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Home My WebLink AboutSTANDUP FOR KIDS (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES '9-' 15 '20 CITY CLERK A-2023-084-18 DATE: FIRST AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND STANDUP FOR KIDS (24 CFR Part 570) �Qu> THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT ("First Amendment") is entered into this 1" day of July 2023, 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 Standup for Kids, a California nonprofit organization ("Subrecipient"). (24 CFR Part 570) RECITALS A. On July 1, 2022, the City entered into Community Development Block Grant ("CDBG") Subrecipient Agreement #A-2022-092-20 with Subrecipient to provide CDBG Funds from the United States Department of Housing and Urban Development ("HUD") to be used in the operation of a public service program for homeless students with a personalized path to self-sufficiency. The case manager will mentor, provide tutoring in order for student to graduate and become self-sufficient ("Agreement"). B. In accordance with the terms and conditions of the Agreement, the parties desire to amend the Agreement to report the current Catalog of Federal Domestic Assistance ("CFDA") Number and Federal Award Identification Number ("FAIN") for Subrecipient, and to report the current federal award date and amount of the award as required for pass -through entities. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of the Agreement, except as herein modified, the parties agree as follows: Recital A shall be amended to update the City's current CFDA Number to 14.218 and FAIN to B-23-MC-06-0508 in accordance with the requirements for pass -through entities outlined in 2 CFR 200.332. 2. Article II, Section A, shall be amended to report the current federal award date of July 1, 2023, and update the amount of the award to be $4,808,057.00 in accordance with the requirements for pass -through entities outlined in 2 CFR 200.332. Except as modified by this First Amendment, all terms and conditions of the Agreement, shall remain in full force and effect. Page 1 of 2 A-2023-084-18 IN WnNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year fast written above. ATTEST CITY OF SA7A Jennife al Kristine Ridge City Clerk. City Manager APPROVED AS TO FORM SONIA R. CARVALHO City Attorney LE �] �44cCu4 �Glta- / Andrea Garcia -Miller Assistant City Attorney RECOMMENDED FOR APPROVAL Michael L. Garcia Executive Director Community Development Agency SUBRECIPIENT: Jus almore Exfcu)fve Officer TaUD # 33-0414855 Unique Entity ID: MB2BL426L3W8 Page 2 of 2 DlgWly,'mby 1-11-- orI Ierson WI1:13D 01 M "cvRn CERTIFICATE OF LIABILITY INSURANCE °0711`81 o°°"""' 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- N the consul ate holder is an ADDITIONAL INSURED, the polieypes) must be andorsed. N SUBROGA7TON IS WANED, sublaet m the terms and conditions of the policy, certain policies may require an andorsamani A statement on this eerdfleate does not confer rights to the certi0sate holder In lieu of such endorsem s). PRODUCER Kraft Lake Insurance Agency PO BOX 1428-Loc 1482 Grand Rapids, MI49501 18058 Stand Up For Kids 200 Nelson Ferry Rd, STE. B Decatur, GA 30030.2318 ReMICIN NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDINGLISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTricn DOCUMENT6Yi i}t RESPECT TO WtiiCH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LM TYPE OP INSURANCEAMR JAMOM POr.1OY xwmaz °WPERSOM&ADVNJURY 6ENBrALUAM.iTY 1,000,001) X COLI)dERCMLGENETIN.UIIBILITY rV91W,W0 X CWMSIWDE A OCCUR PHPK2304124 07/15/2022 07/15/2011000,000 5.000 EENERALADBREGAM s 31000,000 A PHPK2304124 07/15/2022 07/15/2023 GAWrcAPLIES PER X w AUTOMOBILE LWENYfY ANYAUTO NONZ Vq�l'0 S��IR.® AUTOS ED X HIRED AUTOS X AUTOS )( 08.09 PREMDG $3,00.000 3°x abuse! Molestasor s SOGLYINAIRyiPinPsxm) s i3OW,00p 1,000,000 S BODLYUNKYW rawasing E PROPERTY s S A B �( DLSRELLAUAB OfOP.BS UAB X X OCCUR CLAIMNANDE NIA PHU8778398 07115/2022 07/15/2023 EACHD000RREN% S 3,OW,OW ADGREOAM a 3,OW,OW DEED I IRVISN'17101,141 10,000 WORKERS COMPENSATION ANOEMPLOYERS•UABRITY YIN MY OFRCERIMIEMSFRE)ICLUD®4 Ctri1YE QN (Mmdidary In Hill IryBs, d nO-1WESCRIPTION OF IP D X WCSTATU-W_Uuns OTH- ER S ELFACHACCIDENT E 1,000.01M) LL OISFASE-EA EtYPL S 11=0,000 e.L.OIaFA6E_POLICY IRAT S 1,000,000 C Directors $ Olflcars Liability DEBCNPTNDNDFOPE1rATUMILOCAnONBIVEHWAM (Ameh ACORDIM.Addwa,tl Pr s h d,dq Rneroa 4.a9aSad1 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE° BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEJVEM IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 Tlye RhLMa WNtestaM Rsv,E &/Vrrsovm By: i/05) 0 1OM2010 ACORD C rs;,xnu,,,a�„a„amwaar i The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 1 111 07/15/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lauren Justus NAME: Turner, Wood,&Smith Agency, Inc. PA HONENo ( (770)536-0161 FAX 770) 536-1283 Ext: A/C No : 1515 Community Way E-MAIL lauren.justus@twsinsurance.com ADDRESS: PO Box 1058 INSURER(S) AFFORDING COVERAGE NAIC g Gainesville GA 30503 INSURER A: Accident Fund Insurance Company of America 10166 INSURED INSURER B: United States Liability Insurance Company 25895 Stand Up For Kids INSURER C: 200 Nelson Ferry Rd INSURER D : Ste 6 INSURER E: Decatur GA 30030 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2252728855 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Lm TYPE OF INSURANCE INSD MD POLICY NUMBER POLICY MMIDDIYYYY POLICY EXP MMIDONYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea orom,ence $ CLAIMS -MADE 0OCCUR MED EXP(Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRO- JECT LOC GENERALAGGREGATE $ PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aokkant $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY BODILY INJURY Per amitlent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE Y� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, DESCRIPTION antler DESCRIPTION under OPERATIONS below NIA Y WCP100031316 O6/27/2022 06/27I2023 v PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1.000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY OMIT 1,000,000 $ B Directors 8 Officers Liability Y ND01562548H 05/18/2022 05/18/2023 Each Claim Aggregate 1,000,000 1,000,000 Retention -Each Claim 5,000 DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Blanket WES is included per form WC000313. 30-Days Notice of Cancellation, except for Non -Payment which is 10-Days Notice. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana 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 w MnagmmdDiNabn CA 92702 +urzrLif, `I ' 7ev;%m as lJ lSaa-ZUID ACVKU - ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHUBB23705 ®PHILADELPHIA INSURANCE COMPANIES A Flember of Llie 'I okio %I arise Group PI-CXL-002 (05/19) One Bala Plaza, Suite 100 Bala Cynwyd, Pennsylvania 19004 610.617.7900 Fax 610.617.7940 PHLY.com COMMERCIAL UMBRELLA LIABILITY INSURANCE POLICY DECLARATIONS Philadelphia Indemnity Insurance Company NAMED INSURED: Stand Up for Kids MAILING ADDRESS: 200 Nelson Ferry Rd Ste B Decatur, GA 30030-2318 105160 Kraft Lake Agency PC Box 1426 Grand Rapids, MI 49501 (800)339-3114 POLICY PERIOD: FROM 07/15/2022 TO 07/15/2023 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. EACH OCCURRENCE LIMIT (LIABILITY COVERAGE) ITS OF INSURANCE $ 3, 000, 000 PERSONAL & ADVERTISING INJURY LIMIT $ 3,000,000 PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT GENERAL AGGREGATE LIMIT (LIABILITY COVERAGE) (except with respect to Auto Liability and Products Completed Operations) RETAINED LIMIT: PI-CXL-002 (05/19) RETAINED $ 10,000 $ 3,000,000 $ 3,000,000 _ RENPL erDL MrxwmBr + � 7OTe pecwo" MEW Rkx,x,,.age,r,arz na,uiaae Page 1 of 5 Includes copyrighted material of Insurance Services Office, Inc., with permission. PI-CXL-002 (05/19) Ilil1111 [ova RRu�1 f PREMIUM PREMIUM SUBTOTAL $ 2,195.00 STATE TAXES, FEES, SURCHARGES (if applicable) Not Applicable PREMIUM TOTAL(including Taxes, Fees, Surcharges) $ 2,195.00 AUDIT PERIOD: I ® NOTAPPLICABLE 10 ANNUALLY ❑ SEMI-ANNUALLY 10 QUARTERLY1 ❑ MONTHLY SINESS FORM OF BUSINESS: NON PROFIT ORGANIZATION BUSINESS DESCRIPTION: Non -Profit Umbrella PI-CXL-002 (05/19) Ikntwm6rmRwmBr: Reh M1Lmage,rmeUmulMtle Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., with permission. PI-CXL-002 (05/19) POLICY NUMBER: PHUBB23705 SCHEDULE OF UNDERLYING INSURANCE Employers' Liability Company: Policy Number: Policy Period: Minimum Applicable Limits Bodily injury by accident $ Each Accident Bodily injury by disease $ Each Employee Bodily injury by disease $ Policy Limit Commercial General Liability ❑ Occurrence E Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2438009 Policy Period: 07/15/2022 07/15/2023 Retroactive Date: 09/04/2016 Minimum Applicable Limits: General Aggregate $ 3,000,000 Products -Completed Operations Aggregate $ 3,000,000 Personal And Advertising Injury $ 1,000,000 Each Occurrence $ 1,000,000 Commercial Auto Liability Company: Policy Number: Policy Period: Minimum Applicable Limits Garage Aggregate Limit For Other Than Autos (if applicable) $ Each Accident $ Professional Liability ❑ Occurrence ® Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2438009 Policy Period: 07/15/2022 07/15/2023 Retroactive Date: 09/04/2016 Minimum Applicable Limits Each Professional Incident $ 1,000,000 Acrarecate $ 3,000,000 PI-CXL-002 (05/19) e.., RIi�Mv�gew<nt IXW r HenecmLAPPROJH)Dr. '? - %u %%reeJox 00 Rak Ma tnmralNtle .1 rki9e�ren Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc., with permission. PI-CXL-002 (05/19) POLICY NUMBER: PHUBS23705 Employee Benefits Liability ❑ Occurrence ® Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2438009 Policy Period: 07/15/2022 07/15/2023 Retroactive Date: 09/04/2016 Minimum Applicable Limits Each Claim $ 1,000,000 Aggregate $ 1,000,000 Abusive Conduct Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits Directors & Officers Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits Liquor Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits PI-CXL-002 (05/19) ��^n' 7au F�rcxsa« ftkr ,,,yn,R.,.a«,w Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with permission. POLICY NUMBER: PHUBB23705 Watercraft Liability Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits PI-CXL-002 (05/19) ❑ Occurrence ❑ Claims -Made Other Coverages Not Included in Above ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY. Countersigned: By: (Date) (Authorized Representative) IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. John W. Glomb, Jr. Secretary President & CEO r�amrs �/IE14m6 MPXw®Br. PI-CXL-002 (05/19) �rsawn ve �mm�iaee Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc., with permission.