Loading...
HomeMy WebLinkAboutSECOND BAPTIST CHURCHCity of Santa Ana Clerk of the Cour. AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with - o L� J �bJ ✓I'{R L No. A-2008- Q �0, l —& D was completed on /> 'J'� 6 -7 and final payment has been made. Revised 12-07-07 Department: Phone/Ext.: Signature:/ Date: 7 z� A ,e - _s rs_.-_8- w -__ A-2008-069-60 INSURANCE ON 1 �_ WORKMAN PROCEED UNTIL INSURANCE VPIRES sios CLERK OF COUNCAGREEMENT BETWEEN THE CITY OF SANTA ANA AND (14TF rL-(.!� ..' _--...�......-- � SECOND BAPTIST CHURCH FOR USE OF COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS This Agreement, is hereby made and entered into this 1st day of July, 2008, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ("CITY") and SECOND BAPTIST CHURCH, a California nonprofit corporation ("SUBRECIPIENT"). WITNESSETH Recitals: A. The CITY, as an entitlement recipient and grantee of the United States Department of Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG") Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq. ("CDBG REGS"); and B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the Housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"); and C. The SUBRECIPIENT is a private nonprofit agency that has been selected by the CITY to receive CDBG funds and administer such financial assistance; and to provide the services described in Exhibit A, in accordance with the schedule of performance included therein, hereinafter referred to as "said program". SUBRECIPIENT represents that it is qualified and willing to operate said program and certifies that the activities carried out with funds provided under this Agreement will meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208). D. SUBRECIPIENT agrees that it will adhere to the performance measurements and outcomes as indicated on Exhibit A -I (Outcome Tracking). Failure to follow the measurements and meet the stated outcomes may constitute breach of contract that could result in termination of this Agreement or serve as reason for the City to recapture the grant funds awarded to SUBRECIPIENT pursuant to this Agreement. E. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure of such funds; and WHEREFORE, it is agreed by and between the parties that the foregoing Recitals are a substantive part of this Agreement and the following terms and conditions are approved and together with all exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and SUBRECIPIENT: 1 5105 I. SUBRECIPIENT'S OBLIGATIONS A. Non -Profit Status - Representations and Warranties. (a) Authority. SUBRECIPIENT is a duly organized and existing non-profit corporation in good standing and authorized to do business under the laws of the State of California. SUBRECIPIENT has full right, power and lawful authority to accept the funding hereunder and to undertake all obligations as provided herein and the execution, performance and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite actions on the part of SUBRECIPIENT. (b) Experience. SUBRECIPIENT is a qualified provider of the services to be provided hereunder. (c) Familiarity With Services Required. By executing this Agreement, SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to be performed and provided hereunder, (ii) it has carefully considered how the services should be performed, and (iii) it fully understands the facilities, difficulties and restrictions attending performance of the services under this Agreement. (d) No Conflict. To the best of SUBRECIPIENT'S knowledge, SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement will not constitute a default or a breach under any contract, agreement or order to which SUBRECIPIENT is a party or by which it is bound. (e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or threatened bankruptcy proceeding. (f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a current or threatened litigation that would or may materially affect SUBRECIPIENT'S performance under this Agreement. (g) Application Veracity. All provisions of and information provided in SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true and correct in all material respects. (h) No Pending Investigation. SUBRECIPIENT is not aware that it is the subject of any current or threatened criminal or civil action investigation by any public agency, including without limitation a police agency or prosecuting authority, that would relate to affect performance of the Agreement or provision of services hereunder. B. Amount of Grant and Quarterly Disbursement. The amount granted to SUBRECIPIENT is $ 10,000 ("CDBG FUNDS"), and such funds shall be expended by SUBRECIPIENT on or before June 30, 2009. The CDBG FUNDS shall be disbursed by CITY to SUBRECIPIENT on a quarterly basis (October, January, April and July) subject to and upon receipt and approval of a complete quarterly activity report from SUBRECIPIENT, with the final K 5105 payment subject to the satisfaction of the condition precedent of submittal of complete reporting information due on or before July 15 of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be obligated to perform such duties as would normally extend beyond the term, including but not limited to obligations with respect to indemnification, audits, reporting, data retention/reporting, and accounting. C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit A," attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as required may, in addition to other remedies set forth in this Agreement, result in readjustment of the amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT hereunder. D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before June 30, 2009 and to use said funds to pay for necessary and reasonable costs allowable under the federal law and regulations to operate said program. Said amounts shall include, but not be limited to, wages, administrative costs, and employee benefits comparable to other similarly situated employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income received from said funds only for the same purposes for which said funds may be expended pursuant to the terms and conditions of this Agreement. E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing its operations. SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses, registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's operations hereunder. Such licensing requirements include obtaining a City business license, as applicable. F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local, state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make good -faith efforts to gain compliance with local, state or federal rules and regulations following written notification of said violation(s) from the CITY or other authorized citing agency. SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY of pending violations, or to remedy such known violation(s) shall result in termination of grant funding hereunder. SUBRECIPIENT must make all corrections required to bring the facility/property into compliance with the law within sixty (60) days of notification of the violation(s); failure to gain compliance within such time shall result in termination of grant funding hereunder. G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY pursuant to this Agreement shall be maintained in an account in a federally insured banking or savings and loan institution with record keeping of such accounts maintained pursuant to applicable OMB Circular A-110 requirements. SUBRECIPIENT is not required to maintain separate depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to 3 5105 account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB Circular A-110 requirements. H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT receives Five Hundred Thousand Dollars ($500,000.00) or more in federal funds, SUBRECIPIENT 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. SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the year following the program year in which this Agreement is executed. 1. Record Keeping/Reporting. SUBRECIPIENT shall keep and maintain complete and adequate records and reports to assist CITY in meeting and maintaining its record keeping responsibilities under the CDBG BEGS, including the following: (1) Records a. Documentation evidencing program income requirements in conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24 CFR 570.208(a)(2)(B) of the income level of persons and/or families participating in or benefiting by the SUBRECIPIENT program. b. Documentation of the number of persons and/or families participating in or benefiting by the SUBRECIPIENT program. c. Household information shall include number of persons, identification of head of household, race/ethnicity, and income verification. d. Documentation of all CDBG FUNDS received from CITY. e. Documentation of expenses as identified in the Budget Proposal, including evidence of incurring the expense, invoices for goods or services, copies of any and all contracts or documentation pertaining to costs for subcontractors, plus all other invoices for which CDBG FUNDS were expended, and any payments therefor. f. Any such other related records as CITY shall reasonably require or as required to be maintained pursuant to the CDBG REGS. (2) Reports (i) Payment Request. Concurrently with the submittal of each quarterly report, on or before the 15th day of October, January, April and July, SUBRECIPIENT shall submit both: an original invoice and true copies of invoices, receipts, agreements, copies of any and all contracts or documentation pertaining to costs for subcontractors or other documentation supporting and evidencing how the CDBG FUNDS have been expended during the applicable quarter. Di 5/05 (ii) Quarterly Activity Report: SUBRECIPIENT agrees to keep monthly records of all ethnic and racial statistics of persons and families benefited by SUBRECIPIENT in the performance of its obligations under this Agreement, including, but not limited to, the number of low and moderate income persons and households assisted in accordance with federal income limits, the number of female heads of households assisted, new program information and year-to- date program statistics on expenditures, caseload and activities. J. Access to Records. CITY and the United State Government and/or their representatives shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities and performance, to books, documents and papers, and the right to examine records of SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in regard to said program. CITY and the United States Government and/or their representatives shall also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are not limited to, questioning employees and participants in said program and entering any premises or any site in which any of the services or activities funded hereunder is conducted or in which any of the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any privileged or confidential information as set forth in federal or state law. K. Location of Records/Required Length of Record Keeping. All accounting records, reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and thereafter for five (5) years after completion of an audit in conformity with the CDBG REGS's. Records which relate to (a) complaints, claims, administrative proceedings or litigation arising out of the performance of this Agreement, or (b) costs and expenses of this Agreement to which CITY or any other governmental agency takes exception, shall be retained beyond the five (5) years until complete resolution or disposition of such appeals, litigation claims, or exceptions. In the event SUBRECIPIENT does not make the above -referenced documents available within the city of Santa Ana, California, SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in conducting any audit at the location where said records and books of account are maintained. L. Compliance with Law/Program Income. SUBRECIPIENT acknowledges that the funds being provided by CITY for said program are received by CITY pursuant to the ACT as amended and that expenditures of these funds shall be in accordance with the ACT and all pertinent regulations issued by agencies of the federal government, including, but not limited to, all regulations found at Title 24 of the Code of Federal Regulations. Program income received by SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement. SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders applicable to its operation whether or not referred to in this Agreement. M. Standing. SUBRECIPIENT shall be in good standing, without suspension by the California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY. 5 5105 N. Confidentiality. Without prejudice to any other provisions of this Agreement, SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided to it concerning participants in accordance with the requirements of federal and state law. However, SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested, including audit, examinations, monitoring and verifications of reports submitted by SUBRECIPIENT, costs incurred and services rendered hereunder. O. Independent Contractor. SUBRECIPIENT agrees that the performance of obligations hereunder is rendered in its capacity as an independent contractor and that it is in no way an agency of CITY. P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse the CITY of all such funds that were obtained/spent under fraudulent circumstances. Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non - expendable personal property acquired under the terms of this Agreement. Said record shall be made available to CITY upon request. The term "non -expendable personal property" shall include leased and purchased equipment. R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use funds provided through this Agreement to pay for entertainment, meals or gifts. S. Lobbying. SUBRECIPIENT certifies that it will comply with federal law (31 U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay any person for influencing or attempting to influence an officer or employee of any agency, Member of Congress, or an officer or employee of a Member of Congress in connection with awarding of any federal contract, the making of any federal grant or loan, entering into any cooperative agreement and the extension, renewal, amendment or modification of any federal contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein. SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any sums to SUBRECIPIENT under the terms and conditions of this Agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of 5105 Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit a 'Disclosure Form to Report Lobbying," in accordance with its instructions (see C-I). T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds to pay salaries and other related administrative or personnel costs, no persons who exercise or have exercised any function with respect to CDBG activities assisted under the terms of this Agreement, or who are in a position to participate in a decision -making process or gain inside information with regard to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity of SUBRECIPIENT, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter. This prohibition applies to any person who is an employee, agent, consultant, officer, or elected or appointed official of CITY, or of any designated public agencies, or the SUBRECIPIENT. U. Davis -Bacon Act. All laborers and mechanics employed by contractors or subcontractors in the performance of construction work, including alterations and repairs, in excess of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5. Further, the payroll reports (along with the "Statement of Compliance") and basic records are required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless there is on file with the agency a certification by the contractor that the contractor and its subcontractors have complied with the provisions of 29 C.F.R. §5.5. A breach of the contract clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)]. V. Drug Free Workplace. SUBRECIPIENT 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 SUBRECIPIENT will be required to: a) Abide by the terms above in statement 1. b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any criminal drug statute conviction for a violation occurring in the workplace not later than five days after such conviction. 7 5105 3. The CITY and the United State Department of Housing and Urban Development will be notified within ten days after receiving notice of any such violation. 4. 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. II. CITY'S OBLIGATIONS A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall pay to SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for CITY's 2008-2009 CDBG program year amounts expended by SUBRECIPIENT in carrying out said program for fiscal year 2008-2009 pursuant to this Agreement up to a maximum aggregate payment of Ten Thousand Dollars ($10,000) in installments determined by CITY. Payments shall be made to SUBRECIPIENT through the submission of invoices on a quarterly basis (October, January, April and July) in a form prescribed by CITY, detailing such expenses. CITY shall pay such invoices within thirty (30) days after receipt thereof provided CITY is satisfied that such expenses have been incurred and documented within the scope and provisions of this Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this Agreement. B. Audit of Account. CITY shall include an audit of the account maintained by SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of the Code of Federal Regulations and other applicable federal laws and regulations. C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of the grant program requirements and monitors grant and subgrant supported activities to assure compliance with Federal requirements. Such monitoring covers each program, function and activity and performance goals are reviewed periodically. D. Environmental Review: In accordance with 24 CFR 58, the CITY is responsible for undertaking environmental review and maintaining environmental review records for each applicable project. E. Performance Monitoring: CITY shall monitor the performance of the SUBRECIPIENT against goals and performance standards required herein. Substandard performance as determined by the CITY will constitute non-compliance with this Agreement. If action to correct such substandard performance is not taken by the SUBRECIPIENT within a reasonable period of time after being notified by the CITY, contract suspension or termination procedures will be initiated. 1.1 5/05 III. NONDISCRIMINATION SUBRECIPIENT agrees that no person on the ground of race, age, color, national origin, religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with CDBG funds. IV. CONFLICT OF INTEREST Pursuant to the conflict of interest requirements set forth in 24 CFR 576.57 and OMB Circulars 1-102 and A-110, SUBRECIPIENT agrees that no officer, employee, agent or assignee of CITY having direct or indirect control of any CDBG monies granted to the CITY, inclusive of the subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing prior to the execution of this Agreement and said writing shall be attached and deemed fully incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any changes or modifications to its board of directors and list of officers. V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection with the provision of the services SUBRECIPIENT shall provide with CDBG funds, in accordance with 24 CFR 570.2000): A. SUBRECIPIENT shall not discriminate against any employee or applicant for employment on the basis of religion and shall not limit employment or give preference in employment to persons on the basis of religion. B. SUBRECIPIENT shall not discriminate against any person applying for the services SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and shall not limit such services or give preference to applicants for such services on the basis of religion. C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct any religious worship or services, or engage in any religious proselytizing, or exert any religious influence in the provision of the services in said program. The parties agree that this covenant is intended to and shall be construed for the limited purpose of assuring compliance with respect to the use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the establishment of religion as set forth in the establishment clause under the First Amendment of the United States Constitution and Article I, Section 4 of the California Constitution, and is not in any manner intended to restrict other activities of SUBRECIPIENT. D. Where the services to be provided under said program are rendered on property owned by the primarily religious entity SUBRECIPIENT, CDBG funds may also be used for minor 9 5/05 repairs to such property which are directly related to the cost of rendering the services under said program, where the cost constitutes in dollar terms only an incidental portion of the CDBG expenditure for rendering the services under said program. VI. PROHIBITION OF NEPOTISM SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position funded through this Agreement if a member of that person's immediate family is employed in an administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in- law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and stepchild. The term "administrative capacity" means having selection, hiring, supervisor or management responsibilities. VII. NOTICES Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail, postage prepaid, and addressed as follows: TO CITY: City of Santa Ana Community Development Agency (M-25) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702-1988 TO SUBRECIPIENT: Sonya Tabb Director 4300 Westminster Avenue Santa Ana, CA 92703 VIII. ASSIGNABILITY None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement shall be subcontracted or assigned to any agency, consultant, or person without the prior written consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal obligations of SUBRECIPIENT pursuant to this Agreement. 5/05 IX. HOLD HARMLESS SUBRECIPIENT shall indemnify, defend and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all damages to or for loss of use of property and for injuries to or death of any person or persons, including property and employees or agents of CITY, and shall defend, indemnify and save harmless CITY, its officers, employees, agents, representatives and volunteers from and against any and all claims, demands, suits, actions or proceedings of any kind or nature, including, but not by way of limitation, workers compensation claims and including attorney fees and reasonable expenses for litigation or settlement, resulting from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and suppliers arising out of SUBRECIPIENT's performance of this Agreement. X. INSURANCE A. In accordance with the provisions of Section 3300 of the Labor Code, if SUBRECIPIENT has any employees it is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing performance of this Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor workers' compensation coverage, it must execute a Declaration available from the CITY, and update as is necessary. B. SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a policy or policies of commercial general liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall: (1) name the City of Santa Ana, its officers, agents, representatives, employees and volunteers as additional insured's; (2) be primary with respect to insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of insured's provisions; and (4) give to CITY prompt and timely notice of claim made or suit instituted arising out of SUBRECIPIENT's operations hereunder. SUBRECIPIENT shall: (a) prior to exercising any right under this Agreement, furnish properly executed certificates of insurance and additional insured endorsement to the CITY which shall clearly evidence all coverages required above; (b) provide that such insurance shall not be materially changed or terminated except on 30 days prior written notice to the CITY; (c) maintain such insurance for the period covered by this Agreement; and (d) replace such certificates for policies expiring prior to the expiration of this Agreement. XI. REVERSION OF ASSETS 11 5105 A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(8).] B. Any real property under SUBRECIPIENT's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000.00 must either be: 1. Used, where CITY has given written approval, to meet one of the national objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement, or for such longer period of time as determined to be appropriate by CITY; or 2. If not used in accordance with subparagraph A above, SUBRECIPIENT shall pay to CITY an amount equal to the current fair market value of the property less any portion of the value attributable to the expenditure of non-CDBG funds for acquisition of, or improvement to, the property. Such payment is program income to CITY. C. Subject to the obligations set forth herein, title to equipment acquired under the terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment which has been acquired in accordance with this Agreement and all applicable regulations is no longer needed for said program, disposition of said equipment will be made as follows: 1. Items of equipment with a current per unit fair market value of less than $5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY. 2. Items of equipment with a current fair market per unit value of $5,000.00 or more may be retained or sold and CITY shall have the right to an amount calculated by multiplying the current market value or proceeds from the sale by CITY's share of federal funds used to acquire the equipment, in accordance with 24 CFR 85.32(e)(2). D. SUBRECIPIENT hereby agrees, upon the demand of CITY, to execute, acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder or under any document, instrument or agreement executed in furtherance of the services and activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignment(s), quit claim deed(s) or such other and further instruments, documents and agreements as may be necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or local accounts or program funds or allocation of funds to which CITY is or may be entitled, either for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the performance of this Agreement or any previous agreements relating to the same subject matter or activities as this Agreement, together with any instruments, loans, grants or advances by SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof. SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI. REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements 12 5105 pertaining to program income shall not be affected by the termination of this Agreement and shall survive the date of termination of this Agreement for such period of time as CITY and/or HUD deems necessary for the responsibilities, duties and obligations to be performed and completed to the satisfaction of CITY and HUD. XII. TERMINATION A. This Agreement may be terminated on thirty (30) days' written notice by either party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred to the effective date of termination. B. This Agreement may be suspended or terminated by CITY upon five (5) days' written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT shall only be entitled to reimbursement for approved expenses incurred up to the effective date of suspension or termination. C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill all or any of its obligations hereunder, CITY may declare a default and termination of this Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective on a date stated in the notice which is to be not less than ten (10) days after certified mailing or personal service of such notice, unless such default is cured before the effective date of termination stated in such notice. If terminated for cause, CITY shall be relieved of further liability or responsibility under this Agreement, or as a result of the termination thereof, including the payment of money, except for payment for approved expenses incurred for services satisfactorily and timely performed prior to the mailing or service of the notice of termination, and except for reimbursement of (1) any payments made for services not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by CITY in obtaining substitute performance. D. The grant of funds under this Agreement may be terminated for convenience in accordance with 24 CFR 85.44. E. The grant of funds under this Agreement may be terminated due to the non- performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described in Exhibits A and B or failure to meet the performance standards and program goals set forth therein. F. In the event this Agreement is terminated as set forth in subparagraphs XII.A. through XII.E., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used, and to comply with paragraph "XI. REVERSION OF ASSETS" of this Agreement. XIIL LIMITATION OF FUNDS 13 5105 The United States of America, through HUD, may in the future place programmatic or fiscal limitations on the use of CDBG funds which limitations are not presently anticipated. Accordingly, CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion, reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to implement a reduction in funding, in whole or as to a cost category, with respect to funding for this Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and effecting such a reduction and in revising, modifying, or amending the Agreement for such purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal accountability, financial soundness, or compliance with this Agreement, CITY may suspend the operation of this Agreement for up to sixty (60) days upon five (5) days written notice to SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions. In no event, however, shall any revisions made by CITY affect expenditures and legally binding commitments made by SUBRECIPIENT before it received notice of such revision, provided that such amounts have been committed in good faith and are otherwise allowable and that such commitments are consistent with HUD cash withdrawal guidelines. XIV. EXCLUSIVITY AND AMENDMENT OF AGREEMENT This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the use of CITY's CDBG funds by SUBRECIPIENT and contains all the covenants and agreements between the parties with respect to such employment in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and SUBRECIPIENT. XV. LAWS GOVERNING THIS AGREEMENT This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal laws and regulations. XVI. VALIDITY The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any other provision of this Agreement. XVII. MISCELLANEOUS PROVISIONS 14 5/05 a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. c. No delay or omission by either party hereto to exercise any right or power accruing upon any noncompliance or default by the other party with respect to any of the terms of this Agreement shall impair any such right or power or be construed to be a waiver thereof. A waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be performed by the other shall not be construed to be a waiver of any succeeding breach thereof or of any other covenant, condition or agreement herein contained. 15 5/05 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and year written below. ATTEST: CITY OF SANTA ANA PATRICIA E. HEALY / r 4DAN. RE Clerk of the Council / City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: LISA E. STORCK Assistant City Attorney DATE: 16 SUBRECIPIENT: 26ukotv z Name:4rV-ncCc'v u�2 Title: %'/1,u�5�'-QQ_ C",&uL# _4',`r•-' Tax ID: 95-3290869 City of Santa Ana Scope of Work Name of Organization Second Baptist Church/ Community Mission Services Name of Funded Program Sports League Association 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. 400 Persons II. Number of ONLY unduplicated Santa Ana residents to be served by the funded program, named above, during the 12-month contract period. 400 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 viewable space will print. Type in description here. Sports is only the first park of our program. Our organization Community Mission Services has several program tha will assist the family and if we can introduce them to the Sports program we know that they will migrate to the others. We have a summer tutoring program our Reading and Math Lab to keep our your sharp and ready for the next school year. We also prepare the youth to take the Stanford 9 in the spring and SAT's. We have programs foi adults as well and we are hoping that as their children get involved and are helped then they will see and training that we provide. We have partnered with Santa Ana College to create a computer lab with has been in operation fol over 5 years. We also provide counseling for youth regarding college. We have been working with Pepperdine University in adminstering the Pre -SAT and SAT. Sports League Association is just apart of a big program. Second Baptist Church / Community Mission Services sees the need in our community to assist the youth in several areas. We also wanted to find a way the would draw the youth in our area in order to help in others. We choice sports as out tool to get them in. Once they are in we will evaluate them in several areas and then begin to provide the services needed. Example: Our cost for registration for our basketball program is only $25.00, if we see a family that are in a hardship situation we will wavie that fee, but would as the parent to volunteer in some way (team mom, games day volunteer, snack volunteer, phone tree, etc.). After we evaluate the child, if we see they are unsocial we will encourge them by putting them in a leadership position which has proven to bring them out of their shell. If we see they are have diffeculties in school we encourage them to join our Tutoring program. Teenager that are looking for summer employment we send them to the Y.E.S. program (youth employment service). Finally we want to do our part in assisting in the fight for childhood obesity. We plan to have a Health and Nurition program. The goal of our program is to be a one -stop -shop and have fun doing it. Schedule of Performace Estimate the number of ONLY 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 quarte Quarter 1: July 1 -September 30 Quarter 2: October 1 - December 31 Quarter 3: January 1 - March 31 Quarter 4: April 1 -June 30 Persons Persons Persons Persons 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 Quarter 2: October 1 - December 31 Quarter 3: January 1 - March 31 Quarter 4: April 1 -June 30 25 200 400 $ 2,500.00 $ 2,500.00 $ 2,500.00 $ 2,500.00 $ 10,000.00 Total Grant Exhibit A City of Santa Ana Performance Outcome Tracking Please find the activity most closety associated to the service that will be provided and place an "X" next to it then answer the question below. Please note the tracking that is involved with this activitv. Place an "X" next to one Activity Activity/ Program City Outcome Tracking Goal HUD Outcome Tracking HUD Goal 3. Track children/youth 3. 90% of children/youth Number of persons assisted: Accessibility for the seeking referrals that were seeking referrals will be -with new access to a service purpose of creating linked to the services linked to the services -with improved access to a service Suitable Living sought. sought. -where activity was used to meet a Environments quality standard or measurably improved quality, report the number that no longer only have access to substandard service Describe how you will gather the tracking information, noted above, for that activity. Registration application and one -on -one with parents to see what we can assists the family.Then make refferrals to Community Organizations to help facilatate the needs. Exhibit A-1 Page 3 of 3 Program Year 2008-2009 Final Budget Organization Name Second Baptist Church/ Community Mission Services Program Name Sports League Association Expenditures Category Expenses Funded by Santa Ana CDBG Expenses Funded by Other Sources Total Program Budget Total Organizational Budget Administrative Staff Salaries & Benefits $ - $ - Program Staff Salaries & Benefits $ - $ - Contractual/Professional Services $ 3,825 $ 3,825 $ 2,500 Office Supplies $ 1,500 $ 1,500 $ 1,500 Rent $ 5,000 $ 5,000 $ 4,000 Communications $ 1,000 $ 1,000 $ 1,000 Utilities $ - Insurance $ 2,000 $ 2,000 $ 2,000 Other: List below , r ,� 1 Trophies $ 1,175 $ 1,175 $ 2,500 2 $ - $ 1,000 3 $ 500 $ 500 $ 500 4 $ 2,000 $ 2,000 $ 2,000 5 $ _ Total $ 10,000 $ 7,000 $ 17,000 $ 17,000 LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED FOR 07-08 (Total Funds for Program must equal Total Program Budget above) Source Amount Santa Ana CDBG $ 10,000 PRIVATE DONORS $ 7,000 Total Funds for the Program $ 17,000 Exhibit B Page 1 of 1 2008-2009 Funded Personnel Name of Organization: Second Baptist Church/ Community Mission Services Name of Program Sports League Association NOTE: Please remember that this is only a budget and that reimbursement should be based on actual service. ADMINISTRATIVE STAFF Position Title Annual Salary Annual Benefits Total Compensation CDBG Funds Requested for this position Of this time percent of time serving Santa Ana Maximum Amount of eligible Complensation Total Amount Requested $ - Must equal amount indicated on Exhbit B PROGRAM STAFF Position Title Annual Salary Annual Benefits Total Compensation CDBG Funds Requested for this position Of this time percent of time serving Santa Ana Maximum Amount of eligible Com lensation Total Amount Requested $ - Must equal amount indicated on Exhbit B CONTRACTUAL/PROFESSIONAL SERVICES Type of Service Annual Contract Amount Total Compensation CDBG Funds Requested for this position Of this time percent of time serving Santa Ana Maximum Amount of eligible Com lensation Refrees $ 3,600 $ 3.600 $ 2,700 75% $ 2.700.00 Coach Training $ 1.500 $ 1.500 $ 1,125 75% $ 1.125.00 Total Amount Requested $ 3.825 Must equal amount indicated on Exhbit B ***Please note for personnel whose time is not directly traced to serving Santa Ana and instead a percentage is used please confirm the percentage is accurate prior to requesting reimbursement. Exhibit B-1 Page 1 of 1 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 4DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 9DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Certification Regarding Lobbying Certification for Contracts, Grants, Loans, and Cooperative Agreements 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 attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contact, grant, loan or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontract, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Grantee/Contactor of Certifying Signature EXHIBIT C Page 1 of 2 Program Title SUBRECIPIENT warrants the following: 1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR Part 1. 2. No person in the United States shall on the ground of race, color, religion, national origin, or sex, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with community development funds made available pursuant to the ACT. 3. All laborers and mechanics, employed by contractors or subcontractors in the performance of construction work financed in whole or in part with community development funds shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined in accordance with the Davis -Bacon Act, as amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for which they volunteered; do not receive compensation for such services; or are paid expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise employed at any time in construction work. 4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded with community development funds, except that (a) SUBRECIPIENT does not assume CITY'S environmental responsibilities described at 24 CFR 570.604; and (b) SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process under Executive Order 12372. EXHIBIT C Page 2 of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE 711812008Y' PRODUCER (800) 995-7525 FAX: (800) 995-7521 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Church & Casualty Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3440 Irvine Ave Suite 150 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ne ort Beach CA 92660 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Church Mutual Insurance 18767 SECOND BAPTIST CHURCH OF SANTA ANA INSURERB: 4300 WESTMINSTER AVE INSURERC: INSURER D: SANTA ANA CA 92703 INSURER E: COVERAGES 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. AG 3REGATE LIMITSWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L INSRDI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RRENTEDn e $ X COMMERCIAL GENERAL LIABILITY A X CLAIMS MADE FX OCCUR 0091927-02-641154 4/l/2006 4/l/2009 MEDEXP (Any oneperson) $ 10,000 PERSONAL DV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER, PRODUCTS MP PA $ 1,0001000 POLICY IE PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -.EA ACCIDENT $ I ANY AUTO OTHER THAN EA ACC $ _ $ AUTO ONLY. AGG EXCESWUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE /> $ RETENTION - $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OP ERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Santa Ana, its Officers, Agents, Employees and Volunteers are named as additional insured as respects to their interst in connection with the named insured (relating to a grant provided to the insured) (,tKIItIGAIt HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Santa Ana - CDBG M-25 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL X46&) MXXMAIL Community Development Agency 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN: Lucy Flores �X�XAUjX�� XkX Santa Box M- Santa Anaa,, 92 CA 702 AUTHORIZED REPRESENTATIVE — j— uvo/ © ACORD CORPORATION 1988 INS025lo1oat.o8a Page 1 of 2 ENDORSEMENT DECLARATIONS EFFECTIVE: 07/18/08. SUPERCEDES ANY PREVIOUS DECLARATIONS BEARING THE SAME POLICY NUMBER FOR THIS POLICY PERIOD. GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE POLICY NO.: 0091927-02-641154 ITEM 1. LIMITS OF INSURANCE: GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED OPERATIONS AND SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT EACH OCCURRENCE LIMIT (BODILY INJURY AND PROPERTY DAMAGE COMBINED) PERSONAL AND ADVERTISING INJURY LIMIT (COMBINED) MEDICAL EXPENSE LIMIT - ANY ONE PERSON (OTHER THAN SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) PROPERTY DAMAGE LEGAL LIABILITY - ANY ONE OCCURRENCE SEXUAL MISCONDUCT OR SEXUAL MOLESTATION LIMIT (COMBINED) - ALL LOCATIONS AND OPERATIONS EACH CLAIM LIMIT AGGREGATE LIMIT SEXUAL MISCONDUCT OR SEXUAL MOLESTATION MEDICAL EXPENSE LIMIT ANY ONE PERSON AGGREGATE LIMIT LEGAL DEFENSE COVERAGE LIMIT EACH DEFENSIBLE INCIDENT LIMIT AGGREGATE LIMIT CATASTROPHIC VIOLENCE RESPONSE PER PERSON LIMIT EACH VIOLENT INCIDENT LIMIT VIOLENT INCIDENT AGGREGATE LIMIT ITEM 2. DESCRIPTION AND CLASSIFICATION OF PREMISES AND OPERATIONS: ALL PREMISES AND OPERATIONS UNLESS EXCLUDED IN ITEM 3 BELOW. NONE ITEM 3. EXCLUSION ENDORSEMENTS: NONE A 001 G(03-04) -CA PAGE 1 $ 3,000,000 $ 1,000,000 $ 1,000,000 $ 1,000,000 $ 10,000 $ 300,000 $ 500,000 $ 1,000,000 $ 10,000 $ 50,000 $ 15,000 $ 45,000 $ 50,000 $ 300,000 $ 300,000 Church Mutual EASY RANI [O M PAAYM ISSUED DATE: 09/19/08 IMPORTANT - ATTACH TO YOUR POLICY CHURCH MUTUAL INSURANCE COMPANY CHANGE ENDORSEMENT THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW: ENDORSEMENT EFFECTIVE DATE: 07/18/08 POLICY EFFECTIVE DATE: 04/01/06 SECOND BAPTIST CHURCH OF SANTA ANA 4300 WESTMINSTER AVE SANTA ANA CA 92703 SUMMARY CHANGES TO YOUR POLICY: POLICY NO.: 0091927-02-641154 THE GENERAL LIABILITY COVERAGE PART IS AMENDED. SEE THE REVISED GENERAL LIABILITY DECLARATIONS PAGE. FORM A 220(01-98) ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION APPLIES. IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS AGREED THE CONDITION REGARDING 10 DAYS ADVANCE NOTICE OF CANCELLATION IS AMENDED TO READ 30 DAYS ADVANCE NOTICE. ALL OTHER PROVISIONS OF THE CONDITIONS OF CANCELLATION REMAIN UNCHANGED, PREMIUM: NO ADDITIONAL PREMIUM DUE AGENT: 75-133 CHURCH & CASUALTY INSURANCE AGENCY 3440 IRVINE AVE., SUITE 150 NEWPORT BEACH CA 92660 (800) 995-7525 UN 412(06-86) CHANGE ENDORSEMENT PAGE 1 ISSUED DATE: Church Mutual lY INS URAN[P(0 M PANT 09/19/08 (a) liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract'; and (b) such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance, or regulation relating to the sale, gift, distribution, or use of alcoholic beverages. This Exclusion applies only if you are in the business of manufacturing, distributing, selling, serving, or furnishing alcoholic beverages. d. Any obligation of the insured under a workers compensation, disability benefits or unemployment compensation law or any similar law. e. "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother, or sister of that "employee" as a consequenceof paragraph (1) above. This Exclusion applies: (1) Whether the insured maybe liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. This Exclusion does not apply to liability assumed by the insured under an "insured contract." f. "Bodily injury" or "property damage" that arises out of any: (1) Refusal to employ; (2) Termination of employment; (3) Coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination, sexual misconduct, or other employment -related practices, policies, acts, or omissions; or (4) Consequential "bodily injury" as a result of f.(1), f.(2), or f.(3) above. This exclusion applies whetherthe insured is liable either as an employer or in any other capacity; or there is an obligation to fully or partially reimburse a third party for damages arising out of paragraph f.(1), f.(2), f.(3), or f.(4) above. g. (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release, or escape of pollutants: (a) At or from any premises, site, or location which is or was at any time owned or occupied by, or rented or loaned to, any insured; (b) At or from any premises, site, or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing, or treatment of waste; (c) Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by or for any insured or any person or organization for whom you may be legally responsible; or (d) At or from any premises, site or location on which any insured or A 200 (01-04) copyright, Church Mutual Insurance Company, 2004. Page 2 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment' by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. "Bodily injury" or "property damage" due to war, whether or not declared, or any act or condition incident to war. War includes civil war, insurrection, rebellion, or revolution. This Exclusion applies only to liability assumed under a contract or agreement. k. "Property damage" to: (1) Property you own, rent, or occupy; (2) Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody, or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired, or replaced because "your work" was incorrectly performed on it. Paragraph (2) of this Exclusion does not apply if the premises are "your work" and were never occupied, rented, or held for rental by you. Paragraph (6) of this Exclusion does not apply to "property damage" included in the "products -completed operations hazard." I. "Property damage" to "your product' arising out of it or any part of it. m. "Property damage" to "your work" arising out of it or any part of it and included in the "products -completed operations hazard." This Exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. n. "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy, or dangerous condition in "your product' or "your work"; or (2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This Exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. o. Damages claimed for any loss, cost, or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal, or disposal of: (1) "Your product; (2) "Your work"; or (3) "Impaired property"; if such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy, or dangerous condition in it. Paragraphs (3), (4), (5) and (6) of this Exclusion do not applyto liability assumed p. "Bodily injury" or "property damage" under a sidetrack agreement. arising out of any actual or alleged act of "sexual misconduct or sexual molestation." This includes, but is not limited to any claim or suit seeking A 200 (01-04) Copyright, Church Mutual Insurance Company, 2004. Page 4 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. (b) That the insured would have in the absence of the contract or agreement. (5) Arising out of any actual or alleged act of "sexual misconduct or sexual molestation." This includes, but is not limited to any claim or suit seeking damages based upon, arising out of, or attributable to vicarious liability; negligence in hiring, employment, supervision, retention, or transfer of any employee or volunteer workers; recommendation or referral of any person for employment or volunteer work; failure to protect or negligent supervision of any person (whether an adult or child) failure to warn, failure to investigate, or failure to comply with any obligation to report; and counseling. (6) Arising out of any "counseling incident." b. (1) "Personal injury" or "advertising injury" which would not have occurred in whole or part but for the actual, alleged, or threatened discharge, dispersal, seepage, migration, release, or escape of pollutants at any time. (2) Any loss, cost, or expense arising out of any: (a) Request, demand, or order that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify, or neutralize, or in any way respond to, or assess the effects of pollutants; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, or neutralizing, or in any way responding to, or assessing the effects of pollutants. Pollutants means any solid, liquid, gaseous, or thermal irritant or contaminant including smoke, vapor, soot, fumes, acid, alkalis, chemicals, and waste. Waste includes material to be recycled, reconditioned, or reclaimed. c. "Personal injury" to: (1) An employee of the insured if it occurs in the course of employment by the insured; or (2) Consequential injury to a spouse, child, parent, brother, or sister of such injured employee. This exclusion applies where the insured is liable either as an employer or in any other capacity; or there is an obligation to fully or partially reimburse a third party for damages arising out of paragraph c.(1) or c.(2) above. This exclusion does not apply to liability assumed by the insured under a contract covered under Contractual Liability Coverage. d. "Personal injury" if benefits are provided or are required to be provided by the insured under a workers' compensation, disability benefits, occupational disease, unemployment compensation, or like law. e. "Personal injury" that arises out of any: (1) Refusal to employ; (2) Termination of employment; (3) Coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination, sexual misconduct, or other employment -related practices, policies, acts, or omissions; or (4) Consequential "personal injury" as a result of e.(1), e.(2), or e.(3) above. This exclusion applies where the insured is liable either as an employer or in any other capacity; or there is an obligation to fully or partially reimburse a third party for damages arising out of paragraph e.(1), e.(2), e.(3), or e.(4) above. A 200 (01-04) Copyright, church Mutual Insurance company, 2004. Page 6 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. G. GENERAL LIABILITY CONDITIONS 1. Bankruptcy. Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties in the event of Occurrence, Offense, Claim, or Suit. a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when, and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses, or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us. No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured obtained after an actual trial, but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable Limit of Insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant orthe claimant's legal representative. 4. Otherinsurance. If other valid and collectible insurance is available to the insured for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance. This insurance is primary except when b. below applies. If this insurance is primary, ourobligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excess Insurance. (1) This insurance is excess over any of the other insurance, whetherprimary, excess, contingent, or on any other basis: (4) Assist us, upon our request, in the (a) That is Fire, Extended Coverage, enforcement of any right against any Builders' Risk, Installation Risk, A 200 (01-04) Copyright, Church Mutual Insurance Company, 2004. Page 8 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer of Rights of Recovery Against Others to Us. 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. 9. Two or More Coverages. If two or more coverages of this policy apply to the same loss, the maximum amount we will pay as damages under all the coverages will not exceed the highest Limit of Insurance that applies to any one of the coverages. 10. Two or More Policies. If two or more policies issued by us apply to the same insured and these policies also apply to the same loss, the maximum amountwewill pay as damages under all the policies will not exceed the highest applicable Limit of Insurance that applies to any one of the policies. This does not apply to any policy issued by us that is specifically written as excess insurance. 11. When We Do Not Renew. If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations Page written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. H. DEFINITIONS 1. "Advertising injury" means injury arising out of one or more of the following offenses: a. Oral or written publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; c. Misappropriation of advertising ideas or style of doing business; or d. Infringement of copyright, title, or slogan. 2. "Auto" means a land motor vehicle, trailer, or semitrailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment." 3. "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including death resulting from any of these at any time. "Bodily injury" does not include mental or emotional injury, suffering, or distress that does not result from physical injury. 4. "Counseling incident" means any act or omission in the furnishing of counseling services. 5. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico, and Canada; International waters or airspace, provided the injury or damage does not occur in the course of travel or transportation to or from any place not included in a. above; or c. All parts of the world if: (1) The injury or damage arises out of: (a) Goods or products made or sold by you in the territory described in a. above; or (b) The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; and (2) The insured's responsibility to pay damages is determined in a "suit" on the merits, in the territory described in a. above or in a settlement we agree to. "Employee" includes a "leased worker." "Employee does not include a "temporary worker." b. Oral or written publication of material that violates a person's right of privacy; 7. "Executive officer" means a person holding any of the officer positions created by your A 200 (01-04) Copyright, Church Mutual Insurance Company, 2004. Page 10 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. - (b) In the handling of deceased human bodies; (c) Arising out of service by any persons as members of a formal accreditation, standards review or similar board of the Named Insured or as a person who executes the duties of such board. (2) Failure to comply with any right of a health care facility resident under any state law regulating you as a resident health care facility; (3) Failure to comply with any right of a resident as included in the United States Department of Health, Education, and Welfare regulation governing intermediate care facilities and skilled nursing facilities regardless of whetheryou are subject to such regulations; and (4) Failure to protect any resident from undue influence by an insured when such undue influence is to the personal or financial detriment of the resident. b. "Professional Health Care Services" as used in this exclusion endorsement means your professional medical, nursing, cosmetic, social, and similar professional services that relate to the care of any resident. 10. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker." 11. "Loading or unloading" means the handling of property: a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft, or "auto"; b. While it is in or on an aircraft, watercraft, or "auto"; or c. While it is being moved from an aircraft, watercraft, or "auto" to the place where it is finally delivered; movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft, or "auto." 12. "Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment. a. Bulldozers, farm machinery, forklifts, and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1) Power cranes, shovels, loaders, diggers, or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers, or rollers. e. Vehicles not described in a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps, and generators, including spraying, welding, building cleaning, geophysical exploration, lighting, and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers. Vehicles not described in a., b., c., or d. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment' but will be considered "autos." (1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not but "loading or unloading" does not include the construction or resurfacing; or A 200 (01-04) copyright, Church Mutual Insurance Company, zooa. Page 12 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. video or other reproduction of sexual activity, sexual stimulation, fondling, intimacy, exposure of sexual organs, lewd, or lascivious behavior or indecent exposure, fornication, undue familiarity, or unauthorized touching. 18. "Suit' means a civil proceeding in which damages because of "bodily injury," "property damage," "personal injury," "advertising injury," and injury for sexual misconduct or sexual molestation to which this insurance applies are alleged. "Suit' includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 19. "Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 20. "Your product' means: a. Any goods or products, other than real property, manufactured, sold, handled, distributed, or disposed of by: (1) You; (2) Others trading under your name; or (3) A person or organization whose business or assets you have acquired; and b. Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. "Your product" includes: a. Warranties or representations made at any time with respect to the fitness, quality, durability, performance, or use of "your product"; and b. The providing of or failure to provide warnings or instructions. "Your product" does not include vending machines or other property rented to or located for the use of others but not sold. 21. "Your work" means: a. Work or operations performed by you or on your behalf; and b. Materials, parts, or equipment furnished in connection with such work or operations. "Your work" includes warranties or representations made at any time with respect to the fitness, quality, durability, or performance of any of the items included in a. or b. above. A 200 (01-04) Copyright, church Mutual Insurance Company, zooa. Page 14 of 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. B. SUPPLEMENTARY PAYMENTS - BODILY INJURY AND PROPERTY DAMAGE LIABILITY COVERAGE AND PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGES 1. We will pay, with respect to any claim we investigate or settle, or any "suit' against an insured we defend: a. All expenses we incur. b. Up to $250 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. c. The cost of bonds to release attachments, but only for bond amounts within the applicable Limit of Insurance. 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 $250 a day because of time off from work. e. All costs taxed against the insured in the "suit." For the purpose of this provision, costs do not include prejudgment interest or post judgment interest. f. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable Limit of Insurance, we will not pay any prejudgment interest based on that period of time after the offer. g. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable Limit of Insurance. These payments will not reduce the Limits of Insurance. a. The "suit' against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contractor agreement that is an "insured contract"; b. This insurance applies to such liability assumed by the insured; c. The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; d. The allegations in the "suit' and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit' and agree that we can assign the same counsel to defend the insured and the indemnitee; and f. The indemnitee: (1) agrees in writing to: (a) cooperate with us in the investigation, settlement, or defense of the "suit'; (b) immediately send us copies of any demands, notices, summonses, or legal papers received in connection with the "suit'; (c) notify any other insurer whose coverage is available to the indemnitee; and (d) cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (2) provides us with written authorization to: 2. If we defend an insured against a "suit' and an indemnitee of the insured is also named as a (a) obtain records and other party to the "suit," we will defend that information related to the "suit'; indemnitee if all the following conditions are and met: (b) conduct and control the defense of the indemnitee in such "suit." A 202 (01-04) Copyright, Church Mutual Insurance Company, 2004. Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1995. (2) 'Bodily injury" or "personal injury" arising out of his or her providing or failing to provide professional health care services; or (3) "Property damage" to property owned or occupied by or rented or loaned to that "employee" or any of your other "employees." f. Any organization controlled by you is an insured, but only if there is no other similar insurance available to that organization. However, no organization is an insured for any injury or damage that occurred before you acquired control of the organization. g. Any person (other than your "employee") or any organization is an insured while acting as your real estate manager. h. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: (1) "Bodily injury" to a co -"employee" of the person driving the equipment; or (2) "Property damage" to property owned by, rented to, in charge of or occupied by you or the employer of any person who is an insured under this provision. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture, or limited liability company that is not shown as a Named Insured in the Declarations Page. A 202 (01-04) Copyright, Church Mutual Insurance Company, 2004. Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. S g Copyright, Insurance Services Office, Inc., 1995.