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Home My WebLink AboutWISE PLACE 6 - 2002 INSURANCE ON FILE WORK MAY PROCEED UNTIL IrUrNCE EXPIRES I I O~ CLERK Of ~OUNCIL DATE. 7/Llo ~ e-; got;,,,,...J THIS AMENDMENT, made and entered into this J!!:-day of.1U/~ 2003, by and between WISE p-A PLACE, a California nonprofit organization ("Subrecipient") and the of the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). '-' ~ AMENDMENT TO AGREEMENT FOR USE OF EMERGENCY SHELTER GRANT FUNDS ~-20ol' Ott3- K-/ RECIIALS A. The City and Subrecipient entered into that certain Agreement Between the City of Santa Ana and WISE PLACE for the Use of Emergency Shelter Grant Funds dated April I, 2002, hereinafter referred to as "said Agreement", for Subrecipient to receive Emergency Shelter Grant Funds (ESG) in the amount of Seventy Five Thousand Dollars ($75,000.00) for the operation of an emergency shelter program for the homeless. B. The parties hereto now desire to amend the amount of the grant to increase it with an additional Five Thousand Five Hundred Dollars ($5,500) for this fiscal year. This additional money is part of prior year funding that had been awarded to three subrecipients that were unable to expend their entire grant amounts in the federally mandated 24-month period. C. City Council authorized this reallocation at its regular meeting of April 7, 2003. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: I. The total Grant Award to Subrecipient will be amended to include the additional Five Thousand Five Hundred, for a total grant award of Eighty Thousand Five Hundred Dollars ($80,500) in ESG funds. 2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST: .~ ~ .. -'" ~. ~J.....,., P ATRlCIA E. HEALY ~ Clerk of the Council CITY OF SANTA AN AV .REAM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER SUBRECIPIENT -WISE PLACE d.L[~ By: Lisa E. Storck Assistant City Attorney &w~~~ Name: p.....:./-AI (u. Da}vi:s. !3ocJ.>n...., Title: E:. X. Eeu/,'Vf. 7),'"fl-cJo r l ') - ..... 4F1!-.?u02 - 013 /5 ACO@. . CERTIFICA'~ OF LIABILITY INSUF\..NC~si';l~ m1 DATE {MMtDDfYV) - :01/17/03 -. l~UCER THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE dvanced Insurance Marketing HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR .0. Box 4459 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. range CA 92863-4459 INSURERS AFFORDING COVERAGE hone:714-997-8100 .- - 5UREO INSURER A: Philadelphia Indemni tv Ins CO. INSURER B: Wiseplacer a Ca Corp INSURER c: 1411 N. Broadwa1 INSURER 0: Santa Ana CA 92 06 I INSURER E. JVERAGES 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 ',.lAY PERTAIN, THE INSURANCE AFFORDED BYTHE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ;:i TYPE OF INSURANCE POLICY NUMBER b~W:C7Mif,b~~E Pr?A~~~~~~m?N LIMITS LGENERAl LIABILITY EACH OCCURRENCE '1,000,000 . rxl COMMERCIAL GENERAL llABIUTY PHPK039141 01/01/03 01/01/04 FIRE DAMAGE (Anyone fire) , 100,000 ITI CLAIMS MADE ~ OCCUR MEa EXP (Anyone person) -'-.1_~,<U>Q___1 ~- .. ...------ PERSONAL & ADV INJURY , 1,000,000 , GENUGG~nE ;;:'~T APnS PER GENERAL AGGREGATE '2,000,000 PRODUCTS - COMP/OP AGG '2,000,000 POllCY JECT LOC .. ~TOM081LE LIABILITY COMBINED SINGLE LIMIT , ~ ANY AUTO PHPK039141 01/01/03 01/01/04 (Eaacddent) C- ALL OWNED AUTOS BDDIL Y INJURY , 1,000,000 SCHEDULEO-AUTOS (Per person) I-- I-- HIRED AUTOS BODILY INJURY (Per accident) , I-- NQN-DWNED AUTOS I-- PROPERTY DAMAGE , (Per accident) RRAGE LIABILITY AUTO ONLY. EA ACCIDENT , ANY AUTO OTHER THAN EA ACC , I AUTO ONLY: AGG , ~CESS LIABILITY EACH OCCURRENCE , 1,000,000 X OCCUR 0 CLAIMS MADE PHUB015081 01/01/03 01/01/04 AGGREGATE '1,000,000 I , f;:j DEDUCTIBLE , X RETENTION , 10,000 , i WORKERS COMPENSATlON AND APPi~OVEl l\S -10 I" bRM I TORY llMrrsl IU~~- , EMPLOYERS' LIABILITY I ~.l. EACH ACC.IOENT , I ,i%J~ft I , ri!~ E.L DISEASE - EA EMPLOYE , 7?f. E.L DISEASE - POLICY LIMIT , I OTHER LaUfi.! :)lJl"<.:Jy ( I DepulY City ^,ll()rncy i i i SCRIPTION OF OPERAT10NS/lOCATIONSNEHICLESJEXCLU510NS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS en Day Notice of Cancellation for non-payment/non-reporting/ The City of , 1 r are named as ~nta Ana, 1t s off1cers. agents, employees, and vo untee s jditional insured per attached Additional Insured Endorsement. cRTIFICATE HOLDER i y I ADDITIONAL INSURED; INSURER LETTER: SANTAAN CANCELLATION CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY M-25 MICHAEL GARCIA P.O. BOX 1988 SANTA ANA CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT!O DATE THEREOF, THE ISSUING INSURER WILL MAll ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, AUTHO ~~ E ATIVE :ORD 25-S (7/97) @ACORD CORPORATION 1988 , . F eb :0'4 03 '. MON I"EB 03 , FROM: 7149971994 - (7' 542-3653' '....I PACE . po2 10:32a 2003 Id I' 03:33 ~ lace 2 ADDITIONAL INSURED ENDORSEMENT fOK COMMERCIAL CtNERAL LIA~ILrTY POLICY Insurance Company PhUadelphia Insurance This cndorsemer.t modifies such insurance co is a"orded by the pro'lis;o(\! OT Potiq if PHPK0391~1 rel;;.ting \0 the follOWIng' 1. The City of Santa M~ 20 Civic Center PI.oza. $2I1ta M~. C..litorrja 92701 , its ot:icers, employees, agentS and represen'"I,vES ~re n2meO "-5 additional insureds \<idditionaJ insuredsO) with regard to Iietilhy end ceiense of suitS erising frcm !Jle oper;:tions 2nd uses performed by or on ber.elf of \~e n<!meC insured. 2. Witil respect to cl2ims ~risi"g out of It.e Gperc.tions 2..d uses performed by cr on b~M!f of U'\E named insured, such insurance as ls aiiorced by lhis policy is prim2ry 2fld is not additional to or contribUting "ith eny cl-'c( murmce canied by or lor tile oeneflt uC the addition.::1 insureds. 3. This inSUl"Ql1ce appliES sepcrately to ~:dl insured 2gcinst whom cl:;im is made or sui: is brought except witrl respect to l'1.. COIT.pany's limits of Uabffity. Tne indusion at aITi person or organi%.Sicn as an insu~ec shalt not affect Cfly right which such pGrson or arQanizetion would have 2S 2 de!marit r. . ,I so induCed. 4. \'-lilh respect 10 tile additional insureds, :r Js reur2l1Ce shell not be cancell ed. or materlally rec\tx:l!d in coverage or limitS except <"~r lhirty (30) days written notice has been given 10 the City 0; Santa M:;, 20 Civic Cema P!cz2, SCflla Ana..Ceiliamia 92701. (CompletIon ot the following, Including counH'C';r;nature, i$ required 10 make Ihis endorsement eflective.) EHective 01101103 . 11;$ endorsemenl form as a part ot Policy '# PHPK039141 ISSUEd 10 W;,eplace, A California Corp. Named Insured Coenter::Ji;ncd b~ ..--i1.r)v I\. n,<. ,-- I:'; . )- r.,...~) f"_:;H).~ized Repr&'sent.a.ti.ve: APFROVED AS '10 FORM Ih~ ~J.2~ ;)~;~_Cii_.!~_/\ I :l'_rll;,'V ~. """ 'wi INSURED: POLICY NUMBER: EFFECTIVE DATE: Wiseplace, a Ca Corp PHPK039141 01101/03 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: City of Santa Ana Community Development Agency M-25, its officers, agents, employees and 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 liahility arising out of your operations or premises owned by or rented to you. APPROVED AS 10 FO/{I".! CG 20 26 I I 85 NOV 07; 2,(102 11 : 25 AM FROM: 7149971994 rt- L.UUI ...UlC'~. 1 PAGE 2 'wi ' '-' CERTIFICATE HOLDER COPY STATE P.o. BOX 420807. SAN FRANCISCO, CA 94142.0807 COMPENSATION INSURANCE FUN 0 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE NOVEMBER 7. 2002 GROUP: 000488 POLICY NUMBER: 679-2002 CERTIFICATE 10: 2 CERTIFICATE EXPIRES: 08-15-2003 08-15-2002108-15-2003 CITY OF SANTA ANA CO}~NITY DEVELOPMENT AGENCY M-25 P.O. BOX 1988 SANTA ANA. CA 92702-1988 This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice 10 the employer. We \ViII also give you 30 days advance notice should this policy be cancelled prior 10 its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or aller the coverage afforded by the polidas listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certifICate of insurance may be issued or may pertain, the insurance afforded by Ihe policies described herein is subject to all the tenms. exclusions. and conditions. of such pOlicies. ~ I{~ PRES DENT AUTliOAIZED REPRESENTATIVE EMPLOYER'S LIABILITY LIMIT INCLUDI~G DEFENSE COSTS: $1,000,000 PER OCCURRENCE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-15-2002 IS ATTACHED TO AND FORMS A PART OF THTS POLICY. ru d<.OYbD AS 1U d.h,. . L~:/d) Deputy City Attorney EMPLOVER WlSEPLACE. A CA CORP 1411 N BROADW.~ Y , ... ~-200')..- I. - ~ ~ ~r/., 0 /lCORD. CERTIFICJ..t..: OF LIABILITY INSlJ....t .NC~ISg~l~ PJ ""'-OATE (MM/D01YY) 01/04/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Advanced Insurance Mark&ting HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 4459 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orange CA 92863-4459 'f 0.."1- QQ"l-r'i9'-! INSURERS AFFORDING COVERAGE Phone: 714-997-8100 INSURED INSURER A Philadelnhia Insurance CO. INSURER B: Clarendon National Wiseplace, a Ca Corp INSURER c: 1411 N. Broadwa~ INSURER D: ,santa Ana CA 92 06 INSURER E: 6~ 5~ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '~f~ TYPE OF INSURANCE POLICY NUMBER I 6i~~TMM/DDrvY)- DATE MMlDDfYY LIMITS ~NERAL LIABILITY EACH OCCURRENCE .1,000,000 A X COMMERCIAL GENERAL LIABILITY PHPKOl7702 01/01/02 01/01/03 FIRE DAMAGE (Anyone fire) .100 000 I CLAIMS MADE ~ OCCUR MED EXP (Any on8 person) .10,000 - PERSONAL & ADV INJURY .1,000,000 - G=NERALAGGRF.GATE .2,000,000 ~'L AGG~EnE ~~M: APnS PER: PRODUCTS - COMPIOP AGG .2,000,000 POLICY JECT LOC ~TOMOBILE LIABIlITY COMBINED SINGLE LIMIT . A ~ ANY AUTO PHPKOl7702 01/01/02 01/01/03 (Eaaccident) f.- ALL OWNED AUTOS BODILY INJURY .1,000,000 SCHEDULED AUTOS (Per person) I- APi'ROVED AS TO FO ~M ~ HIRED AUTOS BODILY INJURY Ll21 (Per accident) . Santa Ana ~ NON-OWNED AUTOS ~ '!r JAY..ec PROPERTY DAMAGE . CAn {Peraceident) GARAGE LIABILITY Deputy City All Drney AUTO ONLY - EA ACCIDENT . - R ANY AUTO OTHER THAN EAACC . AUTO ONLY: AGG . EXCESS LIABILITY EACH OCCURRENCE .1,000,000 A ~ OCCUR 0 CLAIMS MADE PHUBOO7205 01/01/02 01/01/03 AGGREGATE .1,000,000 . ;::i DEDUCTIBLE . X RETENTION .10 000 . WORKERS COMPENSATION AND I rci'R~'u~YTS I IU~lt B EMPLOYERS' L1ABIUTY SCTQT004070801 08/15/01 08/15/02 E. L. EACH ACCIDENT .1000000 E.L. DISEASE - EA EMPLOYEE . 1000000 I E.L. DlSE.;Sl; - roucy LIMIT .1000000 OTHER DESCRIPTION OF OPERATlONSlLOCATIONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS Ten Day Notice of Cancellation for non-payment/non-reporting/ The City of Santa Ana, it's officers. agents, employees, and volunteers are named as additional insured per attached Additional Insured Endorsement. CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SANTAAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TIO DATE THEREOF, THE ISSUING INSURER WILL MAIL ~ DAYS WRITTEN CITY OF SANTA ANA COMMUNITY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, DEVELOPMENT AGENCY M-25 MICHAEL GARCIA ~TWE P.O. BOX 1988 SANTA ANA CA 92702-1988 , COVERAGES ACORD 25-S (7/97) @ACORDCORPORATION 1988 -,Feb 28 02 03: 'l3p WISEPlace (714)542-3653 -p.2 "-' ~ FEA. ~. 2002 4: 2'2PM P 3 rnrJM : P<>n:l.Scn,c ~ KXlUllIT B ADDITiONAL WSURF.n F.NDORSEMEN1: FOR COMMERCIAL GENERAl LTAIlIW'V POLICY .Insurance Compllljl Philadelphia fnsurllnce This cndOl'icmcnl modifies such wurancc as is afforded by the PMvisicns of P"liey # PHPKDl77D2 relating 10 the following: . I. . lbeCilyofSanla Ana, 2() Ch.ic Cemer:l>lll2a, SanmAna, Ddlfomia 92701; it. of!iCfJfS, emp~yees, agents, volunteeril and representatives are natlltd u' additional insureds' ("additional Wuroda") with ~pnl to liabill!)' an<i dc/i:nso orsuils arlsinS!om u,., operations and \LIC8 perfOl!D.ed by at on behal f of the nam~ illS1.lml, 2. With RS~llo claiJIu lIrisi"l! out "rim OPenlt;<ln' ond \lS..s petfotmed by or o~, bebalf oflbe n:mcd insured, such insurance .. ;" affurded by thi. policy I, primuy and is not additiOllal1o or conlrib'Jling with any o!beT insuranc. carried by or for the benefit oflhe addjliol\J.1 insureds. 3. Thi~ insurance applies separately 10 each insured aB"ill$l whom chUm is mtde or suit is brought except with. Wlpeet to tho eolllpany'.limits of liability. The inclusion of any pOl1OIl or Ql"GlIlIimtion as lIt1 inaurcd e1~1I not affect any right whioh .ueh p.rson or or~""iz"tjon would have as a claimant if nol "" included. 4. With ra'p~Gt lolhe additiOlUll jllSuteds, this in$unnee shall not bo GanceJl~d, or materially reduced in ""vcrago or linlit. except .Il.r tIlfrty (30) days written notice It.. !teen given \Q !he City of Sana Mil, 20 cM. Center PI=. Sena Ana, California 92701. (0)mpl.tloll ofth. following, illc!OO;"S oounler.:ipolure, j. c"'1\Urcd to 1I1~ thi. endo",""",,! . ef!l!ctivl.) Effective 01/Dl102 --' this endor$el1Ient fonn as a pa.rt of Poliey II PHPK017702 ISSUe<! to WISEPLACE, A CA CORP/SOUTH ORANGE COUNTY YWCA. Named Insured Connter.li8n~ hy AS TO FORM