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HomeMy WebLinkAboutWOMEN'S TRANSITIONAL LIVING CENTER (WTLC) (2)-2015� e V f� INWRANCF ON rit- WORK MAY PROCEE, A -2014- 088•(111 A UNTIL INSURANCE t °Cif ; C AMENDMENT TO AGREEMENT FOR USE GLCR_ K NF COI hl J R OF EMERGENCY SOLUTIONS GRANT FUNDS DATE: /-7 0" THIS AMENDMENT, made and entered into this I" day of January 2015, by and between Women's Transitional Living Center, a California nonprofit organization ( "Subrecipient ") and the City of Santa Ana, a charter city and municipal corporation of the State of California ( "City "). RECITALS A. The City and Subrecipient entered into that certain Emergency Solutions Grant Subrecipient Agreement Between the City of Santa Ana and Women's Transitional Living Center dated July 1, 201.4 (Agreement #A- 2014- 088 -011) hereinafter referred to as "said Agreement ", for Subrecipient to receive Emergency Solutions Grant Funds (ESG) in the amount of $30,669,00 for the operation of an emergency shelter program for the homeless. B. The parties hereto now desire to amend the amount of the grant to increase it with an additional Three Thousand Five Hundred Eighty Three Dollars and Twelve Cents ($3,583.12) for this fiscal year. This additional money is part of prior year funding that had been awarded to other subrecipients that were unable to expend their entire grant amounts in the federally mandated 24 -month period. C. City Council authorized this reallocation at its regular meeting of April 1, 2014, in the Request for Council Action by stating that any unallocated FY 2013 -14 funds shall be redistributed proportionately among the subrecipients. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: 1. The total Grant Award to Subrecipient will be amended to include an additional Three Thousand Five Hundred Eighty Three Dollars and Twelve Cents ($3,583.12) for a total grant award of Thirty Four Thousand Two Hundred Fifty Two Dollars and Twelve Cents ($34,252.12) in ESG funds. 2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement, the date and year first above: written. ATTEST: Maria D. IIuizar, Clerk4r the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney G Lisa Storcic Assistant City Attorney RECOMMEND APPROVAL: Ke11y R nd , Exec Live Director Community Development Agency 14NY ' TA% ANA C� - Ir'r1 L/ David Cavazos, City Man er SUBRECIPIENT WOMEN'S TRANSITIONAL LIVINCfENTER Gigi Tso t s Exeeutivirector A ®AI CERTIFICATE OF LIABILITY INSURANCE 04/14/2014' PRODUCER 310393.9477 FAX 310.393.7186 White .& Company Insurance Inc.___ __ ° - -' � — P 0 Box 70 Santa Monica, CA 90406 -0070 Sally Austin -- -�— THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE - HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE POLICY NUMBER NAIC6 INSURED Women's Transitional Living Center PO BOX 6103 Orange, CA 92863 INSURERA: Philadelphia Ins Co INSURER B: PHPK1156635 04/04/2014 INSURER O: EACH OCCURRENCE $ 1,000,000 INSURER D: X COMMERCIAL GENERAL LIABILITY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSfl LTR ADDA NSA TYPE OF INSURANCE POLICY NUMBER POLOYEFFECTIVE WOO POLICY EXPIRATION LIMITS GENERAL LIABILITY PHPK1156635 04/04/2014 04/04/2015 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO PRINTED $ 1,000,000 CLAIMS MADE OCCUR $ 20,060 .•5,_ncau[eer M50 EXP IAny one person) A PERSONAL &AOV INJURY $ 11600,000 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. comp /OP AGO $ 1,000,006 X POLICY PRO• JECT LOS AUTO MOBILE LIABILITY PHPKII56635 04/04/2014 04/04/2015 COMBINED SINGLE LIMIT ANY AUTO (En arridan9 $ 1,000,00 BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS - (Per person) A BODILY INJURY $ X HIRED AUTOS X NON-OWNCOAUTO$ (Per=ldroiQ PROPERTY DAMAGE S (Per accidenU GARAGE LIARRJT� r. AUTO ONLY• EA ACCIDENT 5 I I ANY AUTO OTHER THAN EA ACC 5 �.,•,• $ AUTO ONLY: AGG SS/UMBRELLA LIABILITY PHUB455286 04/04/2014 04/04/2015 EACH OCCURRENCE s 5 000 000 OCCUR CLAMS MADE AGGREGATE $ 5,000,000 A EA $ DEDUCTIBLE �q�f" B% $ RETENTION $ 10,00 qp S o FO $ ,..._. WORKERS COMPENSATION AND ORYI MIU OT , Y PR EMPLOYERS LIABILITY ° E.L EACH ACCIDENT 5 ANY PROPRIETOPlPARTNGMXECUnVE OEFICENMEMBEB EXCLUDED? ._ n Il ye s, describe under u n es �'�i1Rv A W IRBY E;L DISEASE- 1A EMPLOYEE 5 E,L.OIBEASE•POLICY LIMIT 9 SPECIAL PROVISIONS bolow ._s CI #y Attt OTHER —• Ea1'V> —`� DESCRIPTION OF OPERATIONS( LOCATIONS I VEHICLES I EXCLUSIONS ADDED B.Y ENDORSEMENTISPECALPROVISIONS ity of Santa Ana, its officers, agents, employees, and volunteers are additional insureds as per form G 20 26 07 04 and Primary Insurance as per form CG 00 01 04 03 both attached to the general liability olicy and accompanying this certificate. *Except for 10 days written notice of cancellation for non - payment of premium. City of Santa Ana - CDBG M -25 ESG Attn: Daniel Perez P.O. Box 1988 M -25 Santa Ana, CA 92702 A rnan efl rannvnnl FAX: 71.4.647.6549 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF-, THE ISSUING INSURER WILL *W1YC7 ft MAIL 30''° DAYS WRITTEN NO "HCETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XIX MHUXM& ,)(xmM T�xx)wdI.> kkkNXiXmU6X)6xXLtXIYJXXXX AUTHORIZED REPRESENTATIVE IA b` ,OM1 "I "Irr s—n '?,;C°R�'® CERTIFICATE OF LIABILITY INSURANCE D /28/I0011'3 3/28/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER Brown & Brown Insurance Services of CA, Inc. 2401 E. Katella Ave. Suite 550 Anaheim CA 92806 ON ACT Marlene Valencia NAME: _........ _.. -..__ ._�__.._.__ -.�... PHONE (714) 221 -1800 JA C No: (919)221 -9196 EMAIL mvalencia @bbsocal. com INSURERtS)AFFORDING COVERAGE NAM INSURERA:New York Marine and General 16608 INSURED Women's Transitional Living Center PO Box 916 Fullerton GA 92632 INSURER a: INSURER C: INSURER D: INSURER E : $ INSURER F: COMMERCIAL GENERAL LIABILITY cnV RR AG FS CERTIFICATE NUMSER:2013 -2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER PO ICY fFF POLICY EXP MMIODA, LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISESE. occcnenca $ CLAIMS-MDE F-1 OCCUR MED EXP (MY one person $ PERSONAL &ADV INJURY It WY4 GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S $ POLICY PRO- LOG AUTOMOBILE LIABILITY COMBINED SIN. LELMI ad_idd $ BODILY INJURY (Per parson) $ ANY AUTO BODILY INJURY (Per accident) $ ALL O'NNE^ (— :+�.riF; :.:!'D AUTOG AUTOS NON -OWNED HIRED AUTOS AUf05 Pere eo'entOAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB (Z-AIMS-MADE OED I I RETENTION$ $ A: WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE� X I WCSTAMIT' OERI' TORY E, L. EACH ACCIDENT $ 1,000,000 OFFICEWMEMaER EXCLUDED? (Mandatory in NH) NIA m201400005491 3/2B/2014 3/28/2015 E.L. DISEASE. EAEMPLOYE $ 1 000 000 E.L. DISEASE - POLICY LIMIT S 1�n000 000 r pre,deeorioeunder DESCRIPTION OF OPERATIONS babw TOO TO DESCRIPTION OF OPERATIONS I I.00ATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is requlred�d G�sA �. cSy °A�ornev PSSXs��n{ City of Santa Ana - CDBG M -25 ESG Attn: Frank Hernandez P.O. Box 1988 -M -25 Santa .Ana, CA 92702 ACORD 25 (201 SHOO Lb ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, . AUTHORIZED REPRESENTATIVE Murphy /MVAI.LN �,� � ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (zoleoJill The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK1156636 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. CONTRACTORS ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE City of Santa Ana, its officers, agents, employees, and volunteers Section 11— Who is An Insured is amended to in- clude as an additional insured the person(s) or or- ganizations(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age' or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 O ISO Properties, Inc,, 2o�� Roy, P e of 1 q L E 0 Assistant city Attor V /S_ 5 4. Other Insurance (3) When this insurance is excess over other If other valid and collectible insurance is available insurance, we will pay only our share of the to the insured for a loss we cover tinder amount of the loss, if any, that exceeds the Coverages A or B of this Coverage Part, our sum of: obligations are limited as follows: (a) The total amount that all such other a. Primary Insurance insurance would pay for the loss in the absence of this insurance; and This insurance is primary except when Paragraph b. below applies. If this insurance is (b) The total of all deductible and self - primary, our obligations are not affected unless insured amounts under all that other any of the other insurance is also primary, insurance. Then, we will share with all that other (4) We will share the remaining lass, if any, insurance by the method described in with any other insurance that is not Paragraph c. below, described in this Excess Insurance b. Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance (1) This insurance is excess aver: shown in the Declarations of this Coverage (a) Any of the other insurance, whether Part. primary, excess, contingent or on any c. Method Of Sharing other basis: If all of the other Insurance permits contribution (i) That is Fire, Extended Coverage, by equal shares, we will follow this method Builder's Risk, Installation Risk or also. Under this approach each Insurer similar coverage for "your work "; contributes equal amounts until it has paid its (ii) That is Fire insurance for premises applicable limit of Insurance or none of the loss rented to you or temporarily remains, whichever comes first. occupied by you with permission of If any of the other insurance does not permit the owner; contribution by equal shares, we will contribute (iii) That is insurance purchased by you by limits. Under this method, each insurer's to cover your liability as a tenant for share is based on the ratio of its applicable "property damage" to premises limit of insurance to the total applicable limits of rented to you or temporarily insurance of all insurers. occupied by you with permission of S. Premium Audit the owner; or a. We will compute all premiums for this (iv) If the loss arises out of the Coverage Part in accordance with our rules maintenance or use of aircraft, and rates, "autos" or watercraft to the extent not b. Premium shown in this Coverage Pat as subject to Exclusion g. of Section I — Coverage A — Bodily Injury And advance premium is a deposit premium only. Property Damage Liability. At the close of each audit period we will compute the earned premium for that period (b) Any other primary insurance available to and send notice to the first Named Insured. you covering liability for damages The due date for audit and retrospective arising out of the premises or premiums is the date shown as the due date operations, or the products and on the bill. If the sum of the advance and audit completed operations, for which you premiums paid for the policy period is greater have been added as an additional than the earned premium, we will return the insured. excess to the first Named Insured, (2) When this insurance is excess, we will have c. The first Named Insured must keep records of no duty under Coverages A or B to defend the information we need for premium the insured against any "suit" if any other computation, and send us copies at such times insurer has a duty to defend the Insured as we may request. against that "suit ". If no other Insurer defends, we will undertake to do so, but we 6. Representations will be entitled to the insured's rights By accepting this policy, you agreo. against all those other insurers. a. The statements in the Declarations are accurate and complete; 'To FOR% App'ktQVE"D AS Page 12 of '16 © Insurance Services Office, Inc., 2012 CP?t 0413 STCRCK LISA E. Attorney City Assistant �� 11tvV mpp WUMI:N -3 OP It)' I CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDrYYYY) COMMERCIAL GENERAL LIABILITY CLAWS-MACE T OCCUR 09/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Fullerton Insurance Service CDI #0696796 P.O.B°X4064 Fullerton CA 92834.4064 Leslie A. McCarthy, CIO NAW A T Leslie A. McCarthy, CIC PHC NNO Ex1:714- 577.5800 A+c No: 714- 447 -0011 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Nonprofits Ins. Alliance of CA $ 6,00 INSURED Women's Transitional Living Mrs. Gig! Tsontos P.O. Box 6103 INSURER B: New York Marine & General Ins. 16608 INSURER C GENERAL AGGREGATE INSURER D: PRODUCTS - COMP /OP AGG Orange, CA 92863 INSURER E: $ Included A AU X _ X X INSURER F X \,- YIJIVIY ItlUlY16C.Ri THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN ­SR ADDL 9M LT TYPE OF INSURANCE POLICYNUMBER WMI��Y� MM/DCIYEXP LIMITS A X GENT X COMMERCIAL GENERAL LIABILITY CLAWS-MACE T OCCUR X 201401835NPO 09/01/2014 09/01/2015 EACH OCCURRENCE $ 1,000,00 ppEMlsES Ee owurrence $ 100,00 MED EXP (Any one person) $ 6,00 PERSONAL &ADV INJURY $ 11000100 AGGREGATE LIMIT APPLIES PER: POLICY ❑ P JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG $ 1,000,00 Emplo Ban $ Included A AU X _ X X UNCOILS LIABILITY ANY AUTO ALL OWNED $CHEOULED AUTOS AUTOS HIRED AUTOa X AUTOaWNED $500 Comp X $1000 Coll X 207401835NP0 09/01/2014 09/01/2015 COMBINED SINGLE LIMI F Ea ae�lnert ,,,. $ 1,000,00 BODILY INJURY (Per person) -- ---- _.......... $ -.. - -- BODILY INJURY (Per accident) - -DAMAGE $ PROPERT Porecemerrt $ A B X UMDRELLA LIAU EXCESS UAa X OCCUR CLAIMS -MADE N!A 201401835UMENPO WC20140006441 09/01/2014 03/28/2014 0910112016 03!28/2015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 11000100 DED X RETENTIDN$ None WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECLITIVE YIN � � OFFICER /MEMBER EXCLUDED? T Prod /Com , _ X SEAT TE �R H $� 1,000,00 - - - --- E. L. EACH ACCIDENT $^ 11000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Adelllonal Remarks Schedule, maybe atechetl it more space Is required)) City of Santa Ana, its officers, agents employees and volunteers are named"�„Ti P as additional insured as respects to their interest in connection with the named insured. Addit'l insured as respects to general liability per form attached to pol. This pol is primary & is not additional to or contributing 10 ey w/ any other insurance *except for gross negligence and willful misconduct. P E•S �ttOCCI x,15 G�ty P5sls�art I' „I CISANBE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana -ESG M -26 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS. Daniel Perez AUTHORIZED REPRESENTAT�IIV�EE�-�� pp � P.O. BOX 1908 927 (,— 1 �•.L_.i-�t�X-.d Santa Ana, CA 92702 1. ,,�,1 O 1988.2094 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/09) The ACORD name and logo are registered marks of ACORD Women's Transitional Living POLICY NUMBER: 2014.01838NPO COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Section If — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organk zation(s) shown in the Schedule, but only with respect to liability for "bodily Injury", "property damage" or personal and advertising Injury" caused, In whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 the wO 10 V00 Page 1 of 1 0