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HomeMy WebLinkAboutINTERVAL HOUSE (20)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 0117-5- CITY CLERK A-2024-188 DATE: DEC 0 2 2024 FIRST AMENDMENT TO EMERGENCY SOLUTIONS GRANT SUBRECIPIENT b mwc) AGREEMENT WITH INTERVAL HOUSE fidru�nvw 1imu�(K�'� THIS FIRST AMENDMENT to the above -referenced agreement is entered into November 19, 2024, by and between Interval House, a California nonprofit corporation ("SUBRECIPIENT"), and 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"). SUBRECIPIENT and the City shall be collectively referred to as the 'Parties." RECITALS A. The Parties entered into Agreement No. A-2024-090-02 ("Agreement") dated July 1, 2024, whereby SUBRECIPENT agreed provide emergency shelter and supportive services to survivors of domestic violence from the City of Santa Ana, via the Emergency Solutions Grant ("ESG") funds the CITY received through the United States Department of Housing and Urban Development ("Program"). B. The Parties now wish to amend the Agreement to increase the aggregate compensation paid by the CITY to SUBRECIPIENT, by $35,124, as a result of reallocation of a portion of unspent funds from the ESG Program at the close of Fiscal Year 2023-2024, Federal Award Identification Number (FAIN) E-23-MC-06-0508. The Parties therefore agree: 1. The Agreement shall be amended to include revised attached "Exhibit A-1" (Scope of Work) to replace Exhibit A, and include revised attached "Exhibit B-1" (Budget) to replace Exhibit B. 2. Paragraph 5 of the RECITALS, is hereby amended to read in its entirety as follows: The SUBRECIPIENT has agreed to be reimbursed for the above services in an amount not to exceed $111,321 in grant funding for Shelter, Outreach Services, Rapid Re -Housing or Homeless Prevention. 3. Section III, DISBURSEMENT OF FUNDS, the first two paragraphs only, is hereby amended to read in its entirety as follows: The CITY was allocated $422,578 in Emergency Solutions Grant Funds under the McKinney- Vento Homeless Assistance Act for fiscal year 2024-2025 from the Department of Housing and Urban Development. At the close of Fiscal Year 2023-2024, the CITY had unspent funds from the ESG Program totaling $87,810 and it desires to reallocate for distribution for Fiscal Year 2024-2025. The CITY agrees to pay SUBRECIPIENT when, if and to the extent federal funds are received under provisions of the Act a sum not to exceed $111,321 for SUBRECIPIENT's performance in accordance with the Budget attached hereto as "Exhibit B-1" during the period of this Agreement. The breakdown of said sum is $35,124 from Fiscal Year 2023-2024 funds under FAIN E-23-MC-06-0508, and $76,197 from Fiscal Year 2024- 2025 funds under FAIN E-24-MC-06-0508. Said sum shall be paid after CITY receives invoices submitted by SUBRECIPIENT as provided herein above. Page 1 of 2 A. Amount and Expenditure End Date The CITY agrees to reimburse the SUBRECIPIENT a maximum amount not to exceed $111,321 from Emergency Solutions Grant (ESG) funds, as outlined in Exhibit B-1, Final Budget, and such funds shall be expended by the SUBRECPIENT on or before June 30, 2025. SUBRECIPIENT has the ability to adjust line item amounts in the Budget with the written approval of the CITY'S Executive Director of the Community Development Agency, so long as the total Budget amount does not increase. 4. Except as modified by this First Amendment, all terms and conditions of the Agreement, shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST APPROVED AS TO FORM ---SONIA R. CARVALHO City Attorney l By: q& '("' 4 , Andrea Garcia -Miller Assistant City Attorney FOR APPROVAL Michael L. Garcia Executive Director Community Development Agency CITY OFSANTA ANA Ava­olo,_-'�T Alvaro Nunez City Manager INTERVAL HOUSE Wm�;1M�- WN-311"TERM011%,/ Executive Director Page 2 of 2 City of Santa Ana Scope of Work Name of Organization Interval House Name of Funded Program Domestic Violence Shelter Services Annual Accomplishment Goal I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the funded program, named above, during the 12-month contract period. 250 Persons II. Number of unduplicated Santa Ana residents expected to be served by the funded program during the 12-month contract period. 106 Persons Program and Funding Description III. 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 Interval House will continue to provide life-saving shelter and comprehensive supportive services to a minimum of 110 individuals (homeless victims of domestic violence and their children) from the City of Santa Ana. Services will include: EMERGENCY SHELTER: Interval House shelter programs offer a safe, caring, and homelike environment for adults, adolescents, and children in life -threatening situations who are left homeless as a result of domestic violence ADDITONAL SPECIALIZED SUPPORT SERVICES: Comprehensive counseling; legal; health and wellness; financial management; employment counseling; permanent housing; and other services as needed, provided by skilled counselors in over 70 languages. 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 ETotal Persons Quarter 2: October 1 - December 31 Persons Quarter 3: January 1 - March 31 Persons Quarter 4: April 1 -June 30 Persons 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 $ 27,830.25 Quarter 2: October 1 - December 31 $ 27,830.25 Quarter 3: January 1 - March 31 $ 27,830.25 Quarter 4: April 1 -June 30 $ 27,830.25 $ 111,321.00 Total Grant Exh ibit A -1 Page 1 of 1 Organization Name ESG Final Budget Interval House Program Name Domestic Violence Shelter Services Expenditures Category Expenses Funded by Santa Ana Expenses Funded by Other Sources Total Program Budget Total Organizational V—ssentlal Services DV Advocate $ 66,201 $ 55,455 $ 121,656 $ $ $ Shelter Operations Shelter Repair & Maint $ 35,000 $ 35,000 $ $ $ $ Other Indirect Cost $ 10,120 $ 5,545 $ 15,665 Total $ 111,321 $ 61,000 $ 172,321 $ Balance LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED (Total Funds for Program must equal Total Program Budget above) Source Amount Santa Ana $ 111,321 City of Anaheim $ 25,000 City of Garden Grove $ 21,000 City of Fountain Valley $ 15,000 Total Funds for the Program $ 172,321 Exhibit B-1 Page 1 of 1 A� o® CERTIFICATE OF LIABILITY INSURANCE DATE/3MIDDIY ) 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 CON AC NAME: Jennifer Fleming Arthur Gallagher Risk Management Services, LLC PHONE B 500 N Brand Boulevard, Suite 100 61644E 0251 aC No: E-MAIL ADDRESS: 'ennifer ftemin a" .com Glendale CA 91203 INS ERS AFFORDING VERIIGE N IC# M n 6 I .:R DSBI ie V INSURED U Sl' ER Q Ce n a 10 0 an I 152 Interval House INSURER L G�e - 727 P.O. Box 3356 INSURER:: Seal Beach, CA 90740 NSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 666515058 REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLILYEFF MMIDO POLICYEXP MMyDDITYYYI LIMITS A X COMMERCIAL GENERALLIABILITY Y HHN 8525626-18 10/1/2024 10/1/2025 EAEA CE $1,000,000 CLAIMS -MADE M OCCUR DAED PRRENTED nce 8500,000 MEarson) $20,000 PEINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GEGATE $3,000,000 %t POLICY PRLOC PRODUCTS -COMPIOP AGG $3,000,000 $ OTHER: A ADTOMOBILELIABILITY HHN 8525626-18 10/1/2024 10/1/2025 COMBINED SINGLE LIMIT Es accident $1,000,000 BODILY INJURY (Par person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS ) BODILY INJURY (Per accident $ X HIRED X NON,OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Ps,.cc ni $ $ A UMBRELLA LIAB X OCCUR HHS 8525626-18 10/1/2024 10/1/2025 EACH OCCURRENCE $2,000,000 AGGREGATE $2.000,000 X EXCESS LIAB CLAIMS -MADE DED X RETENTION$n $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN V SAT1SO405003 2/1/2024 2/1/2025 X STATUTE EORH E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNEWEXECUTIVE OFPICER/MEMBEREXCLUDEDP NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be. E.L DISEASE - POLICY LIMIT $1,000,000 C Cfber liability C aims -Made fans Retm Date: Full Prior Acts RPS-P-50252618M tOH/2024 10/1/2025 Limit Aggregate Retention $1,000,000 $1.000.000 $2.500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftachad if more space is required) Policy: Crime Coverage Policy Term: 10/1/2024 To 10/1/2025 Policy #: 107707393 Carrier: Travelers Casualty and Surety Company of America Employee theft: Limit:$2,000,000 / Deductible: $15,000 ERISA: Limit:$2,000,000 Forgery & Alteration: Limit $2,000,000 / Deductible: $15,000 Theft Money and Securities : Limit:$2,000,000 / Deductible: $15,000 See Attached... City of Santa Ana Attn: Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 AUTHORIZED RE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC Risk MnugemattDiwion REIAEWED6 APPROVED BAY: ,1" ® Ruk Management Speantht ©1988-201 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTEHOU-03 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, LLC NAMED INSURED Interval House P.O. Box 3356 Seal Beach, CA 90740 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ;omputer Fraud: Limit:$2,000,000 / Deductible: $15,000 -und transfer fraud: Limit:$2,000,000 / Deductible: $15,000 64oney Orders and counterfeit paper currency: Limit::$2,000,000 / Deductible: $16,000 or Molestation Liability 8525626-18 Insurance Company t 10/1/2025 ggregate: $3,000,000 Commercial Property HHS 8525626-18 Berkley Regional Insurance Company rerm:10/1/2024 To 10/1/2025 I Building : Limit: $7,896,476 / Deductible $1,000 i Business Personal Property: Limit: $1,097,835/ Deductible $1,000 Directors & Officers Liability Carrier: Philadelphia Indemnity Insurance Company Policy Term: 10/1/2024 To 10/1/2025 Per Claim: $1,000,000 / Aggregate: $1,000,000 / Retention: $5,000 ^: Contract #A-2024-090-02 City of Santa Ana, its officers, agents, employees and volunteers are named additional insured with respect to the General Liability dicy of the named insured. The insurance provided in the General Liability and Network Security and Privacy Liability policy is primary and any other insurance all be excess only, and not contributing. Waiver of Subrogation for Workers Compensation policy applies in favor of Additional insured. Such insurance is imary and Non -Contributory. Written notice shall be provided at least ten (10) days in advance of cancellation for non-payment of premium and thirty (30) days advance for any other cancellation or policy change. ACORD 101 (2008101) iskm aDivigon R & v' `!1ni111d'�' �. - A�:rA Ruk Management Specialist The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per- form work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be See Below % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization City of Santa Ana Attn: Risk Managment Division Job Description 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 D00: Re Specific Waiver is $200 Flat Charge This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date: 0 2 / 0 1 / 2 0 2 4 Policy No. SATISO405003 Endorsement No. Policy Effective Date: 02/01/2024 to 02/01/2025 Premium $ Insured: Interval House DBA: Carrier Name / Code: Service American Indemnity Company Countersigned by WC 04 03 06 (Ed. 4-84) 3`4 P.1@IIMmIp�MQIt}�l%91W1 \- i&vI & APPRt BY: M Management Spedalist Page 1 of 1 POLICY NUMBER: HHS 8525626-18 COMMERCIAL GENERAL LIABILITY Berkley Regional Insurance Company CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Santa Ana, its officers, agents, employees and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or 'personal and advertising injury" caused, in whole or in part, by: 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(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 2. 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. RAManagemerdDi ,im REVIEWED&ApnR maY. ®' Risk Management Specialist of CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 Risk MoNgeneraDM81M xy \� REVIEWED(&APPR6J &r ®' RBk Management SpentAnt 01 CG 20 10 04 13 COMMERCIAL GENERAL LIABILITY CG 83 91 05 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ CAREFULLY. GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Throughout this endorsement, the words "you' and "your' refer to the Named Insured shown in the Declarations. The word "we," "us," and "our' refer to the company providing this insurance. The following is only a summary of the additional coverages provided by this endorsement and is provided only for your reference and convenience. For the Limits of Insurance and the additional coverages provided by this endorsement, read the provisions on the following pages and the Coverage Form, which this endorsement modifies. SUBJECTS OF INSURANCE Broadened Bodily Injury Broadened Personal and Advertising Injury Broadened Property Damage Broadened Fire, Lightning, Explosion, and Sprinkler Leakage - $500,000 Broadened Medical Payments - $10,000 Broadened Supplementary Benefits a. Bail Bonds - $1,000 b. Expenses Incurred to Assist in Defense - $500 per Day Broadened Newly Acquired or Formed Organization Broadened Non -Owned or Chartered Watercraft or Aircraft Broadened Commercial General Liability Conditions a. Duties in the Event of Occurrence, Offense, Claim, or Suit b. Liberalization — Automatic Coverage If We Adopt Broader Coverages c. Notice to Company Automatic Coverage for "Special Events" Automatic Additional Insureds a. Athletic Activity Participants b. Contractual Obligations c. Funding Sources d. Manager or Lessor of Premises e. Owner, Manager, Operator, or Lessor of "Special Event" Premises f. Supervisors or Higher in Rank — Co -Employee Exclusion Removed g. Limitations Blanket Waiver of Subrogation Priority of Application for Multiple Insureds The coverages listed in this endorsement are provided as extensions or additions to your insurance program. CG 83 91 05 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. �M¢>vgzmateotx�an A-�, A,,v44 MWX RlkManagementspeoAiist or A. BROADENED BODILY INJURY Paragraph 3. of Section V — Definitions is deleted and replaced with the following: 3. "Bodily injury' means physical injury, sickness, or disease sustained by a person, including death resulting from any of these. "Bodily injury' also means mental injury, mental anguish, humiliation, or shock sustained by a person, if directly resulting from physical injury, sickness, or disease sustained by that person. B. BROADENED PERSONAL AND ADVERTISING INJURY 1. Paragraph 14. of Section V — Definitions is deleted and replaced with the following: 14. "Personal and Advertising Injury" means injury, including consequential "bodily injury' arising out of one or more of the following offenses during the policy period. a. False arrest, detention, or imprisonment; b. Malicious prosecution or abuse of process; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling, or premises that a person occupies by or on behalf of its owner, landlord, or lessor; d. Oral, written, televised, videotaped, or electronic publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; e. Oral, written, televised, videotaped or electronic publication of material that violates a person's right of privacy; or f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title, or slogan. h. Mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.9.above. 2. Exclusions 2.b. and 2.c. under Coverage B Personal and Advertising Injury Liability are deleted and replaced with the following: b. Material Published with Knowledge of Falsity "Personal and advertising injury" arising out of oral, written, televised, videotaped, or electronic publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. Material Published Prior to Policy Period "Personal and advertising injury" arising out of oral, written, televised, videotaped, or electronic publication of material whose first publication took place before the beginning of the policy period; C. BROADENED PROPERTY DAMAGE Exclusion 2.a. under Coverage A Bodily Injury and Property Damage Liability is deleted and replaced with 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. D. BROADENED FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE 1. Paragraph 6. under Section III — Limits Of Insurance is deleted and replaced with the following: 6. Subject to 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: a. Any one premises while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner; and b. Personal property of others in your care, custody, or control, while at premises rented to you or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner, arising out of any one fire, lightning, explosion or sprinkler leakage occurrence. Page 2 of 8 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. ^24$ge NMi ow9emadDhUlan aewEweosnaanw®er. Risk Management SpedAut 01 The Damage to Premises Rented to You Limit is the greater of: c. $500,000; or d. The amount shown in the Declarations for Damage to Premises Rented to You Limit. 2. Paragraph 2. Exclusions of Coverage A Bodily Injury and Property Damage Liability is amended as follows: Paragraphs c. through n., do not apply to damage by fire, lightning, explosion, or sprinkler leakage 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. 3. Paragraph 4. Other Insurance of Section IV — Commercial General Liability Conditions is amended as follows: Paragraph b. (1) (a) (ii) is deleted and replaced with the following: (11) That is Fire, Lightning, Explosion, or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; or 4. Paragraph 9.a. under Section V — Definitions is deleted and replaced with the following: a. 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 or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'; 5. This Broadened Coverage is subject to all the terms of Section III — Limits Of Insurance. 6. This Broadened Coverage does not apply if Fire Damage Liability of COVERAGE A (SECTION 1) is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. E. BROADENED MEDICAL PAYMENTS 1. The following provision is added to Paragraph 7. of Section III — Limits Of Insurance: The Medical Expense Limit shall be the greater of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit. 2. This Medical Expense Limit is subject to all the terms of Section III — Limits Of Insurance. 3. This above Medical Expense Limit does not apply if Coverage C Medical Payments is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. F. BROADENED SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. under Supplementary Payments — Coverages A and B are deleted and replaced with the following: b. Up to $1,000 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 bonds. 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 $500 a day because of time off from work. G. BROADENED NEWLY ACQUIRED OR FORMED ORGANIZATION Paragraph 3.a under Section II — Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is afforded only until the 1201h day after you acquire or form the organization or the end of the policy period, whichever is earlier. H. BROADENED NON -OWNED OR CHARTERED WATERCRAFT OR AIRCRAFT Exclusion 2.g. under Coverage A Bodily Injury and Property Damage Liability is deleted and replaced by the following: g. "Bodily injury' or "property damage" arising out of the ownership, maintenance, use, or entrustment to others of any aircraft," auto," or watercraft owned by or operated by, or rented or loaned to, any insured. Use includes operation and "loading or unloading". This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to premises you own or rent, provided the "auto" is not ow h„ ^e a f-d ^e i--A to you or the ins CG 83 9105 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. ugen®M Rentwm aw ® Risk Managemen[Spetlalist (4) Liability assumed under any "insured contract" for the ownership, maintenance, or use of aircraft, watercraft, or "autos"; or (5) "Bodily injury' or "property damage" arising out of the operation of any of the equipment listed in Paragraph f. (2) or f. (3) of Section V — Definitions, Paragraph 12., "Mobile Equipment"; or (6) An aircraft you do not own that is: (a) Hired, chartered, or loaned with a crew; and (b) Not owned in whole or in part by any insured. (7) This insurance does not apply, under Paragraph g.(1) and g.(2) above, if the insured has any other insurance for "bodily injury" or "property damage" which would also apply to loss covered under this provision, whether the other insurance is primary, excess, contingent, or on any other basis. (8) This insurance is excess, under Paragraph g. (6) above, over any other insurance, whether the other insurance is primary, excess, contingent or on any other basis. I. BROADENED COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Paragraph 2. Duties in The Event Of Occurrence, Offense, Claims Or Suit under Section IV —Commercial General Liability Conditions is amended to add the following provision: e. Your obligation to notify us as soon as practicable of an "occurrence," or offense under Paragraph 2.a. above, or a claim or "suit" or offense under Paragraphs 2.a., 2.b., and 2.c above, is satisfied if you send us written notice as soon as practicable after any of your "executive officers," directors, partners, insurance managers, or legal representatives becomes aware of, or should have become aware of, such "occurrence," offense, claim or "suit" 2. The following provisions are added to Section IV — Commercial General Liability Conditions: 10. Liberalization If we adopt any revision that would broaden the coverage under this coverage part without additional premium within 30 days prior to or during the policy period, the broadened coverage will immediately apply to this coverage part. 11. Notice To Company If you report an "occurrence" or offense to your Workers' Compensation insurer which later becomes a claim under this Coverage Part, failure to report such "occurrence" or offense to us at the time of the "occurrence" or offense will not be considered a violation of the Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition, if you notify us as soon as practicable when you become aware that the "occurrence" or offense has become a liability claim. J. AUTOMATIC COVERAGE FOR SPECIAL EVENTS 1. You are automatically covered for all "special events" which you organize, promote, administer, sponsor, or conduct during the term of this policy. 2. Section V — Definitions is amended to add the following paragraph: 23. "Special Event" means any event: a. The purpose of which is to raise funds for you; or b. To recognize the accomplishments of your organization, your "employees," or your volunteer workers; or c. Which you, or an individual or organization with whom you have entered into a contract or agreement, organize, promote, administer, sponsor, or conduct for the purposes described in Paragraphs a. or b. above; and d. Which takes place on premises owned by you, or on premises while rented or leased to you or to that organization described in Paragraph c. above. K. AUTOMATIC ADDITIONAL INSURED(S) The following provisions are added to Section II — Who Is An Insured: 4. Automatic Additional Insured(s) a. Additional Insureds —Athletic Activity Participants (1) This policy is amended to include as an insured any person(s) [hereinafter called Additional Insured(s)] representing you while participating in amateur athletic activities that you sponsor. However, no such person is an insured for: (a) "Medical expenses" under COVerana r Marlir•.al Pnvmantc (b) "Bodily I Page 4 of 8 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. a Risk MwvgawdDivi®nn REVIEWED&AppR ay: enq� ® Risk Managementspeaalist (i) A co -participant, your volunteer worker or your "employee" while participating in amateur athletic activities that you sponsor; or (it) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company); or (c) "Property damage" to property owned by, occupied or used by, rented to , in the care, custody, or control of, or over which physical control is being exercised for any purpose by: (1) A co -participant, your volunteer worker, or your "employee"; or (ii) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Additional Insured —Contractual Obligations (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) that you are required by a written "insured contract"; to include as an insured, subject to all of the following provisions: CG 83 91 05 15 (a) Coverage is limited to liability arising out of: (i) Your ongoing operations performed for such Additional Insured; or (it) Such Additional Insured's financial control of you; or (III) The maintenance, operation or use by you of equipment leased to you by such Additional Insured; or (iv) A permit issued to you by a state or political subdivision. (b) Coverage does not apply to any "occurrence" or offense: (1) Which took place before the execution of, or subsequent to the completion or expiration of, the written "insured contract"; or (ii) Which takes place after you cease to be a tenant in that premises. (c) With respect to architects, engineers, or surveyors, coverage does not apply to "Bodily Injury," "Property Damage," "Personal Injury," or"Advertising Injury" arising out of the rendering or the failure to render any professional services by or for you including: (i) The preparing, approving, or failing to approve or prepare maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (it) Supervisory, inspection, or engineering services. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) In the event that you are engaged in the manufacture or assembly of any goods or products for the benefit or at the direction of another party, pursuant to a contract or agreement with that party, this paragraph (e). does not extend coverage to that party as an Additional Insured. Coverage for such a party will be extended only by a specific endorsement issued by us and naming such party. c. Additional Insured —Funding Sources (1) This policy is amended to include as an insured any Funding Source (hereinafter called Additional Insured) which requires you in a written contract to name such Additional Insured but only with respect to liability arising out of your premises or "your work" for such Additional Insured, and only to the extent set forth as folio a RWeM.""; 5MdM REVIEVVEn&APRRQ Eh- 9 s ' A-f, "44 Risk Management Speakist Includes copyrighted material of Insurance Services 01 Office, Inc. used with its permission. (a) The Limits of Insurance applicable (2) With respect to the insurance afforded to the Additional Insured are the the Additional Insured identified in lesser of those specified in the Paragraph d. (1) immediately above, written contract or agreement or in the following additional provisions the Declarations for this policy and apply: subject to all the terms, conditions (a) This insurance applies only to and exclusions for this policy. The liability arising out of the Limits of Insurance applicable to ownership, maintenance, or use of the Additional Insured are that portion of the premises inclusive of, and not in addition to, leased to you; the Limits of Insurance shown in the Declarations. (b) The Limits of Insurance applicable to the Additional Insured are the (b) The coverage provided to the lesser of those specified in the Additional Insured is not greater written contract or agreement or in than that customarily provided by the Declarations for this policy and the policy forms specified in and subject to all this policy's terms, required by the contract. conditions, and exclusions. The (c) In no event shall the coverages or Limits of Insurance applicable to Limits of Insurance in this the Additional Insured are Coverage Form be increased by inclusive of, not in addition to, the such contract. Limits of Insurance shown in the (d) Coverage provided herein shall be Declarations. considered excess over any other (c) In no event shall the coverages or valid and collectible insurance Limits of Insurance in this available to the Additional Insured Coverage Part be increased by whether that other insurance is such contract or agreement. primary, excess, contingent, or on (d) Coverage provided herein shall be any other basis unless a written considered excess over any other contractual arrangement valid and collectible insurance specifically requires this insurance available to the Additional Insured to be primary. whether that other insurance is d. Additional Insured — Manager or Lessor primary, excess, contingent, or on of Premises any other basis unless a written (1) This policy is amended to include as contractual arrangement an insured any person or organization specifically requires this insurance (hereinafter called Additional Insured) to be primary. from whom you lease or rent your (3) This insurance does not apply to: premises and which requires you to (a) Any "occurrence" or offense which add such person or organization as an takes place after you cease to be Additional Insured in this policy under: a tenant in the premises covered (a) A written contract; or by this endorsement; or (b) An oral agreement or contract (b) Structural alterations, new where a Certificate of Insurance construction, or demolition has been issued showing that operations performed by or on person or organization as an behalf of the Additional Insured. Additional Insured; e. Additional Insured — Owner, Manager, but only if the written or oral Operator or Lessor of "Special Events" agreement is an "insured Premises contract"; (1) This policy is amended to include as (1) Currently in effect or to an insured any person or organization become effective during the (hereinafter called Additional Insured) term of this policy; and from whom you lease, rent or occupy (ii) Executed prior to the "bodily the premises upon which a "special injury," 'property damage," event" is held, sponsored or "personal injury", or conducted b- --.'advertising injury." under: 4j Risk M W90Kcaor8[n �� I�VIEWED 6a APPROV®6Y: I .ate ®' RBk Management Speciaut Page 6 of 8 Includes copyrighted material of Insurance Services 01 Office, Inc. used with its permission. (a) A written contract; or (b) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an Additional Insured; but only if the written or oral agreement is an "insured contract," (1) Currently in effector to become effective during the term of this policy; and (ii) Executed prior to the "bodily injury," "property damage," "personal injury," or "advertising injury." (2) With respect to the insurance afforded the Additional Insured identified in Paragraph e. (1) of this endorsement, the following additional provisions apply: (a) This insurance applies only to liability arising out of the use of that portion of the premises while leased or rented to you for the specific "special event"; (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the contract or agreement pertaining to the use of the premises or in the Declarations for this policy and subject to all of this policy's terms, conditions, and exclusions. The Limits of Insurance applicable to the Additional Insured are inclusive of, not in addition to, the Limits of Insurance shown in the Declarations. (c) In no event shall the coverage or Limits of Insurance in this Coverage Form be increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (3) This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant, licensee or occupant in the premises covered by this endorsement; or (b) Any acts or "occurrences" caused by or attributable to the owner, manager, operator, or lessor of the premises upon which the "special event" is held. f. Additional Insured — Supervisors or Higher in Rank (1) This policy is amended to include as insured any "employees" (hereinafter called Additional Insured), designated as supervisor or higher in rank, who are authorized by you to exercise direct or indirect supervision and control over "employees" and the manner in which work is performed, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" designated as supervisor or higher in rank, is an insured for: (a) "Bodily injury" or "personal injury': (1) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if you are a limited liability company); (ii) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph (a)(i) above; or (Ili) Arising out of his or her providing or failing to provide professional health care services. (b) "Personal Injury": (i) To a co -"employee" while in the course of his or her employment, or (ii) To the spouse, child, parent, brother or sister of that co- .. am of P wta>gM CG 83 91 05 15 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. (ill) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (b) (i) or (b) (ii) above. (c) "Property damage" to property: (i) Owned, occupied or used by; or (ii) Rented to, in the care, custody, or control of, or over which physical control is being exercised for any purpose by you, any of your "employees," any partner, or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). g. Additional Insured — LIMITATIONS (1) The persons, entities, or organizations to which coverage is extended under Paragraphs a. (Athletic Activity Participants), b. (Contractual Obligations), c. (Funding Sources), d. (Managers or Lessors of Premises), and e. (Owner, Manager, Operator, or Lessor of "Special Events" Premises) are Additional Insureds, but only: (a) With respect to each Additional Insured's vicarious liability for "actual damages" solely caused by you or by "your work" that is ongoing for such Additional Insured's supervision of "your work"; and (b) If the Additional Insured did not cause or contribute to the "occurrence" or act resulting in liability. (2) If an endorsement is attached to this policy and specifically names a person or organization as an Additional Insured, then the coverage extended under this paragraph 4. AUTOMATIC ADDITIONAL INSURED(S) does not apply to that person, entity, or organization. (3) The following is added to Section V — Definitions: 24. "Actual Damages" is to have its usual and customary legal meaning and excludes without limitation, punitive damages, restitution, penalties, and formula damages added to "actual damages" and any other enhanced damages. (4) All other terms and conditions of this Coverage Part which are not inconsistent with this Paragraph h. apply to coverage extended to the above referenced Additional Insureds REGARDLESS OF WHETHER OR NOT A COPY OF THIS COVERAGE PART AND/OR ITS ENDORSEMENTS ARE DELIVERED TO AN ADDITIONAL INSURED. L. BLANKET WAIVER OF SUBROGATION Paragraph 8. under Section IV — Commercial General Liability Conditions is deleted and replaced with the following: 8. Transfer of Rights Of Recovery Against Others To Us And Blanket Waiver Of Subrogation a. If an 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. b. If required by written "insured contract," we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard." M. PRIORITY OF APPLICATION FOR MULTIPLE INSUREDS Section III — Limits Of Insurance is amended to add the following paragraph: 8. In the event a claim or "suit" is brought against more than one insured, due to "bodily injury' or "property damage" from the same "occurrence," or "personal injury," or "advertising injury," from the same offense, we will apply the Limits of Insurance in the following order: a. You; b. Your "executive officers," directors, "employees," and ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. c. Any other insureds in any order that we choose. Page 8 of 8 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. ., Risk MawgemegDmnlon REVIEWED&APP ovmft 7 �. 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