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HomeMy WebLinkAboutORANGE COUNTY CONSERVATION CORPS (3)o ,, City of Santa " na � Clerk of the Cc....cil 1- J-1 x� AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. CM Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. / Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with A-2019-165 No. (List all amendments. Revised: 10-18-16 COTC Office Use Only AMA CITY CLERK 13123 Pm3:44 - was completed odLtV9 30j X?-Oand final payment has been made. Use space below it needed.) GOP,- Department: �/iJA' Phone/Ext.: Signature: Date: INSURANCE NOT ON FILE VVORK MAY NOT PROCEED CLERK OF COUNCIL e DATE: SEP 2 5 2019 O'.cDAh) 5 �,Na13w� A-2019-165 FIRST AMENDMENT TO AGREEMENT UNDER THE WORKFORCE INNOVATION AND OPPORTUNITY ACT THIS FIRST AMENDMENT TO AGREEMENT is hereby made and entered into this 17`h day of September, 2019, by and between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("CITY"), and Orange County Conservation Corps, a non-profit corporation ("SUBRECIPIENT"). RECITALS: A. The parties entered into a one-year agreement under the Workforce Innovation and Opportunity Act (WIOA) dated July 1, 2019 (hereinafter "Agreement"), by which CITY agreed to expend federal funds for workforce development programs for at -risk youth that provide preparation for secondary and post -secondary education, occupational training and employment skills for entry into the labor market, as defined in the scope of work attached to said Agreement. B. The Agreement included funding from the Department of Labor, Employment and Training Administration for fiscal year 2019-2020. For fiscal year 2019-2020, CITY was designated a Local Workforce Development Area (LWDA) under WIOA, Public Law 1-113-128, Catalog of Federal Domestic Assistance (CFDA) Number 17.259 and Federal Award Identification Number (FAIN) AA253421455A6, and the CITY was awarded $785,103.00 for youth workforce development programs. C. In accordance with the terns and conditions of said Agreement, the parties desire to amend the Agreement to provide additional funds for fiscal year 2019-2020 to SUBRECIPIENT for the WIOA Youth Workforce Development Program based on unspent funds from fiscal year 2018- 2019. WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Agreement, the parties agree as follows: Section II, City's Obligations, Subsection A, on page 5 of the Agreement, shall be amended to increase the amount of youth funds CITY agrees to pay to SUBRECIPIENT by a sum not to exceed $14,935.85 for fiscal year 2019-2020, for a total amount during the term of the Agreement not to exceed $129,935.85 for youth workforce development programs in accordance with the Budget attached hereto as "Exhibit All and incorporated herein by reference. 2. Except as hereinabove amended, all terms and conditions of said Agreement shall remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. ATTEST: ATTEST: Daisy Gomez Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City By: RECOMMENDED FOR APPROVAL: Steven A. Mendoza Executive Director Community Development Agency CITY OF SANTA ANA "CITY" By: Kristine Ridge City Manager G°SUBRECIPIENT": KatharW O. Munb Chief Executive Officer Orange County Conservation Corps Orange County Conservation Carps Santa Ana Workforce Investment Board - The Youth Service Provider Network Request for Proposal PY 201912020 ORANGE COUNTY CONSERVATION CORPS BUDGET NARRATIVE Administrative Staff —.02 FTE — $2,800 or 2.43% of budget Administrative staff consists of a small percentage of the Chief Financial Officer to perfo`an various administrative functions including; general <S: financial managemctit, payroll, accounts payable and office coordination. Administrative Staff Taxes and Benefits - $242 or 0.21 % of budget Taxes and benefits include state unemployment at 6.2% of first $7,000 earned, 7.65% FICA and workers compensation. Program Staff —1.27 FTE — $59,550 or 45.83% of budget Program staff consists of 3 individuals of which 1 'Program Specialist will be exclusively dedicated to ensure the programmatic success of the grant which includes recruit, enroll youths and overall case management. Other programs staff will be involved to provide overall support, leadership, management, coordination, daily supervision, training engagement and menonhip of enrolled youths. WIOA Program Specialist— 80% FTE: fully responsible for the success of grant Operations Manager —2% FTE: projects management and acquisition Crew Supervisor I -- 45% FTE: project supervision and inentorship Program Staff Taxes and Benefits -- $12,190 or 9.38% of budget These include taxes and fringe benefits associated with each staff and their corresponding percentage of time spent on fulfilling all programmatic aspect of the grant. 6.2% for State Unemployment Insurance for first $7,000 earned, 7.65% for FICA and an allocated % of respective health benefits including retirement contribution cost for each associated staff. Project Transportation — $1,.925 or 1,48% of budget Project transportation includes vehicle insurance, fuel, repair and maintenance. Costs are allocated based on the number of participant hours on the grant compared to overall Corps total participants 'hours. Total costs are computed and allocated during each billing period. Participant Wages, Taxes and Benefits — $39,577 or 30.460/0 of budget Wages are paid directly to participants who earn a minimum of $12.00/$13.00 per hour and are scheduled to work up to 29 hours per week while enrolled in our program. Taxes and workers compensations are directly associated with participants wages and are paid by the Corps. 14 participants @7 weeks with 29 hours per week average @$12 per hour and @$13 per hour Orange County Conservation Corps Santa Ana Workforce Investment Board - The Youth Service Provider Network Request for Proposal PY 201912020 effective January 1, 2020, NOT including any additional leveraged wages by OCCC. Additional costs include taxes and workers compensation. Support Services — $9,100 or 7.00 % of budget Supportive Services mainly include uniforms, bus passes and gas cards. Other supportive service may include hotel voucher, car repair, tattoo removal, dress for success, material and supply for certification training and any other related costs in helping the participants to successfully complete the program. This is for both new enrollments and follow-up services. Incentives — $4,550 or 3.50% budget Incentives are costs associated with prepaid cards given directly to the participants for successfully completing or accomplishing certain required or encouraged milestones. These include obtaining; certification, earning a high school diploma and other milestones. This is for both new enrollments and fallow -up services. Budget Summary Overall, 97% of the budget is budgeted toward programmatic expenses where most of the fund budgeted is directly benefiting the participants in fornns of wages, benefits, incentives and supportive services. In addition to the budget, the Corps will also be leveraging approximately up to $115,964 of various costs associated with operating the program. Follow-up Services — Follow-up services for prior, year participants (PY1Sf19) using current budgeted amount in supportive services. Tracking OCCC uses finger biometric to track all participant hours in additions to daily field sign -in. sheet. Time cards are generated bi-weekly and are signed off by participants with trio corresponding supervisor. Various labor distribution reports are used to track participant hours and earnings, Incentives and supportive services are requested through an applicable form witli proper approval 'before they are delivered. Incentives and supportive services report can be generated at will from our tracking databases. Subcontracting — OCCC does not subcontract any obligations or duties in this proposal. Santa Ana Workforce Investmet BoardYouth Council Workforce Innovation & Opportunity Act Program Year 2019/2020 Orange County Conservation Corps Administrative Program Total WIOA Personnel Salaries (List titles and FTEs)' -T---2,800 go F Baratta* 1 242,201 12,190.581 12,432:78 Total Personnel 3,042,201 71,740.581 74,782.78 Opeariting Expertsw - - —TentUc—cupancy 'Rolated' Utilities Phones Internet fees Parking fees Security Maintenance Insurance Equipment rental Fees* Vehicle Jesse charges (whicles may not be purchased) Office expenses (consumables) Accounting SeNces Project Expenses Adminstratim SeNcer; Indirect costs (attach Indirect cost rate plan*) Professional Sordic-e—s Marketing/Membership Finance Uh—argoD Staff training Staff travol/mileage/confetences Participant Wages & Benefits* 39,577,21 39,577,21 Support services' w/follow ups 9,100.00 9,100.00 Profit (for prolits; only) - Incentives 4,55a00 4,550.00 Project Transportation 1,925.87 1.92a.8-7 Charter School Total Operating Expenses 55,1153A8 55,153.08 Follow-up Services (22) (staff time + fol up Svcs) Grand Total with Follow-up Services 3,042.20 126,89165 - 129,935.85 _ Santa Ana Worktorce /nvastmet ftoardi both Council OCCC Workfwae lerm.1lan & Oppattunity Act Direct Program Expanses Program Year 2019/2020 VEDA WIOA OCCC Staff Wages<Salarles TIma % Amount 66MBISlsfivo Staff Chief Flnanclat Officer T, Huynh 2% 2,800.00 SnbCotal Admin Staff zg00,00 Employer Taxes 214,20 Workers Compensation 28.00 Benefits Subtotal Admin Staff ralse8anents 242.20 Total Administrative Expenses. 3,042.20 Program Staff Project Manager J. Newton 2% 2,000.00 SUpaMeor I TB.D 45% 17,650.00 WiOA Program Specialist D. G8mla. 80% 40,000.e0 Subtnral Program Staff 59,650.00 Employer'raxes 4,555.SB Workers Compensatian 2,175.00 Benefits 5,460.00 Subtotal Program Staff Taxeesene&s 12;190.6a PYoglam Expenses Project Teanapoitation (whlcle, Inswama,hml, lepalr & Saint) 1,925.87 Staff Tmining Occupancy Related (rema4 utilities, repair & maint) Subtotat Pfdgram Expenses _..___ 1,926.87 Total Program Expenws 73,66EA5 CnrpvrremlWr(CM) Expenses Average Total hrar WIDA CMS1lpende #ofNewCMa Hourly Rate CM Amount CMs(29 hrlwk x'I I Mt) 14. $12to$13 2,842 34,221,00 Carr *Duets p CMS Total Hours/Paid Work Ez erlenre 2842 Employe-Taxe5 4618,53 Workers Compensation _ 7.737,68 OM SOP"d Total .__-. _ 14 39,577.21 Supportive 5ervises/Untf/bus rolbsC/Uaoks/tuiffon/w follow -Up Services 34 $ 650 9,100M CM 'Kell [Ives/WfalIOW- UpsemlceS 14 $ 325 4,550,00 Subtotal Cams EKiteneas _33,227 2t Follow-up SeNicos Error Year (22) (alaff time + sup We) Total with Follow-up Services 128,935,85 MCC Match OCCC Staff Salaries & Wages 47,61000 Tnxas & Benefits 915077 OCCC Match- participant Wages & Benefits 20,000.00 OCDE Charter School 2,407.34 OCCC Expenses 36,796,26 Total OCCC Cash & In Kind 115,fl0416 57% 41% loop/ 89% Santa Ana Workforce investmet BoardYooth Connell occc W OYMMe IOnaVAOOO & 01000u111ty Act Matrhag Pragre m Year 2019I2020 - WIOA OCCC tffS Tenn. 53. V!99Ss WPA1, Bfffi.£ L^$LIp Chief Execurve Ogleer K. 6andc,Al 0% - 3,8W.W Chle7 Fl,andal Mar T. Huynb 2% 21OCO.W 2,8W.W Accounts Payable N�HVales 0% - 1,260,00 Payroll 9pecfalfst S, Cones 0% 1,740,00 ITManager P. glOnge 0% 2,000.W IDrepter Of Operations l.V.]p 0% - 2,mm Project Menage, J Nexlvn 2% 2,00,W 2,WO.W SupeMeorI MD 45% 17,550.W 9,750.W sepenlsvr ll MD 0% 319w.00 pmgmma Pa." Ss.. 0% 3 CMb.W Pmgrem Seel V. Y.P. 0^A 9,000.W WIA Program Spoalalist D. Gruela 80% 40,000,W io,WO.W Recmiler Bt Paetae 0% - 2(200.0d Sub.torel staff Warner &wages _ 82,380.0 447,610.00 Subtotal sh Benefits 12,432.78 9,150,17 Tofal Sd6Wepes and SeneNrs 74,78278 86, 760,77 WIOA Amount WIOA WIOA OOCO tJpgry-tinu Expenses Sudget 3.3% Portion 003 M-kind Ngte Ad,elnlsiraTon 34,500 ;154 - - 1,153.52 Staf{trainin8/stnif and hoard meedn6s Oueupanoy 554,OW' 3,210 - 5,20539 8ebt/urlil Cle@/phones/boildove/oceupzncy related Fidancing/barSingipayroll Charge, 35,OW 1,170 - - 1,170 A Dank/kDC/payrell procescor Fee Mar-rtiufld=bnrshp 27,OOO 903 - 902.75 Corps ,aebrrWpand oufreachcampa'rgn Offe. Expenses 19,000 635 - - 63527 Office eupplue Professional SeMeee 251OQb 836 - - 835.88 CPA AcdIU HRlLagai)Uu,,ll contracted eeracae Ptojest Expenses 182,ox 25,GA - 25,(K0,00 Cmstools/safety supplies/unifiarma/projac[direct related Tr2nmtldation(Fuel, ins wanee, MairrP 144,cl 4,815 401% 1,925.87 2,N8GS1 Vah la",/pgrY...... ear alfocatinn, teal, ns, malm Trauai&GonfArence 12,50p 1,W0 0es - 1,WO.W Staffmllaeg@ end miXcellaneaus travels/conferences QCDE C'ih&tef$Lfiopl 72,a)J 2,407 - 2g07,34 Std}f tYll$ag2 and mSCni annnUS tYIlV45/CI)n(n(enp@6 OCCC Particlpapt Wages&Ba,nOta 10,O00 20,OW - 20,OW.W Othorfayetagad participsntawerkhrg Imm&benefit, Tbx.-J Opornt(ne Expenses 8 i,tl39,Op0 S 61,t2B 1,926.87 50,203.00 "— TdW Occc Mgch (Cash & In 10ntlf 118,864.38 Tvfal WIOA Prpfepted Houm 2,842 Total OCCC Projected. Houre 85,000 Pr.j.ut%(WIA hreel hre) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/VYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DUES 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 pclloy(los) 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 Sri endorsement. A statement on this Certificate does net center Hahts to the certificate holder In lieu of such endorsamentfat. Arthur J, Gallagher & Co, Insurance Brokers of California, Inc. LIC# 0725293 1255 Battery Street ##450 San Francisco CA 94111 INSURED Orange County Conservation. Corps 1853 North Raymond Avenue Anaheim, CA 92801 COVERAGES. _ ._. —_- CERTIFICATE NUMBER:10IS193701 J REVISION NUMBER: THIS IS 1-0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 199UE� TO Tf`IE�INBUR:EfaNAMED ABOVE FOR THE POLICY PENIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXOLUSIONS-AND CONDITI1— OFSUCH-POLICIES. LIMITS -SHOWN MAY HAVEBEENREDUCEDBY PAIDCLAIMS, 1-11ONS ... ...,...._. ._.. .,A6l4L STidff .... __.. _PaDLIOY IN RIF— .R LICY K.—..Pd.... TYPE OF INSURANCE NUM CR wun I LIMITS COMMERCIALtlENERAL LIABILITY EACH OCCURRENCE Po OOOUR frM'AGC'rtFiiN'7F6 PERSONAL W,ADV INJURY b GEN'L AGG912 #ATjjE UMpIIT APPLIES PEP, OENLRAL AO(MM ATC S POLICY ._..I JLCT _,.� LOG .. ._.. ,..„_... PRODUCTS OCMP/OP AtaO & _ AUTOMOBILE LIABILITY ANY AUTO pOtlILY INJURY Ipar ptursg0) li OWNED ..... SCHEDULED AUTOS ONLY AUTOS _ .. ROtlILY INJURY (par waldenq ...,. HIRED NON?OWNED PROPERTY DAMAOL E AUTOS ONLY AU'rg9ONLV (Pjira4Cldenp E _ UMBRELLA LIAR pflCUR EACH OCCURRENCE........._,__.: __.._ ...... EXCESS LIAR CLAIM: -MADE AOGpECATE,.. DEC I I RETF TI NSWOHKEPS _ B A N NPU • VVOG 001.2019 1/f/2010 1/1/2020 X AND EMPDOYbEnSCMPENSATIO'LIARIL ITY Yy ry ANYPROPRIET0I-1/PARTNENlEXEMJ'I'IVE (—"j E.4. EACH AOCIOENT $9O0,0tl0, gF.1,1 RIMhMaena xrLUDEDR L. NIA .. (Mdndydary In NH) E L DISEASE, • CA EMPLOYEE' IR 500 000 II ag,d scribe under C �' N FOPERATION3 below G.L. DISEASE • POLICY LIMIT 1 T 540,Og4 'B Exaeee Wnkers'DamP SPp4598➢1 1l112019 1/1I2020 Ulnit Per0coe"nem Slatuloryy E.Lper O0e6A00 2,000,000 I _ XB of G00,000 DESCRIPTION OEbPERATItlN51 LtlCAT10NSI VEHICLES (ACORD 101, Atldllidrvbl p®mel•kg BaNadnle, lnay be attachedll more vpaae l9 requited) n—��•_ OPEN_ l Santa Ana Workforce Investment Board Fran Jutzi 1000 East Santa Ana Boulevard #200 . Santa Ana CA 92701 u SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEIJVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 26 (2010103) The ACORD name and logo are registered marks of ACORD rights CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDAYYY) 1 p/1/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this Certificate does not confer rl hts to the certificate holder in lieu of such enciorsement(s). PRODUCER Arthur J, Gallagher Bt CO. Insurance Brokers of GA. LIC.00726293 505 N Brand Blvd, Suite 600 rvamIT e:o Annie Lee P ONE Fq 818.639.8001 AI No:818.839.s709 L • Annie Lee a •com 11 AFFORDINGOOVERAOS NA)Ce Glendale CA91203 WSURSRA; Great American Alliance lnaurance Cc 26832 INSURED ORANCOU•19 Orange County Conservation Corps 1853 N. Raymond MS. Anaheim, CA 92801 INSURER a l Great American Insurance Company of NY 22135 INSURERa: NonProfits United wsuRERD: Navl ators Insurance Company.42307 INSURER E: COVERAGES CERTIFICATE NUMBER:8$7487771 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LI57E0 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. POLICIESLIMITS SHOWN MAY HAVE BEEN REDUCED BY _PAID CLAIMS. T TYPE OF INSURANCE PO ADPF LIMITS A X COMMEROIALOENBRALLIAHILITY Y PAC 810460D 14 10M/2010 10/1/2019 EACH OCCURRENCE 111,900,000 CLAIMS -MADE OCCUR PREMISED (En accurm ce -„ $IAA OAO MED EXP (Any o119 Peracn) $ 8,000 PERSONAL& ADV INJURY $1000.000 GENT AOOREGATE LIMITAPPLIES PER GENERALAGGREGATE $3000.000 PRODUCTS - COMPIOP AGO $a,0001000 X PO(.IOY D JEW 171LOO $ OTHER: B AUTOMODILELIABILITY CAP 090124008 10/l/2010 101112o19 M%M=ftfL_$1.000,000 $ X ANYAUro BODILY INJURY(Perparaan) OWNED SCHEDULED AUTOS ONLYNxAUTOS X AUTOS DNLY AU708 ONLY SonILY I NJURY(Par opmenp $ P APccrJe IDAMAGE -- $ $ X C.M01 0 CoA$S00 A X UMBRELLA LIAD X OCCUR UMS cSW79614 101112MB 10(1/7.019 EACH OCCURRENCE $4000000 AOGRSUATE $4000000 RX9B83 LIAE CLAIMS.MADE DE X I RETENTION94QMQqq $ O WORKERS COMPENSATION AND EMPLOYERS -LIABILITY AFPROPR MOEREATNERMXECUTIVE YI rNi (Mandatoryln NH) If yB§, de1011bounnor DESCRIPTION OF OPERATIONS WQW NIA NPU-WCG001-2016 1/112019 1/1P2019 X SATUTE E.L. EACH ACCIDENT _ $ 000,000 E.L. DISEASE- PA EMPLOYE $1.000,00o EL,DISEAaE-POUCYLIMIr 81000,000 O Directors&DflloPrg NYIBUOLV03161NV 10MIDDID 'IDI1/20IR Pell OlahPo Aggrepdte: $2,000.000 92,000,000 DESCRIPTION Ok OPEItATIONS I LOCATIONS IVeHIOLR$ IADDRD 101. Additional Remarks schedule, may he Aaarhod if maro apace fa regairod) Policy � AbUSD and molestation Coverage Policy s; PAC 515408014 Term: 10/0ea 018 -1010 Alliance Insurance Co, NAIC; 28832 Term; 10/01 /2p18-1 D/0172019 Each Occ : $1 OD0,000 Aggregate :$9,000,000 Reviewed by Audrey Goodson Page of ROIIPy' Professional Liability See Attached,,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, City of Santa Ana, Workforce Investment Board 1000'E. Santa Ana Blvd., Ste. 200 Santa Ana CA 92701 AUTHORIZEDREP ASENTATIVE A' AI ® 1988-20$ AGORD CORPORATIOM All rights reserved. ACORD 26 (2D1S/0$) The ACORO name and logo sea registered marks ofACORD AGENCY CUSTOMER ID: ORANCOU-19 LOC: e � ADDITIONAL REMARKS SCHEDULE Page 1 of 1 NAMED INSURED Gallagher a Co, Orange County Conservatlon Corps 1853 N. Raymond Ave, IeER Anaheim, CA 92601 CARRIER I NAI0 0002 EMOTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 RORM TITI P. CERTIFICATE OF LIASILITY Insurance Co, NAIL; 26832 a officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are named additional with respaot to the operations of the named Insured per the attached CO 2026 endorsement, Such Insurance Is Primary and IS Compensation coverage evidence only, .t Reviewed by Audrey GoodsonPage of w tuvu AVIdKLI UURPORATION. All rights The ACORD name and logo are registered marks of ACORD Orangs county Conservation Corps Polloy No: PAC 0154680 14 Eftaofivs bate: 10/01/2018 CG 20 26 (Ed, 04 1$) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(s) or Organlzatlon(s): The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its. officers, employees, and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Deciaratlons, A. SECTION 11 - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organizatlon(s) shown in the Schedule, but only with respect to Ilabhity for "bodily Injury," "property damage" or "personal and advertising injury" caused, In whole or In part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1, in the performance of your ongoing operations; or 2. in connection with your premises owned by or rented to you, However: 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the Addltlonal 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 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 Additlonal Insured is the amount of insurance: 1, required by the contract or agreement; or Reviewed by Audrey Goodson 1.°. � Page � of� Copyright, 150 Properties, Inc., 2012 CG 20 26 (Ed. 04113) (Page 1 of 2) 2, available under the applicable Limits of Insurance shown In the Declarations; whichever Is less This endorsement shall not increase the appllcable Limits of Insurance shown in the Declarations, Reviewed by Audrey Goodson_t Page of Copyright, ISO Properties, Inc., 2012 GG 20 26 (Ed. 04/13) (Page 2 of 2)