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Home My WebLink AboutORANGE COUNTY UNITED WAY (5)MAYOR Vicente Sarmtento MAYOR PRO TEM Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza David Penaloza Thai Viet Phan CPA- co ) (''IWCS) IFA >UiANCE N07 ON FILE 'ORK MAY NOT PROCEED CLERK OF COUNCIL DATE: APR 0 7 1011 Orange County United Way Attn: Emilee Tello, CPO 18012 Mitchell South Irvine, CA 92614 CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 WwW.santa•ana.orc March 3, 2022 Re: Extension of Agreement #A-2021-107-03 Dear Ms. Tello: A-2021-107-03A CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section I.B. ("Term of Agreement") of Agreement No. A-2021-107-03 ("Agreement'), entered into by Orange County United Way and the City of Santa Ana dated August I, 2021, the parties hereby agree to extend the Term of the Agreement fora six (6) month period through c" , ^_"�^22 4,YG 3it2ozZ The insurance certificates are required to be extended and/or renewed to cover this extension. All other l terms and conditions of said Agreement remain unchanged and in frill force and effect. %, Sincerely, �I Steven Mendoza Executive Director, Community Development Agency CITY OF SANTA ANA: ristine Ridge City Manager APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Ryalyl 0. IHodge Assistant City Attorney ORANGE COUNTY ij IT) Y I,dilee Tello CFO ATTEST: I A. Daisy Gomez Clerk of the Council SANTA ANA CITY COUNCIL V.0alo Somali. NOB... Thal Viet Phan David Pmmm loza JOse Lopez JohIm111an Ryan Hernandez Nano. Mendoso Mayor Mayor Pro Tem. Word 4 Word Word Ward Word Wardo v1vmicn.4bvr.aann pm pb,comaeRannlmnna om InhonlMoanMamoora dpennloza0sanlmana urn aszelon.z(Asnn inns or lrvanhemnndn,0g nlaana ern �mendOiiMaan n�ana orn A-2021-107-03A Tori Pierson Dlgltallysigned by'ronPamon Dat¢ 202IJ1.09 ni25:42 ,0V a�oizo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/3/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (OC) Heffernan Insurance Brokers 18004 Sky Park Circle, Suite 210 CONTACT NAME, 949-771-3400 FAixc Ha ; 949-771-3401 Irvine CA 92614 EMAIL ADDR SS: INSURERB AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnl Insurance -----ny 18058 Lice se#: 05642 9 INSURED ORANCOU-05 Orange County's United Way INSURER B: INSURERC: 18012 Mitchell South Irvine CA 92614-6008 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATF NIIMRFR-1A1DD11999 oclnc,nsr uuue.-... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR _ TYPE OF INSURANCE ADDL BUSH POLICYNUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A TCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y PHPK2320247 11/1/2021 11/1/2022 EACH OCCURRENCE $1,000,000 D A ETORE D PREMISES Ea occurrence $1,000,000 MED EXP Any one person) $20,D00 PERSONAL&ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JPECT LOC GENERALAGGREGATE $3,000,000 PRODUCTS-COMP/OP AGG $3,000.000 $ OTHER I A AUTOMOBILEUMILITY PHPK2320247 11/1/2021 11/1/2022 COMBINED SINGLELIMIT Ea acddent $1,000.000 AUTO BODILY INJURY (Par person) $ IDAMAANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY GE PBOPEERTYcoldY $ A X UMBRELLALIAB X OCCUR PHUB783584 11/1/2021 11/1/2022 EACH OCCURRENCE $5,000. DOD AGGREGATE $ 5,000,D00 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER/E(ECUTIVE OFFICERIMEMBEREXCLUDED9 N/A IPER I OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ (Mandatory In HE) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiUonal Remarks Schedule, may be attached if more space is required) Re: Agreement #A-2021-107-03, CARES for Tenants Program (ERAP Funds). City of Santa Ana, officers, agents, employees, representative and volunteers are included as an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement on the General Liability policy is attached, If required. This Certificate replaces and supersedes all previously issued certificates. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 'EPESSRisk McnagamedDNdm - 'u =%o1i Yre1,'u rn 10RR-9nlS arnGn rr Ruk MavgenmrGviW Nde ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD L, —�