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HomeMy WebLinkAboutFAMILIES FORWARD (11)INSURANCE ON FILE WORK MAY UNTIL NSURANCEEEXPIRES A-2022-053 I • � • 7� CLERK OF COUNCIL DATE: AUG 18 2022 SECOND AMENDMENT TO AGREEMENT BETWEEN THE CITY OF SANTA ANA AND FAMILIES FORWARD FOR USE OF EMERGENCY SOLUTIONS GRANT CORONAVIRUS (ESG-CV) FUNDS THIS SECOND AMENDMENT TO THE EMERGENCY SOLUTIONS GRANT CORONAVIRUS AGREEMENT is entered into this 5n' day of April, 2022, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"), and Families Forward, a California nonprofit organization ("Subrecipient"). RECITALS A. On July 24, 2021, the City entered into an Emergency Solutions Grant Coronavirus ("ESG-CV") Agreement #A-2020-251-06 with Subrecipient to be used in the operation of an emergency solutions program for the homeless or at -risk of homelessness of the City of Santa Ana ("said Agreement"). B. On September 1, 2021, the Parties entered into a First Amendment to the Agreement (#A-2020-251-06A) to amend the Scope of Work for additional services and increase funds related to the expanded services. C. In accordance with the terms and conditions of said Agreement, the parties desire to further amend the Agreement to update the Scope of Work for additional services, increase the funding to the Subrecipient, and extend the term of the Agreement for one (1) additional month. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, as amended, except as herein modified, the parties agree as follows: 1. Recital I shall be amended to increase funding to Subrecipient by $80,000.00 in ESG-CV Funds for the Santa Ana Motel Voucher Program. The new total sum shall not exceed $178,500.00 in grant funding. 2. Section I, subsection A, shall be amended to add the specific tasks required of the new funds, as detailed in the Amended Scope of Work attached hereto as Exhibit A to this Second Amendment and incorporated herein by reference. 3. Section I, subsection B, shall be amended to add the levels of performance required of the new funds, as detailed in the Amended Scope of Work attached hereto as Exhibit A to this Second Amendment. 4. Section III and Section III, subsection A, shall be amended to increase funding to Subrecipient by $80,000.00, for a total sum not to exceed $178,500.00. Subrecipient's Amended Budget taking into consideration these new funds is attached hereto as Exhibit B to this Second Amendment, and incorporated herein by reference. A-2022-053 5. Section II, TERM OF AGREEMENT, shall be amended to extend the term until June 30, 2022. 6. Except as hereinabove modified by this Second Amendment, the terms and conditions of said Agreement, as amended, remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to said Agreement the date and year first above written. ATTEST: =�ZLO7) DAISY GOMEZ A -(.,,Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney By: RYJ04 Q. HODGE Assistant City Attorney RECOMMENDED FOR APPROVAL: --2:5�A STEVEN MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA KRISINE RIDGE City Manager SUBRECIPIENT: Michelle Silva Chief Advancement Officer Tax ID#:33-0086043 DUNS#: 610093825 EXHIBIT A AMENDED SCOPE OF WORK City of Santa Ana Scope of Work Name of Organization Families Forward Name of Funded Program Santa Ana Motel Voucher Program Annual Accomplishment Goal I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the funded pro ram, named above, during the 12-month contract period. 73 Persons II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month contract period. I 731 Persons Program and Funding Description Ill. Description of Work - In the space below, describe the program to be funded during the 12-month contract period. What specific activities will be undertaken during the contract period. Please be concise in your response. Only the viewable space will print. Families Forward will provide Motel Vouchers to 18-21 homeless families - approximately 73 individuals (with this amendment, an additional 2 homeless families - approximately 7 individuals) - with ESG-CV funds during the time between the closure of the Link Shelter and the opening of the new Carnegie Shelter. CDBG-CV funds will be used to provide those families with Case Management Services since they will not have access to these types of services due to the closure of the shelter. Supportive services like case management will be offered as long as families are staying at the motel. Keeping in mind the current funding amount, we anticipate each family will be able to stay in a motel up to 2 months. The provision of services will be dependent upon the availability of grant funding. Schedule of Performance Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12-month contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served in quarter 1 do not count them again in quarter 2 Quarter 1: July 1 - September 30 32 Persons Quarter 2: October 1 - December 31 16 Persons Quarter 3: January 1 - March 31 1 18 Persons Quarter 4: April 1 -June 30 171 Persons 73 Total unduplicated Santa Ana Residents to be served. Schedule of Invoicing Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis. Quarter 1: July 1 - September 30 $26,532.20 Quarter 2: October 1 - December 31 $16,745.76 Quarter 3: January 1 - March 31 $89,665.56 Quarter 4: April 1 -June 30 $45.556.48 $ 178,500.00 ]Total Grant Exhibit A Page 1 of 1 EXHIBIT B AMENDED BUDGET Organization Name ESG Final Budget Families Program Name Santa Ana Motel Voucher Program Expenditures Category lzparis Funded by Santa Ana Expenses Funded by Other Sources Total Program Budget Total Organizational Budget Essential Services Shelter Operations Other Motel Vouchers $ 178,500 $ - $ 178,500 Indirect Cost $ Total $ 178,500 $ - $ 178,500 $ LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED (Total Funds for Program must equal Total Program Budget above) ouurce Santa Ana I Total Funds for the Proarann I $ 178.500 1 Page 1 of 1 City of Santa Ana Suope of Wadi Name of Organization -- - _ Fainfife's Forward,` < Name of Funded Program Banta Aria Mrltal Vaachar _ rogram. Annual Accomplishment Goal I. Total number of undupllcated clients (Santa Ana end Non -Santa Ana Residents) anticipated to be served by the funded to am, named above, during the 12-month contract period, 7 Persons II, Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month oontraot Period, 17 Persons Program and Funding Description Ill. Description of Work . b7 the apace below, describe the program to be funded during the 12-month contract period. What speolflo activlU®s will be undertaken during the contrsot period. Please be aerates In your response. Only the vlambie space will prblt famlAas Forward will provide MotelVouchersto 4.5 homeless families -approximately 17Individuals -with kSt3-CV funds during the time between the closure of the Link Shelter and the opening of the new Carnegie Shelter, CDBG-LV funds will be used to provide those famflles with Case lvlanagement Servtoes since they will not have access to these typos of services due to the closure of the shelter, Supportive services like case managementwili be offered as long as families are staying at the Motel. Keeping In mind the current funding amount, we anticipate each family will be able to stay In a motel up to 2 months. The provision of services wttl be dependent upon the ovallabllRy of grant funding. r50hoQule or Forronnance Estimate the number of unduplicated Santa Ana residents to be served by the funded program during the 12-month contract period per quarter. (Enter number of new Santa Ana ollents served each quarter, if they were served In quarter 1 do not count them again in quarter 2 Quarter 1: July 1 •September 3t7 .,; :.,;,. ;y Persons Quarter 2: October 1- December 31 :10 persons Quarter 3: January 1 • March 31 Persons Quarter 4: April l -dune 30 i `.,;k . 'O Persons „„„„ 17 Total unduplicated SantaAna Residents to be served, Schedule of Invoicing Estimate the amount of grant funds to be requested dtlrin tt o 12-month contract period on a quarterly basis, Quarter 1: July 1 - September 30 2ift. U;q4 Quarter 2: October 1 - December $1 2'kfQu.t}p`•:::; Quarter 3: January 1- March 31 Quarter 4: April 1-June 303,Q:p i6 25 t1Qll.0E) Total Grant Exhibit A page 1 of 1 SG Final budget OrganlzatIon Name Families 1o1M d Program Name Santa Ana Motel Veuoher Prn ram LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECUR50 (Total Funds for PfOgtam meet aqual Total Program Budget above) Page 1 of 1 Certification Ragarding Nbument, Suspension, Inelis€billty gad voluntary Exclusion Lower Tier Covered Transactions This certification is required by dw regulations implementing Executive Order 12549, Debarmeut and Suspension, 29 CFR Fart 98, Seetlon 98.510, pardeiparrli rosponsibillties, The rvSulations were published as part VTT Of May 26, 088 Fedmil Rcaister (pages 19160-19211), (BEFORE COMPLETING CERTIF1C9,171ON, READ 1NSTRUMONS FOR C7JICIVIGATION Attached) (i) The prospective roolplent of federal assistance funds certiries,'by submission of this proposal, that neither it nor its principals are presently debarred, mospendod, proposed for debarnaen4 declared Ineligible, or voluntarily excluded ii'om parRotpation in this txmisaction by any federal depmtrgent or agency. (2) Where the prospective recipient of federai assistance (curds its uaablo to custify to any of the statements in this certl6cation, such pxoapeative participant shall attach an explanation to this proposal, A EXHIBIT C Page 1 of 2 INS1'ttUC," �UntSrS]l '+fftlrfc'A,MO_N I.. By signing raid submitting this proposal, the prospective recipient of federal assistance Rands is providing the certification as set out below. 2. The oertti3cation hi this clause is a material 10Prosentation of fact upon which, reliance was placed when this transaction was entered into, If it is later determined that the prospective reotpient of federal assistance hauls knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Dek7art=rrt of Labor (DOL) may pursuo available remedies, inclttdingsispensionand/or debarment, 3, The prospective recipient of fhderal assistance funds shall provide immediate written notice to the person . to which this proposal. Is submitted if at arry time the prospective recipient of. federal assistince Rinds learns that Its certification was erroneous when submitted or has become erroneous by reason of changed oirounrstanGas. 4. The terms "covered trausnotion,n "dubworl," "suspended,' "ineligible," "lower tier covered transaction," "partiolpant," "parson,' "pilmary covered transaction," "principal," "proposal," and "voluntarily oxcluded," as used III this clause, have the meanings set out in the Definitions grid Covea'age sections of rules lrnplaricatlng Executive Order 12549. You may contact the person to which this proposal Is submitted for assistance In obtaining a copy of those regulations, 5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should tine proposed covered transaction be entered into, it shall not knowingly enter Into any lower tier, covered transaction with a person who is debarred, suspended, declared inellgib1% or voluntarily excluded from participation in this covered transaction, unless authorized by the DOL. b. The prospective recipient of federal assistance Rinds further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and voluntary exclusion - Lower Tier Coverei. Transactions," without modifioation, in all. lower tier covered transactions and in all solfc[tatlons for lower tier covered transactions, 7. A participant in a covered transaction may rely upon a eertificatiou of a prospective participant in a lower tier covered transaction that it Is not debarred, suspended, ineligible, or voluntarily excluded from the covered transactlon, untoss it knows that the certification is erroneous. A participant may decide the ineihod and frequency by which it detr.�mmas the eligibility of its principals. Rach participant may, but is not required to check tiro List Iuti w Fx_aludcxi firm i'rc>crucinent ar Now proerrt,�� R, Nothing contained in the foregoing shall be construed to require establishment of It system of records in. order to render in good faith the cortli'leation required by this clause, The knowledge and Information of a participant is not 1'ecltuired to oxceed that which !s normally possessed by a prudent person hi the ordinary course of business dealings, 9, Except for transactions authod-zed under paragraph 5 of these instructions, if It participant In a covered transaction knowingly entets into a lower tier covered transaction with a person who is suspended, debarred, ineliglhlq or vohntarily exoludcd fi•orn participation In this transaction, in addition to other remedies available to the Federal. Government, the DOL may pursue availalrlG remedies, including susponMon and/or debarment, EXHIBIT C Pane 2 cI 2 Certification Regarding Lobbying The undersigned certifies, to the best of his or her knowledge and belief, that; (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or atteropting to influence an officer or employee Of ally agency, a Member of Congress, an officer or employee of Congress, or an employe© of a Member of Congress in connection withtltc awarding of any Federal contract, the malcing of my cooperative agreement, and the extension continuation, renewal, amendment, or rnodifieation of any Federal contact, grant, loan or cooperative agreements (2) if any fonds other than Federal appropriated ands have been paid or will be paid to any person for influencing or attempting to influence so officer or employee of arty agency, a Member of Congress, an officer or employee of Congress, or all employee of a Member of Congress [a oonneotion with this Federal contract, grant, loan, or cooperative agreotttent, the undersigned shall Whoploto and submit Standard Fonn-LLL, "Disclosure Form to Report Lobbykig;," in accordance with its instructions, (3) The undersigned shall require that the language of this certification be Inoluded in the award documents for all aubawardg at all tiers (Including anbContrat t, subgrants, and contracts under grant$, loalrs, and 000perativo agreements) anti that ail subrecipients shall eertity and disclose accordingly. This Certification is a material representation of fact upon which reliance was placed. when this transaCtlan was ltttttle tar entered into, Submission of tills ocrtifioatlon is a pracquisite tar making or entering into this transaction. imposed by Soctlou 1352, Title 31, Lf, S, Code, Any parson who falls to Cale the required certification shall be subieot to a civil penalty of not less than $10,000 and not more than $1.00,000 rot each snob failure, Organivation Program Title its Nance of Certifying Officer 53gnstare Date EXHIBIT D Page 1 of 2 SUBRECIPTENT warrants the following; 1, SU13RECIPIENT will oenrply wish Public law 88.352, Title Vl of the Civil Rights Aot of 1964 (42 V. S. t . seotion 2000 et NO and Implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, valor; religion, national origin, or sex, be excluded.from.parNalpution in, ar be denied tine benefits of, or be subjected to disoriminationuRder nny progra'n or activity funded in wholo or In part with community development #finds made, available pursuant to to ACT, 1 All laborers and meahanies, employed by contractors or subcontractors In the performance of conatruotion work financed in whole or in part with community douelopmont funds shall be paid wages at rates not less than tl'oso prevailing an similar conatruetlon. In tine locality as determined In a000rdance with the Dowis-Bacon Aet, as amended, 40 U. S. C. wtloag 276 a 14, exoept for individuals who perform servicas for whioh they volunteered, (to 'lot receive compensation for such aeMces; or arepaid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUDIMCIPIENT will comply wvitli all Federal statutes applicable to projects funded With eammunity cicvalopn'mnt funds, oxoept that SUSRECIPTENT does not assume C1TY'S envhronmental responsibilities described tit 24 CFR 570,604; and (b) SUBRBCIPM''NT class not assuma CITY'S responsibility for initiating the review process under Executive Order 12372, P.,3Cf•11131T D Page 2 of 2 OC M M IS .Participating Agency Agreement Purpose The HMIS (Homeless Management Information System) Is a HUD-mandatad Informatlan technology system that is designed to capture client laVel Information over time, on the characteristics and service needs of horn Blass persons, Client data is maintained on a central server, which will contain all client information In an encrypted state, HM IS Integrates data from all homeless service providers and organizations In the community and captures basic descriptive Information on every person served, Participation In the OC HMIS allows organizations to she re Information with other participating organizations to create a more coordinated and effective service delivery system, The OC HMIS is the secured electronic database for Orange County and Is a valuable resource far local communities. Agreement and Understanding This Agreement akith orixes this participating Agenoy(Agency) to designate HMIS Users (User). A User Is a staff person entrusted to enter protected personal Information (PPI) into the OC HMIS, on behatfof this Agency, in order to allow a User to access the OC HMIS, a User Agreement must be stoned by the User and stored electronically in the HMIS, Confidentiality and informed Consent Confidentiality: This Agency must require all Users to abide by Its organization's policies and procedures; uphold all privacy protection standards established by the OC HMIS Policies and Procedures; and comply with all relevant federal and State of California confidentiality laws and regulations that protect client records, Except where otherwise provided for by taw, this Agency shall ensure that confidential client records are released with the client`s written consent. Written Consent; To obtain written consent, prior to each client's assessment, each client must be Informed that the client's Informatlan wilt be entered Into an electronic database called HMIS. The terms of the Consent In to share Protected Personal Information form must also be explained to each ellanL Clients who agree to have their PPl entered Into the QC HMIS must sign the Consent to Share Protected Personal Information form, Verbal Consent: Verbal consent to enter PPl into the OC HMiS may be obtained during circumstances such as phone screenings, street outreach, or community access centerstgn-Ins, Each client must be informed that their Information will be entered Into the HMIS database. The terms of the Consent to Share Protected Personal Information forth must also be explained to each client. The client's written consent must be obtained once the client appears for their Initial assessment. updated 8124110 Client's Rights The client has a right to receive a copy of this Agency Agreement at the time of request, Each client has the right to receive thefutlowing, no laterthan five IS) business days of a Written request: + A cormot€an of tneccurate or incaffl piete pPl A copy of their consent form A copy of their HMIS records a A current list of participating agencies that have access to HMIS data Data Use This Agency must protect HMIS data by ensuring that: + A link to the Privacy Notice Is accessed from the Organization's web site, OC HMIS is not accessible to unauthorized users • OC HMIS Is only accessed bycomputers approved by the organization • HMIS Users are trained regarding user responsibilities and conduct e HMIS Users sign and comply with the OC HM1S User Agreement + HMIS Users forward a copy ore cilanes Revocation of Consent to the HMIS System Administrator, 2.1. 1 Orange County (2110C), within 24 hours of receipt Responsibilities This Agency Is responsible to ensure that: The -Notice Regarding Collection of Personal Information is posted at each intake desk Or comparable location s HMiS users do not misuse the system e Clients are notified if a breach of their PPi is discovered * Any HMIS User who finds a possible security lapse On the system is obligated to immediately report it to 211OC A signed cagy of the Consent. to Share Protected Personal information is retained for a period of seven (7) years after the PPI was created or last changed, Rights and Privileges OC HMIS data Is stored in one central database and Is managed by 2110C, While each agency owns their own data within the database, the Orange County Continuum of Care (CoQ may release aggregate data about its own continuum at the program, sub regional, and regional level. Aggregate data may be released without orlianlsatlon permission at the discretion of the Continuum. Use Of the OC HMIS Is a privilege and is assigned and managed by 2110C, Updated 9124118 Copyright The QC HMIS and other CoC-provided software are protected by copyright and are not to be copied, except as permitted bylaw or by contract with the owner of the copyright, The number and dlstributlon of copies of any CoC provided software are at the sole discretlon of 2110C. Violations Any violations or suspected violations of any of the tarms and tonditlons of this agreement, the HMIS User Agreement, and/or the HMIs Polleles and Procedures, must be tmmediately.and confidentlaily reported to 2110C and the Executive Director or other authorized representative of this Agency. Term This participating Agency Agreement becomes effective on the date of final execution and shall remain in effect unlesstermfnated pursuant to paragraph Xi,'rerminatlon, below. Amendment and Termination • The QC CoC reserves the right to amend this agreement by providing a 3-day notice to this Agency. • dither party has the right to terminate this agreement, with or without cause, by providing a 3-day written notice to the other party, • If this agreement Is terminated, this Agency shall no longer have access to HMIs or any Information thefelm The CoC shell retain the right to use all client date previously entered by this Agency, subject to any restrictions requested by the client, All agencles that sign this agreement and are granted access to the QC HMIS agree to abide by QC HMIS, Policies and Procedures. The signature of the Executive Director or other authorized representative of this Agency indicates acceptance of all terms and conditions set forth in this agreement. This Agreement la executed between the CoC and the Participating organisation, Upon final execution, this Agency will be given access to the QC HMIS, Agency Name DO NOT WRITE IN THIS SECTION —21JOC USE QNLy HMIS System AdminOtratorMama (Print) &aautfva Dlrector/Authorized Representative Name (Print) — « %C. AA . S t.,,._� 6� Executive 01raetor/Authorized Representative Signature (wut signature only) Delta Updated 8224118 HMiS System Admrnlstrator Signature (Wet signature only) Date, Orange County C©C Inter -Agency Data Sharing • Memorandum of Agreement The _ s _(i_ tti t^tr t i 7 agency agrees to share client data among participating agencies via the OC HMIS ((I range County Homeless Managemant Information system} for the. purposes outlined below, Each participating agency must complete and comply with the Agency Agreement, Each Individual HMIS user must complete and.comply with the HMIS User Agreement, This document is available on the QCHMIS webslte, Uses of HMIS Data: * CoordIne to housing services for famitles and individuals experlencIng homelessness or facing a housing crisis In Orange County * Understand the extent and the nature of homelessness in orange County • Evaluate performance and progress toward community benchmarks * Improve the programs and services available to Orange County residents experiencing homelessness or a housing crisis * Improve access to services for all Orange County homeless and at-rlsl<populatlons * Reduce inefficiencies and duplication of services within our community * Ensure that services are targeted to those most in need, Including "hard to serve" populations * Ensure that clients receive the amount and type of services that "best fits" their needs and preferences * Pursue additional resources for ending homelessness * Advocate for policies and legislation that will support efforts to end homelessness in Orange County Client Protection: * Informed consent must be given by clients In order for their identifying Information to be shared among agencies In the OC I•IMIS (see Orange County HMIS participating agencies on 9 IS,o ). if the client does not give consent, their Identifying Information can still be entered Into HMIS, but the record should only be visible to the agency entering the data. * All agencies participating In HMIS must sign this agreernent The client has the right to see a current list of the OC HMIS partlelpating agencies. As part of the Informed consent process, clients must be Informed that additional agencies mayjoin the OC HMIS at any time and will have access to their Information. + HMIS Users will maintain IiMIS data In such a way as to pruteGt against revealing the Identity of clients to unauthorized agencies, individuals, or entities, Last Updated: 8/28/2018 + Clients may not be denied services based on their choice to withhold their consent, Each partyto this memorandum of agreement shall defend, indemnify, and hold all other parties harmless from any and all claims arising out of that party's negligent performance of this agreement. Any loss or [lability to third parties resulting from negligent acts, errors, or omissions of an OC t"IMJS user while acting within the scope of their authority underthis Agreement shall be borne by that user exclusively, Agreed to And sigried by the foilowtng agency representative (Executive Director or equivalent only): Printed Name :....___......._.._.._M 1CAO'P—. t E7 i \ \ 1 /n Agency Name; �,YYi`1.�%0—c, (.)(?,l 7 Last Updated:8/2812018 Francine R, Villareal hl°a I`la"aanrFmna"nn CAMFOR na Dafca0x 1.a1.nikeeS oTep' HC'CJO�R 7" -- CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDUh-M) s/30/2021 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 BELOW. THIS CERTIFICATE BY THE POLICIES OF INSURANCEDOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED If SUBROGATION IS WAIVED, sub)act to the terms and conditions of this certificate does not confer righta to the provisions or bo endorsed. the Policy, Certain policies may require an endorsement. A statement certificate holdor in Ile u of such PRODUCER License IF OM1 U410 endorsements . on ArmstronglRobitallle/Rlegle Business and Insurance Solutions % TACT P�y{p.•II E IMIV, rak, S.M 949 381-7700 AAic, No: 949 487-8151 830 Roosevelt, Suite 200 Irvine, CA 92620 .arrinfo@alera rOU .Dom INSURER 8 FP08IDINO 9PYBRAGS NAIC INsu ERA •Phil dI hla IndemnityIns Co 18058 ' INSURED INS AERB;COm West Insure --- man 12177 Families Forward IN uaea B Thomas INSURER Irvine, CA 92618 INSURER E: INSURER F: C E GES CERTIFICATE U BE - LISTED BELOW HAVE R ISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. CERTIFICATE NO ANY MAY BE ISSUED OR MAY REQUIREMENT, PERTAIN, TERM OR CONDITION OF BEEN ISSUEDTO ANY CONTRACTOR THE INSURED OTHER NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH. RESPECTTO WHICH EXCLUSIONS AND CONDRIONS OFSUCH POLICIES. THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE THE POLICIES DESCRIBED THIS HEREIN$ SUBJECT TO ALL THE TERMS, TYPE OF INSURANCE ADDLSUSR SEEN POLICY NUMBER REDUCED BY POLICYEFF PAID CLAIMS. POLdCY EXP A X COMMERCIAL GENERAL LIASILRY 0 LIMITS 71 CLAIMS•MAOE X OCCUR X PHPK2293752 711/2021 711/2022 EACH OCCURRENCE $ 1,000,000 PR GET NTED I $ 10Q000 MEDEXBP one e n 20,000 PERSONAL & ADVINJURY t 1,000,000 GUNLAGOREGATELIMRAPPLIES PER: POLICY P LOC GE NE OREGA 3,000,DOO CD /0 AGO 3,000AN PRX UC'I'S- A AUTOMOBILE LIABILITY 3EXUALABUSE 1,000,000 X ANYAUTC PHPK2293752 711/2021 7/1/2022 EMS EDSINGLELIMIT 1,000,000 AAryL�pTOS ONLY REIRESL EDn SODgyINJURY Pef son X AUT�3 ONLY X A06 INIUR�GE nddenl ADOPEJY ONLY A UMBRELLA LIAR 'X OCCUR X EXCESS LIAR CLAIMS•MAOE PHUB774554 7/112021 7/1/2022 ENCE 4,000,000 OED X RETENTION$ 10,000 4,000,000 g waaRKERS COMPS,ySA7IIppN Af10 RMPLOYERS'CLAST LITY YIN ANYPR�O�PgIgTOR/PARTNERtXEcuTIVE WCV550516100 1/1/2021 71t12022DE ETH- 1,POD,000 WEPLOYE foryE9E%CLUDED4NIAfyySAE UESCRIPTIOND 0 ERATIO SbelowA PLOYS 1,000,00D Professional (E&O) PHPK2293752 7l1l202171112 222 PoLl YUMIT 1,000,00C 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlllenei Remark, Schedule, may be alkched If mono e0aoe le r,gUlfed) The City of Santa Ana, Its officers, employees, Booms, and representatives AYe named as Additional Insured on Primary and Non•Coniribory heals with respect to General Liability coverage per attached forms as required In a written contract, agreement, or memorandum of understanding, 30 Days Cancellation Notico unless 10 Days for Non -Payment. CERTIFICATF_ NDI_nFR City of Santa Ann 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, N0710E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE a ACORD 25 (2018/03) - 05.,. 01988.2015 ACORD C , The ACORD name and logo are registered marks of ACORD "NSI R! MaRa9r mAITRiyaf Policy Number: PHPK2293752 PI-GLD-HS (10111) 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 spoolflc coverage for the Indicated loss exposure is provided under this policy. If Such specific coverage applies, the terms, condl0ons and limits of that coverage are the sole and exctusive 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 oontractwording. Coverage Applicable Limit of Insurance page # Extended Properly Damage Included $50,000 Iimlt Less than 58 fast 2 2 2 Limited Kemal lease Agreement Contractual Liability Non -Owned Watercraft Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premisas Rented to You $1,000,000 3 HIPAA wMedical Clarification 4 Payments $20 000 5 Medical Payments— Extended Reporting Period 3 years 5 Athletic Actvitles Amended 5 Supplementary Payments --Ball Bonds $5 000 5 Supplementary Payment - Loss of Earnings $1,000 per day 5 Employee Indemnfficatki Defense Coverage $25,000 5 Key and Lock Replacement - Janitor!; Servlces Cllent Coverage $10,000 limit 8 Addltlonallnsured-Newly Acquire-nmmePeriod Amended - 8 Additional Insured -Medical E i Aore and Administrators Included Addltlonal Insured - Managers and Supervisors (with 1 ellow Included 7 Em to ee Covera e 7 Addltlonallnsured - Broadened Named Insured Included 7 Additional Insured - FundingSourco 'Insured- Included 7 Addltlonal Home Care Providers Included 7 Additional Insured - Managers, Landlords, or Lessors of Premises Included 7 Addltlonal Insured - Lessor of Leased Equipment Included 7 Additionallnsured-GrantorofPermits Included 8 Addltlonallnsured -Vendor Included 8 Addltionalinsured- Franchisor Included g Additional insured - When Required by Contract Included g Addltlonal insured - Owners, Lessees, or Contractors ' Included g Addltlonallnsured - State or PoliticalSuhdlvisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc„ with its pa aft �o b 2011 Philadelphia Indemnity Insurance Company Famm o&APPsovtnay; i Ruk K)rWgcment Anxly*xt PI-GID-HS (10/11) Duties In the Event of Occurrence, Clalm or Suite unintentional allure to Disclose Hazards 0 0 Transferor Rights of Recovery Agalnst Others To Us !C=1ar1flcatlon110Liberalization 11Bodily Injury— includes MentalAngulsh 1Personal and Advertising Injury• -Includes Abuse of Process, Discrimination ' t A. Extended Property Damage SECTION I — 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 I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY 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 68 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 pe p Ruk © 2011 Philadelphia Indemnity Insurance Company hEOMsn�&APPRtwEDr3r Risk htanagemetR.MalySt PI-GLD-HS (10/11) 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 9.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 indemnlfles 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 rot an "Insured contract"; 2. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (11) 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 Promises 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 pe RtekMana�enuntr vision © 2011 Philadelphia Indemnity Insurance Company NenevsD&APParnarar. FV44W R, V:tG,unt 91 RIrk.ManagnnentAmi 61t PI-GID-HS (10/11) a. $1,000,000; or h. 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 fallure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its pe w��tnwn © 2011 Philadelphia Indemnity Insurance Company itEnwsD&MPRavao Bvr dk AM%W P MMMt RdzRManagemenT Analyst PI-GLD-HS (10/11) G. Medical Payments — Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: I. 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 1— 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 AAND B are amended as follows: I. b. is deleted In its entirety and replaced by the following; 1. b. Up to $5000 for cost of ball 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; I. 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 $26,000 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 pe tuaia tuMebn © 2011 Philadelphia Indemnity Insurance Company RE ADM � RavrQsy; F u6ae R, tl&"d Rik MOrny�eplentAnr�lYst V..S PI-GLi (10/11) K. Key and Lock Replacement— Janitorial Services Client Coverage SECTION I — COVERAGES, SUPPLEMENTARY. PAYMENTS — COVERAGES A AND B Is amended to include the following: We will pay for the cast 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 fallowing, 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 (a) 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 pe ©2011 Philadelphia Indemnity Insurance Company RensW�o& soar ✓)'i F"kv Rislc Mana9NrylCflrAn.ltµ4[ PI-GID-HS (1o/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 oo- "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 Promises — 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 pe r� tuyjtPpRov lefp, © 2011 Philadelphia Indemnity Insurance Company Bwlsmm&JNPeova�Br. P, ul�nnea� . RWc Mdne�gemenl analyst - PI-GLD-WS (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. 1. 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; (a) 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 8of12 Includes copyrighted material of Insurance Services office, Inc., with its pe Rtel+MnnagemenEWolan OO 2011 Philadelphia Indemnity Insurance Company R4MMEe&APPiR,OVE) at: 2t�ic M,enagnment rinafyrsi PI-GLD-HS (10111) (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: (i) The exceptions contained in Sub -paragraphs (d) or (f); or (11) 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 additlonal 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 1. 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 pe Wekbla ,+enrt)Ate�on G02011 Philadelphia Indemnity Insurance Company ttensv D&aapRavegeY: nl�k ManagemencMaryst i.o":, + 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. I 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 pe 02011 Philadelphia Indemnity Insurance Company on n 1RRItMRY�fIReRr y[Y�6(bly R6'RryWAD &APPR.tl,}'V�aJ t t F0416W k. V4K/krifAC Risk ManRRement AnAlyst 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. O: BodilyInjury— MentalAnguish 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 pe w"kMe g, "ntAiwaw © 2011 Philadelphia Indemnity Insurance Company RenoaNmeovastitt Is ttRk MtmagermntHnatyst 21 itC:. PI-GLD-HS It0/11) 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 vfolation 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 pe . tMr '� aaVMains © 2011 Philadelphia Indemnity Insurance Company P fl1MWso&APPR0VWB1: t•aw ae U: t (�.ik kianpgement An�lyal Policy Number: PHPK2293752 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifles 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 contributlon 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 010413 @ Insurance Services Office, Inc., 2012 RIekMx+�mtuRtUivlel¢n KMMV- t&APPRMFDax a F46� IUzk hlinRgemcnS Mrlyxl Policy Number: PHPK2293752 PICA-00410/14 THIS ENDORSEMENT G, I-IANGES THE PQLIGY PLEASE READ IT GAREFULLY. PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following is added to SECTION IV -BUSINESS AUTO CONDITIONS, B. General Conditions, S. Other Insurance: The insurance provided by this policy for any additional insured endorsement attached to this policy is primary when prlmary coverage is required In a written contract. In addition, we will not seek contribution from any insurer when insurance on a non-contributing basis is required in a written contract for any additional insured endorsement attached to this policy. For coverage to apply, the written contract must have been executed prior to the occurrence of "loss." This endorsement supersedes anything to the contrary, Page 1 of 1 ©2014 Philadelphia Consolidated Holding Corp. Rd&kManagnnrartAlxleWn t REmEwa)&APPRov`m�e�y/, 1 F� 1z, k'Mf:4FKAf�4 RIsk.Mampincnt.Arj*$t k .r.i�:ft 1f '•:iF;: tf,�.,a :..,';�I.:r6:;(`fi'.