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HomeMy WebLinkAboutKOMPASHION, INC. INSURANCE NOT ON FILE N-2024-218 WORK MAY NOT PROCEED CITY CLERK DATE: JUL 0 8 2024 0: (n (1) AGREEMENT WITH (-u0\wo) KOMPASHION INC FOR MENTAL HEALTH SERVICES GRANT THIS AGREEMENT is made and entered into on this 25th of June, 2024 by and between Kompashion, Inc. a California Nonprofit Corporation ("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 California("City"). City and Contractor shall hereinafter be referred to singularly as "Party" and collectively as the"Parties." RECITALS A. The City desires to retain a Contractor having special skill and knowledge in Santa Ana community-based mental health services for that will promote emotional wellness services. B. Contractor represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: 1. SCOPE OF SERVICES Contractor shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described in the Scope of Services and Proposal—Exhibit A attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services for City, the rates and charges identified in Scope of Services and Proposal -Exhibit A. The total amount to be expended during the term of this Agreement shall not exceed $50,000.00. b. Payment by City shall be made within forty-five(45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment shall be made in two (2) installments: 1) the first payment in the amount of$25,000 (50% of the grant total) after full execution of the agreement; and 2) the second payment in the amount of$25,000(the remaining 50%of the grant total)shall be issued six (6) months after the full execution of the agreement or thereafter. City and Page 1 of 10 Contractor agrees that all payments due and owing under this Agreement shall be made through Automated Clearing House(ACH)transfers. Contractor agrees to execute the City's standard ACD Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Contractor's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on June 25, 2024, and continue for a 1-year term, with an option for the City to grant up to one (1) additional year renewal, exercisable by a writing by the City Manager and City Attorney unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes,which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time,provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. Page 2 of 10 6. INSURANCE Prior to undertaking performance of work under this Agreement,Contractor shall maintain and shall require any subcontractors to obtain and maintain insurance as described below for the entire Term of this Agreement against claims for injuries to persons or damage to property which may arise from or in connection with services,products and materials supplied to City. Total cost of insurance shall be borne by Contractor. a. MINIMUM SCOPE AND LIMIT OF INSURANCE:: 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 $1,000,000 per occurrence and $2,000,000 aggregate.. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. Automobile Liability: Insurance Services Office Form Number CA 0001 covering, any auto (Code I), , with limit no less than $1,000,000 combined single limits. In the event Contractor does not maintain commercial automobile liability insurance,City will accept evidence of personal automobile insurance. 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, policy or employee, for bodily injury or disease. Coverage is not required is Contractor has no employees and signs request to waive such insurance. 4. Professional Liability Insurance: with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. b. If the Contractor maintains broader coverage and/or higher limits than the minimum requirements 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 c. Other Insurance Provisions —The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. City, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds, under Contractor's CGL, Professional Liability, and Automobile Liability policies, with respect to any liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. Contractor's Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work Page 3 of 10 performed by Contractor under this Agreement. 3. For any claims related to this contract, Contractor's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. A severability of interest provision must apply for all the additional insureds, ensuring that Contractor's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Insurance policies required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non-renewed by the carrier,or materially changed except after thirty(30)days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non-renewal due to non-payment of premium. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Executive Director, Community Development Agency, 20 Civic Center Plaza M-25, Santa Ma, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. d. 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. e. 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. f. 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. g. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. h. 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. 7. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents,employees, contractors, special counsel,and representatives from liability: (1) for personal injury,damages,just compensation, restitution,judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons Page 4 of 10 acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution,judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages,just compensation, restitution,judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Contractor thither agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution,judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding.Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to,or relate to the negligence, recklessness, or willful misconduct of the Contractor. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent,trademark,or copyright infringement,including costs,contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 9. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 10. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance,but in no event less than reasonable care. "Confidential Information"shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered Page 5 of 10 by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that(a)has been disclosed in publicly available sources; (b)is,through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e) is independently developed by the Contractor without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interests and shall not have interests,direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Contractor shall not discriminate because of race, color,creed,religion, sex,marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the Parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The Parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof,shall not bind or obligate Contractor or the City. 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 is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. Page 6 of 10 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment,the Executive Director may require Contractor to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the Party waiving the breach, failure,right or remedy.No waiver of any breach,failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION-VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County,California,shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals,waivers,and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice,tender, demand,delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: Page 7 of 10 To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Michael Garcia, Executive Director, Community Development Agency City of Santa Ana 20 Civic Center Plaza(M-25) P.O. Box 1988 Santa Ana, California 92702 To Contractor: Maria Case, CEO Kompashion, Inc 2 MacArthur Place, Suite 250 Santa Ana, CA 92707 (714) 721-1353 A Party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal,state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. 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. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. Page 8 of 10 IN WITNESS WHEREOF,the Parties hereto have executed this Agreement the date and year first above written. ATT t ST: CITY OF SANTA AN a. ]ANr �� t ��:»1 i f end r H f c., Alvaro Nufiez Cit ler c Acting City Manager APPROVED AS TO FORM: SONIA R, CARVALHO CONTRACTOR: City Attorney n/' ( d,ac, ( . a2LE& By iitiu.„ 84,a____.— Andrea Garcia-Miller Maria Case Assistant City Attorney CEO Kompashion, Inc. RECOMMENDED FOR APPROVAL: r vri Michael Garcia Executive Director Community Development Agency Page 9 of 10 EXHIBIT A SCOPE OF SERVICES AND PROPOSAL \ N O © O N i N ® \ / N / - E x - Q r » m » = 3 \ - \ f % / ƒ ƒ EGGS \ & 3 % \ ® % 80 7 - S G \ R 0 ° - r N « $ 2k - a » & » y » CO } \ / C 2 f E a \ ; < ) \ < \ \ ? 3 0 [ / C j 0 c ) \ \ / \ \ � _ - o § % / E \ \ 0 \ a 0 \ \ § } j / t E - g t 2 e 2 , § \ \ / g lij j \ \ } \ @ ° « § 0 0 » -c ) 7 2 ) o 7 E 2 ( { § a - - \ \ - \ \ < ) o . § $ < sr: E G G 2 < G < 8 h > z > 16 > e z > z z i City of Santa Ma powered by Submittable 0 Title 0008 06/03/2024 by maria case in Mental Health Services Grant for id. 46683622 Santa Ana for Non-Profit Organization $50,000 maria@kompashion.com Original Submission 06/03/2024 Score n!,i Organization Name Kompashlon Name of Primary Maria Contact Case Mailing Address 2 MacArthur PI suite 250 Santa Ana CA 92707 US 33.70263 -117.86507 Telephone +17147211353 Email Maria@kompashion.com Website Www.kompashion.com Fiscal Sponsor Kompashion (optional if using a fiscal sponsor) Fiscal Sponsor Maria Contact Name Case Fiscal Sponsor +17147211353 Telephone Fiscal Sponsor Email Maria@kompashion.com • Non-Profit Yes Organization Determination Employer 87µ2017781 Identification Number 501(c)3 Designation 4/23/2024 Date (if applicable) Non-Profit Kompashion began as a non-profit on 4-23-24. Our launch event will be the Organization Emotional Wellness Fiesta at the Santa Ana College in conjunction with the Description Orange County Hispanic Chamber of Commerce. We have been bringing awareness to the event with local school talks and bringing personal development resources to the classrooms. As well as working with NAMI to help grow their latino outreach/ This grant will help our efforts to continue reaching out to the Santa Ana latino youth community. This grant will also help us maintain programs to guide the youth of Santa Ana dealing with mental health issues.. Brief Project Seminar with behavioral speakers to break the mental health stigma and Description offering local resources Statement of Our program aims to reach Santa Ana's youth through speaking Interest/ Need engagements, behavioral support, and various resources, providing clarity and solidarity in their journey to overcome struggles and realize they're not alone. Program Description Our initiative, in partnership with Nami, integrates behavioral expertise to enhance education and awareness of local programs and support groups. We're committed to deploying diverse strategies to empower individuals in their daily battles and uplift their mental well-being. Our primary focus is youth, aiming to address issues preemptively to prevent detrimental outcomes. Our launch event is set to welcome over 400 attendees, while our school presentations and resource distributions cater to classrooms of around 30-40 students at a time. Schedule of Our classroom discussions and resource distributions have been ongoing Activities/Timeline since April 2024. Our Emotion Wellness Event is scheduled for June 29th 2024, featuring a lineup of behavioral professionals and local community resource providers. Additionally, we'll have music and dance performances to maintain high energy and keep the youth engaged. Following the June event, we'll continue collaborating locally and reaching out to schools with NAMI, along with distributing our Kompashion resource curated support boxes Budget (upload) Emotional_Weliness_Fiesta_Budget.docx Letters of Support (upload) Letter_ofsupport_-_John_Amador.pdf Additional Information (optional) Reference Contact Orange County Hispanic Chamber Board Member/Vice President US Bank, Information John Amaclor, 209-598-6422, john.amador cusbank.com Emotional Wellness Fiesta Budget Trent - Keynote Speaker $15,000.00 Mariachi Band $1 ,000.00 Aztec dancers $1 ,000.00 Salsa dancers $500.00 DJ $500.00 Video/photographer $2,500.00 Attendees catering - 450 people $6,000.00 Breathwork facilitator $500.00 MC - Yesi Ortiz $1 ,500.00 Kompashion resource bags for attendees - 450 people $3,500.00 2 interpreters for 3 hours each and devices $1 ,500.00 Event coordinator $1 ,500.00 Ongoing Outreach NAMI collaboration Programs: breathwork, meditation, sound healing, music $15,000.00 events, Kompashion resource boxes, mental health work shops KOi ii°^§' Y' i.�l . }..,, 1- 35" `� r:V taiB..+ ;6;��;r,{ ';+.;ir;}rt ',v F.� 't"" : , .•yt,k39k ea {. 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'A, �fi ` '''sui^!x. s., ° w %crcsy a,: S , s a x r t R "a'1 r^� fit� t a+; ,t} 4f s is , A. v� t xbr1 ';L,4 3'r d -- • t'Yx w '4 T :t. `i Sr., S �wrt i3JJ' 01) °s*T£Pnjt7f Cn?"-''{ has, 'S.va�, w7i yt g?- 2 fir'?-"r s `'h§ #� }'iisF ,"r v�'L- s^ e �.':`t • it`t {,a,tw rc eJ 4(a ,xtA �•# y , .i' �+ 5. . Y } K x. Ain x+'t li YFy Y a!4 ytJFi. a ..,i r ' ,[ i,, t v-0 °4e,,A Pr.tA'�a kaxz x r. 9 4 r kaa_,a' u3' e,3fl a Gr3 s r i AnYh, » 1 y pflns,!f �r t t1, a 'i' 1. + rf.:.'' 7 j,'3 fi l ,' Y} x r'i,� �jss •".,5 v^`' A° , �5k ¢ <'r. a�-..,�.X 7 i 1. v`# i_ .3 Department of the Treasury Date: ivy Internal Revenue Service 05/0212024 IRSTax Exempt and Government Entitles Employer ID nu r: P,O. Box 2508 87-20177 Cincinnati, OH 45201 contact: Name:Customer Service ' ID number: 31954 Telephone:877 829.5500 KOMPASIIION INC Accounting period ending: 33 ESTERO POINTE December 31 ALISO, CA 92656 Form*90-PF required: yes Effective date of exemption: April 23, 2024 Addendum applies: No DLN: 26053516002234 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC)Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055,2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a private foundation within the meaning of Section 509(a). You're required to file Form 990-PF, Return of Private Foundation or Section 4947(a)(I)Trust Treated as Private Foundation, annually, whether or not you have income or activity during the year. If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.govicharities, Enter "4221-PF" in the search bar to view Publication 4221-PF, Compliance Guide for 501(0)(3)Private Foundations,which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, - 44&e a- . Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 1076 (Rev. 2.2020) Catalog Number 35101A ACC)RL>® DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 0 611 1/2 0 24 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 CIA • • • Brian Case(9715360) 4. PH 3607 S El Camino ReAn-q-ie A/C,NO,E 49-716-364 A/C,NO):949-498-7817 E-M IL • San Clemente AD- Ic .com INSURE AFFORDING COVERAGE NAIL# INSURED knof , su RA: Truck Insuran Exchange 21709 INS r e xchange 21652 KOMPASHION INC 33 ESTERO POINTE INsuR, c: Mid Century Insurance Company 21687 eved — • NS � • • ALISO VIEJO Ac --- INSURER F: COVERAGES CERTIFICATENI''nBEP • • RE SI N E UO THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA'E R'-A ISSUED TOTH E INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDTL SUBR POLICYNUMBER POLICY Err POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE N OCCUR PREMISES(Ea Occurrence) $ 75,000 X Professional Liability MED EXP(Any one person) $ 5,00 B Y Y 607081680 06/10/2024 06/10/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 4,000,000 X POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Fa accident) ANYAUTO BODILY INJURY(Per person) $ B OWNEDAUTOS SACOEDULED BODILY INJURY(Per accident)$ Y Y 607081680 06/10/2024 06/10/2025 HIRED AUTOS X NON-OWNED PROPERTY DAMAGE X ONLY AUTOSONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ 1,000,000 N/A EXECUTIVE OFFICER/MEMBER A09521216 06/10/2024 06/10/2025 B EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1 1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Santa Ana City,its officers,officials,employees,and volunteers are covered as additional insureds. This insurance coverage shall be primary coverage at least as broad as ISO CIS 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 Contractors insurance and shall not contribute with it.This policy grants 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 CERTIFICATE HOLDER CANCELLATION R1AMnnaganedDMs1c% " Clerk of the City Council,City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLI, ?% REVIEwED&APPROVEDBY: 20 Civic Center Plaza(M-30) DATE THEREOF NOTICE WILL BE DELIVERED It y �1 A�Acevedo P.O.BOX 1988 AUTORIZ€D REPR TATIVE ®' Risk Management Specialist Santa Ana CA 92702 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD