HomeMy WebLinkAboutASIAN AMERICANS ADVANCING JUSTICE SOUTHERN CALIFORNIA E VSURA-ITE UPI FILE
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6-095
L)AFE. MAY 0 7 2026
o:crko(k) CONSULTANT AGREEMENT BETWEEN THE CITE'OF SANTA ANA AND ASIAN
sttPaan��(ir �iuCoi) AMERICANS ADVANCING JUSTICE SOUTHERN CALIFORNLA
T141S AGREEMENT is made and entered into on this 20' day of March, 2026 by and
between Asian Americans Advancing Justice Southern California, a California Nonprofit
Corporation ("Consultant"), 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").
RECITALS
A. The City desires to retain a Consultant having special skill and knowledge in the field of
Immigration defense services.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant 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
Consultant 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 and set forth in Scope of Services - Exhibit A,
attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for
City, the rates and charges identified in Compensation - Exhibit B, attached hereto
and incorporated by reference.The total amount to be expended during the term of this
Agreement shall not exceed $50,000.
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. City and
Consultant agree that all payments due and owing under this Agreement shall be made
through Automated Clearing House(ACH)transfers. Consultant agrees to execute the
City's standard ACH Vendor Payment Authorization and provide required
documentation. Upon verification of the data provided, the City will be authorized to
deposit payments directly into Consultant'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.
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3. MONITORING AND EVALUATION
a. Consultant shall furnish,except where limited by attorney-client confidentiality,all
data, statements, records, information, and reports necessary for the City to
monitor, review and evaluate the performance of the Scope of Services and its
components. Consultant shall cooperate with the City in the conduct of any
evaluation of Consultant's Services. Consultant shall further cooperate to
incorporate minor modifications that may be discovered as necessary and
appropriate as a result from the monitoring and evaluation process.
4. PROGRAM COORDINATION
a. The City Manager or his or her designee shall monitor Consultant's progress and
performance of this Agreement.
b. Consultant shall assign a Program coordinator ("Consultant Coordinator") who
shall have overall responsibility for the performance of this Agreement by
Consultant. Should circumstances or conditions subsequent to the execution of this
Agreement require a substitute Consultant Coordinator,Consultant shall notify City
immediately of such occurrence. Consultant's staff shall cooperate fully with the
City with respect to all matters related to this Agreement.
c. Consultant's staff shall attend meetings as required or requested by City.
5. CONSULTANT'S FISCAL RESPONSIBILITIES; RETENTION OF MATERIALS
a. General Fiscal Responsibilities of Consultant. Consultant shall:
i. If applicable, appoint and submit to the City, the name of a fiscal
agent, who shall be responsible for the financial and accounting
activities of Consultant, including the receipt and disbursement of
the Funding installments.
ii, Establish and maintain a system of accounts for the Funding that
shall be in conformance with generally accepted accounting
principles. Such system of accounts shall be subject to review and
approval of the City.
iE Document all costs by maintaining complete and accurate records
of all financial transactions, including but not limited to contracts,
invoices, time cards, cash receipts, vouchers, canceled checks,bank
statements and/or other official documentation evidencing in-.proper
detail the nature and propriety of all charges.
iv. Submit to the City at such times and in such forms as the City may
require, such statements, records, reports, data, and information
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pertaining to matters covered by this Agreement.
b. Records of Consultant
i. Consultant shall maintain records of all matters related to this
Agreement including, but not limited to, books, financial records,
supporting documents, statistical records, personnel records,
property records, and all other pertinent records sufficient to reflect
properly:
(A)All direct and indirect costs of whatever nature claimed to
have been incurred and anticipated to be incurred in
performance of this Agreement.
(B)All other matters covered by this Agreement.
ii. Consultant shall preserve and make available its records:
(A)For the period of three (3) years from the date of expiration
or sooner termination of Agreement; or
(B) For such longer period, if any, as may be required by
applicable law.
c. Examination of Records. All such records and invoices shall be clearly
identifiable. Consultant 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. Consultant 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
Consultant under this Agreement.
d. Audits, fn the event that the City determines, from inspection of records, or any
other source, that there is a problem or discrepancy regarding Consultant's
compliance with the terms and conditions of this Agreement, including but not
limited to the Project Budget, then the City shall, in its sole discretion, have the
right to require an audit by an independent auditor at City's sole expense relating
to the Scope of Services and Consultant' compliance hereunder. Notwithstanding
the foregoing, the City shall have the right for any reason whatsoever to perform,
or cause to be performed an independent audit. Such audits may cover
programmatic as well as fiscal matters.
6. TERM
This Agreement shall commence on April 1, 2426 for a 1-year term, unless terminated
earlier in accordance with Section 19, below.
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7. RELATIONSHIP OF PARTIES
It is understood and agreed by and between the parties that Consultant in the performance
of this Agreement, shall not act nor is it at any time authorized to act, as the agent or representative
of the City in any matter. Consultant further agrees that it will not in any manner hold itself out as
the agent or representative of the City or act in such a fashion as would give the impression to a
reasonable person that Consultant is acting in such a capacity.
8. INDEPENDENT CONTRACTOR
Consultant 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 Consultant
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Consultant shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Consultant 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.
9. 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 Consultant under this Agreement ("Documents & Data"). Consultant
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.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant 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.
10. INSURANCE
Insurance requirements are attached hereto as Exhibit C, attached hereto and incorporated
by reference.
11. INDEMNIFICATION
Consultant 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
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personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Consultant, its subcontractors, agents, employees, or other persons
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 Consultant
further 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 Consultant'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 Consultant.
12. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant 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 Consultant to the City pursuant to this Agreement.
13. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant 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 Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant 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. Consultant 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 Consultant under this Agreement.
14. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant 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
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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
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
Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e)
is independently developed by the Consultant without reference to information disclosed by the
City.
15. CONFLICT OF INTEREST CLAUSE
a. Consultant 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.
b. No immediate family members of either the Mayor, City Council Member, or any
appointed City Official, including appointed board and commission members, as
defined under the City's Municipal Code, whose position with the City shall award or
influence the award of this Agreement, or any competing contract or amendment
thereof, shall be employed in any capacity by the Consultant or have any other direct
or indirect financial benefit or interest in this Agreement.
c. The section also prohibits the awarding of any agreement, contract, grant, or any
amendment to those awards, to any former full-time employee for one-year from date
of employee separation except for any Ca1PERS retiree as authorized by City Council
resolution
d. The Consultant must comply with all conflict of interest laws, ordinances, and
regulations now in effect or hereafter to be enacted during the term of this Agreement.
The Consultant warrants that it is not now aware of any facts which conflict with the
prohibitions defined above. If the Consultant hereafter becomes aware of any facts that
might reasonably be expected to create a conflict of interest, it must immediately make
full written disclosure of such facts to the City. Full written disclosure must include,
but is not limited to, identification of all persons implicated and a complete description
of all relevant circumstances. Failure to comply with the provisions of this paragraph
will be a material breach of this Agreement.
e. Consultant covenants that none of its directors, officers, employees, or agents shall
participate in selecting or administrating any subcontract supported(in whole or in part)
by City funds stemming from the Agreement where the awarding of the subcontract
has any direct or indirect financial benefit or interest to any individual, as defined in
subsections (b) and (c) above.
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16. NON-DISCRIMINATION
Consultant 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. Consultant affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
17. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, 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 Consultant. 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 Consultant 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.
18. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant 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 Consultants retained by City.
19. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant 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 Consultant 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
Consultant 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.
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20. 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.
21. 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.
22. PROFESSIONAL LICENSES
Consultant 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 rewired by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Consultant 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.
23. 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:
To City:
City Cleric
City of Santa Ana
20 Civic Center Plaza(M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
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With courtesy copies to:
City Manager's Office
City of Santa Ana
20 Civic Center Plaza (M-31)
P.O. Box 1988
Santa Ana, California 92702
To Consultant:
Kathy Khommarath
Institutional Giving Manager
Asian Americans Advancing Justice Southern California(AJSOCAL)
2401 East Katella Avenue,
Anaheim, CA, 92806
Fax: 213-977-7595
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.
24. 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.
[signature appear on the following page
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SIGNATURE PAGE TO CONSULTANT AGREEMENT BETWEEN THE CITY OF
SANTA ANA AND ASIAN AMERICANS ADVANCING JUSTICE SOUTHERN
CALIFORNIA
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST: ;; CITY OF ANTA AN
ennifer all Alvaro Nufiez
City C City Manager
APPROVED AS TO FORM;
SOMA R. CARVALHO CONSULTANT:
City Attorney
Jonathan T. Martinez Dahni Tsuboi
Assistant City Atto Chief Executive Officer
RECOMMENDED FOR APPROVAL:
Sylvia Vazquez
Deputy City Manager
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EXHIBIT A
SCOPE OF SERVICES
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AVIAN AMLH.It AN
4141
ADVANCING
JUSTICE
SOUTNFRN CALIFORNIA City of Santa Ana
Removal Defense Legal Services Scope of Services
Organizational Information
1. Organization: Asian Americans Advancing Justice Southern California(AJSOCAL)
2. Contact: Kathy Khornmarath
3. Contact Email: kkhornmarath@aisocal.org
4. Contact Phone Number: (213) 241-0213
5. Organization CEO; Dahni Tsuboi
6. Organization CEO Email: dtsuboi ajsocal.or
7. Tax ID Number/EIN: 95-3854152
Mission Statement & Organizational Overview
AJSOCAL is a social justice organization that protects and strengthens the rights and dignity of
Asian American and Pacific Islander(AAPI) communities, especially those that are most
disadvantaged. We are the nation's largest AAPI civil rights and legal services organization and
are directly embedded in the communities we serve across Southern California, working directly
with clients, community partners, and leaders. We deploy actionable programs and services that
provide an immediate impact on the issues that affect us. Our mission, programs, and capacity
are directly tied and built to respond to crises like the ones our immigrant communities are facing
today.
Project Overview
1. Project Title: AJSOCAL Removal Defense Legal Services in the City of Santa Ana
2. Proposed Project Duration: 12 months { March 1, 2026—December 31, 2026
3. Project Goals& Objectives
As part of this project, AJSOCAL shall serve as a consultant vendor to the City of Santa Ana that
will provide immigration and removal defense legal services and representation to residents of
the City of Santa Ana over the course of 12 months, or until AJSOCAL exhausts funding while
executing this project and the resulting agreement if awarded, whichever occurs first.
2401 East Katella Avenue,Suite 550,Anaheim,CA 92806 T 213-977-7500 F 213-977-7595 www.a;socaf.org
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Scope of Services
AJSOCAL, as consultant, at our discretion, shall provide services that may include, but not be
limited to, the following types of legal services:
1. Representation of an individual in any removal, exclusion, deportation, bond, or
expedited removal proceedings under section 212(d)(5)(A), 235(b)(1)(13), 236, 238, 240,
or 241, or in any matter related to any such proceeding before the U.S. Citizenship and
Immigration Services (USCIS), any State court, or any court created under Article III of
the Constitution of the United States.
2. Representation of a detained individual in a bond hearing, petition for writ of habeas
corpus, ICE detainer recession request, parole request, or in any other form to challenge
continued detention or conditions of detention.
3. Representation of an individual subject to removal in limited scope withholding-only
proceedings before a federal immigration judge.
4. Representation of an individual seeking relief from an Immigration Judge's final
administrative order in prior removal proceedings directly with the Immigration Court,
including via motions to reopen or reconsider.
5. Representation of an individual in state court proceedings related to removal defense or
immigration proceedings, such as proceedings regarding Special Immigrant Juvenile
Status and Post-Conviction Relief.
6. Representation of an individual at risk of removal before USCIS in standalone
affirmative immigration proceedings that are not ancillary to removal, exclusion,
deportation, or expedited removal proceedings, for the purpose of protection against
removal proceedings.
7. Representation of derivative family members in related immigration petitions or
applications.
S. Provision of limited-scope services to pro se individuals detained during or impacted by
immigration raids, such as conducting legal consultations, providing legal advice,
accompaniment to related appointments with the U.S. Department of Homeland Security
(DHS), preparing individuals for credible and reasonable fear interviews, and other
related services.
9. Appellate representation to individuals that AJSOCAL did or did not represent in
immigration court(prior to any appellate proceedings), should AJSOCAL determine that
such representation is warranted. This may include, but is not limited to:
a. Assistance in submitting Motions to Reopen to the Board of Immigration Appeals
(BIA), filing petitions for review, motions for stays of removal with the Federal
Court of Appeals for the Ninth Circuit(Ninth Circuit). Notwithstanding the
foregoing, AJSOCAL's decision to represent an individual before the
Immigration Court or the BIA does not obligate it to represent such an individual
Is before the Ninth Circuit.
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b. When warranted, offer and provide representation until the completion of
appellate cases before the BIA or Ninth Circuit.
AJSOCAL shall produce quarterly reports and be available to attend one in-person meeting,
including the following actions:
1. Provide quarterly reports, in a format prescribed by the City to City's Project Manager to
share progress on providing services under the agreed upon Scope of Services;
2. Consultant shall be prepared to attend at least one (1) in-person meeting with the City's
Project Manager and staff and/or City representatives as requested by the City.
AJSOCAL shall have the discretion to reallocate, repurpose, or modify the use of funds, within
the scope of the agreement's overall purpose, to address emergent and evolving immigration
legal needs of clients and immigrant communities. This flexibility is essential to ensure that
AJSOCAL remains effectively responsive to rapidly changing circumstances, including but not
limited to, shifts in federal immigration policy, community crises, urgent legal needs, or other
unforeseen immigration Iegal challenges impacting immigrant populations.
1. Any such modifications shall be communicated to the City in a timely manner with a brief
rationale outlining the nature of the change and its alignment with the agreement's intended
impact. AJSOCAL commits to maintaining transparency and accountability in all financial and
programmatic adjustments.
AJSOCAL will provide such services and engage in activities in this proposed scope of services
for a period of 12 months, or until AJSOCAL exhausts funding while executing this project and
the resulting agreement if awarded, whichever occurs first.
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EXHIBIT B
COMPENSATION
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Ch
Ch
LA
e
City of Santa Ana Removal Defense Budget
OrganiZolon: Asian Arnaleare Advancing Juatice Southom Cdfmils Pf p tad Budge! $49.999.80
Persomef Expwam
Base Annuai AmWI Emoe
@}�! (Base Annual I FIE on Fjogram Tatar(B tAF)•FTF
Salary x fnrvre X,1
Aram prgep
and provide
Juseph Naaalesl OC immigrabon Pr ram Director direct earvicas $132,509 $221552 0.05 $7 81 B
Evan Hu 181affAttame sen10ae 1 $105,624 $19012 0.10 $12 7ic
wde area
AINsa SuhaidilSlwffAtbm eeroc." $80042 3114,407 0.10 $9445
POW*drod
Sit-brans Trap!Loual Advacame ssvima 587 7f8 $15 7E9 O.OB S5 175
pro**5too
Moron Yen!Legal Advacate eervta $60 432 St 1.968 t05 S3,919
TOTAL PERSOflFL EXAEJI9E$ f39.087
OtharT11u1PerlwnriN ies TP£
' Deec ion f
Estimated coat of'Xmw Yaw R g is"ethnic media and
Advartsing and Marks social madre ads $2,000
Ofroa Epensas USPWO:iox SWO04,Poswe,Conds ps 5o
EsWinted can of proleamonaf trainers and bcl n"I
Professional Feet 1B0 su assistance
onc complicated immigmtim deimnlion mlalad
$1 000
Translation Expenses Vounce Estimated cast of tanalaion exlpenses $500
trine a Estimated%off mileage mirnbursements $250
ca ARaae 1s.00% $8,532
TOTAL OTPE EXPEME 5_ $10.932
TOTAL DUDGET $'MAM
EXHIBIT C
INSURANCE REQU1RMENTS
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Insurance Requirements
Prior to undertaking performance of work under this Agreement, Consultant 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 such insurance shall be borne by Consultant.
MINIMUM SCOPE AND LIMIT OF INSURANCE
l. 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
$2,000,000 per occurrence and $4,000,000 aggregate. Required policy limits can be met
with primary and umbrella/excess insurance policies.
2. Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1
(any auto), with limits no Iess than$1,000,000 combined single limits. In the event
Consultant does not maintain commercial automobile liability insurance, City will accept
evidence of personal automobile insurance,provided that such policy is endorsed for
business use and provides coverage with a minimum limit of$1,000,000, Required policy
limits can be met with primary and umbrella/excess insurance policies.
3. Workers' Compensation (WC): 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 if
Consultant has no employees and signs request to waive such insurance.
4. Professional Liability(PL) /Errors and Omissions(E&O): with limits no less than
$2,000,000 per occurrence or claim, and $2,000,000 aggregate.
5. If Consultant maintains broader coverage and/or higher limits than the minimum
requirements for each line of coverage shown, above, City requires and shall be entitled to
the broader coverage and/or the higher limits maintained by Consultant. Any available
insurance proceeds in excess of the specified minimum limits of insurance and coverage
shall be available to City.
Other Insurance Provisions
The above required 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 Consultant's CGL and AL policies, with respect to
any liability arising out of work or operations performed by or on behalf of the Consultant
including materials, parts, equipment, and personnel furnished in connection with such
work or operations.
#2166415vl
2. Consultant'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 Consultant's CGL,AL, and WC policies which arise from work
performed by Consultant under this Agreement.
3. For any claims related to this contract, Consultant'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
Consultant'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: (Name of Department Staff Responsible for Agreement), Address of
Department Responsible for Agreement,M-XX, Santa Ana, CA 92701. The name and
location of project must be included in the Description of Operations section of each
certificate.
Self Insured Retentions
Self-insured retentions must be declared to and approved by the City.The City may require the
Consultant 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.
Acceptability of Insurers
Insurance is to be placed with insurers authorized to conduct business in the State of California
with a current A.M. Best rating of no less than A:VII,unless otherwise acceptable to City.
Verification of Coverage
Consultant shall furnish 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 COL policy
listing all policy endorsements before work begins. However, failure to obtain the required
documents prior to the work beginning shall not waive Consultant's obligation to provide them.
City reserves the right to require complete, certified copies of all required insurance policies,
including endorsements required by these specifications, at any time.
Special Risks or Circumstances
{#2166415vl
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.
#2166415v1
ASIAAME-02 LPIER50N
,a►��Rp CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
3/16/2026
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 License#1_100460 CONTACT
NAME:
Knauf Maxwell Insurance Services —
2900 W.Broadway (AI°No,Ext)-(323)550-7900 _FAX No):(323)256-0800
Los Angeles, CA 90041 E-MAIL knaufrece
ADDREss: ption@kmins.com
� INsU ERfS)AFFORDING COVERAGE NAIL p
INSURER A:The Hanover Insurance ComMpa� 22292
INSURED �II
I 's uRER B:Service American Indemni
Asian Americans Advancing Justice Southern California t Corn 39152
(AJSOCAL) P1 URER C:
dba Asian Americans Advancing Justice Los Angeles INSURER D
1145 Wilshire Blvd.,Floor 2(Ste.200)
Los Angeles,CA 90017 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.
INSR ADODLi SiJBR� POLICY NUMBER LTR TYPE OF INSURANCE PM Q Y EFF�MLICDY EXP LIMITS
A X J COMMERCIAL GENERAL LIABILITY 1 000,000
EACH OCCURRENCE $ r
CLAIMS-MADE L�OCCUR X X ZH3H881263 111/2026 1 1/1/2027 DAAMAAGETO RENT ED 1a0 000
SES fEa-occurrence $
rIrD EXP(Any one_person $ 10,000
J FPERSONALSAbVINJURY $ 1,000,000
X 1 N'L AGGREGATE LIMIT APPLIES PER:POLICY�f PRO- . GENERAL AGGREGATE $ 2,006,000
n LOC P70P AGG `
1 JECT -- PRppUCTS-COM $ 2r000,aaa
OTHER: SEXUAL ABUSE I 1,000,000
'Q AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,00a
~ Ea acciden(] $ r
CANY AUTO ZH3H881263 1/112026 1/1/2027 BODILY INJURY Pe erspn)
DWNED SCHEDULED ���
AIR DS ONLY I AUTOS BODILY INJURY(Per accident $
�X�AUTOS ONLY X AUTOSNON-O N ONLY
PROPERTY DAMAGE AUTOS ONLY ;fir accidence_ $
$
A X UMBRELLA LIAR X DCCUR 4,t}aa,aaa
EACH OCCURRENCE $
. EXCESS LIAR CLAIMS-MAOE IUH3H881266 1/1/2026 1/1/2027
DE D X RETENTIDN$ Q� �GGREGRTE _ $
Aggregate 4,000,000
g WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY x' STATUTE OERH
ANY PROPRI ETC RIPARTNE RIEXEC UTIVE YIN X ISATIS0395705 1/112026 111/2027 1,aD0,0.0a
FFIC El MBER EXCLUDED? NIA E.L.EACH ACCIDENT $
Mandatory in NH) —_ 1oao oea
If yes,describe under E.L DISEASE-EA EMPLOYE ,
$ r
DESCRIPTION OF OPERATIONS below
A Prof.Liability ZH3H881263 ' E.L.DISEASE-PDLICYUMIT $ 1-000,000
A Sexual Abuse 111l2026 111/2027 'Occurrence
ZH3H881263 1/1/2026 1/1/2027 Occurrence 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Commercial Crime Coverage
Hiscox Insurance Company APPROVED
Policy#UC24277726.26 BY TO Tran Nguyen at 9:28 am,Mar 20,2026
Effective 111126-111127 Employee Theft$1,000,000 Deductible$5,000
Third Parties'Property$1,000,000 Deductible$5,000
Physical Abuse,Sexual Misconduct or Sexual Molestation Liability Coverage
SEE ATTACHED AGORD 101
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Santa Ana,its Officers,Agents,and Employees,Risk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Management ACCORDANCE WITH THE POLICY PROVISIONS.
20 Civic Center Plaza
Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
I
y
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION.. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
ASIAAME-02 LPIERSON
LOC#: 1
AC 0 Q+ ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY License#L100460 NAMED INSURED
Asian Americans Advancing Justice Southern California(AJSOCAL)
Knauf Maxwell Insurance Services dba Asian Americans Advancing Justice Los Angeles
1145 Wilshire Blvd.,Floor 2(Ste.200)
POLICY NUMBER Los Angeles,CA 96017
EE PAGE 1
NAIr CODE
CARRIER
SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER; ACORD 25 FORM TITLE: Certificate of LiabilityInsurance
Description of Operations/LocativnsNehicles:
Hanover Insurance Company
Policy#ZH3H881263-05
Effective 111126-111127
Each Incident Limit$1,000,000
Aggregate$2,000,000
Lawyers Professional Liability-Errors&Omissions
NLADA Mutual Insurance Company
Policy#LPL100108-03
Effective 111126-111127
Each Claim$3,000,000
Aggregate$3,000,000
Deductible$2,500
Retro Date 211186
Directors&Officers Liability
HDI Global Specialty SE
Policy#FRSHPML00015084-01
Effective 111126-1/1127
Directors&Officers$1,500,000 Deductible$50,000
Employment Practices$1,500,000 Deductible$50,000
Fiduciary Liability$500,000 Deductible$0
Cyber Insurance
QBE Specialty Insurance Company
Policy#AB6772205-03
Effective 111126-111127
Each Claim$3,000,000
Deductible: $10,000
and Wa Waiver of ubrogatio applies as respects General Liability cove agesmy as percers, officials,employees,agent , and t Additional insured
Council,its the attached endorsementseers are also included as .
O 2008 ACORD CORPORATION. All rights reserved.
ACORD 101 (2008101)
The ACORD name and logo are registered marks of ACORD
Policy# CH3 H881263 05
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUMMARY OF COVERAGES
1. Additional Insured by Contract, Agreement or Permit Included
2. Additional Insured — Primary and Non-Contributory Included
3. Blanket Waiver of Subrogation Included
4. Bodily Injury Redefined Included
5. Broad Form Property Damage —Borrowed Equipment, Customers Goods & Use of Elevators Included
6. Knowledge of Occurrence Included
7. Liberalization Clause Included
8. Medical Payments—Extended Reporting Period Included
9. Newly Acquired or Formed Organizations - Covered until end of policy period Included
10. Non-owned Watercraft 51 ft.
11. Supplementary Payments Increased Limits
- Bail Bonds $2,500
- Loss of Earnings $1000
12. Unintentional Failure to Disclose Hazards Included
13. Unintentional Failure to Notify Included
This endorsement amends coverages provided under the Commercial General Liability Coverage Part through
new coverages, higher limits and broader coverage grants.
1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s)
Permit designated in the contract, agreement or
The following is added to SECTION II — WHO IS permit;
AN INSURED: (2) Premises you own, rent, lease or occupy;
Additional Insured by Contract, Agreement or or
Permit (3) Your maintenance, operation or use of
a. Any person or organization with whom you equipment leased to you.
agreed in a written contract, written agreement b. The insurance afforded to such additional
or permit that such person or organization to insured described above:
add an additional insured on your policy is an (1) Only applies to the extent permitted by
additional insured only with respect to liability law; and
for "bodily injury", "property damage", or
"personal and advertising injury" caused, in (2) Will not be broader than the insurance
whole or in part, by your acts or omissions, or which you are required by the contract,
the acts or omissions of those acting on your agreement or permit to provide for such
behalf, but only with respect to: additional insured
421-2915 06 15 Includes copyrighted material of insurance Services Office, Inc.,with its permission Page 1 of 4
Policy# ZH3 H881263 05
(3) Applies on a primary basis if that is advertising injury" involved the rendering
required by the written contract, written of or failure to render any professional
agreement or permit. services by or for you.
(4) Will not be broader than coverage d. With respect to the insurance afforded to
provided to any other insured. these additional insureds, the following is
(5) Does not apply if the "bodily injury", added to SECTION III — LIMITS OF
"property damage" or "personal and INSURANCE:
advertising injury" is otherwise excluded The most we will pay on behalf of the
from coverage under this Coverage Part, additional insured for a covered claim is the
including any endorsements thereto lesser of the amount of insurance:
c. This provision does not apply: 1. Required by the contract, agreement or
(1) Unless the written contract or written permit described in Paragraph a.; or
agreement was executed or permit was 2. Available under the applicable Limits of
issued prior to the "bodily injury', "property Insurance shown in the Declarations.
damage", or "personal injury and This endorsement shall not increase the
advertising injury". applicable Limits of Insurance shown in the
(2) To any person or organization included as Declarations
an insured by another endorsement 2. Additional Insured — Primary and Non-
issued by us and made part of this Contributory
Coverage Part. The following is added to SECTION IV —
(3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY
(a) After the equipment lease expires or CONDITIONS, Paragraph 4.Other insurance;
(b) If the "bodily injury', "property Additional Insured — Primary and Non-
damage", "personal and advertising Contributory
injury" arises out of sole negligence of If you agree in a written contract, written
the lessor agreement or permit that the insurance provided to
(4) To any: any person or organization included as an
(a) Owners or other interests from. whom .Additional Insured under SECTION II — WHO IS
land has been leased which takes AN INSURED, is primary and non-contributory,
place after the lease for the land ex- the following applies:
pires; or If other valid and collectible insurance is available
(b) Managers or lessors of premises if: to the Additional Insured for a loss covered under
Coverages A or H of this Coverage Part, our
(i) The occurrence takes place after obligations are limited as follows:
you cease to be a tenant in that a Primary Insurance
premises; or
n The "bodilyinjury", "property
damage'°, "personal injury" This insurance is primary to other insurance
( ) or that is available to the Additional Ensured
which covers the
"advertising injury arises out of
structural alterations, new con- Additional Insured as a Named Insured. We
struction or demolition operations will not seek contribution from any other
performed by or on behalf of the insurance available to the Additional Insured
manager or lessor. except:
(5) To "bodily injury", "property damage" or (1) For the sole negligence of the Additional
"personal and advertising injury" arising Insured;
out of the rendering of or the failure to (2) When the Additional Insured is an
render any professional services. Additional Insured under another primary
This exclusion applies even if the claims liability policy; or
against any insured allege negligence or (3) when b. below applies.
other wrongdoing in the supervision,
If this insurance is primary, our obligations are
hiring, employment, training or monitoring
of others by that insured, if the not affected unless any of the other insurance
"occurrence" which caused the "bodily is also primary Then, we will share with all
injury" or"property damage" or the offense that other insurance by the method described
which caused the "personal and In c. below.
421-2915 06 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 4
Policy# ZH3 H881263 05
b. Excess Insurance insurer contributes equal amounts until it has
(1) This insurance is excess over any of the paid its applicable limit of insurance or none of
other insurance, whether primary, excess, the loss remains, whichever comes first. If any
contingent or on any other basis: of the other insurance does not permit
contribution by equal shares, we will contribute
(aJ That is Fire, Extended Coverage, by limits. Under this method, each insurer's
Builder's Risk, Installation Risk or share is based on the ratio of its applicable
similar coverage for"your work"'; limit of insurance to the total applicable limits
(b) That is Fire insurance for premises of insurance of all insurers
rented to the Additional insured or 3. Blanket Waiver of Subrogation
temporarily occupied by the Additional
Insured with permission of the owner, The following is added to SECTION IV —
COMMERCIAL GENERAL LIABILITY
(c) That is insurance purchased by the CONDITIONS, Paragraph 8. Transfer Of Rights
Additional Insured to cover the Of Recovery Against Others To Us:
Additional Insureds liability as a
tenant for "property damage" to We waive any right of recovery we may have
premises rented to the Additional against any person or organization with whom you
Insured or temporarily occupied by the have a written contract that requires such waiver
Additional with permission of the because of payments we make for damage under
owner, or this coverage form. The damage must arise out of
your activities under a written contract with that
(d) If the loss arises out of the person or organization. This waiver applies only to
maintenance or use of aircraft, "autos" the extent that subrogation is waived under a
or watercraft to the extent not subject written contract executed prior to the "occurrence"
to Exclusion g, of SECTION I — or offense giving rise to such payments.
COVERAGE A — BODILY INURY
AND PROPERTY DAMAGE 4. Bodily Injury Redefined
LIABILITY. SECTION V — DEFINITIONS, Definition 3. "bodily
(2) When this insurance is excess, we will injury" is replaced by the following:
have no duty under Coverages A or B to 3. "Bodily injury" means bodily injury, sickness or
defend the insured against any"suit" if any disease sustained by a person including death
other insurer has a duty to defend the resulting from any of these at any time "Bodily
insured against that "suit", If no other injury" includes mental anguish or other
insurer defends, we will undertake to do mental injury resulting from "bodily injury",
so, but we will be entitled to the insured's 5. Broad Form Property Damage — Borrowed
rights against all those other insurers.
Equipment, Customers Goods, Use of
(3) When this insurance is excess over other Elevators
Insurance, we will pay only our share of a. SECTION I —COVERAGES,COVERAGE A—
the amount of the loss, if any, that BODILIY INJURY AND PROPERTY
exceeds the sum of: DAMAGE LIABILITY, Paragraph 2.
(a) The total amount that all such other Exclusions subparagraph j, is amended as
insurance would pay for the loss in the follows:
absence of this insurance, and Paragraph (4) does not apply to "property
(b) The total of all deductible and self damage" to borrowed equipment while at a
insured amounts under all that other jobsite and not being used to perform
insurance. operations.
We will share the remaining loss, if any, Paragraphs (3), (4) and (6) do not apply to
with any other insurance that is not "property damage" to "customers goods" while
described in this Excess Insurance on your premises nor do they apply to the use
provision and was not bought specifically of elevators at premises you own, rent, lease
to apply in excess of the Limits of or occupy.
Insurance shown in the Declarations of b, The following is added to SECTION V —
this Coverage Part. DEFINTIONS:
c. Method Of Sharing 24. "Customers goods" means property of
If all of the other insurance permits your customer on your premises for the
contribution by equal shares, we will follow this purpose of being
method also. Under this approach each
421-2915 06 15 Includes copyrighted material of Insurance Services Office, Inc_with its permission. Page 3 of 4
Policy# ZH3 H881263 05
a. wormed on; or 10. Non-Owned Watercraft
b. used in your manufacturing process. SECTION I — COVERAGES, COVERAGE A
c, The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGELIABILITY, Paragraph 2. Exclusions,
excess over any other valid and collectible
subparagraph g.(2) is replaced by the following'.
property insurance (including deductible)available to the insured whether primary, g• Aircraft, Auto Or Watercraft
excess, contingent (2) A watercraft you do not own that is:
6. Knowledge of Occurrence (a) Less than 51 feet long; and
The following is added to SECTION IV — (b) Not being used to carry persons or
COMMERCIAL GENERAL LIABILITY property for a charge,
CONDITIONS, 'Paragraph 2. Duties in the Event This provision applies to any person who,
of Occurrence, Offense, Claim or Suit: with your consent, either uses or is
e. Notice of an "occurrence", offense, claim or responsible for the use of a watercraft.
"suit" will be considered knowledge of the 11. Supplementary Payments Increased Limits
insured if reported to an individual named
insured, partner, executive officer or an SECTION I — SUPPLEMENTARY PAYMENTS
"employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and
a notice. 1.d. are replaced by the following:
7. Liberalization Clause 1.b.Up to $2,500 for cost of bail bonds required
The following is added to SECTION IV — because of accidents or traffic law violations
COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which
CONDITIONS: the Bodily Injury Liability Coverage applies.
We do not have to furnish these bonds.
Liberalization Clause 1.d.AII reasonable expenses incurred by the
If we adopt any revision that would broaden the insured at our request to assist us in the
coverage under this Coverage Form without investigation or defense of the claim or "suit",
additional premium, within 45 days prior to or including actual loss of earnings up to $1000 a
during the policy period, the broadened coverage day because of time off from work.
will immediately apply to this Coverage Part. 12. Unintentional Failure to Disclose Hazards
8. Medical Payments — Extended Reporting The following is added to SECTION IV
Period COMMERCIAL GENERAL LIABILITY
a. SECTION I—COVERAGES,COVERAGE C— CONDITIONS, Paragraph 6. Representations:
MEDICAL PAYMENTS, Paragraph 1• We will not disclaim coverage under this Coverage
Insuring Agreement, subparagraph a.(3)(b) Part if you fail to disclose all hazards existing as of
is replaced by the following: the inception date of the policy provided such
(b) The expenses are incurred and reported failure is not intentional.
to us within three years of the date of the 13. Unintentional Failure to Notify
accident; and
b. This coverage does not apply if COVERAGE The following is added to SECTION IV —
C —MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY
by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event
endorsement. of Occurrence, Offense, Claim or Suit:
S. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be
prejudiced if you fail to give us notice of an
SECTION II —WHO IS AN INSURED, Paragraph ..occurrence", offense, claim or "suit", solely due to
3.a. is replaced by the following: your reasonable and documented belief that the
a. Coverage under this provision is afforded until "bodily injury` or "property damage" is not covered
the end of the policy period. under this policy.
ALL CTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED.
421-2915 06 15 Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 4 of 4
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA
We have the right to recover our payments from anyone liable for an injurycovered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per-
form work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
The additional premium for this endorsement shall be 0 . 02 0 % of the California workers'compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization
Blanket waiver of subrogation as required by written
Job Description
contract
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Date:01/01/2 0 2 6 Policy No. SAT I S 0 3 9 5 7 0 5 Endorsement No.
Policy Effective Date: 01/01/2026 to 01/01/202 7 Premium $
Insured: Asian Americans Advancing Justice Southern California
DBA:
Carrier Name/Code: Service American Indemnity Company
Countersigned by
WC 04 03 06
(Ed.4-84)
Page 1 of 1