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HomeMy WebLinkAboutOLIVE CREST 1ECity of Santa F j g Clerk of the Council AGREEMENT TERMINATION FORM A i"It —- (.®T� ce— Use Only ✓C Q Ti . 5 = j Please complete this form when the attached agreement and all U01 YWL amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-2520 if you have any questions. The agreement with �!zi 7 7-1 � �� Ci �% was completed on and final payment has been made. No.(List all amendments. Use space below if needed.) Department: /r—s Phone/Ext.: K- 5 3 8 Signature: (J aa Date: 5 Revised 04-12-10 A-2011-221-01 P, UIT ,2 FOURTH AMENDMENT TO AGREEMENT BETWEEN THE CITY OF SANTA ANA AND OLIVE CREST FOR THE USE OF HOMELESSNESS PREVENTION AND RAPID REHOUSING GRANT FUNDS 4 THIS FOURTH AMENDMENT TO AGREEMENT is entered into on the day of vFebruary 2012, by and between Olive Crest, a California non-profit corporation ("Subrecipient") 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"). J RECITALS: A. The parties entered into that certain Agreement Between the City of Santa Ana and Olive CJ Crest for Use of Homelessness Prevention and Rapid Rehousing Grant Funds (Program Year 2009-10), dated September 30, 2009, (hereinafter "said Agreement") by which Subrecipient has been providing support to the homeless youth or those who are at risk for homelessness. B. On September 7, 2010, said Agreement was amended to decrease services and funding for this Subrecipient based on expenditure rates and projections as to whether each grantee could meet the HPRP statutory requirement that grantees expend 60% of its award funds within 2 years of the date that the U.S. Department of Housing and Urban Development ("HUD") signed the grant agreement. C. The City's HPRP program requires that grantee's expend 100% of its award funds by June 20, 2012. HUD may recapture and reallocate unused HPRP funds if grantee cannot meet this requirement. Said Agreement was further amended on January 3, 2011 and August 24, 2011. D. Based upon current expenditure rates and projections as to whether each grantee can meet the requirements stated herein, the parties hereto have agreed to this amendment to further decrease services and the amount of Homelessness Prevention grant funds. WHEREFORE., in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this Third Amendment to Agreement, the parties agree as follows: 1. The Budget that is referenced in the Agreement as "Exhibit B" shall be amended and replaced with a revised Exhibit B due to this Amendment. 2. Section VI, A. "Agreement Amount", the amount of the Homelessness Prevention grant shall be reduced by $40,000, due to the reduced services. 3. Except as hereinabove amended, all teens and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Fourth Amendment to Agreement on the date and year first written above. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: City Attorney By: LISA E. STORCK Assistant City Attorney CITY OF SANTA ANA PAUL WALTERS Interim City Manager SUBRECIPIENT Olive Crest i lf�affi-e: E ±____ T D 1 r 0- l."'t P. • ► e-w- 1<L1J\ Title: $ C-ro Tax ID: 3.5 _ a g -7 -1 / o �L_ 2 Organization Name Place an X : Final Budget (Exhibit B) Olive Crest Treatment Centers, Project Independence Homelessness Prevention Rapid Rehousing�� Expenditures Category Expenses Funded by Santa Ana Expenses Funded by Other Sources Total Program Budget Administration Administrative Staff Salaries & Benefits $ 2,025.18 $ 2,025 Other: List below 1 $ _ 2 $ _ 3 $ _ 4 $ _ 5 $ _ Total $ 2,025.18 $ - $ 2,025 Housing Relocation and Stabilization Services Case Management $ 48,747.25 $ 48,747 Outreach and Engagement $ - $ - Housing Search and Placement $ 1,879.00 $ 1,879 Legal Services $ - $ - Credit Repair Counseling $ - $ - Total $ 50,626.25 $ - $ 50,626 Financial Assistance Rental Assistance $ 140,674.07 $ 140,674 Utility Payments $ 774.50 $ 775 Deposits $ 900.00 $ 900 Moving Costs $ _ Motel/Hotel Vouchers $ - $ Total $ 142,348.57 $ - $ 142,349 Program Total $ 195,000.00 $ - $ 195,000 LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED (Total Funds for Program must equal Total Program Budget above) Source Amount Santa Ana HPRP $ 195,000 Total Funds for the Program $ 195,000 Page 1 of 1 Client#: 28768 20LIVCRE ACORM CERTIFICATE OF LIABILITY INSURANCE DATE (MMI)D/YYYY) 09/16/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must 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 Willis Insurance Services of CA Inc 3536 Concours, Suite 220 Ontario, CA 5594 License #0371719 719 NcAO.NTA:cT Dottie Adams AIC�Ne E„t 909476-3300 ac Nc: 909-084-5184 E-M IL AODREs , dorothy.adams@willis.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Ins Co 118058 INSURED Olive Crest INSURER B: Philadelphia Indemnity Ins Co 23850 2130 E. 4th St., Ste. 200 Santa Ana, CA 92705 INSURERC: INSURER D: 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 CONTRACTOR 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. VTR TYPEOFINSURANCE INSR S UBN WVD POLICYNUMBER MINDDYEFF MPIM1DDYEXP LIMITS A GENERAL LIABILITY PHPK766115 9/01/2011 0910112012 EACH $1,000,000 X: COMMERCIAL GENERAL LIABILITY ��OCCURRENCE PREMISES E,,oMEOrence $1,000,000 CLAIMS -MADE I OCCUR MED EXP (Any one pe on) s20 000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG s3,000,000 POLICY P QT LOC $ AUTOMOBILE LIABILITY PHPK766115 9/01/2011 09/01/201 McINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per awident) $ X MIRED AUTOS )( NON -OWNED AUTOS PROPERTY DAMAGE Per a " dent $ S B I UMBRELLA LIAR IX OCCUR PHUB357623 9/01/2011 09101/2012 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 X EXCESS LIAR CLAIMS -MADE DED I X RETENTION $10000 $ WORKERS COMPENSATION WC STATIJ I OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT S EL. DISEASE - EA EMPLOYEE'S (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below i E-L. DISEASE - POUCY UMIT $ A ABUSE PHPK766115 9/01/2011 09/01/201 $1,000,000 / $1,000,000 A PROFESSIONAL LIAB PHPK766115 9/01/2011 09/011201 $1,000,000 I $3,000,000 A EE DISHONESTY PHPK766115 9/01/2011 09/01/201 $500,000 / $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Grant Certificate Holder is Additonal Insured per'Additional Insured Endorsement for Commercial General Liability Policy' attached 10 Day Notice of Cancellation for Non Payment of Premium City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REP SENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S856106/M854076 APPROVED AS TO FORM P. LISP s.. STORCK Assistant City Attorney, 2DADA ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company PHILADELPHIA INDEMNITY INSURANCE COMPANY This endorsement modifies such insurance as is afforded by the provisions of Policy # PHPK766115 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 902701; its officers, employees, agents, volunteers and representatives are named as additional insured ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 09/01/2011 TO 09/01/2012 , this endorsement form as a part of Policy # PHPK766115 Issued to OLIVE CREST Named Insured Countersigned by A-Tff , AtQ4-. Authorized Representative APPRO D AS TO FOAM 1 1SA i . STORCK Assistant City Attorney.