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0�� City of Santa Ana r Clerk of the Council !. -r 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes , No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. COTC Office Use Only City of Santa ME JAN I I ZOM City Clerk's Office The agreement with orw'� OV A-2022-033-04 No. was completed on ',).LD-j8 and final payment has been made. (List all amendments. Use space below if needed ) hagreementslformslform - agreement termination form_goldenrod,doc Department: Phone/Ext.: 5L�43 Signature: ftA,-- Date: li �l10�'23 �� INSURANCE ON FILE A-2022-033-04 WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: AGREEMENT BETWEEN THE CITY OF SANTA ANA AND MAR 1 0 2022 ONEOC FOR USE OF AMERICAN RESCUE PLAN ACT (ARPA) FUNDS This Agreement is hereby made and entered into this 1 st day of March, 2022, 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 OneOC, a California domestic nonprofit corporation ("CONTRACTOR"). RECITALS: A. The American Rescue Plan Act ("ARPA") was signed into law in March 2021. ARPA provides funding for a number of different programs, including the Coronavirus State and Local Fiscal Recovery Fund ("SLFRF"), to provide monetary support to local governments to respond to, mitigate, and recover from the COVID-19 public health emergency. B. On July 20, 2021, the Santa Ana City Council authorized the City Manager to utilize ARPA SLFRF funding from the United States Department of Treasury for the Revive Santa Ana Spending Plan, which includes five spending categories: recovery from the pandemic, direct assistance programs, public health and safety, critical infrastructure, and city fiscal health. C. CONTRACTOR has been selected by the CITY to receive ARPA SLFRF Funds in order to provide food distribution and/or food supply programs, in accordance with the Scope of Work attached hereto as Exhibit A and incorporated herein by reference ("said program"). CONTRACTOR represents that it is qualified and willing to operate said program and certifies that the administration of said program carried out with funds provided under this Agreement will meet ARPA's objectives to respond to, mitigate, and recover from this historic COVID-19 public health crisis. D. CONTRACTOR agrees that it will adhere to the tasks and services as indicated in Exhibit A for said program. Failure to follow the requirements and meet the stated expectations 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 CONTRACTOR 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 CONTRACTOR: ARPA PROGRAM PROVISIONS A. Scope of Work. CONTRACTOR shall be responsible for the specific tasks and services of said program, and agrees to administer said program in compliance with the tasks and services as described in the Scope of Work attached hereto as Exhibit A. CONTRACTOR's failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of funds for said program or termination of this Agreement. B. Term of Agreement. The term of said Agreement shall commence on the date first written above and continue through February 28, 2023 ("Term"), unless terminated earlier pursuant to the terms of this Agreement. This Agreement shall also cover any and all services provided by the CONTRACTOR to the CITY since the date the ARPA SLFRF Funds were awarded to the CITY. Additionally, the Term of this Agreement may be extended by a writing executed by the City Manager, or designee, and the City Attorney. C. Amount of Grant Funding. The total amount of funds provided for said program shall not exceed ONE HUNDRED EIGHTY-EIGHT THOUSAND FIVE HUNDRED TWENTY-EIGHT dollars ($188 528) ("ARPA SLFRF Funds") during the Term of the Agreement. CONTRACTOR agrees to use said ARPA SLFRF Funds to administer said program as outlined in Exhibit A. D. Disbursement of Funds. Said ARPA SLFRF Funds shall be disbursed by CITY to CONTRACTOR pursuant to the terms found in the Fee Payment Schedule attached hereto as Exhibit B, with payments subject to the submittal of invoices and other reporting requirements, as hereinafter more fully set forth. CONTRACTOR 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 retention/reporting, 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 ARPA SLFRF Funds, or return the entire request to CONTRACTOR, until such documentation and reporting has been received and approved by CITY. (1) Reduction in ARPA SURF Funding. The CITY reserves the right to reduce the amount of ARPA SLFRF Funds to CONTRACTOR, or to completely terminate this Agreement, in the CITY's sole discretion, if there is a reduction in ARPA SLFRF Funds provided to the CITY. (2) Reduced Distribution of Funds. The CITY reserves the right to reduce the grant application if the CITY's fiscal monitoring indicates that CONTRACTOR's rate of expenditure will result in unspent funds at the end of the program term. Amendments in the grant allocation will be made after consultation with CONTRACTOR. (3) Reversion of Assets. CONTRACTOR agrees that any and all funds received under this Agreement shall be utilized during the Term of this Agreement, and that any and all funds remaining as of the end of the Term, which have not been utilized, shall be returned by CONTRACTOR to the CITY within thirty (30) days of the expiration or earlier termination of the Agreement. No expense of CONTRACTOR will be reimbursed by CITY if incurred after the end of the Term of the Agreement. E. Grant Program Requirements. (1) CONTRACTOR acknowledges that the source of funding for said program is the federal ARPA, and that payments from the ARPA SLFRF Funds are only to be used to make necessary expenditures incurred due to the public health emergency with respect to COVID-1 9. (2) CONTRACTOR acknowledges that ARPA provisions allow the use of ARPA SLFRF Funds to respond to, mitigate, and recover from the COVID-19 public health emergency, and will not use these funds for any other uses. (3) CONTRACTOR shall follow the process and determination of eligibility for participants in said program as outlined in Exhibit A. F. Performance Monitoring. (1) CONTRACTOR shall submit program performance information as often as requested by CITY, but no less than the submission of monthly reports and a final report to CITY with the information requested by and in the format acceptable to CITY. Each monthly report is due within thirty (30) days of completion of work for each month. The final report is due within thirty (30) days after the termination or expiration of this Agreement. (2) CITY will evaluate CONTRACTOR's management and operation of said program with respect to the project expectations as described in Exhibit A. (3) CITY will review the audit of the CONTRACTOR to ensure that grant funds are used for authorized purposes in compliance with laws, regulations, and the provisions of contracts or grant agreements under this Agreement, including attachments and exhibits. (4) If action to correct any substandard performance is not taken by the CONTRACTOR within a reasonable period after being notified by CITY, suspension or termination procedures may be initiated by CITY. (5) All performance shall be subject to review by the CITY or other regulatory agencies at all times. CONTRACTOR shall provide adequate cooperation to any inspector or other CITY representative to permit the same to determine CONTRACTOR's conformity with the terms of this Agreement. If any services performed by CONTRACTOR are not in conformance with the terms of this Agreement, the CITY shall have the right to require CONTRACTOR to perform the services in conformance with the terms of the Agreement at no additional cost. The CITY may also terminate this Agreement for default and charge CONTRACTOR for any costs incurred by the CITY because of CONTRACTOR's failure to perform. (6) CONTRACTOR shall establish adequate procedures for self -monitoring and quality control and assurance to ensure proper performance under this Agreement; and shall permit a CITY representative or other regulatory official to monitor, assess, or evaluate CONTRACTOR's performance under this Agreement at any time, upon reasonable notice to CONTRACTOR. G. Audit (1) CONTRACTOR shall maintain complete and accurate records and supporting documentation to facilitate financial and/or program audits by CITY. This requirement shall apply to any records and documentation CITY shall reasonably require or as required to be maintained pursuant to the ARPA regulations. (2) The books and accounts, files, and other records of CONTRACTOR, which are applicable to this Agreement, shall be available for inspection, review, and audit during normal business hours by CITY to determine the proper application and use of all ARPA SLFRF Funds provided to or for the account or benefit of CONTRACTOR. (3) CONTRACTOR assumes responsibility for reimbursement toCITY asum of money equivalent to the amount of any expenditures disallowed should the CITY, or an authorized agency, rule through audit, exception, or some other appropriate means, that expenditures from funds allocated to CONTRACTOR for direct and/or administrative costs were not made in compliance with the applicable cost principles, regulations, or the provisions of this Agreement. (4) CONTRACTOR agrees to comply with the requirements of OMB Uniform Guidance 2 CFR Part 200. CONTRACTOR further agrees to provide CITY with a copy of completed independent auditors' report within thirty (30) days of CITY's request for such report. If the report contains instances of non-compliance with federal laws and regulations that bear directly on the performance or administration of this Agreement, CONTRACTOR shall provide CITY copies of responses to auditors' reports, a plan for corrective action, and auditors' response that the noncompliance has been resolved. All reports prepared in accord with the requirements of OMB Uniform Guidance 2 CFR Part 200 shall be available for inspection by representatives of CITY or the federal government during normal business hours. (5) All accounting records, reports, and evidence pertaining to all costs, expenses and the ARPA SLFRF Funds of CONTRACTOR and all documents related to this Agreement shall be maintained and kept available at CONTRACTOR'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) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement; or, (b) costs and expenses of this Agreement to which CITY or any other governmental agency takes exception, shall be retained beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In the event CONTRACTOR does not make the above -referenced documents available within the City of Santa Ana, California, CONTRACTOR agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. H. Ownership/Use of Materials. CONTRACTOR agrees that all materials, reports or products in any form, including electronic, created by CONTRACTOR for which CONTRACTOR has been compensated pursuant to this Agreement shall be the sole property of the CITY. The material, reports, or products may be used by the CITY for any purpose that the CITY deems to be appropriate, including, but not limit to, duplication and/or distribution within the CITY or to third parties. CONTRACTOR agrees not to release or circulate in whole or part such materials, reports, or products without prior written authorization of the CITY. I. Close -Out. CONTRACTOR agrees to comply with the closeout procedures detailed in 2 CFR §200.343, including the following: (1) CONTRACTOR 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 terms and conditions of this Agreement; (2) CONTRACTOR 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 CONTRACTOR for use in other projects (See OMB Circular A-129 and 2 CFR §200.345); and, (3) CITY should complete all closeout actions for the Federal award no later than one year after receipt and acceptance of all required final reports. 11. CONTRACTOR'S OBLIGATIONS A. Representations and Warranties. (1) Authority. CONTRACTOR is a duly organized and existing domestic nonprofit corporation in good standing and authorized to do business under the laws of the State of California. CONTRACTOR 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 CONTRACTOR has been fully authorized by all requisite actions on the part of CONTRACTOR. (2) Experience. CONTRACTOR is qualified to provide the administrator services for said program detailed herein. (3) Familiarity With Services Required. By executing this Agreement, CONTRACTOR warrants that: (i) it has thoroughly investigated and considered the administrator services to be performed and provided for said program as detailed in Exhibit A; (ii) it has carefully considered how the services should be performed; and, (iii) it fully understands the facilities, difficulties and restrictions attending performance of the services under this Agreement. (4) No Conflict. To the best of CONTRACTOR'S knowledge, CONTRACTOR'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 CONTRACTOR is a party or by which it is bound. (5) No Bankruptcy. CONTRACTOR is not the subject of any current or threatened bankruptcy proceeding. (6) No Pending Legal Proceedings. CONTRACTOR is not the subject of a current or threatened litigation that would or may materially affect CONTRACTOR'S performance under this Agreement. (7) Proposal Veracity. All provisions of and information provided in CONTRACTOR' proposal submitted to CITY, including any exhibits, are true and correct in all material respects. (8) No Pending Investigation. CONTRACTOR 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 or prosecuting authority, which would relate to or affect performance of the Agreement or provision of services hereunder. B. Licensing. CONTRACTOR agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. CONTRACTOR shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing CONTRACTORSs operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. C. Zoning, CONTRACTOR agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activities. Should CONTRACTOR fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and regulations relating thereto, CONTRACTOR shall immediately make good -faith efforts to gain compliance with local, state orfederal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. CONTRACTOR shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. CONTRACTOR must make all corrections required to bring the facility/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. D. Separation of Accounts. All funds received by CONTRACTOR from CITY 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 200.302 requirements. CONTRACTOR is not required to maintain separate depository accounts for ARPA SLFRF Funds; provided however, the CONTRACTOR must be able to account for receipt, obligation, distribution and expenditure of ARPA SLFRF Funds pursuant to applicable 2 CFR 200.302 requirements. E. Audit Report Requirements. CONTRACTOR agrees that if CONTRACTOR expends Seven Hundred Fifty Thousand Dollars ($750,000) or more in federal funds, CONTRACTOR shall have an annual audit conducted by a certified public accountant in accordance with the standards as set forth and published by the United States Office of Management and Budget. CONTRACTOR 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. F. Compliance with Law/Program Income. CONTRACTOR acknowledges that the funds being provided by CITY for said program are received by CITY pursuant to ARPA, and that distribution and expenditure of these ARPA SLFRF Funds shall be in accordance with ARPA 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. Any program income received by CONTRACTOR shall be returned to CITY, unless otherwise provided for in this Agreement. CONTRACTOR agrees to comply fully with all federal, state and local laws and court orders applicable to its operation and administration of said program, whether or not referred to in this Agreement. G. 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. CONTRACTOR must review and sign Exhibit D "Debarment', which is attached hereto and incorporated herein by this reference. CONTRACTOR shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board or Internal Revenue Service. Any change in the corporate status or suspension of CONTRACTOR shall be reported immediately to CITY. H. Confidentiality. Without prejudice to any other provisions of this Agreement, CONTRACTOR shall, where applicable, maintain the confidential nature of information provided to it concerning participants in accordance with the requirements of federal and state law. However, CONTRACTOR shall submit to CITY or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by CONTRACTOR, costs incurred and services rendered hereunder. I. Independent Contractor. CONTRACTOR agrees that the performance of obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way an agent of CITY. J. Violation of Terms and Conditions. CONTRACTOR agrees that if CONTRACTOR violates any of the terms and conditions of this Agreement or any prior Agreement whereby ARPA SLFRF Funds were received by CONTRACTOR, or if CONTRACTOR reports inaccurately, or if on audit there is a disallowance of certain expenditures, CONTRACTOR agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If CONTRACTOR engaged in fraudulent activity to obtain and/or justify distribution or expenditure of the ARPA SLFRF Funds granted hereunder, CONTRACTOR shall be required to reimburse the CITY of all such funds that were obtained, distributed and/or spent under fraudulent circumstances. K. Fraud. CONTRACTOR shall immediately report all suspected or known instances and facts concerning possible fraud, abuse or criminal activity related to said program for the ARPA SLFRF Funds under this Agreement. L. Prohibited Use. CONTRACTOR hereby certifies and agrees that it will not use ARPA SLFRF Funds provided through this Agreement to pay for entertainment, meals or gifts, or other prohibited uses. M. Lobbying. CONTRACTOR certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay any person 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. CONTRACTOR shall sign a certification to that effect in a form as set forth in Exhibit E, attached hereto and by this reference incorporated herein. CONTRACTOR shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to CONTRACTOR 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 E). N. Financial Interest. CONTRACTOR agrees that except for the use of administrative fees to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to administering said program 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 the administration of said program, may obtain a financial interest or benefit from said program, 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 CITY, or of any designated public agency, or the CONTRACTOR. O. Labor Standards. The CONTRACTOR agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis -Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this Agreement. The CONTRACTOR 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 CONTRACTOR 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. P. Equal Employment Opportunities. CONTRACTOR shall make every effort to ensure that all projects funded wholly or in part by ARPA SLFRF Funds shall provide equal employment opportunities for minorities and women. Q. Women and Minority -Owned Businesses (W/MBE) CONTRACTOR will use its best efforts to afford small businesses, minority business enterprises, and women's business enterprises the maximum practicable opportunity to participate in the performance 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. CONTRACTOR may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. R. Drug Free Workplace. CONTRACTOR agrees to provide a drug -free workplace and to execute a certification as set forth in Exhibit F attached hereto and incorporated herein by this reference. S. Uniform Administrative Requirements Cost Principles, and Audit Requirements for Federal Awards. The following requirements and standards must be complied with: 2 CFR Part 200 et al. CONTRACTOR shall procure all materials, property, or services in accordance with the requirements of 2 CFR 200.318-326. III, CITY'S OBLIGATIONS A. Audit of Account. CITY shall include an audit of the account maintained by CONTRACTOR in CITY's audit of all ARPA SLFRF Funds in accordance with Title 24 of the Code of Federal Regulations and other applicable federal laws and regulations. B. Common Rule: 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 subgrant supported activities to assure compliance with federal requirements. Such monitoring covers each program, function and activity and performance goals are reviewed periodically. C. Protect Expectations: CITY shall monitor the performance of CONTRACTOR against goals and performance standards required herein. The CONTRACTOR shall be responsible to accomplish the project expectations as set forth in Exhibit A, and report such results to the CITY. If the CONTRACTOR estimates such goals will not be met, the CONTRACTOR 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 CONTRACTOR 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 CONTRACTOR in writing of its determination specifying in full detail the objections that it has to the CONTRACTOR's performance. If action to correct such substandard performance is not taken by the CONTRACTOR 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. IV. GENERAL PROVISIONS A. Non -Discrimination. 1. CONTRACTOR agrees to comply with Executive Order 11246, which requires that during the performance of this Agreement, CONTRACTOR agrees not to discriminate 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. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the CONTRACTOR setting forth the provisions of this nondiscrimination clause. 2. CONTRACTOR 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. 3. 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 of, or otherwise be subject to discrimination in any activities, programs or employment supported by this Agreement. CONTRACTOR 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. 4. CONTRACTOR agrees to comply with the Age Discrimination Act of 1975, which requires that during the performance of this Agreement, CONTRACTOR agrees not to discriminate against any employee or applicant for employment because of age. 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. CONTRACTOR agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the CONTRACTOR setting forth the provisions of this age discrimination clause. 5. CONTRACTOR 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 of 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. B. Conflict of Interest. Pursuant to the conflict of interest requirements set forth in 24 CFR 570.611 and 2 CFR 200.112, CONTRACTOR certifies that no member, officer, employee, agent or assignee of CITY having direct or indirect control of any ARPA SLFRF Funds granted to the CITY, inclusive of the subject ARPA SLFRF Funds, shall serve as an officer of CONTRACTOR. Further, any conflict or potential conflict of interest of any officer of CONTRACTOR 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 CONTRACTOR to CITY regarding any changes or modifications to its board of directors and list of officers. C. Special Certification for Religious Entities. If CONTRACTOR is a religious entity, CONTRACTOR hereby agrees that in connection with the provision of the services CONTRACTOR shall provide with ARPA SLFRF Funds, in accordance with 24 CFR 570.2006): 1. CONTRACTOR 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. 2. CONTRACTOR shall not discriminate against any person applying for the services CONTRACTOR agrees to provide under the terms 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. 3. CONTRACTOR 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 of the services in said program. The 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 CONTRACTOR 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 CONTRACTOR. 4. 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. 5. Where the services to be provided under said program are rendered on property owned by the primarily religious entity CONTRACTOR, ARPA SLFRF Funds may also be used for minor repairs to such property, which are directly related to the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the ARPA expenditure for rendering the services under said program. D. Prohibition of Nepotism. CONTRACTOR agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by CONTRACTOR. For the purposes of this section, the term "immediate family" means spouse, 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. E. Notices. Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: City of Santa Ana Daisy Perez Assistant to the City Manager City Manager's Office 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702-1988 TO CONTRACTOR: OneOC 1505 E. 17th Street, Suite 101 Santa Ana, CA 92705 F. Assi nq ability. None of the duties of, or work to be performed by, CONTRACTOR under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY. CONTRACTOR must submit all subcontracts and other agreements that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal obligations of CONTRACTOR pursuant to this Agreement. G. Indemnification/Hold Harmless. CONTRACTOR 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 kind 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 CONTRACTOR, its officers, directors, employees, agents, subcontractors and suppliers arising out of CONTRACTOR's performance of this Agreement. H. Insurance. Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the Contractor, its agents, representatives, employees, or subcontractors. a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGQ: Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: Insurance Services Office Form Number CA 0001 covering, Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non -owned), with limit no less than $1,000,000 (if program services includes transportation of youth, the limit shall be no less than $5,000,000) per accident for bodily injury and property damage. (Not required if an automobile is not required to fulfill services.) 3. Workers' Compensation: insurance as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. Sexual Abuse or Molestation (SAM) Liability. If the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Contractor shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit no less than $1,000,000 per occurrence or claim. 5. If the Contractor maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions — The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Contractor's insurance (at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if a later edition is used). 2. Primary Coverage: For any claims related to this contract, the Contractor's insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall state that coverage shall not be canceled, except with notice to the City. 4. Waiver of Subrogation: Contractor hereby grants to City a waiver of any right to subrogation which any insurer of said Contractor may acquire against the City by virtue of the payment of any loss under such insurance. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. l 5. Self -insured Retentions: Self -insured retentions must be declared to and approved by the City. The City may require the Contractor to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or City. 6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 7. Claims Made Policies: If any of the required policies provide coverage on a claims -made basis: 1. The Retroactive Date must be shown and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Contractor must purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: Contractor shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 9. Special Risks or Circumstances: City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Termination. 1. This Agreement may be terminated on thirty (30) days' written notice by either party. In the event of such termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. 2. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by CONTRACTOR of Federal Laws governing the use of ARPA SLFRF Funds. In the event of such suspension or termination, CONTRACTOR shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. 3. Pursuant to 2 CFR 200.340, in the event CONTRACTOR 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 CONTRACTOR, 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 termination 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 termination thereof, including the payment of money, except for paymentfor 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 CITY in obtaining substitute performance. 4. The grant of funds under this Agreement may be terminated for convenience by either the CITY or CONTRACTOR, in whole or in part, by setting forth the reasons for such termination, the effective date, and, in the case of portion termination, their portion to be terminated. However, if in the case of a partial termination, the CITY determines that the remaining portion of the award will not accomplish the purpose for which the award was made, the CITY may terminate the award in its entirety. 5. The grant of funds under this Agreement may be terminated due to the non-performance of CONTRACTOR and/or failure of SUBRECIPENT to perform the work described in Exhibit A. 6. The grant of funds under this Agreement may be terminated due to the failure of the CITY to receive sufficient or anticipated funding for the ARPA program for any term subject to this Agreement. 7. In the event this Agreement is terminated as set forth in subparagraphs 1(1) through I(6), inclusive, CONTRACTOR agrees to immediately return to CITY upon CITY's demand and prior to any adjudication of CONTRACTOR's rights, any and all funds not used, and to comply with the Reversion of Assets requirements in this Agreement. J. Limitation of Funds. The United States of America may in the future place programmatic or fiscal limitations on the use of ARPA SLFRF Funds, which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting ARPA program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement, may limit the rate of CONTRACTOR's authority to utilize funds, or may restrict CONTRACTOR's use of uncommitted funds. Where CITY has been directed to implement a reduction in funding, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY 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, CONTRACTOR shall be permitted to de -scope accordingly. Where CITY has reasonable grounds to question CONTRACTOR's fiscal accountability 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 CONTRACTOR of its intention to so act, pending an audit or other resolution of such questions. In no event, however, shall any revisions made by CITY affect expenditures and legally binding commitments made by CONTRACTOR 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 ARPA SLFRF Funds withdrawal guidelines. K. Exclusivity 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 ARPA SLFRF Funds by CONTRACTOR and contains all the covenants and agreements between the parties with respect to SUBRECIPIIENT's administration of said program. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which 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 CONTRACTOR. L. 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. M. 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. N. 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 any 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. O. Federal Award Identification Information. CONTRACTOR's pertinent Federal Award Identification Information, including DUNS Number and Federal Award Identification Number (FAIN), as well as the applicable information for ARPA, are included in Exhibit C attached hereto and incorporated herein by this reference. P. Miscellaneous Provisions. 1. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 2. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 3. This Agreement must be signed below and may be signed in counterpart and delivered by fax, email as a PDF (Portable Document Format) file attachment, or by other means that displays the original or a copy of the signatures. Any subsequent amendments may be signed and delivered in the same manner. {Signatures on following page} DocuSign Envelope ID: 963F15BE-ED4C-4614-B5E9-30B718CC8745 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year first written above. ATTEST: DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attom4, iI k By: RY CONTRACTOR: �ooc�SW" �ed by: il�V I u d a 'U�4i- Director of Finance & Accounting Services OneOC DUNS #: 054360722 CITY OF SANTA ANA KRISTINE RID City Manager IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year first written above. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Aft rn , O By: RYAN' O. I `QDGE Assistant Pity Attorney CONTRACTOR: Randa Wren Director of Finance & Accounting Services OneOC DUNS #: 054360722 CITY OF SANTA ANA RISTIN RID( City Manager Exhibit A City of Santa Ana REVIVE: SANTA ANA FOOD SUPPLY/ DISTRIBUTION PROGRAMS RFP NO.: 22-009A MPNA GREEN Programs, a fiscally sponsored project of OneOC This grant will support the food assistance component of MPNA-GREEN's COVID-19 in the Southeast Santa Ana project. The health and socio-economic impacts due to COVID-19 including rate of infection, deaths, job loss or loss of income, and risk of eviction have been and continue to be overrepresented in Anaheim, Garden Grove, and Santa Ana in comparison to other cities in Orange County (Parks et al. 2020). These impacts have also been disproportionately felt by Orange County's Hispanic Community (according to OCHCA dashboard). In Southeast Santa Ana, the impact and need are exacerbated given that this area of Santa Ana and in particular, neighborhoods including Minnie Street and Cedar Evergreen were severely economically disadvantaged and housing insecure before the Pandemic. In April 2020, MPNA-GREEN in collaboration with Madison Elementary, Santa Ana Unified School District, Radio Santa Ana and University of California, Irvine offered its first COVID-19 virtual information town hall as part of our health & wellness programs. This served to provide clear and culturally appropriate health communication to residents of Southeast Santa Ana. Subsequent town halls have taken place in July 2020 and January 2021, February, March and April in 2021. The sessions will continue in order to prevent more transmission, increase vaccinations, and recover from COVID-19. Since this time, MPNA-GREEN has also grown its COVID-19 response to include the COVID-19 Information Sessions and also (1) food assistance, (2) a rental assistance program, (3) vaccination outreach and recruitment, (4) an adult health Promoter Training, (5) Youth Education Curriculum, and (6) efforts to Measure the Impact of the Pandemic in this Community. This growing response and recovery plan is the project, COVID-19 in Southeast Santa Ana, for which we are seeking funding from Revive Santa Ana. This grant will provide food assistance to community members who have not been able to access food assistance so far. These neighbors include those who are food insecure but who lack transportation or experience other barriers to mobility to access food assistance locations that we offer at Madison Elementary. Through a partnership with UCI and UCLA, MPNA- GREEN received a Community Engagement Alliance (CEAL) grant from the National Institutes of Health with the purpose of getting the community vaccinated as soon as possible. MPNA-GREEN has recruited 10 promotoras who are from the community. These promotoras will identify the households that are food insecure as described above. The criteria for people to receive food vouchers includes: 1) Losing a job 2) Losing a family member due to COVID-19, and 3) Hospitalization due to covid-19. MPNA-GREEN will purchase food vouchers from Gonzales Market. These vouchers exclude the purchase of alcohol and tobacco. With this grant, promotoras will be able to provide $300 food vouchers (estimated monthly grocery costs for household) for over 100 families. This grant specifically will fund 448 households and be matched with other funding sources. When the promotoras interact with neighbors they will also be connecting them to local, state, and federal resources to meet other needs. This grant will support the food assistance program for 18 months between March 2021- May 2022. MPNA-GREEN staff will oversee the food assistance program and CEAL promotoras will implement the program by delivering vouchers. This program will leverage these promotoras as trusted messengers, making the food distribution voucher program unique by having and paying community residents to distribute the resources. Providing food assistance and other resources that meet people's basic needs (e.g., rental assistance) will also build trust of the promotoras which will strengthen their messaging and hopefully also have the added benefit of increasing vaccination rates. MPNA-GREEN has a vital and growing network of partners that have been critical to our accomplishments including previous food voucher distribution campaigns. Key partners include James Madison Elementary School (see letter of support), and Century High School. Other key partners include organizations with whom MPNA-GREEN formed the El Plan Del Pueblo Coalition. El Plan Del Pueblo Coalition is a group of organizations that is advocating and working with the City of Santa Ana government to ensure that the update to the city's general plan and subsequent element updates follow SB1000 and prioritize environmental justice. These organizations include Orange County Environmental Justice, The Kennedy Commission, Santa Ana Active Streets Coalition, El Centro Cultural de M6xico, Thrive Santa Ana Community Land Trust, Rise Up Willowick. These organizations are critical to our work and help leverage more resident engagement which is key to MPNA-GREEN'S mission and the goals of this grant to continue building community capacity. Because of our long-standing history in Santa Ana, we already have strong relationships based on past collaborations with these entities that are ready to be activated if we want to expand the scope geographically to the other environmental justice communities and topically. Exhibit B Bud et OneOC is a California nonprofit public benefit corporation established in 1958. During its 60- year history, OneOC, formerly Volunteer Center of Greater Orange County, has grown and matured from a simple clearinghouse for recruiting and placing volunteers in local nonprofit organizations to a one -stop -shop offering a comprehensive suite of integrated services for nonprofit organizations and companies. As a professional services organization, OneOC accomplishes its goals with funding from private sources, public contracts, and earned revenue. Personnel: MPNA GREEN Programs Executive Director, For the Executive Director role, we are requesting $2288 in salary and $889 in benefits for a 12-month period of this work. The Executive Director will dedicate 1 hrs./week (6.7%) of their time to the goals and objectives of the program. Hourly salary is $43.88/hour. Total benefits of 38.87% include payroll taxes (7.65%), workers compensation (1 %), unemployment (4%), health (22%), dental (.20%), life (0.02%), and 403b (4%). MPNA GREEN Programs Health Equity Academic Coordinator, (TBN) under the supervision of the executive director will be responsible for the daily operations and management of work plan in the community. Will coordinate the implementation of the program, support program evaluation, provide monthly program activity statistics and facility usage reports, manage program participation, develop master schedule for program activities and facilities. Work closely with the Executive Director in regard to budget management, provide support with grant reports, and monthly updates on progress of work plan. The budget request for this role is $11,252 and $4,374 in benefits for the 12-month period. The position will be dedicated 10 hrs./week (25%) to the goals and objectives of the program. Annual salary is $45,009.71. Total benefits of 38.87% include payroll taxes (7.65%), workers compensation (1%), unemployment (4%), health (22%), dental (.20%), life (0.02%), and 403b (4%). Non -Personnel Printing and Postage - MPNA GREEN Programs is requesting $202 to cover expenses for reproduction costs associated with meeting, outreach, and recruitment; including routine production flyers, agendas, documents, and reports. Training and Recruitment- Community Health Promoters (Promotoras), we are requesting funding for the participation of trained volunteer resident leaders to support the MPNA GREEN Programs Health Equity Academic Coordinator in the community outreach & recruitment efforts. As part of their involvement, they will receive ongoing training, attend meetings, and coordinate focus groups and community forums. Request is for $15,000 (10 positions at $1500). Supplies — We are requesting $100 for office and computer supplies; including paper, basic office printer ink, pens, clipboards, folders, paper clips, envelopes and other office items shared among all staff. Communications — We are requesting $225 for costs associated with telecommunications (cell phone allowance to maintain contact and document activities), social media, and website maintenance. Travel and Meetings - We are requesting $245.00 dollars to cover travel expenses for staff (e.g., mileage at current IRS reimbursement rate, meeting attendance, etc.). Administrative Fees - MPNA GREEN Programs is a fiscally sponsored project of OneOC, a California public benefit corporation. We are requesting $18,852.80 (10%) for administrative fees. Contingency- $700.20 Food Vouchers - 448 valued at $300 each - $134,400 Total Program Budget - $188,528 Reimbursement Schedule MPNA is to submit an invoice requesting reimbursement of program expenses, along with a report outlining all program outcomes and performance metrics to the City on a quarterly basis as follows: Q1: March 1, 2022 - May 31, 2022 Reporting/Invoicing Due: June 30, 2022 Q2: June 1, 2022 - August 31, 2022 Reporting/Invoicing Due: September 30, 2022 Q3: September 1, 2022 - November 30, 2022 Reporting/Invoicing Due: December 31, 2022 Q4: December 1, 2022 - February 28, 2023 Reporting/Invoicing Due: March 31, 2023 Lnsr v/x!a(ad by Randy W,en wn Jmr 07, 2022 of 06.-40 PM ONEOC Unique Entity ID pose of Registration Awards Physical Address 1901 E 4TH ST STE 100 Santa Ana, California 92705-3918 United States EXHIBIT C SAM Unique Entity ID STSKJPET6WJ3 Registration Status Active Mailing Address 1901 E 4TH ST STE 100 Santa Ana, California 92705.3918 United States CAGEl NCAGE 5CCC3 Expiration Date Jan 7, 2023 Doing Business as Division Name Division Number Volunteer Center Orange County Oneoc (blank) Congressional District State / Country of Incorporation URL California 46 California / United States www.oneoc.org Registration Dates Activation Date Submission Dale Initial Registration Dale Jan 7, 2022 Jan 7, 2022 Mar 5, 2009 Entity Dates Emily Start Date Fiscal Year End Close Dale Nov 1, 1958 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation Registrants In the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration In SAM demonstrates the registrant responded to the questions. Proceedings Questions Registrants in the System for Award Management (SAM) respond to proceedings questions In accordance with FAR 52.209.7, FAR 52.209-9, or 2.C.F.R. 200 Appendix XII. Their responses are not displayed in SAM. They are sent to FAPIIS.gov for display as applicable. Maintaining an active registration in SAM demonstrates the registrant responded to the proceedings questions. Active Exclusions Records? Business Types Entity Structure Corporate Entity (Tax Exempt) Profit Structure Non -Profit Organization Entity Type Business or Organization Organization Factors (blank) httgs:/Lsnrn.Snv/aalin,/OS43607221canUaWsmms=11CIN& Page 1 of3 Lost uPdnred by Ronda Wren on J07, 2022 a106:40 PM ONH'OC Socio-Economle Types Check the registrant's Reps & Carts, If present, under FAR 52.212-3 or FAR 52.219.1 to determine If the entity Is an SBA-certlfied HUBZone small business concern. Additional small business Information may be found in the SBA's Dynamic Small Business Search If the entity completed the SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset Yes No EFT Indicator CAGE Code 0000 5CCC3 EFT Indicator CAGE Code 5CCC (blank) Electronic Business R 1901 E. 4TH ST. STE, 100 Rands Wren, Miss Santa Ana, California 92705 United States Government Business A 1901 E. 4TH ST. STE. 100 Rands Wren, Miss Santa Ana, California 92705 United States Past Performance A 1901 E. 4TH ST., STE. 100 Rands Wren, Miss Santa Ana, California 92705 United States NAICS Codes Primary NAICS Codes NAICS Title Yes 813410 Civic And Social Organizations Product and Service Codes PSC PSC Name G099 Social- Other Yes, this entity appears in the disaster response registry. States Counties Metropolitan Statistical Areas California CA: Orange hvps:ifsorn.gm./ea fin s 10543607221,mcDwv?srnmr—derive Pr,e 2 af2 00 IRS Anparu 1 H of INo TeanumY ��'97�p1 JL�.1;f Irctemni RovanuG AntNIGe OGDEN UT $4201-0046 ONEOC 1901 E 4TH ST STE 100 SANTA ANA CA 92709 In reply refer toa 0423258262 Feb. 23, 2015 LTR 252C 0 95-2021700 000000 00 000063.58 BOOM TE 015240 Taxpayer Identification NUmberc 95-20Z1700 Dear Taxpayers Thank you for the inquiry dated Jan. 13, 2015. We have changed the name an your account as requested, The number shown above is valid for use on all tax documents. if you need farms, schedules, or publications, you may get them by visiting the IRS website at www.irs.gov or by calling toll-froa at I-800-TAX-FORM (1-800-829"3676). 1f you have any questions, please call us toll free at 1-817-829-5500. If you prefer, you may write to us at the address shown at the top of the first page of this letter. whenever you writes please include this letter ands in the spaces below, give us your telephone number with the hours we can reach you. Also, you may want to keep a copy of this letter for your records. Telephone Number t Cnclosure(s)z Copy of this letter Hours.._ Sincerely yours, uridn Brett S. Bomenderfer Dept. Managers Code & Edit/Entity 3 tfB71 IRS napartnwut ot'thc Traesmy �7)J 1 S 111ternal Rove041C Sol -vice OLDEN UT 84201-0038 VOLUNTEER CENTER OF GREATER ORANGE COUNTY 1901 E 4TN ST STE.100 ,;. SANTA ANA CA 92705-3918 005766 In reply refer to: 0437672883 Apr. 03, 2012 LTR 4168C 0 95-2021700 000000 00 00030008 BODCt TE Employer Identification Number: 95-2021700 Person to Contact: Mrs Sheffield Toll Free' Telephone 'Numb'er: 1-877-829-5500 Dear Taxpayert This is in response to your Mar, 22, 2012, request for information regarding your tax-exempt status. Out, records indicate that you were recognized as exemp4 under, section 501(c)(3) of the Internal Revenue Code in a determination letter, issued in January 1964. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in Section 509(a)(2). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies,, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irs.gov/eo for information regarding filing requirements. Specifically, section 6033(j) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the thi.rd.raturn fmr organiza.tions.,r.equi.red to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(9) of the Code on our website beginning in early 2011. Apr. 03, 2012 LTR 95-2021700 000000 VOLUNTEER CENTER OF GREATER ORANGE COUNTY 1901 E 4TH ST STE 100 SANTA ANA CA . 92705-3918 0457672885 4168C 0 00 00050009 If you have any questions, please call, us at the telephone number shown in the heading of this letter. Sincerely yours, Sharon Davies Accounts Management l u State of California Secretary of State CERTIFICATE OF STATUS ENTITY NAME: ONEOC FILE -NUMBER'" C0363736 _ FORMATION DATE: 11/19/1958 TYPE: DOMESTIC NONPROFIT CORPORATION JURISDICTION: CALIFORNIA STATUS: ACTIVE (GOOD STANDING) I, ALEX PADILLA, Secretary of State of the State of California, hereby certify: The records of this office indicate the entity is authorized to exercise a7.1 of its powers, rights and privileges in the State of California. No information is available from this office regarding the financial condition, business activities or practices of the entity. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of July 31, 2018, ALEX PAIDILLA Secretary of State NP-25 (REV 03/2018) MAIL APPENDIX ATTACHMENT 3-1: NON -COLLUSION AFFIDAVIT CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR REVIVE: SANTA ANA FOOD SUPPLY/DISTRIBUTION PROGRAMS RFP NO.: 22-009A NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA CITY MANAGER'S OFFICE In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares thatthe bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any BIDDER, orto fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Organization Signed and P Title Director of Finance & Accounting Services Date City of Santa Ana RFP 22-009A Page 42 EXHIBIT E APPENDIX ATTACHMENT 3-2: NON -LOBBYING CERTIFICATION CERTIFICATIONS CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR REVIVE: SANTA ANA FOOD SUPPLY/DISTRIBUTION PROGRAMS RFP NO.: 22-009A The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: 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 federal 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 federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, 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 any officer or employee of any federal 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, loan or cooperative agreement, the undersigned shall complete and submit a "Disclosure of Lobbying Activities". 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. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify and disclose accordingly. Organization OneOC Signed and Printed Name: Title Director of Finance & Accounting Services Date Randa Wren City of Santa Ana RFP 22-009A Page 43 DRUG -FREE WORKPLACE Certification Regardinq Druq-Free Workplace Requirements The certification set out below is a material representation upon which reliance is placed by the U.S. Department of Treasury 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 Treasury, 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 Treasury within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; (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). B. 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 Treasury immediately upon the decision to use such additional sites by submitting a revised "Place of Performance" form. Organization Authorized Signature Date PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS Date: 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): ONM�Y�'1 Digitally O 6g I e Si ned b TQRRE Ar gieDAKEgNa4DVYYV) CERTIFICATE OF LIABILITY INSURAN b te: 2l2512022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOCeV N THE Cr.RTIF2022.7MMIER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COV GE At FURQQ��QQ��S5 111iE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN 1I;if:G IN SURER�AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. UUttff 00ooff 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 endorsements) PRODUCER License 100757776 1 cpj)TACT Diana DeLaTorre HUB International Insurance Services Inc 4695 MacArthur Court Suite 600 Newport Beach, CA 92660 INSURED OneOC 1901 E. Fourth Street, Suite 100 Santa Ana, CA 92705 COVERAGES CFRTIFICATF NIIMRFR• ov,ncrnur uu Ifta—.. 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 T TYPE OF INSURANCE qNS SUBR POLICY NUMBER PO LDICCYEFF 111512022 POLICYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X X PHPK2369594 111512023 EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTurz0ence $ 100000 MEDEXP An one erson $ 5,000 — PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY❑ PEO E LOG GENERALAGGREGATE AM001000 GEN'L X PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 11000,000 X ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS Epp AUTOS ONLY X AUTOS ONFILV X X PHPK2369594 1/1512022 1115/2023 BODILY INJURY Perperson) BODILY INJURY Per accident FOPcclG n AMAGE A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB800132 111512022 1/75/2023 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000- WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PR�O���PRIETORIPARTNERIEXECUTIVE 1Mandats aBER EXCLUDED? NH) If yas, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- S E E E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L. DISEASE -POLICY LIMIT A Sexual Abuse PHPK2369594 1/15/2022 1115/2023 Each Abuse 1,000,000 A Prof. Liability PHPK2369594 1/15/2022 1115/2023 Aggregate Limit 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mores ace is required) RE: MPNA GREEN Programs Revive: Santa Ana Food Supply/Distribution Programs RFP: No.: 22-009rk City, Its officers, officials, employees, and volunteers are additional insured on a primary and non contributory basis as respects to General Liability as required by written contract. General Liablity Waiver of Subrogation also applies per same form as required by written contract. Automobile Liablity Additional Insured on a primary and non contributory basis as respects to General Liability as required by written contract applies as per form to follow from carrier. Automobile Liablity Waiver of Subrogation also applies per same form as required by written contract as per form to follow from carrier. SEE ATTACHED ACORD 101 City of Santa Ana 20 Civic Center Plaza PO Box 1988 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. AUTHORIZED ��,{{RR�,E..PP- REPRESENTATIVE 1.PM.�C=%LL4"d Im— ACORD 25 (2016/03) 01988.2015 ACORD The ACORD name and logo are registered marks of ACORD ,+ "a'ManagL-menl:Dtyulon REVIEWED/&APPROpVB7 BY: '1 i ( �- , Ai uittle, ' IMM,I Risk Management Specialist DTORRE ONE0000-01 CERTIFICATE OF LIABILITY INSURANCE DAT12512DIVYYY) 2lIMMiD 22 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 endorsements . PRODUCER License#0757776 HUB International Insurance Services Inc. 4695 MacArthur Court Suite 600 Newport Beach, CA 92660 CONTACT Diana DeLaTorre NA E PHONE (AIC, No, Ext: _ _ (AIC, No): ADOA E s: diana.delatorre@hubinternational.com INSURER AFFORDING COVERAGE NAIC M INSURER A:Philadelphia lndemnitylnsuranceCompany 18058 _ INSURED OneOC 1901 E. Fourth Street, Suite 100 Santa Ana, CA 92705 INSURER B : INSURER C INSURER D INSURER E : INSURER F : RF\ILCVIM NI IMRFR- COVERAGES �cnTHIS 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. ILSR TYPE OF INSURANCE ADDL D SUBR POLICY NUMBER POLICY EFF D VY 1/1512022 POLICY EXP DD 11111512023 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X PHPK2369594 EACH OCCURRENCE - $ 1,000,000 DAMAGE TOED Eaolccure $ 1001000 MED EXP (Any one persom $ 5,000 PERSONAL &ADV INJURY 1,000,000 GE N'L AGGREGATE LIM IT APPLIES PER: X POLICY❑jEO7 LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOP AGG $ 3,000,000 A OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accl $ 1,000,000 BODILY INJURY Per arson $ ANYAUTO X X PHPK2369594 1/15/2022 1/1512023 BODILY INJURY Per accident $ OWNED X SCHEDULED AUTOS ONLY AUTOppSWWNNEEpp X AUTOS ONLY X ARO$ONLV fe0r aicRdent AMAGE $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE - PHUB800132 1/1512022 111512023 EACH OCCURRENCE $ - 4,000,000 AGGREGATE 4,000,000 DED XI RETENTION$ 10,000 MPOY'IALIIT ANUELERSLBIY YIN ANY PROPRE1ABER EXCLUDED' CUTIVE ❑ (Mandatary in NH)EXCLUDED? NIA PER OTH- ER _�. E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L. DISEASE- POLICY LIMIT Each Abuse 1,000,000 A If yes, describe under DESCRIPTION OF OPERATIONS below Sexual Abuse PHPK2369594 1115/2022 111512023 A. Prof. Liability PHPK2369594 1/1512022 1/1512023 Aggregate Limit 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mores ace Is required) RE: MPNA GREEN Programs Revive: Santa Ana Food Supply/Distribution Programs RFP: No.: 22.009A City, Its officers, officials, employees, and volunteers are additional Insured on a primary and non contributory basis as respects to General Liability as required by written contract. General Liability Waiver of Subrogation also applies per same form as required by written contract. Automobile Liablity Additional Insured on a primary and non contributory basis as respects to General Liability as required by written contract applies as per form to follow from carrier. Automobile Liablity Waiver of Subrogation also applies per same form as required by written contract as per form to follow from carrier. SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza PO Box 1988 Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE �(�Y['A"• ���- 1 y � REVEEWER^^& gAaPnPRenO/rtrrVDDBY.' � Pf rlGdUrc�4 ACORD 25 (2016/03) ©1988-2015 ACORD I The ACORD name and logo are registered marks of ACORD Risk Management spedalist ® J! CERTIFICATE OF LIABILITY INSURANCE DATE(k1M/2022 Y) �-� ,' oz/zvzozz 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 CONTACT Christy Dunlap NAME: ISU- Dunlap Agency PHONE (714)838-3158 FAx (714)922-6157 C No Exl : AIC, No 700 West 1 at St., Suite 8 _ a DO REss: Christy@dunlapins.com INSURER(S) AFFORDING COVERAGE NAICA Tustin CA 92780 INSURERA: Service American Indemnity Co. INSURED INSURER 8: OneOC INSURER C 1901 E. 4th Street, #100 INSURER D INSURER E : Santa Ana CA 92705 INSURER F: COVERAGES CERTIFICATE NUMBER: CL22223U6421 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 INSURANCE A..L INSD o1JoK WVD POLICY NUMBER POLICY EFF MMIDDIYYYI' POLICY E P MMIDDIYYI'Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ E T PREMISES Ea occurrence $ CLAIMS -MADE OCCUR MED ESP(An one person) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- ❑OC JECT PRODUCTS-COMP/OP AGG $ $ OTHER: 1 AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ Ea accident ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEOULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE Peraccldenl $ AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE If EXCESS LIAR CLAIMS -MADE DEB I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N/A SATI50407201 03f01l2022 03I01/2023 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) lives, describe undo, E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Such insurance as Is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. Thirty (30) days notice of cancellation required. Waiver of Subrogation Included. 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 ©1988.2015 ACOF ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD saar+nw Riek.MenegemattDtvufml. 8' �?'r `&.1 REVIEWEDn&APPROOVED BY, 1 1 f f"!� flEXYra� Risk Management Specialist AGENCY CUSTOMER ID: ONE0000-01 LOG #: 1- DTORRE ACC?RV ® Ill ADDITIONAL REMARKS SCHEDULE AGENCY "��"�"• �' "' iUB International Insurance Services Inc. POLICY NUMBER SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: 10 day Notice of Cancellation will follow from carrier. Fourth Street, Suite 100 na. CA 92705 EFFECTIVE DATE: ACORD 101 (2008101) © 2008 ACORD CC The ACORD name and logo are registered marks of ACORD Page Of 1 any RiekMar>agmnel>tDMalnn REVIEWED&APPROVEDBY: �'fir �(4p I�uaw44 Risk Management Specialist Policy Number: PHPK2369594 Policy Effective Date: 01/15/22 - 01/15/23 PI-GLD-HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy, If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following Is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000limit 2 Non -Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments — Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments — Bail Bonds $5,000 5 Supplementary Payment — Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement —Janitorial Services Client Coverage $10,000 limit 6 Additional Insured —Newly Acquired Time Period Amended 6 Additional Insured — Medical Directors and Administrators Included 7 Additional Insured — Managers and Supervisors (with Fellow Employee Coverage) Included 7 Additionallnsured — Broadened Named Insured Included 7 Additional Insured — Funding Source Included 7 Additional Insured — Home Care Providers Included 7 Additional Insured — Managers, Landlords, or Lessors of Premises Included 7 Additional Insured —Lessor of Leased Equipment Included 7 Additional Insured — Grantor of Permits Included 8 Additionallnsured —Vendor Included 8 Additional Insured — Franchisor Included 9 Additional Insured — When Required by Contract Included 9 Additional Insured — Owners, Lessees, or Contractors Included 9 Additional Insured — State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company R1ek Manageme�ttDlvieion REVIEIt/ED&APPROVm BV: g��ra/' rt} �seua�u AN—M—P Risk Nlanageptent specialist PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury — includes Mental Anguish Included 11 Personal and Advertising Injury — includes Abuse of Process, Discrimination Included 11 A. Extended Property Damage SECTION 1— COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury" or property damage' expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non -Owned Watercraft SECTION 1— COVERAGES, COVERAGE A BODILY INJURY AND PROPER t 1 DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company Riekhtanagement hWun +, I'sr,°O REVIEWED&APPROVED BY: II A4fe &4v4o �-.� Rhk Man4mentspecialist PI-GLD-HS (10111) LIABILITY, Subsection 2. Exclusions, Paragraph j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire' is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective systems" where it appears in: a. The last paragraph of SECTION I —COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE. b. SECTION III —LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V — DEFINITIONS, Paragraph g.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract" 2. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) is deleted In its entirety and replaced by the following: That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company ylell, Ie REIAEWEDD&&APPovmB ,`' f)/leeus,te � Risk Management Specialist PI-GLD-HS (10/11) a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a "violation(s)" of the Health Insurance Portability and Accountability Act (HIPAA). We have the right and the duty to defend the insured against any "suit," "investigation," or "civil proceeding" seeking these damages. However, we will have no duty to defend the insured against any "suit" seeking damages, "investigation," or "civil proceeding" to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional, Willful, or Deliberate Violations Any willful, intentional, or deliberate "violation(s)" by any insured. b. Criminal Acts Any "violation" which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V — DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding" means an action by the Department of Health and Human Services (HHS) arising out of "violations." b. "Investigation" means an examination of an actual or alleged "violation(s)" by HHS. However, "investigation" does not include a Compliance Review. c. "Violation" means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p a�ec RlekMamgementDMsimt © 2011 Philadelphia Indemnity Insurance Company N "; x REVIEWED &APPRO/�VED RY: A4fg �—' Rl*maingementspeclaliet PI-GLD-HS (10111) G. Medical Payments — Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I — COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I — COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGE A AND B are amended as follows: 1. b, is deleted in its entirety and replaced by the following: 1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I - COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an "employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any "employee" who is alleged to be directly involved in a criminal proceeding is $25,000 regardless of the numbers of "employees," claims or "suits" brought or persons or organizations making claims or bringing "suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company Risk himugemer&DMs[Pn REVIEWED&APPROVM BY: Risk Management Spedah5t PI-GLD-HS (10111) K. Key and Lock Replacement — Janitorial Services Client Coverage SECTION 1— COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your "client," up to a $10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers', directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client' for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client' means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II — WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company �,, RiekManaymnrntDtvtalmt /.� REVIHWED&APPR=BY: Risk Management Specialist PI-GLD-HS (10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following Is also an insured: a. Medical Directors and Administrators — Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors — Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your "employees" are also insureds for "bodily injury" to a co - "employee" while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company. c. Broadened Named Insured —Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source — Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers — At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises — Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment — Automatic Status When Required in Lease Agreement With You — Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company ,+e PJAMmagemenEDMslon �: T REMEWEDqq&APPRO/�Vm BY: Rlsk Mana4ement Specialist PI-GLD-HS (10/11) organization is an insured only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. h. Grantors of Permits — Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. L Vendors — Only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company as+p y ':. RIek.Manegemwfl[X 1= REVIEWED (,&APPROVED BY.' A4fe AeV44 ® Risle Management Specialist PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor: or (h) 'Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Sub -paragraphs (d) or (f); or (i1) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor — Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract — Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors — Any person or organization, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of "your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company F 8+ I3 RlekMmWmentD[Welon REVIEWED 6 APPRWmBY: A4,P rrlw44 Rhk Management Spmalist PI-GLD-HS (10/11) m. State or Political Subdivisions —Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury," "property damage' or "personal and advertising injury" arising out of operations performed for the state or municipality; or (b) 'Bodily injury" or "property damage' included within the "products -completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the "occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or "suit' is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company Al " e, tnRisk ManagemmenLDtvbMim ,� RewED&Apmovm8r: A r�ca d# Risk Management Spedali5t PI-GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury — Mental Anguish SECTION V — DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. R. Personal and Advertising Injury — Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of "personal and advertising injury" is amended as follows: 1. SECTION V — DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V— DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company RlekM nagMMtDMsinn 5 "0 RwEWEo&APPROVED BY.' Risk Management Specialist PI-GILD-HS (10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its p © 2011 Philadelphia Indemnity Insurance Company m. RiekManagcmumtD[Walon. EllREVIEWED&APPRDV®BY. Af4A44,ais 26k Management Specialist Policy Number: PHPK2369594 Policy Effective Date: 01/15/22 - 01/15/23 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 21 50,411060111 50"Elk, [91=80101 oil s 0' This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 a^ RlskManegtnvtmEDtvisfun REVIEWED/n&APPRW/� y: f"I4 f t P1aN4 4 RI5k Management Specialist POLICY NUMBER: PHUB800132 PHILADELPHIA INSURANCE COMPANIES A Memher of the Toldo Marine Group PI-CXL-002 (06/19) One Bala Plaza, Suite 100 Bala Cynwyd, Pennsylvania 19004 610.617.7900 Fax 610.617.7940 PHLY.com COMMERCIAL UMBRELLA LIABILITY INSURANCE 0 4 EWA Q , ZT lei L1 3334 Hub International Insurance Services 4695 MacArthur Ct Ste 600 Philadelphia Indemnity Insurance Company Newport Beach, CA 92660 (714)569-2700 NAMED INSURED: oneoa MAILING ADDRESS: 1901 E 4th St Ste 100 Santa Ana, CA 92705-3918 POLICY PERIOD: FROM 21/15/2022 TO 01/15/2023 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIM EACH OCCURRENCE LIMIT (LIABILITY COVERAGE) $ 4,000,000 PERSONAL& ADVERTISING INJURY LIMIT $ 4,000,000 PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT GENERAL AGGREGATE LIMIT (LIABILITY COVERAGE) (except with respect to Auto Liability and Products Completed Operations) RETAINED LIMIT RETAINED LIMIT: $ 10,000 $ 4,000,000 $ 4,000,000 PI-CXL-002 (05/19) Page 1 of 5 Includes copyrighted material of Insurance Services Office, Inc., with pei a., RiekManagnnaetDlvislnn ,+ REMEWED&APPROVEDBr. S A4fg AwA4 Risk Management Specialist POLICY NUMBER: PHUBB00132 PREMIUM SUBTOTAL STATE TAXES, FEES, SURCHARGES (if applicable) ® NOT FORM OF BUSINESS: NON PROFIT ORGANIZATION BUSINESS DESCRIPTION: Non -Profit Umbrella PI-CXL-002 (05119) Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., with per PI-CXL-002 (05/19) Not 00 4,157.00 RlnkMWgM'dDMsIm REVIEWED &APPROVM BY: L■1 '� �I�4�ICWe�4 Risk Management Speoa65t is PI-CXL-002 (05/19) POLICY NUMBER: PHUBB00132 SCHEDULE OF UNDERLYING INSURANCE Employers' Liability Com pany: Policy Number: Policy Period: Minimum Applicable Limits Bodily injury by accident $ Each Accident Bodily injury by disease $ Each Employee Bodily injury by disease $ Policy Limit Commercial General Liability IN Occurrence ❑ Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2369594 Policy Period: 01/15/2022 01/15/2023 Retroactive Date: Not Applicable Minimum Applicable Limits: General Aggregate $ 3,000,000 Products -Completed Operations Aggregate $ 3,000,000 Personal And Advertising Injury $ 1,000,000 Each Occurrence $ 1,000,000 Commercial Auto Liability Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2369594 Policy Period: 01/15/2022 01/15/2023 Minimum Applicable Limits Garage Aggregate Limit For Other Than Autos (if applicable) $ Not Applicable Each Accident $ 1,000,000 Professional Liability ® Occurrence ❑ Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: PHPK2369594 Policy Period: 01/15/2022 01/15/2023 Retroactive Date: Not Applicable Minimum Applicable Limits Each Professional Incident $ 1,000,000 Acrcrecate $ 3.000,000 PI-CXL-002 (05/19) Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc., with per man. RlaleManagnnattDiWe[o: f��IiEWED,„y&APPROhhVm aY: F fl A i�f Risk Management Specialist PI-CXL-002 (05/19) POLICY NUMBER: PHUBB00132 Employee Benefits Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits Abusive Conduct Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits Directors & Officers Liability ❑ Occurrence ® Claims -Made Company: Philadelphia Indemnity Insurance Company Policy Number: tbd Policy Period: 01/15/2022 01/15/2023 Retroactive Date: 01/15/2019 Minimum Applicable Limits Each Claim $ 1,000,000 Aggregate $ 11000,000 Liquor Liability ❑ Occurrence ❑ Claims -Made Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits PI-CXL-002 (05/19) Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with per y�=n. P1AMarievementD1v1e1on REMEWED&APPROVED BY.' 8 1� A r"1aNG4 ` Rulc Management Speci Mist 01 POLICY NUMBER: Pxoe800132 Watercraft Liability Company: Policy Number: Policy Period: Retroactive Date: Minimum Applicable Limits PI-CXL-002 (05/19) ❑ Occurrence ❑ Claims -Made Other Coverages Not Included in Above ❑ Occurrence ® Claims -Made EPLI - Non -Profit Company: Philadelphia Indemnity Insurance Company Policy Number: tbd Policy Period: 01/15/2022 01/15/2023 Retroactive Date: 01/15/2019 Minimum Applicable Limits Each Claim $ 1,000,000 Aggregate $ 1,000,000 THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY. Countersigned: BY (Date) (Authorized Representative) IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. jo - '<'�-Q , John W. Glomb, Jr. Secretary President & CEO PI-CXL-002 (05/19) Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc., with per PJAManagenmtorwston RenerrEo/=1010v�av: 8 Rlsk Management Spedzlist Burke, Lauren From: CTrax <certificate-request@ctraxjdidata.com> Sent: Monday, September 26, 2022 3:26 PM To: diana.delatorre@hubinternational.com, Burke, Lauren Subject: Internal Notice of Compliance NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor OneOC Name: Project A-2022-033-04 Number: Project Agreement Between The City Of Santa Ana And OneOC For Use Of Name: American Rescue Plan Act (ARPA) Funds The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE AUTOMOBILE LIABILITY GENERAL LIABILITY SEXUAL ABUSE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with POLICY NUMBER EXPIRATION DATE COI DATE FILE NAME RFP 22-009A Food Supply Distribution PHPK2369594 01/15/2023 02/25/2022 Programs -OneOC (CAO signed )(179572.3).pdf OneOC CO[ Exp 01- PHPK2369594 01/15/2023 09/22/2022 15-2023 RMD03072022.pdf PHPK2369594 01/15/2023 02/25/2022 22-23 ONEOC - City of Santa Ana.pdf Workers SATIS0407201 03/01/2023 02/24/2022 Compensation COI Exp 03-01-2023.pdf 1