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HomeMy WebLinkAboutBOYS & GIRLS CLUB OF SANTA ANA (4)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES (n.1-2-2- CLERK OF COUNCIL DATE: A-2020-157-08 FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND C OR (9 BOYS AND GIRLS CLUB OF SANTA ANA BRA BOYS AND GIRLS CLUBS OF (Dui d PIOR S� CENTRAL ORANGE COAST W (24 CFR Parts 570) THIS FIRST AMENDMENT TO THE COMMUNITY DEVELOPMENT BLOCK GRANT AGREEMENT is entered into this 10r 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 Boys and Girls Club of Santa Ana BRA Boys and Girls Clubs of Central Orange Coast, a C ' California nonprofit organization ("Subrecipient"). co cv Cl- RECITALS w cn A. On July 1, 2020, the City entered into Community Development Block Grant ("CDBG") Subrecipient Agreement #A-2020-043-03 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 terms 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 H, 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. rm ui in A-2020-15 7-08 N IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to said Agreement the date and year first above written. ATTEST: rDA' , � � ,'V�iClerk h APPROVED AS TO FORM: Sonia RrCarvall City tto �y I I M RECOMMENDED FOR APPROVAL: v A--- STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISTINE RIDGE City Manager SUBRECIPIENT: Name: Robe Santan Title: Executive for Tax ID# 95-1893417 DUNS# 030603781 Tori Pierson °ohe`aioi; o; z,bs,,,e-o 00' ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 06/04/2021 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 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LUNTACT Carmencita Josef NAME: Hays Companies Inc. PHON(909) 243-8200 ^x 909 )243-8201 ( ME.,1AIC No C: 4200 Concour3, Suite #350 E-MAIL cJosefQhayscompanles.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # Ontario CA 91764 INSURERA: Philadelphia Indemnity Ins Co 18058 INSURED INSURER B: Insurance Company of the West 27847 Boys & Girls Clubs of Central Orange Coast INSURER C: 17701 Cowan, Ste. 110 INSURER D: INSURER E: Irvine CA 92614 INSURER F: :ERTIFICATE NUMBER: UI-216413806 THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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, TR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICYEFF MMIDDIYYYYI YEXP IMMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 1,000,000 X MED EXP(Any one person) $ 20,000 Abuse & Molestation X1 Professional Liability PERSONAL &ADV INJURY $ 1,0005000 A Y PHPK2279909 06101/2021 06/01/2022 GEN'L AGGREGATE LI MIT APPLI ES PER: X POLICY PRO- JECT LOC GENERAL AGGREGATE $ 3,0005060 PRODUCTS - COMP/OP AGG $ 3,0005000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accldent $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS PHPK2279802 06/01/2021 06101/2022 BODILY INJURY (Per accldent ) $ HIRED NON-0WNED AUTOS ONLY AUTOS ONLY PROPERTYDAM4GE Peramident $ X $ Comp/Coll X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE PHUB769704 06/01/2021 06/0112022 AGGREGATE $ 5,000,000 DED I X1 RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETCRIPARTNEWEXECUTIVE YIN OFFICEWMEMBER EXCLUDED? ❑N (Mandatory In NH) ?ryes, describe antler DESCRIPTION OF OPERATIONS below NIA WVE 505577301 06/01/2021 06/01/2022 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Property -Replacement Cost Special Form PHPK2279802 06/01/2021 06/0112022 Blanket BPP $921,000 Deductible $15000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached If more space Is rec ul red) City of Santa Ana, officers, agents, employees and volunteers are additional insured on the General Liability only per written contract, agreement or memorandum of understanding. Policy Is Is primary and and any insurance carried by City shall be excess and non contributory. 30 day cancellation except 10 days for non payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana - Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE ,t „�, RlakbiawgmudlDMdmt Santa Ana CA 92702 �. A� 9 j'r prcW n i7RR.gn14ArnPn `rsiskM19anaoenant ClMulNde ;T ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD V POLICY NUMBER: PHPK2279802 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): The City of Santa Ana, its Officers, Agents, and Employees, and Volunteers Information required to complete this Schedule, if not shown above, will be shown In the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law: and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. w� �%y Ree�wEo&rv�rrovcnBx . �`i Jt fasieeutan "`" RNeMvvgmmtOMwl/'Ar CG 20 26 0413 © Insurance Services Office, Inc., 2012 4. Otherinsurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (if) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner: or (iv) 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 Liability. (b) Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3) 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. (4) 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. Method Of Sharing If all of the other insurance 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 of the other insurance 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. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; >u�ro�aea l�wEas.Arwawea ar:.. Page 12 of 16 © Insurance Services Office, Inc., 2012 , ,