr., Governor DEPARTMENT OF INDUSTRIAL RELA OFFICE OF SELF-INSURANCE FLANS It 050 Olson Drive, Suite 230 Rancho Cordova,CA 95670 Plione No. (916) 464-7000 FAX (916) 464-7007 CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION TO WHOM IT MAY CONCERN: This certifies that Certificate of Consent to Self -Insure No. 0566 was issued by the Director of Industrial Relations to: The Salvation Army under the provisions of Section 3700, Labor Code of California with an effective date of November 15, 1933, The certificate is currently in fill force and effective. Dated at Sacramento, California This clay the 20di of April 2017 Lyn Asio Booz, Chief ORIG: Craig Nicles Director Of Claims Management The Salvation Army 180 Easf Ocean BOUIEvar(l, 10th Floor Long Beach, Ca 90802 �, n' i� �IY '_ Oil ItLvk Mansgnmurabidstatt IiEV1Ea7JE481 eKd'aP+KC/gV/GfJ 9Yp: MA Maneaewnt Analyst POLICY NUMBER: G7183,119A 002 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Location(s) Of Covered Operations As required by written contract signed by both parties prior to loss, Information required to complete this Schedule_ if not shown above, will be shown In the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising Injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional Insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 ir6i��py�.,r Rleit M1lpltRglM1ytCpl'I)N{9tMl ' °P(%4 j�I pGVIEWPti&@MyNRtlVpex�DYe: ' % r'��5,3.f.*R+E R„ VaPAAALFiG NON-CONTRIBUTORY OTHER INSURANCE ENDORSEMENT Named Insured The Salvation Army Endorsement Number Polley Symbol Policy Number Policy Period Effective Dato or Endorsement GLW G7183119A 002 10/01/2021 To 10/01/2022 10/01/2021 Issued By (Nome of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph 4. c. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted in its entirety and replaced by the following: c. Method of Sharing If all of the other Insurance permits contribution by equal shares, we will follow this method unless you are required by written contract to provide insurance that is primary and non-contributory, and the contract has been signed by you prior to any loss. Where required by such a written contract, this insurance will be primary and non-contributory only when and to the extent required by that written contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first If any of the other Insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of Insurance of all insurers. All other terms and conditions remain unchanged. GLE0096 (07/10) ©Chubb. 2016 All rights reserved. ,,, s, a R1a4h1anagementG7AisUm I q . r1'c' fgAf�y.a P, Mud ��' risk Management Analyst