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HomeMy WebLinkAboutNATI'S HOUSE (DBA NEUTRAL GROUND) (8)INSURANCt ON FILE WORK MAY PROCELU UNIT INSURANCE EXPIRES (Oran CLERK OF COUNCIL DATE: A-2020-157-13 FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND �OR@) NATI'S HOUSE DBA NEUTRAL GROUND 06k\l a 0, S 1 f-- (24 CFR Parts 570) THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT is entered into this IOTH day of September 2021, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"), and Nati's House dba Neutral Ground, a California nonprofit organization ("Subrecipienf). RECITALS A. On July 1, 2020, the City entered into Community Development Block Grant ( CDBG") Subrecipient Agreement #A-2020-043-14 with Subrecipient to provide CDBG Funds from the United States Department of Housing and Urban Development ("HUD') to be used in the operation of a public service program for the youth of the City of Santa Ana ("said Agreement'). B. In accordance with the terms and conditions of said Agreement, the parties desire to amend said Agreement to report the current Catalog of Federal Domestic Assistance ("CFDA') Number and Federal Award Identification Number ("FAIN' for Subrecipient, and to report the current federal award date and amount of the award as required for pass -through entities. NOW THEREFORE. in consideration of the mutual and respective promises, and subject to the term and conditions of said Agreement, except as herein modified, the parties agree as follows: 1. Recital A shall be amended to update the City's current CFDA Number to 14.218 and FAIN to B-21-MC-06-0508 in accordance with the requirements for pass -through entities outlined in 24 CFR 200.332. 2. Article I1, Section A, shall be amended to report the current federal award date of July 1, 2021, and update the amount of the award to be $5,640,635 in accordance with the requirements for pass -through entities outlined in 24 CFR 200.332. 3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect 111 /// 111 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said A-2020-157-13 Agreement the date and year first above written. ATTEST: ,,/DAISY GOMEZ the Council APPROVED AS TO FORM: Sonia R. Carvalho Assistant1CityAdmey RECOMMENDED FOR APPROVAL: STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager SUBRECIPIENT: 4UJ6"� N e: Natividad Alvarado Ti4e: Executive Director Tax ID#45.4041042 DUNS# 079536874 Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.05.21 1131:24-07r A c O® CERTIFICATE OF LIABILITY INSURANCE MM DATE(192021 YYI 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 endersement(s). PRODUCER LovNAME: t Marsh and McLennan Agency, LLC 1050 W Washington Street, Suite 233 1050 & ToucWashington Tempe AZ 85281 CONTACT Kolb Kearney PHONE .602-792-2306 ac No,602-956-2258 E-MAIL ADDREs3: kkearne lovitt-touche.com INSURERS AFFORDING COVERAGE NAICN INSURER A: Houston Casualty Company 55555 INSURED NATIHOU-Cl NE IDS House INSURER B : Neutral Ground INSURERC: INSURERD: 1733 Valencia $t Santa Ana CA 92706 NSU RER E: NSURERF: COVERAGES CERTIFICATE NUMBER: 982983375 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 ADOL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/VYYY LIMITS A X COMMERCIAL GENERAL LIABILITY H21SS2007100 1/612021 1/6/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 171 OCCUR DAMAGE TO RE TED PREMISES Ea occurrence $50,000 X MED EXP (Any oneperson) $ 5,000 1.000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- � ECT LOC GENERALAGGREGATE $3,000,000 PRODUCTS-COMP/OPAGG $1,000,000 $ OTHER: A LIABILITY H21SS2007100 116/2021 1/6/2022 COMBINED SINGLE LIMIT En accident $1,000,000 BODILY INJURY(Per person) $ ANY AUTO POMOBILE OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accldent $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ OFF CERIMEM EREXCLUDED9ANYPROPRIETORIPARTNEWEXECUTIVE El E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yea, descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability H21SS2007100 1/6/2021 1/6/2022 Each Claim 1,000,000 SexuallPhysical Abuse Pro(Aggregate SAML Aggregate 3, 000,D00 1,000,D00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) Certificate holder is named Additional Insured to General Liability coverage if required by written contract, subject to all policy terms, conditions, definitions and exclusions. Primary/Non-Contributory applies. Notice of Cancellation for Specified Entity, City of Santa Ana. "City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as Is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory." The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 06W ©1988.2015 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ki RlelrMartagammtDivision :fi€ 2 REVIEWED&APPROVEDBY: �i11. V' ®' Rnk Management. Analyst Houston Casualty Company Houston, TX End. Effective Date Named Insured Policy Number Endorsement 01/06/2021 Nati's House H21SS20071-00 5 3. Notwithstanding any other provision contained in Section Vill. POLICY CONDITIONS, (C) Other Insurance, if required by written contract or agreement, this insurance is primary to and will not seek contribution from any other valid and collectible insurance available to any Additional Insured, except where the liability of such Additional Insured is caused by his, her or its own negligence. 4. As used in this Endorsement, "Additional Insured" means any person or organization designated in the Schedule of Additional Insured(s) below. Schedule of Additional Insured(s) Applicable Retroactive Date Additional Insured Coverage Section (Applicable to Professional Termination Date Liability only 1. Charitable Ventures of Orange County Project Kinship Professional & 4041 MacArthur General Liability January 29, 2019 NA Blvd, Set 510 Newport Beach, CA 92660 2.Santa Ana Unified School District its governing Professional & board, officers, agents General Liability January 29, 2019 NA and employees 1601 E. Chesnut Ave. Santa Ana, CA 92701 37he City of Santa Ana its officers, employees, agents and Professional & volunteers General Liability January 29, 2019 NA 20 Civic Center Plaza Santa Ana, CA 92701 BY: Ince Author RIskMangftRMLDhision 8� p` R�nexEo & Arreovm Br ASP 2010 Page 2 of 3 t1J F P, V' 1 [tick Management Analyst Houston Casualty Company Houston, TX End, Effective Date Named Insured Policv Number Endorsement 01/06/2021 Nati's House H21SS20071-00 5 All other terms and conditions of this Policy remain unchanged. Bv: REME"D & APPROVM BY. 1` ASP 2010 Page 3 of 3IMW • RNk Manageurnt Analyst Houston Casualty Company Houston, TX End. Effective Date Named Insured Policy Number Endorsement 04/2712021 Nati's House dba Neutral Ground H21SS20071-00 11 This insurance is issued pursuant to the California Insurance Code, Sections 1760 through 1780, and is placed in an insurer or insurers not holding a Certificate of Authority from or regulated by the California Insurance Commissioner. PROFESSIONAL LIABILITY AND GENERAL LIABILITY INSURANCE ENDORSEMENT A. PROFESSIONAL LIABILITY (CLAIMS -MADE AND REPORTED COVERAGE) B. GENERAL LIABILITY (OCCURRENCE COVERAGE) NOTICE OF CANCELLATION OR NON -RENEWAL TO SPECIFIED ENTITY(IES) It is understood and agreed that if this Policy is canceled or non -renewed, the Company will provide the entity(ies) listed below with at least 30 days written notice of cancellation or non - renewal: Entity IAddress City of Santa Ana; Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 All other terms and conditions of this Policy remain unchanged. moo&ovmar ASP 2035 Page 1 of 1r S ® Risk Management Analy4t Houston Casualty Company Houston, TX End. Effective Date Named Insured Pollc Number Endorsement 01/06/2021 Nati's House H21SS20071-00 5 This insurance is issued pursuant to the California Insurance Code, Sections 1760 through 1780; and is placed in an insurer or insurers not holding a Certificate of Authority from or regulated by the California Insurance Commissioner. PROFESSIONAL LIABILITY AND GENERAL LIABILITY INSURANCE ENDORSEMENT A. PROFESSIONAL LIABILITY (CLAIMS -MADE AND REPORTED COVERAGE) B. GENERAL LIABILITY (OCCURRENCE COVERAGE) SPECIFIED ADDITIONAL INSURED(S) - VICARIOUS LIABILITY WITH PRIMARY AND NON- CONTRIBUTORY INSURANCE In consideration of the premium charged, it is understood and agreed that this Policy is amended as follows: 1. Section III. DEFINITIONS, (P) Insured, is amended to include any Additional Insured, but only for such Additional Insured's vicarious liability arising from the acts, errors or omissions of any Insured other than an Additional Insured. There shall be no coverage under this Policy for any independent liability of any Additional Insured. 2. Coverage under this Policy for any Additional Insured shall be further limited as follows: (a) coverage shall only be afforded under the applicable Coverage Section(s), as specified in this Endorsement, and subject to all other terms, conditions, definitions and exclusions of this Policy; (b) the Professional Liability Coverage, if appliable, shall only apply to Claims for Wrongful Acts that are committed or allegedly committed: (i) on or after the applicable Retroactive Date, as specified below, and (ii) prior to the applicable Termination Date, as specified below, or prior to the end of the Policy Period if no Termination Date is specified; (c) the General Liability Coverage, if applicable, shall only apply to Claims for General Liability Incidents that occur during the Policy Period, but prior to the applicable Termination Date, as specified below; and (d) Additional Insured(s) shall share in the Limits of Liability set forth in the Declarations of this Policy. By: /Awlt tAt X -I' fWt £ uffioYT RickM.vwg "tDlulelpn REVIEWED &APPROVED BY. ASP 2010 Page 1 of 3 t( 1�j`r F ,R, v ' Risk Management Anailst Houston Casualty Company Houston, TX End. Effective Date Named Insured Polic Number Endorsement 01/0612021 Nati's House H21SS20071-00 5 3. Notwithstanding any other provision contained in Section Vill. POLICY CONDITIONS, (C) Other Insurance, if required by written contract or agreement, this insurance is primary to and will not seek contribution from any other valid and collectible insurance available to any Additional Insured, except where the liability of such Additional Insured is caused by his, her or its own negligence. 4. As used in this Endorsement, "Additional Insured" means any person or organization designated in the Schedule of Additional Insured(s) below. Schedule of Additional Insured(s) Applicable Retroactive Date Additional Insured Coverage Section (Applicable to Professional Termination Date Liability only) 1. Charitable Ventures of Orange County Project Kinship Professional & 4041 MacArthur General Liability January 29, 2019 NA Blvd, Set 510 Newport Beach, CA 92660 2.Santa Ana Unified School District its governing Professional & board, officers, agents General Liability January 29, 2019 NA and employees 1601 E. Chesnut Ave. Santa Ana, CA 92701 33he City of Santa Ana its officers, employees, agents and Professional & volunteers General Liability January 29, 2019 NA 20 Civic Center Plaza Santa Ana, CA 92701 Audimi RlakManagtmentD[Weion zfgy'i` REVIEWED&APPROVETJ HY.- ASP 2010 Page 2 of 3 8! viil;l) ' (~ � P, (t;, w Wk Management Analyst Digitally signed by Francine Francine R. Villareal POLICYHDLOER COPY R. VIIIareal 16:33302070055P P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-11-2021 GROUP: POLICY NUMBER: 9257170-2021 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 07-11-2022 07-ii-2021/07-11-2022 CITY OF SANTA ANA SP RISK MANAGEMENT DIVISION 20 CIYIC CENTER PL2- SANTA ANA CA 02701-4058 This is to certify that we have Issued a valld Workers' Compensation Insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period Indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to Its normal expiration. This certificate of insurance is not an Insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of Insurance may be Issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, Land conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTSt $1,000,000 PER OCCURRENCE. ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-11-2020 15 ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER NATI'S HOUSE (A NON PROFIT CORP) NEUTRAL SP GROUND FAMILY SERIVCES 1733 VALENCIA ST SANTA ANA CA 92706 tHEV.7-20141 e z lUekMxtmgenoit0ivislsn -� h @ REVIEWED &APPROVIIJ BY: PRINTED 0 �'. '' Ritk M4nagement Malyzt Policy Informal_on >> Policy Details IN Payments Policy Viewer Inception Date 07-11-2021 Regional Office Southern NEUTRAL GROUND FAMILY SERVICES Expiration Date 07-11-2022Field Services Office SP - SANTA ANA 1733 VALENCIA ST,SANTA ANA, CA 92706 Anniversary Rating Date --- Quote 10 700041232 Policy Number 9257170-2021 Coverage Period 07-11-2021 to 07-11-2022 Details CONTACT BRIANNA ALVARADO 'PRIMARY BUSINESS (714)980-0953 PHONE Primary Contact Info, jEMAIL BREE@NGSERVICES.ORG ®' View more contacts... NATI'S HOUSE(A NON-PROFIT CORP.) (A Legal Names NONPROFIT MUTUAL BENEFIT CORP.) NONPROFIT MUTUAL BENEFIT Term Type CONTINUOUS COVERAGE State Fund Years 5 Est. Annual Premium $9,943.00 Minimum Premium $500.00 Entity M - NON-PROFIT CORPORATION Loss Analysis Reports.--- ' Endorsed Classes Class Description Effective 8868 COLLEGES OR SCHOOLS--PRIVATE--NOT G (1) AUTOMO 07-11-2021 8804 SUBSTANCE USE DISORDER RECOVERY (1) HOMES- - 07-11-2021 9101 COLLEGES OR SCHOOLS--PRIVATE--NOT (1) AUTOMO 07-11-2021 Experience Modifications XMOD Effective 9 There Is no XMOD data available. Interim Billing Factors Factor Effective 0.77793 07-11-2021 Final Billing Factors Factor Effective W There Is no final billing factor data available. Exclusions B.r There are no exclusions available. Unit Stat Reoort Status Status Status Code Report Date Z' There is no Unit Stat Report Status data available. �nRick Maaganent Division � �t Rexm & APPRMED Br. al= ®' Risk Management Analyst