Loading...
HomeMy WebLinkAboutINTERVAL HOUSE (11)INSURANCE NOT ON FILE WORK MAY DJ PROCEED CLERK OF COUNCIL 00DATE: JUL 2 G td19 Oa oq P', L t,�rrt �aJ'�5 EMERGENCY SOLUTIONS GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND INTERVAL HOUSE (24 CFR Parts 91 and 576) A-2019-088-01 THIS GRANT AGREEMENT, is hereby made and entered into this , 2019, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California, herein called the "CITY', and INTERVAL HOUSE, a California nonprofit organization, herein called the "SUBRECIPIENT". RECITALS: 1. The CITY is the recipient of Emergency Solutions Grant ("ESG") funds from the United States Department of Housing and Urban Development ("HUD"), pursuant to subtitle B of title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. I t 371-11378], for the rehabilitation or conversion of buildings for use as emergency shelter for the homeless, for the payment of certain expenses related to operating emergency shelters, for essential services related to emergency shelters and street outreach for the homeless, and for homelessness prevention and rapid re -housing assistance. Catalogue of Federal Domestic Assistance ("CFDA") 14.231 and Federal Award Identification Number (FAIN) E-19-MC-06-0508. 2. The CITY has approved the provision of federal funds under the ESG to be used in the operation of an emergency solutions program ("program") for the homeless or at -risk of homelessness of the City of Santa Ana as farther described by Exhibit A, Scope of Work; attached hereto and by this reference incorporated herein. 3. The SUBRECIPIENT represents that it has the requisite qualifications, expertise, and experience in the provision of emergency solutions programs for the homeless or at -risk of homelessness and is willing to use said federal finds to operate said program. 4. The SUBRECIPIENT agrees to assist individuals and families that are homeless or at risk of homelessness in obtaining appropriate supportive services including, but not limited to: temporary and permanent housing, relocation and stabilization services, rapid re -housing assistance, medical and mental health treatment, counseling supervision, and other services essential for achieving independent living. 5. The SUBRECIPIENT has agreed to be reimbursed for the above services in an amount not to exceed $36,315 in grant funding for Shelter, Outreach Services, Rapid Re -Housing or Homeless Prevention. 6. This AGREEMENT is contingent upon the award of Emergency Solutions Grant funds from the United States Department of Housing and Urban Development, 7. The CITY and the SUBRECIPIENT have duly executed th s AGREEMENT for the expenditure and utilization of said funds. NOW THEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of this AGREEMENT and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire AGREEMENT between the CITY and the SUBRECIPIENT: I. SCOPE OF PROGRAM A. General Administration The SUBRECIPIENT agrees to implement this activity as set forth in detail in Exhibit A, Scope of Work, which shall provide a description of each activity, including the services to be performed, the person or entity providing the service, the estimated number of recipients of the service, and the manner and means of the services. B. Levels of Accomplishment — Goals and Performance Measures The SUBRECIPIENT shall be responsible to accomplish the levels of performance as set forth in Exhibit A and report such measures quarterly to the CITY. If the SUBRECIPIENT estimates such goals will not be met, the SUBRECIPIENT is to contact the CITY, at which time the CITY will determine if any adjustments to the grant award is appropriate. C. Staffm The SUBRECIPIENT shall ensure adequate and appropriate staffing is allocated to each ESG activity. Nothing contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. II. TERM OF AGREEMENT This AGREEMENT shall take effect on July 1, 2019, and shall terminate on June 30, 2020, unless otherwise cancelled or modified according to the terms of this AGREEMENT. IIl. DISBURSEMENT AND FUNDS The City was allocated $493,582 in Emergency Solutions Grant funds under the McKinney-Vento Homeless Assistance Act for fiscal year 2019-2020 from the Department of Housing and Urban Development. CITY agrees to pay to SUBRECIPIENT when, if and to the extent federal funds are received under provisions of the Act a sum not to exceed $36,315 for SUBRECIPIENT'S performance in accordance with the Budget attached hereto as "Exhibit B" during the period of this Agreement. Said sum shall be paid after CITY receives invoices submitted by SUBRECIPIENT as provided hereinabove. A. Amount and Expenditure End Date The CITY agrees to reimburse the SUBRECIPIENT a maximum amount not to exceed $36,315 from Emergency Solutions Grant (ESG) funds, as outlined in Exhibit B, Final Budget, and such funds shall be expended by the SUBRECIPIENT on or before June 30, 2020. SUBRECIPIENT has the ability to adjust line item amounts in the Budget with the written approval of the CITY's Executive Director of the Community Development Agency, so long as the total Budget amount does not increase. B. Invoicing Procedures The SUBRECIPIENT shall submit quarterly invoices (on or before the 15"' day of October, January, April, and July) in a form prescribed by the CITY, detailing such expenses. Such schedule may be modified with the approval of the CITY. C. Payment Payment is subject Co the receipt and approval of such invoices and quarterly activity reports, as hereinafter more fully set forth below under Reporting, with the final payment subject to the satisfaction of the condition precedent of submittal of complete invoicing and reporting information clue on or before July 15 of the applicable funding year. The CITY shall pay such invoices within thirty (30) days after receipt thereof, provided the CITY is satisfied that such expenses have been incurred within the scope of this AGREEMENT and that the SUBRECIPIENT is in compliance with the terms and conditions of this AGREEMENT. The thirty (30) day period will discontinue if the reimbursement request is determined to be incomplete and will restart the thirty -day timeline once the remaining required elements have been submitted. Failure to provide any of the required documentation and reporting will cause the CITY to withhold all or a portion of a request for reimbursement until such documentation and reporting has been received and approved by the CITY. D. Use of Funds The SUBRECIPIENT agrees to use said funds pursuant to this AGREEMENT to pay for necessary and reasonable costs allowable under federal law and regulations to operate said program only. Said amounts shall include and will be limited to, street outreach, emergency shelter, homelessness prevention, rapid re -housing assistance, housing relocation and stabilization services, short-term and medium -term rental assistance, and Homeless Management Information Systems ("HMIS") data contribution as set forth in 24 CFR § 576.101 — § 576.107. Allowable program costs are detailed in the Budget, as set forth in Exhibit B, attached hereto and by this reference incorporated herein. The SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this AGREEMENT, result in readjustment of the amount of funds the CITY is otherwise obligated to pay to the SUBRECIPIENT pursuant to the terms hereof. The SUBRECIPIENT agrees that the homeless shelter/services under said program shall be available for the entire period during which said funds are provided. E. Condition of Funding (1) The CITY advises the SUBRECIPIENT that a significant change in entitlement funding may result in a change in the current process utilized by the CITY to determine funding allocations. The SUBRECIPIENT acknowledges that the obligation of the CITY is contingent upon the availability of Federal, State or Local government funds, which are appropriated or allocated for the payment of such an obligation. If funding levels are significantly affected by Federal budgeting or if funds are not allocated and available for the continuance of the function performed by the SUBRECIPIENT, this AGREEMENT may be terminated by the CITY at the end of the period for which funds are available. At the earliest opportunity, the CITY shall notify the SUBRECIPIENT of any service which may be affected by a shortage of funds. No penalty shall accrue to the CITY in the event this provision is exercised and the CITY shall not be liable for any damages as a result of termination under this provision of this AGREEMENT. Nothing herein shall be construed as obligating the CITY to expend funds in excess of appropriations authorized by law. (2) The SUBRECIPIENT shall allow representatives of the CITY or HUD to inspect facilities which are used in connection with the AGREEMENT or which implement programs funded under this AGREEMENT. F. Matching The SUBRECIPIENT is required to make matching contributions to supplement the ESG program in an amount that equals or exceeds the amount of ESG funds provided by HUD through the CITY. Such contributions shall be entirely consistent with the Matching Requirements as outlined by 24 CFR § 576.201. The anticipated source and amount of all matching funds contributed by the SUBRECIPIENT will be enumerated in Exhibit B, Final Budget. G. Program hicome (1) Definition. Program income means, as provided by 2 CFR 200.80, gross income received by the SUBRECIPIENIdirectly generated by a grant supported activity, or earned only as a result of the grant agreement during the grant period. For purposes of ESG, program income will also include any amount of a security or utility deposit returned to the SUBRECIPIENT. (2) Use. The SUBRECIPIENT shall use all income received from said funds only for the same purposes for which said funds may be expended pursuant to the tenns and conditions of this AGREEMENT. (3) Counts toward Matching. Costs paid by program income may count toward meeting the matching requirements, provided the costs are eligible ESG costs that supplement the program. H. Separation of Accounts All funds received by the SUBRECIPIENT from the CITY pursuant to this AGREEMENT shall be maintained separate and apart from any other funds of the SUBRECIPIENT, or of any principal or member of the SUBRECIPIENT, in an account (the "Account') at a federally insured banking or savings and loan institution with record keeping of such Accounts maintained pursuant to applicable legal requirements. The SUBRECIPIENT shall keep all records of the Account in a manner that is consistent with generally accepted accounting principles. No monies shall be withdrawn from the Account except for expenditures relating to essential services, homeless prevention, and/or operations costs, as authorized hereunder. All disbursements from the Account shall be for obligations incurred in the performance of this AGREEMENT and shall be supported by contracts, invoices, vouchers, and other data, as appropriate, evidencing the necessity of such expenditure. The CITY may withhold payment allocation requests if the SUBRECIPIENT fails to comply with the above requirements until such compliance is demonstrated. Expenditure of Funds Much like how HUD requires the CITY, pursuant to 24 CFR 576.203, to expend all of the grant funds for eligible activity costs within 24 months after the date that HUD signs the grant agreement with the CITY, it is a requirement for the SUBRECIPIENT to expend all of the grant funds for eligible activity costs within the aforementioned period. For the purposes of this paragraph, expenditure means either an actual cash disbursement for a direct charge for a good/service or an indirect cost, or the accrual of a direct charge for a good/service or an indirect cost. Failure to expend said funds within said timeframe can result in a reallocation of funds. J. Prohibited Use (1) Generally. The SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this AGREEMENT to pay for meals for persons other than those identified as homeless or at risk of homelessness. Said funds shall not be used for entertainment purposes or for gifts. The SUBRECIPIENT certifies that it will not use said farads for illegal or dishonest conduct, rather, fund use will remain in compliance with all applicable federal, state, and local laws, including applicable laws not outlined in this AGREEMENT. (2) Lobbying. The SUBRECIPIENT certifies and agrees that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, loan, or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of IV, 19 Congress in connection with awarding of any 'federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. The SUBRECIPIENT shall sign a certification to that effect in a form as set forth in Exhibit C, attached hereto and by this reference incorporated herein. The SUBRECIPIENT shall submit said signed certification to the CITY prior to performing any of its obligations under this AGREEMENT and prior to any obligation arising on the part of the CITY to pay any sums to the SUBRECIPIENT under the terns and conditions of this AGREEMENT. If any fiords other than Federal appropriated fiends have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit a 'Disclosure Form to Report Lobbying," in accordance with its instructions (see Exhibit D). NOTICES The SUBRECIPIENT and the CITY agree that all notices required by this AGREEMENT shall be made in writing and delivered via mail (postage prepaid); commercial courier; personal delivery; or sent by facsimile or other electronic means (provided that receipt is confirmed). Any notice delivered or sent as aforesaid shall be effective on the date of delivery or sending. All notices and other written communications under this AGREEMENT shall be addressed to the individuals in the capacities indicated below, unless modified by subsequent written notice. Communication and details concerning the AGREEMENT shall be delivered to the office of, and directed to, the following representatives: Terri Eggers Sr. Comtur ity Development Analyst City of Santa Ana Community Development Agency (M-25) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702-1988 (714)647-5378 (714) 647-6549 FAX [eU�ersi �r.�santa-ana. ors* GENERAL CONDITIONS A. Coordination with Continuum of Care SUBRECIPIENT: Carol Williams Executive Director Interval House P.O. Box 3356 Seal Beach, CA 90740 562-594-9492 The SUBRECIPIENT must work with the Continuum of Care ("CoC") to ensure the screening, assessment, and referral of program participants are consistent with the CITY's written standards for providing ESG assistance as described in its consolidated plan. The SUBRECIPIENT mast keep documentation evidencing the use of, and written intake procedures for, the centralized or coordinated assessment system(s) developed by the CoC in accordance with the requirements established by HUD. See 24 CFR 576.400. B. Evaluation of Program Participants Eligibility and Needs The SUBRECIPIENT must conduct evaluations and re-evaluations to determine the eligibility of each individual or family's eligibility for ESG assistance in accordance with 24 CFR 576.401. C. Terminating Assistance If a program participant violates program requirements, the SUBRECIPIENT may ternvnate the assistance in accordance with a formal process established by the SUBRECIPIENT that recognizes the rights of individuals affected. See 24 CFR 576.402 D. Shelter and Housing Standards The SUBRECIPIENT certifies that shelters and housing supported by ESG funds and used by ESG beneficiaries will conform to 24 CFR 576.403. E. Homeless Involvement The SUBRECIPIENT certifies that it will involve, to the maximum extent practicable, homeless individuals and families in constructing, renovating, maintaining, and operating facilities assisted under the ESG program, and in providing services for occupants of these facilities. See 24 CFR 576.405(c) and 42 USC I I375(d). F. Independent Contractor Nothing contained in this AGREEMENT is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. The SUBRECIPIENT and its subcontractors shall at all times remain independent contractors with respect to the services to be performed under this AGREEMENT. The CITY shall be exempt from payment of any Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance as the SUBRECIPIENT is an independent contractor. G. Subcontracts (1) Content Requirements. The SUBRECIPIENT will include all relevant provisions of this AGREEMENT in all subcontracts entered into as part of the activities undertaken in furtherance of this AGREEMENT and will take appropriate action pursuant to any subcontract upon a finding that the subcontractor is in violation of regulations issued by any federal agency. The SUBRECIPIENT will not subcontract with any entity where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR Part 135 (Economic Opportunities for Low- and Very Low -Income Persons) and will not allow any subcontract unless the entity has first provided it with a preliminary statement of ability to comply with the requirements of these regulations. (2) Submission to the CITY. The SUBRECIPIENT must submit all subcontracts and other agreements that relate to this AGREEMENT to the CITY. H. Licensing The SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation, and inspections from all agencies governing its operations. The SUBRECIPIENT shall ensure that its staff and subcontractors shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing the SUBRECIPIENT's operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. I. Responsibilities Toward Employees The SUBRECIPIENT accepts full responsibility for payment of any and all unemployment compensation, insurance premiums, workers' compensation premiums, income tax withholdings, social security withholdings, and any and all other taxes or payroll withholdings required for all employees engaged in the performance of the work and activities authorized by the AGREEMENT. The SUBRECIPIENT accepts full responsibility for providing workers with proper safety equipment and taking any and all necessary precautions to guarantee the safety of workers or persons otherwise affected. J. Insurance and Bonding (1)Generally. The SUBRECIPIENT shall maintain liability and property insurance to cover actionable legal claims for liability or loss which are the result of injury to or death of any person, or damage to property (including property of Grantee) caused by the negligent acts or omissions, or negligent conduct of the SUBRECIPIENT, its employees, agents or subcontractors, to the extent permitted by law, in connection with the activities pursuant to this AGREEMENT. The SUBRECIPIENT shall comply with the bonding and insurance requirements of 2 CFR 200,427, and 2 CFR 200.447. The SUBRECIPIENT shall undertake self-insurance, or shalt obtain, at its sole cost, a policy or policies of commercial general liability insurance, or equivalent form. Such insurance shall: (1) name the City of Santa Ana, its officers, agents, employees and volunteers as additional insureds; (2) be primary with respect to insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of insureds provisions; and (4) give to the CITY prompt and timely notice of claim made or suit instituted arising out of the SUBRECIPIENT's operations hereunder. (2) Limits, The SUBRECIPIENT shall maintain, at all times, the following minimum levels of Insurance, and shall, without in any way altering its liability, obtain, pay for, and maintain insurance for the coverages and amounts of coverage not less than those set forth below: a. Workers' Compensation. Amount must comply with State and Federal Laws b. Comprehensive General Liability. $1,000,000 combined single limit of liability for bodily injuries, death, and property damage resulting from any one occurrence, including the following coverages: Prenuses and Operations; and Broad Form Commercial General Liability Endorsement to include blanket contractual liability (specifically covering, but not dinited to, the contractual obligations assumed by the SUBRECIPIENT); Personal Lijury (with employment and contractual exclusions deleted); and Broad Form Property Damage coverage. C. The SUBRECIPIENT's self -insured retention or deductible per line of coverage shall not exceed $25,000 without the permission of the CITY. (3) Proof of Insurance. The SUBRECIPIENT shall furnish the CITY's Clerk of the Council with an insurance certificate from insurance carrier certifying that it carries such insurance and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior notice to the CITY. The SUBRECIPIENT shall, prior to exercising any right under this AGREEMENT: a. furnish properly executed certificates of insurance and additional insured endorsement to the CITY which shall clearly evidence all coverage required above; b. provide that such insurance shall not be materially changed or terminated except on thirty (30) days prior written notice to the CITY; c, maintain such insurance for the period covered by this AGREEMENT; and d. replace such certificates for policies expiring prior to the expiration of this AGREEMENT. (4) Company Rating. All insurance coverage shall be written with a company having an A.M. Best Rating of "A" or better and financial size of VIII or larger. (5) Failure to Comply. In the event of any failure by the SUBRECIPIENT to comply with these provisions, the CITY may, after notice to the SUBRECIPIENT, suspend the program for cause until there is Full compliance. K. Zoning. The SUBRECIPIENT agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should the SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local, state, or federal rules and regulations relating thereto, the SUBRECIPIENT shall immediately make good -faith efforts to gain compliance with local, state, or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. The SUBRECIPIENT shall notify the CITY immediately of any pending violations. Failure to notify the CITY of pending violations, or to remedy such known violation(s), shall result in termination of grant funding hereunder. The SUBRECIPIENT must make all corrections required to bring the facility/property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. L. Displacement and Relocation. The SUBRECIPIENT must assure that it has taken all reasonable steps to minimize displacement of persons. Relocation must be consistent with requirements as set forth in 24 CFR § 576.408. M. Provisions Required by Law Deemed Inserted. Each and every provision of law and clause required by law to be inserted in this contract shall be deemed to be inserted herein and the AGREEMENT shall be read and enforced as though it were included herein, and if through mistake or otherwise any such provision is not inserted or correctly inserted, then upon the application of either party the contract shall forthwith be physically amended to make such insertion or correction. VI. ASSURANCES AND CERTIFICATIONS A. Non -Profit Status The SUBRECIPIENT certifies that: (1) The SUBRECIPIENT is a duly organized and existing non-profit corporation in good standing and authorized to do business under the laws of the State of California and in possession of required non-profit status under the United States Internal Revenue Code [for example, 26 USC § 501(e)(3)]. The SUBRECIPIENT has full right, power, and lawful authority to accept the funding hereunder and to undertake all obligations as provided herein and the execution, performance, and delivery of this AGREEMENT by the SUBRECIPIENT has been fully authorized by all requisite actions on the part of the SUBRECIPIENT. (2) If the SUBRECIPIENT's non-profit status changes at anytime during this AGREEMENT, it will advise the CITY within 15 days. (3) If the SUBRECIPIENT is a private non-profit, it hereby agrees that the members of its Board of Directors will receive no compensation, directly or indirectly, other than reimbursement for expenses, from any funds generated from or because of the ESG program, for their services. (4) As a non-profit, the SUBRECIPIENT acknowledges that administration of its operation and services are subject to the requirements as established in 2 CFR 200. B. Adherence to Federal. State and Local Laws and Regulations (1) General. The SUBRECIPIENT agrees to comply with all requirements of the ESG program and applicable cross -cutting Federal, State, and Local requirements. (2) Economic Opportunities for Low- and Very Low-income Persons. The SUBRECIPIENT shall ensure that employment and other economic opportunities generated by the Program shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly those who are recipients- of government assistance for housing. Section 3 of the Housing and Urban Development Act of 1968, 12 U.S.C. 1701u, and regulations at 24 CFR part 135 apply, except that homeless individuals have priority over other Section 3 residents in accordance with § 576.405(c), (3) Civil Rights. The SUBRECIPIENT agrees to comply with Title VI of the Civil Rights Act of 1964, as amended, Title VIII of the Civil Rights Act of 1968, as amended, Section 109 of the Title I of the Housing and Community Development Act of 1974, Section 504 of the .Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and 41 CFR Chapter 60. (4) Nondiscrimination and Equal Employment Opportunity. During the performance under this AGREEMENT, the SUBRECIPIENT shall not discriminate against any employee or applicant for employment based on race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familial status, sexual orientation, or any other basis prohibited by applicable law. The SUBRECIPIENT shall take affirmative action to ensure that all applicants and employees are treated without regard to race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familial status, and sexual orientation. The SUBRECIPIENT shall comply with all provisions of Executive Order 11246, Equal Employment Opportunity, as amended by Executive Orders 11375 and 12086. (5) Nondiscrimination and Equal Opportunity in Participation. The requirements in 24 CFR part 5, subpart A are applicable, including the nondiscrimination and equal opportunity requirements at 24 CFR 5.105(a). The SUBRECIPIENT shall not discriminate against any participant on the ground of race, color, creed, religion, sex, age, handicap, disability, ancestry, national origin, marital status, familiar status, sexual orientation, or any other basis prohibited by applicable law. The SUBRECIPIENT shall, through affirmative outreach, make known that use of the facilities, assistance, and services are available to all on a nondiscriminatory basis. The SUBRECIPIENT must take appropriate steps to ensure effective communication with persons with disabilities. (6) Americans with Disabilities Act. The SUBRECIPIENT agrees to comply with any federal regulations issued pursuant to compliance with the Americans with Disabilities Act which prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, State and Local government services, and public accommodations. (7) Fair Housing. Under section 808(e)(5) of the Fair Housing Act, HUD has a statutory duty to affirmatively further fair housing. HUD requires the same of its funded sub -recipients. The SUBRECIPIENT has a duty to affirmatively further fair housing opportunities for classes protected under the Fair Housing Act. C. Falsification of Information The SUBRECIPIENT represents and warrants that it has made no false statements to the CITY in the process of obtaining this award of the ESG Funds. D. Drue Free Workplace The SUBRECIPIENT represents and warrants that it has established the following drug -free workplace policy: (1) The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace for any employee involved in a federally funded program. (2) As an employee working in conjunction with a federally funded program, the employees of the SUBRECIPIENT will be required to: a. Abide by the terms above in statement (1), and b. Notify the appropriate SUBRECIPIENT authorities and CITY officials of any criminal drug statute conviction for a violation occurring in the workplace. Such notification shall be made no later than five (5) days after conviction. (3) The CITY and the United States Department of Housing and Urban Development will be notified within 10 ten days after receiving notice of any such violation. (4) Within thirty (30) days of receiving such notice, appropriate personnel action will be taken against such employee, up to and including termination. (5) Each such employee shall be required to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or Local health, law enforcement, or other appropriate agency. E. Religious Organization The SUBRECIPIENT may not engage in inherently religious activities, such as worship, religious instruction, or proselytization as part of said program or services. If the SUBRECIPIENT conducts such activities, the activities must be offered separately, in time or location, from said programs or services, and participation must be voluntary for the program participants. The SUBRECIPIENT shall not, in providing program assistance, discriminate against a program participant or prospective program participant on the basis of religion or religious belief. If the SUBRECIPIENT is a religious organization, it retains its independence from Federal, State, and Local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that the religious organization does not use direct ESG funds to support any inherently religious activities. The SUBRECIPIENT agrees that rehabilitation of structures by the religious organization in connection with said program must be in sound accord with the provisions under 24 CFR § 576.406. F. Additional Terms between the CITTY and IlUD The SUBRECIPIENT agrees further that it shall be bound by the standard terms and conditions used in the Grant Agreement between HUD and the CITY and such other rules, regulations, or requirements as HUD may reasonably impose in addition to the aforementioned assurances at or subsequent to the execution of this AGREEMENT by the parties hereto. G. OSHA Where employees are engaged in activities not covered under the Occupational Safety and Health Act of 1970, they shall not be required or pernutted to work, be trained, or receive services in buildings or surroundings of under working conditions which are unsanitary, hazardous, or dangerous to the participants' health or safety. H. Hatch Act The SUBRECIPIENT agrees that no funds provided, nor personnel employed under this AGREEMENT, shall be in any way or to any extent engaged in the conduct of political activities in violation of the Hatch Act, 5 U.S.C. Section 1501 et seq. 11 I. Davis -Bacon Act All laborers and mechanics employed by contractors or subcontractors in the performance of construction work, including alterations and repairs, in excess of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5. Further, the payroll reports (along with the "Statement of Compliance") and basic records are required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless there is on file with the agency a certification by the contractor that the contractor and its subcontractors have complied with the provisions of 29 C.F.R. §5.5. A breach of the contract clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations shall be made as necessary to assure compliance. See 29 C.F.R. §5.6(a)(3). VII. ADMINISTRATIVE REQUIREMENTS A. Generally The following requirements and standards must be complied with: 2 CFR Part 200, et al. SUBRECIPIENT shall procure all materials, property, or services in accordance with the requirements of 2 CFR 200.318-326. B. Procurement (1) Compliance. The SUBRECIPIENT shall comply with current HUD and, CfpY policies concerning the procurement of equipment, goods, and services, and shall maintain inventory records of all non -expendable personal property as defined by such policy as may be procured with funds provided herein. The SUBRECIPIENT shall report to the CITY all program assets (unexpended program income, property, equipment, etc.), and upon the CITY' S request, such assets shall revert to the CITY upon termination of this AGREEMENT. (2) Pursuant to 2 CFR 200.331 (a) (4), the Indirect Cost Rate for the SUBRECIPIENT's award shall be an approved federally recognized cost rate negotiated between the SUBRECIPIENT and the Federal government, or, if no cost rate exists, the de minims indirect cost rate as defined in 2 CFR 200.414(b) Indirect (F & A) costs shall be used. For this agreement, the de minims indirect cost of 10% will apply. (3) Use and Reversion of Assets. The use and disposition of equipment under this AGREEMENT shall be in compliance with the requirements of 2 CFR Part 200. C. Reportine Reporting requirements must conform to the policies and procedures as established by the CITY and 24 CFR § 576.500. The SUBRECIPIENT shall submit to the CITY, on or before the 15`r' day of October, January, April, and July, as part of the Quarterly Report: (1) Payment Request. An original request for reimbursement and true copies of invoices, receipts, agreements, or other documentation supporting and evidencing how the ESG Funds have been expended during the applicable quarter. 12 (2) Quarterly Activities and written cumulative (year-to-date) reports of activities, program accomplishments, new program information, and up-to-date program statistics on expenditures, caseload and activities. Failure to provide any of the required documentation and reporting will cause the CITY to withhold all or a portion of a request for reimbursement until such documentation and reporting has been received and approved by the CITY. (i) Matching, Quarterly certification of match, plus documentation of match source. (4) Any other such reports as the CITY (or HUD) shall reasonably require and/or request, including but not limited to the following information: monthly records of all ethnic and racial statistics of persons and families benefited by the SUBRECIPIENT in the performance of its obligations under this AGREEMENT. D. Record Keeping Sufficient records must be established and maintained to enable the CITY and HUD to deternnne whether the ESG requirements are being met. Record keeping requirements must conform to the policies and procedures as established by the CITY. All accounting records, reports, all evidence pertaining to costs, expenses, and ESG Funds of the SUBRECIPIENT, and all documents related to this AGREEMENT shall be maintained and kept available at the SUBRECIPIENT'S office or place of business for the duration of the AGREEMENT and thereafter for five (5) years post -completion of an audit in conformity with the ESG requirements, except as hereinafter provided relating to retention of any records or documentation existing, created, or maintained in compliance with Lead -based Paint regulations, which likely require longer retention as outlined below. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this AGREEMENT, or (b) costs and expenses of this AGREEMENT to which the CITY or any other governinental agency takes exception, shall be retained beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. All said records must be retained for the greater of the aforementioned duration or the periods specified in 24 CFR 576.500(y). All records relating to, or created or maintained in compliance with, the Lead -Based Paint regulations shall be retained and maintained by the SUBRECIPIENT indefinitely, including without limitation, all inspection report(s), disclosure statement(s), and clearance report(s). Copies made by microfilnung, photocopying, or similar methods may be substituted for the original records. The CITY, HUD and auditors shall have the right to access all the SUBRECIPIENT records for as tong as the records are retained by the SUBRECIPIENT. In the event the SUBRECIPIENT does not make the above -referenced documents available within the City of Santa Ana, California, the SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by the CITY in conducting any audit at the location where said records and books of account are maintained. The SUBRECIPIENT agrees to meet the requirements set forth in 24 CFR § 576.500, E. Homeless Manaeement Information Systems (HMIS) (I) Generally. The SUBRECIPIENT must ensure that data on all persons served and all activities assisted trader ESG are entered into the applicable community -wide HMIS in the area in which those persons and activities are located, or with the express knowledge and written consent of the CITY, a comparable database, in accordance with HUD's standards on participation, data collection, and reporting under a local HMIS. (2) HMIS Agency Agreement. The SUBRECIPIENT shall have an agreement in place with the HMIS lead agency to participate in the regionally HMIS system. A copy of the SUBRECIPIENTS agreement with the HMIS lead agency shall be attached to this agreement as Exhibit F. In the case of Domestic Violence service providers 13 or other agencies prohibited from entering data into HMIS, documentation from the HMIS lead agency certifying that the SUBRECIPIENT is using a comparable database shall be attached to this agreement as Exhibit E. (3) HMIS Interagency Data Sharing Agreement. The SUBRECIPIENT shall enter into an Interagency Data Sharing Agreement with the HMIS Lead Agency where the SUBRECIPIENT agrees to share HMIS data with other ESG Amded agencies regarding clients that are served in ESG funded programs, unless prohibited by law. A copy of such agreement shall be attached as Exhibit F-1. (A.) The SUBRECIPIENT agrees to provide 2110C with all required data needed to complete data analysis regarding project performance, data timeliness, or data quality. F. Audit Report Requirements The SUBRECIPIENT agrees that if the SUBRECIPIENT expends Seven Hundred Fifty Thousand Dollars ($750,000.00) or more in federal funds, the SUBRECIPIENT shall have an annual audit conducted by a certified public accountant in accordance with the standards as set forth and published by the United States Office of Management and Budget (2 CFR 200.501 a). The SUBRECIPIENT shall provide the CITY with a copy of said audit by April 1 of the year following the program year in which this AGREEMENT is executed. Further, the SUBRECIPIENT shall comply and/or cause compliance with audit report(s) required by applicable provisions of the Lead -Based Paint Regulations as further detailed below. VIII. EVALUATION AND MONITORING A. Generally The CITY will monitor the performance of the SUBRECIPIENT against goals and performance standards as required herein. The SUBRECIPIENT shall provide the CITY all necessary reporting information as required by the CITY in the administration and review of the Program. Substandard performance as determined by the CITY will constitute noncompliance with this AGREEMENT. If action to correct such substandard performance is not taken by the SUBRECIPIENT within a reasonable period of time after being notified by the CITY, contract suspension or termination procedures will be initiated. B. Access to Records The SUBRECIPIENT gives the CITY and HUD, including their authorized representative, access to and the right to examine all records, books, papers, items, emails, and documents, both physical and electronic, relating to the program. C. Audit The CITY shall have the right to audit and monitor any program income as a result of an ESG activity. Upon request by the CITY and for audit purposes, the SUBRECIPIENT further agrees to provide all files, records, and documents pertaining to related activities and clientele demographic data. IX. LIABILITY A. Generally 14 Each party to this AGREEMENT acknowledges that it will be liable for its own negligent acts or negligent omissions by or through itself, its employees, agents, and subcontractors. Each party further agrees to defend itself and themselves, and to pay any judgments and costs arising out of such negligent acts or omissions, and notlung in this AGREEMENT shall impute or transfer any such liability from one to the other. In other words, the SUBRECIPIENT agrees to be fully responsible for its negligent acts or omissions, or any intentional tortuous acts which result in claims or suits against the CITY, and agrees to be liable for any damages proximately caused by said acts or omissions. Nothing herein shall be construed as consent by a State or CITY agency or subdivision to be sued by thud parties in any matter arising out of any contract, and nothing herein is intended to serve as a waiver of sovereign immunity where sovereign immunity applies. B. CITY not Liable for Funds The SUBRECIPIENT further acknowledges that the source of the ESG Funds is a federal pass -through grant to the SUBRECIPIENT. The CITY shall have no obligation to advance or pay the SUBRECIPIENT with any funds other than the ESG Funds the CITY receives from HUD. C. Hold Harmless The SUBRECIPIENT shall defend, indemnify and save harmless the CITY, its officers, agents, employees, representatives, volunteers, and student externs from and against any and all damages to property or injuries to or death of any person or persons, including property and employees or agents of the CITY, and shall defend, indemnify and save harmless the CITY, its officers, agents, employees, representatives, volunteers, and student externs from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and attorney fees/expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of the SUBRECIPIENT, its officers, directors, employees, agents, subcontractors, and suppliers arising out of the SUBRECIPIENT's performance of this AGREEMENT. X. ENVIRONMENTAL CONDITIONS A. Generally ESG activities are subject to environmental review by HUD under the environmental regulations in 24 CFR 50. The SUBRECIPIENT, or any contractor of the SUBRECIPIENT, may not acquire, rehabilitate, convert, lease, repair, dispose of, demolish, or construct property for a project under this part, or commit or expend HUD or local funds for eligible activities under this part, until HUD has performed an environmental review under 24 CFR part 50 and the recipient has received HUD approval of the property. The SUBRECIPIENT agrees to comply with all applicable environmental requirements insofar as they apply to the performance of this AGREEMENT, including but not limited to the Clean Air Act, the Federal Water Pollution Control Act and the Flood Disaster Protection Act. If applicable, the SUBRECIPIENT also shall comply with the Historic Preservation requirements of National Historic Preservation Act of 1966. B. Lead -based paint remediation and disclosure The Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4821-4846), the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851-4856), and implementing regulations in 24 CFR part 35, subparts A, B, H, J, K, M, and R apply to all shelters assisted under ESG program and all housing occupied by program participants that were built before 1978.. 15 C. Assignment of Responsibilities By this AGREEMENT, the SUBRECIPIENT will accept assignment from the CITY of all responsibilities set forth in Subpart K of 24 CFR 35. D. Compliance with Subpart K The purpose of Subpart K is to establish procedures to eliminate as far as practicable lead -based paint ("LBP") hazards in a residential property that receives Federal assistance under certain HUD programs for acquisition, leasing, support services, or operation. In connection with the grant funds under this AGREEMENT, the CITY requires that the SUBRECIPIENT comply and show evidence of compliance with all applicable subparts of 24 CFR 35, and especially, Subpart K ("LBP Regs"). The SUBRECIPIENT shall conduct the following activities for the dwelling unit, common areas servicing the dwelling unit, and the exterior surfaces of the building in which the dwelling unit is located: (1) A visual assessment of all painted surfaces in order to identify deteriorated paint; (2) Paint stabilization of each deteriorated paint surface, and clearance, in accordance with §§ 35.1330(a) and (b), before occupancy of a vacant dwelling unit or, where a unit is occupied, inunediately after receipt of Federal assistance; and (3) Ongoing lead -based paint maintenance activities into regular building operations, in accordance with § 35.1355(a), if the dwelling unit has a continuing, active fmancial relationship with a Federal housing assistance program, except that mortgage insurance or loan guarantees are not considered to constitute an active programmatic relationship for the purposes of this part. (4) And, notice to occupants in accordance with §§ 35.125(b)(1) and (c), describing the results of the clearance examination. E. Notification of LBP Hazard The SUBRECIPIENT shall provide to all occupants of housing: (1) In accordance with Section 35,130 of the LBP Regs - the LBP hazard information pamphlet. The pamphlet shall be the EPA/HUD/Consumer Product Safety Commission lead hazard information pamphlet or an EPA -approved equivalent. The current form and version of the pamphlet can be found at: http://www. h ud.gov/offices/lead/I i bra ry/e nforcem ent/fs-d iscl.pdf (2) In accordance with 24 CFR 35, Subpart A, all available information and knowledge regarding the presence of LBP and LBP hazards prior to leasing a housing unit. 16 (3) In accordance with 24 CFR 35, Subpart A, notification in writing of the results of the presumption of LBP and/or LBP hazards, results of any lead hazard evaluation, and any lead hazard reduction work. F. LBP Information Summary For purposes of information only and in no respect intended to be a representation or warranty of the provisions of the LBP Regulations, the CITY has caused to be prepared an information summary relating to the LBP Regulations and Application to dwelling units that may be occupied by recipients of services and/or funding from the SUBRECIPIENT under this AGREEMENT. CITY staff will cooperate with and be available to the SUBRECIPIENT to assist in implementation of compliance with the LBP Regs as to residential dwelling units to be assisted by the SUBRECIPIENT. The parties acknowledge and agree the CITY shall not be liable or responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP Regulations and implementing guidance published and provided by HUD relating to compliance with such. LBP Regulations. G. Exemptions Section 35.115(a) provides exemptions from Subparts B through R. For example, lead -based paint requirements do not apply to housing assistance if the assistance lasts less than one hundred (100) days. XL CONFLICTS OF INTEREST The SUBRECIPIENT shall comply with 2 CFR 200,112 with respect to the use of program funds to procure services, equipment, supplies, or other property. With respect to all other decisions involving the use of program funds, the following restriction shall apply: No person who is an employee, agent, consultant, officer, or elected or appointed official of the SUBRECIPIENT and who exercises or has exercised any functions or responsibilities with respect to assisted activities, or who is in a position to participate in a decision making process or gain inside information with regard to such activities, may obtain a personal or financial interest or benefit from the activity, or have an interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either for himself or herself, or for those with who he or she has fanily or business ties, during his or her tenure or for one (1) year thereafter. The SUBRECIPIENT agrees to abide by the ESG Program's Conflict of Interest provisions as expressly detailed in 24 CFR § 576.404 regarding Organizational Conflicts of Interest and Personal Conflicts of Interest. All contractors of the SUBRECIPIENT must comply with the same requirements that apply to the SUBRECIPIENT under this section. XII. ASSIGNABILITY None of the duties of, or work to be performed by, the SUBRECIPIENT under this AGREEMENT shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of the CITY. The SUBRECIPIENT must submit all subcontracts and other agreements that relate to this AGREEMENT to the CITY. No subcontract or assignment shall terminate or alter the legal obligations of the SUBRECIMENT pursuant to this AGREEMENT. XIII. EXCLUSIVITY OF AGREEMENT This AGREEMENT supersedes any and all other agreements, either oral or in writing, between the parties hereto 17 with respect to the use of the CITY's ESG Funds by the SUBRECIPIENT and contains all the covenants and agreements between the parties with respect to such ESG Funds in any manner whatsoever. 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 are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both the CITY and the SUBRECIPIENT. XIV. AMENDMENTS OR MODIFICATIONS The SUBRECIPIENT shall not obligate, encumber, spend, or otherwise utilize program funds for any activity or purpose not included or not in conformance with the budget as apportioned and as submitted to the CITY unless: (1) The SUBRECIPIENT has received explicit written approval from the CITY to undertake such actions, or (2) Budget changes may be made among approved program activities and among approved budget categories so long as the specific project activity has been approved, there is no change to the total grant amount, and the changes to the budget are documented. Any program modification request by the SUBRECIPIENT must be requested at least forty-five (45) days prior to the end of the term of this AGREEMENT. No modification to this AGREEMENT shall be binding by either party unless in writing and signed by both parties. In the event that the CITY approves any amendment to the funding allocation, the SUBRECIPIENT shall be notified in writing and such notification shall constitute an official amendment. The CITY may, at its discretion and upon provision of proper notice to the SUBRECIPIENT, amend this AGREEMENT to conform with changes in Federal, State, and/or the CITY laws, regulations, guidelines, directives, and objectives. Such amendments shall be incorporated by written amendment as a part of this AGREEMENT. XV. VIOLATION OF TERMS AND CONDITIONS A. Termination If, due to any cause, the SUBRECIPIENT fails to comply with the terms, conditions or requirements of this AGREEMENT, or any prior AGREEMENT whereby ESG funds were received by the SUBRECIPIENT, whether stated in a Federal statute or regulation, an assurance, a State plan or application, a notice of award, or elsewhere, the CITY may terminate or suspend this AGREEMENT in accordance with 2 CFR 200.339 and in accordance with 2 CFR 200.340 by giving written notice, and the CITY may request in writing that all or some of the grant funds be returned even if the SUBRECIPIENT has expended the funds. If the SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, the SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay the CITY all amounts spent in violation thereof. If the SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the ESG fiords granted hereunder, the SUBRECIPIENT shall be required to reimburse the CITY of all such funds that were obtained and/or spent under fraudulent circumstances, and the CITY reserves the right to take other remedies that may be legally available. lu The SUBRECIPIENT agrees to return all finds as requested by the CITY under this section within thirty (30) days of receipt of the written request. Any objections regarding terminations or suspensions shall be made by the SUBRECIPIENT in writing and mailed to the CITY pursuant to the above NOTICES section. XVI. CLOSE-OUT The SUBRECIPIENT agrees to comply with the closeout procedures detailed in 2 CFR 200.343, including the following: 1. SUBRECIPIENT must submit, no later than ninety (90) calendar clays after the end date of the period of performance, all financial, performance, and other reports as required by the terms and conditions of the Federal award; 2. Unless the CITY authorizes an extension, SUBRECIPIENT must liquidate all obligations incurred under the Federal award not later than ninety (90) calendar days after the end date of the period of performance as specified in the terms and conditions of the Federal award; 3. SUBRECIPIENT must promptly refund any balances of unobligated cash that the CITY paid in advance or paid and that is not authorized to be retained by SUBRECIPIENT for use in other projects (See OMG Circular A-129 and 2 CFR 200.345); 4. SUBRECIPIENT must account for any real and personal property acquired with Federal funds or received from the Federal government in accordance with 2 CFR 200.310-200.316 and 200.329; and, 5. The CITY should complete all closeout actions for the Federal award no later than one year after receipt and acceptance of all required final reports. XVII. VALIDITY AND SEVERABILITY The invalidity in whole or in part of any provision of this ARGREEMENT shall not void or affect the validity of any other provision of this AGREEMENT. Whenever possible, each provision of this AGREEMENT shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this AGREEMENT is held to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this AGREEMENT. XVIII. LAWS GOVERNING THIS AGREEMENT This AGREEMENT shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XLX. WAIVER No delay or omission by the CITY hereto to exercise any right or power accruing upon any noncompliance or default by the SUBRECIPIENT with respect to any of the terms of this AGREEMENT shall impair any such right or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition, or agreement herein contained. 19 XX. AGREEMENT DOCUMENT EXHIBITS AND ATTACHMENTS All of the attachments and exhibits attached to this AGREEMENT are deemed incorporated by reference. This document may be executed in three (3) counterparts, each of which shall be deemed to be an original. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this AGREEMENT, and shall indemnify the CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to the CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT on the date and year first above written. ATTEST: DAISY GOMEZ CLERK OF THE COUNCIL APPROVED AS TO FORM: SONU., CARVALHO By: arY:�HODGE Assis a t Cit Attorney RECOMMENDED FOR APPROVAL: STEVEN A. MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA a municipal corporation KRISTINE RIDG City Manager UBRECIPIENT': Intervat House Carol Williams Tax ID: q6- 53 81115 DUNS #: 11 351017 6 W City of Santa Ana Scope of Work Name of Organization Interval House Name of Funded Program Domestic Violence Shelter Services Annual Accomplishment Goal I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the funded program, named above, during the 12-month contract period. 198 Persons II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month contract period. 66 Persons Program and Funding Description III. Description of Work - In the space below, describe the program to be funded during the 12-month contract period. What specific activities will be undertaken during the contract period. Please be concise in your response. Only the viewable space will print. Interval House will continue to provide life saving shelter and support to a minimum of 6 homeless victims of domestic violence and their children from the most underserved communities in Santa Ana. If additional funding is available, Interval House can expand the number of victims assisted proportionate to increased funding level. Services will include: EMERGENCY SHELTER: Interval House shelter programs offer a safe, caring, and homelike environment for adults, adolescents, and children in life -threatening situations who are left homeless as a result of domestic violence ADDITONAL SPECIALIZED SUPPORT SERVICES: Comprehensive counseling; legal; health and wellness; financial management; employment counseling; permanenet housing; and other services as needed, provided by skilled counselors in over 70 languages. Schedule of Performance Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12-month contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in quarter 1 do not count them again in quarter 2) Quarter 1: July 1 - September 30 17 Persons Quarter 2: October 1 - December 31 17 Persons Quarter 3: January 1 - March 31 17 Persons Quarter 4: April 1 -June 30 17 Persons 66 Total unduplicated Santa Ana Residents to be served. Schedule of Invoicing Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis. Quarter 1: July 1 - September 30 9,078.75 Quarter 2: October 1 - December 31 9,078.75 Quarter 3: January 1 - March 31 9,078.75 Quarter 4: April 1 -June 30 9,078.75 36,315.00 Total Grant Exhibit A Page 1 of 1 ESG Final Budget Organization Name Interval House Program Name Domestic Violence Shelter Services Expenditures etSesiu ded Expenses Funded Total Program Organizational Category y`Santai dna . by Other Sources Budget Budget Essential Services DV Advocate$~_" Q0 $ 29,386.00 $ 62,400.00 $ 62,400.00 - $ $ e�- $ $ $ $ $ Shelter Operations e $ " $ $ w c`• , $ $,4 — Other $ $ Indirect Cost $ 2,939,00 $ 6,240.00 $ 6,240.00 $ Total 8 15 $ 32,325 $ 68,640 $ 68,640 LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED (Total Funds for Program must equal Total Program Budget above) Source Amount Santa Ana $ 36,315 Cal OES DVAP $ 32,325 Total Funds for the Program $ 68,640 Exhibit B Page 1 of 1 Name of Organization: Name of Program Program Staff ESG Funded Personnel Hiterval House Domestic Violence Shelter Services Position Title (only list funded positions) Budget Category Annual Salary Hourly Rate Approximate # of Hours per month serving Santa Ana Total Amount Requested DV Advocate Essential Services $ 41,600 $ 20.00 138 $ 33,014.00 Total ESG Requested $ 33,014.00 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26,1988 Federal Register (pages 19160-19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - Attached) (1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (2) Where the prospective recipient of federal assistance fiords is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. CAAoi, Wlf-WftmsS EXECUTIWe 010-6c7GP- Name and Title of Authorized Representative &12gl Date EXHIBIT C Page 1 of 2 INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal, the prospective recipient of federal assistance ftmds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of federal assistance fiends knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Goverrunent, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to wl-rich this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective recipient of federal assistance fiords agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL, 6. The prospective recipient of federal assistance hinds farther agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to check the List of Parties Excluded from Procurement or Non - Procurement Programs. S. Nothing contained in the foregoing shall be construed to require establislnnent of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and/or debarment. EXHIBIT C Page 2 of 2 Certification Regarding Lobbying Certification for Contracts, Grants, Loans, and Cooperative Agreements. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contact, grant, loan or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontract, subgrants, and contracts trader grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. {N 69U14i- !iyarc- PbMESitc- ✓IOCti-f4c ' -"AFt T-A. S'Cje"Ce--C Grantee/Contactor Organization Program Title Name of Certifying Officer to lz V Date EXHIBIT D Pagel of 2 SUBRECIPIENT warrants the following: 1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics, employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process tinder Executive Order 12372. EXHIBIT D Page 2 of 2 Orange County Coo hil-r_Agency Data Shadng Memorandum of Agreeniettt The fN CAS (//+(, I -to VS ex agency agrees to share client data among participating agencies via the LNOC FIMIS tHomeless Management Information System) for the purposes outlined below. Each participating agency must complete and comply with the Agency Agreement. Each individual HMIS user must complete and comply with the HMIS User Agreement. This document is available on the OCHMIS website httu'//www. ochm is_org. Uses of HMIS Data: • Coordinate housing services for families and individuals experiencing homelessness or facing a housing crisis in Orange County • Understand the extent and the nature of homelessness in Orange County • Evaluate performance and progress toward community benchmarks • Improve the programs and services available to Orange County residents experiencing homelessness or a housing crisis • Improve access to services for all Orange County homeless and at -risk populations • Reduce inefficiencies and duplication of services within our community • Ensure that services are targeted to those most in need, including "hard to serve" populations • Ensure that clients receive the amount and type of services that "best fits" their needs and preferences • Pursue additional resources for ending homelessness • Advocate for policies and legislation that will support efforts to and homelessness in Orange County Client Protection: • Informed consent must be given by clients in order for their identifying information to be entered into HMIS and shared among agencies in the LA/OC HMIS (see Orange County HMIS participating agencies on OCHMIS.org). Non -identifying client information may be, entered in the system for all clients regardless of whether they give their informed consent and regardless of their domestic violence status. • Only non -identifying information will be entered for clients currently fleeing or in danger from a domestic violence, dating violence, sexual assault or stalking situation. • Identifying client information will only be shared among agencies that have signed this agreement. At the time of Informed consent, and at any point after, the client has the right to see a current list of the OC HMIS participating agencies. • Additional agencies may join the LA/OC HMIS and will be added to the list of HMIS participating agencies. As part of the informed consent process, clients must be informed that additional agencies may join the collaborative at any time and will have access to their information. • HMIS Users will maintain HMIS data in such a way as to protect against revealing the identity of clients to unauthorized agencies, individuals, or entities (see the "OC HMIS Client Consent Form," and the "Client Rights Brochure OC" available on the OCHMIS.org website). • Clients may not be denied services based on their choice to withhold their consent. Each party to this memorandum of agreement shall defend, indemnify, and hold all other parties harmless from any and all claims arising out of that party's negligent performance of this agreement. Any loss or liability to third parties resulting from negligent acts, errors, or omissions of a LA/OC HMIS user while acting within the scope of their authority under this Agreement shall be borne by that user exclusively. Agreed to and signed by the following agency representative: kOL WiLL(,gMS 1NTMAU HvLPSe P 'nted Name Agency Name lo%gl jl ignature Date OC HMIS Participating Agency Agreement Purpose The HMIS (Homeless Management Information System) is a HUD -mandated information technology system that is designed to capture client -level information overtime, on the characteristics and service needs of homeless persons. Client data is maintained on a central server, which will contain all client information in an encrypted state. HMIS integrates data from all homeless service providers and organizations in the community and captures basic descriptive information on every person served. Participation in the OC HMIS allows organizations to share information with other participating organizations to create a more coordinated and effective service delivery system. The OC HMIS is the secured electronic database for Orange County and is a valuable resource for local communities. Agreement and Understanding This Agreement authorizes this Participating Agency (Agency) to designate HMIS Users (User). A User is a staff person entrusted to enter Protected Personal Information (PPI) into the OC HMIS, on behalf of this Agency. In order to allow a User to access the OC HMIS, a User Agreement must be signed by the User and stored electronically in the HMIS. Confidentiality and Informed Consent Confidentiality: This Agency must require all Users to abide by its organization's policies and procedures; uphold all privacy protection standards established by the OC HMIS Policies and Procedures; and comply with all relevant federal and State of California confidentiality laws and regulations that protect client records. Except where otherwise provided for by law, this Agency shall ensure that confidential client records are released with the client's written consent. Written Consent: To obtain written consent, prior to each client's assessment, each client must be informed that the client's information will be entered into an electronic database called HMIS. The terms of the Consent to Share Protected Personal Information form must also be explained to each client. Clients who agree to have their PPI entered into the OC HMIS must sign the Consent to Share Protected Personal Information form. Verbal Consent: Verbal consent to enter PPI into the OC HMIS may be obtained during circumstances such as phone screenings, street outreach, or community access center sign -ins. Each client must be informed that their information will be entered into the HMIS database. The terms of the Consent to Share Protected Personal Information form must also be explained to each client. The client's written consent must be obtained once the client appears for their initial assessment. Updat,,d 8/24/18 Client's Rights The client has a right to receive a copy of this Agency Agreement at the time of request. Each client has the right to receive the following, no later than five (5) business days of a written request: • A correction of inaccurate or incomplete PPI • A copy of their consent form • A copy of their HMIS records • A current list of participating agencies that have access to HMIS data Data Use This Agency must protect HMIS data by ensuring that: • A link to the Privacy Notice is accessed from the Organization's website. • OC HMIS is not accessible to unauthorized users • OC HMIS is only accessed by computers approved by the Organization • HMIS Users are trained regarding user responsibilities and conduct • HMIS Users sign and comply with the OC HMIS User Agreement • HMIS Users forward a copy of a client's Revocation of Consent to the HMIS System Administrator, 2-1- 1 Orange County (2110C), within 24 hours of receipt Responsibilities This Agency is responsible to ensure that: • The Notice Regarding Collection of Personal Information is posted at each intake desk or comparable location • HMIS Users do not misuse the system • Clients are notified if a breach of their PPI is discovered • Any HMIS User who finds a possible security lapse on the system is obligated to immediately report it to 2110C • A signed copy of the Consent to Share Protected Personal Information is retained for a period of seven (7) years after the PPI was created or last changed. Rights and Privileges OC HMIS data is stored in one central database and is managed by 2110C. While each agency owns their own data within the database, the Orange County Continuum of Care (CoC) may release aggregate data about its own continuum at the program, sub -regional, and regional level. Aggregate data may be released without organization permission at the discretion of the Continuum. Use of the OC HMIS is a privilege and is assigned and managed by 2110C. Updated 8/2, 4118 Copyright The OC HMIS and other CoC-provided software are protected by copyright and are not to be copied, except as permitted by law or by contract with the owner of the copyright. The number and distribution of copies of any CoC provided software are at the sole discretion of 2110C. Violations Any violations or suspected violations of any of the terms and conditions of this agreement, the HMIS User Agreement, and/or the HMIS Policies and Procedures, must be immediately and confidentially reported to 2110C and the Executive Director or other authorized representative of this Agency. Term This Participating Agency Agreement becomes effective on the date of final execution and shall remain in effect unless terminated pursuant to paragraph XI. Termination, below. Amendment and Termination • The OC CoC reserves the right to amend this agreement by providing a 3-day notice to this Agency. • Either party has the right to terminate this agreement, with or without cause, by providing a 3-day written notice to the other party. • If this agreement is terminated, this Agency shall no longer have access to HMIS or any information therein. The CoC shall retain the right to use all client data previously entered by this Agency, subject to any restrictions requested by the client. All agencies that sign this agreement and are granted access to the OC HMIS agree to abide by OC HMIS' Policies and Procedures. The signature of the Executive Director or other authorized representative of this Agency indicates acceptance of all terms and conditions set forth in this agreement. This Agreement is executed between the CoC and the Participating Organization. Upon final execution, this Agency will be given access to the OC HMIS. Agency Name I K- y -e. Executive Director/Authorized Representative Name (Print) A'�6 l W, lL a aMS ecutive Director/Authorized Representative Signature (W signature only) Date -711119 Updated 8/24/18 DO NOT WRITE IN THIS SECTION — 2110C USE ONLY HMIS System Administrator Name (Print) HMIS System Administrator Signature (Wet signature only)0 Date q " X' 1 ' "R[7°" CERTIFICATE OF LIABILITY INSURANCE --DATEIMM,DD/YYYYI 2/1/2019 THIS OERT'IFICATE 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 THR POLICIES EELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder la an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or ba endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pclldy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in Neu of suoil endorsements). PRODUCER Arthur J. Gallagher & Co. Insuran0e Brokers of CA, Inc. LIC #0726293 NA it.o T MDMMcDonald oNE �A7c PA N¢ Eve • 818.539 862E P/O o • 818.539,8725� E.Ir�I IC" mauroen mGdonald(3elg,aom 606 N Brand Blvd, Suite 600 Glendale CA 91203 �I,[(,$,{1,RaR(SIAFPtlR01NG COVERAGE �^^ LAID eURe • Borkle Nalonal Insurance Company 38911 INSURED INT59OU43 Interval $5 P.O, Boxox$366 INSURER 0•L14 d'sSyndicate 2987 M aulumo:GreetAmericanSpiritInsuranceComan _ �S3723 INSURER D. New York Marine And General Insurance Company 16-,..,.,.,_.6084 Seal Beach, CA 90740 INSURER E v SURER F: COVERAGES CERTIFICATE NUMBER: 1f1nRRAn94A 1AWWAlnM MIIaelgco, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISBUBD TD 'rFIE INSURED NAMED ABOVE FOR THE POLICY PERICD 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, EXCLUSIONSANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rL SR TYPE OFINSURANCB OAUSUB L POLICYNUMRB PO P` P LIMITS A X C0MMERCIALGENERALLIABILIrY CLAIMS -MADE M OCCUR Y INHS952562042 10/112018 10/112019 8ACHOCCURRENCE loo(LoG0 P A a¢ cannot 1500,000 —_ MSD EXP (Any aneper!E _..._ $10,000 PERSONAL& ACV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: '� POLICY 0 JQOT ❑ LCC GENERALAOOREOATa S3000,000 PROOUCTS •COMPrOP AGO 3,000.000 S OTHER• AUTaMORILBUADILITY ._.. ANYAUTO OWNED SCHEDULED AUTOS ONLY ppLL�1T09 HIRED NON-OIAMEd AUTOS ONLY AUTOS ONLY a occiNtl, ING —LIMIT'"' ..LAB]--,—__.. § BODILY INJURY IPw Person) § BODILY INJURY IPer peaiganl ) § _�- PROPERTY AMAOa Per accltl¢nt '$ R UMRRELLALIAR X OCCUR NPXS20180025 10114010 101112010 EACH OCCURRENCE $2,000,000 X Excess LIAR CLAIMS -MADE AGGREGATE $2.010000 DED I X I RETeNTI N IS n$ 0 WORKERS COMPENSATION AND EMPLOYERS'LIABILIrY YIN ANYPROPRIaTOR/PARTNER/EXECUTIVE OFFICER NEMBEREXCLUDED7 NIA W0201900005078 211/2019 2/1/2020 E,L. EACH ACCIDENT $1008000 a.L. DISEASE• EA EMPLOYEE $1,000,010 IfMy nd.t r IF unldor OESORIFTIONOFOPBRATIONSbelow 8,L, DISEASE • POLICY LIMIT $1.000,000 c CyymrLloblNy Claims -Made form Rmre Dme:71lpn1p NET 1280-6-74-03 10/1/201a 10/1/2019 LIMIT Ag%egnla ReanGGOon Si,000tl00 $1,000:00on S5,OOtl DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES IACORD 101, Addltlonnl Ramarea Schaduc, MAY be atlached if mom space to required) Polley, Crime Coveragge Policy Term: 12/01/2018 To 10/01/2019 Policy Number; UC11717955.18.038 Carrier: Underwriters at Lloyyd's, London ERp$A: then $3,000,0001 Deductible: $25,000 ER 0,000.000 Theft of money and aBOur,000,0 01 Ded 0 /Deductible : $25,000 SMoneyao At and Securities: $3,000,000I Deductible : $26,000 Sae Attached... The City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0198E-20116 ACORD ACORD 26 (2016103) The ACORD name slid logo are roglatarod marks of ACORD :.1 U7"Rtff CERTIFICATE OF LIABILITY INSURANCE DATetMMIDD/YYYY) 211/201a 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the poticy(les) 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 PRODUCES ArthurJ. Gallagher& Co. Insurance Brokers of CA, Inc. LIC 00726293 505 N Brand Blvd, Suite 600 Glendale CA 91203 INSURED Interval House P.O. Box 3356 Seal Beach, CA 90740 COVERAGES CERTIFICATE NUMBER:1623108007 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 OP 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, IM�SS� —___ _.___._­Arfi ILTaQaFI---_ ____._ __..,..___ r -POLICY EFF POLICV E%P .. .-_-.-._.. _ TR . TYRE OFItdSUSANCE P LICV NUMBER MMm 1YYVY M19Mt D- VV LIST A X COMMERCIAL GENERAL LIABILITY - Y HHS8525626.12 i 90/112016 19/1/2019 EACH OCCURAENfE $1 R00000 il; CLAIMS MADE LX 1 OCCUR ; j DAMAGE'ib-RB'FJ'PE 500 000 } FPifEMISESIEA osd rro so _ _. MBQ EXP SA�ane peraonf $10900 J PEnSONALe_ADV INJURY39004000 CCNL AGGREGATE LIMIT APPLIES PER: j l GENERAL AGt7nEOATE `,g3040000 X " , PRO- - POLICY , JFCT �_; LOG _ _ ..__ PRODUCTS COMPAJP AGO $ 3,000,000 _ 01HER' AUTOMOBILE LIABILITY �~� COfgecNgEDi)SINGLE LIMIT $ �� ANY AUTO i i BODILY INJURY (Par pp son) $ OWNED '-"? SOHEDULEQ I AUTOS ONLY �—iAUTOS } e ! BODILY INJURY( l.ccowfl$ _ HIRED NON OWNFp i PRGPERTV dAMP'taE - AUTOSONLY AUTOS ONLY l (PQr Accideail _ $ C { UMBRELLA LIAR j X OCCUR ' NPX62018D025 - i 1 10/i/2018 1011/2019 EACHOCCUI�nCN,GE ' g?OOQOW X _ EXCESS LIAR j CLAIMSMADE —_ _' __.._...._ AGGREGATE =$2,000,000. LED 1 X l RETENTION _ 1 = crewel miswn wu I $ Included Y WC291900006079 B AN➢RKERS EMPLOYERTUAIAILITY PER 1OT ?f'i/2019 't/112424 X PER aTH. - Vr�N ANYPROPRIC't0r4PARTNEPoEXCCUTIVE _ p 'N/A OFFICENMEMBER EXCLUDED CI EACH ACCIDENT �_$1,000,900 ---- - ------ - (MandalorylnBE) p 7 E EL DISEASE- EA EMPLOYEEI$90D99D0 ;1l yot,, oesadbaundr✓ j -- -- i9FSCHIPTIONOPOPERATIONSbalaw I _EL DISEASE -POLICY LIMIT S1,000,000 A E Property Covamge I '1-I1158525626-12 ; 10/1/2018 1 101112019 _ Blanket Sharing $4,934,910 IOPP Limit $815,000 Daducllaie $1,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Addiimnal Remarks eonadela, may be attached If more spade is required) Policy: Crime Coverage Policy Term; 121011201$ To/0101/2019 Policy Number: UC11717955.18-038 Carrier: Underwriters at Lloyd's, London Employee theft: $3,000,000 / Deductible: $25,000 ERISA: $3,000,000 Theft of money and securlties: $3,000,0001 Deductible : $25,000 Money and Securities: $3,000,000 / Deductible : $25,000 Soo Attached.,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Community Development Agency (M-25) ACCORDANCE WITH THE POLICY PROVISIONS. Administrative Services Division Attu: Terri Eggers 20 Civic Center Plaza, M-25 Santa Ana, CA 92701 AUTHORIZEDREPIESENIATIVE t`l il.J� 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 2 arl 818 AGENCY CUSTOMER 11): INTEHOU-03 LOC#'. AGENCY NAMED INSURED Arthur J. Gallagher & Co, Interval House P.O. Box 3356 POLICY NUMBER Seal Beach, CA 90740 CARRIER I NAIL CODE EFFECTIVE DATE; The ACORD name and logo are registered marks of ACORD 3 & 7 616 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) We have the right to recover our payments from anyone liable for an injury covered 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 perform 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 2.00% of the California workers' compensation premium otherwise due on such remuneration, Schedule Any Person or Organization as Required By Written Contract Any Person or Organization as Required By Written Contract All Operations of the Name Insured 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 2019-02-01 Insured Interval House Insurance Company New York Marine and General Insurance Company / 28746 WC 04 03 06 Policy No. Endorsement No. WC201900005078 Countersigned (Ed. 04,84) 01098 by the Workers' Compensation Insurance Being Bureau of California, All rights reserved. �Q 00 � 0 V 407 81a fiWasiffiffim M14 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This Insurance Is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 @ Insurance Services Office, Inc., 2012 Page 1 of I POLICY NUMBER: HHS8526626-12 COMMERCIAL GENERAL LIABILITY Berkley National Insurance Company CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) I Or Organization(s) I Location(s) Of Covered Operations City of Santa Ana, its officers, agents, employees and volunteers -— Information ro aired to cam laka this Schedule, if not shown above, will be shown in the Declarations A. Section 11 — Who Is An Insured is amended to include as an additional insured the porson(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional Insured(s) at the location(s) designated above. However: 21 1. The Insurance afforded to such additional Insured only applies to the extent permitted by law: and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work!' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project, CG 20 10 0413 C Insurance Services Office, Inc., 2012 Page I of 2 6 M 7 818 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: I. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 * Insurance Services Office, Inc,, 2012 J�M CG 2010 04 13 A 7of7 Is COTC PROCESSING FORM Agreements / Amendments / Deeds 15 gg J Project Manager is responsible to ensure agreement has f 1 j) P I 9 reviewed and approved by City Attorney, all exhibits attached, Certificate of Insurance meets mandatory coverage, con-OlTsy OF SANTA ANA with CMO contract authority as defined in NS-2963, ftcERK OF COUNCIL ultimately, agreement is ready for City Manager execution. COTC will onlv be responsible for attestation of CMO signature, TO: CLERK OF THE COUNCIL OFFICE FROM: DEPT.: CDA PROJECT MANAGER: Terri Eggers MAIL STOP: 25 AGREEMENT NUMBER (if amendment): A / N Vz ollcf ' O `17 7>' ok EXT.: 5378 AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3RD ❑ NAME OF CONSULTANT / PARTY: ��lexy rib AMOUNT: ❑ * OVER ❑ *UP TO `Note: Council approval is required if an agreement with a $50,000 — (A) $50,000 - (AIN) vendor exceeds $50,000 within a Fiscal Year for non- public works agreements. Bid for contracts exceeding $25 000 will continue to require a formal Invitation for Bid. ❑ 1) Approved by council. ❑ 2) NOT approved by council. COUNCIL APPROVAL DATE: June 4, 2019 ITEM M 60 D TERMOFAGREEMENT EFFECTIVEDATE: July 1, 2019 TERMINAT/ONDATE: June 30, 2020 SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY ❑ CITYATTORNEY❑ OTHER (INSURANCE APPROVAL REQUIRED BY CAD PRIOR TO SUBMITTING TO COTC) INSURANCE REQUIRED: ❑ YES ❑ NO (Provide City Attorney Office approval) ❑ AUTO ❑ CGL (Commercial General Liability) ❑ PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION COMMENTS: FOR CLERK OFFICE USE ONLY: ❑ PROCESS ❑ DO NOT PROCESS ❑ Missing Signatures ❑ Needs Council Approval ❑ Other authority increased via Ordinance NS-2963. IAAgreemenlfform -AGREEMENT PROCESSING FORM_canary_REVISED.doc Revised: 4/18/2019 'ORH CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER 4F 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 cert1 in: : holder is an ADDITIONAL INSURED, fhe policylies) muss 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 ondorsement. A statement on this certificate does not confer rights to the certificate, hnldnr in IIe„ . f a„�� ..licy, certain PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 605 N Brand Blvd, Suite Boo Glendale CA 91203 INSURED Interval House P.O. Box 3356 Seal Beach, CA 90740 COVERAGES CERTIFICATE NUMBER• 1 2 THIS INDICATED. IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING OF INSURANCE . 30.d1875 LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION NUMBER: NAMED A86VE FOR THE POLICY ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES WITH RESPECT TO WHICH THIS EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, INSR TR -�..�...e..�...,_._...®.._ TYPE OF INSURANCE aDE'LISTla f _ ,..._._.._®.®_ POLICY NUMaE BY POL CT PAID CLAIMS. ....._.___...._._..�__,_. A X COMMERCIAL GENERAL UABKITY CAIMS MADE Y I HH88525626-12 IR M 70/7/2418 yyyy 10/1/2019 I LIMITS EACH OCCURRC1111, AVOG"CM1,1l $1u000 000 .- -�CLAIMS-MADE {I P8elMJf_SJE.oqoare„��.� _..-. _.._.- 3500 OOQ I 1 MEDE�h..yanepersm) I$1- 0000 ..__ DEN LAGGRFGATELIMITAPP X NAL9ADVNJUR ALA-GATE r1R11V..CTS. $1000000 -8000 POLICY OTHER.COMPIOP A 000000 AUTOMOBILE LIABILITY Ii C Ea $ $ ANYAUTO xlpgEt7 _...._ WI -�.._...._�... OWNED SCHEDULED I Sol INJURY Per _.. AHIRED ONLY �„ AUTOS HIRED NONQNVNED AUTOS ONLY L e441LY INJURY IParamltlant} �_„_ $ ._ AUTOSONLY i ( I PROPERTY bAMAbE--- Leer acddam .._-�. $ .....__ B UMBRELLALIAa X OCCUR X EXCC�3 LIAa NPXS20180025 10Al2g78 IOP12019 EACH OCCURRENCE .....�__ $ 2 000 000 _ CLAIMS -MADE ------ �- —' DEO X ` RETENTION $ AGGREGATE 0 52000000 D WORKERS COMPENSATION AND EMP64YERS LIA6IUTV ANYPROPRIETORIPARTNER/EXECUTIVE YIN I i W020100000507a I 211l2019 I I -' 2/1l2020 I P—T ER—T'''�`' X STATUTE $ OFPICERltyEn NMREXCLUDEp7 ❑ N/AI E,L EACHACCIDCNT _ y $.1000000 (Mandato If ySddesalbe waver DESCRIPTION OF OPERATIONS palaw , I _EL DISEABE_EAEMPLOVBE'910000,Otl .� C O bar LleWllty NET 1280-6-7§-03 F„L. OISEA-I2-POLICY LIMIT i� $1,A00,000 POP,ate:7Porn Relro Date: 711/201A I 70/1/2g19 10Hi2019 Limit -A � $1,004,040 I ! Ratenban $1,U40,g00 $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IA44RD 1a1. AtldlHonal Remarks Schedule, may ba attached ilmpra span is rayulratl) Policy: Crime Coverage Policy Term: 12Po1/2018 To 10/0112019 Policy NUmber: UC 11717955,18-038 Carrier: Underwriters at Lloyd's, London Employee theft: $3,000,000 / Deductible: $25,000 ERISA: $3,000,000 Theft ofmoney and securities: $3,000,000 / Deductible: $2.5,000 Money and Securities: $3,000,000 / Deductiblo : $25,000 See Attached... CERTIFICATE HOLDER City of Santa Ana Risk Management Div 20 Civic Center Plaza, Santa Ana CA 92702 ACORD 25 (2016/03) MIYl51 N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 019 ACCORDANCE WITH THE POLICY PROVISIONS, M, IAMBERi CO 1985.2015 ACI The ACORD name and logo are registered marks of ACORD reserved. AGENCY CUSTOMER ID: INTEHOU-03 LOC #: ADDITIONAL REMARKS SCHEDULE page 1 of 1 Gallagher & Co. CARRIER NAIL CODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY rouIaiTerm: 10/01/2018 to per m: $1,000.0001 AD Liability I - ability / Deductible : $25,000 Company 3,000 / Retention: $0 Seal Beach, CA 90740 DATE: City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured with respect to the operations of the named red. Workers Compensation coverage is evidence only. Insurance is Primary and Non -Contributory. Written notice shall be provided at least ten (10) days In advance of cancellation for non-payment of premium thirty (30) days In advance for any other cancellation or policy change. ACORD 101 (2008/01) - - - @ 2008 ACORD CORPORATION. All The ame and logo are registered marks of ACORD Policy # HH88525626-12 Named Insured: Interval House COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. •. '' r f 0 Onkill]0 This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This Insurance Is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed In writing In a contract or agreement that this insurance would be primary and would not seek contribution from any other Insurance available to the additional insured. CG 20 01 0413 I ` k- ///7Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: HHS8525626-12 COMMERCIAL GENERAL LIABILITY CG 83 91 05 15 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REACT CAREFULLY, GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Throughout this endorsement, the words "you" and "your" refer to the Named Insured shown in the Declarations. The word "we," "us," and "our" refer to the company providing this insurance. The following Is Only a summary of the additional coverages provided by this endorsement and Is provided only for your reference and convenience. For the Limits of Insurance and the additional coverages provided by this endorsement, read the provisions on the following pages and the Coverage Form, which this endorsement modifies. SUBJECTS pFINSURANGE Broadened Bodily Injury Broadened Personal and Advertising Injury Broadened Property Damage Broadened Fire, Lightning, Explosion, and Sprinkler Leakage - $500,00o Broadened Medical Payments � $10,OOQ Broadened Supplementary Benefits "— a. Bail Bonds - $1,Q00 b. Expenses Incurred to Assist in Defense - $500 per Day Broadened Newly Acquired or Formed Organizatlon Broadened Nan -Owned or Chartered Watercraft or Aircraft Broadened Commercial General Liability Conditions a. Duties in the Event of Occurrence, Offense, Claim, or Suit b. Liberalization — Automatic Coverage If We Adopt Broader Coverages c. Notice to Company Automatic Coverage for "Special Events" Automatic Additional Insureds "' a. Athletic Activity Participants - o. ContractualalObligations c Funding Sources d. Manager or Lessor of Premises a. Owner, Manager, Operator, or Lessor of "Special Event" Premises f. Supervisors or Higher in Rank — Co -Employee Exclusion Removed g. Limitations Blanket Waiver of Subrogation Priority of Appiication for Multiple Insurads The coverages listed in this endorsement are provided as extensions or additions to your insurance program. CG 83 91 05 15 q1nIudes copyrighted material of Insurance Services Page 1 of 8 Office, Inc. used with its permission, A. BROADENED BODILY INJURY Paragraph 3. of Section V — Definitions is deleted and replaced with the following: 3, "Bodily injury" means physical Injury, sickness, or disease sustained by a person, including death resulting from any of these, "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock sustained by a person, if directly resulting from physical injury, sickness, or disease sustained by that person. B. BROADENED PERSONAL AND ADVERTISING INJURY 1. Paragraph 14. of Section V —Definitions is deleted and replaced with the following: 14. "Personal and Advertising Injury" means injury, including consequential bodily injury" arising out of one or more of the following offenses during the policy period. a. False arrest, detention, or Imprisonment; b. Malicious prosecution or abuse of process; e, The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling, or premises that a person occupies by or on behalf of its owner, landlord, or lessor; d. Oral, written, televised, videotaped, or electronic publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; e. Oral, written, televised, videotaped or electronic publication of material that violates a persons right of privacy; or f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title, or slogan. h. Mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14,a. through 14.g.above. 2. Exclusions 2.b. and 2.c. under Coverage B Personal and Advertising Injury Liability are deleted and replaced with the following: b. Material Published with Knowledge of Falsity "Personal and advertising injury" arising out of oral, written, televised, videotaped, or electronic publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. Material Published Prior to Policy Period "Personal and advertising Injury" arising out of oral, written, televised, videotaped, or electronic publication of material whose first publication took place before the beginning of the policy period; C. BROADENED PROPERTY DAMAGE Exclusion 2.a. under Coverage A Bodily Injury and Property Damage Liability is deleted and replaced with the following: a. Expected Or intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. D. BROADENED FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE Paragraph 6. under Section III — Limits Of Insurance is deleted and replaced with the following: 6. Subject to 5, above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to; a. Any one premises while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner; and b. Personal property of others in your care, custody, or control, while at promises rented to you or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner, arising out of any one fire, lightning, explosion or sprinkler leakage occurrence. Page 2 of 8 "y ncludes copyrighted material of Insurance Services j Office, Inc. used with its permission. CG 83 91 05 15 The Damage to Premises Rented to You Limit is the greater of: C. $500,000; or d. The amount shown in the Declarations for Damage to Premises Rented to You Limit, 2. Paragraph 2. Exclusions of Coverage A Bodily Injury and Property Damage Liability is amended as follows: Paragraphs c. through n., do not apply to damage by fire, lightning, explosion, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section Ill — Limits Of Insurance. 3. Paragraph 4. Other Insurance of Section IV — Commercial General Liability Conditions is amended as follows: Paragraph b, (1) (a) (it) is deleted and replaced with the following: (11) That is Fire, Lightning, Explosion, or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; or 4. Paragraph 8.a. under Section V — Definitions Is deleted and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 5. This Broadened Coverage Is subject to all the terms of Section III — Limits Of Insurance. 6. This Broadened Coverage does not apply if Fire Damage Liability of COVERAGE A (SECTION 1) Is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. E. BROADENED MEDICAL PAYMENTS 1. The following provision is added to Paragraph 7. of Section III — Limits Of Insurance: The Medical Expense Limit shall be the greater of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit, CG 83 91 05 15 2. This Medical Expense Limit is subject to all the terms of Section III— Limits Of Insurance, 3. This above Medical Expense Limit does not apply if Coverage C Medical Payments is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part, F, BROADENED SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. under Supplementary Payments — Coverages A and B are deleted and replaced with the following: b. Up to $1,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies, We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us In the investigation or defense of the claim or "suit," including actual loss of earnings up to $500 a day because of time off from work. G. BROADENED NEWLY ACQUIRED OR FORMED ORGANIZATION Paragraph 3.a under Section II —Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is afforded only until the 120" day after you acquire or form the organization or the end of the policy period, whichever is earlier. H. BROADENED NON -OWNED OR CHARTERED WATERCRAFT OR AIRCRAFT Exclusion 2.g. under Coverage A Bodily Injury and Property Damage Liability is deleted and replaced by the following: g. 'Bodily injury" or "property damage" arising out of the ownership, maintenance, use, or entrustment to others of any aircraft," auto," or watercraft owned by or operated by, or rented or loaned to, any insured. Use Includes operation and "loading or unloading", This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or Property for a charge; (3) Parking an "auto" on, or on the ways next to premises you own or rent, provided the "auto" is not owned by or rented, or loaned to you or the insured; copyrighted material of Insurance Services Page 3 of 8 Dffice, Inc. used with its permission. (4) Liability assumed under any "insured contract" for the ownership, maintenance, or use of aircraft, watercraft, or "autos"; or (5) "Bodily injury" or"property damage" arising out of the operation of any of the equipment listed in Paragraph f. (2) or f. (3) of Section V - Definitions, Paragraph 12., "Mobile Equipment"; or (6) An aircraft you do not own that is: (a) Hired, chartered, or loaned with a crew; and (b) Not owned In whole or in part by any Insured. (7) This insurance does not apply, under Paragraph g.(1) and g.(2) above, if the Insured has any other insurance for "bodily Injury" or "property damage" which would also apply to loss covered under this provision, whether the other insurance is primary, excess, contingent, or on any other basis. (8) This insurance Is excess, under Paragraph g. (6) above, over any other insurance, whether the other insurance is primary, excess, contingent or on any other basis. 1. BROADENED COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Paragraph 2, Duties in The Event Of Occurrence, Offense, Claims Or Suit under Section IV -Commercial General Liability Conditions is amended to add the following provision e. Your obligation to notify us as soon as practicable of an "occurrence," or offense under Paragraph 2,a. above, or a claim or "suit" or offense under Paragraphs 2.a., 2.b., and 2.c above, is satisfied if you send us written notice as soon as practicable after any of your "executive officers," directors, partners, insurance managers, or legal representatives becomes aware or, or should have become aware of, such "occurrence," offense, claim or "suit" 2, The following provisions are added to Section IV - Commercial General Liability Conditions; 10. Liberalization If we adopt any revision that would broaden the coverage under this coverage part without additional premium within 30 days prior to or during the policy period, the broadened coverage will immediately apply to this coverage part. 11. Notice To Company If you report an "occurrence" or offense to your Workers' Compensation insurer which later becomes a claim under this Coverage Part, failure to report such "occurrence" or offense to us at the time of the "occurrence" or offense will not be considered a violation of the Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition, if you notify us as soon as practicable when you become aware that the "occurrence" or offense has become a liability claim. J. AUTOMATIC COVERAGE FOR SPECIAL EVENTS 1, You are automatically covered for all "special events" which you organize, promote, administer, sponsor, or conduct during the term of this policy. 2, Section V - Definitions is amended to add the following paragraph: 23. "Special Event" means any event: a. The purpose of which Is to raise funds for you; or b. To recognize the accomplishments of your organization, your "employees," or your volunteer workers; or c. Which you, or an individual or organization with whom you have entered into a contract or agreement, organize, promote, administer, sponsor, or conduct for the purposes described in Paragraphs a. or b. above and d. Which takes place on premises owned by you, or on premises while rented or leased to you or to that organization described in Paragraph c. above. K. AUTOMATIC ADDITIONAL INSURED(S) The following provisions are added to Section If - Who Is An Insured: 4. Automatic Additional Insureds) a. Additional Insureds -Athletic Activity Participants (1) This policy is amended to include as an insured any person(s) [hereinafter called Additional Insured(s)j representing you while participating in amateur athletic activities that you sponsor. However, no such person is an insured for: (a) "Medical expenses" under Coverage C Medical Payments. (b) "Bodily Injury" to: Page 4 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 {� 4 Office, Inc. used with its permission. A DY (i) A co-paricipant, your volunteer worker or your (11) Which takes place after you "employee" while participating cease to be a tenant in that in amateur athletic activities that you sponsor, or premises. (c) With respect to architects, (ii) You, or any partner or engineers, or surveyors, coverage member, (if you are a does not apply to "Bodily Injury," "Property Damage," "Personal partnership or joint venture), or any member (if you are a Injury," or "Advertising Injury" limited liability company); or "Property arising out of the rendering or the failure to render any professional (c) damage" to property services by or for you including: owned by, occupied or used by, rented to , in the care, custody, or (1) The preparing, approving, or control of, or over which physical failing to approve or prepare maps, drawings, opinions, control is being exercised for any purpose by: reports, surveys, change (1) A co -participant, your orders, designs or specifications; and volunteer worker, or your "employee"; or (11) Supervisory, inspection, or (11) You, or any partner or engineering services. (d) coverage provided herein shall be member, (if you are a partnership or joint venture), considered excess over any other or any member (if you are a valid and collectible insurance available to the Additional Insured limited liability company). b. Additional Insured — Contractual whether that other insurance is primary, excess, contingent, or on Obligations any other basis unless a written (1) This policy Is amended to include as contractual arrangement an insured any person or organization specifically requires this insurance (hereinafter called Additional Insured) to be primary, that you are required by a written 'Insured (a) In the event that you are engaged contract"; to include as an insured, subject to all of the following in the manufacture or assembly of provisions: any goods or products for the benefit or at the direction of (a) Coverage is limited to liability another party, pursuant to a arising out of: contract or agreement with that (1) Your ongoing operations party, this paragraph (a), does performed for such Additional not extend coverage to that party Insured; or as an Additional Insured. (11) Such Additional Insured's Coverage for such a party will be financial control of you; or extended only by a specific endorsement issued by us and (111) The maintenance, operation naming such party, or use by you of equipment leased to you by such C. Additional Insured — Funding Sources Additional insured; or (1) This policy is amended to include as (1v) A permit issued to you by a an insured any Funding Source (hereinafter called Additional Insured) state or political subdivision. which requires you in a written (b) Coverage does not apply to any contract to name such Additional occurrence" or offense: Insured but only with respect to (1) Which took place before the liability arising out of your promises or execution of, or subsequent to "your work" for such Additional the completion or expiration Insured, and only to the extent set of, the written "insured forth as follows: contract": or CG 119115 15 Includes copyrighted material of Insurance Services Page 5 of 8 Office, Inc. used with its permission. (a) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this policy and subject to all the terms, conditions and exclusions for this policy. The Limits of Insurance applicable to the Additional Insured are inclusive of, and not in addition to, the Limits of insurance shown in the Declarations. (b) The coverage provided to the Additional insured is not greater than that customarily provided by the policy forms specified in and required by the contract. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance Is Primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. d. Additional Insured— Manager or Lessor of Premises (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) from whom you lease or rent your Promises and which requires you to add such person or organization as an Additional Insured in this policy under: (a) Awritten contract; or (b) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an Additional Insured; but only if the written or oral agreement is an "insured contract"; (i) Currently in effect or to become effective during the term of this policy; and (it) Executed prior to the "bodily injury,' "property damage," "personal injury", or "advertising injury." (2) With respect to the insurance afforded the Additional Insured identified in Paragraph d, (1) immediately above, the following additional provisions apply: (a) This insurance applies only to liability arising out of the ownership, maintenance, or use of that portion of the promises leased to you; (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified In the written contractor agreement or in the Declarations for this policy and subject to all this policy's terms, conditions, and exclusions. The Limits of Insurance applicable to the Additional Insured are Inclusive of, not In addition to, the Limits of insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance In this Coverage Part be increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other Insurance is Primary. excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (3) This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant in the premises covered by this endorsement; or (b) Structural alterations, new construction, or demolition operations performed by or on behalf of the Additional Insured. e. Additional insured —Owner, Manager, Operator or Lessor of "Special Events" Premises (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) from whom you lease, rent or occupy the premises upon which a "special event" is held, sponsored or conducted by you, or on your behalf, under: Page 6 of S Includes copyrighted material of Insurance Services CG 83 91 0515 Office, Inc. used with its permission. (a) A written contract; or (b) An oral agreement or contract where a Certificate of Insurance has been Issued showing that person or organization as an Additional Insured; but only if the written or oral agreement Is an "Insured contract; (1) Currently in effector to become effective during the term of this policy; and (ii) Executed prior to the "bodily Injury,' "property damage," "personal injury," or "advertising injury." (2) With respect to the insurance afforded the Additional Insured identified in Paragraph e. (1) of this endorsement, the following additional provisions apply: (a) This Insurance applies only to liability arising out of the use of that portion of the premises while leased or rented to you for the specific "special event"; (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the contract or agreement pertaining to the use of the premises or in the Declarations for this policy and subject to all of this policy's terms, conditions, and exclusions. The Limits of Insurance applicable to the Additional Insured are inclusive of, not In addition to, the Limits of Insurance shown in the Declarations. (c) In no event shall the coverage or Limits of Insurance in this Coverage Form be Increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. CG83911 16 F! 1 (3) This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant, licensee or occupant in the premises covered by this endorsement; or (b) Any acts or "occurrences" caused by or attributable to the owner, manager, operator, or lessor of the premises upon which the "speclal event" is held. Additional Insured — Supervisors or Higher in Rank (1) This policy is amended to include as Insured any "employees" (hereinafter called Additional Insured), designated as supervisor or higher in rank, who are authorized by you to exercise direct or indirect supervision and control over "employees" and the manner in which work is performed, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" designated as supervisor or higher In rank, is an insured for: (a) "Bodily injury' or "personal injury": (1) To you, to your partners or members (if you are a partnership orjoint venture), or to your members (if you are a limited liability company); (it) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph (a)(1) above;or (111) Arising out of his or her providing or failing to provide professional health care services. (b) "Personal injury"; (i) To a co -"employee" while in the course of his or her employment, or (11) To the spouse, child, parent, brother or sister of that co - "employee" as a consequence of Paragraph (b)(i) above; Includes copyrighted material of Insurance Services page 7 of 8 Office, Inc, used with Its permission. (fit) For which there is any obligation to share damages With or repay someone else who must pay damages because of the injury described in Paragraph (b) (i) or (b) (11) above. (c) "Property damage" to property: (1) Owned, occupied or used by; or (11) Rented to, In the care, custody, or control of, or over which physical control is being exercised for any purpose by you, any of your "employees," any partner, or member (if you are a partnership orjoint venture), or any member (if you are a limited liability company). g. Additional Insured —LIMITATIONS (1) The persons, entitles, or organizations to which coverage Is extended under Paragraphs a. (Athletic Activity Participants), b. (Contractual Obligations), c. (Funding Sources), d. (Managers or Lessors of Premises), and e. (Owner, Manager, Operator, or Lessor of "Special Events" Premises) are Additional Insureds, but only: (a) With respect to each Additional Insured's vicarious liability for "actual damages" solely caused by you or by "your work" that is ongoing for such Additional Insured's supervision of "your work and (b) If the Additional Insured did not cause or contribute to the "occurrence" or act resulting in liability. (2) If an endorsement is attached to this policy and specifically names a person or organization as an Additional Insured, then the coverage extended under this paragraph 4. AUTOMATIC ADDITIONAL INSURED(S) does not apply to that person, entity, or organization. (3) The following is added to Section V — Detinitions: 24. "Actual Damages" is to have its usual and customary legal meaning and excludes without limitation, punitive damages, restitution, penalties, and formula damages added to "actual damages" and any other enhanced damages. (4) All other terms and conditions of this Coverage Part which are not Inconsistent with this Paragraph h, apply to coverage extended to the above referenced Additional Insureds REGARDLESS OF WHETHER OR NOT A COPY OF THIS COVERAGE PART AND/OR ITS ENDORSEMENTS ARE DELIVERED TO AN ADDITIONAL INSURED. L. BLANKET WAIVER OF SUBROGATION Paragraph 8, under Section IV — Commercial General Liability Conditions is deleted and replaced with the following: 8. Transfer of Rights Of Recovery Against Others To Us And Blanket Waiver Of Subrogation a. If an insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impalr them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. If required by written "insured contract," we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard." M. PRIORITY OF APPLICATION FOR MULTIPLE INSUREDS Section III— Limits Of Insurance is amended to add the following paragraph: 8. In the event a claim or "suit" is brought against more than one insured, due to "bodily injury` or "property damage" from the same "occurrence," or 'personal injury," or "advertising injury," from the same offense, we will apply the Limits of Insurance in the following order: a. You; b, Your "executive officers," directors, "employees," and c. Any other Insureds in any order that we choose. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Page $ of 8 �/i/ f/ I Includes copyrighted material of Insurance Services CG 83 91 0515 Office, Inc. used with its permission. �K" CERTIFICATE OF LIABILITY INSURANCE OATE(MMDDYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hz/s/zozo OLDER. 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 Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. 505 N Brand Blvd, Suite 600 Glendale CA 91203 INSURED IN I LHOU-03 INSURER B: Great AmericanSpirit Interval House P.O. Box 3356 INSURER C : New York Marine And Seal Beach, CA 90740 ... COVERAGES CERTIFICATE NUMBER•258746756 • 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 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, INSR ADDL SUBR PAID CLAIMS. POLICY EFF LTR TYPALGINSURANCE D POLICY NUMBER MM/DD/YYYY POLICY EXP MMIOD/YYVY LIMITS A X COMMERCIAL GENERAL LIABILITY V HHS8525626-13 10/1 /2019 10/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE T OCCUR DAMA ETO ENT PREMISES Ea occurtence $500,000 MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- ❑ LOC GENERAL AGGREGATE $3,000,000 JECT PRODUCTS - COMP/OP AGG $3,000.000 OTHER: $ A AUTOMOBILE LIABILITY HHS8525626-13 10/1/2019 10/1/2020 COMBINEDSINGLE LIMIT $1,000,000 ANY AUTO Ea accident BODILY INJURY(Perperson) $ OWNED CHEDULED S AUTOS ONLY AUTOS HIRED NON X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ AUTOS ONLY AUTOSONLY V Per accident A UMBRELLA LIAR X OCCUR HHN8585444-10 10/1/2019 10/1/2020 X EXCESS LIAB EACH OCCURRENCE $2.000,000 AGGREGATE $2000,000 CLAIMS -MADE X DED I I RETENTION$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC202000005078 2li/2020 Z/1/2021 X PER OTH- $ YIN ANYPROPRIETORIPARTNER/EXECUTNE STATUTE ER OFFICER/MEMBEREXCLUDED? NIA E.L. EACH ACCIDENT $1,000,000 (Mandatorydetain NH) E.L. DISEASE -EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Cyber Liability E.L. DISEASE -POLICY LIMIT $1,000,000 Claims -Made form NET 1280674-04 10/1/2019 10/1/2020 Limit $1,000,000 Ratio Date: 7/12016 A99regate $1,000,000 Retention $5,000 DESCRIPTION OF OPERATIONS / EDCATIONS / VEHICLES (ACORD 101, AddiOonal Remarks Schedule, maybe attached if more space is required) Policy: Crime Coverage Policy Term: 10/01 /2019 to 10/01 /2020 8 Policy : ndeUC11 ricers t Lloyd's, Carrier: Underwriters at Lloyd's, London REVIEWED & APPROVED Employee theft: Limit:$3,000,000 / Deductible: $25,000 By Risk MANAGEMENT DIVISION ERISA: Limit:$3,000,000 Theft of 25,000 1I Money and Securities: Limit:$3,000,000 Deductible: $25,00uctible 0 O 10 U See Attached... r FQTIFIr ATP lint nED _ ---_—_ City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All riahte resnrvnd 11110 HCUKU name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTEHOU-03 _ LOC #: ,A`� o�® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher & Co. Interval House P.O. Box 3356 Seal Beach, CA 90740 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Computer fraud: Limit:$3,000,000 / Deductible : $25,000 Funds transfer fraud: Limit:$3,000,000 / Deductible: $25,000 Money orders and counterfeit paper currency: Limit:$3,000,000 / Deductible : $25,000 Clients' Property (Other): Limit:$3,000,000 / Deductible: $25,000 Policy: Abuse or Molestation Liability I To 10/1/2020 /Aggregate: $3,000,000 Professional Liability k: HHS8525626-13 -: Berkley National Insurance Company Term: 10/1/2019 To 10/1/2020 aim: $1,000,000 /Aggregate: $3,000,000 Berkley National Insurance Company Term: 10/1/2019 To 10/112020 t Building : Limit: $5,231,005 / Deductible $1,000 t Business Personal Property: Limit: $872,540 / Deductible $1,000 & Officers Liability Philadelphia Indemnity Insurance Company arm: 10/1/2019 To 10/1/2020 IT: $1,000,000 /Aggregate: $1,000,000 / Retention: $0 of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured with respect to the operations of the named Workers Compensation coverage is evidence only. surance is Primary and Non -Contributory. Written notice shall be provided at least ten (10) days in advance of Cancellation for non-payment of premium / (30) days in advance for any other cancellation or policy change. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION 2008 ACORD The ACORD name and logo are registered marks of ACORD All riahtC YPGPNPfi COMMERCIAL GENERAL LIABILITY CG 83 91 05 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ CAREFULLY. GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Throughout this endorsement, the words "you" and "your" refer to the Named Insured shown in the Declarations. The word "we," "us," and "our" refer to the company providing this insurance. The following is only a summary of the additional coverages provided by this endorsement and is provided only for your reference and convenience. For the Limits of Insurance and the additional coverages provided by this endorsement, read the provisions on the following pages and the Coverage Form, which this endorsement modifies. SUBJECTS OF INSURANCE Broadened Bodily Injury Broadened Personal and Advertising Injury Broadened Property Damage Broadened Fire, Lightning, Explosion, and Sprinkler Leakage - $500,000 Broadened Medical Payments - $10,000 Broadened Supplementary Benefits a. Bail Bonds - $1,000 b. Expenses Incurred to Assist in Defense - $500 per Day Broadened Newly Acquired or Formed Organization Broadened Non -Owned or Chartered Watercraft or Aircraft Broadened Commercial General Liability Conditions a. Duties in the Event of Occurrence, Offense, Claim, or Suit b. Liberalization —Automatic Coverage If We Adopt Broader Coverages c. Notice to Company Automatic Coverage for "Special Events" Automatic Additional Insureds a. Athletic Activity Participants b. Contractual Obligations c. Funding Sources d. Manager or Lessor of Premises e. Owner, Manager, Operator, or Lessor of "Special Event' Premises f. Supervisors or Higher in Rank — Co -Employee Exclusion Removed g. Limitations Blanket Waiver of Subrogation Priority of Application for Multiple Insureds The coverages listed in this endorsement are provided as extensions or additions to your insurance program. \00 CG 83 91 05 15 Includes copyrighted material of Insurance Services Page 1 of 8 Office, Inc. used with its permission. A. BROADENED BODILY INJURY b. Material Published with Knowledge of Paragraph 3. of Section V — Definitions is Falsity deleted and replaced with the following: "Personal and advertising injury" arising 3. "Bodily injury" means physical injury, sickness, out of oral, written, televised, videotaped, or disease sustained by a person, including or electronic publication of material, if death resulting from any of these. "Bodily done by or at the direction of the insured injury" also means mental injury, mental with knowledge of its falsity; anguish, humiliation, or shock sustained by a c. Material Published Prior to Policy person, if directly resulting from physical Period injury, sickness, or disease sustained by that "Personal and advertising injury" arising person. out of oral, written, televised, videotaped, B. BROADENED PERSONAL AND ADVERTISING or electronic publication of material whose INJURY first publication took place before the 1. Paragraph 14. of Section V — Definitions is beginning of the policy period; deleted and replaced with the following: C. BROADENED PROPERTY DAMAGE 14. "Personal and Advertising Injury" means Exclusion 2.a. under Coverage A Bodily Injury injury, including consequential "bodily and Property Damage Liability is deleted and injury" arising out of one or more of the replaced with the following: following offenses during the policy period. a. Expected Or Intended Injury a. False arrest, detention, or "Bodily injury' or "property damage" expected imprisonment; or intended from the standpoint of the insured. b. Malicious prosecution or abuse of This exclusion does not apply to "bodily injury' process; or "property damage" resulting from the use of c. The wrongful eviction from, wrongful reasonable force to protect persons or entry into, or invasion of the right of property. private occupancy of a room, dwelling, D. BROADENED FIRE, LIGHTNING, EXPLOSION or premises that a person occupies by AND SPRINKLER LEAKAGE or on behalf of its owner, landlord, or 1. Paragraph 6. under Section III —Limits Of lessor; Insurance is deleted and replaced with the d. Oral, written, televised, videotaped, or following: electronic publication of material that 6. Subject to 5. above, the Damage to slanders or libels a person or Premises Rented to You Limit is the most organization or disparages a person's we will pay under Coverage A for or organization's goods, products, or damages because of "property damage" services; to: e. Oral, written, televised, videotaped or a. Any one premises while rented to you, electronic publication of material that or in the case of damage by fire, while violates a person's right of privacy; or rented to you or temporarily occupied f. Misappropriation of advertising ideas by you with permission of the owner; or style of doing business; or and g. Infringement of copyright, title, or b. Personal property of others in your slogan. care, custody, or control, while at h. Mental injury, mental anguish, premises rented to you or in the case humiliation, or shock, if directly of damage by fire, while rented to you resulting from Items 14.a. through or temporarily occupied by you with 14.g. above. permission of the owner, arising out of 2. Exclusions 2.b. and 2.c. under Coverage B any one fire, lightning, explosion or Personal and Advertising Injury Liability sprinkler leakage occurrence, are deleted and replaced with the following: 40��, Page 2 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 Office, Inc. used with its permission. The Damage to Premises Rented to You Limit is the greater of: c. $500,000; or d. The amount shown in the Declarations for Damage to Premises Rented to You Limit. 2. Paragraph 2. Exclusions of Coverage A Bodily Injury and Property Damage Liability is amended as follows: Paragraphs c. through n., do not apply to damage by fire, lightning, explosion, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits Of Insurance. 3. Paragraph 4. Other Insurance of Section IV — Commercial General Liability Conditions is amended as follows: Paragraph b. (1) (a) (it) is deleted and replaced with the following: (ii) That is Fire, Lightning, Explosion, or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; or 4. Paragraph 9.a. under Section V — Definitions is deleted and replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'; 5. This Broadened Coverage is subject to all the terms of Section III — Limits Of Insurance. 6. This Broadened Coverage does not apply if Fire Damage Liability of COVERAGE A (SECTION 1) is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. E. BROADENED MEDICAL PAYMENTS 1. The following provision is added to Paragraph 7. of Section III — Limits Of Insurance: The Medical Expense Limit shall be the greater of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit. 2. This Medical Expense Limit is subject to all the terms of Section III — Limits Of Insurance. 3. This above Medical Expense Limit does not apply if Coverage C Medical Payments is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. F. BROADENED SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. under Supplementary Payments — Coverages A and B are deleted and replaced with the following: b. Up to $1,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to $500 a day because of time off from work. G. BROADENED NEWLY ACQUIRED OR FORMED ORGANIZATION Paragraph 3.a under Section II — Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is afforded only until the 1201h day after you acquire or form the organization or the end of the policy period, whichever is earlier. H. BROADENED NON -OWNED OR CHARTERED WATERCRAFT OR AIRCRAFT Exclusion 2.g. under Coverage A Bodily Injury and Property Damage Liability is deleted and replaced by the following: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use, or entrustment to others of any aircraft," auto," or watercraft owned by or operated by, or rented or loaned to, any insured. Use includes operation and "loading or unloading". This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to premises you own or rent, provided the "auto" is not owned by or rented, or loaned to you or the insured; CG 83 91 05 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. Page 3 of 8 (4) Liability assumed under any "insured contract" for the ownership, maintenance, or use of aircraft, watercraft, or "autos'; or (5) "Bodily injury" or "property damage" arising out of the operation of any of the equipment listed in Paragraph f. (2) or f. (3) of Section V — Definitions, Paragraph 12., "Mobile Equipment"; or (6) An aircraft you do not own that is: (a) Hired, chartered, or loaned with a crew; and (b) Not owned in whole or in part by any insured. (7) This insurance does not apply, under Paragraph g.(1) and g.(2) above, if the insured has any other insurance for "bodily injury" or "property damage" which would also apply to loss covered under this provision, whether the other insurance is primary, excess, contingent, or on any other basis. (8) This insurance is excess, under Paragraph g. (6) above, over any other insurance, whether the other insurance is primary, excess, contingent or on any other basis. BROADENED COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Paragraph 2. Duties in The Event Of Occurrence, Offense, Claims Or Suit under Section IV — Commercial General Liability Conditions is amended to add the following provision: e. Your obligation to notify us as soon as practicable of an "occurrence," or offense under Paragraph 2.a. above, or a claim or "suit" or offense under Paragraphs 2.a., 2.b., and 2.c above, is satisfied if you send us written notice as soon as practicable after any of your "executive officers," directors, partners, insurance managers, or legal representatives becomes aware of, or should have become aware of, such "occurrence," offense, claim or "suit." 2. The following provisions are added to Section IV — Commercial General Liability Conditions: 10. Liberalization If we adopt any revision that would broaden the coverage under this coverage part without additional premium within 30 days prior to or during the policy period, the broadened coverage will immediately apply to this coverage part. 11. Notice To Company If you report an "occurrence" or offense to your Workers' Compensation insurer which later becomes a claim under this Coverage Part, failure to report such "occurrence" or offense to us at the time of the "occurrence" or offense will not be considered a violation of the Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition, if you notify us as soon as practicable when you become aware that the "occurrence" or offense has become a liability claim. J. AUTOMATIC COVERAGE FOR SPECIAL EVENTS 1. You are automatically covered for all "special events" which you organize, promote, administer, sponsor, or conduct during the term of this policy. 2. Section V — Definitions is amended to add the following paragraph: 23. "Special Event" means any event: a. The purpose of which is to raise funds for you; or b. To recognize the accomplishments of your organization, your "employees," or your volunteer workers; or c. Which you, or an individual or organization with whom you have entered into a contract or agreement, organize, promote, administer, sponsor, or conduct for the purposes described in Paragraphs a. or b. above; and d. Which takes place on premises owned by you, or on premises while rented or leased to you or to that organization described in Paragraph c. above. K. AUTOMATIC ADDITIONAL INSURED(S) The following provisions are added to Section II — Who Is An Insured: 4. Automatic Additional Insured(s) a. Additional Insureds —Athletic Activity Participants (1) This policy is amended to include as an insured any person(s) [hereinafter called Additional Insured(s)] representing you while participating in amateur athletic activities that you sponsor. However, no such person is an insured for: (a) "Medical expenses" under Coverage C Medical Payments. (b) "Bodily Injury" to: Page 4 of 8 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. CG 83 91 05 15 \ V (1) A co -participant, your volunteer worker or your "employee" while participating in amateur athletic activities that you sponsor; or (ii) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company); or (c) "Property damage" to property owned by, occupied or used by, rented to , in the care, custody, or control of, or over which physical control is being exercised for any purpose by: (i) A co -participant, your volunteer worker, or your "employee"; or (ii) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Additional Insured — Contractual Obligations (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) that you are required by a written "insured contract"; to include as an insured, subject to all of the following provisions: (a) Coverage is limited to liability arising out of: (1) Your ongoing operations performed for such Additional Insured; or (ii) Such Additional Insured's financial control of you; or (iii) The maintenance, operation or use by you of equipment leased to you by such Additional Insured; or (iv) A permit issued to you by a state or political subdivision. (b) Coverage does not apply to any "occurrence" or offense: (i) Which took place before the execution of, or subsequent to the completion or expiration of, the written "insured contract"; or (ii) Which takes place after you cease to be a tenant in that premises. (c) With respect to architects, engineers, or surveyors, coverage does not apply to "Bodily Injury," "Property Damage," "Personal Injury," or "Advertising Injury" arising out of the rendering or the failure to render any professional services by or for you including: (i) The preparing, approving, or failing to approve or prepare maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (ii) Supervisory, inspection, or engineering services. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) In the event that you are engaged in the manufacture or assembly of any goods or products for the benefit or at the direction of another party, pursuant to a contract or agreement with that party, this paragraph (e). does not extend coverage to that party as an Additional Insured. Coverage for such a party will be extended only by a specific endorsement issued by us and naming such party. c. Additional Insured— Funding Sources (1) This policy is amended to include as an insured any Funding Source (hereinafter called Additional Insured) which requires you in a written contract to name such Additional Insured but only with respect to liability arising out of your premises or "your work" for such Additional Insured, and only to the extent set forth as follows: CG 83 91 05 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. Page 5 of 819 -1 (a) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this policy and subject to all the terms, conditions and exclusions for this policy. The Limits of Insurance applicable to the Additional Insured are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. (b) The coverage provided to the Additional Insured is not greater than that customarily provided by the policy forms specified in and required by the contract. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. d. Additional Insured — Manager or Lessor of Premises (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) from whom you lease or rent your premises and which requires you to add such person or organization as an Additional Insured in this policy under: (a) A written contract; or (b) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an Additional Insured; but only if the written or oral agreement is an "insured contract' (1) Currently in effect or to become effective during the term of this policy; and (ii) Executed prior to the "bodily injury," "property damage," "personal injury', or "advertising injury." (2) With respect to the insurance afforded the Additional Insured identified in Paragraph d. (1) immediately above, the following additional provisions apply: (a) This insurance applies only to liability arising out of the ownership, maintenance, or use of that portion of the premises leased to you; (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this policy and subject to all this policy's terms, conditions, and exclusions. The Limits of Insurance applicable to the Additional Insured are inclusive of, not in addition to, the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Part be increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (3) This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant in the premises covered by this endorsement; or (b) Structural alterations, new construction, or demolition operations performed by or on behalf of the Additional Insured. e. Additional Insured —Owner, Manager, Operator or Lessor of "Special Events" Premises (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) from whom you lease, rent or occupy the premises upon which a "special event" is held, sponsored or conducted by you, or on your behalf, under: Page 6 of 8 Includes copyrighted material of Insurance Services CG 83 91 05 15 Office, Inc. used with its permission. Vo (a) A written contract; or (3) This insurance does not apply to: (b) An oral agreement or contract (a) Any "occurrence" or offense which where a Certificate of Insurance takes place after you cease to be has been issued showing that a tenant, licensee or occupant in person or organization as an the premises covered by this Additional Insured; but only if the endorsement; or written or oral agreement is an "Insured contract," (b) Any acts or "occurrences" caused (1) Currently in effect or to by or attributable to the owner, manager, operator, or lessor of become effective during the the premises upon which the term of this policy; and "special event" is held. (ii) Executed prior to the "bodily f. Additional Insured — Supervisors or injury," "property damage," Higher in Rank "personal injury," r . "advertising injury."" (1) This policy is amended to include as "employees" (2) With respect to the insurance afforded insured any (hereinafter called Additional Insured), designated the Additional Insured identified in as supervisor or higher in rank, who Paragraph e. (1) of this endorsement, are authorized by you to exercise the following additional provisions direct or indirect supervision and apply: control over "employees" and the (a) This insurance applies only to manner in which work is performed, liability arising out of the use of but only for acts within the scope of that portion of the premises while their employment by you or while leased or rented to you for the performing duties related to the specific "special event'; conduct of your business. However, (b) The Limits of Insurance applicable none of these "employees" designated to the Additional Insured are the as supervisor or higher in rank, is an lesser of those specified in the insured for: contract or agreement pertaining (a) "Bodily injury" or "personal injury": to the use of the premises or in (i) To you, to your partners or the Declarations for this policy and members (if you are a subject to all of this policy's terms, partnership or joint venture), conditions, and exclusions. The or to your members (if you are Limits of Insurance applicable to a limited liability company); the Additional Insured are inclusive of, not in addition to, the (ii) For which there is any Limits of Insurance shown in the obligation to share damages Declarations. with or repay someone else (c) In no event shall the coverage or who must pay damages because of the injury Limits of Insurance in this described in paragraph (a)(i) Coverage Form be increased by above; or such contract or agreement. (iii) Arising out of his or her (d) Coverage provided herein shall be providing or failing to provide considered excess over any other professional health care valid and collectible insurance services. available to the Additional Insured (b) "Personal Injury": whether that other insurance is primary, excess, contingent, or on (I) To a co -"employee" while in any other basis unless a written the course of his or her contractual arrangement employment, or specifically requires this insurance (!I) To the spouse, child, parent, to be primary. brother or sister of that co - "employee" as a consequence of Paragraph (b)(i) above; CG 83 91 05 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. Page 7 of 8 V� (III) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (b) (1) or (b) (ii) above. (c) "Property damage" to property: (i) Owned, occupied or used by; or (ii) Rented to, in the care, custody, or control of, or over which physical control is being exercised for any purpose by you, any of your "employees," any partner, or member (if you are a partnership orjoint venture), or any member (if you are a limited liability company). g. Additional Insured — LIMITATIONS (1) The persons, entities, or organizations to which coverage is extended under Paragraphs a. (Athletic Activity Participants), b. (Contractual Obligations), c. (Funding Sources), d. (Managers or Lessors of Premises), and e. (Owner, Manager, Operator, or Lessor of "Special Events" Premises) are Additional Insureds, but only: (a) With respect to each Additional Insured's vicarious liability for "actual damages" solely caused by you or by "your work" that is ongoing for such Additional Insured's supervision of "your work"; and (b) If the Additional Insured did not cause or contribute to the "occurrence" or act resulting in liability. (2) If an endorsement is attached to this policy and specifically names a person or organization as an Additional Insured, then the coverage extended under this paragraph 4. AUTOMATIC ADDITIONAL INSURED(S) does not apply to that person, entity, or organization. (3) The following is added to Section V — Definitions: 24. "Actual Damages" is to have its usual and customary legal meaning and excludes without limitation, punitive damages, restitution, penalties, and formula damages added to "actual damages" and any other enhanced damages. (4) All other terms and conditions of this Coverage Part which are not inconsistent with this Paragraph h. apply to coverage extended to the above referenced Additional Insureds REGARDLESS OF WHETHER OR NOT A COPY OF THIS COVERAGE PART AND/OR ITS ENDORSEMENTS ARE DELIVERED TO AN ADDITIONAL INSURED. L. BLANKET WAIVER OF SUBROGATION Paragraph 8. under Section IV — Commercial General Liability Conditions is deleted and replaced with the following: 8. Transfer of Rights Of Recovery Against Others To Us And Blanket Waiver Of Subrogation a. If an insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. If required by written "insured contract," we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard." M. PRIORITY OF APPLICATION FOR MULTIPLE INSUREDS Section III — Limits Of Insurance is amended to add the following paragraph: 8. In the event a claim or "suit" is brought against more than one insured, due to "bodily injury" or "property damage" from the same "occurrence," or "personal injury," or "advertising injury," from the same offense, we will apply the Limits of Insurance in the following order: a. You; b. Your "executive officers," directors, "employees," and c. Any other insureds in any order that we choose. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Page 8 of 8 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. CG 83 91 05 15 / — / 0 ^� CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/DD/YYYY) 2/5/2020 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($), 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 Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. 505 N Brand Blvd, Suite 600 Glendale CA 91203 CONTACT NAME: Maureen MoMo McDonald PHONE No 818.539.8625 uc Not. 818.539.8725 nopaess: maureen mcdonald@aig.com INSURERM AFFORDING COVERAGE NAICM INSURERA: Berkley National Insurance Company 38911 'tense ' 0726293 INSURED INTEHOU-03 Interval House INSURERS: New York Marine And General Insurance Company 16608 INSURER C: P.O. Box 3356 Seal Beach, CA 90740 INSURERD: INSURER E : INSURER F ---'--• -- THISIto vrOlvry rvUm CCK: 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 LTR TYPE OF INSURANCE A15 LSUBR POUCYNUMBER POLICYEFF (Mll POLICVEXP MM/DDn'YYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y HHS8525626-13 10/1/2019 10/1/2020 EACH OCCURFENCE $1.000,000 DAMAGE A AGET Roccurrence $500,000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ JECT LOG ❑ GENERALAGGREGATE $3,000,000 PRODUCTS-COMP/OP AGG $3,000.000 $ OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A B UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE NIA Y HHN8585444-10 WC202000005078 10/1/2019 2/1/2020 10/1/2020 2/1/2021 EACH OCCURRENCE $2,000,000 X AGGREGATE $2,000,000 DEO X RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECLMVE OFFICERIMEMBEREXCWDED? XPER exual Misenntluct STATUTE ERH $IDCIUded E.L. EACH ACCIDENT $1,000,000 (Mandatary In NH) I[ yedescribe s, L.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000, 000 DESCRIPTION OF OPERATIONS below A Commercial Property HHS8525626-13 10/1/2019 10/1/2020 BLKT Building Limit BLKT BPP Limit Deductible $5,231,005 $872,540 $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space Is r l\CYIE Policy: Crime Coverage 1`CY Policy Term: 10/01/2019 to 10/01/2020 BY RISk MANAGEMENT DIVISION Policy* UC11717955.19-038 Carrier: Underwriters at Lloyd's, London Employee theft: Limit:$3,000,000 / Deductible: $25,000 F g Q�2�il ERISA: Limit:$3,000,000 Theft of money and securities: Limit:$3,000,000 I Deductible: $25,000 Money and Securities: Limit:$3,000,000 / Deductible : $25,000 See Attached... / =Mm IPm`ATr• tin, - City of Santa Ana Attn: Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REI RE64 . Fi Vmu'D kZU IOIUS) ©1 I ne ACORD name and logo are registered marks of ACORD rights reserved_ ACOR"e 1*� AGENCY CUSTOMER ID: INTEHOU-03 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher & Co. Interval House P.O. Box 3356 Seal Beach, CA 90740 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY Iterfraud: Limit:$3 transfer fraud: Lim orders and counh ' Property (Other): or Molestation Liability surance Company 10/1 /2020 gregate: $3,000,000 Professional Liability HHS8525626-13 Berkley National Insurance Company Perm: 10/1/2019 To 10/1/2020 im: $1,000,000/Aggregate: $3,000,000 / Deductible: $25,000 Policy: Cyber Liability Policy#: NET 1280674-04 Carrier: Great American Spirit Insurance Company Policy Term: 10/112019 To 101112020 Per Claim: $1,000,000 / Aggregate: $1,000,000 / Retention: $5,000 Contract #A-2019-088-01 City of Santa Ana, its officers, agents, employees and volunteers are named additional insured with respect to the General Liability yy of the named insured. Such insurance is primary and non-contributory. Waiver of Subrogation for Workers Compensation policy applies in favor of ificate holder. RgE iJIVIEWiskED & APPRANAqEMENTpOVEDD EB 1 � ACORD 101 (cl7nnR ArnRn rnRPnRATInnl All.:.- 4 The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered 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 perform 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 2.00% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Any Person or Organization as Required By Written Contract Any Person or Organization as Required By Written Contract All Operations of the Name Insured 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 2020-02-01 Insured Interval House Insurance Company New York Marine and General Insurance Company128746 WC 04 03 oa Policy No. Endorsement No. WC202000005078 Countersigned By (Ed. 04-84) 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. POLICY NUMBER: HHS8525626-13 COMMERCIAL GENERAL LIABILITY Berkley National Insurance Company CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Onerationc City of Santa Ana, its officers, agents, employees and volunteers Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. try Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1