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HomeMy WebLinkAboutA8674 - DESERT AIDS PROJECTContract Company Name 11 Company Contact II Summary of Services I Contract Price: Funding Source Contract Term: CONTRACT ABSTRACT Desert Aids Project David Brinkman, Chief Executive Officer CDBG-CV Emergency Response — Mitigation & Prevention of the spread of COVID-19 $13,970.00 CDBG-CV 137-4822-63001 FY20-21 Contract Approvals City Council Approval Date: Minute Order/ Resolution Number: Agreement No: -A � 6-74 July 9, 2020 — Item 2.A. 24781 Contract Administration Lead Department: Community & Economic Development Contract Administrator: Jay Virata, Director of Community & Economic Development Darrell Stamps, The Ramsay Group t- Contract Compliance Exhibits: Yes Signatures: Yes Insurance: Yes Bonds: N/A Contract prepared by. - Submitted on: January 6, 2021 By: Annie Rodriquez, Housing Program Assistant COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM COVID-19 EMERGENCY RESPONSE SUBRECIPIENT AGREEMENT BETWEEN THE CITY OF PALM SPRINGS WDE Desert AIDS Project (Federal Grant No. [B-20-MW-06-0561) THIS AGREEMENT (herein "Agreement"), is made and entered into this 15thday of December, 2020, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and DESERT AIDS PROJECT, Federal Tax Number: [ ' j3 IDa086$3 (herein "Provider"). WHEREAS, on March 27, 2020, the President of the United States signed H.R. 748, known as the Coronavirus Aid, Relief, and Economic Security ("CARES") Act, which provides an additional $5 billion of Community Development Block Grant - Coronavirus ("CDBG-CV") funds to rapidly prepare, prevent, and respond to the coronavirus pandemic; and WHEREAS, the City has received CDBG-CV CARES Act, Public Law 116-136 from the United States Department of Housing and Urban Development ("HUD"); and WHEREAS, CARES Act provides that the City may grant the CDBG-CV funds to nonprofit organizations for certain purposes allowed under the CARES Act, namely according to HUD, the City "may use the funds for a range of eligible activities that prevent and respond to the spread of infectious disease such as the coronavirus"; and WHEREAS, the Provider is a nonprofit organization that operates a program that is eligible for a grant of CDBG-CV funds and the City desires to assist in the operation of the program by granting CDBG-CV Funds to the Provider to pay for all or a portion of those costs incurred in operating the program permitted by the Act and the Regulations on terms and conditions more particularly set forth herein; WHEREAS, according to federal regulations (24 CFR 570.503), before disbursing any CDBG funds to a subrecipient, a written agreement shall be signed by the recipient and subrecipient; and NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF PROVIDER. 1.1 Scope of Services. Activities funded with CDBG-CV funds must meet one of the Program's National Objectives (Title 24, Part 570, Sections 570.200(a)(2) and (3), 570.208(a)-(d), and 570.208). For purposes of this Agreement, Provider agrees to provide services meeting the National Objective of benefitting low and moderate - income area benefit, or low and moderate income limited clientele. Provider agrees to 55575.18175\33228209.1 1.4 Financial Reporting. Any Provider receiving or due to receive $20,000.00 or more from the City during the 2020 — 2021 Fiscal Year shall provide to City a financial statement prepared by a recognized accounting firm approved by or satisfactory to City's Finance Director completed within the most recent twelve (12) months showing the Provider's financial records to be kept in accordance with generally accepted accounting standards. The report shall include a general ledger balance sheet that identifies revenue sources and expenses in sufficient detail to demonstrate contract compliance and be balanced to bank statements. Any organization receiving or due to receive less than $20,000.00 in the current fiscal year from the City shall provide a copy of the organization's most recent charitable trust report to the Attorney General, or other financial information satisfactory to City's Finance Director. The financial information provided for in this paragraph shall be furnished not later than January 31st of the current fiscal year. 1.5 Records/Audit. Provider shall maintain separate accounting records for the CDBG-CV funds provided by the City. The City, HUD, the Comptroller General of the United States, or any of their duly authorized representatives shall have access to all books, documents, papers and records maintained by Provider in connection with the services for the purpose of audit, examination, excerpts and transcriptions. Unless otherwise notified by the City, Provider shall retain all financial records, supporting documents and statistical reports related to the project identified under this Agreement until June 30, 2026. All records subject to an audit finding must be retained for five (5) years from the date the finding is made or until the finding has been cleared by appropriate officials and Provider has been given official written notice. The City shall have the right to ensure that necessary corrective actions are made by the Provider for any audit findings pertinent to Provider handling of funding attributable to the CDBG-CV Program. In response to audit deficiencies or other findings of noncompliance with this agreement, the City may impose additional conditions on the use of the CDBG-CV and/or CDBG funds to ensure future compliance, or provide training and technical assistance as needed to correct noncompliance. 1.6 Client Data and Other Sensitive Information. Provider is required to maintain data demonstrating client eligibility for activities provided under this Agreement. Such data may include, but not be limited to, client name, address, income level or other basis for determining eligibility, and description of activities provided. Provider must comply with 2 CFR §200.303 and take reasonable measures to safeguard protected personally identifiable information, as defined in 2 CFR § 200.82, and other information HUD or Provider designates as sensitive or Provider considers sensitive consistent with applicable Federal, state, local, and tribal laws regarding privacy and obligations of confidentiality. Protected personally identifiable information means an individual's first name or first initial and last name in combination with any one or more of types of information, including, but not limited to, social security number, passport number, credit card numbers, clearances, bank numbers, biometrics, date and place of birth, mother's maiden name, criminal, medical and financial records, educational transcripts. This does not include personally identifiable information that is required by law to be disclosed.(2 CFR § 200.82.) 55575.18175\33228209.1 - 3 - 3.4 Independent Contractor. Neither the City nor any of its employees shall have any control over the manner, mode or means by which Provider, its agents or employees, perform the services required herein, except as otherwise set forth herein. Provider shall perform all services required herein as an independent contractor of City and shall remain at all times as to City a wholly independent contractor with only such obligations as are consistent with that role. Provider shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of City. 4.0 COMPLIANCE WITH FEDERAL REGULATIONS. 4.1 The Provider acknowledges that the funds being provided by the City for the Project are distributed pursuant to the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"), Public Law 116-136. The Provider agrees to comply with the requirements of the CARES Act, Public Law 116-136, and any implementing regulations and programmatic requirements. Further, the Provider agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants (CDBG)) including subpart K of these regulations, except that (1) the Provider does not assume the City's environmental responsibilities described in 24 CFR 570.604 and (2) the Provider does not assume the City's responsibility for initiating the review process under the provisions of 24 CFR Part 52. The Provider also agrees to comply with all other applicable Federal, state and local laws, regulations, and policies governing the funds provided under this Agreement including: financial standards according to OMB Circular A-22 (non-profit), OMB Circular A-87 "Cost Principles for State and Local Governments, OMB Circular A-133 "Audits of State and Local Government and Non -Profit Organizations." The Provider further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 4.2 The Provider shall maintain records of its operations and financial activities in accordance with the requirements of the Housing and Community Development Act and the regulations promulgated thereunder, which records shall be open to inspection and audit by the authorized representatives of the City, the Department of Housing and Urban Development and the Comptroller General during regular working hours. Said records shall be maintained for such time as may be required by the regulations of the Housing and Community Development Act, but in no case for less than five years after the close of the program. 4.3 The Provider certifies it shall adhere to and comply with the following as they may be applicable, and as may be amended from time to time: (a) Submit to City through its Community and Economic Development Department semi-annual reports on program status (Exhibit E); (b) Section 109 of the Housing and Community Development Act of 1974, as amended and the regulations issued pursuant thereto; 55575.18175\33228209.1 _ rj (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB Super Circular 2 CFR 200 as they relate to the acceptance and use of federal funds under the federally - assisted program; (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (q) Title VIII of the Civil Rights Act of 1968 (P.L. 90-284) as amended; (r) The lead -based paint requirements of 24 CFR Part 35 issued pursuant to the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.); (s) Procure, use, manage and dispose of personal property in accordance with 2 CFR 200.310 and 2 CFR 200.312 through 2 CFR 200.316; (t) Reversion of asset. Upon the Expiration of the agreement, the Subrecipient shall transfer to the City any CDBG funds on hand at the time of expiration and any accounts receivable attributable to the use of CDBG funds. Additionally, any real property under the Subrecipient's control that was acquired or improved in whole or in part with CDBG funds (including CDBG funds provided to the Subrecipient in the form of a loan) in excess of $25,000 is either: (i) Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or (ii) Not used in accordance with paragraph (t)(i) above, in which event the Subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in paragraph (t) of this section.) (u) Conflict of Interest. The Provider is required to disclose to the City in writing any potential conflict in accordance with 24 CFR Part 570.611; and 55575.18175\33228209.1 _ 7 _ 4.8 Subrecipient certifies that they will not or have not used federal appropriated funds to pay any persons or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, or offier or employee of Congress in connection with obtaining any Federal contract, grant, loan, cooperative agreement, or any other award including the extension, continuation, renewal, or modification of same. Subrecipient shall disclose any lobbying with non- federal funds that takes place in conjunction with obtaining any federal award. 5.0 INSURANCE AND INDEMNIFICATION. 5.1 Insurance. The Provider shall procure and maintain, at its cost, and submit concurrently with its execution of this Agreement, public liability and property damage insurance against claims for injuries against persons or damages to property resulting from Provider's acts or omissions arising out of or related to Provider's performance under this Agreement. Provider shall also cant' Workers' Compensation Insurance in accordance with State Workers' Compensation laws. Such insurance shall be kept in effect during the term of this Agreement and shall not be cancelable without thirty (30) days' prior written notice of the proposed cancellation to City. A certificate evidencing the foregoing and naming the City, its elected officials, officers, employees and agents as additional insureds shall be delivered to and approved by the City's Risk Manager prior to commencement of the services hereunder. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of Provider's obligation to indemnify the City, its elected officials, officers, employees or agents. The amount of insurance required hereunder shall be as required by the Contract Officer not exceeding One Million Dollars ($1,000,000). 5.2 Indemnification. The Provider shall defend, indemnify and hold harmless the City, its elected officials, officers, employees and agents, from and against any and all actions, suits, proceedings, claims, demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death of person(s), for damage to property (including property owned by the City) arising out of or related to Contractor's performance under this Agreement, except for such loss as may be caused by City's own negligence or that of its officers or employees. 6.0 CITY OFFICERS AND EMPLOYEES: NON-DISCRIMINATION, TERMINATION, AND ENFORCEMENT. 6.1 Non -Liability of City Officers and Employ. No officer or employee of City shall be personally liable to the Provider, or any successor -in -interest, in the event of any default or breach by City or for any amount which may become due to the Provider or its successor, or for breach of any obligation of the terms of this Agreement. 6.2 Conflict of Interest. Provider acknowledges that no officer or employee of the City has or shall have any direct or indirect financial interest in this Agreement nor shall Provider enter into any agreement of any kind with any such officer or employee during the term of this Agreement and for one year thereafter. Provider warrants that Contractor has not paid or given, and will not pay or give, any third party any money or other consideration in exchange for obtaining this Agreement. 55575.18175\33228209.1 _ 9 _ 7.0 MISCELLANEOUS PROVISIONS. 7.1 Notice. Any notice, demand, request, consent, approval, or communication that either party desires, or is required to give to the other party or any other person shall be in writing and either served personally or sent by pre -paid, first- class mail to the address set forth below. Notice shall be deemed communicated seventy-two (72) hours from the time of mailing if mailed as provided in this Section. Either party may change its address by notifying the other party of the change of address in writing_ TO CITY: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Manager WITH COPY TO: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Attorney TO PROVIDER: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262" Attn: Senior Grant Writer 7.2 Amendment. This Agreement may be amended at any time by the mutual consent of the parties by an instrument in writing. IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the date first written above. [ End — Signatures on Next Page ] 55575.18175\33228209.1 - 11 - Proiect/Activity Title: Desert AIDS Project Name/Address of Provider: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect Number: Obiectives/Activities Desert AIDS Project will commit these awarded CDBG funds toward the mitigation and prevention of the spread of COVID-19 for the benefit of patients and clients living with HIV/AIDS. Objective 1: Assist the City by timely providing any additional information requested. TARGET DATE ACTIVITY #1 On -Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process. TARGET DATE ACTIVITY #1 On -Going Establish and maintain an efficient program process/procedure for proper record keeping. Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise, market and publicize the program to facilitate positive promotion for all parties (i.e., Provider. City. CDBG, etc.). TARGET DATE ACTIVITY #1 On -Going Advertise the program through any chosen media. Submit final publication to City. Objective 4: Maintain records for all CDBG activities related to this program. TARGET DATE ACTIVITY #1 On -Going Document and maintain all records related to this program, including those required, in accordance with HUD Regulations, in a stable and secure location. ACTIVITY #2 On -Going Submit Semi -Annual reports — referenced Exhibit E within fifteen (15) calendar days of the program mid -year, December 3111, and program completion, June 30tn Objective 5: Manage/monitor program activities. TARGET DATE ACTIVITY #1 On -Going Perform monitoring activities necessary to ensure that the program is being conducted in compliance with the CDBG policies, federal regulations, and local statues, including Davis - Bacon Act, Copeland Act, and Non-discrimination / EEO requirements. Objective 6: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY #1 07/15/21 Provide an evaluation and final report on all programmatic and financial activities. Provide Additional Objectives, Activities and Descriptions below: Objective 7: Provide twice daily deep clean and sanitize our primary care clinic and other areas of our buildings used by patients and clients living with HIV/AIDS who are low-income population for purposes of HUD/CDBG. TARGET DATE ACTIVITY #1 At least 2, 000 patients/clients living with HIV/AIDS during the program year 20-21. General Administration Provide the management oversight and leadership to address specific operational tasks in meeting the established performance levels, as well as perform supportive activities (i.e., clerical, monitoring, etc.) CITY OF PALM SPRINGS EXHIBIT B Beneficiary Qualification Statement Proiect/Activity Title: Project Number: not assigned by the City of Palm Springs Desert AIDS Project Name/Address of Provider: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian) receiving benefits form the described projectlactivity. Please answer each of the following questions. 1. How many persons are in your household? For this question a household is a group of related or unrelated persons occupying the same house with at least one member being the head of the household. Renters, roomers, or borders cannot be included as household members. 2. Circle your combined gross annual income (Riverside -San Bernardino -Ontario, CA MSA— 07101/2020) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME (AMI) 1 2 3 4 5 6 7 8 LEVEL - $75,300 EXTREMELY LO INCOME $15,850 $18,100 $21,720 $26,200 $30,680 $35,160 $39,640 $44,120 0 - 30% of AMI LOW INCOME $26,400 $30,150 $33,900 $37,650 $40,700 $43,700 $46,700 $49,700 30 - 50% of AMI MODERATE INCOME $42,200 $48,200 $54,250 $60,250 $65,100 $69,900 $74,750 $79,550 50 - 80% of AMI NON LOW & MOD INCOME $42,201+ $48,201+ $54,251+ $60,251+ $65,101+ $69,901+ $74,751+ $79,551+ > 80% 3. What racelethnicity do you identify yourself as; please note that this self -identification is voluntary in accordance with equal opportunity laws? ❑ White ❑ American Indian or Alaska Native AND White ❑ Black/African American ❑ Asian AND White ❑ Asian ❑ Black/African American AND White ❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander ❑ Other: HISPANIC/LATINO ETHNICITY ❑ Yes ❑ No If yes, check one: ❑ Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: 4. Are you female Head of Household? ❑ YES ❑ NO 5. Do you have a disability? ❑ YES ❑ NO If YES, please describe: 6. Have you been impacted by the Coronavirus? ❑ YES ❑ NO If YES, please describe: ACKNOWLEDGEMENT AND DISCLAIMER I CERTIFY UNDER PENALTY OF PERJURY THAT INCOME AND HOUSHOLD STATEMENTS MADE ON THIS FORM ARE TRUE. NAME: ADDRESS: SIGNATURE: DATE: PHONE NO: The information you provide on this form is confidential and is only utilized for Community Development Block Grant (CDBG) program purposes, a Federally -funded program, governmental reporting purposes to monitor CITY OF PALM SPRINGS EXHIBIT C Budget Summary Proiect/Activity Title: Proiect Number: Not Assigned by the City of Palm Springs Desert AIDS Project Name/Address of Provider: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262 BUDGET SUMMARY COST CATEGORY CDBG SHARE OTHER SOURCES TOTAL COST 1 Personnel $11,723.83 0 $11,723.83 2 Consultant/Contract Services Architectural Services 0 0 3 Travel 0 0 4 Space Rental 0 0 5 Consumable Supplies $2 246.17 0 $2,246.17 6 Rental, Lease or Purchase of Equipment 0 0 7 Insurance 0 0 8 Other — 0 0 TOTALS $13,970.00 If costs are to be shared by other sources of funding, including CDBG funds from other jurisdictions, identify the source of funding, grantor/lending agency, and cost category information. Progress payments, approved by the Subrecipient and based upon the percentage of completion of the work with a 10% retention, shall be paid by the 301h day of each month, provided that the payment application has been submitted to the City on or before the first working day of the month. The Subrecipient shall receive reimbursements and/or its suppliers/vendors shall receive direct payments by way of a two-party check, in accordance with the aforementioned cost categories and line items which are subject to receipt of an acceptable requisition in the form of a monthly Request for Reimbursement. The Subrecipient recognizes that the CDBG Funds are received from the HUD, and that the obligation of the City to make payment to Subrecipient is contingent upon receipt of such funds from HUD. In the event that said funds, or any part thereof, are, or become, unavailable, then the City may immediately terminate or amend this Agreement. Services are to be performed over a twelve month period of July 1, 2020 through June 30, 2021 with funds allocated from 2020 — 21 Program Year. CITY OF PALM SPRINGS EXHIBIT D Request for Reimbursement Promect/Activity Title: Project Number: Desert AIDS Project Name/Address of Provider: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262 BENEFICIARY QUALIFICATION STATEMENT Description Approved Grant Amount Current Reimbursement Period Prior Reimbursement Perlod(s) Total YTD Reimbursement Grant Balance (Over/ Under) Corona Virus Facility Sanitation $13,970 $13,970 TOTAL $13,970 1E 11 $13,970 I CERTIFY THAT, (a) the City of PALM SPRINGS, as grantee of the CDBG, has not previously been billed for the costs covered by this invoice, (b) funds have not been received from the Federal Government or expended for such costs under the terms of the Agreement or grant pursuant to FMC-74-4 & 24 CFR Part 58;(c) this agency is in full compliance with all applicable provisions under the terms of the Contractor grant; and (d) this agency is in full compliance with all applicable tax laws and hereby affix original signatures. PREPARED BY: Name, Title, Date APPROVED BY: Name, Title, Date City of PALM SPRINGS Use Only Audited by: Examined by: Approved by: If necessary, additional sheet(s) must be attached detailing cost breakdowns, and verified by original signatures. CITY OF PALM SPRINGS EXHIBIT E Semi -Annual Program Progress Report Proiect/Activity Title: Project Number: Desert AIDS Project Name/Address of Provider: Desert AIDS Project 1695 N. Sunrise Way Palm Springs, CA 92262 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First -Time Program Beneficiaries Serviced: # of Households # of Persons < or = 30%: 30-50%: 50-80%: > 80%: ♦ Number of First -Time Female Headed Households: Counts by Race/Ethnicity: White American Indian or Alaska Native AND White Black/African American Asian AND White Asian Black/African American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/IATINO ETHNICITY: Mexican/Chicano Cuban ♦ Number of Disabled: ♦ Number of Homeless Persons Given Overnight Shelter: Puerto Rican Other: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date ACORO® �� CERTIFICATE OF LIABILITY INSURANCE 10/5i2021 DATE (MMIDD/YYYY) 10i2i2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers,LLC CA License #OF15767 777 S. Figueroa Street, 52nd fl. Los Angeles CA 90017 CONTACT NAME: PHONE FA No E-MAIL ADDRESS: 213-689-0065 INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Fire and Marine Insurance Co 20079 INSURED Desert AIDS Project Inc. 1419776 1695 N. Sunrise Way INSURER B : Travelers Property Casualty Co of America 25674 INSURER C : Palm Springs CA 92262 INSURER D : INSURER E : INSURER F : COVERAGES DESAI01 CERTIFICATE NUMBER: 14391990 REVISION NUMBER: XXXXXXX 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. ILTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MMIDDPOLICY EFF MM/DD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE U OCCUR Y N H1V017770 10/5/2020 10/5/2021 EACH OCCURRENCE $ 1000000 PREM SES Ea occu ence $ 250,000 MED EXP (Any one person) $ XXXXXXX PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO SCHED AUTOS ONLY AUTOSULED HIRED NON -OWNED ONLY AUTOS ONLY N N 810-6N644236-20-43-G 10/5/2020 10/5/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $OWNED I INJURY (Per accident) �BODILY $ XyXX ${�{}{�{}{}{AUTOS PROPERTY DAMAGE Per accident Comp/Coll Ded $ 1,000 UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXX= AGGREGATE $ xxxxy,_� DED RETENTION $ $ �{�{�{�{�{]{�{ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) y s, describe under DESCRIPTION OF OPERATIONS below N I A NOT APPLICABLE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE $ �{�{�{}{XXX E.L. DISEASE - POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Palm Springs, it's officers, employees and agents are included as additional insureds with respect to General Liability. General Liability coverage shall be primary and non-contributory. A thirty (30) day notice of cancellation applies. CERTIFICATE HOLDER CANCFI I ATIrIN 14321290 City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 2743 ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs CA 92262 AUTHORIZED REPR 7At o�-11&1111110__ ACORD 25 (2016/03) ©1988-2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF WORKERS' COMPENSATION COVERAGE DATE Dec 11, 2020 PRODUCER NonProfits' United Workers' Compensation Group 610 Fulton Avenue, Suite 200 Sacramento, CA 95825 Phone: (916) 868-6231 Fax: (916) 880-5251 THIS CERTIFICATE IS ISSUED AS 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. Arthur J. Gallagher & Co Insurance Brokers of California, Inc 1255 Battery Street #450 San Francisco, CA 94111 INSURERS AFFORDING COVERAGE INSURED INSURER A: NonProfits' United Workers' Compensation Group Desert AIDS Project 1695 N Sunrise Way INSURER B: Safety National Casualty Corp [NAIC415105] INSURER C: Response Indemnity Company of California [NAIL # 10970] Palm Springs, CA 92262 INSURER 0: INSURER E: COVERAGES This Certificate is not intended to specify all endorsements, coverages, terms, conditions and exclusions of the policies shown. THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER 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 COVERAGE 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. INSR LTR TYPE OF COVERAGE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ CLAIMS MADE I OCCUR MED EXPENSE (Anyone $ GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY $ POLICY I I PROJECT I LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Each accident) ANY Al ]To ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIREDAUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE cr Per accident X PER STATUTE 0 T A WORKERS' COMPENSATION AND NPU-WCG 001-2021 1/1/2021 1/1/2022 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 EMPLOYERS LIABILITY E.L. DISEASE -COVERAGE LIMIT $ 500,000 OTHER C XSWC -Buffer Layer ABL1000013-00 1/1/2021 1/1/2022 XS of $500,000 $250,000 (EL & WC) B XSWC SP4064079 1/1/2021 1/1/2022 XS of $750,000 $2,000,000 (EL) XS of $750,000 Statutory (WC) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS Waiver of Subrogation provided by Endorsement NPUWCG-DAID-011 CERTIFICATE HOLDER CANCELLATION NPU WCG-DAID-011 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED City of Palm Springs IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Tahquitz Canyon Way Palm Springs, CA 92262 6959 City Clerk Based on ACORD 25 (2016/03) THIS ENDORSEMENT CHANGES THE MEMORANDUM OF COVERAGE PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US NonProfits' United Workers' Compensation Group Memorandum of Coverage: NPU-WCG 001-2021 This endorsement modifies the coverage provided under the following: Memorandum of Coverage: PART ONE: WORKERS' COMPENSATION COVERAGE Paragraph H. RECOVERY FROM OTHERS is amended with respect to the following: Name and Address of Person or Organization: City of Palm Springs 3200 Tahquitz Canyon Way Palm Springs, CA 92262-6959 DESCRIPTION OF OPERATIONS/LOCATIONS ADDED BY ENDORSEMENT: - With regard to the City of Palm Springs, its employees and officers. NPU-WCG waives any right of recovery it may have against the person or organization shown above because of payments made by NPU-WCG for injury or damage arising out of the Members' operations done under a contract with that person or organization shown above and included in the coverage provided by the Memorandum of Coverage. This waiver applies only to the person or organization shown on the Schedule Above. This endorsement is part of the Memorandum of Coverage and is effective on the date shown below. All other terms and conditions remain unchanged. Effective Date: January 1. 2021 Expiration Date: January 1. 2022 Member: Desert AIDS Proiect Endorsement No: NPUWCG-DAID-011 Date Issued: Dec 11. 2020 Aut orized Representative for NPU-WC NPU-WCG Page 1 MOC: NPU-WCG 001-2021