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Home My WebLink AboutA7186 - THE LGBT SANCTUARY PALM SPRINGSCity of Palm Springs I l.ilu(uii: C .ij,\..ii • I'nlm ^pfUlu^ I •./:.3o2 .1 pv>» August 7. 2018 VIA ONITED STATES MAII Lance Thompson The LGBT Sanctuary Palm Springs 1301 N. Palm Canyon Drive Suite 202 Palm Springs, OA 92262 .ldlhompson@sanctuarvDalmsprinpg niyj He '^^"'"^■'°^®''®®ei«*emCIVo(Pfl(iii8pnn9stonieLGBTSaiaij«yPaiinS|)(in,s wThe LGBT Sanduary Palm SorinosVcran^-* tr ?e Srant awarded to your organizallon,and condihoos u^n ^Toh mratv and lhelerme"As8iaaooe-),,,aybesZ™r^eOMfollo^^^ '' ^ ('he $5,000 cash erant In support of the Independent Uvino Of ^rwrrSirto K IhaTSe^Te!S^?"''!l'r «"<>follow all of the Terms Despite its informalliv ritu ahh r^ t ® acceptance of. and promise toa fully blndlno and^foS^We STf ,'ha' 'his Agreemenl shaU serve asAssisLce as quickTa™^ Assisiance. City wHi tender allexpressed to City, upon Grantees return of this AflreemeUt.tlUy ' -vices irsTTTisupporting Services. ^ Assjstance hereunder to funding and/or act on Grantee^"iMhatf*NLm^^^ tolhe'sorvJce^and^r^^®®^^ representative, authorized toLance Thompson. CEO Services and all interaction with City related thereto; 2. ( ^l l i., B.,x SpMiiv... r.r.hh.jiM,, August 7, 2010 The LGBT Sanctuary Pairn Springs - Independent Uvina Page 2 4. 5 6 Grantee and its represantaiive shall ensure that all commumcalions and other ^cIlyTeLssarv in relation to Services, the provision of Asststance. and Ihts Agreemenl shall be With Anthony J Mejla, City Clerk rmntPfe shall comolv with all applicable federal, state and local law and regulationsprS^Iltae?SaVse?ure any and all necessary licenses and pannils required by Lavr In doing so Granlee agrees to use the ofTiclal City logo lo acknowledge the City's support on website infhe m^nlr noted below (with a hyperlink lo Ihe City's website) and on any P'f®® associated with its program or event. Grantee is also encourage to Include the City of Springs in all relevant social media poslings Special Funding provided by The City of Palm Springs 7. Granlee ^all, upon any reasonable City request, notify Us employees, merrtbers and volunleers of opportunities lo volunteer at City events. a Grantee is an indepsndenl organization, not aflilialed with City except by way of this Agreementas rr^P^rtl or Assignee Neither City nor any of Us offtctals, employees contracfors, volunleers or agents (in Ihe aggregate -City's Related Parties") shall ® manner mode or means by which Grantee, its managers, employaes. contractors votunleers or aaents (in Ihe aggregate, "Grantee's Related Parties") perform Services. Furlher. this Agreernenl does not establish any retalionship vi/hatsoever between City and any person(sj who ^ benefit from Grantee'^ Services CGramee^s Beneficiariea") Granl^ warrants and none of Grantee's Related Parties or Grantee's Beneficianes has any contractual or other relationship \wllh City arising from or retated to this Agreement Grantee is merely a entity recognized by City as worthy of City's Assistance, for the sole and exclusive purpose ofpror^oting Grantee's Services m the community. However, in recognition of the fs receiving public funds pursuant to this Agreemant In the form of the Assis ance, City shall have the right to review Grantee's work product, results, records and advice in relation to any Services rendered to Benefidaries that are funded or supported. In whole or in part, by the Assistance 9 Neither Granlee nor any person who is one of Grantee"s Related Parties or ® Beneficiaries sftail at any lime or in any manner represent that any person who is one of Grantee's Related Parties or Grantee's Beneficianes is one of City's Related Parties, by virtue of this Agreement or otherwise 10 Granlee shall prepare and deliver lo City a Final Report that documents ^ ®pptolion the Assistance to the advancement of Services; Ihese reports shall Include but expenditures of City funds by Grantee. Final Report must accompany your applica ion for the 2019-20 grant cycle, or be submitted by December 31, 2019 if you are not applying. 11 Granlee shall procure and maintain, at Grantee's sole cost and expense, policies of insurance as reguired by the City Attorney 7hoi(-DTe August?, 2018The LG8T Sanciuary Palm Springs - Independent Living Page 3 the City or any of City's Related Pariifli: i innZ. • 'ne negligence or wjllful misconduct of Grantee's Insurance '"<»««(» or nature ofdefend or hold City hai^ss hLund?r «>n9«™ed to limit Grantee's duty to Indemnify, iTy^frapSf a^ams. any 14 This Agreement contains all of the agreements between CJtv snri ^ agrrcss.i.-aa ;=ajry.«'ysfg August 7, 2018 The LGBT Sanctuary Palm Springs - Independent Living Page 4 . CITY OF PALM SPRINGS David H. Ready. PhD City Manager agreed The LGBT Sanctuaiv Palm SprinQS By. Name and T^tie CEO Signwre APPROVED BY CmT COUNCIL C.o<vVac.^ ATlt5(<? ACORdf CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/13/2018 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 1st Community Insurance Services PO Box 2408 Palm Springs OA 92263 NAME*^^ 1 St Community Insurance Services phone fax (WC.No. Ext): (A/C. No): A^ESS: serviceigcisps.com INSURER(S) AFFORDING COVERAGE NAIC« INSURER A Non Profits Insurance Alliance of Califomia NIAC INSURED The LGBT Sanctuary Palm Springs, Inc. (The) 1301 N Palm Canyon Ste 202 Palm Springs CA 92262 INSURER B ACE Fire Underwriters Insurance Company 20702 INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE 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 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. -p-fiOCVEFP (MM/DD/YYYY) P6UCY£Xf> IMM/DD/YYYY)TYPE OF INSURANCE AODLtSUBR INSD WVD POLICY NUMBER UMIT5 irasff LTR COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) 2018-46096 01/15/2018 01/15/2019 PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER; PRO JECTXPOLICY OTHER: GENERALAGGREGATE PRODUCTS - COMP/OP AGG Liquor Liability 1.000.000 500.000 20.000 1.000.000 2.000.000 2.000.000 s 1,000.000 AUTOMOBILE LIABILITY ANY AUTOX COMBINED SINGLE LIMIT (Ea accident)S 1,000.000 BODILY INJURY (Per person) OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY 2018^6096 01/15/2018 01/15/2019 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) Uninsured motorist S 1.000.000 UMBRELLA LIAB EXCESS LIAB DEO OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE RETENTION S WORKERS COMPENSATION AND EMPLOYERS* UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER STATUTE OTH ER □E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Directors and Officers Liability NFPCAG280557542003 12/04/2017 12/04/2018 Aggregate SI .000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD101. Additional Remari<s Sctiedule, may be attactied if more space is required) Certificate liolder is named as additional insured if indicated by "Y" above. Additional insured status applies only to ttie extent ttiat ttie work is performed under or subject to a written agreement or contract. Ttie policy provisions govem in all situations. CERTIFICATE HOLDER CANCELLATION City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E. Tahquitz Canyon Way AUTHORIZED REPRESENTATIVE Palm Springs 1 CA 92262 ACORD 25 (2016/03) (S) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD National WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Casualty INSURANCE POLICY - INFORMATION PAGE Company INSURER: POLICY NO: WCNCC 311046 NATIONAL CASUALTY COMPANY 1100 Locust St. Dept 3000 NEW BUSINESS Des Moines, lA 50391-3000 NCCI Company No: 18805 Account No: RISK ID # N.J. Taxpayer Identification No. ITEM 1. NAMED INSURED AND MAILING ADDRESS: PRODUCER NAME AND ADDRESS: THE L6BT SANCTUARY PALM SPRINGS, INC ILLINOIS MIDWEST INSURANCE AGENCY, 1301 N PALM CANYON LLC 202 PO BOX 13107 PALM SPRINGS, CA 92262 SPRINGFIELD, IL 62791 PRODUCER NO.: 95515 LEGAL ENTITY: Non Profit Corporation OTHER WORKPLACES NOT SHOWN ABOVE: (See Workers Compensation Classification Schedule) ITEM 2. POLICY PERIOD: From: 06/01/2018 To: 06/01/2019 Effective 12:01 A.M. Standard Time at the Insured's mailing address. ITEMS. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: CA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident: $ 1,000,000 each accident Bodily Injury by Disease: $ 1,000,000 policy limit Bodily Injury by Disease: $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AL AK AZ AR CO CT DE DC PL GA HI ID IL IN lA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC OK OR PA RI SC SD TN TX UT VT VA WV WI D. This Policy includes these Endorsements and Schedules: See Schedule of Forms and Endorsements. ITEM 4. PREMIUM: The premium for this Policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to verification and change by audit. Total Estimated Minimum Premium: $ 750 Annual Premium: $ 8,262 Audit Period: ANNUAL Issued At: Date: 05-22-18 Countersigned by WC GO DO 01 A Copyright 1987 National Council on Compensation Insurance Advance Copy NATIONAL CASUALTY COMPANY Policy Number WCNCC 311046 SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured The L6BT Sanctuary Palm Springs, Inc Effective Date: 06-01-2018 12:01 A.M., Standard Time Agent Name ILLINOIS MIDWEST INSURANCE AGENCY, LLC Agent No. 95515 Number Edition Description WCCB182 08-10 Cailfornia Loss Control Consultation WC 00 00 01 A 11-99 Schedule of Names & Locations - NCC WC 00 00 01 A 07-97 Information Page - NCC WC 00 00 01 A 01-87 Classification Schedule - NCC WC 00 00 00 C 01-15 Workers Compensation And Employers Liability insurance WCOO 04 19 01-01 Premium Due Date Endorsement WC 00 04 21 D 01-15 Catastrophe {other than Certified Acts of Terrorism) Premium Endorsement WC 00 04 22 B 01-15 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement WC 04 03 01 C 10-14 Policy Amendatory Endorsement - CA (Ed. 10-14) WC 04 03 10 01-95 Duty to Defend - CA (Ed. 1-95) WC 04 03 31 A 04-16 Endorsement Agreement Limiting And Restricting This Insurance - Exclusion of Fam WC 04 03 37 A 04-16 Endorsement Agreement Limiting And Restricting This insurance - Exclusion of Joint WC 04 03 60 B 01-15 Employers Liability Coverage Amendatory Endorsement - CA (Ed. 01-15) WC 04 04 21 01-08 Optional Premium Increase Endorsement - California WC 04 04 22 01-12 California Short Rate Cancellation Endorsement (Ed. 01-12) WC 04 06 01 A 12-93 California Cancellation Endorsement PN 04 99 01 F 03-15 Policyholder Notice - Your Right to Dividend Information PN 04 99 02 B 05-02 Policyholder Notice - California Workers Compensation Insurance Rating Laws PN 04 99 04 12-01 Policyholder Notice - California Insurance Guarantee Association (CIGA) Surcharge PN 04 99 06 C 07-15 Policyholder Notice - Payroll Record Requirements for Dual Wage Construction or E PN 04 99 07 A 07-15 Policyholder Notice - Audit Requirements for High Dual Wage Construction Classes WC 99 06 89 01-16 Cover Page WC000001A Advance Copy NATIONAL CASUALTY COMPANY Policy Number WCNCC 311046 EXTENSION OF INFORMATION PAGE WORKERS COMPENSATION CLASSIFICATION SCHEDULE State of; California Risk ID: Named Insured The LGBT Sanctuary Palm Springs, Inc Effective Date: 06-01-2018 12:01 A.M., Standard Time Agent Name ILLINOIS MIDWEST INSURANCE AGENCY, LLC Agent No. 95515 Total Estimated Estimated Classification of Operation Code Annual Per $100 of Annual No.Remuneration Remuneration Premium Premium Period: 06/01/2018 to 06/01/2019 SOCIAL REHABILITATION FACILITIES FOR ADULTS - all 8804 137,000 5.55 7,604 employees. CLERICAL OFFICE EMPLOYEES - N.O.C.8810 16,000 0.47 75 Total Manual Premium 7,679 Employers Liability Limits 9812 0.028 215 Total Modified Premium 7,894 Total Standard Premium 7,894 Premium Discount 0063 0.013 -103 Expense Constant 0900 125 Terrorism 9740 0.01 15 Catastrophe (other than Certified Acts of Terrorism)9741 0.01 15 California Guarantee Fund Assessment 9687 0.02 159 California Fraud Surcharge Assessment 9682 0.00255 20 California Workers' Compensation Admin Fund Assessment 9681 0.008146 65 Califomia Uninsured Employer's Benefits Fund Assessment 9684 0.000573 5 Califomia Subsequent Injury Benefits Trust Fund Assessment 9683 0.003599 29 Califomia Workers' Occupational Safety & Health Education 9685 0.002655 21 Assessment Califomia Labor Enforcement & Compliance Fund Assessment 9686 0.00215 17 State Total Cost 8,262 Estimated Annual Premium 7,946 Total Assessments 316 Total Amount Due 8,262 WC000001A Advance Copy