Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
CASA DE LA FAMILIA
INSUKANC€ ON FILE A-2020-110 WORK MAY PROCEED UNTIL INSURANCE EXPIRES 3/z3/2- _ CLERK OF COUNCIL DATE- N 13 /2v AGREEANNT WITH CASA DE LA FAMILIA TO PROVIDE OPERATIONS SUPERVISOR FOR HE SANTA ANA FAMILY JUSTICE CENTER THIS AGREEMENT is made and entered into on this 2nd day of June, 2020, by and between Casa delaFamiliar a 501(c)(3) non-profit organization ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City of Santa Ana and the Santa Ana Police Department have sought federal funding assistance to assist in the full implementation of the Santa Ana Family Justice Center (SAFJC). The establishment of a Family Justice Center modeled after best practices from across the country is uniquely situated to not only be vastly successful but is expected to immediately and directly positively impact many lives. B. On February 28, 2020, the City issued a Request for Proposal No. 20-036 ("RFP") seeking a qualified firm to provide a professional and experienced specialist with a background in community service, victim advocacy, and/or social services to coordinate and accomplish the daily operations of the Santa Ana Family Justice Center (SAFJC), while maintaining strong relationships with community partners, planning and coordinating special events, and organizing staff. C. The Consultant provided a timely proposal, incorporated by reference to this Agreement, which was selected by the City and Consultant represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that she is knowledgeable in this field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations required to fully and adequately complete the services detailed in the scope of services related to the SAFJC Operations Specialist project as set forth in Exhibit A. Consultant shall provide an independent sub -contractor who demonstrates experience, knowledge, and capacity to carry out services as specified herein with the intent that this subcontractor(s) shall be on -site at the SAFJC between 30 — 40 hours per week staffing the SAFJC Monday through Friday. #40617v3 Paget of 9 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges provided in Exhibit B. The maximum amount to be paid during the term of this Agreement, including any extension periods, shall not exceed $131,040. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July 1, 2020 and continue for a six month period until December 31, 2020, with the option for the City to grant up to two (2) six (6) month renewals, exercisable by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 16, below. 4. INDEPENDENT CONTRACTOR Consultant, and any employees, subcontractors or substitutes shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to he prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. #40617v3 Page 2 of 9 6. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self- insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Consultant is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: i. Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ii. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved by the City. iii. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. iv. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. #40617v3 Page 3 of 9 V. Consultant shall supply City with a fully executed additional insured endorsement. f. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. S. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements #40617v3 Page 4 of 9 charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information' shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Consultant, and any employees, subcontractors or substitutes shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. LIVE SCAN BACKGROUND CHECK Consultant, and any employees, subcontractors or substitutes, shall arrange for and submit their fingerprints for a criminal background check through the Department of Justice through the #40617v3 Page 5 of 9 City's Human Resources or Santa Ana Police Department process. Consultant shall be responsible for all charges associated with fingerprinting. Consultant shall not perform any services pursuant to this Agreement until clearance is received and Consultant is notified by the Santa Ana Police Department. 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 16. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 17. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by #40617v3 Page 6 of 9 the parry waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 18. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 19. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 20. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Chief of Police City of Santa Ana 20 Civic Center Plaza (M-97) P.O. Box 1988 Santa Ana, California 92702 Fax:714-245-8007 #40617v3 Page 7 of 9 To Consultant: Casa de la Familia Attn: Ana Nogales 1650 E. 4m Street Santa Ana, CA 92701 Fax:714-619-5937 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 21. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. C. The Agreement is the final and complete agreement and any prior or contemporaneous agreements for similar services between the parties is superseded by this Agreement. This clause shall not apply where the Parties are currently engaged and Consultant is providing services not contemplated by this Agreement. [signature page to follow] #40617v3 Page 8 of 9 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. .,,..,, -.— Clerk of the Council APPROVED AS TO FORM: City orney By: Tamara Bogosian Assistant City Attorney RECOMMENDED FOR APPROVAL: (!Da ' ;entin Chief of Police CITY OF SANTA ANA Z� Stine Ridge City Manager CASA DE LA FAMILIA: Ai- Ge� x By:Karina Palma -Rojas Title: Managing Program Director #40617v3 Page 9 of 9 1*4:IiYI/:1 SCOPE OF SERVICES Kie CITY OF SANTA ANA EXHIBIT A SCOPE OF SERVICES The City of Santa Ana is seeking a professional and experienced entity to provide a qualified specialist who can oversee the daily operations of the Santa Ana Family Justice Center. Specific expected responsibilities include, but are not limited to the specifications outlined herein. DESCRIPTION An Operations Specialist (OS) is expected to be onsite at the SAFJC between 30 to 40 hours per work week, staffing the center Monday through Friday. The OS will be hired by the awarded entity and deployed by that entity to the SAFJC, to provide services to the City under the direction of the Santa Ana Police Department's Criminal Investigations Division Commander. The OS will be responsible for the Justice Center's consistent achievement of its mission and objectives as they pertain to the operation of the SAFJC. It is understood that the Subcontractor assigned to the SAFJC will have pre - approved days off, vacation time, training days, etc. It shall be the Contractor's responsibility to ensure 5 day per week coverage at the center and the RFP response should indicate how the proposer will ensure compliance with this need. The SAFJC is a collaboration of 17 service organizations that create a one -stop service center for survivors of domestic violence, sexual assault, child abuse, human trafficking, and elder abuse. This service model houses a multidisciplinary team of professionals under one roof to provide support and services, while promoting self-sufficiency and effectively breaking the cycle of violence. II. MINIMUM CONTRACTOR QUALIFICATIONS Contractor must possess the following minimum qualifications: A. Three (3) years of non-profit experience in community service, victim advocacy or social services. B. Familiarity with the Alliance for HOPE and the national Family Justice Center model. III. ESSENTIAL CONTRACTOR FUNCTIONS Contractor shall be responsible for, but not be limited to providing personnel capable of performing the following: A. Ensuring the mission and core values of the SAFJC are put into practice in every aspect of the center's operation. B. Maintaining strong relationships with both on -site and off -site community partners, interns and volunteers as well as a positive trauma -informed working environment. C. Developing and continuously improving appropriate systems, policies, protocols and procedures that create a trauma -informed coordinated service delivery model and support the effective victim -centered operation of the SAFJC (e.g. information handling and confidentiality). D. Working closely with experts in the field to implement best practices and guiding principles. RFP No. 20-036 SAFJC OPERATIONS SPECIALIST Page 17 of 32 CITY OF SANTA ANA E. Initiation/collaboration for the procurement of grants for programs, general operating expenses, and special events. F. Developing strategic partnerships with, nonprofits and formal and non -formal community leaders. G. Producing content for use in communications (Newsletters / Letters to targeted groups, social media, etc.). H. Collaborating with SAPID CID Commander to produce financial data and financial reporting for special events, programs, operating budget, and all financial reporting responsibilities. I. Planning and managing special events with assistance from various event committees. J. Facilitating graphic creation/writing, printing, addressing and mailing and/or emailing invitations, sponsor packets, programs and display signage for special events. K. Acting as spokesperson for media requests, proactive communication and special events for the Santa Ana Family Justice Center at the direction of the SAPID CID Commander. L. Supervising volunteers/interns. M. When directed by the SAPID CID Commander, to collaborate with the National Family Justice Center Alliance on various initiatives and participate in relevant trainings/webinars hosted by the Alliance. N. Performing other duties as assigned by the SAPID CID Commander. IV. MINIMUM SUBCONTRACTOR QUALIFICATIONS A. Three (3) years of non-profit experience in community service, victim advocacy or social services. B. Familiarity with the Alliance for HOPE and the national Family Justice Center model. C. Bilingual, biliterate in English and Spanish. V. DESIRABLE SUBCONTRACTOR KNOWLEDGE, SKILLS, AND ABILITIES A. Prior supervisory experience. B. Degree from an accredited college or university in social science, business administration, or similar field. C. Knowledge of Microsoft Office programs and database management programs. RFP No. 20-036 SAFJC OPERATIONS SPECIALIST Page 18 of 32 EXHIBIT B RATES AND COMPENSATION (9) CITY OF SANTA ANA EXHIBIT B PROPOSER'S CERTIFICATION AND PROPOSAL ITEM PRICING Certification - I certify that I have read, understand and agree to the terms and conditions of this Request for Proposals. I have examined the Scope of Services (Exhibit 1) and am familiar with the products and services being requested. I understand and agree that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification prior to the submission of my proposal. Proposal Item Price - Pricing shall be all inclusive and based on the scope of services described in this RFP, including Exhibit 1. Cost proposal shall include all costs for the provision of a 6 month subcontractor(s) to perform the duties of the SAFJC Operations Specialist. Item A refers to the proposers pricing for a 30 hour per week subcontractor while item E lists hourly wage for a 40 hour per week position. Please complete both sections. Item Service Pricing Equation Subtotal A. Operations Specialist (30 Hours Per $ 28 Per Hour / 780 hours X's $ 21,840 Week) Hourl Wage Hourl Wa e B. Contractor Expected Contract Management Costs (Percentage of Percentage 20 % % x's 780 Hours $ 4.368 Hourly Wage - 30 hours) C. Employers social Security Taxes, Unemployment Insurance, Workers Percentage 30 % % x's 780 Hours $ 6,662 Compensation Insurance, Other Associated Employee Costs 30 hours D. $ 32,760 30 Hour Subcontractor 6 Month Total E. Operations Specialist (40 Hours Per $ 28 Per Hour / 1040 hours X's $ 29,120 Week) Hourly Wage Hourly Wage F. Contractor Expected Contract Management Costs (Percentage of Percentage 20 % % x's 1040 Hours $ 6824 Hourly Wage - 40 hours) G. Employers social Security Taxes, Unemployment Insurance, Workers Percentage 30 % % x's 1040 Hours $ 8,736 Compensation Insurance, Other Associated Employee Costs 40 hours H. $ 40 Hour Subcontractor 6 Month Total 43,680 THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. RFP No. 20-036 SAFJC OPERATIONS SPECIALIST Page 9 A� d CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 6/24/2020 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 C NTA T Van Wagner Agency 135 Crossways Park Drive PHONE FAX . 800-735-1588 N 888-290-0302 AE,,'R"Ess vanwagnerinsurancelDstedingrisk.com P.O. Box 9017 INSURERS AFFORDING COVERAGE NAIC0 Woodbury NY 11797 INSURER A: Great American Assurance Company 26344 Licenses- INSURED CASAVEL41 INSURER e: Casa De La Familia Karina Palma -Rojas INSURER C INSURER D Karina Palma -Rajas 1650 E. 4th Street#101 INSURER E: Santa Ana CA 92701 INSURER F COVERAGES CERTIFICATE NUMBER: 1207416509 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [NSA LT TYPE OF INSURANCE ADOLSUBR POLICY NUMBER POLICY EFF IMNUDPIYYYYI POLICY EXP (MMIDDfYYYYILIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR Y Y GLP 4293 84I5 SBI2020 ✓ 616U2021 ✓ EACH OCCURRENCE 31000000 L� n n SIN'(100 MED EXP An one persm $ 5.000 PERSONAL& ADVINAl1RY 51,000,00o GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.00D X POLICY0JJECOT n LOG PRODUCTS - COMP/OP AGG $3.0000DO $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT (Ea a cileni $ BODILY INJURY (Per person) S ANY AUTO ALL OPINED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMA E P r $ NON -OWNED HIRED AUTOS AUTOS 3 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CWMS-MADE DED I I RETENTION Is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN TA E ERµ EL EACH ACCIDENT $ ANY PROPRIETORPARTNERVEXECU IVE OFFICERIWMSER EXCLUDED? ❑NIA E.L, DISEASE - EA EMPLOYE $ (Mandatary In NH) If yes. desoibeunder DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMB 1 $ A Professional Liability / GLP 429.3 "e 5S 020 MQ021 Each madent 5100D000 � / Aggregate $3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES(ACORO 101. Additional Remarks Schedule. may be attached If more spaceis required)���� O lnnrTn`/L City of Santa Ana, officers, employees, agents, volunteers, and representatives are named as additionally insured on�$y 1 sG4fifflJfNr 1, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any W VFAiQq&C,&j;IDW"Wess and noncontributory. L'Y e1 Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. ✓ JU 2020 CERTIFICATE HOLDER CANCELLATION / ✓ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, 4th floor Santa Ana CA 92701 C 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD acoRo® CERTIFICATE OF LIABILITY INSURANCE 414.� DATE(MMIDD/YYYY) 1 06/24/2020 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(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 Tom Saumur Insurance Agency CONTNAME, 4242 Obispo Ave PHONE FA% fAIC. No. Eldh c Not; Lakewood CA 90712 EMAIL Do SS, INSURSIUSH AFFORDING COVERAGE NAIC# INSURER A:State Fund INSURED Casa De La Familia Inc INSURER 8: INSURERC:Hudson Insurance VZ 1650 E 4th St INSURER D: Santa Ana Ca 92701 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A L SUBR POUCYNUMBER POLICY EFF IMMIDDNYWI POLICY EKP (MINIODArYYY1LIMITS COMMERCIALGENERALUABILITY EACH OCCURRENCE S PREMISES Me oncurv..)S CLAIMS -MADE OCCUR MED EXP one arson S PERSONAL B ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER POLICYO jERC ❑LOC GENERALAGGREGATE S PRODUCTS-COMPIOPAGG S S OTHER: AUTOMOBILELIABILRY COMBINED SINGLE LIMIT Me arediderill S ANY AUTO BODILY IWURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INLARY(Per a I, ilkM) S PROPERTY DAMAGE S HIRED NONOWTlED AUTOS ONLY AUTOS ONLY S UMBRELLA LMB OCCUR EACH OCCURRENCE S AGGREGATE S "LESS L1118 CLAIMS -MADE DIED I I RETENTION S S (A WORKERSCOMPENSATION AND EMPLOYERS' UABILRY ANYPROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMSERMLUDED9 Y❑ (Mandatory In NN) NIA 248318-19 1312312020 3123/2021 ✓ PER T OTH- E.L EACH ACCIDENT S1,000,000 E.1- DISEASE -EA EMPLOYEE $1,000,000 ifyea, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $1,000,000 C rinployer Liability 100,000 Retention ncludes-Sexual Misconduct Liability FP-HN-NPP-3783 2/17/2019 2/17/2020 1,000,000 Aggregate Employer Practices DESCRIPTION OFOPERATK)NS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aeached if more space Is mgubad) REVIEWED & APPROVE By Risk MANAGEMENT DiVis1 ertificate Holder Listed as Additional Insured JUL 9 2020 CERTIFICATE HOLDER CANCELLATION Aaicic Arcvcrin iof Santa Ana , / V SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Divison THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 0 Civic Center Plaza 4Th Floor ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, Ca 92701 AUTHO W 2ED REPRESEMAI W E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forma Bass Web softeme. www.FormsBoss.wm; 9 Impressive Publishing 809-208-1977 Casa de Is Familia Orange County Corporate Office- 1650 E 41h St., Santa Ana, CA 9270 (714)667-5220 508 W Commonwealth Ave., Fullerton, CA 92832 Los Angeles County: 3550 Wilshire Blvd., Ste 670, Los Angeles, CA 90010 (213)413-7777 June 24, 2020 Casa de la Familia requires every employee who drives a motor vehicle as part of his or her job duties (whether frequently or infrequently), and every employee who utilizes Casa de la Familia's- provided parking to maintain current vehicle insurance for at least the minimum liability required by law (as of November 2007, the minimum liability is $15,000 for injury/death of one person; $30,000 for injury/death for more than one person; $5,000 for property damage). The renewal date of an employee's automobile insurance will be noted in his or her personnel file. The employee will be responsible for submitting proof of renewal to Casa de la Familia at each renewal period. Failure to provide proof of renewal by the renewal date will result in immediate suspension of the employee's duties that require the employee to drive a motor vehicle. Respectfully, C&w Ax Karina Palma -Rojas Managing Program Director Casa de la Familia REVIEWED & APPROVED BY Risk MANAGEMENT DlvlsloN JU42020 ANgiE AcEVEdo Digitally signed by Francine R. Villareal Francine R. VillarealDate: 2022.01.05 10:15:41 -08'00' DA 7E 4r0,M0I3JYYYYl CERTIFICATE OF LIABILITY INSURANCE 11116021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE, CERTIFICATE HOLDER, THIS CERTIFICATE DOE'S NOT AFFIRMIATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD15D BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DQF;S NOT CONS71TUTE A CONTRAci BETWEEN THE ISSUING INSURFRS). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER111I HOLDER, IMPOIRTAN"r� if bita, cortificite holder is in ADDITIONAL, INSURED, the policy(ies) must boonclorsod, If SUET R00ATION P WAIVED. subject tO the t@rms and conditions of tho plicy, cartalivi policies may requilre an endorsement, A statement, on this cairtificato does apt confer rights to the certificate holder in lieu of such ondorsorri,anilt(s).. PRODUCER I mm . ...................... . ................ I F Van IN89ner Age ricy� PH,0NE I Ael 13 5 Drive . ...................... P.O. Box 901Qste Il-grisk.coin V4v&&-,,u NY 1A 7 W INSURErJs affqrup!raq cOUER E NAIC N . .......................................................... INSURER A: Ci10at Ar'nenzart Assurance Gorrlpny 20'�44 . . . . . . . .......................... . . INWRED CASADEL-01 INSURER B G I 0,3t Army li il,�,kn ITuo orance CArn a 1 Casa De La Fa ills P Karina Palma -Rajas __LN5JRER.C.� . .... .............. Karin@ Pahia-Rojas . . . .. ........................ . ...... i. ........... 1650 E. 4th Street # 101 Ft E R r, &inta An@ CA 92701 ...... . ... . . ...... .. . . . . ......... . . ....... . WSjURER, F � COVERAGES CERTIFICATE NUMBER: 165635(1`17t3 REVISION NUMBER,, THIS IS TO CERTIFY THAT THE PQII(',IE13 OF' INqi,JRANCE LISTED [It.,A.UmV 11AVE BEEN ISSUED TO THE INSURED NAMED ARIDVEI-'01'�, I'ME POLICY PERIOD INOIC'ATED NQTWITHSTANDING ANY RFOUIRCMENT, 11":!I4M OR OL)NDVTION OF ANY CONTRACT OR OTHER DOCUMEATWITH III TOWHICH THIS CERTIFI[t ATE MAY BE 1$,9L1FD OR MAY PERTAIN. THE INSURAINOL AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SIJHJt'0 I to ALL TIi[E TERmS, EXCLLR�10N$ AND CONr)ITIQN$ OF,$1.)CH LIMITSSHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. ................ LJA 'TYPE or INSORANC E 1141sb MID POLICY NUMBER �MNJJDDNYYY� 41MMeDWYYYYr A X C OMMURC IAL GC-NeRAL, WARILITY 01. 42 L%23 411 0,1 &W2021 5612022 EACM I CCCLJRREhr.1E I I arml Dou, .. .......... . 7--RRT- GLAfMS-I`.IADE [�] OCCUR -5A "AR 7) IT b ;vIr,01.110 ALE —DE-Y-2-j vn!:O� . ............. i-11L1_1,S0—NAL%±P-V-!NL!yr ......... . . ................. . R1ENI- AV,,bREUATE, LINII r APPLIES FEfik AGGREGATr Lno wl,�,11 G G POLICY JEGr LC{; ori4,p AUTO MOBILE LIABILITY COMBINED . ............ . ANY AL170 . .......... . ... . ALL OWNED SCHEDULED AUTOS AUT05 NON-UlAINED I IREI6AU11 Ti L AUTOS IL4-2 . . ................... . ....... .......... ... . . UMBRELLA LIAD .',C.C UH EAGI I OCCLJRRCNCE ... ......... F XCESS LIAla ACCIREGA7E, . ................ WORKFIR5 CONIPFN9A710N I PER, &ND EMPLOYERS'LIAM) IJIY...................... ......... ANY I-w)H HIF PoH"F-AH I NFH'1FXF(,;W A-'� El EACHACrIDENT $ MEN�IA . ...... .......................... .. I. Mandplrry in Nlk� El DIKIASE - EA EMPU)Yrl,�' .3 ........... . ............... ................ • nr II JR(I" i 0 0 I`� I ID IN S b 0 1 eN E.L. DISF-ASE, POLIcY 0MI r 3 A UtkAly y 'e GLP 429-3.2-4&IM 560321 5.162.012 Each 'YP 22KA9 - v E3 Cybei Uabilk, y y Q u -01 WFiV2921 5M;2022 AIbe,,1MWaN ............. (A,4'QRR t*I. To—&ll.11Ww.'ir i u'tks SeheduAo, onaV be atiazhad If morn space, Is rairwrqap Cily Of Santa Ana, its officors. ornploye-as. agonts, on(j roprnjabve.s are narned as additionally inGLIred on qhiS P,DliCy PUIrij@IjI 1r j t I (IF II contract, agreement, or memorandLIM of understanding. SL,Ich insjrance as is afforded by lkis pol Icy shall be primary, FInd any iPSUrance carried by City sliall bra oxcA�,,s anti norawrvl ribu lory, Certificate of lnsufanco sIrlalil Pfovido thirty t'W) �Iay prior wirlori nofte of cancpJlatiun CERTIFICATE HOLDER CANCELLATION SHIOUL D A NY OF THE ABOVE: DESCRI BE D PO LICIES, 91E AN 1Ie LLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE Wll�l- aE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE, POLICY PROVISION S. Risk Management Division ........................ . ............. 20 Civic Center Plaza, 4th floor AUTHOM2PIJ R:EPq.EqFN7ATTWF Santa Ana CA 92701 Risk MujgmadDMsIcrn 59 198,a.20114 ACORD COF REviEWED&APPROVEDBY: ACORD 2fi (2014101) The ACORD narne and logo are rug istered inarks of ACORD AM= Risk Management Analyst * S1 * 12/21/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 IL 70 02 (Ed. 10 07) Policy No. GLP 429-33-48 - 06 Effective Date of Change 12/13/2021 POLICY CHANGES NAMED INSURED CASA DE LA FAMILIA AND ADDRESS: 1650 E 4TH STREET 101 SANTA ANA CA 92701 POLICY ALTERNATE MAILING ADDRESS: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AGENT'S NAME •ADDRESS:THE VAN WAGNER -y `! BOX 9017 WOODBURY, NY 11797 Insurance is afforded by the Company named below, a Capital Stock Corporation: GREAT AMERICAN ASSURANCE COMPANY POLICY PERIOD: From 05/06/21 To 05/06/22 12:01 A.M. Standard Time at the address of the Named Insured i i�iil�1•C1�:7 cT'/;Ts7:7� �7a��1��1/�17:1:�1r �hl�i�ar�r dai&Mafl0i[il'M&WA]11:1kj1 Vigo iNA 1 • • i FORMS A• ENDORSEMENTS hereby••-• 1 i Agent Signature IL 70 02 (Ed. 10107) PRO (Page 1 of 1) Date o Nye RiskMwaganadDMsian z REVIEWED & APPROVED BY.- 1 Risk Management Analyst °G1°12/21/2O21°GGREAT AMER|CANASSURANCE CO 378559 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizatiom(s): CITY OF SANTA ANA, ITS 0FFICE&S, OFFICI&LS, EMPLOYEES' AND VOLUNTEERS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 88 - Who Is An Insured is amended to include as an additional insured the peroon(o)or organization(s) shown in the Schedu|e, but only with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" ceusmd, in whole or in part, by your acts or omissions or the acts or omissions of those acting onyour 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 O. U 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 oragreement to provide for such additional insured. B. With respect to the insurance afforded to these additional inourmda, the following ioadded to Section UUU ~ Limits Of Insurance: If coverage provided to the additional insured is required by moontract 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 @|nsunanoe Services Office, Inc., 2018 RAMwaganadDMsiun Risk Management Analyst * S1 * 12/21/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 2. Available under the applicable limits of insurance; whichever is less. : III I I I I I I! I I I I T 1 11 11==�=Ii @Insurance Services Office, Inc., 2018 CG 20 26 (Ed. 12119) (Page 2 of 2) o NSF Risk MmaganedDMsiun REVIEWED & APPROVED BY. - Risk Management Analyst * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 CG 89 47 (Ed. 11 14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ALLIED HEALTH GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies and is subject to the insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE PART This is a summary of the various additional coverages and coverage modifications provided by this endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Limit of Insurance Page Non -Owned Aircraft Included 2 Non -Owned Watercraft Included 2 Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Included 3 Medical Payments $20,000 3 Damage to Premises Rented to You $1,000,000 3 Supplementary Payments - Bail Bonds $3,000 4 Supplementary Payments - Loss of Earnings $1,000 per day 4 Newly Formed or Acquired Organizations Included 4 Unintentional Failure to Disclose Hazards Included 5 Knowledge of Occurrence, Claim or Suit Included 5 Property Damage Liability - Elevators Included 5 Property Damage Liability - Borrowed Equipment Included 5 Liberalization Clause Included 6 Amendment of Pollution Exclusion (Premises) Included 6 Limited Property Damage to Property of Others $5,000 6 Additional Insured - Manager or Lessor of Premises Included 7 o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 1 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 Additional Insured - Funding Sources Included 8 Additional Insured - By Contract Included 8 Primary and Non -Contributory Additional Insured Extension Included 10 Additional Insureds - Protection of Your Limits Included 11 Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Included 11 Property Damage Extension With Voluntary Payments $1,000/$5,000 11 Who Is an Insured - Fellow Employee Extension - Management Employees Included 12 Broadened Personal and Advertising Injury Included 12 A. Non -Owned Aircraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non -Owned Watercraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 60 feet long; and (b) not being used to carry persons or property for a charge. o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 2 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. D. Medical Payments If Coverage C - Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $20,000; or b. the amount shown in the Declarations for Medical Expense Limit. This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water 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. However, this insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with the permission of the owner, caused by: i. rupture, bursting, or operation of pressure relief devices; ii. rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; iii. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or iv. flood. o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 3 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection system or water while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water or any combination of the six, is the higher of $1,000,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water" 4. As regards coverage provided by this provision I. Damage to Premises Rented to You - paragraph 9.a. of Definitions is replaced with the following: 9.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, smoke, leakage from automatic fire protection systems or water to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract"; F. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: 4. Up to $3,000 for the 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. 2. Paragraph 1.d. is replaced by the following: 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 $1,000 a day because of time off work. G. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a named insured if there is no other similar insurance available to that organization However: a. coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 4 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a named insured in the Declarations or qualifies as an insured under this provision. H. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. I. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such occurrence, claim or suit shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership; c. an executive officer or insurance manager, if you are a corporation. J. Property Damage Liability - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) of exclusion j. Damage to Property do not apply if such "property damage" results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance , paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. K. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subparagraph (4) of exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance , paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is insurance, whether primary, excess, contingent or on any other basis. excess over any property o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 5 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 L. Liberalization Clause If we revise this Allied Health General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the date the revision is effective in your state. M. Amendment of Pollution Exclusion (Premises) 1. The following is added to paragraph (1)(a) of Exclusion f. of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: (iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage, migration, release or escape of "pollutants." As used in this endorsement, the actual discharge, dispersal, seepage, migration, release or escape of pollutants must: (aa) commence on a clearly identifiable day during the policy period; and (bb) end, in its entirety, within seventy-two (72) hours of the commencement of the discharge, dispersal, seepage, migration, release or escape of "pollutants"; and (cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape of "pollutants" commences; and (dd) be neither expected nor intended from the standpoint of any insured; and (ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and (ff) not originate at or from a storage tank or other container, duct or piping which: a. is below the surface of the ground or water; or b. at any time has been buried under the surface of the ground or water and then is subsequently exposed. 2. For the purposes of this coverage, the following is added to the definition of "property damage" of SECTION V - DEFINITIONS and applies only as respects this coverage: Land or water, whether below ground level or not, is not tangible property. 3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown to have actually occurred. N. Limited Property Damage to Property of Others The following is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B: 4. We will pay up to $5,000 for loss to personal property of others while in the temporary care, custody or control of an insured caused by any person participating in your organized activities. For the purpose of this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 6 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 a. coverage is otherwise provided by the Property Coverage part (if any) of this Policy; or b. the loss is covered by any other insurance you have or by any insurance of such person who causes such loss. These payments will not reduce the Limits of Insurance. O. Additional Insured - Manager or Lessor of Premises 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an additional insured has been issued; but the written or oral contract or agreement must be an "insured contract," and, (i) currently in effect or become effective during the term of this Policy; and (ii) entered into prior to the "bodily injury," "property damage," "personal and advertising injury." 2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1 above, the following additional provisions apply: (a) This insurance applies only with respect to the liability arising out of the ownership, maintenance or use of that part 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 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. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein is excess over any other valid and collectible insurance available to the Additional Insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Insured. o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 7 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 P. Additional Insured - Funding Sources 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows: 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 insurance afforded to the Additional Insured only applies to the extent permitted by law c. 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. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. Q. Additional Insureds - By Contract 1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of: a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the Additional Insured that are subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. the maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or c. the Additional Insureds financial control of you; or d. operations performed by you or on your behalf for which the state or political subdivision has issued a permit o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 8 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 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 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 such additional insured. With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (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 for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "you 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. With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage." We have no duty to defend an additional insured under this endorsement until we receive written notice from the Additional Insured of a "suit" as required in paragraph b. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION. 2. With respect to the insurance provided by this endorsement, the following are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 9 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 Insured, if the "occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal or advertising injury," involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. c. "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 for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "you 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. d. Any person or organization specifically designated as an additional insured for ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. 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: a. required by the contract or agreement; or b. 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. R. Primary and Non -Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary 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. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreem o NSF Risk Management Division z REVIEWED & APPROVED BY. - Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 10 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non -contributor, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an additional insured on other policies. S. Additional Insureds - Protection of Your Limits This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the Additional Insured; and c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part. d. we have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the Additional Insured. 2. The Limits of Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy and defined in SECTION III - LIMITS OF INSURANCE of this Policy, whichever are less. These limits are inclusive of and not in addition to the Limits of Insurance available under this Policy. T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 8. Transfer of Rights of Recovery Against Others to Us: If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment 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" provided that the injury or damage occurs subsequent to the execution of the written contract or written agreement. U. Property Damage Extension with Voluntary Payments 1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: At your request we will pay for loss to property of others caused by your business operations for which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so. The "loss" must occur during the policy period and must take place in the "coverage territory." o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 11 of 12) * S1 * 03/04/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO 378559 2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of SECTION I - COVERAGES A - Bodily Injury and Property Damage Liability is amended as follows: Exclusions j.(3), j.(4), j.(5) and j.(6) are deleted. 3. As respects coverage afforded by this coverage, SECTION III - LIMITS OF INSURANCE is replaced by the following: Regardless of the number of insureds, claims made or "suits" brought or persons or organizations making claims or bring "suits": 1. Subject to 2. Below, the most we will pay for one or more "loss" arising out of any one "occurrence" is $1,000. 2. The aggregate amount we will pay for the sum of all "loss" in an annual period is $5,000. This aggregate amount is part of and not in addition to the General Aggregate Limit described in paragraph 2. of SECTION III - LIMITS OF INSURANCE. V. Who Is an Insured - Fellow Employee Extention - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to your "employee." W. Broadened Personal and Advertising Injury 1. Unless "Personal and Advertising Injury" is excluded from this Policy, the following is added to SECTION V - DEFINITIONS Item 14.: h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.e. o NSF Risk Management Division z REVIEWED & APPROVED BY.- -��" Risk Management Analyst CG 89 47 (Ed. 11/14) (Page 12 of 12) DATE (MWDDNVYV) CERTIFICATE OF LIABILITY INSURANCE 1110W2021 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE HOLDER. THIS CERTIFI,CATE 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 CERTIFIGATE HIOLDER. IMPORTANT., If the oeTtificale hiolodILr is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be, ondorsed.. If SUBROOATION IS WAIVED, subject to the terms and conditions, of the policy,. certain policies may roquiro an endorsement, A Statement on this cartiheata doas not confer irighte to the certificate holder in fleu of Such endorsernontfs), Tom Saumur Insurance Agency N.AME mbNr' - - — --------------------- T��A 4242 Obispo Ave (W', M49 F"�L ................ . ....... . . ...... ................... E-MAK Lakewood C.A,901712 . . . . . . . . . ........ . ...... .............. . . NAIG1 .. . . . .. . . . ................................................. .IrtiY34afk.E1R.A . . ............ . ........................ Casa Do La Farnifia Inc 1650 E 4th St Santa Ana Ca 92701 ludson Insurance COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS 13 FO ClRIIFY II -Al 11 IE POLICIES Or- INSURANCE LIS7ED BELOIN HAVE SEEK, ISSUED TO THE IN$URET) NAMEh� A130VC [h"OR 11 IE POLICY PERIOD INDiCATED. NOTWITI iSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CQKTRACT Dr () I'FIER I)OCI)MIENT Wll1 I RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE SORIBF",f) HERON IS :I!LMJIECT TO ALL THE TERMIS. LXCLUMONS AND CONDINONS OFSUCH POIACIES LIMITSSHOWN MAY HAVE BEEN REDUCED BY` PAID 0I.AIM$. . .. . . . ................. . .... .. . . . ... ...... ............................ . ........................ SUBRI POLICY EFF PIOLKV EXP TYPE OF INSURANCE PMIGY NIUMBF;R (MM,DDIYYYYI 14000,,YYVVI LEMITS GENERAL LILIABILITY E6GH 001-JRRINCE 13 .. ... . ......... . ................ ME.. . ..... ....... ......... 1' ) E .2M [:9 P0 !3 I KIP" !S GENT AGGREGA rL L�,MIT APPL pl•k: y . .............. wx'10 IO, PRODLA'7S - GOMRk")p i('i AUTOMOHM, 11 E ll I. "I I I A I'll F 11 1 I'll I "I I I "1 7 I'll, Y "I'l""I'll""I'll'll""I'll""I'll",'ll,�,-�Ill""--,�,�'ll,�,"I ........... C37Km �N Er, —swo r I 7Tk il .. . ... . .... . ....... iiI 2 L1 I —rlr I E 1. 2--ij j .. .................. . "I'll , 5 ,WY Aur.o 1 WWII V INJI)KY (PprpW,40�1) 5 . . ...... . . .. ........ WM-'o fir AkOfirn, ONI'y II)II V INAL)KY k1lor 1111-19 NOWLPANEC) OPERTV DAAMGE� 5 A010S I)NI y Am 01S cwy Par 1-r1ruL . . .. ..... .. UMBREIAA UAB (,)CCjR EAC 110 C:C J R R E NIC C EX,C E:55 L.IAI3 DrD R:TENTI�JN S— i�6Kf RS 666KFENSATION pEk 1 K- Ar4D EMF`I,GYERS'LIAI3IWTY VN i I ] -....................... AN�,PROPI),IiETC,,R�PART�IER�'[!KECU FNE 9248318-19 X2X20211 0,af212022 S1000'00 crncr R.-&Omm EXCLUDED? NIA . . . . ... .. . . .............. . ...... IMandalury in N11i I 11 duNci nuu- ixule7 'Y D SCRT710N 07, OPERA71ONG tx!hyx E.L, DI.GEA, -�fn �E . . ..... 51,000,000 C qq Empivyer Liability 104.000 Rolonijun Includes-Suxual MiscondLICt Liability p FP-HN-NPP-3783 3411,6f,2021 0,4A&2022 1,000,000 Aggragate pruidirel DESCRIPTION OF OPERAMONS I'LOCATIONS.1 VEHIGLES IACORD 101, Additional Reimarks Schaduln, may lie atlachnd IN imorn n pare Rn roquiroari ertificate Holder Ulsted as Additional Insured CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABON VE DESCRIBED POLICIES CAE GKEIL QLIED BuFORI�- Risk Management Divison THE EXPIRATION DATE THEREOF, NOTME VUrILL, BAE DELIVERED IN 2C Civic Center Plaza 4Th Floor ACCORDANCE WITH THE POLICY PROVISIONS - Santa Ana, Ca 92!701 EDREPRESENTATIVE %&MwaganedDiMsiun 0) 1988-2015 AC�ORD CO� ,7p' REVIEWED &APPRCYVEDBY.- ACORD 25112016103) The ACORD name and logo are registereld marks of ACORD Profluced 'JAIM9 l'offlis 606s Web Software. www,Forir,0osij,eut,i; y 11wrNpru5sive Publml-iing 9 0,2094977 Risk Management Analyst Casn de I WIN tgo (- o i,i i t 1 1650 F, 4,1, St. MW Ana. ( VT 9270 171 1 A67-522tt 508 W Com rn n n " e a k h A ve , F u 11 e no n, t 4 9283 2 LED A o pi vs Ci P u E 1 11) ;55 0 Vi bA N u 8 k d. `pax: 670. 1 os A up& ea, C k 900 10 12 13 10 3.7 7 77 June 24, 2020 Casa de ki kanvili.a 1-C(jUkCS CV0r ' CM1[A0YQm '�Nrbo drivo. ;! Motor vtdkkp tias pi�u'l cil", his or Iter job dmics (whoki Queruty or inngwndyL and every cinyoyee Ywho uidbes Am do la FnallUds- pmvkkd pxihng in Wnuhi onrl'oh Adde Wgurmwe A at I= to n9hmum habdhy mquVal I i y twx lams o f N w, c t n be r 20O7, t h c i i i i ii i i rtu n i Inability is S 15,000 ff) I i N jI Y(d C,' , 11, 1:1 0 f () t I Q. [10'!m I v; 530M9. O A 41 uryidendi for nwre Own one peso, STODO Ar pwpeny dwrlage). The rencivid, &atc or an Qn,byee; awomo,Nk hwwww will N nowd in his or her per�,,ojinel Mo. 111C Qr)1j+:)YCQ wifl be responihlc A swMAhair g . pro (�) f o (' R'C ti ov al I to ('ass de pat 1-""l El'i i I ill a each immal period. AM u) proyWe psof of rawwal by TQ NnewAl dam! will iwit in ilturi,ediate orow vmMs,nds dKis Otal rupke Tc onphiaQ to dKe as momr vehile. Karina, Paimm-Rojas IdarlAng Pmgmm 11hroor Cna I N AmHia, Risk MxmqvnmiDhVWun REVIEWED & APPROVED BY. - Risk Management Analyst