HomeMy WebLinkAboutFAMILIES TOGETHER 1 - 2004
A-2004-201
INSURANCl fjOT ),i'iLt
WORK MAY NQI PROCEED
CLERK OF COUNCIL
DA TEe .;4 -I '5-oS
CONSULTANT AGREEMENT
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THIS AGREEMENT, made and entered into this ~ day of Ctkh.ev ,2004 by
and between Families Together of Orange County (hereinafter "Consultant"), 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 (hereinafter "City").
RECITALS
A. The City, as a grantee of the United States Department of Justice Weed and Seed Grant
Award, pursuant to Title I of the Omnibus Crime Control and Safe Streets Act of 1968,
42 U.S.C. 3701, et. seq. (hereinafter "the Act"), desires to enter this Agreement with
Consultant for the expenditure of Weed and Seed Grant funds to provide a reading
Ischool readiness program within the Empowerment Zone.
B. Consultant represents that it is able and willing to provide such services to the City.
C. The City and Consultant have duly executed this Agreement for expenditure of said
funds.
NOW THEREFORE, it is agreed by and between the parties that the foregoing Recitals are a
substantive part of this Agreement and the following terms and conditions are approved and,
together with all exhibits and attachments hereto, shall constitute the entire Agreement between
the City and Consultant:
1. SCOPE OF SERVICES
Consultant shall provide a reading readiness I school readiness program for children
living in the Empowerment Zone II, as set forth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expended under this
Agreement shall not exceed $11,500.00 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence on October 1, 2004 and terminate on September 30,
2005, unless terminated earlier in accordance with Section 14, below. The term of this
Agreement may be extended upon a writing executed by the Executive Director of the
Community Services Agency and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee ofthe City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant shall pay all salaries
and wages, employer's social security taxes, unemployment insurance and similar taxes relating to
employees and shall be responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to protection against
claims arising from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out of Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1 ,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non-owned automobiles.
c. Worker's Compensation Insurance. In accordance with the provisions of Section
3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured
against liability for worker's compensation or to undertake self-insurance. Prior to commencing
the performance of the work under this Agreement, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
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(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
e. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its
time and materials expended prior to notification of termination. Consultant waives the right to
receive compensation and agrees to indemnify the City for any work performed prior to approval
of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section I of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason ofthe events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold
harmless, and pay all costs for the defense of the City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If CONSULTANT receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
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party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
9. SOURCE OF FUNDS
Consultant acknowledges that the funds being provided by City for Consultant's services
are received by City as a grant from the United States Department of Justice, and warrants that
expenditures of these funds shall comply with the laws, regulations and policies governing use of
said funds as set forth in Title I of the Omnibus Crime Control and Safe Streets Act of 1968, 42
U.S.C. 3701, et. seq.
10. CONSULTANT CERTIFICATIONS
Consultant agrees to be bound by all the terms and conditions of City's Grant Agreement with the
United States Department of Justice, including but not limited to:
a. Audit Report Requirements. Consultant agrees that if Consultant receives Three
Hundred Thousand Dollars ($300,000.00) or more in federal funds. Consultant shall
have an annual audit conducted by a certified public accountant in accordance with the
standards as set forth and published by the United States Office of Management and
Budget - OMB Circular A-133. Consultant shall provide City with a copy of said Audit
by October I.
b. Record KeepinglReporting. Consultant shall keep and maintain complete and adequate
records to assist City in meeting and maintaining its record keeping responsibilities
under the Act. City and the United States Government and/or their representatives shall
have access for purposes of monitoring, auditing and examining Consultant's activities
and performance, to books, documents and papers, and the right to examine records of
Consultant's subcontractors, bookkeepers and accountants, employees and participants
in regard to said program. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
c. Use of Funds. Consultant certifies and agrees that it will not use funds provided through
this Agreement to pay for entertainment, meals or gifts.
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d. Lobbying. Consultant certifies that it will comply with federal law and regulations
found at 24 CFR Part 87, which provide that no appropriated funds may be expended by
the recipient of a federal contract, grant, loan or cooperative agreement to pay any
person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection
with awarding of any federal contract, the making of any federal grant or loan, entering
into any cooperative agreement and the extension, renewal, amendment or modification
of any federal contract, grant, loan or cooperative agreement.
e. Drug Free Workplace. Consultant certifies that it has established the following drug-
free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the workplace for any employee involved in a
federally funded program.
2. As an employee working in conjunction with a federally funded program, the
employees of Consultant will be required to:
. Abide by the terms above in statement I.
. Notify appropriate officials of Consultant and City officials of any criminal drug
statute conviction for a violation occurring in the workplace not later than five
days after such conviction.
. The United State Department of Housing and Urban Development will be notified
within ten days after receiving notice of any such violation.
. Within 30 days of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
. Each such employee shall be required to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a federal, state
or local health, law enforcement, or other appropriate agency.
f. Consultant assures and certifies that it will not use any funds appropriated under this
Agreement for religious activity or anti-religious activity, or to promote or oppose any
political candidate, party or belief.
g. Consultant assures and certifies that where applicable, classroom instructors are properly
credentialed, and training curriculums comply with State Education Codes.
h. Consultant assures and certifies that it is in good standing with the California Secretary
of State, Franchise Tax Board and Internal Revenue Service.
11. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
5
mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director of Community Development
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6736
and,
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
Families Together of Orange County
80 I S. Lyon Street
Santa Ana, California 92705
telefacsimile (714) 836-4478
Attn: Maria Halverson
A party may change its address by giving notice in writing to the other party. Thereafter,
any notice, tender, demand, delivery, or other communication shall be addressed and transmitted
to the new address. If sent by mail, any notice, tender, demand, delivery, or other
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or
other communication shall be effective or deemed to have been given twenty-four (24) hours
after the time set forth on the transmission report issued by the transmitting facsimile machine,
addressed as set forth above. For purposes of calculating these time frames, weekends, federal,
state, County or City holidays shall be excluded.
6
12. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of Consultant. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor
the City. Each party to this Agreement acknowledges that no representations, inducements,
promises or agreements, orally or otherwise, have been made by any party, or anyone acting on
behalf of any party, which are not embodied herein.
13. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
14. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of termination,
subject to the following conditions:
a. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
15. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
16. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
7
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
17. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
18. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
----,
CITY OF .S.A. ~aTA N...A~
, 'A/7
. .1.
DA VI ~. ~A~U V(r;~_
City Manager
PATRICIA E. HEALY
Clerk of [he Council
APPROVED AS TO FORM:
~"P21."!
rOSEPH~W~LETCH R
City Attorney
Tax ID# ;<0- 03\ O(osY
8
EXHIBIT A
SCOPE OF SERVICES
Consultant shall develop, coordinate and implement a "Weed and Seed Safe Haven" site
program at its Lyon Street Parent Center to provide a reading readiness / school readiness
program for children ages four and five. The program will provide instruction on developing
basic learning skills to ensure early academic success. Activities will include pre-reading
activities; shape, number and letter recognition; safety; classroom behavior skills and exposure to
classroom tasks.
Consultant will comply with all reporting requirements of the Executive Office for Weed and
Seed. Such requirements include providing monthly report to the City Community Development
Agency, describing the number of clients served and the type and level of services provided.
Consultant shall include the following documentation regarding the program:
Registration forms
Attendance sheets or sign-in sheets
Copies of flyers/marketing materials used to promote the program
Pictures of special events
Pre and post tests to determine program effectiveness
Safe Haven survey
COMPENSA nON
Consultant shall be compensated as follows:
Reading Readiness / School Readiness Instructor
$11.00 per hour x 20 hours per week x 48 weeks
$10,560.00
Supplies - pencils, paper, books, craft supplies, etc.
$ 940.00
Total
$11,500.00
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EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
I. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 I; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective.)
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
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-
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Feb-24-05 02:07P Mar1a Halverson
P.02
PRODUCER
Driver. AUiant Infliuranco Serviens, Inc.
P.O. 80. 25684
Santa Ana, CA 92799
(800) 821.9283 ElCt 190. Fox (949) 756-2713
l.Jc.n~ No. OC36&61
INsURED 'SPCCi;.[i>>.iiLlNlHSulWCE.. lSLl~""'IA~H'
FAMILIES TOGErHER OF ORANCE COUNTY
80' S, l YON ST,
SANr A ANA. CA il270S
tS~t-L1Aft:IMM"'OOl'n',
2/14/05
THIS CERTIFICATE IS ISSUED AS A MATTER OF lNFOIlMATIONON/,.V JINO.,.'.
CONFIRS NO RIGHTS UPON rHE CEllnFlCATE 1l0LDER. THIS CElmFfC.Ii'rE' '
DOIS NOT AMEND, EXTEND OR ALTER THE coveltAGl! AfFO_D 8YTHE
POUCIES 8ELOW,
COMPANIES AFFORDING COVERAGE
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THIS. TO C&1tT1~ THAT THl POL.It:IU OJ: INIURAHCa Ul'l'1IO"lOW HAW( .lI!eN IHUED TO TI-I!! IUltll'tED NAMED AacYl FOR' ,NIl. "OUCy "'1aOO IN/)ICATED.
NO'TWITHSTl\NDfNQ. All., IIEOUMM&HT. TaAM OR CONDI1lOH ot= ANY COHTaA(;t O..1'J'rttM DOCUII!!:NT MTl1l11t8P!CT TO WNCH T.. CERT~TI_,... tStufD
OR 'My NRTNN, THE JHSUMIfCI! Al"fORD!D BY THE POUCIf.S DElCRIBIIID IWlEJN IS. SL*.IECT TO AU. THE lE_. !XCLUSION MO CONDlTlClNI ClF ~ POt.IeIe6,
~....,.. MAY HAft REM ReDUCED BY PAID CLNIlIIJ.
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AS RESF>ECTS TO rHE COMMUNITY OEVElOF>MENT BlOCK GRANT, THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS I\NO EMPLOY~~S SHAU BE
NAMED AS ADDITIONAL INSURED. AD[ljTIONAL INSURED ENDORSEMENT ATTACHED. SUIlJECT TO FOLlCY TERMS, CONDITIONS AND EXCLUSIONS,
.
SHOULD ANY OF THIi ABOVE DE8CRlBliD F>OLJCIES BE CANCIiLLIiD BEFOIlE THE
.!XJlaUTI01II OAre THEIlliEOF~ THE ISSUING COM~ANYWlLL ..I"'~"'~- ." MAIL
:a DAYS WRITTEN NOnCE TO THE CERnFICA TE HOLDER NAMED ro THE LEFT.
aUT FAILURE TO MAJI,. SUCM NOTICI! SHALL IMPOSE NO OIIUGATION ORLlAB.....TY
01 ANY KINO UPON THE COMPANY. ITS "GENTS OR REI'RESENTATlVES
'EXCEI'T to DAYS FORNON-PAYMENT
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CITY OF SANTA ANA
20 CIVIC CENTER PLAZA. M-25
SANTA ANA,CA 92702
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Endorselnent.~o.3
IT IS AGREED THAT TIm FOLLOWING ARE ADDED AS ADDITIONAL INSURED (8) HEREUNDER
BUT ONLY AS RESPECTS LJABILF/Y ARISING OUT OF 'rHE OPERATIONS OF THE NAMEP "
INSUR.ED, AND FURTHER, PROVIDf.;o THAT THE INCLUSION OF SUCH ADDITIONAL INSURED
SHALL NOT SERVE TO INCREASE THE COMPANY'S LIMIT OF LJABlLITY AS SPECIFiED l1'll"l-fB
DECLARATIONS OF THE POUCY.
SCHEDULE
NAMED INSUREP;
FAMIUES TOGETHER OF ORANGE COUNTY
801 S,I,YONI>T,
SANTA ANA, CA 92705
NAMJ<; OF PERSON OR
ORGANlZA nON/CERTIFICATE HOLDER,:
CI1'Y OF SANTA ANA
2(J CIVIC CP.N1'I!R PLAZA. 110I.25
SANTA ANA.CA 927112
PER CERTTF1CA n:;s OF INSIlRANCE APPROVED BY THJ.i COMPANY, AND ON FILE WM'H THE COMPANY
EFFF;CTJVE DATE OF TIllS ENDORSEMENT: 10/27/04
ArT ACHED TO AND FORMING A PART OF POLICY NO.: 022078458
All other terms and condilions remain unclumgcd. .. ,'KOV ED AS TO FORM
Insurer: Ii ,L1NOJS UNION INSURANCE COMPANY h"7//2..
Special Liability Insurance Program (SLIP) -- _..-:~ UfO Stitt Sheedy
Effcctive September 29, 2004 10 Seplember 29,2005 _.,,,rant City Attorney
DATE ISSUED: 2/14105
9497562713
P02/0! F-547
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1 Of6/05
PROD\.lCeR
Driver. AJlianllnsurance Services. Inc,
P,O, Sox 25884
Santa Ana, CA 92799
(BOO) 821-9283 Ex!. 190 . Fax (949) 706-2713
Lieen&8 No. ~1
lNSURiO SPEClAL LlAI5LlfY lN$iJAANCE PROGAM4 ~LtPj W;;MIifR---
FAMII.IES TOGETHER OF ORANGE COUNTY ,4--';;;004 _ ;;;;"'0 I
801 S, I. YON ST.
SANTA ANA. CA 92705 k ,:}Ct:Y'/ - ..10;;J..
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THIS CERTIFICATE.S ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERllACATE HOLDER. THIS CERllACATE
DOES NOT AMEND, EXTEND OR ALTER rHE COVERAGE AFFORDED BY THE
POUCIES BELOw,
COMPANIES AFFORDING COVERAGE
COMPANY
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A EVANSTON INSURANCE COMPANY
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THW IS TO CERTIf!V TKA.T TH! POUCIQ: OF INSUWoIcI! LIIT&O IELOW HAVI!! BEDI THe INSUREQ ~g ~ ,.OFt- THI.!"CILlCY KRIOP INOICATED.
NO'TWrrHSTANOt~ IV('( AEOUIREMIlNT, TliRM 0fII CONDITION OF AHfCMMCT OR 0lltER QOCuMOiT W1T"Re~mr TO WHICH 'Oft. CIUtTlPtCATE IW4V AlISSUf;D
OR MA,l' PERT""'. THE .NSIJR.\NCI AfFORDep IIW TtIlI fi'Ouae oeac..lttl1lftE1N III SUBJI!CT TO AU. THE TER. JiXCl.uStON AND COWDIT1ONS OF SUCH PO..IC:~
UMfTS a MAY HAVE Bl!lEN ftl!OUeED BY P.AID CLAIMI.
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GENERAL I..IA8ILJTY
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LIABILITY
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AGG,
PER$ONAl $. AO'l/. INJl.RY
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$1,000,000
$1,000.000
$1.000,000
$1.000.000
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$1,000,000
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WORKER's COMPBlSA'nON
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SI.IP3000.05
09129105
09129106
$1.000.000
PER OCCURRENCe AND
ANNUALAGGfleGATE
PQ~ION OF OPERATlONSJI.OCA.."ON5o'VEHCLUIS~1Al. n1:MS
AS RESPECTS TO THE COMMUNITY DEvELOPMENT BI.OCK GAANT, THE CITY OF SANTA ANA. ITS OFFICERS. AGENTS. EMPLOYEES AND
VOLUNTEERS SHAI.L BE ~MED AS ACOITIONAL INSURED. THIS INSURANCE IS PRIMARY ANO ANY I"'SuRANC~ OR SELF INSURANCe MAINl AINED BY
SUCH ADDITIONAL INSUReDS SHAll NOT CONTRIBUTE TO IT. ADDlTION.A/.. INSURED ENDORSEMENT A TTACHEO, SUBJECT TO POl.ICY TERMS,
CONDITIONS AND ExCLUSIONS.
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CITY OF SilNT A ANA
COMMUN'TY DEVElOP"'~N'T AGENCY M-25
20 CIVIC CENTER DRive
PO BOX 1_
SANTA ANA,CA 92702
SHOUI-D <\Ny 01' TIlE ABO\l~ DESCRiBeD POUClES BE CANCEI.l.EC BEFORE rHe
EXPIRATION DA'tIiTHEREOF. THE I$SUING COMPANY W\I..L ~W',!::'H''''''Cf"fa MAlL
"SO PAYS WRITTEN NOTICe TO THE CERllFICATti HllI.OER NAMED TO THE LeFT.
BUT FAILURe TO MAlL :;JUCH NOTtCE SttAl.L IMPOSE NO OBLIGATION OR L..tAalulY
Of ANY KIND UPON 'tHE COMPANY. ITS AGlitHS OR REPRGSlSNTATIVES
"EXCEPT 10 OAY$ FOR NON-PAYMl:NT
AU ORIZEO A TIV
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Oct-06-05 02:22pm From-ORIVER ALLIANT INS, C
6467562713
T-470 P03/03 F-547
- ~
Endorsement. No.3
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
IT IS AGREED THAT THE FOLLOWING ARE ADDED AS ADDITIONAL INSURED (S) HEREUNDER
BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED
INSURED, AND FURTHER PROVIDED THAT THE INCLUSION OF SUCH ADDITIONAL INSURED
SHALL NOT SERVE TO INCREASE THE COMPANY'S LIMIT OF LIABILITY AS SPECIFIED IN THE
DECLARATIONS OF THE POLICY.
SCHEDULE
NAMED INSURED:
FAMIUES TOGETHER OF ORANGE COUNTY
801 S, LYON ST.
SANTA ANA, CA 92705
NAME OF PERSON OR
ORGANIZATION/CERTIFICATE HOLDE~:
CITY OF SANTA ANA
COMMUNITY DEVELOPMENT AGENCY M-25
20 CIVIC CENTER DRIVE
POBOX 1988
SANTA ANA,CA 92702
THIS INSURANCE IS PRIMARY AND ANY INSURANCE OR SELF INSURANCE
MAINTAINED BY SUCH ADDITIONAL INSUREDS SHALL NOT CONTRIBUTE
TO IT,
PER. CERTIFICATES OF INSURANCE APPROVED BY THE COMPANY, AND ON FILE WITH THE COMPANY
EFFECfIVE DATE OF THIS ENDORSEMENT: 09/29/05
ATTACHED TO AND FORMING A PART OFPOUCY NO.: SLIP3000-OS
All other terms and conditions remain unchanged,
Insurer:
EVANSTON INSURANCE COMPANY
Spl!eial Liability Insurance Program (SLIP)
Effeclive September 29, 2005 to September 29, 2006
DATE ISSUED: 10/6/05
APPROVED AS TO FORM
& elL
Laura Slltt SLccdy
Assistant Cit.y ;\[/nf.;'iey
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