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HomeMy WebLinkAboutCOMMUNITY HEALTH INITIATIVE OF ORANGE COUNTYCity of Santa " na Clerk of the Council �� I AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CLER have been satisfied prior to signing the termination form. A 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 COTC Office Use Only UE THE COUNCIL 28123 P,44.33 A-2020-043-05 No. was completed on���nd final payment has been made. (List all amendments. Use space below if needed.) Department: C_/1�✓� Phone/Ext.: Signature: Date: i:lagreementsUormstform - agreement termination form_goldenrod.doc A-2020-043-05 INSURANCE ON FILE WORK MAY PROCEED N UNTIL I SUURRTCE EXPIRES J. tp CLERK OF COUNCIL DATE' L =� . C DQ! 1, CM 1 I C I I ��AGREEMENT BETWEEN THE CITY OF SANTA ANA AND Community Health Initiative of Orange County FOR USE OF CONDIUNI1'Y DEVELOPMENT BLOCK GRANT FUNDS This Agreement is hereby made and entered into this 1st day of July, 2020, by and between 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"), and Community Health Initiative of Orange County, a California nonprofit corporation ("SUBRECIP0, T'). RECITALS: A. The CITY, as an entitlement recipient and grantee of the United States Department of Housing and Urban Development C HUD' Community Development Block Grant C CDBG') Entitlement Program, Catalog of Federal Domestic Assistance (CFDA) Number 14.218, and Federal Award Identification Number (FAIN) B-20-MC-06-0508, desires to enter into this Agreement with the SUBRECIPIENT for the expenditure of CDBG funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq. C'CDBG REGS'J. B. CITY has applied for and received CDBG funds from HUD pursuant to Title i of the housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"). C. The SUBRECIPIENT is a private nonprofit corporation that has been selected by the CITY to receive CDBG funds and administer such financial assistance; and to provide the services described in Exhibit A, in accordance with the Schedule of Performance included therein, hereinafter referred to as "said program". SUBRECIPIENT represents that it is qualified and willing to operate said program and certifies that the activities carried out with funds provided under this Agreement will meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208). D. SUBRECIPIENT agrees that it will adhere to the performance measurements and outcomes as indicated on Exhibit A (Schedule of Performance). Failure to follow the measurements and meet the stated outcomes may constitute breach of contract that could result in termination of this agreement or serve as reason for the City to recapture the grant funds awarded to SUBRECIPIENT pursuant to this Agreement. WHEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of this Agreement and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and SUBRECIPIENT: I. SUBRECIPIENT'S OBLIGATIONS A. Nonprofit Status - Representations and Warranties. (a) Authority. SUBRECIPIENT is a duly organized and existing nonprofit corporation in good standing and authorized to do business under the laws of the State of California. SUBRECIPIENT has full right, power and lawful authority to accept the funding hereunder and to undertake all obligations as provided herein and the execution, performance and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions on the part of SUBRECIPIENT. (b) Experience. SUBRECIPIENT is a qualified provider of the services to be provided hereunder. (c) Familiarity With Services Required. By executing this Agreement, SUBRECIPIENT warrants that W it has thoroughly investigated and considered the services to be performed and provided hereunder, (H) it has carefully considered how the services should be performed, and (iii) it fully understands the facilities, difficulties and re Agreement. strictions attending performance of the services under this (d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement will not constitute a default or a breach under any contract, agreement or order to which sUBRECIPIENT is a party or by which it is bound. (e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened ban!¢uptcy proceeding. IPI threatened litigationmthat wouldlor mayemagriallyaffee UBRECIP oIENT S Performance underthir Agreement. (g) Application Veracity. All provisions of and information provided in SUBRECIPIENT,S application for funding submitted to CrM including any exhibits, are true and correct in all material respects. (h) No Pending Investigation. SUBRECIPIENT has no knowledge that it is the subject of any current or threatened criminal or civil action investigation by any public agency, including without limitation a police agency sor ervices herprosecuting authori Agreement or provision of serty, that would relate to or affect performance of the eunder. B. Amount of GranVTerm and rl Disbursement. The amount S0, 2022 PIENT "' $60 006t CDBG FUNDS'l, for the two-year term from July 1, 2020 through June d to 30, 2022 for the program named; Community Health Access. Such funds shall be expended by SUBRECIPIENT on or before June 30, 2022. The Term of this Agreement may be extended by a writing executed by the City Manager, or his or her designee, and the City Attorney. The CDBG FUNDS shall be disbursed by CITY to SUBRECIPIENT on a quarterly basis subject tt and upon receipt and approval of a complete quarterly activity report firm SUBRECIPIENT, with the final payment subject to the satisfaction of the condition precedent of submittal of complete reporting information due on or before July 15 of the applicable funding year, as hereinafter, more fully set forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the term, including but not limited to, Obligations with respect to indemnification, audits, reporting, data retentiontreporting, and accounting. Failure to provide any of the required documentation and reporting will cause CITY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by Crry, Funding for the second year of the term is subject to and contingent on the CITY receiving sufficient CDBG FUNDS from HUD for the 2021 2022 CDBG program year. Tire CITY reserves the right to reduce the amount of CDBG FUNDS to SUBRECIPIENT, or to completely terminate this Agrce right t, to the CITY's sole discretion, if there is a reduction in CDBG FUNDS provided t i the CITY for program year2021-2022. The CITY reserves the right to reduce the grant application if the CiTY's fiscal monitoring indicates that SUBRECIPIENT's rate of expenditure will result in unspent funds at the end of the program years. Amendments in the grant allocation will be made after consultation with SUBRECIpHM C. Use of Fo_s SUBRECIPIENT agrees to use all federal funds Provided by Crl.1, to SUBRECIPIENT pursuant to this Agreement to Operate said program, hereto and by this reference inc P P giant as set forth in Exhibit A," attached addition to other remedies set forth incorporated pin S�C�S �� to perform as required may, in otherwise obligated to pay to SUBRECIp' result m readjustment of the amount of fiords CITY is IHNT hereunder. D. Allowable Costs, SU13RECIPMW agrees to complete said ro 2022. and to use said fiords to pay for necessary program on or before June 30, regulations to operate said and reasonable costs allowable under the federal law and Program. Said amounts shall include, but not be limited to, wages, administrative allowable employee benefits comparable to other similarly situated employees and indirect costs Other reference income costs are detailed in the budget, as set forth in "Exhibit B;' attached hereto and by this s iporated herein. SUBRECIPMNT shall use all income received from said funds only for the amto the and iti ons of this e purposes for which said funds may be expended pursuant terms cond Agreement. SUBRECIPIENT has the ability to adjust line item amounts in the budget with the written approval of the CPTY's Executive Director of the Community Development Agency, or designee, so long as the total budget amount does not increase. be Pursuant to 2 CFR §200.33 1 (a)(4), the Indirect Cost Rate for the SUBRECIpIEN'T's award shall Federal an approved federally recognized indirect cost rate negotiated between the SUBRECIPIENT and the government or, if no such rate exists, the de minimis indirect cost rate as defined in 2 CFR §200.414(b) Indirect (F&A) costs For this agreement, the de minimis indirect cost rate of 10% will apply. E. Li_ c� SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operatio. SUBRECIPIENT ns shall ensure that its staff shall also obtain and maintain all required licenses, registrations inspections from all agencies governing SUBRECIPIEaccreditation and Nl"s operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. F. ZQnjng. SUBRECand Permitted IPIENT agrees that any facility/properly, used in Rutherance of said failvee the reshall be quired land eecifically ntitlement and/or for such use(s) and activity(ies). Should SU13RECIPIENT regulations relating thereto, SUBRECIPIpNT shall immediately ediatels, thus nm� any local, state or federal rules and with local, state or federal rules and re Y good -faith efforts to gain compliance CITY or other authorized ci ' agency. regulations following written notification of said violation(s) from the violations. Failure to no SUBRECIPIENT shall notify CITY immediately of any pending termination Failure �3' CITY of Pending violations, or to remedy such known violation(s)shall result in term grant funding hereunder. SUBRECIPIENT must make all corrections requ red to bring the ty/ProPertY into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. G. S_pe arationofAccounts. �_. All funds received by SUBRECIPIENT from C1TY pursuant to this Agreement shall be maintained in an account in a federally insured banking or savings and loan institution with record keeping of such accounts maintained pursuant to applicable 2 CFR 200302 requirements. SUBRECIPIENT is not required to maintain separate depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to account for receipt, obligation and expenditure of FUNDS pursuant to applicable 2 CFR 200.302 requirements, CDBG H. Audit Rrnnrt Recuire ----�— �_ t($75 • SUBRECIPIENT agrees that if SUBRECIPIENT expends Seven Hundred Fifty Thousand Dollars 750,000) or more in federal funds, SUBRE annual audit conducted by a cent tied public accountant in accordance with the standards s� rt �n published by the United States Office of Management and Budget. SUBRECIPIENT shall Provide CITY with a copy of said audit by April 1 of the year following the program year in which this Agreement is executed, L Record Keenino o N adequate records and report, SUBRECIPIENT shall keep and maintain complete and eports on program Participants to determine their initial and continuing eligibility for the Program services being Provided to assist C17y in meeting and maintaining its record keeping responsibilities under the CDBG REGS, including the following: (1) Records a. Documentation evidencing program income requirements in conformity with 24 CPR 570.504(b((2)(i), (ii) and 24 CPR 570.503(bx3) and 24 CFR 570.208(a)(2)(B) of the income level of persons and/or families participating in or benefiting by the SUBRECIPIENT program. b. Documentation of the number of pp by the SUBRECIPIEN'1' program. rsons and/or families participating in or benefiting c. Household information shall include number of persons, identification of head of household, racetcthnicity, and income verification of all household members ages 18 and over. d. Documentation of all CDBG FUNDS received from C1ry. e. Documentation of expenses as identified in the Budget Proposal, including evidence of incurring the expense, invoices for goods or services, copies of any and all contracts or documentation pertaining to costs for subcontractors, plus all other invoices and proof ofpayment for which CDBG FUNDS were expended, and any payments therefor. f Any such other related records as CrMshall reasonably require or as required to be maintained pursuant to the CDBG REGS. (2) Reports a. Payment Request. Concurrently with the submittal of each quarterly report, on or before the 15th day of October, January, April and July, SUBRECIPIENT shall submit both: an original invoiceJrequest for reimbursement and true copies of invoic, canceled checks, bank statements, credit card statementses, receipts , procurement documentation for goods or services, timesheets Payroll records, benefit statements, agreements, contracts or documentation pertaining subcontractors, and/or other documentation supporting to costs for and evidencing how the CDBG FUNDS have been expended during the applicable quarter. b. arterly Progress racial statistics of persons and families benefitedenby S�IJBRECIpgo keep records of all ethnic and obligations under this Agreement, including, but not limited tq the numb ofjth erf mmdannccedof is income persons and households assisted in accordance with federal income limits, the number to female heads of households assisted, new program information and limiYear-ts date program of statistics on expenditures, caseload and activities. Failure to provide any of the required documentation and reporting will cause MY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by Cfly. I Access to Records, CITY and the United States Government and their representatives or auditors shall have access for purposes of monitoring, auditing, and examining SUBRECIpIENTs activities and performance, to books, documents and papers, and the right to examine records of SUBRECIPIENTs subcontractors, bookkeepers and accountants, employees and participants in regard to said program. CITY and the United States Government and their representatives or auditors shall also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants in said program and entering any premises or any sio in which any of the services or activities funded hereunder is conducted or in which a SUBRECIPIENT are kept. ny of the records of Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. K. Location of Records/Reovi Len of Record Keep' - All accountingrecords, and evidence pertaining to all costs, expenses and the CDBG FUNDS of SUBREIPIENT rand ail documents related to this Agreement shall be maintained and kept available at SUBRECIPMNT'S office or place of business for the duration of the Agreement and thereafter for five (5) years from the date of final payment under this Agreement. Records which relate to (a) ee complaints, claims, administrative of this this Agreementedings or )itigation o which CITYorany other governmeental agenncy takements exception, shall be retained and expenses of beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In the event SUBRECIPIENT does not make the above -referenced documents avail the city of Santa Ana, California, SUBRECIPIENT agrees within es to pay all necessary and reasonable expanses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. L. Compliance with Law/Pr m Income. SUBRECIPIENT acknowl being provided byedg CITY for said program are received � that the funds by C1TYpursuant to the ACT as amended and that expenditures of these funds shall be in accordance with the ACT and all pertinent regulations issued by agencies of the federal government, including, but not limited to, all regulations found at Title 24 of the Code of Federal Regulations. Program income received by SUBRECIPIENT shall be returned to C otherwise provided for in this Agreement. SUBRECIPIENT agrees to comply fully with all fITY unless ederal, state and local laws and court orders applicable to its operation whether or not refereed [o in this Agreement, M. Debarment. To protect the public interest and ensure the integrity of Federal programs, CITY may only conduct business with responsible persons and may not make any award or permit any award to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension". See also 24 CFR 570.609. SUBRECIPIENT must review and sign Exhibit C "Debarment", which is attached hereto and incorporated herein by this reference. SUBRECIPIENT shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue Service. Anny change in the corporate status or suspension of SUBRECIPIENT shall be reported immediately to N. Confi halite. Without prejudice to any other provisions of this SUBRECIPIENT shalt, where applicable, maintain the confidential nature of information Providedce�o concerning participants in accordance with the requirements of federal and state law. However, SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested including audit, examinations, monitoring and verifications of reports submitted by SUBRECiPIENT, costs incurrerl and services rendered hereunder. O. Indeoenden��ctor SUBRECIPIENT agrees that the performance of obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way an agency of CITY. P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if SLIBRECIPIENp violates any of the terms and conditions of this Agreement or any prior Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIpDWr reports inaccurately, or if on audit there is a disallowance of certain expenditures, sUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or Justify expenditure of the CDBG funds granted hereunder, SU13RECIPIENT shall be required to reimburse the CITY of all such funds that were obtained and/or spent under fraudulent circumstances. Q. E4ui rent. SUBRECIPIENT agrees to maintain a record for each item of non -expendable Personal property acquired under the terms of this Agreement, Said record shall be made available to CITY Upon request. The term "non -expendable personal property" shall include leased and purchased equ pment. R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this Agreement to pay for entertainment, meals or gifts, or other prohibited uses. S. Lobbying, SUBRECIPIENT certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CPR Part 87, which provide that no appropriated funds maybe expended by the recipient of a federal contract, grant, loan to cooperative agreement to Pay any Peron for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that effect in a form as set forth in 'Exhibit D," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall submit said signed certification to CrrY prior to performing any sumsobligations under this Agreement and prior to any obligation arising on the part of CITY to pay any under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any Person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance with its instructions (Exhibit D). SUBRECIPIENT shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontractors, sub -grants, and contracts under grants, loans, and cooperative agreements), and agrees to take all actions necessary to ensure that all subrecipients shall similarly certify and disclose accordingly. T. Financial Interest SUBRECIPIENT agrees that except for the use of CDBG funds to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to CDBG activities assisted under the terms of this Agreement, or who are in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity of SUBRECIPIENT, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer or elected or appointed official of CUY, or of any designated public agency, or the SUBRECIPIENT. U. Labor Standards, The SUBRECIPIEW agrees to comply with the requirements of theed, the provisions of Contract Work Secretary of Labor in accordance with the Davis -Bacon Act as amend Hours and Safety Standards Act (40 U.S.C. state and local 327 et seq.) and all other applicable Federal, laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this Agreement. The SUBRECIPIENT agrees to comply with the Copeland Anti -Kick Back Act (18 U.S.C. 874 et seq.) and its implementing regulations of the U.S. Department of Labor at 29 CFR Part 5. The SUBR13CIPIENT shall maintain documentation that demonstrates compliance with hour and wage requirements of this part. Such documentation shall be made available to the CITY for review upon request. SUBRECIPIENT agrees that, except with respect to the rehabilitation or construction of residential property containing less than eight (8) units, all contractors engaged under contracts in excess of vi ed under for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of Labor, under 29 CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to journey workers; provided that, if wage rates higher than those required under the regulations are imposed by state or local law, nothing hereunder is intended to relieve the SUBRECIPIENT of its obligation, if any, to require payment of the higher wage. The SUBRECIPIENT shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. V. Section 3 of the Housin and Urban Devel meet Act of 1968. SUBRECIPIENT will make -and moderate -income persons residing within the every effort to provide training opportunities for low community where the construction project is located and contracts awarded to local businesses therein to the greatest extent feasible as required underthe provisions of Section 3 of the Housing and Urban Development Act of 1968, the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this Agreement. Compliance with the foregoing requirements shall be a condition of the federal financial assistance provided under this Agreement and binding on the SUBRECIPIENNT. Failure to fulfill these requirements shall subject the SUBRECIPMW, its successors and designees, to those sanctions specified by the Agreement through which federal assistance is provided. The SUBRECIPIEN'I' certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. SUBRECIPIENT shall make every effort to ensure tht ll projects funded wholly or in part by CDBG funds shall provide equal employment opportunities aafor minorities and women. W. Drug Free Workotace. SUBRECIPIENT agrees to provide a -free work place execute a certification as set forth in "Exhibit Ellattachedhereto and incorporated heerein by this references to X. UniforMnminsstrative Requirements Cost Principles and Audit Remnrements for Federal Awards. The following requirements and standards must be complied with; 2 CFR Part 200 et al. SUBRECIPIENT shall procure all materials, Property; or services in accordance with the 2 CFR 200.318-326, drequirements of Y. SW= K of 24 CFR 570, SUBRECIPIENT will carry out its activities in compliance with the requ cements of Subpart K of 24 CFR 570. However, SUBRECIPIENT does not assume the CTTY's environmental responsibilities or the responsibility for initiating the environmental review process under 24 CFR Part 52. Z. Women- and Minority-O efforts to wned Businesses (W/MBEI SUBRECIPIENT will use its best afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the perfomtance of this Agreement in accordance with the requirements of 2 CFR 200.321 "Contracting with small and minority businesses, women's business enterprises, and labor surplus area firms". As used in this Agreement, the term "small business" means a business that meets the criteria set forth in section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women's business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are African -Americans, Spanish-speaking, Spanish surnamed or Spanish - heritage Americans, Asian -Americans, and American Indians. SUBRECIPMNT may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. IL CTTY'S OBLIGATIONS A. Payment of Funds. On July 1, 2020, the CrI'Y was allocated $5,735,518 for fiscal year 2020- 2021 from the United States Department of Housing and Urban Development ("HUD') Community Development Block Grant ("CDBG') Entitlement Program Subject to the terms of this Agreement, and contingent on CITY receiving at least the same amount of CDBG funds from HUD for the 2021-2022 program year, CITY agrees to pay to SUBRECIPIENT when, if and to the extent federal funds are received a sum not to exceed Sixty Thousand Dollars ($60,000) for SU13RECIPMNTIS performance in accordance with the Budget attached hereto as "Exhibit B" during the two-year period of this Agreement. Payments shall be made to SUBRECIPIENT through the submission of invoices/reimbursement requests. CITY shall pay such invoices/reimbursement requests within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been incurred and documented within the scope and provisions of this Agreement and that SUBRECIPMNT is in compliance with the terms and conditions of this Agreement. Failure to provide any of the required documentation and reporting will cause CITY to withhold all or a portion of a request for reimbursement, or return the entire reimbursement package to SUBRECIPIENT, until such documentation and reporting has been received and approved by CITY, Documentation may include, but is not limited to, true copies of invoices, receipts, canceled checks, bank statements, credit card statements, procurement documentation for goods or services, timesheets, payroll records, benefit statements, agreements, contracts or documentation pertaining to costs for subcontractors, and/or other documentation supporting and evidencing how the CDBG FUNDS have been expended during the applicable quarter. B. Audit of Account. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of the Code of Federal Regulations and other applicable federal laws and regulations. C. Comm_ on Rulle: Pursuant to 2 CFR 200.328(a), the CITY manages the day-to-day operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant program requirements and monitors grant and subgmnt supported activities to assure compliance with Federal requirements. Such monitoring covers each program, function and activity and performance goals are reviewed periodically. D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for undertaking environmental review and maintaining environmental review project. records for each applicable E. Performance Monitorine; CITY shall monitor the performance of SUBRECIPIENT against goals and performance standards required herein. The SUBRECIPIENT shall be responsible to accomplish the levels of performance as set forth in Exhibit A and report such measures quarterly to the CITY. If the SU13RECIPMNT estimates such goals will not be met, the SUBRECIPIENT is to contact the CITY, at which time the CITY will determine if any adjustments to the grant award is appropriate. Substandard performance as determined by the CITY will constitute non-compliance with this Agreement. Should the CITY determine that the SUBRECIPIENT has not performed its obligations as stated in this contract in a satisfactory manner, or if the CITY determines that insufficient supporting information has been submitted, the CITY shall notify the SUBRECIPIENT in writing of its determination specifying in full detail the objections which it has to the SUBRECIPIENT's performance If action to correct such substandard performance is not taken by the SUBRECIPIENT after being notified by the CITY, within a reasonable period of time as stipulated in the written notification, contract suspension or termination procedures will be initiated. III. NONDISCRMIINATION A. SUBRECIPIENT agrees to comply with Executive Omer 11246 which requires that during the Performance of this Agreement, SUBRECIPIENT agrees not to discrinanate against any employee or applicant for employment because of race, religion, sex, color or national origin. Such action shall include, but not be limited to the following. employment, upgrading, demotion, or transfer, rates of pay or other forms of compensation, and selection for training, including apprenticeship. SUBRECIPIENT agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the SUBRECIPIENT setting forth the provisions of this nondiscrimination clause. B. SUBRECIPIENT agrees to comply with Title VI of the Civil Rights Act of 1964 which indicates that no person shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program of activity receiving federal financial assistance. C. No Person shall, on the grounds of race, sex, creed, color, religion, marital status, national origin age, sexual orientation, or physical or mental handicap be excluded from participation in, be refused the benefits o� or otherwise be subject to discrimination in any activities, programs or employment supported by this Agreement. SUBRECIPIENT is prohibited from discrimination on the basis of age or with respect to an otherwise qualified handicapped person as provided for under Section 109 of the Housing and Community Development Act of 1974, as amended. D. SUBRECIPIENT agrees to comply with the Age Discrimination Act of 1975 which requires that during the performance of this Agreement, SUBRECIPIENT agrees not to discriminate against any employee or applicant for employment because of age. Such action shall include, but not be limited to the follo employment upgrading, demotion or transfer, ratewing s of pay or other forms of compensation, and selection for brining, including apprenticeship. SUBRECIPIENT agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the SUBRECIPIENT setting forth the Provisions of this age discrimination clause. E. SUBRECIPIENT agrees to comply with Section 504 of the Rehabilitation Act of 1973 which requires that no otherwise qualified individual with a disability in the United States, shall, solely by reason h his or her disability, be excluded from the participation in, be denied the benefits of or be subjected to discrimination under any program or activity receiving federal financial assistance or under any program or activity conducted by any executive agency or by the United States Postal Service. 1V. CONFLICT OF INTEREST Pursuant to the conflict of interest requirements set forth in 24 CFR 570.611 and 2 CFR 200.112, SUBRECIPIENT certifies that no member, officer, employee, agent or assignee of = having direct or indirect control of any CDBG monies granted to the CITY, inclusive of the subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of interest of any officer hall SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof Notice shall be sent by SUBRECIpIENf to CrfY regarding any changes or modifications to its board of directors and list of officers. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection with the Provision of the services SUBRECIPIENT shall provide with CDBG funds, in accordance with 24 CFR 570.2000): A. SUBRECIPIENT shall not discriminate against any employee or applicant for employment on the basis of religion and shall not limit employment or give preference in employment to persons on the basis of religion. B. SUBRECIPIENT shall not discriminate against any person applying for the services SUBRECIPIENr agrees to provide under the texas of this Agreement on the basis of religion and shall not limit such services or give preference to applicants for such services on the basis of religion. C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct any religious worship or services, or engage in any religious proselytizing, or exert any religious influence in the provision m Of the services in said prograThe parties agree that this covenant is intended to and shall be construed for the limited purpose of assuring compliance with respect to the use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the establishment of religion as set forth in the establishment clause under the First Amendment of the United States Constitution and Article I, Section 4 of the California Constitution, and is not in any manner intended to restrict other activities of SUBRECIPIENT. D. The portion of a facility used to provide public services assisted in whole or in part under this Agreement shall contain no sectarian or religious symbols. E. Where the services to be provided under said program are rendered on property owned by the Primarily religious entity SU13RECIPIENf, CDBG funds may also be used for minor repairs to such property which are directly related c the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the CDBG expenditure for rendering the services under said Program. VL PROHIBITION OF NEPOTISM SU13RECIPIENT agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of tbat person's immediate family is means spouse employed in an administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immaliate family° , child mother, father, brother, sister, brother-in-law, sister-in-law, father-in-law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and stepchild The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VII. NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CrrY: City of Santa Ana Community Development Agency (M-25) 20 Civic Center plaza 10 P.O. Box 1988 Santa Ana, California 92702-1988 TO SUBRECIPIENT: Georgina Maldonado Community Health Initiative of Orange County 1505 E.17" Street, Suite 121 Santa Ana, CA 92705 VHI. ASSIGNABHdTY None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of C1T e SUBRECIPIENT must submit all subcontracts and other agreements that relate to this Agreement to C1TY. No subcontract or assignment shall terminate or alter the legal obligations of SUBRECIP]ENT pursuant to this Agreement. IX. HOLD HARMLESS SUBRECIPIENT shall indemnify, defend and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all damages to or for loss of use of property and for injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all claims, demands, suits, actions or proceedings of any k nd or nature, including, but not by way of limitation workers compensation claims and including attorney fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPIENPs performance of this Agreement. X. INSURANCE 1. Commercial General Liability SUBRECIPIENT agrees to obtain and keep in force during the term of this Agreement a policy of comprehensive commercial public liability insurance insuring the CPPY, and SUBRECIPIENT against any liability for accident, injury or death arising out of or in consequence of this Agreement. Such insurance shall be in an amount not less than One Million Dollars ($1,000,000.00) for any injury to or death of any person or persons in any single accident or occurrence. Said policy of comprehensive liability insurance shall be endorsed to provide to CITY at least thirty (30) days written notice prior to cancellation; name CITY, its officers, agents, employees, and volunteers, additional insured; and state that such coverage is primary to any other coverage or self- insurance and CITY. Governmental entities may provide proof of self-insurance. (a) Such insurance shall: (1) name the City of Santa Ana, its officers, agents, representatives, employees and volunteers as additional insured's; (2) be primary with respect to insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of insured's provisions; and (4) give to CrfY prompt and timely notice, of claim made or suit instituted arising out of SUBRECIPIENT's operations hereunder, (b) SUBRECIPIENT shall: (1) prior to exeroising any right under this Agreement, furnish properly executed certificates of insurance and additional insured endorsement to the CrrY which shall clearly evidence all coverages required above; (2) provide that such insurance shall not be materially changed or terminated except on 30 days prior written notice to the CITY; (3) maintain such insurance for the period covered by this Agreement; and (4) replace such certificates for policies expiring 11 Prior to the expiration of this Agreement 2. Automobile Liability Coverage, SUBRECIPIENT shall also obtain and maintain, during the effective period of this Agreement, broad form automobile liability coverage with a $1,000,00o limit unless reduced by CITY, which applies to both owned/leased and non -owned automobiles used by SUBRECIPIENT employees or participants in performance of this Agreement, or, in the event that SUBRECIPIENT will not utilize such owned/leased automobiles but intends to require employees, participants or other agents to utilize their own automobiles in the performance of this Agreement, SUBRECIPIENT shall secure and maintain on file from all such employees, partici, pantsor agents as self certification of automobile insurance coverage. Governmental entities may provide proof of self. insurance. 3. Workers' Comoensaii n If SUBRECIPIENT is an "employer", as set forth in California Labor Code Section 3300 et seq., or utilizes participants as "employees," as set forth in California Labor Code Section 3350 et seq., SUBRECIPIENT shall obtain and keep in force during the term of this Agreement full Worker;' Compensation insurance coverage for injuries suffered by participants. Said insurance policy shall guarantee CITY at least thirty (30) days written notice of cancellation or modification. 4. Equipment Cove . SUBRECIPIENT shall purchase a policy or policies of insurance covering loss or damage to any and all Equipment provided to or purchased by SU13RECIPIENT in accordance with this Agreement. Said insurance shall be in the amount of the full replacement value thereof, providing protection against the classification of fire, extended coverage, vandalism, malicious mischief, theft, and special extended perils. Governmental entities may substitute a certificate of self- insurance. 5. Proof of Insurance. Certificates and endorsements must be submitted and approved by CITY prior to any work under this Agreement. SUBRECIPWM understands that CTfY will make no payments under this Agreement until the required certificates and endorsements have been approved by CITY. XI REUH9MN OF ASSET A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to Cfl'Y any CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(7)] B• Any real property under SUBRECIPH NT5 control that was acquired or improved in whole or in Part with CDBG funds in excess of $25,000.00 must either be: 1. Used, where CITY has given written approval, to meet one of the national objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement or for such longer period of time as determined to be appropriate by CrrY; or 2• If not used in accordance with subparagraph 1 above, SUBRECIPMW shall pay to CIattTYribanutable atomountthe equal to the current fair market value of the property less any portion of the value expenditure of non-CDBG funds for acquisition of, or improvement to, the property, Such payment is program income to CITY, C. Subject to the obligations set forth herein, title to equipment acquired under the terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment which has been acquired 12 in accordance with this Agreement and all applicable regulations is no longer needed for said program, disposition of said equipment will be made as follows: 1. Items of equipment with a current per unit fair market value of less than $5,000,00 may be retained, sold or otherwise disposed of with no further obligation to cTTY. 2. Items of equipment with a current fair market per unit value of $5poo.00 or more may be retained or sold and CfIY shall have the right to an amount calculated by multiplying the current market value or proceeds from the sale by C Iys share of federal funds used to acquire the equipment, in accordance with 2 CFR 200.313(e)(2). D. SUBRECIPMNT hereby agrees, upon the demand of CITY, to execute, acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder or under any document, instrument or agreement executed in furtherance of the services and activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignmrent(s), quit claim deed(s) or such othd further mstmer an ments, documents and agreements as may be necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or local accounts or program funds or allocation of funds to which CrTY is or may be entitled, either for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the performance of this Agreement or any previous agreements relating to the same subject matter or activities as this Agreement, together with any instruments, loans, grants or advances by SUBRECIPMM on behalf of C1T'Y, in furtherance of the activities hereunder or thereof. SUBRECIPEEWs obligations and responsibilities set forth in this paragraph "XI. REVERSION OF ASSETS." and in Paragraph '77QII. TERMINATION" and other requirements pertaining to Program income shall not be affected by the termination of this Agreement and shall survive the date of termination of this Agreement for such period of time as CITY and/or HUD deems necessary for the responsibilities, duties and obligations to be performed and completed to the satisfaction of CrrY and HUD. XU. TERMINATION A. This Agreement maybe terminated on thirty (30) days' written notice by either party. In the event of such termination, SUBRECIPIENf shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CTIy upon five (5) days' written notice for violation by SUBRECIPIENr of Federal Laws governing the use of Community Development Block Grant Funds. In the event of such suspension or tenninatioq SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. Pursuant to 2 CFR 200.340, in the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of this Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such notice, unless such default is cured before the effective date of tenrunatioa stated in such notice. If terminated for cause, CITY shall be relieved of further liability or responsibility under this Agreement, or as a result of the temunation thereof including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any Payments made for services not subsequently performed in a timely and satisfactory manner. and (2) costs incurred by CrTY in obtaining substitute performance. 13 D. The grant of funds under this Agreement may be terminated for convenience by either the CITY and in or SUBRtheECIcasPIeENT, in whole or in part, by setting forth the reasons for such termination, the effective date, of portion tarmination their portion to be terminated. However, if in the case of a partial termination' the CTTY determines that the remaining portion of the award will not accomplish the purpose for with the award was made, the CITY may terminate the award in its entirety. E. The grant of funds under this Agreement may be terminated due to the non-performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described in Exhibits A and B or failure to meet the performance standards and program goals set forth therein. F. The grant of funds under this Agreement may be terminated due to the failure of the CITY to receive sufficient or anticipated funding from MUD for the CDBG program for any year term subject to this Agreement. inclusive G, In the event the Agreement is terminated as set forth in subparagraphs XE.A. through XII.F, SUBRECIPIFbIT agrees to immediately return to CITY upon CTIY's demand and prior to any adjudication of SUBRECMENT's rights, any and all funds not used, and to comply with paragraph "XI. EM . ION OF ASSETS" of this Agreement. XIM LDWATION OF FUNDS The United States of America, through HUD, may in the future pace programmatic or fiscal limitations on the use of CDBG funds which l mitations are not presently anticipated Accordingly, CITY fundin reserves the light to revise this Agreement in In order to take account of actions affecting HUD program g. thevent of funding reduction CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of SUBRECIPIEN rs authority to commit and spend funds, or may restrict SUBRECIPIENT's use of both its uncommitted and its unspent funds_ where HUD has directed or requested CITY to implement a reduction in n wle or as to a cost category, with inspect to funding for this Agreement, CTI1" s City Manager Orr deellegate sauth rorized to act for CrI Y in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope accordingly, where CITY has reasonable grounds to question SUBRECIPIENT"s fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days written notice to SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions. In no event, however, shall say revisions made by CITY affect expenditures and legally binding commitments made by SUBRECIPIENT before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines. XN. EXCLUSIVEff AND AMENDMENT OF AGREEMENT This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of CITY's CDBG funds by SUBRECIPIENT and contains an the covenants and agreements between the parties with respect to such empl Each party to this Agreement acknowledges that oyment in any manner whatsoever. no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and SUBRECIPM-NT. 14 XV. LAWS GOVERNING THIS AGREEMENT This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XVI. CLOSE-0L1T The SUBRECIPIENT agrees to comply with the closeout procedures detailed in 2 CFR §200.343, including the following: 1. SUBRECIPIENT must submit, no later than ninety (90) calendar days after the end date of the period of performance, all financial, performance, and other reports as required by the terns and conditions of the Federal award; 2. Unless the CITY authorizes an extension, SUBRECIPIENT must liquidate all obligations incurred under the Federal award not later than ninety (90) calendar days after the end date of the period of performance as specified in the terms and conditions of the Federal award; 3. SUBRECIPIENT must promptly refund any balances of unobligated cash that the CITY paid in advance or paid and that is not authorized to be retained by SUBRECIPIENT for use in other proj ects (See OMB Circular A-129 and 2 CFR §200.345); 4. SUBRECIPIENT must account for any real and personal property acquired with Federal funds or received from the Federal government in accordance with 2 CFR §§200.310- 200.316 and 200.329; and, 5. The CITY should complete all closeout actions for the Federal award no later than one year after receipt and acceptance of all required final reports. XVH. VALIDITY AND SEVERABILITY The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. Whenever possible, each provision of this AGREEMENT shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this AGREEMENT is held to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this AGREEMENT. XVM. WAIVER No delay or omission by either party hereto to exercise any right or power accruing upon any noncompliance or default by the other party with respect to say of the terms of this Agreement shall impair any such right or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition or agreement herein contained. 15 XIX. MISCELLANEOUS PROVISIONS and t. bindach uhergned represents and wanants that its signahue herein below has the power, authority ir 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 Cr!'Y in the event that such authority or power is not, in fact, held by the signatory or is withdrawrL b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. {Signatures on followingpage} L IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and year written below. ATTEST: DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM: RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency 17 CITY OF SANTA ANA KRIS FINE RIDGE — City Manager SU13RECIPIENT: Georgi aldona Exec a Director Tax ID: 47-2671013 DUNS #: 080155867 City of Santa Ana CDBG Scope of Work Program Year 2020.2021 (July 1, 2020 - June 30, 2021) Name of Organization Community Health Initiative of Orange County Name of Funded Program Community Health Access Annual Accomplishment Goal Undu Iicated Participants anticipated to be served durin the 12-m-o7nth contract Period. 865 TOTAL 885 Santa Ana Participants �100� I � 865 Low Income Partirinants 100°; Schedule of Performance (estimated) Quarter 1: JUL 1 - SEP 30 Quarter 2: OCT 1 - DEC 31 Quarter 3: JAN 1 - MAR 31 Quarter 4: APR 1 - JUN 30 Unduplicated Partial ants 216 216 216 217 865 Program and Funding Description Estimated Invoicing $ 7,500.00 $ 715 00.00 $ 7,500.00 $ 7,500.00 $ 30,000.00 rlvigidril. CHIOC's Community Health Access Program provides healthcare and social service program enrollment to low- income families that empowers them with the education and assistance they need to enroll into coverage, make appointments, navigate insurance coverage, receive preventative care, establish a primary care provider, and maintain coverage over time. The program encompasses the outreach, enrollment, retention and utilization (OERU) model. Outreach via partner sites, community events, toll -free phone number, flyer distribution which offers culturally and linguistically appropriate information in hard -to -reach, low-income and minority communities. Enrollment is conducted by Health Access staff using the web -based One-e-App database to immediately determine eligibilityfor 18 different health care and social services programs and submit households' applications, if qualified. The majority of clients come to us seeking Medi-Cal enrollment assistance. Care Connections (Retention and Utilization) provides case management that helps individuals and families navigate, utilize, and retain available services and benefits once enrolled. CHIOC also conducts "Know Your Benefits" workshops to educate clients on the health system and their benefits. These are conducted at local schools across the county. The goal of this program is to increase access to care by providing enrollment and navigation services to the uninsured, including low-income families, immigrants, and racial and ethnic minorities. These populations often face greater barriers when accessing care, such as limited transportation, limited English proficiency, and low health literacy. Furthermore, coverage alone does not always equal access to care. Thus we aim to help clients not only enroll but also retain and use their benefits, offering navigation and education as an effective strategy to address the complexities of our healthcare system in Orange county. Funding Description: CDBG Funding request is to support the salary of one Health Access Specialist to provide the services listed. EXHIBIT A FISCAL YEAR 2020.2021 PROGRAM BUDGET Organization Name Community Health Initiative of Orange County Program Name Community Health Access EXPENDITURES Enter budget categories and projected expenditures for the 0 In -Kind Funded By Expenditures Santa Ana Funded By CDBG Other Sources H 17 Costs r �u 16,745 Total Program Organization 27 17,730 TOTAL BUDGET > 2,72 $30 600 $1 151 259 $ , Q, ,59 ----- r+i+.,59 $1rLUy,1Z * Indirect cost rate: 10% Non -Federal entity without federaly recognized negotiated indirect cost rate, will charge a de minimis rate of 10%of modified total direct costs. PROGRAM RESOURCES LIST ALL OTHER PROGRAM RESOURCES FOR 2020-2021 Funding Source Total i EXHIBIT B yards operations) 2020-2021 CDBG BUDGET LINE ITEMS Annual Salary I CDBG Position Title I & Benefits Renu Dir. & Fund EXHIBIT B-1 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26,1988 Federal Register (pages 19160-19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION - Attached) (1) The prospective recipient of federal assistance fiords certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended proposed for debarment del, I t ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (2) Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. and T`1of Authorized Representative EXHIBIT C Page 1 of 2 INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective recipient of federal assistance funds is providing the certification as set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment. 3. The prospective recipient of federal assistance funds shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective recipient of federal assistance fimds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction "principal," o voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. 6. The prospective recipient of federal assistance funds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to check the List of Parties Excluded from Procurement or Non - Procurement Programs g. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the DOL may pursue available remedies, including suspension and/or debarment. EXHIBIT C Page 2 of 2 Certification Regarding Lobbying Certification for Contracts Grants Loans and Coo erative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contact, grant, loan or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontract, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a Prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Nett Ftf,, IKiiiall;ye o� DLH K CDMM''"u�r"t%*�V�8` -�� Organization� _ R� !� c S Program Title ..v Il'V 1 YM1vv/y,��v CO Name oTcertifying Officer ignatur Date HXHIBTT D Page 1 of 2 SUBRECIPIENT warrants the following 1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics, employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process under Executive Order 12372. EXHIBIT D Page 2 of 2 Certification Regarding Drug -Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Housing and Urban Development in awarding the grant. If it is later determined that the contractor knowingly rendered a false certification, or otherwise violates the requirements of the Drug -Free Workplace Act, the U.S. Department of Housing and Urban Development, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug -Free Workplace Act. CERTIFICATION A. The contractor certifies that it will provide a drug -free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing a drug -free awareness program to inform employees about — (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance program; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee who will be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph -(a) that, as a condition of employment under the contract, the employee will - (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction. (e) Notifying the U.S. Department of Housing and Urban Development within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; EXHIBIT E Page 1 of 2 (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). The contractor shall insert in the space provided on the attached 'Place of Performance" form the site(s) for the performance of work to be carried out with the grant funds (including street address, city, county, state, and zip code) .the contractor further certifies that, if it is subsequently determined that additional sites will be used for the performance of work under the contract, it shall notify the U.S. Department of Housing and Urban Development immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. The Contractor shall insert in the space provided below the site(s) expected to be used for the performance of work under the contract covered by the certification: Place of Performance (include street address, city, county, state, zip code for each site): T1 L� _ � • I'i S'Nee f Su -+fie- 12l 0 554ct Al.Ia% , c44" 7 o S W D& - Z3 Aut ized gnature Date EXHIBIT E Page 2 of 2 Memorandum of Understanding (MOI9 between Community Health Initiative of Orange County (CHIOQ and The City of Santa Ana W101RX Center 1. PARTIES: The parties to this Memorandum of Understanding (MOU) are Community Health Initiative of Orange County ("Subrecipient') and the City of Santa Ana W/O/R/K Center ("Work Center"). 2. PURPOSE: The Work Center, in conjunction with Subrecipient, endeavors to establish a cooperative working relationship between the parties in order to provide program beneficiaries with information about Work Center opportunities to find better jobs and careers. The MOU serves to establish the framework for providing services to employees, job seekers and others needing workforce services. The goal is to ensure that all program beneficiaries have been provided an opportunity to connect with the Work Center and be assisted with the tools and knowledge necessary to enter the workforce or obtain a higher- payingjob. 3. RESPONSIBILITIES: A) The Work Center shall perform the following: 1) Accept referrals to the Work Center. B) Subrecipient shall perform the following: 1) Provide Work Center information to participants and their families; and, 2) Refer participants in need of employment, training, or career counseling to the Work Center utilizing the referral form attached hereto as Attachment 1 and incorporated herein by reference. 4. DURATION: This MOU shall commence on July 1, 2020, and shall remain in effect through June 30, 2022. 5. AMENDMENTS: Either party may propose amendments to this MOU at any time by providing written notice to the other party. Amendments to this MOU shall require the approval of the City Manager, or her/his designee ("City Manager'), on behalf of the Work Center. 6. CONFIDENTIALITY: If Subrecipient receives information, which due to the nature of such information is reasonably understood to be confidential and/or proprietary, such information shallnot be used or disclosed except in the performance of this MOU, and Subrecipient 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 non-public 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 MOU. 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 Subrecipient disclosed in a publicly available source; (c) is in rightful possession of Subrecipient without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by Subrecipient without reference to information disclosed by the City of Santa Ana. 7. ACCESSABH,ITY: Subrecipient will assure that its services and premises are accessible to persons with disabilities pursuant to the requirements of the Americans with Disabilities Act. 8. HOLD HARMLESS CLAUSE: Each party to this MOU agrees to indemnify and hold harmless the other parties, their officers, agents, employees, and volunteers from and against any and all loss or damage, and from any and all suits, actions and claims filed or brought by any person or persons arising out of acts or omissions of the party or its officers, agents, employees or volunteers in the performance of this MOU. 9. DISPUTES: The parties shall first attempt to resolve all disputes informally. Any party may call a meeting of all parties to discuss and resolve disputes. Should informal resolution efforts fail, the dispute shall be referred to the City Manager to act as mediator, to attempt to resolve the dispute by holding an informal hearing with presentations by both parties. If the City Manager's resolution efforts fail any party may file a grievance with the City Manager for review and hearing. The parties agree to be bound by the final determination resulting from that procedure. Each party to bear its own costs associated with any grievance procedures. 10. DISCRIMINATION: Subrecipient shall not discriminate because of race, color, creed, religion, sex, marital states, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Subrecipient affirms that it is la equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. I L SEVERABH,ITY: If any part of this MOU is found to be null and void, or is otherwise stricken, the rest of this MOU shall remain in force. 12. JURISDICTION: Jurisdiction over any disputes arising under this MOU shall reside in Orange County, California. 13. AUTHORITY AND SIGNATURES: The individuals signing this MOU or its attachments have the authority to commit the party they represent to the terms of this MOU, and do so commit by signing. IN WITNESS WHEREOF, the parties hereto have executed this Memorandum of Understanding the date and year first above writtea ATTEST: APPROVED AS TO FORM; SONIA R. CARVALHO RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA a municipal corporation of the State of California KRISTINE MOE City Manager Community Health Initiative of OC G ` qaa-ldonado Execurector ia&49S:DZLAWA CenterT:liteator Santa.Ana W.QMcentep .� 10 ACOROm CERTIFICATE OF LIABILITY INSURANCE Dareto9ndnola4/2019 Y) 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: N the certificate holder is an ADDITIONAL INSURED, the policy(Wit) 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 CCONTACT ONE: Cj7"ta Issuance Team RaNE (949) 709,8800 t. Ne1. (949) 709:1688 Comprehensive Insurance Services ADDRESS: J remy®themmpmhenslvelnsumnce.mm 26429 Rancho Parkway South INSUREI AFFORD4 COVERAGE MICA Suite 120 INS RERA: NonprofitalnsuramcsAJIQnceof Calif0r is 10023 Lake Forest CA 92630 INSURED INSURERS: _ INSURER C: Community Health Initmbve of Orange County INSURER 0: 1505 E. 17th Street, Su@e 121 INSURER E : INwRERF: Santa Ana CA 92705 COVERAGES CERTIFICATE NUMBER: CLI992404256 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 VNTH 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. LTR TYPE OF INSURANCE IN POLICY NUMBER IMOOIYYYY Y LIMITS EACIAL oENIRAL LUBRJTY / COYY12 EACH OCCURRENCE S 1.000.000 ✓ CLAILIS.MADE � OCCUR ✓ ✓ PR MI .M. 5000 MEDEXP aMdnan) S 20.000 A Y 2019-44927 10/1512010 lotlttr020 PERSONALAAJWINJURY a 1.D00,000 GENLAGGREGXreUMITAPPLIESPER GENERALAGGREGATE S 2.000,000 PCUCY O JE T ® LCC PRODUCTS-COMPIOPAGG S 2.000.000 $o Deductible f OTHEa AUTOYOdLE W&UTr N E LDI IIIANYAUTO s / DD0.000 BOOILYIWURV(P Pasan) S A OWNED SCHEDULED AUTOS ONLY AU1D$ 2019A4927 10/15/2019 1Otl 5/2020 800nYIWURY(PM..0 rn S A N s HIRED NOKOANED X AUTOS ONLY AUTOS ONLY SO Owumble a UMBRELLA LAS OCCUR EACHOCCURRENCE S AGGREGATE S EXCESS UAQ3 cuuus-MADE pED I I RETENTION f S YIOr1NERS COMMIATRW ANDEYPLOYERS'WIaWTY YIN H- TATU'E I I CK ANY PROPpIETORNARTNER,D(ECUnVE OFMIERIMEMBER EXCLUDEDT NIA EL EACHACCIDENT S (YMMMArya NH) E L DISEASE EA EMPLOYEE S =yd 0asce.~ OESCRIPTgN OF CPERATp/Saww E L DISEASE POLICY LIMIT S A Social Service Professional Improper Sexual Conduct 2019A4927 10/152019 10,15/2020 $1,000.00011.000.000 $1,000,OD011,000,000 Aggreplair0m Aggregate/Om $0 Deductible DESCRIPmOR OF OPERATIONS I LOCATIONS I VEWCUi (ACORD 101. Ad4klnnM RPnark. SeM&Aa, Ina, d zru d a coon sped H npWM7 City of Santa Ana, its officers, ampoyees, agents and volunteers are included as Additional Insured automatically per written contract or agmennav/Pey / attached endorsement CG202S.YY G day notice of cancellation Mmth 10 day, notice of wnceltafion for nonpayment of premium per poky provWon. This ✓ insurance is Primary and Noncontributory per attached endorsement NIAC E61. FWzt# 2020 City of Santa Ana Risk Management Division ✓ NC1fE ACnx jC 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT14OR2ED REPRESENTATIVE 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM�)DIYYYY) 0On 21/2020 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 INSURERS , AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATIONIS 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 endorsemen s . PRODUCER CONTACT NAME: PAYCHEX INSURANCE AGENCY INC/PAC PHONE (877)266-6850 (AX:, No, Ext): Fax (585)389-7894 (A/C, No): 76250881 150 SAWGRASS DRIVE E-NALADDREss: ROCHESTER NY 14620 INSURERS) AFFORDING COVERAGE NNC6 INSURER A: Hanford Accident and Indemnity Company 22357 INSURED INSURER B : COMMUNITY HEALTH INITIATIVE OF ORANGE INSURER C: COUNTY INSURER D: 1505 E 1TTH ST STE 121 INSURER E_: SANTA ANA CA 92705-8520 INSURER F : i3'itli[93i� 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE❑OCCUR EACH OCCURRENCE DAMAGE TO NTED MEO EXP (Any one person) PERSONAL S ADV INJURY GENLAGGREGATE LIMIT APPLIES PER: POLICY ❑PRO ❑LOC OTHER: GENERAL AGGREGATE PRODUCTS-COMPIDPAGG AUTOMOBILE LIABILITY ANYAUTO A OWNED SCHEDULED AUTOS AUTOS HIRED NON WNED AUTOS AtROS COMBINED SIN LE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per acadent PROPERTY DAMAGE (Peraccident UMBRELLA DAB EXCESS LAS HOCCUR CLAIMS - MADE EACH OCCURRENCE AGGREGATE E RETENTION$ A WORKERS COMPENSATION AND EMPLOYERS'LNBILT' MY YIN PROPRIETORIPARTNER(EXECUTNE OFFICERMIEMBER EXCLUDED? (Mandatory In NH) N yes, decnbe Under DESCRIPTION OF OPERATIONS be[aw MIA 76 WEG PK2991 11/01/2019 / J 11/01/2020 X PER - OTH, ER E.L. EACH ACCIDENT $1,000,000 EL DISEASE -EA EMPLOYEE $1,000,000 El- DISEASE -POLICY LIMIT $1,OW,000 DESCRIPTION OF OPER417ONSILOCATMNS I VEHICLES (ACORD 101. Ad iftimal Rtnnift SchedUN, may Ca attached B mwe apace Is required) Those usual to the Insured's Operators. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. CERTIFICATE HOLDER PAAIr PI I ATInM CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED RISK MANAGEMENT DIVISION / 20 CIVIC CENTER PLZ �1 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED CCORDANCE WffH THE POLICY PROVISIONS. HORIiEO REPRESENTATIVE ISYf14at,, CQO r��ct� SANTA ANA CA 92701-4058 REVIEWED&APPRO BY RISK MANAl I Div I- LULU ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The AC and to egts[ered marks of ACORD ANgIE AcoxdO Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.03.08 13:55:50-08'00' A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02125/2021 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 CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services HCNE. (949) 709-8800 a/c, (949) 709-1668 Ext : No): 26429 Rancho Parkway South E-MAIL jeremy@thecomprehensiveinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Suite 120 INSURERA: Nonprofits Insurance Alliance of California 10023 Lake Forest CA 92630 INSURED INSURER B Community Health Initiative of Orange County INSURER C : 1505 E. 17th Street, Suite 121 INSURER D : INSURER E : Santa Ana CA 92705 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2082704831 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX OCCUR PREM SDA AGES Ea oNcurDmnce $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,000 A Y 2020-44927 10/15/2020 10/15/2021 LAGGREGATE LIMITAPPLIES PERGENERAL AGGREGATE $ 2,000,000 POLICY ElPRO FX LOC JECT: MOTHER PRODUCTS-COMP/OP AGG $ 2,000,000 $0 Deductible $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 2020-44927 10/15/2020 10/15/2021 BODILY INJURY (Per accide nt) $ X PROPERTY DAMAGE Per accident $ HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY $0 Deductible $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN OFFICER/MEMBER EXCLUDED? /A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Social Service Professional $1,000,000/1,000,000 Aggregate/Occ A Improper Sexual Conduct 2020-44927 10/15/2020 10/15/2021 $1,000,000/1,000,000 Aggregate/Occ $0 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are included as additionally insured on this policy pursuant to written contract or written agreement per attached endorsement NIAC E61. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana ACORD 25 (2016/03) CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 The ACORD name and logo are registered marks of ACORD µow NCF Risk ManagementDivisian k4e 1'x REVIEWED & APPROVED BY.- .v —� Risk hrtanagement Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Fend for Insurance. A Rewf for NonproflM POLICY NUMBER: 2020-44927 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. SECTION II — WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. SECTION III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 ew cF RAMwagementDMsiun Jy/ 1'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Fend for Insurance. A Hewf for NonproflM POLICY NUMBER: 2020-44927 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I - COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. C. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 ew cF RAMwagementDMsiun Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst AR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/18/2020 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 CONTACT Paychex Insurance Agency Inc NAME: A/CONN Ext : 877-266-6850 A/C No : 585-389-7426 PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 E-MAIL certs@paychex.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: STATE COMPENSATION INSURANCE FUND INSURED INSURER B INSURER C: Community Health Initiative of Orange County INSURER D: 1505 E 17Th St Suite 121 INSURER E: Santa Ana, CA, 92705 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 ADDL SUBR POLICY NUMBER POLICY EFF /Y MM DDYYY POLICY EXP /Y MM DDYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS -MADE OCCUR S(RENTED PREMISES Ea occurrence) ccurrence)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ FIR ERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) N/A 928909 11/05/2020 11/05/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE qCL cF RA Management Division REVIEWED & APPROVED BY: @ 1988-2016 ACORD C �, , ` .. The ACORD name and logo are registered marks of ACORD _ _ Risk Pjanagement Analyst Francine R. Digitally signed by Francine R. Villareal Villareal Date:2021.10.0716:1435-07'00 A`� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/27/2021 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 CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services A/CONN. Ext : (949) 709-8800 q/c, No): (949) 709-1668 E-MAIL jeremy@thecomprehensiveinsurance.com ADDRESS: 26429 Rancho Parkway South INSURER(S) AFFORDING COVERAGE NAIC # Suite 120 Lake Forest CA 92630 INSURERA: Nonprofits Insurance Alliance of California 10023 INSURED INSURER B Community Health Initiative of Orange County INSURER C 1505 E. 17th Street, Suite 121 INSURER D INSURER E : Santa Ana CA 92705 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2192705434 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED SES Ea occurrence) PREMISES $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,000 A Y 2021-44927 10/15/2021 10/15/2022 LAGGREGATE LIMITAPPLIES PERGENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO FXLOC JECT: MOTHER PRODUCTS-COMP/OPAGG $ 2,000,000 $0 Deductible $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 2021-44927 10/15/2021 10/15/2022 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY $0 Deductible $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Social Service Professional Liability Improper Sexual Conduct Liability 2021-44927 10/15/2021 10/15/2022 $1,000,000/1,000,000 $1,000,000/1,000,000 Aggregate/Occ Aggregate/Occ $0 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are included as additionally insured on this policy pursuant to written contract or written agreement per attached endorsement NIAC E61. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana ACORD 25 (2016/03) CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 AC The ACORD name and logo are registered marks of ACORD �oRaN IiiskManagmerdDivisian REVIEWED & APPROVED BY. - Risk Management Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Mead for 1nsufance- A Heart for Munprofit5• POLICY NUMBER: 2021-44927 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. SECTION II — WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions-, or b. The negligent acts or omissions of those acting on your behalf-, in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. SECTION III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below-, or NIAC-E61 02 19 �oRaN 3 Ii:AMwaganedDMsian REVIEWED & APPROVED BY.- r Risk Management Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Heart for 1nsufance- A Heart far flManprafit5• POLICY NUMBER: 2021-44927 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I - COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. C. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 �oRaN 3 RiskMarWmentDMsian REVIEWED & APPROVED BY.- r Risk Management Analyst AC ► DV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/18/2020 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 CONTACT Paychex Insurance Agency Inc NAME: AICONN Ext : 877-266-6850 A/C No : 585-389-7426 PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 E-MAIL certs@paychex.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: STATE COMPENSATION INSURANCE FUND INSURED INSURER B INSURER C: Community Health Initiative of Orange County INSURER D: 1505 E 17Th St Suite 121 INSURER E: Santa Ana, CA, 92705 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 ADDL SUBR POLICY NUMBER POLICY EFF /Y MM DDYYY POLICY EXP /Y MM DDYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE1:1 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ FIR ERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) NIA 928909 11/05/2020 11/05/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � G oRaN Ride Management Dngs(nn z REVIEWED & APPROVED BY. ©1988-2016 ACORD C11 The ACORD name and logo are registered marks of ACORD ' Risk Management Analyst MEMORANDUM To: Risk Management Division From: David Flores, Senior Community Development Analyst Date: October 6, 2021 Subject: Review of Certificate of Insurance for CDBG Funded Programs The purpose of this Memorandum is to provide Risk Management Division with clarification and guidance on the Equipment Coverage clause in the Community Development Block Grant (CDBG) Funded "Subrecipient Agreement". Throughout the year, the City's CDBG program awards federal funds to subrecipients to provide a myriad of public services to our residents. In order to deliver these services, the City's attorney office created a Subrecipient Agreement that all subrecipients must enter into before commencing the work. Section X. INSURANCE, of the agreement insures that any subrecipient that enters into this agreement shall purchase a policy or policies of insurance covering loss or damage to any equipment provided to or purchased by the subrecipient. However, the Santa Ana CDBG program does not provide or allow any subrecipient to purchase any equipment in order to deliver the services as indicated in the Exhibit -A "Scope of Work", and Exhibit B "Budget", sections of the Agreement. The CDBG program is respectfully asking the Risk Management Division to disregard Section X. item 4, of the CDBG Funded Subrecipient Agreements when reviewing the Certificate of Insurance. Please contact me if you have any questions or concerns regarding this matter. oRaN } z a RAMmVmadoMsiun REVIEWED & APPROVED BY.- p R. VSA44a Risk Management Analyst