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HomeMy WebLinkAboutA6392 - MIZELL SENIOR CENTERCERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 11/13/2024 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). CONTACT PRODUCER NAME: QUBtha Rodriguez Garcia Insurance Inc RECEIVED aCNN Eau: (760)320-1711 FAX No: (760)320-1115 2099 E. Tahquitz Canyon Way ao..Ess: NOV 18 20]CA INSURER(S) AFFORDING COVERAGE Palm Springs 92262 INSURERA: GreatAmencsn Non -Profit INSURED OFFICE OF THE CITY CLERK INSURER B: Mizell Senior Center INSURER C : 480 South Sunrise Way INSURER D: INSURER E : Palm Springs CA 92262 COVFRAC.FR CERTIFICATE NUMBER: UL24111JU6411 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: EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ICY LTR TYPE OF INSURANCE INSD MD POLICY NUMBER MWDD/YYYY UP MW00 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR PREMISES Eacmareance $ 100,000 MEDEXP(Anypn.M.) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 A Y PAC5361176 01 10/14/2024 10/14/2025 GEN'LAGGREGATE LIWTAPPLIES PER GENERALAGGREGATE $ 3,000,000 POLICY 0 PRa JECT LOC PRODUCTS-COMP/OPAGG $ 3,000,000 S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident s 1,000000 BODILY INJURY (Per person) s ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CAP536117701 10/14/2024 10/14/2025 BODILY INJURY (Par accicent) s PROPERTY DAMAGE Per accident S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000.000 A EXCESS LIAR CLAIMS -MADE UMB 582750501 09/13/2024 10/14/2025 DED RETENTION S $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN PER OTH- STAT TE ER ANY ECUTIVE E. L. EACH ACGOENT $ OFFICERIMEMBER EXCLUDED❑ NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If'. descnt a Under DESCRIPTION OF OPERATIONS te. EL DISEASE -POLICY LIMIT s DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached it more space is requi ed) City of Palm Springs is named as additional insured. *10 day notice of cancellation may be issued for nonpayment of premium. City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 SHOULD 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (201111 The ACORD name and logo are registered marks of ACORD ' 81 ' 10/16/2024' PAC 5361176 01 00 Great American Insurance Company 'D/B' 340052464 410488 CG 89 70 (Ed. 11/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT This Endorsement modifies and is subject to the insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following extension only applies in the event that no other specific coverage for the indicated loss exposure is provided under this Policy. If other specific coverage applies, the terms, conditions and limits of that Coverage are the exclusive coverage applicable under this Policy, unless otherwise noted in this Endorsement. This is a summary of the various additional coverages and coverage modifications provided by this Endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Description Limit of Insurance Page Non -Owned Aircraft Included 2 Non -Owned Watercraft Included 2 Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Included 3 Medical Payments $ 20,000 3 Damage to Premises Rented to You $ 1,000,000 3 Supplementary Payments - Bail Bonds $ 3,000 4 Supplementary Payments- Loss of Earnings $ 1,000 per day 4 Newly Formed or Acquired Organizations Included 4 Unintentional Failure to Disclose Hazards Included 5 Knowledge of Occurrence, Claim or Suit Included 5 Property Damage Liability - Elevators Included 5 Property Damage Liability - Borrowed Equipment Included 5 Liberalization Clause Included 6 Amendment of Pollution Exclusion (Premises) Included 6 Limited Property Damage to Property of Others $ 5,000 6 Additional Insured - Manager or Lessor of Premises Included 7 CG 89 70 (Ed. 11/14) (Page 1 of 12) " 81 * 10/16/2024 * PAC 5361176 01 00 Great American Insurance Company "D/B* 340052464 410488 Coverage Description Limit of Insurance Page Additional Insured - Funding Sources Included 7 Additional Insured - By Contract Included 8 Primary and Non -Contributory Additional Insured Extension Included 10 Additional Insureds - Protection of Your Limits Included 10 Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Included 11 Property Damage Extension With Voluntary Payments $ 1,000/$ 5,000 11 Who Is An Insured - Fellow Employee Extension - Management Employees Included 12 Broadened Personal and Advertising Injury Included 12 A. Non -Owned Aircraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non -Owned Watercraft Under paragraph 2. Exclusions of SECTION 1 - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 60 feet long; and CG 89 70 (Ed. 11114) (Page 2 of 12) 81 ' 10/16/2024' PAC 5361176 01 00 Great American Insurance Company •D/B' 340052464 410488 (b) not being used to carry persons or property for a charge. C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Under SECTION V - DEFINITIONS, Definition 3.-is replaced by the following: 3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. D. Medical Payments If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $ 20,000; or b. the amount shown in the Declarations for Medical Expense Limit This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION 1 - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. However, this insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with the permission of the owner, caused by: i. rupture, bursting, or operation of pressure relief devices; ii. rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; III. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or iv. flood 2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: CG 89 70 (Ed. 11/14) (Page 3 of 12) ' 81 ' 10/16/2024 ' PAC 5361176 01 00 Great American Insurance Company 'D/B' 340052464 410488 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection system or water while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water or any combination of the six, is the higher of $ 1,000,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water." 4. As regards coverage provided by this provision 1. Damage to Premises Rented to You - paragraph 9.a. of Definitions is replaced with the following: 9. a. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract"; F. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $ 3,000 for the 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. 2. Paragraph 1.d. is replaced by the following: 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 $ 1,000 a day because of time off work. G. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a named insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. coverage A does not apply to "bodily injury" or property damage that occurred before you acquired or formed the organization; and c, coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. CG 89 70 (Ed. 11/14) (Page 4 of 12) 81 ' 10/16/2024' PAC 5361176 01 00 Great American Insurance Company 'D/B' 340052464 410488 d. records and descriptions of operations must be maintained by the first named insured. 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 or qualifies as an insured under this provision. H. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. I. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such injury, claim or suit shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership c. an executive officer or insurance manager, if you are a corporation. J. Property Damage Liability - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) of exclusion j. Damage to Property do not apply if such property damage results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. K. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) of exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. CG 89 70 (Ed. 11/14) (Page 5 of 12) 81 ' 10/16/2024' PAC 5361176 01 00 Great American Insurance Company 'D/B` 340052464 410488 L. Liberalization Clause If we revise this Signature General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the date the revision is effective in your state. M. Amendment of Pollution Exclusion (Premises) 1. The following is added to paragraph (1)(a) of Exclusion f. of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: (iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage, migration, release or escape of "pollutants." As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or escape of pollutants must: (aa) commence on a clearly identifiable day during the policy period; and (bb) end, in its entirety, within seventy-two (72) hours of the commencement of the discharge, dispersal, seepage, migration, release or escape of "pollutants"; and (cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape of "pollutants" commences; and (dd) be neither expected nor intended from the standpoint of any insured; and (ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and (ff) not originate at or from a storage tank or other container, duct or piping which: a, is below the surface of the ground or water; or b. at any time has been buried under the surface of the ground or water and then is subsequently exposed. 2. For the purposes of this coverage, the following is added to the definition of "property damage" of SECTION V - DEFINITIONS and applies only as respects this coverage: Land or water, whether below ground level or not, is not tangible property. 3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown to have actually occurred. N. Limited Property Damage to Property of Others The following is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B: 3. We will pay up to $ 5,000 for loss to personal property of others while in the temporary care, custody or control of an insured caused by any person participating in your organized activities. For the purpose of this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: a. coverage is otherwise provided by the Property Coverage part (if any) of this Policy; or CG 89 70 (Ed. 11/14) (Page 6 of 12) * 81 ' 10116/2024' PAC 5361176 01 00 Great American Insurance Company 'D/B' 340052464 410488 b. the loss is covered by any other insurance you have or by any insurance of such person who causes such loss. These payments will not reduce the Limits of Insurance. O. Additional Insured - Manager or Lessor of Premises 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an additional insured has been issued; but the written or oral contract or agreement must be an "insured contract," and, (i) currently in effect or become effective during the term of this Policy; and (ii) executed prior to the "bodily injury," "property damage," "personal and advertising injury." 2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1. above, the following additional provisions apply: (a) This insurance applies only with respect to the liability arising out of the ownership, maintenance or use of that part of the premises leased to you. (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein is excess over any other valid and collectible insurance available to the Additional Insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to: (a) Any 'occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Insured. P. Additional Insured - Funding Sources 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: CG 89 70 (Ed. 11/14) (Page 7 of 12) * 81 * 10/16/2024 * PAC 5361176 01 00 Great American Insurance Company *D/B* 340052464 410488 a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows: a. The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. b. The insurance afforded to the Additional Insured only applies to the extent permitted by law c. If coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. Q. Additional Insureds - By Contract 1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of: a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the Additional Insured that are subject of the written contract or written agreement provided that the "bodily injury" or "property damage occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. the maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or c. the Additional Insureds financial control of you; or d. operations performed by you or on your behalf for which the state or political subdivision has issued a permit However: 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide such additional insured. With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this Endorsement ends when: CG 89 70 (Ed. 11/14) (Page 8 of 12) " 81 ` 10/16/2024' PAC 5361176 01 00 Great American Insurance Company "D/B" 340052464 410488 (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this Endorsement applies only, if the written contract or written agreement is signed prior to the "bodily injury" or "property damage." We have no duty to defend an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured as required in paragraph b. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION. 2. With respect to the insurance provided by this Endorsement, the following are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: This insurance does not apply to: a. 'Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the 'occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. c. 'Bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 89 70 (Ed. 11114) (Page 9 of 12) ' 81 ` 10/16/2024' PAC 5361176 0100 Great American Insurance Company 'D/B' 340052464 410488 d. Any person or organization specifically designated as an additional insured for ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: a. required by the contract or agreement; or b. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This Endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. R. Primary and Non -Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) the Additional Insured is a named insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an additional insured on other policies. S. Additional Insureds - Protection of Your Limits This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: An additional insured under this Endorsement will as soon as practicable: CG 89 70 (Ed. 11/14) (Page 10 of 12) 81 ` 10116/2024' PAC 5361176 01 00 Great American insurance Company 410488 64 a, give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the Additional Insured; and c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part. d. we have no duty to defend or,, indemnify an additional insured under this Endorsement until suit" by the Additional Insured. we receive written notice of a s 2. The Limits of Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy of this Policy, whichever are less. These and defined in SECTION III - LIMITS OF INSURANCE limits are inclusive of and not in addition to the Limits of Insurance available under this Policy. T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) SECTIONUnder TV - of Rights f IIL GENERAL ry LIABILITYainst CO oDITIONS, the following is added to Condition B Us If required by a written contract or written agreement, we waive any right of recovery we may ayment we make for have against aper erationsaorl? your wo ksdone under a contract for'njury or damage that person or organization of your ongoing op p and incoccurs luded in the subsequent top pthe execution pOftthe written contract or writtenagreement.injury or damage U. Property Damage Extension with Voluntary Payments 1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: At your request we will pay for "loss" to property of others caused by your business operations for which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so. The "loss" must occur during the policy period and must take place in the "coverage territory." raph 1. graph 2. clusions of 2 SWith respect to the coverage 'afforded under pars ECTION I - COVERAGES A - Bodily Injury andgPropertybDamageaLiabi Liability sxamended as follows: Exclusions 1.(3), j.(4), j.(5) and j.(6) are deleted. 3. As respects coverage afforded by this coverage, SECTION III LIMITS OF INSURANCE is replaced by the following: Regardless of the number of insureds, claims made or "suits" brought or persons or organizations making claims or bring "suits": 1. Subject to 2. Below, the most we will pay for one or more "loss" arising out of any one "occurrence" is $ 1,000. 2. The aggregate amount we will pay for the sum of all "loss" in an annual period is $ 5,000. This aggregate amount is part of and not in addition to the General Aggregate Limit described in paragraph 2. of SECTION III - LIMITS OF INSURANCE. CG 89 70 (Ed. 11/14) (Page 11 of 12) ' 81 ' 10/16/2024 ' PAC 5361176 01 00 Great American Insurance Company 'D/B' 340052464 410488 V. Who Is an Insured - Fellow Employee Extension - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to your "employee." W. Broadened Personal and Advertising Injury 1. Unless "Personal and Advertising Injury" is excluded from this Policy, the following is ac SECTION V - DEFINITIONS Item 14.: h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Item through 14.e. CG 89 70 City of Palm Springs 3200 1:. l:ilu|iiit: *. \X':iv • Palm Spritvj,-;, C-alik'i t\i:t 02202 |:ilms|Min'.'.Ni-.i.o(n' August 7, 2018 VIA UNITED STATES MAIL AND E-MAIL Mark Marshall Mizell Senior Center 480 S. Sunrise Way Palm Springs, OA 92262 ericar@mizell.orq Re: Letter Agreement, 2018-19 Grant from City of Palm Springs to Mizell Senior Center Congratulations on receiving an award of a grant by the City Council of the City of Palm Springs ("City"). This letter agreement ("Agreement") memorializes the nature of the grant awarded to your organization, Mizell Senior Center ("Grantee") for the (fiscal) year 2018-19 (the "Grant"), and the terms and conditions upon which the City provides It. The City's grant of assistance to Grantee (the "Assistance") may be summarized as follows: $100,000 cash grant in support of the Nutrition Program The City makes this grant upon the following terms and conditions ("Terms"). Your signature below and return of this Agreement to the City shall serve as evidence of Grantee's acceptance of, and promise to follow all of the Terms. Despite Its Informality, City and Grantee Intend that this Agreement shall serve as a fully binding and enforceable contract between them in relation to the Assistance. City will tender all Assistance as quickly as practicable, and in coordination with Grantee's reasonable requirements as expressed to City, upon Grantee's return of this Agreement, fully executed, to the City. 1. Grantee Is known in the community for performing a function and/or providing services ("Services") that may reasonably be described as follows: Nutrition Program. Grantee warrants and covenants to City that It will to continue to provide Services throughout the 2018-19 fiscal year, and that It shall dedicate the entirety to the Assistance hereunder to funding and/or supporting Services. 2. In the event that Grantee anticipates or experiences any interruption of Its provision of Services, Grantee shall provide written notice to City of that fact, and execute any amendment to this Agreement that City deems necessary and appropriate. 3. The following principal of Grantee Is Identified as being Grantee's representative, authorized to act on Grantee's behalf with respect to the Services and all Interaction with City related thereto: Mark Marshall, Chair. I\>.st I ii c Box 274 3 • Piilui Sprini^s, Caliloi nia 92263-2743 August 7, 2018 Mizell Senior Center—Nutrition Program Page 2 4. Grantee and its representative shall ensure that all communications and other interaction with City necessary in relation to Services, the provision of Assistance, and this Agreement shall be with Anthony J. Mejia, City Clerk. 5. Grantee shall comply with all applicable federal, state and local law and regulations ("Law") in providing Services, and shall secure any and all necessary licenses and permits required by Law in doing so. 6. Grantee agrees to use the official City logo to acknowledge the City's support on its website in the manner noted below (with a hyperlink to the City's website) and on any printed materials associated with its program or event. Grantee is also encourage to include the City of Palm Springs in all relevant social media postings. Special Funding provided by The City of Palm Springs 7. Grantee shall, upon any reasonable City request, notify its employees, members and volunteers of opportunities to volunteer at City events. 8. Grantee is an independent organization, not affiliated with City except by way of this Agreement as a recipient of Assistance. Neither City nor any of its officials, employees, contractors, volunteers or agents (In the aggregate, "City's Related Parties") shall have any control over the manner, mode, or means by which Grantee, its managers, employees, contractors, volunteers or agents (in the aggregate, "Grantee's Related Parties") perform Services. Further, this Agreement does not establish any relationship whatsoever between City and any person(s) who receive or benefit from Grantee's Services ("Grantee's Beneficiaries"). Grantee warrants and covenants that none of Grantee's Related Parties or Grantee's Beneficiaries has any contractual or other relationship with City arising from or related to this Agreement. Grantee Is merely a sponsored entity recognized by City as worthy of City's Assistance, for the sole and exclusive purpose of promoting Grantee's Services in the community. However, in recognition of the fact that Grantee is receiving public funds pursuant to this Agreement in the form of the Assistance, City shall have the right to review Grantee's work product, results, records, and advice In relation to any Services rendered to Beneficiaries that are funded or supported, in whole or in part, by the Assistance. 9. Neither Grantee, nor any person who is one of Grantee's Related Parties or Grantee's Beneficiaries, shall at any time or in any manner represent that any person who Is one of Grantee's Related Parties or Grantee's Beneficiaries is one of City's Related Parties, by virtue of this Agreement or otherwise. 10. Grantee shall prepare and deliver to City a Final Report that documents Grantee's application of the Assistance to the advancement of Services; these reports shall include but not be limited to expenditures of City funds by Grantee. Final Report must accompany your application for the 2019-20 grant cycle, or be submitted by December 31, 2019 If you are not applying. 11. Grantee shall procure and maintain, at Grantee's sole cost and expense, policies of insurance as required by the City Attorney. August 7, 2018 Mizell Senior Center-Nutrition Proqram Page 3 12. To the fullest extent permitted by law, Grantee shall defend (at Grantee's sole cost and expense), inderpnify, protect, and hold harrrilessCjty and City's Related Parties from and against any and all liabilities, actions, suits, claims, demands, losses, costs, judgments, arbitration awards, settlements, damages, demands, orders, penalties, and expenses including legal costs and attorney fees {collectively ''GJaims"), including but not limited to Claims arising frbrti or related to (i) injuries to or death of persons, including without limitation Grantee's Related Parties and Grantee's Beneficiaries, (ii) damage to property, including property owned by any of Grantee's Related Parties, Grantee's Beneficiaries, or City, ////J any violation of any federal, state, or local law or regulation, and (iv) actual or alleged errors and omissions of Grantee or any of Grantee's Related Parties, to the full extent not directly caused by the negligehce or willful misconduct of the City or any of City's- Related Parties. Under no circumstahces shall the scope or nature of Grantee's insurance required by this Agreement be construed to limit Grantee's duty to indemnify, defend or. hold City harmless hereunder. 13. In connectfon with Services under this Agreement, Grantee shall not discriminate against any employee or applicant for emproyment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin {i.e., place of origiri, Inimigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical ccnditlon (each a "prohibited basis"). Grantee shall ensure that Grantee's Related Parties are employed, and that contractors and volunteers are engaged (to the extent applicable), and that Grantee's Related Parties are treated during their employmeht or engagement by Grantee, without regard to any prohibited basis. As a condition precedent to City's entry into this Agreement, Grantee has warranted and covenanted that Grantee's actions and omissions hereunder shall not incorporate any discrimfnation arising from or related to any prohibited basis in any Grantee activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or teritiination; provision of benefits,, rates of pay or other forms of compensation; and seJection for training, including apprenticeship. Grantee shall fully comply with the provislDns of Palm Springs Mgnlcipal Code Section 7.09.040 relating to non-discrimination in city contracting. 14. This Agreement contains all of the agreements between City and Gfanteei and cannot be amended or modified except by written agreement. If any portion of this Agreernent Is declared invalid or unenforceable by valid judgment, or decree of a court of competent jurisdiction, such invalidity or unenforceabiilty shall hot affect any of the remaining portions ofthis Agreement, which shall be interpreted to carry out the intent of the parties hereunder. Each of the persons executing this Agreernent on behalf of a party hereto warrants that he/she Is duly .authorized to execute this Agreement on behalf of said party, and that by so executing this Agreement the party hereto for which this Agreement Is executed is formally bound to the provisions of this Agreement. The parties may execute this Agreement in any nurriber of counterparts, received by the City as an original or as a digital image; together, all counterparts form a single document. Ciwulerk August 7, 2018 Mizell Senior Center - Nutrition Program Page 4 CITY OF PALM SPRINGS AGREED Mizell Senior Center By: /^C u R ; r' (3, A . cr iJArJcJ Name and Title David H. Ready, PhD City Manager Signature APPROVED BY CITY COUNCIL m|n>./7oiys i<A QERTIFICATE OF LIABILITY INSURANCE DATE<i|j/4ioD/yYyy| 02yd6if2018 "rWS CERTIPiCA.TE IS. ISSUED AS A MATTER PF. INf.ORMATlbj^ OSltyAHlDjlONFERS NO RIGHTS UPON THE fcERTIFlCATE HOLD^ THIS CERTIFICATE DOK ,NpT AFFIRMATIV^Y OR NEGAliVELV AMEND; .EXTEND. OR ALTER THE COVERAGE AFFORDED .BYTHE POUCI^ BELQWv THIS CffiT.fFICATE.pF INSURANCE DOES NOT CONSTITUTE A CONTRAof BETWEEN THBJSSUING INSURERi®), AUTHORIZED .REPRESENTATIVE OR PRODUCER,.AND THE CERTIFICATEHOLDER. ' . . liyiPORTANT; if the cei^lflc^to holder is. an AppmONAL IfrapREp,. the polfcyi^IeS): must haVa ADDITIONAL INSURED provisions or Be endoreSd. If .SUBROGATION IS WAiy^..subject to. the teims andcondilldns of the policy, certain poJicI^ may requlre'ah endbraerrient A atatementoh this certiflcate^does not center rights to the certificate hblderln lieu of such ehdorsementlfs). PROIWCER ARIhtego-lnsurahce .Group, LLC- -1601 TrapdJo Rdi.Sujte174 Waltham, MA 02451 , PAX.[«D.No,Extl: rAJc.NbIt fffisfi. 6 Lipport@apIntegQ.com . MSURERfSiAPiFbROING'COVEftAGE .'WAlCtf insu'r6R'A.j AmtKlst*^13512 INSURED Mlzell Senior-Center of Paim'Springs'(a cQrp} 480 B S.unrise Way Palm-Springs, CA 92262 INSURERBr .. INSURER c: INSURER D-: Insurer e: INSURER'F: T If .0 E POMCIES :0F. insurance, listed. BELOWHAVEBEEN ISSUEDTOthe INSlilREDNAMED ABOVEFORTHEPOUCyperiod-NOTWTHSTANPINQ. i^Y REQUIREMENT, TERM .OR.CONpTTION -OF ANY. CONTRACT OR OTHERVDOCUMENT WljH RESPECTfO'VVHiCHTHIS ERTIFICATE MAY BE ISSUED OR .MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED. HB^EJN 18 SUBJECT TO ALL THE THtMS' KGLUSIONS AND CONDITIONSOF SUCH FOUCIES.,ClMiTS SHOWN MAY HAVE been reduced BY, PAID CLAIMS' ' INSR LTR TypeOFlNSUfWNCE aodl msD SUBS WVP poucy number poucyefk TMM/DDIVYVVl . POUCV.EXP: mnmorrrm UMITS COMMERCIAL B eneralliabiuty; 3E □ OCCUR Mch occurrence"-S- CLAIMS^J^I DAMAGE TO RENTEDPRPMSlS (Pa oeeufmacol -S s peRsonal-c aov injury .5 GEI■fL aggregate Limit abFu'eb-pbr;policy □toe .OTHER: GeNEWU.. AGGREGATE '•s PRODUCTS-COMP/OPAGG s $ •AU1rOMOaiLSLIAB'tUTY s ANY AUTO' 'At^^S^ONLY 81?^ONLY sckeduleoPAJJOS ■aODILYINjURV (Peroarsotil s' aoOlLV lNJURY'(Pir.acelooBH 's s s .uMajREiaA uab; EliC&BS.UAB OCCUR C.LAIM^^bE •EACH OCCURRENCE 'S aggregate:S ■ DED RETENTIONS sAWORKERSCOMRSaSAnOfl.,WIDEM.PLOYERS^OABlUtV. y.y^ IfYs^dos^'beiuntfbr.. .. ...OSBCRIRTION OF OPERATIONS beftMr KM X SWC117871E 01?31/20i8 01/31/201.9 Y PER OTH--A STATlim PR .E;L each accident s 1,000,000 E L. DISEAS&..EA EMPLOYEE 5 1,000.,0Gi0 E.L. DISEASE •> POLICY LIMIT 5 ^ '1,000,000 City of Palm SpHjigsAtthr Griy Cjerk P0 Box 2743 SHOUIJD.-ANY ofTHe ab5ve,6escribe6 Policies be cancelled beforeTHE EXPIRATION DATE fHEREpF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. ucuivcKtsu in Palm Springs, CA 92262 . I - AGORrr OR MfT-iRinii AUTHORIZEO REPREBENTAnVE The ACbRD nartie-and logo are registered marks of ACORD AiCOk:tf GERTiFlGATE OF UABfLITY INSURANGE DATEiMM/DDttYiWJ ■tfl/2iM0.T8 THlS.CERTiFtCATE IS ISSUED AS,A MAtr£R<7F tNFORMATIO]^ ONLY AND CONFERS NO RIGKfS UPON THE CERTiRCAtB HOLDER. THISCERTIFIQATE POES NOT AFFIRMATIVELY OR MEGATl'VEUV AMEND, EXTEND OR ALTER T-HE CgVERAGEAFFORDED BY THE'P.OLiqlESBELOW. THIS CERTIRCAtE OF INSORANCB'DOES NOT CONStfTUtE A CONTRACT BETWEEN THE ISSUING iNSURERiS). AUTHORIZED RERRESENTAir'^E OR PR0DUCER;.ANP THE CEPrOFIQAJE HOLDER. fMPpRTANTr tfth8(^rtlfl^te holderlsan ADDlTlphULJNSUREPitHe p<dic$(le9) niU8];havA;ADDmoNAL INSURED piroYlaldhs or&eenilaned.if SOBROGMTION ISi^AIVED, sabject tafte tem}'s and'cdnditlons of the.poHi^, calkin policies may require an encTottenisnt A stalemenfbn . tills csrt|flea(edo^;nptcohfer rights, to certificate'fipider in ileu of such. endof88)ti8nt(s}« PRODUCER ■isl.CommuRjly Insurance Senn'ces PO Box. 2^08 Paiin.Spr.fngs CA 922B3 is'lCoiTirnunlty Insurance Services PHONE .. I.8AXrAI&Na. Extl: 1 (AiC. Ko|: A^kssi Sfirvfc^clspa^oom maURSdsiAPPOIUlll^CbVERAGE •NAIC8 .iNSUR^At Ncn Pfontsrn3iiranceAiBan,ce^of Cdiforrna"HIAO tNSUREp Mfast! Sertldf Centerjof Pairt] Springa. 480 Solid) Sunri^ Way Palin'SpnhQs OA 82262 IHSURERSi INSURER C: .INSURER Dj INSURERE: WSURERFt THIS iS.TO CERTIFY THAT THE POLICIES-GF INSURANCE LISTED BELOW.HAVB BEBNJSSUED TO THE INSURED NAMED ABOVB FDR THE POUCV PERIOD-, INDICATED. NpTWrHSTANDIf« APjY.REQUlRB^ENT.TERM 0^^ OF ANY.CONTRACT OROTBER DOCUMENT W»tH.RESPECTTO WHICH THIS ;CERflFICATEMAy"S&lSSOEDOR.MAY PERTAIN,THE i|«JSURANCEAFIH3raE0 BY THE-POUCIES D^RBED HElietN IS SUBJECT To All'thE TERMSEXCLUSiONSAND CONOITlGNSbF SUCH POUCIES^UMltS SHOWN MAV HAVE BEEN REDUCED SV-PAID pUlMS; INSK LTB TYPHrOFIRSUiiAdCE SDDL tNSb SUBR WVD POUbYNUMBER PbUbY-EFT^lMMia22iYYyy>,POUfiyejefe-■(MMmn/YYYV)•LIMITS A X CDMMERCtALffiFERAL UABn^= e 1 X| OCCUR y .ZOtT-OSBSS 10/14/2017 1CV14/2018 eachoccH/rrence s i.ooo;qdo CLAl&e-MAO UAMAfiEIOflENTEtt- PREMESES'IEa otsuiTanco)S .500.000 MED EXFCAiq^eno perieol ^ 20.000 PERSONALS WJVXrUURY J 1.000,000 •jGET X IIAGSREGATE LIMIT ARPUEa PER:POLICY EZ] 5e^" D LOC OTH^ OENERAL AOGREGATE:, 2.ooo;oqp: PflODUCTSVCOMPyOP A<5<3.g .2.000i<JCO HdslUqtJOTilabiilty S T.OM'.OCO .A AU1 X -OMOaiLE-UABli^ ■2Q17-08858'10/1.4/20.17-10/14/2018 COMSiNEO SiNdid UMlt (Ea'aisMSAi) 'S I.QOO.GtfO ARyMWO OWNED.wrosoNiy- MREOALITOS-C^ scheduled AUTOS . MOM-OWNED AUTOS ONLY B.OblLY INJURV (Pcf pMOn);S bodily INjURY' (Pereeddcnt)'s PROPERTT-OAMAOe(PeracefafentV s Medical piaynients s 5;aoD A X UMBRQAAUAB excess UAB- OCCUR. CLA(MS4ylADE 2diy«06aSB*UMB lQ/i4/20T7 IO/IVl/2018 EACkiCRXURREfrCE V 1,000,000 Aggregate S 1,000,000 DEO 1 X RBTBMTION.S- '"'.^'00 WORKERS COMPEHSAHPNARb EMPUDYERS' UABILITY y / ^ ANt PFOPWETdRffARTNEWEXECUrn/e i 1 .OFSICERAiEMBER DCCliJOEO?' ■M'NH){f:^es.'4s«filM undfi/ . . □ESCRlPnON dFaFERAnONS bdw; N/A ■il»6A ^ ■ lOTH-ISTAniTE I.ER E".L EACH ACCIDENT 5. . E.L. DISEASE, EA EMPtClYEE..$ EU oiiSEASe-rPQUCy LIMIT ■■S A.Pirecipra and. Officers LfabiUly 2017-068SB 10/14/2017 10/14/2018, 3t,p0d,0fl0 .DESCRIPTION.PFPP^ATIONS f U]CAT10NS./VEHiq.ES*(ACORDipi, ArfdWopal Wm"arlt#-5ch.o.evf«/rn»>|»:alLcta IMnoi!<l.8^»/»Rulred) CeilK|rate holder-Is nerafed as addjUqqal insured, if lidicated by "V" above^ AdcllUbnal'ltisuredEiatus abplles oHIy -ld.thq ejcfeni that die-work is.pp(fprrted under or sCbjeci to a ^tan'aSra^Bni'br contract nrapolicy-provisidns gwerji Jn alt'slluaiions.- Cily.qi Palm Spdngs P;Qi Box 2748 .Palm-Spn'ngs CA 92262 ■ -1 ■ SKPULiyANY QFTHE^BOVE.DBSCRIBED POIdClESBECANGBLUEO BEFORE TH^ BXPJRATIPN DATE THEBEOF, NOTICE WILL BE DEtlVERED INACpORDANCEiWitH THE.pbUCY PljlOVISiCiNB, AdT»OftiZED REPRES^TA-nVE ACORD'^t2ai6703)the ACORO name and logo-are reglsterett marics of ACORD SUBRECIPIENT AGREEMENT ^ THIS AGREEMENT (herein "Agreement"), is made and entered into this^^day of 2018. by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Mizell Senior Center of Palm Springs . (herein "Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et seg.), as amended from time to time (the "Acf), and the regulations promulgated thereunder (24 C.F.R. Section 570 et sec. ("Regulations"); and WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit organizations for certain purposes allowed under the Act; and WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible for a grant of CDBG funds and the City desires to assist in the operation of the program by granting CDBG 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; NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF PROVIDER. 1.1 Scope of Services. Provider agrees to provide to City all of the services specified and detailed in its application for funding and Exhibit A. Provider represents and warrants to City that it is able to provide, and will use funds granted by the City to provide the services represented in the Provider's application for funding. City provided funds shall be used only for those purposes specified in such application and this Agreement. 1.2 Compliance with Law. All services rendered hereunder shall be provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of the City and any Federal, State or local governmental agency of competent jurisdiction. 1.3 Reports. No later than ten (10) days prior to any payment date specified in Section 2.0, within ten (10) days following the termination of this Agreement, and at such other times as the Contract Officer shall request. Provider shall give the Contract Officer a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of contract funds hereunder, if applicable. At the times and in the manner required by law, the Provider shall provide to the City, the Department of Housing and Urban Development, the Comptroller General of the United States, any other individual or entity, and/or their duly authorized representatives, any and all reports and information required for compliance with the Act and the Regulations. 1.4 Financial Reporting. Any Provider receiving or due to receive $20,000.00 or more from the City during the 2018 - 2019 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 which 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 fi nancial information provided for in this paragraph shall be fumished not later than January 31®* of the current fiscal year. ORIGINAL BID AND/OR AGREEMENT 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for its services a sum not to exceed FORTY THOUSAND DOLLARS ($40.000.00) {the "Contract Sum") in accordance \A/ith the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City periodic statements, in the form of Exhibit F, on reimbursable expenditures pursuant to the attached Budget along with pertinent supporting documentation. The City shall promptly review the monthly expenditure statements and. upon approval, reimburse the Provider its authorized operating costs. 2.2 Pavroll Records. In cases where the contract sum will reimburse payroll expenses as part of operations, the Provider will establish a system of maintaining accurate payroll records which will track daily hours charged to the project by the Provider's respective employees, as set forth in 0MB Circular A-122 Attachment B.6. 2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance of at least 25% of the total grant by the end of each fiscal year quarter (September 30, December 30, March 31, and June 30) shall result in the immediate forfeiture of 25% of the total grant. 3.0 COORDINATION OF WORK. 3.1 Representative of Provider. The following principals of Providers are hereby designated as being the principals and representatives of Provider authorized to act in its behalf with respect to the work specified herein and make all decisions in connection therewith: Laura Castillo. Director of Nutrition & Operational Services 3.2 Contract Officer. The Contract Officer shall be such person as may be designated by the City Manager of City. 3.3 Prohibition Against Subcontracting or Assignment. Provider shall not contract with any other entity to perform in whole or in part the services required hereunder without the express written approval of the City. Neither this Agreement nor any interest herein may be assigned or transferred, voluntarily or by operation of law, without the prior written approval of the City. 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 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 bme 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. -2- 4.2 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; (b) Section 109 of the Housing and Community Development Act of 1974, as amended and the regulations issued pursuant thereto; (c) Section 3 of the Housing and Urban Development Act of 1968, as amended; (d) Executive Order 11246, as amended by Executive Orders 11375 and 12086, and implementing regulations at 41 CFR Chapter 60; (e) Executive Order 11063, as amended by Executive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended, and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 (j); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (I) The Provider is to carry out each activity in compliance with all Federal laws and regulations described in 24 C.F.R. 570, Subpart K, except that the Provider does not assume the City's environmental responsibilities described at 24 C.F.R. 570.604; nor does the Provider assume the City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52; (m) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11288 relating to the prevention, control and abatement of water pollution; (n) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; 0MB Super Circular 2 CFR 200 as they relate to the acceptance and use of federal funds under the federally-assisted program; -3- (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 sea.): (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 (v) Such other City, County, State, or Federal laws, rules, and regulations, executive orders or similar requirements which might be applicable. 4.3 The City shall have the right to periodically monitor the program operations of the Provider under this Agreement. 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 carry 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 as an additional insured shall be delivered to and approved by the City 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 officers, or employees. 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 officers and employees, 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-Liabilitv of Citv Officers and Employees. 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. 6.3 Covenant Against Discrimination. In connection with its performance under this Agreement, Provider shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin ( i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Provider shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Provider certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Provider activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Provider is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. 6.4 Term. Unless earlier terminated in accordance with Section 6.5 of this Agreement, this Agreement shall continue in full force and effect until completion of the services, but not exceeding one (1) year from the date hereof. 6.5 Termination Prior to Expiration of Term. a. In accordance with 2 CFR 200.339, the City may suspend or terminate, in whole or in part, this Agreement if Provider fails to comply with any term of this Agreement or the terms and conditions of the subaward; b. In accordance with 2 CFR 200.339, the City may terminate this Agreement with the consent of the Provider after both parties have agreed upon the termination conditions, including the effective date and, in the case of a partial termination, the portion to be terminated; and 5- c. The Provider may terminate this Agreement at any time, with or without cause, upon thirty (30) days' notification setting forth the reason(s) for such termination, the effective date and, in the case of partial termination, the portion to be terminated. Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. However, if the City determines in the case of partial termination that the reduced or modified portion of the subaward will not accomplish the purposes for which the subaward was made, the City may terminate the subaward in its entirety. Provider shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and City shall be entitled to reimbursement for any services which have been paid for but not rendered. 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: Mizell Senior Center of Palm Springs 480 S Sunrise Wav Palm Springs. CA 92262-7641 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 ] -6 CITY OF PALM SPRINGS a municipal corgpration APPROVED AS TO FORM: AssLcity Attorney PROVIDER: Check one: City Manager APPROVED BY CITY COUN ^ Individual _ Partnership Corporation {Corporations require two notarized signatures: One signature must be from the Chairman of Board, President, or any Vice President. The second signature must be from the Secretary, Assistant Secretary, Treasurer, Assistant Trea^rer, or Chief Financial Officex)tary, i reasurer. Assistant I rea^rer, or cnier hinancia By:. Notarized SignatuNotari^^ Signature of Ch^ii^n of Boar^, Pr^ident or any ViceTresident Name: / a)(a^s4/>I / Title: A H-.PU-r' State of ) County 0^ ) ss A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. state of County of \AJ^ ) ss. I .>PK re Secretary, Asst^ecretary, Treasurer, Asst Treasurer or Chief Financial Officer Name: Title: state of Cgvli^gYVVt<V ) County of. .) ss A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of County of ) .) ss. before me. appeared U- tWiUU who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)(^re subscribed to the within instrument and acknowledged to me that(5i^she/they executed tte same in (^her/their authorized capacity(ies). and that bi(m^her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and olTipi^l se; Notary Signature: un_i (W •>ov6 before me, il'^ji^sonallv appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)(ii)are subscribed to the within instrument and ackr^ledged to me that het^j^they executed the same in his(Fe^heir authorized capacity(ies), and that by hisff^jtheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offici Notary Signature: Notary Seal; 1 CYNTHIAA BERARDI 1Notary Public-California • ? Riverside County > 1 Commission # 2229138 r^ li/ty Comm. Expires Feb 18,2022 y 1 CYNTHIAA BERARDI &< ~ California |i Riverside County 1 j Commission #2229138 r f My Cemm, Exoiroa Feti ifl pn?? 1 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activitv Title: Prelect Number: Mizell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 Objectives/Activities The intent of this program is to provide programming and services for extremely-low income to low income seniors and frail elderly. This will be accomplished through the continuation of their facility's energy-efficiency upgrades. These upgrades will convert an existing open-area patio space to a usable area for programs and services. This too will result in considerable energy-savings due to the constant through traffic and opening of exterior doors, which results in energy loss (cooling and heating) throughout the year. Mizell primarily covers the City of Palm Springs, and the adjacent two communities of Cathedral City and Desert Hot Springs serving 2,750 clients West Valley and 2,200 Palm Springs' clients. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the Citv bv timelv providing anv additional information reouested. 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 orocess. 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 orooram to facilitate positive promotion for all parties (i.e.. Provider. Citv. CDBG. etc.T TARGET DATE ACTIVITY #1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun's daily general circulation. Submit final publication to City. Objective 4: Enroll and income qualify at least a total of two thousand and two hundred (2.000) extremely low income to moderate-income Palm Sorinos residents in accordance with Exhibit D for improved access to the facility. TARGET DATE On-Going ACTIVITY #1 Provide direct client services and advocacy to help 2,750 Valley-wide residents. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: Maintain records for all CDBG activities related to this program. TARGET DATE On-Going On-Going ACTIVITY #1 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 Submit Semi-Annual reports - referenced Exhibit E within fifteen (15) calendar days of the program mid-year, December 31®', and program completion, June 30"'. Objective 6: Manaae/monitor orooram activities. TARGET DATE On-Going ACTIVITY #1 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 7: Make imorovements through Architectural & Engineering Services (A&E) and associated construction costs to convert ooen-area oatio space to a usable area. TARGET DATE ACTIVITY #1 On-Going Conduct activities to improve availability/accessibility in accordance with an 'open competitive' procurement process as stipulated in this Agreement and in consultation with the City. Objective 8: Provide an evaluation within fifteen (151 calendar davs of the program completion or final reimbursement. TARGET DATE 07/15/19 ACTIVITY #1 Provide an evaluation and final report on all programmatic and financial activities. 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 Budget Summary Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BUDGET SUMMARY COST CATEGORY CDBG SHARE OTHER SOURCES TOTAL COST 1 Personnel -0--0--0- 2 Consultant/Contract Services Architectural Services -0--0--0- 3 Travel -0--0--0- 4 Space Rental -0--0--0- 5 Consumable Supplies -0--0--0- 6 Rental, Lease or Purchase of Equipment -0--0--0- 7 Insurance -0--0--0- 8 Other - Construction/Rehabilitation $40,000.$30,446.$70,446. Contingency Proiect Management -0-$4,554.$4,554. TOTALS $40,000.$35,000.$75,000. * 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. Other funding sources may include Mizeil's contribution of $35,000. 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 30 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, 2018 through June 30, 2019 with funds allocated from 2018-19 Program Year. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Prolect/Activitv Title: Project Number: MIzell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non Profits Insurance Alliance of California Effective Dates of Policy 10/14/18 to 10/14/19 Claims Made Policy / / Per Occurrence Policy / / Limits of Liability $2.000.000 Deductibles; Per Occurrence Annual Aggregate. Additional Insured Endorsement (Certificate Holder) IZI Yes □ No Original Certificate of Insurance Attached □ Yes IZI No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Amtrust Effective Dates 01/31/18 to 01/31/19 Limits of Liability $1M Per Occurrence Underlying Coverage Limits. Original Certificate of Insurance Attached □ Yes IZI No eERTIFlCATE OF LIABILITY INSURANCE DATEiMMfl3D/YYYY| 10/26/2016 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 IN.SURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{le&) must have ADDITIONAL INSURED provisions or be endoreed. If SUBROGAtlON IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate doiss riot confer rights to the certificate holder in lieu of such endprsement(s). PRODUCER NFP Property & Casualty Services, Inc. 400 S Farrell Drive B170 Palm Springs CA 92262 NFP Property & Casually Services (760)325.7400 ™ (780)325.7609 AMRESS: servicepal@nfp.eom INSURER(S) AFFORDING COVERAGE NAtC« INSURER A; ^on Pronislnsurafice Alllance.of California NIAC INSURED Mizeil Senior Center of Palm Springs 480 South Sunrise Way Palm Springs CA 92262 INSURERS: insurer C ; INSURER D: INSURER E: INSURER F: COVERAGES CERTinCATE NUMBER: 2018-2019 Liability 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 REqUIREIWENT, TERM OR CONDITION OF ANV CONTf^CT 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 ^CH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR LTR TYPE OF insurance ADDL INSD SUBK WVD PQUCY NUMBER POLICY EPF IMM/DDtYYYYI POUCYEXP IMMTOOyVYYVI UMITS A X COMMERCIAL GENERAL LlABIUTY e 1 X| OCCUR Y 2018-06856 10/14/2018 10/14/2019 EACH OCCURRENCE 5 1,000.000 CLAIUS-MAO DAMAGE TO PENTEO PREMISES (Ea occuirenbe)^ 500,000 MEO £XP (Any one person)S 20,000 personal & ADV INJURY 5 1,000.000 GEN-L AGGREGATE LlMfT APPLIES PER;GENERAL AGGREGATE S 2.000,000 X POLIGY 1 1 jIcT L_J log OTHER; PRODUCTS - CGMP/OP AGG g 2.000.000 Liquor Liability S 1,000,000 A AUTOMOBILE UABILITY 2018-06856 10/14/2018 10/14/2019 COMBINED SINGLE LIMIT (Eaiicctdeni)S 1,000.000 X ANY AUTO HEOULED rros N.OWNED TOSONLY BODILY injury (Per parson)s OWNED AUTOS ONLY HIRED AUTOS ONLY sc AU BODILY injury (Par ecddenl)s NL AU PR0RER1Y DAMAGE (Per accident)s Medical payments S 5,000 UMBRELLA UAB EXCESS UAB OCCUR CUIMS-MAOE EACH OCCURRENCE s AGGREGATE s DEb retention S s workers COMPENSATION AND EiytPLOYERS' LlABIUTY y, ANY PROPRIETOR/PARTNER/EXECUTIVE | 1 OFFtCERrUEMBER EXCLUDED? (Mandatory In NH) tr yet, desdtbe uiuier DESCRrPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L EACH ACCIDENT s E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT S A Directors and Officers Liability Improper Sexual Conduct Liability 2016-06656 10/14/2018 10/14/2019 SI,000,000 S250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD l6l, AifditJonal Remarks Schadulct, may bp pltacKed If more space (s requlradj Cerliricale holder is narned as additional Insured if indicated by'T' above. AdditiohaI insured status spplies only to the extent that the work Is perfomte&v. under or subject to a written agreerrient or ccnttacL The policy provisions govern in all situations, //f) J k /i City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN^6^C;|DBEF0RE / THE EXPIRATION DATE THEREOF, NOTTCE WILL BE DELIVERED IN^"^;:;^ / ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 AUTHORIZED REPRESENTATIVE Palm Springs CA 92262 1 ACORD 25 (20^6/03] ® 1988-2015 ACORD CORPORATION. All rigtits reserved. The ACORD name and logo are registered marks of ACORD NONPROFITS INSURANCE ALLIANCE OF CAUFQRNIA A Head for Insurance. A Heart forNeoproflts, Policy no.; 2018-06856 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF CANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESS AUTO COVERAGE FORM CanceHation: 30 Days Notice of Cancellatlbn Person or Organization City of Desert Hot Springs, Desert Hot Springs Senior Center Riverside County Office on Aging City of Palm Springs If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the number of days shown for cancellation. NIAC-E641012 POLICY NUMBER: 2018-06856 Named Insured: Mizell Senior Center of Palm Springs COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE % Name Of Additiohal lnsured Person(s) Or Organizatioh(s)Locatlon(s) Of Covered Operations 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 becorhing effective during the term of this policy. The additionai 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. All insured premises and operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional msured(sj at the location{is) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be perfomned by or on behalf of the additional jhsured{s) at the location of the covered operations has been completed; or CG 20 1G 04 13 Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to the insurance afforded to these additional ihsureds, the following is added to Section III - Limits Of Insurance; If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance; 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. IP CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heartfor Nonprofits. POLICY NUMBER: 2018-06856 FORM: NIAC-E61 1117 NAMED INSURED; Mizell Senior Center of Palm Springs THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section II - Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or omissions; or 2. The negligent acts or Ohrilssions of those acting on your behalf; in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products-completed operations hazard" or for liability arising out of the spje negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additionarinsured(s) at the location of the covered operations has tieen completed; or 2. That portion of "your work" out of which injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The following is added to SECTION III — LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified In the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of Insurance under this policy. NIAC-E61 11 17 Page 1 of 2 Bhi Nonprofits policy number: 2018-06856 form: niac-e6i h 17 Insurance insured: Mlzell senior Center of Palm Springs ALLIANCE OF CALIFORNIA A Haad for Insurance. A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4. Other Ins SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the folio 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this Insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other Insurance to which the additional insured(s) has been added as an additional insured or to other insurance described In paragraph b. below. b. Excess Insurance This insurance is excess over: i. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied fa y you with permission of the owner; (c) That Is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured{s) has been added as an additional Insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured{s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured{s}' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of: (a) The total arhount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of ajl deductible and self-insured amounts under all that other Insurance, (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additionarinsured(s) does not permit contribution by equal shares, we will contribute by limits, Under this method, each Insurer's share Is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NiAC-E61 11 17 Page 2 of 2 GERTIFICATE OF LIABILITY INSURANCE DATE(MMroO/YYYY) 02/08/2018 THIS C^TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRIVIAtlVELY 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 INSURERfS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poncy(ie5) 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 endorsementfs). PRODUCER AP Intogo insurance Group, LLC 1601 Trapelo Rd. Suite 174 Waitham, MA 02451 rAJc,1fo,Ext): "/W-No): AtSi^kss: support@aplntegb.com INSURER/SI AFFORDING COVERAGE NAICd INSURER A: Amtrust*'^13512 INSURED Mizell Senior Center of Palm Springs (a corp) 480 S Sunrise Way Palm Springs, OA 92262 INSURER B: INSURER C: INSURER D; INSURER E: INSURER P : COVERAGES CERTIFICATE NUMBER: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 CERnnCATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERHN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. ADOL SUBR iilYQ POUCYEFF IMM/DO/YYYV> poucr ExpTYPE OF INSURANCE POUCY NUMBER LIMITS(imiDtyrrrm COMMERCIAL GENERAL UABIUTY CLAIMS-MADE | [OCCUR EACH OCCLIRRENCE DAMAGE TQRENTED PRPMISPS fEa occurrgfieel MED EXP lArw ono personi PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER; POLICY I I LOG OTHER GENERAL AGGREGATE PRODUCTS - CQMPIOP AGG $ COMBINED SINGLE UMITAUTOMOBILE UABIUTY ANY AUTO OWNED AUTO&ONLY bodily injury IPw PBreonI SCHEDULED AUTOS BODILY INJURY (Per aeddenll AUT^SONLY WIOPERTY DAMAGE 1^wscGoonl UMBRELLA LIAB EXCESS LIAB OCCUR CUIMS-MAOE EACH OCCURRENCE RETENTIONS WORKERS COMPENSATION UTYAND EMPLOYERS' UABI V PER ^ STATUTE SWC1178716 01/31/2018 01/31/2019 1,000,000ANY PRCPRIETOWPARTNER/EXeCUTIVE if yes, descdbe under SCRIPTION OF OPERATIONS below E.L EACH ACCIDENT 1,000,000E L. DISEASE - EA EMPLOYEE 1,000,000E.L. DISEASE • POLICY LIMIT OPERATIONS / LOCATIONS / VEHICLES {ACORD 101, Additional.RCfiiarke'SehGdula. may bo attechoci If more epacoTs reaulfod) A Waiver of Subrogatldn applies In favor Of the certificate holder CERTIFICATE HOLDER City of Palm Springs Attn: City Clerk PO Box 2743 SHOULD ANY OF THE ABOVE DESCRIBED PbUCIES BBc^Rotetbep BBFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI5i«MD IN ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs, OA 92262 1 AUTHORIZED ^RESENTATIVE The ACORD name and logo are registered marks of ACORD CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household {legal guardian) receiving benefits fom the described project/activity. 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 (Riverslde-San Bernardino-Ontario, OA MSA - 04/01/18) AREA MEDIAN INCOME (AMI) LEVEL - $65,800 NUMBER OF PERSONS IN YOUR HOUSEHOLD: 1 2 3 4 5 6 7 8 EXTREMELY LOV\ INCOME 0-30% of AMI $14,150 $16,460 $20,780 $25,100 $29,420 $33,740 $38,060 $42,380 LOW INCOME 30-50% of AMI $23,600 $27,000 $30,350 $33.700 $36,400 $39,100 $41,800 $44,500 MODERATE INCOME 50 - 80% of AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 NON LOW & MOD INCOME > 80% $37,751 +$43,151 +$48,551 +$53,901 +$58,251 +$62,551 +$66,851 +$71,151 + 3. What race/ethnicity do you identify yourself as; please note that this self-identification is voluntary in accordance with equal opportunity laws? □ American Indian or Alaska Native AND White□ White □ Black/African American □ Asian □ American Indian or Alaskan Native □ Asian AND White □ Black/African American AND White □ 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 5. Do you have a disability? □ YES □ NO □ 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:DATE: ADDRESS:PHONE NO: SIGNATURE: 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 compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activitv Title: Project Number: MIzell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 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 Aiaskan Native American indian/Aiaska Native AND Biack/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: ¨ Number of Disabled: ¨ Number of Homeless Persons Given Overnight Shelter: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date_ CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT Description Approved Grant Amount Current Reimbursement Period Prior Reimbursement Period(s) Total YTD Reimbursement Grant Balance (Over/ Under) Other - Construction/Rehabilitation $40,000. TOTAL $40,000. 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:APPROVED BY: Name, Title, Date 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 G Employment Restrictions 1. Labor Standards The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act. the Copeiand "Anti-Kickback" Act (40 U.S.C. 276a-276a-5; 40 USC 327 and 40 USC 276c) and ail other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of $2,000.00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1. 3. 5 and 7 governing the payment of wages and ratio of apprentices and trainees to joumeyworkers; provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any. to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. 2. "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3. the regulations set forth in 24 CFR 135. and all applicable rules and orders issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these "Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968. as amended. 12 U.S.C 1701. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low-income residents of the project area and contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low- and very low-income persons residing in the metropolitan area in which the project is located." The PROVIDER further agrees to ensure that opportunities for training and employment arising in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to low- and very low-income persons residing within the metropolitan area in which the CDBG- funded project is located; where feasible, priority should be given to low- and very low-income persons within the service area of the project or the neighborhood in which the project is located, and to low- and very low-income participants in other HUD programs; and award contracts for work undertaken in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to business concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in which the CDBG-funded project is located; where feasible, priority should be given to business concerns which provide economic opportunities to low- and very low-income residents within the service area or the neighborhood in which the project is located, and to low- and very low-income participants in other HUD programs. The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements. b. Notifications The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective bargaining agreement or other contract or understanding, if any. a notice advising said labor organization or worker's representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training. CERTIFICATE OF LIABILITY INSURANCE DATEiMMfOD/mY} THIS CERTIFICATE IS ISSUED AS A MA'l tER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT>VFFiRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSnTUTE A CONTRACT B^WEENTHE ISSUING tNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder te an ADDITIONAL INSURED, the po|lcy(ies) rnust have ADDITIONAL INSURED provisions or be endorsed. If SUBROGAtlON IS WAIVED, subject to the tenns and cohdltians of the policy, certain policies may require an endorsement A statement on this certificate does riot confdr rights to the certificate holder In lieu of such endorsement^). PRODUCER N FP Property & Casually Se rvi ces, 1 nc. 40p S. FarrB!l Drive B170 Palm Sphngs CA 92262 NAME?*'^ NFP Property & Casualty Services (760)325.7«» (780)325-7609 ADDRESS: sefvic8p.al@nfp.com INSURER(S) AFFOROtNG COVERAbe NAICH INSURER A: Hon PrqfitsInsurance AlBance.of California NIAC INSURED Mlzefl Senior Center of Palm Spririgs 450.Soulh Sunrise Way .Palrri Springs CA 92262 tNSitRER a: INSURER C : INSURER D: INSURER E: INSURERF; Tfraff L7R THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQli|R^ENT. TERM OR CONDITION OF. ANY CONTI^Ct OR OTH^ DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN> THE INSURANCE AFFORDED. BY THE POliCiEiS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POMC}ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUlMS.' . .. • PCLlCY EPF.TYPE OF INSURANCE [XHDT INSD [SOBR WVD POUCY NUMBER POUCY exp.- COMMERCIAL GENERAL UABIUTY CtAIMS^MOE OCCUR GENl AGGREGATE LIMir APPLIES PER: PPUGY Q n LOC OTHER; X AUTpMOBlLE.UABiLnY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY UMBRELLA UAB EXCELS iJAB DED SCHEDULED AUTOS NONOWNEO AUTOaONLY OCCUR CtAJMS-MAOE retention s workers compensation AMD EMPLOYERS' LIABILITY ANY PROPRIETb{M»ARTNER/EXECllTiVE OFRCERA/IEMBER EXCLUDED? fM&n(^tory;{n NH)' If.yet, des^ibe under DESCRiPTION OFOPERATtONS below 2G18-Q88SS 2018-08856 IMMIDb/YYYYi 10/14/2018 10/14/2018 IMM/DO/YYYYI 10/14/2019 10/14/2019 UMITS EACH OCCURRENCE 5 1,000,000 DAUAG£7UHbNItt> PREMISES (Ea occurrence)500,000 MED EXP (Any one person)$. 20;Oao personal & ADV INJURY S LQOO.GOO GENERAL AGGREGATE S 2.000,000 PRODUCTS n COMP/OP AGG S 2.000.0Q0 Liquor Liability S 1,000,000 COMBINED Single limit (Eaiiccldent) n 'S 1.000,000 BODILY injury (Par parson)s BODILY injury (Porooadsn))s PROPERTY OAMaGE (Per accident)s Medical payments S-. 5.C00 EACHOCClJRRENCE AGGREGATE Y7N □ PER STATUTE OTH ER N/A E.L EACH ACCIDENT E.L DISEASE - EA EMPLOYEE E.L DISEASE-POUCY LIMIT Directors and Officers Liability Improper Sexual Conduct Uabfllly 2O18tO6056 10/14/2018 10/14/2019 $1,000,000 8250.000 DESCRIPTION OF OPERATIOMS/LOCATIONS / VEHICLES {ACOR0101. Additional Rapiarics Sehadule, may be eltacKed If.mdre space is required) Certiricate holder is narped as additional Insured if Indicated by "Y" above. Addffiorial insured status ^plies only to the extent that the wbric ls perfo under or subject to a written agreenient or contract Thepolicy provisions govern in.ail situations. % Cily .of Palm Springs P.O. 80X 2743 Palm Springs CA 92262 - 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANSfeSteQBEFORE /THE EXPIRATION DATE THEREOF, NbTTCE WILL BE 0EUVEREd1n^^£>. / ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED BEPRES0JTAT1VE ACORD 25 (20^6/03)The ACORD name and logo are registered marks of ACORD NONPROFITS Insurance ALLIANCE OF CALIFORNIA A Httad for InsuraiiM. A Heart forNonprofits, □Policy rio.: 2018-06856 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF GANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESS AUTO COVERAGE FORM Cancellation: 30 Days Notice of Cahcellatibn Person or Organization City of Desert Hot Springs, Desert Hot Springs Senior Center Riverside County Office on Aging City of Palm Springs If we cancel this policy for any statutorily permitted reason other than nonpaylTient of prerhium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the numberof days shown for cancellation. NIAC-E64 10 12 POLICY NUMBER: 2018-06856 Named Insured: Mizell Senior Center of Palm Springs COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDmONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person{s) Or Organizatlon{s)Locatlon(s) Of Covered Operations Any person or organization that you are required to add as an additional msured on this policy, under a written contract or agreement currently In effect, or becorhing effective during the term of this policy. The additionat insured status will not be afforded with respect to liability arising out of of related to your activities as a real estate manager for that person or organization. All Insured premises and operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured Is amended to include as an additional insured the person(s) or organlzation(s) shown in the Schedulei but only with respect to liability for "bodily injury'Vproperty damage" or "personal and advertising Injury" caused. In whole or jn part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing; operations for the additional insured(s) at the location{s) designated above. However.: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured Is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader thari that which you are required by the contract or agreernent to^ provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" ocGUrrlhg after: 1. All work, including materials, parts or equipnrient furnished in connection with such work, on the project {other than service, maihtehahce or repairs) to be periformed; by or on behalf of the additional jhsured(s) at the location of the covered operations has been completed; or CG20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" Out of which the injury or dartjage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional ihsureds, the following is added to Section ill - Limits Of insurahce; If coverage provided to the additional insured is required by a contract or agfeemeht, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. GG 20 10 0413 © Insurance Services Office; Inc., 2012 Page 2 of 2 Nonprofits policy nqmber: 2018-06856 form: niac-e6i hi? INSURA-NGE named insured; Mlzell Senior Center of Palm Springs ALLIANCE OF CALI FOfcNIA A Hgad for Insurance. A Heartfor Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Informatlpn required to complete this Schedule, If not shown above, will be shown in the Declarations.) A. Section II - Who Is An Insured is amdrlded to include any public entity as an additional insured for whom you are perfbrming operations, who may be named In the schedule above, when you have agreed in a wptten eohtract or written agreerhe.nt that such public entity be added as an additional Insijred(s) oh your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or orhissiorts; or 2. The negligent acts or omissions of those acting on your behalf; in the perforhiance of your ongoing operations; No such public entity is an additional insured for liability arising out of the "products-completed operations hazard" or for liability arising out of the sole negligence of that pubic entity. B, With respect to the insurance afforded to these additional !nsufed(s), the following additional exclusions apply. This insurance does not apply to "bodily Injury" or "property damage" occurring after 1. Ail work, including materials, parts or equipmeht furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addifipnai insured(s) at the location of the covered operations has been cbrhpleted; or 2. That portion of "your work" out of which injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. G. The following is added to SEGTION III — LIMITS OF INSURANGE: The limits of insurance applicable to the addltlpnal Insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. NIA0-E61 1117 Page 1 of 2 1 Nonprofits policy number: 201S-06856 F0RM:NIAC-E611117 Insurance named insured: Mlzell senior Center of Palm Springs ALLIANCE OF CAUFORNIA A Head for Insurance. A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured{s), Condition 4. Other Ins SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the folio % 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreernent (1) That this insurance be primary. If other insurance is also primary, we will sh^re with all that other insurance as described in c. below; or (2) The coverage afforded by this Insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1} and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage. Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permissioh of the owner; (c) That lis insurance purchased by you .to cover your liability as a tenant for "property damage'' to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured; by that other insurance. (1) When this Ihsurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additionar insured(s} against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional lnsured{s)' rights against all those other insurers. {2} When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this Insurance; and (b) The total of all deductible and self-Insured amounts under all that other Insurance. (3) We will share the remaining loss. If any,..with any other insurance that is not described in this Excess Insurance provision and was not bought specificaiiy to apply in excess of the Limits of Insurance shown In the Declarations of this Coverage Part. c. Methods of Sharing If all of the other Insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each Insurer contributes equal amounts until it has paid its applicable lirnlt of insurance or none of the loss remains, whichever comes first. If ariy other the other insurance available to the additional jnsuredfs) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicabie limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E611117 Page 2 of 2 IVflZESEN'Ol TPATOK DATE(MMmp/YYYY) ux/odaoiB REPl^Em!TI^^SreO^C°ER/i;§DT"^^^^^ CONTRACT BETWEEN THE ISSUING INSURERfSl, AUTHORIZED IT^BRO^tion"!! SSif hoW'T^s a'TjOOITIONAL INSUI^D,.U» pollcyfles) ihust have ADDITIONAL INSURED piovlstans or be endorsed. PRODUCER AP Ihtego Insurance Group, LLC 1601 Trapelo Rd. Suite 174^ Waltham, MA 02451 j/UCri^ Ext): AtSifflfess-support@aDintegb.com INSURERfSI AFFORDING COVERAGE NAIC0 INSURER A: Amtrust***13512 INSURED lyiizeli Senior Center of Palm Springis (a corp) 480 S Sunrise Way Palm Springs, CA 92262 INSURER B: INSURER C: INSURERD; INSURER E: INSURER F : INSR LL&TYPg OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS^MADE | [ pCCUR G.EN'L AGGREGATE LIMIT APPLIES PER: POUCY □ M □ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOSONLY mONLY UMBRELLA UAB EXCESS LIAB DEO ADOL i£lSB SUBR SCHEDULEDAUTOS OCCUR CUIMS-MADE RETENTIONS. WORK^S COMPENSATIONAND EMPLOYERS* UABIUTY W PROPRIETORyPARTNERffiXECUTIVE If yes, descdbB uimarOESCRIPTION OF OPERATIqNS below XiN N POLiCY NUMBER N/A SWC1178715 CERTIFICATE HOLDER Oi^ of Palm Springs Atln; City Clerk PO Box 2743 Palm Springs, CA 92282 POLICY EPFIMM/DDfYYVrn POUCY EXP IMMIDD/YVVYl LIMITS EACH OCCURRENCE RENTED a occtJtTgiieel MEO EXP lAnv ons oargcnl PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPfOP AG6 COMB NED SINGLE LIMITfEa BCCKlafrtl aODlLy INJURY IPof ofl/ronl BODILY INJURY fPar acddahn EACH OCCURRENCE STATUTB 01731/2018 01/31/2019 1.000,000EX EACH ACCIDENT 1,000,000E.L. DISEASE - EA EMPLOYEE 1,000,000E.L. DISEASE - POLICY LIMIT CANCELLATl&N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEcaJTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESSJTATIVE ACORD 26 (2016/03)1988-2015 ACQRD CORPORATION. All rights reserved.The ACORO name and logo are registered marks of ACORO City of Palm Springs 3200 1:. l:ilu|iiit: *. \X':iv • Palm Spritvj,-;, C-alik'i t\i:t 02202 |:ilms|Min'.'.Ni-.i.o(n' August 7, 2018 VIA UNITED STATES MAIL AND E-MAIL Mark Marshall Mizell Senior Center 480 S. Sunrise Way Palm Springs, OA 92262 ericar@mizell.orq Re: Letter Agreement, 2018-19 Grant from City of Palm Springs to Mizell Senior Center Congratulations on receiving an award of a grant by the City Council of the City of Palm Springs ("City"). This letter agreement ("Agreement") memorializes the nature of the grant awarded to your organization, Mizell Senior Center ("Grantee") for the (fiscal) year 2018-19 (the "Grant"), and the terms and conditions upon which the City provides It. The City's grant of assistance to Grantee (the "Assistance") may be summarized as follows: $100,000 cash grant in support of the Nutrition Program The City makes this grant upon the following terms and conditions ("Terms"). Your signature below and return of this Agreement to the City shall serve as evidence of Grantee's acceptance of, and promise to follow all of the Terms. Despite Its Informality, City and Grantee Intend that this Agreement shall serve as a fully binding and enforceable contract between them in relation to the Assistance. City will tender all Assistance as quickly as practicable, and in coordination with Grantee's reasonable requirements as expressed to City, upon Grantee's return of this Agreement, fully executed, to the City. 1. Grantee Is known in the community for performing a function and/or providing services ("Services") that may reasonably be described as follows: Nutrition Program. Grantee warrants and covenants to City that It will to continue to provide Services throughout the 2018-19 fiscal year, and that It shall dedicate the entirety to the Assistance hereunder to funding and/or supporting Services. 2. In the event that Grantee anticipates or experiences any interruption of Its provision of Services, Grantee shall provide written notice to City of that fact, and execute any amendment to this Agreement that City deems necessary and appropriate. 3. The following principal of Grantee Is Identified as being Grantee's representative, authorized to act on Grantee's behalf with respect to the Services and all Interaction with City related thereto: Mark Marshall, Chair. I\>.st I ii c Box 274 3 • Piilui Sprini^s, Caliloi nia 92263-2743 August 7, 2018 Mizell Senior Center—Nutrition Program Page 2 4. Grantee and its representative shall ensure that all communications and other interaction with City necessary in relation to Services, the provision of Assistance, and this Agreement shall be with Anthony J. Mejia, City Clerk. 5. Grantee shall comply with all applicable federal, state and local law and regulations ("Law") in providing Services, and shall secure any and all necessary licenses and permits required by Law in doing so. 6. Grantee agrees to use the official City logo to acknowledge the City's support on its website in the manner noted below (with a hyperlink to the City's website) and on any printed materials associated with its program or event. Grantee is also encourage to include the City of Palm Springs in all relevant social media postings. Special Funding provided by The City of Palm Springs 7. Grantee shall, upon any reasonable City request, notify its employees, members and volunteers of opportunities to volunteer at City events. 8. Grantee is an independent organization, not affiliated with City except by way of this Agreement as a recipient of Assistance. Neither City nor any of its officials, employees, contractors, volunteers or agents (In the aggregate, "City's Related Parties") shall have any control over the manner, mode, or means by which Grantee, its managers, employees, contractors, volunteers or agents (in the aggregate, "Grantee's Related Parties") perform Services. Further, this Agreement does not establish any relationship whatsoever between City and any person(s) who receive or benefit from Grantee's Services ("Grantee's Beneficiaries"). Grantee warrants and covenants that none of Grantee's Related Parties or Grantee's Beneficiaries has any contractual or other relationship with City arising from or related to this Agreement. Grantee Is merely a sponsored entity recognized by City as worthy of City's Assistance, for the sole and exclusive purpose of promoting Grantee's Services in the community. However, in recognition of the fact that Grantee is receiving public funds pursuant to this Agreement in the form of the Assistance, City shall have the right to review Grantee's work product, results, records, and advice In relation to any Services rendered to Beneficiaries that are funded or supported, in whole or in part, by the Assistance. 9. Neither Grantee, nor any person who is one of Grantee's Related Parties or Grantee's Beneficiaries, shall at any time or in any manner represent that any person who Is one of Grantee's Related Parties or Grantee's Beneficiaries is one of City's Related Parties, by virtue of this Agreement or otherwise. 10. Grantee shall prepare and deliver to City a Final Report that documents Grantee's application of the Assistance to the advancement of Services; these reports shall include but not be limited to expenditures of City funds by Grantee. Final Report must accompany your application for the 2019-20 grant cycle, or be submitted by December 31, 2019 If you are not applying. 11. Grantee shall procure and maintain, at Grantee's sole cost and expense, policies of insurance as required by the City Attorney. August 7, 2018 Mizell Senior Center-Nutrition Proqram Page 3 12. To the fullest extent permitted by law, Grantee shall defend (at Grantee's sole cost and expense), inderpnify, protect, and hold harrrilessCjty and City's Related Parties from and against any and all liabilities, actions, suits, claims, demands, losses, costs, judgments, arbitration awards, settlements, damages, demands, orders, penalties, and expenses including legal costs and attorney fees {collectively ''GJaims"), including but not limited to Claims arising frbrti or related to (i) injuries to or death of persons, including without limitation Grantee's Related Parties and Grantee's Beneficiaries, (ii) damage to property, including property owned by any of Grantee's Related Parties, Grantee's Beneficiaries, or City, ////J any violation of any federal, state, or local law or regulation, and (iv) actual or alleged errors and omissions of Grantee or any of Grantee's Related Parties, to the full extent not directly caused by the negligehce or willful misconduct of the City or any of City's- Related Parties. Under no circumstahces shall the scope or nature of Grantee's insurance required by this Agreement be construed to limit Grantee's duty to indemnify, defend or. hold City harmless hereunder. 13. In connectfon with Services under this Agreement, Grantee shall not discriminate against any employee or applicant for emproyment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin {i.e., place of origiri, Inimigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical ccnditlon (each a "prohibited basis"). Grantee shall ensure that Grantee's Related Parties are employed, and that contractors and volunteers are engaged (to the extent applicable), and that Grantee's Related Parties are treated during their employmeht or engagement by Grantee, without regard to any prohibited basis. As a condition precedent to City's entry into this Agreement, Grantee has warranted and covenanted that Grantee's actions and omissions hereunder shall not incorporate any discrimfnation arising from or related to any prohibited basis in any Grantee activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or teritiination; provision of benefits,, rates of pay or other forms of compensation; and seJection for training, including apprenticeship. Grantee shall fully comply with the provislDns of Palm Springs Mgnlcipal Code Section 7.09.040 relating to non-discrimination in city contracting. 14. This Agreement contains all of the agreements between City and Gfanteei and cannot be amended or modified except by written agreement. If any portion of this Agreernent Is declared invalid or unenforceable by valid judgment, or decree of a court of competent jurisdiction, such invalidity or unenforceabiilty shall hot affect any of the remaining portions ofthis Agreement, which shall be interpreted to carry out the intent of the parties hereunder. Each of the persons executing this Agreernent on behalf of a party hereto warrants that he/she Is duly .authorized to execute this Agreement on behalf of said party, and that by so executing this Agreement the party hereto for which this Agreement Is executed is formally bound to the provisions of this Agreement. The parties may execute this Agreement in any nurriber of counterparts, received by the City as an original or as a digital image; together, all counterparts form a single document. Ciwulerk August 7, 2018 Mizell Senior Center - Nutrition Program Page 4 CITY OF PALM SPRINGS AGREED Mizell Senior Center By: /^C u R ; r' (3, A . cr iJArJcJ Name and Title David H. Ready, PhD City Manager Signature APPROVED BY CITY COUNCIL m|n>./7oiys i<A QERTIFICATE OF LIABILITY INSURANCE DATE<i|j/4ioD/yYyy| 02yd6if2018 "rWS CERTIPiCA.TE IS. ISSUED AS A MATTER PF. INf.ORMATlbj^ OSltyAHlDjlONFERS NO RIGHTS UPON THE fcERTIFlCATE HOLD^ THIS CERTIFICATE DOK ,NpT AFFIRMATIV^Y OR NEGAliVELV AMEND; .EXTEND. OR ALTER THE COVERAGE AFFORDED .BYTHE POUCI^ BELQWv THIS CffiT.fFICATE.pF INSURANCE DOES NOT CONSTITUTE A CONTRAof BETWEEN THBJSSUING INSURERi®), AUTHORIZED .REPRESENTATIVE OR PRODUCER,.AND THE CERTIFICATEHOLDER. ' . . liyiPORTANT; if the cei^lflc^to holder is. an AppmONAL IfrapREp,. the polfcyi^IeS): must haVa ADDITIONAL INSURED provisions or Be endoreSd. If .SUBROGATION IS WAiy^..subject to. the teims andcondilldns of the policy, certain poJicI^ may requlre'ah endbraerrient A atatementoh this certiflcate^does not center rights to the certificate hblderln lieu of such ehdorsementlfs). PROIWCER ARIhtego-lnsurahce .Group, LLC- -1601 TrapdJo Rdi.Sujte174 Waltham, MA 02451 , PAX.[«D.No,Extl: rAJc.NbIt fffisfi. 6 Lipport@apIntegQ.com . MSURERfSiAPiFbROING'COVEftAGE .'WAlCtf insu'r6R'A.j AmtKlst*^13512 INSURED Mlzell Senior-Center of Paim'Springs'(a cQrp} 480 B S.unrise Way Palm-Springs, CA 92262 INSURERBr .. INSURER c: INSURER D-: Insurer e: INSURER'F: T If .0 E POMCIES :0F. insurance, listed. BELOWHAVEBEEN ISSUEDTOthe INSlilREDNAMED ABOVEFORTHEPOUCyperiod-NOTWTHSTANPINQ. i^Y REQUIREMENT, TERM .OR.CONpTTION -OF ANY. CONTRACT OR OTHERVDOCUMENT WljH RESPECTfO'VVHiCHTHIS ERTIFICATE MAY BE ISSUED OR .MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED. HB^EJN 18 SUBJECT TO ALL THE THtMS' KGLUSIONS AND CONDITIONSOF SUCH FOUCIES.,ClMiTS SHOWN MAY HAVE been reduced BY, PAID CLAIMS' ' INSR LTR TypeOFlNSUfWNCE aodl msD SUBS WVP poucy number poucyefk TMM/DDIVYVVl . POUCV.EXP: mnmorrrm UMITS COMMERCIAL B eneralliabiuty; 3E □ OCCUR Mch occurrence"-S- CLAIMS^J^I DAMAGE TO RENTEDPRPMSlS (Pa oeeufmacol -S s peRsonal-c aov injury .5 GEI■fL aggregate Limit abFu'eb-pbr;policy □toe .OTHER: GeNEWU.. AGGREGATE '•s PRODUCTS-COMP/OPAGG s $ •AU1rOMOaiLSLIAB'tUTY s ANY AUTO' 'At^^S^ONLY 81?^ONLY sckeduleoPAJJOS ■aODILYINjURV (Peroarsotil s' aoOlLV lNJURY'(Pir.acelooBH 's s s .uMajREiaA uab; EliC&BS.UAB OCCUR C.LAIM^^bE •EACH OCCURRENCE 'S aggregate:S ■ DED RETENTIONS sAWORKERSCOMRSaSAnOfl.,WIDEM.PLOYERS^OABlUtV. y.y^ IfYs^dos^'beiuntfbr.. .. ...OSBCRIRTION OF OPERATIONS beftMr KM X SWC117871E 01?31/20i8 01/31/201.9 Y PER OTH--A STATlim PR .E;L each accident s 1,000,000 E L. DISEAS&..EA EMPLOYEE 5 1,000.,0Gi0 E.L. DISEASE •> POLICY LIMIT 5 ^ '1,000,000 City of Palm SpHjigsAtthr Griy Cjerk P0 Box 2743 SHOUIJD.-ANY ofTHe ab5ve,6escribe6 Policies be cancelled beforeTHE EXPIRATION DATE fHEREpF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. ucuivcKtsu in Palm Springs, CA 92262 . I - AGORrr OR MfT-iRinii AUTHORIZEO REPREBENTAnVE The ACbRD nartie-and logo are registered marks of ACORD AiCOk:tf GERTiFlGATE OF UABfLITY INSURANGE DATEiMM/DDttYiWJ ■tfl/2iM0.T8 THlS.CERTiFtCATE IS ISSUED AS,A MAtr£R<7F tNFORMATIO]^ ONLY AND CONFERS NO RIGKfS UPON THE CERTiRCAtB HOLDER. THISCERTIFIQATE POES NOT AFFIRMATIVELY OR MEGATl'VEUV AMEND, EXTEND OR ALTER T-HE CgVERAGEAFFORDED BY THE'P.OLiqlESBELOW. THIS CERTIRCAtE OF INSORANCB'DOES NOT CONStfTUtE A CONTRACT BETWEEN THE ISSUING iNSURERiS). AUTHORIZED RERRESENTAir'^E OR PR0DUCER;.ANP THE CEPrOFIQAJE HOLDER. fMPpRTANTr tfth8(^rtlfl^te holderlsan ADDlTlphULJNSUREPitHe p<dic$(le9) niU8];havA;ADDmoNAL INSURED piroYlaldhs or&eenilaned.if SOBROGMTION ISi^AIVED, sabject tafte tem}'s and'cdnditlons of the.poHi^, calkin policies may require an encTottenisnt A stalemenfbn . tills csrt|flea(edo^;nptcohfer rights, to certificate'fipider in ileu of such. endof88)ti8nt(s}« PRODUCER ■isl.CommuRjly Insurance Senn'ces PO Box. 2^08 Paiin.Spr.fngs CA 922B3 is'lCoiTirnunlty Insurance Services PHONE .. I.8AXrAI&Na. Extl: 1 (AiC. Ko|: A^kssi Sfirvfc^clspa^oom maURSdsiAPPOIUlll^CbVERAGE •NAIC8 .iNSUR^At Ncn Pfontsrn3iiranceAiBan,ce^of Cdiforrna"HIAO tNSUREp Mfast! Sertldf Centerjof Pairt] Springa. 480 Solid) Sunri^ Way Palin'SpnhQs OA 82262 IHSURERSi INSURER C: .INSURER Dj INSURERE: WSURERFt THIS iS.TO CERTIFY THAT THE POLICIES-GF INSURANCE LISTED BELOW.HAVB BEBNJSSUED TO THE INSURED NAMED ABOVB FDR THE POUCV PERIOD-, INDICATED. NpTWrHSTANDIf« APjY.REQUlRB^ENT.TERM 0^^ OF ANY.CONTRACT OROTBER DOCUMENT W»tH.RESPECTTO WHICH THIS ;CERflFICATEMAy"S&lSSOEDOR.MAY PERTAIN,THE i|«JSURANCEAFIH3raE0 BY THE-POUCIES D^RBED HElietN IS SUBJECT To All'thE TERMSEXCLUSiONSAND CONOITlGNSbF SUCH POUCIES^UMltS SHOWN MAV HAVE BEEN REDUCED SV-PAID pUlMS; INSK LTB TYPHrOFIRSUiiAdCE SDDL tNSb SUBR WVD POUbYNUMBER PbUbY-EFT^lMMia22iYYyy>,POUfiyejefe-■(MMmn/YYYV)•LIMITS A X CDMMERCtALffiFERAL UABn^= e 1 X| OCCUR y .ZOtT-OSBSS 10/14/2017 1CV14/2018 eachoccH/rrence s i.ooo;qdo CLAl&e-MAO UAMAfiEIOflENTEtt- PREMESES'IEa otsuiTanco)S .500.000 MED EXFCAiq^eno perieol ^ 20.000 PERSONALS WJVXrUURY J 1.000,000 •jGET X IIAGSREGATE LIMIT ARPUEa PER:POLICY EZ] 5e^" D LOC OTH^ OENERAL AOGREGATE:, 2.ooo;oqp: PflODUCTSVCOMPyOP A<5<3.g .2.000i<JCO HdslUqtJOTilabiilty S T.OM'.OCO .A AU1 X -OMOaiLE-UABli^ ■2Q17-08858'10/1.4/20.17-10/14/2018 COMSiNEO SiNdid UMlt (Ea'aisMSAi) 'S I.QOO.GtfO ARyMWO OWNED.wrosoNiy- MREOALITOS-C^ scheduled AUTOS . MOM-OWNED AUTOS ONLY B.OblLY INJURV (Pcf pMOn);S bodily INjURY' (Pereeddcnt)'s PROPERTT-OAMAOe(PeracefafentV s Medical piaynients s 5;aoD A X UMBRQAAUAB excess UAB- OCCUR. CLA(MS4ylADE 2diy«06aSB*UMB lQ/i4/20T7 IO/IVl/2018 EACkiCRXURREfrCE V 1,000,000 Aggregate S 1,000,000 DEO 1 X RBTBMTION.S- '"'.^'00 WORKERS COMPEHSAHPNARb EMPUDYERS' UABILITY y / ^ ANt PFOPWETdRffARTNEWEXECUrn/e i 1 .OFSICERAiEMBER DCCliJOEO?' ■M'NH){f:^es.'4s«filM undfi/ . . □ESCRlPnON dFaFERAnONS bdw; N/A ■il»6A ^ ■ lOTH-ISTAniTE I.ER E".L EACH ACCIDENT 5. . E.L. DISEASE, EA EMPtClYEE..$ EU oiiSEASe-rPQUCy LIMIT ■■S A.Pirecipra and. Officers LfabiUly 2017-068SB 10/14/2017 10/14/2018, 3t,p0d,0fl0 .DESCRIPTION.PFPP^ATIONS f U]CAT10NS./VEHiq.ES*(ACORDipi, ArfdWopal Wm"arlt#-5ch.o.evf«/rn»>|»:alLcta IMnoi!<l.8^»/»Rulred) CeilK|rate holder-Is nerafed as addjUqqal insured, if lidicated by "V" above^ AdcllUbnal'ltisuredEiatus abplles oHIy -ld.thq ejcfeni that die-work is.pp(fprrted under or sCbjeci to a ^tan'aSra^Bni'br contract nrapolicy-provisidns gwerji Jn alt'slluaiions.- Cily.qi Palm Spdngs P;Qi Box 2748 .Palm-Spn'ngs CA 92262 ■ -1 ■ SKPULiyANY QFTHE^BOVE.DBSCRIBED POIdClESBECANGBLUEO BEFORE TH^ BXPJRATIPN DATE THEBEOF, NOTICE WILL BE DEtlVERED INACpORDANCEiWitH THE.pbUCY PljlOVISiCiNB, AdT»OftiZED REPRES^TA-nVE ACORD'^t2ai6703)the ACORO name and logo-are reglsterett marics of ACORD SUBRECIPIENT AGREEMENT ^ THIS AGREEMENT (herein "Agreement"), is made and entered into this^^day of 2018. by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the Mizell Senior Center of Palm Springs . (herein "Provider"). WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which agreements provide funds ("CDBG Funds") to the City under the Federal Housing and Community Development Act of 1974 (42 U.S.C. Section 5301 et seg.), as amended from time to time (the "Acf), and the regulations promulgated thereunder (24 C.F.R. Section 570 et sec. ("Regulations"); and WHEREAS, the Act provides that the City may grant the CDBG Funds to nonprofit organizations for certain purposes allowed under the Act; and WHEREAS, the Provider is a nonprofit organization which operates a program which is eligible for a grant of CDBG funds and the City desires to assist in the operation of the program by granting CDBG 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; NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF PROVIDER. 1.1 Scope of Services. Provider agrees to provide to City all of the services specified and detailed in its application for funding and Exhibit A. Provider represents and warrants to City that it is able to provide, and will use funds granted by the City to provide the services represented in the Provider's application for funding. City provided funds shall be used only for those purposes specified in such application and this Agreement. 1.2 Compliance with Law. All services rendered hereunder shall be provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of the City and any Federal, State or local governmental agency of competent jurisdiction. 1.3 Reports. No later than ten (10) days prior to any payment date specified in Section 2.0, within ten (10) days following the termination of this Agreement, and at such other times as the Contract Officer shall request. Provider shall give the Contract Officer a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of contract funds hereunder, if applicable. At the times and in the manner required by law, the Provider shall provide to the City, the Department of Housing and Urban Development, the Comptroller General of the United States, any other individual or entity, and/or their duly authorized representatives, any and all reports and information required for compliance with the Act and the Regulations. 1.4 Financial Reporting. Any Provider receiving or due to receive $20,000.00 or more from the City during the 2018 - 2019 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 which 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 fi nancial information provided for in this paragraph shall be fumished not later than January 31®* of the current fiscal year. ORIGINAL BID AND/OR AGREEMENT 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to the Provider on a reimbursable basis for its services a sum not to exceed FORTY THOUSAND DOLLARS ($40.000.00) {the "Contract Sum") in accordance \A/ith the Budget attached hereto in Exhibit B and incorporated herein by this reference; and as herein provided. The budget cost categories set out in Exhibit B are general guidelines and if mutually agreed by both parties, may be amended administratively by no more than 10%, without the requirement of a formal amendment to this Agreement, but in no event shall such adjustments increase the Contract Sum. The Provider shall submit to the City periodic statements, in the form of Exhibit F, on reimbursable expenditures pursuant to the attached Budget along with pertinent supporting documentation. The City shall promptly review the monthly expenditure statements and. upon approval, reimburse the Provider its authorized operating costs. 2.2 Pavroll Records. In cases where the contract sum will reimburse payroll expenses as part of operations, the Provider will establish a system of maintaining accurate payroll records which will track daily hours charged to the project by the Provider's respective employees, as set forth in 0MB Circular A-122 Attachment B.6. 2.3 Draw Downs. Failure by Provider to request reimbursement or encumbrance of at least 25% of the total grant by the end of each fiscal year quarter (September 30, December 30, March 31, and June 30) shall result in the immediate forfeiture of 25% of the total grant. 3.0 COORDINATION OF WORK. 3.1 Representative of Provider. The following principals of Providers are hereby designated as being the principals and representatives of Provider authorized to act in its behalf with respect to the work specified herein and make all decisions in connection therewith: Laura Castillo. Director of Nutrition & Operational Services 3.2 Contract Officer. The Contract Officer shall be such person as may be designated by the City Manager of City. 3.3 Prohibition Against Subcontracting or Assignment. Provider shall not contract with any other entity to perform in whole or in part the services required hereunder without the express written approval of the City. Neither this Agreement nor any interest herein may be assigned or transferred, voluntarily or by operation of law, without the prior written approval of the City. 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 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 bme 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. -2- 4.2 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; (b) Section 109 of the Housing and Community Development Act of 1974, as amended and the regulations issued pursuant thereto; (c) Section 3 of the Housing and Urban Development Act of 1968, as amended; (d) Executive Order 11246, as amended by Executive Orders 11375 and 12086, and implementing regulations at 41 CFR Chapter 60; (e) Executive Order 11063, as amended by Executive Order 12259, and implementing regulations at 24 CFR Part 107; (f) Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), as amended, and implementing regulations; (g) The Age Discrimination Act of 1975 (P.L. 94-135, as amended, and implementing regulations; (h) The relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition at 24 CFR Part 42; (i) The restrictions prohibiting use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.200 (j); (j) The labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement and requirements; (k) The Program Income requirements as set forth in 24 C.F.R. 570.504(c) and 570.503(b)(8); (I) The Provider is to carry out each activity in compliance with all Federal laws and regulations described in 24 C.F.R. 570, Subpart K, except that the Provider does not assume the City's environmental responsibilities described at 24 C.F.R. 570.604; nor does the Provider assume the City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52; (m) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11288 relating to the prevention, control and abatement of water pollution; (n) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; 0MB Super Circular 2 CFR 200 as they relate to the acceptance and use of federal funds under the federally-assisted program; -3- (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 sea.): (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 (v) Such other City, County, State, or Federal laws, rules, and regulations, executive orders or similar requirements which might be applicable. 4.3 The City shall have the right to periodically monitor the program operations of the Provider under this Agreement. 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 carry 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 as an additional insured shall be delivered to and approved by the City 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 officers, or employees. 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 officers and employees, 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-Liabilitv of Citv Officers and Employees. 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. 6.3 Covenant Against Discrimination. In connection with its performance under this Agreement, Provider shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin ( i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Provider shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Provider certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Provider activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Provider is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. 6.4 Term. Unless earlier terminated in accordance with Section 6.5 of this Agreement, this Agreement shall continue in full force and effect until completion of the services, but not exceeding one (1) year from the date hereof. 6.5 Termination Prior to Expiration of Term. a. In accordance with 2 CFR 200.339, the City may suspend or terminate, in whole or in part, this Agreement if Provider fails to comply with any term of this Agreement or the terms and conditions of the subaward; b. In accordance with 2 CFR 200.339, the City may terminate this Agreement with the consent of the Provider after both parties have agreed upon the termination conditions, including the effective date and, in the case of a partial termination, the portion to be terminated; and 5- c. The Provider may terminate this Agreement at any time, with or without cause, upon thirty (30) days' notification setting forth the reason(s) for such termination, the effective date and, in the case of partial termination, the portion to be terminated. Upon receipt of the notice of termination the Provider shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. However, if the City determines in the case of partial termination that the reduced or modified portion of the subaward will not accomplish the purposes for which the subaward was made, the City may terminate the subaward in its entirety. Provider shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and City shall be entitled to reimbursement for any services which have been paid for but not rendered. 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: Mizell Senior Center of Palm Springs 480 S Sunrise Wav Palm Springs. CA 92262-7641 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 ] -6 CITY OF PALM SPRINGS a municipal corgpration APPROVED AS TO FORM: AssLcity Attorney PROVIDER: Check one: City Manager APPROVED BY CITY COUN ^ Individual _ Partnership Corporation {Corporations require two notarized signatures: One signature must be from the Chairman of Board, President, or any Vice President. The second signature must be from the Secretary, Assistant Secretary, Treasurer, Assistant Trea^rer, or Chief Financial Officex)tary, i reasurer. Assistant I rea^rer, or cnier hinancia By:. Notarized SignatuNotari^^ Signature of Ch^ii^n of Boar^, Pr^ident or any ViceTresident Name: / a)(a^s4/>I / Title: A H-.PU-r' State of ) County 0^ ) ss A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. state of County of \AJ^ ) ss. I .>PK re Secretary, Asst^ecretary, Treasurer, Asst Treasurer or Chief Financial Officer Name: Title: state of Cgvli^gYVVt<V ) County of. .) ss A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of County of ) .) ss. before me. appeared U- tWiUU who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)(^re subscribed to the within instrument and acknowledged to me that(5i^she/they executed tte same in (^her/their authorized capacity(ies). and that bi(m^her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and olTipi^l se; Notary Signature: un_i (W •>ov6 before me, il'^ji^sonallv appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)(ii)are subscribed to the within instrument and ackr^ledged to me that het^j^they executed the same in his(Fe^heir authorized capacity(ies), and that by hisff^jtheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offici Notary Signature: Notary Seal; 1 CYNTHIAA BERARDI 1Notary Public-California • ? Riverside County > 1 Commission # 2229138 r^ li/ty Comm. Expires Feb 18,2022 y 1 CYNTHIAA BERARDI &< ~ California |i Riverside County 1 j Commission #2229138 r f My Cemm, Exoiroa Feti ifl pn?? 1 CITY OF PALM SPRINGS EXHIBIT A Scope of Services Proiect/Activitv Title: Prelect Number: Mizell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 Objectives/Activities The intent of this program is to provide programming and services for extremely-low income to low income seniors and frail elderly. This will be accomplished through the continuation of their facility's energy-efficiency upgrades. These upgrades will convert an existing open-area patio space to a usable area for programs and services. This too will result in considerable energy-savings due to the constant through traffic and opening of exterior doors, which results in energy loss (cooling and heating) throughout the year. Mizell primarily covers the City of Palm Springs, and the adjacent two communities of Cathedral City and Desert Hot Springs serving 2,750 clients West Valley and 2,200 Palm Springs' clients. The Provider shall be responsible for the completion of the following objectives/activities in a manner acceptable and satisfactory to the City and consistent with the standards required as a condition of providing these CDBG funds. Objective 1: Assist the Citv bv timelv providing anv additional information reouested. 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 orocess. 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 orooram to facilitate positive promotion for all parties (i.e.. Provider. Citv. CDBG. etc.T TARGET DATE ACTIVITY #1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun's daily general circulation. Submit final publication to City. Objective 4: Enroll and income qualify at least a total of two thousand and two hundred (2.000) extremely low income to moderate-income Palm Sorinos residents in accordance with Exhibit D for improved access to the facility. TARGET DATE On-Going ACTIVITY #1 Provide direct client services and advocacy to help 2,750 Valley-wide residents. Maintain records of names, addresses, demographics and service dates for all assistance. Objective 5: Maintain records for all CDBG activities related to this program. TARGET DATE On-Going On-Going ACTIVITY #1 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 Submit Semi-Annual reports - referenced Exhibit E within fifteen (15) calendar days of the program mid-year, December 31®', and program completion, June 30"'. Objective 6: Manaae/monitor orooram activities. TARGET DATE On-Going ACTIVITY #1 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 7: Make imorovements through Architectural & Engineering Services (A&E) and associated construction costs to convert ooen-area oatio space to a usable area. TARGET DATE ACTIVITY #1 On-Going Conduct activities to improve availability/accessibility in accordance with an 'open competitive' procurement process as stipulated in this Agreement and in consultation with the City. Objective 8: Provide an evaluation within fifteen (151 calendar davs of the program completion or final reimbursement. TARGET DATE 07/15/19 ACTIVITY #1 Provide an evaluation and final report on all programmatic and financial activities. 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 Budget Summary Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BUDGET SUMMARY COST CATEGORY CDBG SHARE OTHER SOURCES TOTAL COST 1 Personnel -0--0--0- 2 Consultant/Contract Services Architectural Services -0--0--0- 3 Travel -0--0--0- 4 Space Rental -0--0--0- 5 Consumable Supplies -0--0--0- 6 Rental, Lease or Purchase of Equipment -0--0--0- 7 Insurance -0--0--0- 8 Other - Construction/Rehabilitation $40,000.$30,446.$70,446. Contingency Proiect Management -0-$4,554.$4,554. TOTALS $40,000.$35,000.$75,000. * 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. Other funding sources may include Mizeil's contribution of $35,000. 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 30 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, 2018 through June 30, 2019 with funds allocated from 2018-19 Program Year. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory Prolect/Activitv Title: Project Number: MIzell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Company Non Profits Insurance Alliance of California Effective Dates of Policy 10/14/18 to 10/14/19 Claims Made Policy / / Per Occurrence Policy / / Limits of Liability $2.000.000 Deductibles; Per Occurrence Annual Aggregate. Additional Insured Endorsement (Certificate Holder) IZI Yes □ No Original Certificate of Insurance Attached □ Yes IZI No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Amtrust Effective Dates 01/31/18 to 01/31/19 Limits of Liability $1M Per Occurrence Underlying Coverage Limits. Original Certificate of Insurance Attached □ Yes IZI No eERTIFlCATE OF LIABILITY INSURANCE DATEiMMfl3D/YYYY| 10/26/2016 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 IN.SURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{le&) must have ADDITIONAL INSURED provisions or be endoreed. If SUBROGAtlON IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate doiss riot confer rights to the certificate holder in lieu of such endprsement(s). PRODUCER NFP Property & Casualty Services, Inc. 400 S Farrell Drive B170 Palm Springs CA 92262 NFP Property & Casually Services (760)325.7400 ™ (780)325.7609 AMRESS: servicepal@nfp.eom INSURER(S) AFFORDING COVERAGE NAtC« INSURER A; ^on Pronislnsurafice Alllance.of California NIAC INSURED Mizeil Senior Center of Palm Springs 480 South Sunrise Way Palm Springs CA 92262 INSURERS: insurer C ; INSURER D: INSURER E: INSURER F: COVERAGES CERTinCATE NUMBER: 2018-2019 Liability 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 REqUIREIWENT, TERM OR CONDITION OF ANV CONTf^CT 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 ^CH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR LTR TYPE OF insurance ADDL INSD SUBK WVD PQUCY NUMBER POLICY EPF IMM/DDtYYYYI POUCYEXP IMMTOOyVYYVI UMITS A X COMMERCIAL GENERAL LlABIUTY e 1 X| OCCUR Y 2018-06856 10/14/2018 10/14/2019 EACH OCCURRENCE 5 1,000.000 CLAIUS-MAO DAMAGE TO PENTEO PREMISES (Ea occuirenbe)^ 500,000 MEO £XP (Any one person)S 20,000 personal & ADV INJURY 5 1,000.000 GEN-L AGGREGATE LlMfT APPLIES PER;GENERAL AGGREGATE S 2.000,000 X POLIGY 1 1 jIcT L_J log OTHER; PRODUCTS - CGMP/OP AGG g 2.000.000 Liquor Liability S 1,000,000 A AUTOMOBILE UABILITY 2018-06856 10/14/2018 10/14/2019 COMBINED SINGLE LIMIT (Eaiicctdeni)S 1,000.000 X ANY AUTO HEOULED rros N.OWNED TOSONLY BODILY injury (Per parson)s OWNED AUTOS ONLY HIRED AUTOS ONLY sc AU BODILY injury (Par ecddenl)s NL AU PR0RER1Y DAMAGE (Per accident)s Medical payments S 5,000 UMBRELLA UAB EXCESS UAB OCCUR CUIMS-MAOE EACH OCCURRENCE s AGGREGATE s DEb retention S s workers COMPENSATION AND EiytPLOYERS' LlABIUTY y, ANY PROPRIETOR/PARTNER/EXECUTIVE | 1 OFFtCERrUEMBER EXCLUDED? (Mandatory In NH) tr yet, desdtbe uiuier DESCRrPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L EACH ACCIDENT s E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT S A Directors and Officers Liability Improper Sexual Conduct Liability 2016-06656 10/14/2018 10/14/2019 SI,000,000 S250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD l6l, AifditJonal Remarks Schadulct, may bp pltacKed If more space (s requlradj Cerliricale holder is narned as additional Insured if indicated by'T' above. AdditiohaI insured status spplies only to the extent that the work Is perfomte&v. under or subject to a written agreerrient or ccnttacL The policy provisions govern in all situations, //f) J k /i City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN^6^C;|DBEF0RE / THE EXPIRATION DATE THEREOF, NOTTCE WILL BE DELIVERED IN^"^;:;^ / ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 2743 AUTHORIZED REPRESENTATIVE Palm Springs CA 92262 1 ACORD 25 (20^6/03] ® 1988-2015 ACORD CORPORATION. All rigtits reserved. The ACORD name and logo are registered marks of ACORD NONPROFITS INSURANCE ALLIANCE OF CAUFQRNIA A Head for Insurance. A Heart forNeoproflts, Policy no.; 2018-06856 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF CANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESS AUTO COVERAGE FORM CanceHation: 30 Days Notice of Cancellatlbn Person or Organization City of Desert Hot Springs, Desert Hot Springs Senior Center Riverside County Office on Aging City of Palm Springs If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the number of days shown for cancellation. NIAC-E641012 POLICY NUMBER: 2018-06856 Named Insured: Mizell Senior Center of Palm Springs COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE % Name Of Additiohal lnsured Person(s) Or Organizatioh(s)Locatlon(s) Of Covered Operations 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 becorhing effective during the term of this policy. The additionai 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. All insured premises and operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional msured(sj at the location{is) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be perfomned by or on behalf of the additional jhsured{s) at the location of the covered operations has been completed; or CG 20 1G 04 13 Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to the insurance afforded to these additional ihsureds, the following is added to Section III - Limits Of Insurance; If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance; 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. IP CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heartfor Nonprofits. POLICY NUMBER: 2018-06856 FORM: NIAC-E61 1117 NAMED INSURED; Mizell Senior Center of Palm Springs THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section II - Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or omissions; or 2. The negligent acts or Ohrilssions of those acting on your behalf; in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products-completed operations hazard" or for liability arising out of the spje negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additionarinsured(s) at the location of the covered operations has tieen completed; or 2. That portion of "your work" out of which injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The following is added to SECTION III — LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified In the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of Insurance under this policy. NIAC-E61 11 17 Page 1 of 2 Bhi Nonprofits policy number: 2018-06856 form: niac-e6i h 17 Insurance insured: Mlzell senior Center of Palm Springs ALLIANCE OF CALIFORNIA A Haad for Insurance. A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4. Other Ins SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the folio 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this Insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other Insurance to which the additional insured(s) has been added as an additional insured or to other insurance described In paragraph b. below. b. Excess Insurance This insurance is excess over: i. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied fa y you with permission of the owner; (c) That Is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured{s) has been added as an additional Insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured{s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured{s}' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of: (a) The total arhount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of ajl deductible and self-insured amounts under all that other Insurance, (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additionarinsured(s) does not permit contribution by equal shares, we will contribute by limits, Under this method, each Insurer's share Is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NiAC-E61 11 17 Page 2 of 2 GERTIFICATE OF LIABILITY INSURANCE DATE(MMroO/YYYY) 02/08/2018 THIS C^TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRIVIAtlVELY 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 INSURERfS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poncy(ie5) 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 endorsementfs). PRODUCER AP Intogo insurance Group, LLC 1601 Trapelo Rd. Suite 174 Waitham, MA 02451 rAJc,1fo,Ext): "/W-No): AtSi^kss: support@aplntegb.com INSURER/SI AFFORDING COVERAGE NAICd INSURER A: Amtrust*'^13512 INSURED Mizell Senior Center of Palm Springs (a corp) 480 S Sunrise Way Palm Springs, OA 92262 INSURER B: INSURER C: INSURER D; INSURER E: INSURER P : COVERAGES CERTIFICATE NUMBER: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 CERnnCATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERHN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. ADOL SUBR iilYQ POUCYEFF IMM/DO/YYYV> poucr ExpTYPE OF INSURANCE POUCY NUMBER LIMITS(imiDtyrrrm COMMERCIAL GENERAL UABIUTY CLAIMS-MADE | [OCCUR EACH OCCLIRRENCE DAMAGE TQRENTED PRPMISPS fEa occurrgfieel MED EXP lArw ono personi PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER; POLICY I I LOG OTHER GENERAL AGGREGATE PRODUCTS - CQMPIOP AGG $ COMBINED SINGLE UMITAUTOMOBILE UABIUTY ANY AUTO OWNED AUTO&ONLY bodily injury IPw PBreonI SCHEDULED AUTOS BODILY INJURY (Per aeddenll AUT^SONLY WIOPERTY DAMAGE 1^wscGoonl UMBRELLA LIAB EXCESS LIAB OCCUR CUIMS-MAOE EACH OCCURRENCE RETENTIONS WORKERS COMPENSATION UTYAND EMPLOYERS' UABI V PER ^ STATUTE SWC1178716 01/31/2018 01/31/2019 1,000,000ANY PRCPRIETOWPARTNER/EXeCUTIVE if yes, descdbe under SCRIPTION OF OPERATIONS below E.L EACH ACCIDENT 1,000,000E L. DISEASE - EA EMPLOYEE 1,000,000E.L. DISEASE • POLICY LIMIT OPERATIONS / LOCATIONS / VEHICLES {ACORD 101, Additional.RCfiiarke'SehGdula. may bo attechoci If more epacoTs reaulfod) A Waiver of Subrogatldn applies In favor Of the certificate holder CERTIFICATE HOLDER City of Palm Springs Attn: City Clerk PO Box 2743 SHOULD ANY OF THE ABOVE DESCRIBED PbUCIES BBc^Rotetbep BBFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI5i«MD IN ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs, OA 92262 1 AUTHORIZED ^RESENTATIVE The ACORD name and logo are registered marks of ACORD CITY OF PALM SPRINGS EXHIBIT D Beneficiary Qualification Statement Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household {legal guardian) receiving benefits fom the described project/activity. 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 (Riverslde-San Bernardino-Ontario, OA MSA - 04/01/18) AREA MEDIAN INCOME (AMI) LEVEL - $65,800 NUMBER OF PERSONS IN YOUR HOUSEHOLD: 1 2 3 4 5 6 7 8 EXTREMELY LOV\ INCOME 0-30% of AMI $14,150 $16,460 $20,780 $25,100 $29,420 $33,740 $38,060 $42,380 LOW INCOME 30-50% of AMI $23,600 $27,000 $30,350 $33.700 $36,400 $39,100 $41,800 $44,500 MODERATE INCOME 50 - 80% of AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 NON LOW & MOD INCOME > 80% $37,751 +$43,151 +$48,551 +$53,901 +$58,251 +$62,551 +$66,851 +$71,151 + 3. What race/ethnicity do you identify yourself as; please note that this self-identification is voluntary in accordance with equal opportunity laws? □ American Indian or Alaska Native AND White□ White □ Black/African American □ Asian □ American Indian or Alaskan Native □ Asian AND White □ Black/African American AND White □ 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 5. Do you have a disability? □ YES □ NO □ 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:DATE: ADDRESS:PHONE NO: SIGNATURE: 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 compliance. CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Proiect/Activitv Title: Project Number: MIzell Senior Center of Palm Springs / 0002 Energy-Saving Patio Enclosure Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 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 Aiaskan Native American indian/Aiaska Native AND Biack/African American Native Hawaiian or Other Pacific Islander Other: HISPANIC/LATINO ETHNICITY: Mexican/Chicano Puerto Rican Cuban Other: ¨ Number of Disabled: ¨ Number of Homeless Persons Given Overnight Shelter: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date_ CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Proiect/Activitv Title: Mizell Senior Center of Palm Springs / Energy-Saving Patio Enclosure Proiect Number: 0002 Name/Address of Provider: Mizell Senior Center of Palm Springs 480 S Sunrise Way Palm Springs, CA 92262-7641 BENEFICIARY QUALIFICATION STATEMENT Description Approved Grant Amount Current Reimbursement Period Prior Reimbursement Period(s) Total YTD Reimbursement Grant Balance (Over/ Under) Other - Construction/Rehabilitation $40,000. TOTAL $40,000. 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:APPROVED BY: Name, Title, Date 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 G Employment Restrictions 1. Labor Standards The PROVIDER agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act. the Copeiand "Anti-Kickback" Act (40 U.S.C. 276a-276a-5; 40 USC 327 and 40 USC 276c) and ail other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The PROVIDER shall agree to submit documentation provide by the CITY which demonstrates compliance with hour and wage requirements of this part. The PROVIDER agrees that, all general contractors or subcontractors engaged under contracts in excess of $2,000.00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the CITY pertaining to such contracts and with the applicable requirements of the regulations of the Department of labor, under 29 CFR Parts 1. 3. 5 and 7 governing the payment of wages and ratio of apprentices and trainees to joumeyworkers; provided, that if wage rates higher than those required under the regulations are imposed by state and local law, nothing hereunder is intended to relieve the PROVIDER of its obligation, if any. to require payment of the higher wage. The PROVIDER shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. 2. "Section 3 Clause" a. Compliance Compliance with the provisions of Section 3. the regulations set forth in 24 CFR 135. and all applicable rules and orders issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided under this Contract and binding upon the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors. Failure to fulfill these requirements shall subject the CITY, the PROVIDER and any of the PROVIDER'S subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The PROVIDER certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements. The PROVIDER further agrees to comply with these "Section 3" requirements and to include the following language in all subcontracts executed under this Agreement: "The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968. as amended. 12 U.S.C 1701. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low-income residents of the project area and contracts for work in connection with the project be awarded to business concerns that provide economic opportunities for low- and very low-income persons residing in the metropolitan area in which the project is located." The PROVIDER further agrees to ensure that opportunities for training and employment arising in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to low- and very low-income persons residing within the metropolitan area in which the CDBG- funded project is located; where feasible, priority should be given to low- and very low-income persons within the service area of the project or the neighborhood in which the project is located, and to low- and very low-income participants in other HUD programs; and award contracts for work undertaken in connection with a housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other public construction project are given to business concerns that provide economic opportunities for low- and very low-income persons residing within the metropolitan area in which the CDBG-funded project is located; where feasible, priority should be given to business concerns which provide economic opportunities to low- and very low-income residents within the service area or the neighborhood in which the project is located, and to low- and very low-income participants in other HUD programs. The PROVIDER certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements. b. Notifications The PROVIDER agrees to send to each labor organization or representative of workers with which it has a collective bargaining agreement or other contract or understanding, if any. a notice advising said labor organization or worker's representative of its commitments under this Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training. CERTIFICATE OF LIABILITY INSURANCE DATEiMMfOD/mY} THIS CERTIFICATE IS ISSUED AS A MA'l tER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT>VFFiRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSnTUTE A CONTRACT B^WEENTHE ISSUING tNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder te an ADDITIONAL INSURED, the po|lcy(ies) rnust have ADDITIONAL INSURED provisions or be endorsed. If SUBROGAtlON IS WAIVED, subject to the tenns and cohdltians of the policy, certain policies may require an endorsement A statement on this certificate does riot confdr rights to the certificate holder In lieu of such endorsement^). PRODUCER N FP Property & Casually Se rvi ces, 1 nc. 40p S. FarrB!l Drive B170 Palm Sphngs CA 92262 NAME?*'^ NFP Property & Casualty Services (760)325.7«» (780)325-7609 ADDRESS: sefvic8p.al@nfp.com INSURER(S) AFFOROtNG COVERAbe NAICH INSURER A: Hon PrqfitsInsurance AlBance.of California NIAC INSURED Mlzefl Senior Center of Palm Spririgs 450.Soulh Sunrise Way .Palrri Springs CA 92262 tNSitRER a: INSURER C : INSURER D: INSURER E: INSURERF; Tfraff L7R THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQli|R^ENT. TERM OR CONDITION OF. ANY CONTI^Ct OR OTH^ DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN> THE INSURANCE AFFORDED. BY THE POliCiEiS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POMC}ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUlMS.' . .. • PCLlCY EPF.TYPE OF INSURANCE [XHDT INSD [SOBR WVD POUCY NUMBER POUCY exp.- COMMERCIAL GENERAL UABIUTY CtAIMS^MOE OCCUR GENl AGGREGATE LIMir APPLIES PER: PPUGY Q n LOC OTHER; X AUTpMOBlLE.UABiLnY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY UMBRELLA UAB EXCELS iJAB DED SCHEDULED AUTOS NONOWNEO AUTOaONLY OCCUR CtAJMS-MAOE retention s workers compensation AMD EMPLOYERS' LIABILITY ANY PROPRIETb{M»ARTNER/EXECllTiVE OFRCERA/IEMBER EXCLUDED? fM&n(^tory;{n NH)' If.yet, des^ibe under DESCRiPTION OFOPERATtONS below 2G18-Q88SS 2018-08856 IMMIDb/YYYYi 10/14/2018 10/14/2018 IMM/DO/YYYYI 10/14/2019 10/14/2019 UMITS EACH OCCURRENCE 5 1,000,000 DAUAG£7UHbNItt> PREMISES (Ea occurrence)500,000 MED EXP (Any one person)$. 20;Oao personal & ADV INJURY S LQOO.GOO GENERAL AGGREGATE S 2.000,000 PRODUCTS n COMP/OP AGG S 2.000.0Q0 Liquor Liability S 1,000,000 COMBINED Single limit (Eaiiccldent) n 'S 1.000,000 BODILY injury (Par parson)s BODILY injury (Porooadsn))s PROPERTY OAMaGE (Per accident)s Medical payments S-. 5.C00 EACHOCClJRRENCE AGGREGATE Y7N □ PER STATUTE OTH ER N/A E.L EACH ACCIDENT E.L DISEASE - EA EMPLOYEE E.L DISEASE-POUCY LIMIT Directors and Officers Liability Improper Sexual Conduct Uabfllly 2O18tO6056 10/14/2018 10/14/2019 $1,000,000 8250.000 DESCRIPTION OF OPERATIOMS/LOCATIONS / VEHICLES {ACOR0101. Additional Rapiarics Sehadule, may be eltacKed If.mdre space is required) Certiricate holder is narped as additional Insured if Indicated by "Y" above. Addffiorial insured status ^plies only to the extent that the wbric ls perfo under or subject to a written agreenient or contract Thepolicy provisions govern in.ail situations. % Cily .of Palm Springs P.O. 80X 2743 Palm Springs CA 92262 - 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANSfeSteQBEFORE /THE EXPIRATION DATE THEREOF, NbTTCE WILL BE 0EUVEREd1n^^£>. / ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED BEPRES0JTAT1VE ACORD 25 (20^6/03)The ACORD name and logo are registered marks of ACORD NONPROFITS Insurance ALLIANCE OF CALIFORNIA A Httad for InsuraiiM. A Heart forNonprofits, □Policy rio.: 2018-06856 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF GANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESS AUTO COVERAGE FORM Cancellation: 30 Days Notice of Cahcellatibn Person or Organization City of Desert Hot Springs, Desert Hot Springs Senior Center Riverside County Office on Aging City of Palm Springs If we cancel this policy for any statutorily permitted reason other than nonpaylTient of prerhium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the numberof days shown for cancellation. NIAC-E64 10 12 POLICY NUMBER: 2018-06856 Named Insured: Mizell Senior Center of Palm Springs COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDmONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person{s) Or Organizatlon{s)Locatlon(s) Of Covered Operations Any person or organization that you are required to add as an additional msured on this policy, under a written contract or agreement currently In effect, or becorhing effective during the term of this policy. The additionat insured status will not be afforded with respect to liability arising out of of related to your activities as a real estate manager for that person or organization. All Insured premises and operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured Is amended to include as an additional insured the person(s) or organlzation(s) shown in the Schedulei but only with respect to liability for "bodily injury'Vproperty damage" or "personal and advertising Injury" caused. In whole or jn part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing; operations for the additional insured(s) at the location{s) designated above. However.: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured Is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader thari that which you are required by the contract or agreernent to^ provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" ocGUrrlhg after: 1. All work, including materials, parts or equipnrient furnished in connection with such work, on the project {other than service, maihtehahce or repairs) to be periformed; by or on behalf of the additional jhsured(s) at the location of the covered operations has been completed; or CG20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" Out of which the injury or dartjage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional ihsureds, the following is added to Section ill - Limits Of insurahce; If coverage provided to the additional insured is required by a contract or agfeemeht, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. GG 20 10 0413 © Insurance Services Office; Inc., 2012 Page 2 of 2 Nonprofits policy nqmber: 2018-06856 form: niac-e6i hi? INSURA-NGE named insured; Mlzell Senior Center of Palm Springs ALLIANCE OF CALI FOfcNIA A Hgad for Insurance. A Heartfor Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Informatlpn required to complete this Schedule, If not shown above, will be shown in the Declarations.) A. Section II - Who Is An Insured is amdrlded to include any public entity as an additional insured for whom you are perfbrming operations, who may be named In the schedule above, when you have agreed in a wptten eohtract or written agreerhe.nt that such public entity be added as an additional Insijred(s) oh your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or orhissiorts; or 2. The negligent acts or omissions of those acting on your behalf; in the perforhiance of your ongoing operations; No such public entity is an additional insured for liability arising out of the "products-completed operations hazard" or for liability arising out of the sole negligence of that pubic entity. B, With respect to the insurance afforded to these additional !nsufed(s), the following additional exclusions apply. This insurance does not apply to "bodily Injury" or "property damage" occurring after 1. Ail work, including materials, parts or equipmeht furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addifipnai insured(s) at the location of the covered operations has been cbrhpleted; or 2. That portion of "your work" out of which injury or damage arises has been put to Its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. G. The following is added to SEGTION III — LIMITS OF INSURANGE: The limits of insurance applicable to the addltlpnal Insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. NIA0-E61 1117 Page 1 of 2 1 Nonprofits policy number: 201S-06856 F0RM:NIAC-E611117 Insurance named insured: Mlzell senior Center of Palm Springs ALLIANCE OF CAUFORNIA A Head for Insurance. A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured{s), Condition 4. Other Ins SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the folio % 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreernent (1) That this insurance be primary. If other insurance is also primary, we will sh^re with all that other insurance as described in c. below; or (2) The coverage afforded by this Insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1} and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage. Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permissioh of the owner; (c) That lis insurance purchased by you .to cover your liability as a tenant for "property damage'' to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured; by that other insurance. (1) When this Ihsurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additionar insured(s} against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional lnsured{s)' rights against all those other insurers. {2} When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this Insurance; and (b) The total of all deductible and self-Insured amounts under all that other Insurance. (3) We will share the remaining loss. If any,..with any other insurance that is not described in this Excess Insurance provision and was not bought specificaiiy to apply in excess of the Limits of Insurance shown In the Declarations of this Coverage Part. c. Methods of Sharing If all of the other Insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each Insurer contributes equal amounts until it has paid its applicable lirnlt of insurance or none of the loss remains, whichever comes first. If ariy other the other insurance available to the additional jnsuredfs) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicabie limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E611117 Page 2 of 2 IVflZESEN'Ol TPATOK DATE(MMmp/YYYY) ux/odaoiB REPl^Em!TI^^SreO^C°ER/i;§DT"^^^^^ CONTRACT BETWEEN THE ISSUING INSURERfSl, AUTHORIZED IT^BRO^tion"!! SSif hoW'T^s a'TjOOITIONAL INSUI^D,.U» pollcyfles) ihust have ADDITIONAL INSURED piovlstans or be endorsed. PRODUCER AP Ihtego Insurance Group, LLC 1601 Trapelo Rd. Suite 174^ Waltham, MA 02451 j/UCri^ Ext): AtSifflfess-support@aDintegb.com INSURERfSI AFFORDING COVERAGE NAIC0 INSURER A: Amtrust***13512 INSURED lyiizeli Senior Center of Palm Springis (a corp) 480 S Sunrise Way Palm Springs, CA 92262 INSURER B: INSURER C: INSURERD; INSURER E: INSURER F : INSR LL&TYPg OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS^MADE | [ pCCUR G.EN'L AGGREGATE LIMIT APPLIES PER: POUCY □ M □ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOSONLY mONLY UMBRELLA UAB EXCESS LIAB DEO ADOL i£lSB SUBR SCHEDULEDAUTOS OCCUR CUIMS-MADE RETENTIONS. WORK^S COMPENSATIONAND EMPLOYERS* UABIUTY W PROPRIETORyPARTNERffiXECUTIVE If yes, descdbB uimarOESCRIPTION OF OPERATIqNS below XiN N POLiCY NUMBER N/A SWC1178715 CERTIFICATE HOLDER Oi^ of Palm Springs Atln; City Clerk PO Box 2743 Palm Springs, CA 92282 POLICY EPFIMM/DDfYYVrn POUCY EXP IMMIDD/YVVYl LIMITS EACH OCCURRENCE RENTED a occtJtTgiieel MEO EXP lAnv ons oargcnl PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPfOP AG6 COMB NED SINGLE LIMITfEa BCCKlafrtl aODlLy INJURY IPof ofl/ronl BODILY INJURY fPar acddahn EACH OCCURRENCE STATUTB 01731/2018 01/31/2019 1.000,000EX EACH ACCIDENT 1,000,000E.L. DISEASE - EA EMPLOYEE 1,000,000E.L. DISEASE - POLICY LIMIT CANCELLATl&N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEcaJTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESSJTATIVE ACORD 26 (2016/03)1988-2015 ACQRD CORPORATION. All rights reserved.The ACORO name and logo are registered marks of ACORO ® ^�� ACC)RD CERTIFICATE OF LIABILITY INSURANCE //yr') DATE(MM/DD/YYYY) 11 /20/2023 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 CONTACT Quetha Rodriguez NAME: Garcia Insurance Inc AHONE PIC, Ext : (760) 320-1111 A' No): (760) 320-1115 ADDRESS: 2099 E. Tahquitz Canyon Way INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Great American Non -Profit 38580 Palm Springs CA 92262 INSURED INSURER B : INSURER C : Mizell Center INSURER D : 480 South Sunrise Way INSURER E: INSURER F : Palm Springs CA 92262 COVERAGES CERTIFICATE NUMBER: CL23101107932 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 AVUL INSD bUtSK WVD POLICY NUMBER P LI Y EFF MM/DDIYYYY PDUICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 A Y PAC536117600 10/14/2023 10/14/2024 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS 3,000,000 $ POLICY ❑ JE0 LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY HAUTOS ONLY CAP536117700 10/14/2023 10/14/2024 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT I $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Palm Springs is named as additional insured. *10 day notice of cancellation may be issued for nonpayment of premium. I;tK I It-11,AIt: MULUtK I.ANI.t LLAI IUIV RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs NOV 2 7 2023 ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E. Tahquitz Canyon Way AUTHORIZED REPRESENTATIVE City Hail Palm Springs RecepfiM BaW ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD k39� *" S1 ' 10/19/2023 * PAC.5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 CO 89 70 (Ed., 11/14) THIS ' ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT This Endorsement modifies and is subject to the insurance provided under the following form:, COMMERCIAL GENERAL LIABILITY COVERAGE PART The following extension only applies in. the event that no other specific coverage for the indicated loss exposure is provided under this Policy. If other specific —coverage applies, -the terms, conditions and limits of that Coverage are the exclusive coverage applicable, under this Policy, unless otherwise noted in this Endorsement. This is a summary of the .various additional coverages, and coverage modifications provided by this Endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Description Limit of Insurance Page Non -Owned Aircraft Included 2 Non -Owned Watercraft ' Included 2 Bodily Injury - Mental Injury; Mental Anguish, Humiliation or Shock Included 3 Medical Payments $ 20,000 r .3 Damage to Premises Rented to You $ 1,000,000 3 Supplementary Payments - Bail Bonds $ 3,000 4 Supplementary Payments - Loss of Earnings $ 1,000 per day 4 Newly Formed or Acquired Organizations Included 4 Unintentional Failure to Disclose Hazards Included 5- Knowledge of Occurrence, Claim or Suit Included 5 Property Damage Liability - Elevators Included, 5 Property Damage Liability - Borrowed Equipment Included 5 Liberalization Clause Included 6 Amendment of Pollution Exclusion (Premises) Included 6 Limited Property Damage to Property of Others 1 $ 5,000 6 Additional Insured - Manager or Lessor of Premises Included 7 CG 89 70 (Ed. 11/14) (Page 1 of 12) l� * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY - *D/B* 340052464 .410488 (b) not being used to carry persons or property for a charge. C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. D. Medical Payments - If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $ 20,000; or b. the amount shown in the Declarations for Medical Expense Limit This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water to premises while rented t'o you or temporarily occupied by you with permission -of the owner. A separate Limit of, Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. However, this insurance does not apply to damage to premises while rented to you, or-' temporarily occupied by you with the permission of the owner, caused by: I. rupture, bursting, or operation of pressure -relief devices; ii. rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; ill. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or iv. flood 2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: CG 89 70 (Ed. 11/14) (Page.3 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection system or water while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water or any combination of the six, is the higher of $ 1,000,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV -- COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water." 4. As regards coverage provided by this provision I. Damage to Premises Rented to You - paragraph 9.a. of Definitions is replaced with the following: 9. a. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract'; F. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $ 3,000 for the 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. 2. Paragraph 1.d, is replaced by the following: 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 $ 1,000 a day because of time off work. G. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a named insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you;; b. coverage A does not apply to "bodily injury" ,or property damage that occurred before you acquired or formed the organization; and c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. CG 89 70 (Ed. 11/14) (Page 4 of 12) S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 d. records and descriptions of operations must be maintained by the first named insured. 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 or qualifies as an insured under this provision. H. Unintentional Failure to Disclose 'Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. 1. Knowledge of Occurrence, Claim or Suit / Under SECTION IV - COMMERCIAL GENERAL -LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such injury., claim or suit shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership c. an executive officer or insurance manager, if you are a corporation. J. Property Damage Liability - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) of exclusion j. Damage to Property do not apply if such property damage results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. K. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) of exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded _ by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. CG 8.9 70 (Ed. 11114) (Page 5 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 L. Liberalization Clause If we revise this Signature General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the date the revision is effective in your state. M. Amendment of Pollution Exclusion '(Premises) 1. The following is added to paragraph (1)(a) of Exclusion f. of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: (iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage, migration, release or escape of "pollutants." As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or escape of pollutants must: (aa) commence on a clearly identifiable day during the policy period; and (bb) end, in its entirety, within seventy-two (72) hours of the commencement of the discharge, dispersal, seepage, migration, release or escape of "pollutants"; and (cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape' of "pollutants" commences; and (dd) be neither expected nor intended from the standpoint of any insured; and (ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and (ff) not originate at or from a storage tank or other container; duct or piping which: a. is below the surface of the ground or water; or b. at any time has been buried under the surface of the ground or water and then is subsequently exposed. 2. For the purposes of this coverage, the following is added to the definition of "property damage" of SECTION V - DEFINITIONS and applies only as respects this coverage: Land or water, whether below ground level or not, is not tangible property. 3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown, to have actually occurred. N. Limited Property Damage to Property of Others The following is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B: 3. We will pay up to $ 5,000 for loss to personal property of others while in the temporary care, custody or •control of an insured.caused by any person participating in your organized activities. For the purpose of this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: a. coverage is otherwise provided by the Property Coverage part (if any) of this Policy; or CG 89 70 (Ed. 1 1 /14) (Page 6 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 b. the loss is covered by any other insurance you have or by any insurance of such person who causes such loss. These payments will not reduce the Limits of Insurance. O. Additional Insured - Manager or Lessor of Premises 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an additional insured has been issued; but the written or oral contract o,r agreement must be an "insured contract," and, (i) currently in effect or become effective during the term of this Policy; and (ii) executed prior to the "bodily injury," "property damage," "personal and advertising injury." 2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1 above, the following additional provisions apply: (a). This insurance applies only with respect to the liability arising out of the ownership, maintenance or use of that part of the premises leased to you. (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. I - (d) Coverage provided herein is,excess over any other valid and collectible insurance available to the Additional Insured whether the 'other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. __ _ (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Insured. P. Additional Insured - Funding Sources 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: , CG 89 70 (Ed. 11/14) (Page 7 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows: a. The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. b. The insurance afforded to the Additional Insured only applies to the extent permitted by law c. If coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide' for such additional insured. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. 1 Q. Additional Insureds - By Contract 1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or ,permit. Such person or organization is an additional insured but only with respect , to liability for "bodily injury," ',property damage" or "personal and advertising injury" arising out of: a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the Additional Insured that are subject of the written contract or written agreement provided that the -"bodily injury" or "property damage occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. the maintenance, operation or use by you of equipment' rented or leased to you by such person or organization; or c. the Additional Insureds financial control of you; or d. operations performed by you or on your behalf for which the state or political subdivision has issued a permit However: 1, the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required Uy contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide such additional insured. With respect to paragraph Ca. above, a person's or organization's status as an additional insured under this Endorsement ends when: CG 89 70 (Ed. 11/14) (Page 8 of 12) " S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 i (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to paragraph 1.b. above, this insurance does not apply to any 'occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this Endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage." We have no duty to defend an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured as required in paragraph b. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION. 2. With respect to the insurance provided by this Endorsement, the following are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: This insurance does not apply to: i a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured _allege _negligence o-r_ other_ wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the 'occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. c. "Bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its ,intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for- a principal as a part of the same project. CG 89 70 (Ed. 11/14) (Page 9 of 12) I * 81 * 10/19/2023 'PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 d.. Any person or organization specifically designated as an additional insured for -ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: a. required by the contract or agreement; or b. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. J This Endorsement shall not increase the -applicable Limits of Insurance shown in the Declarations. ,R. Primary and Non -Contributory Additional Insured Extension This provision applies to any person or organization who.qualifies as an additional insured under any form or endorsement under this Policy. z Condition 4. Other Insurance of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary -Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: n (1) the Additional Insured is a named insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. c b. The following is added to paragraph b. Excess Insurance: When a written contract or, written agreement, other than a premises lease, facilities rental contract or agreement, anequipment rental. __ orlease, contract_ or: agreement or_permit, issued by __ a state' or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an additional insured on other policies. S. Additional Insureds - Protection of Your Limits This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: An additional insured under this Endorsement will as soon. as practicable: CG 89 70 (Ed. 11/14) (Page 10 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 a. give written notice of an 'occurrence" or an offense that may result in a claim or "suit' under this insurance to us; b. tender the defense and indemnity of any claim or "suit' to all insurers whom also have insurance available to. the Additional Insured; and c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this.Coverage Part. d. we have no duty to defend or indemnify an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured. 2. The Limits of Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy and defined in SECTION III LIMITS OF INSURANCE of this Policy, whichever are less. These limits are inclusive of and not in addition to the Limits of Insurance available under this Policy. T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 8. Transfer of Rights of Recovery Against Others to Us: If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment we make for .injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard" provided that the injury or damage occurs subsequent to the execution of the written contract or written agreement. U. Property Damage Extension with Voluntary Payments 1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: At your request we will pay for "loss" to property of others caused by your business operations for which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so: The 'loss" must occur during the policy period and must take place in the "coverage territory." 2: With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of SECTION I COVERAGES A - Bodily Injury and Property Damage Liability is amended as — -- follows. Exclusions j.(3), j.(4), j.(5) and j.(6) are deleted. 3. As respects coverage afforded by this coverage, SECTION III- - LIMITS OF INSURANCE is replaced by the following: Regardless of the number .of insureds, . claims made or "suits" .brought or persons or organizations making claims or bring "suits": 1. Subject to 2. Below, the most we will pay for one or more 'loss", arising out of any one "occurrence" is $ 1,000. 2. The aggregate amount we will pay for. the sum of all 'loss in an annual period is $ 5,000. This aggregate amount is part of and not in. addition to the General Aggregate Limit described in paragraph 2. of SECTION III - LIMITS OF INSURANCE. CG 89 70 (Ed. 11/14) (Page 11 of 12) * S1 * 10/19/2023 * PAC 5361176 00 GREAT AMERICAN INSURANCE COMPANY *D/B* 340052464 410488 V. Who Is an Insured - Fellow Employee Extension - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury'.' caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to your "employee." W. Broadened Personal and Advertising Injury 1. Unless "Personal and Advertising Injury" is excluded from this Policy, the following is added to SECTION V - DEFINITIONS Item 14.: h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.e. CG 89 70 (Ed. 11/14)—` (Page 12 of 12)