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A5637 - DESERTARC - CDBG SUBRECIPIENT AGR
SUBRECIPIENT AGREEMENT THIS AGREEMENT (herein "Agreement"), is made and entered into this day of�� 2008, by and between the CITY OF PALM SPRINGS, (herein "City), a municipal corporation and charter city, and the DesertArc. , (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 sec.), as amended from time to time (the "Act"), and the regulations promulgated thereunder(24 C.F.R. Section 570 et semi. ("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 Scone of Services. Provider agrees to provide to City all of the services specified and detailed in its application for funding and Exhibit A, and to conduct all programs specified therein in a manner to reflect credit upon the City and Provider. 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 Providers application for funding. City provided funds shall be used only for those purposes specified in such application. 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 2.2, 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 or due to receiver $20,000.00 or more from the City during the 2008 — 2009 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 financial information provided for in this paragraph shall be furnished not later than January 315t of the current fiscal year. 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 FIFTEEN THOUSAND DOLLARS ($15,000.00) (the "Contract Sum") in accordance with 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 monthly statements 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 Payroll 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 OMB 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: Richard Balocco Executive Director 3.2 Contract Officer. The Contract Officer shall be such person as may be designated by the chief administrative officer of City. 3.3 Prohibition Against Subcontractinq or Assi ng ment. 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 time as -2 - may be required by the regulations of the Housing and Community Development Act, but in no case for less than three years after the close of the program. 4.2 The Provider certifies it shall adhere to and comply with the following as they may be applicable: (a) Submit to City through its Community and Economic Development Department monthly 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 O; (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); (1) 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); - 3- (o) The regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule", 24 CFR Part 85 and subpart J; OMB Circular Nos. A-102, Revised, A-87, A-110 and A-122 as they relate to the acceptance and use of federal funds under the federally- assisted program; (p) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and implementing regulations issued at 24 CFR Part 1; (q) Title VIII of the Civil Rights Act of 1968 (P-L. 90-284) as amended; (r) The lead-based paint requirements of 24 CFR Part 35 issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et see .); (s) Maintain property inventory system to numerically identify HUD purchased property and document its acquisition date as is set forth in OMB Circular A-110 Attachment N Property Management Standard 6d; and (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 570208 (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 (s)(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 (s) of this section.) (u) 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 -4- 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 Providers 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 Five Hundred Thousand Dollars ($500,000). 52 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 properly 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 DISCRIMINATION, TERMINATION, AND ENFORCEMENT, 6.1 Covenant Against Discrimination. Provider covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them that there shall be no discrimination against or segregation of any person or group of persons on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, pregnancy, marital status, age, sex, sexual orientation, or any other basis Protected Characteristic by applicable federal, state or local law in the performance of this Agreement. Provider shall take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, physical or mental disability, national origin, ancestry or any other basis Protected Characteristic by applicable federal, state or local law. 62 Term. Unless earlier terminated in accordance with Section 6.3 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. 6.3 Termination Prior to Expiration of Term. Either parry may terminate this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the other party. 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. 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, document, consent, approval, or communication either party desires or is required to give to the other party shall be in writing and either served personally or sent by prepaid, first-class mail to the address set forth below, or such other addresses as may from time to time be designated by mail. TO CITY.- City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn: City Manager - 5- WITH COPY TO. City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs, CA 92262-6959 Attn. City Attorney TO PROVIDER. DesertArc 73-255 County Club Dr Palm Desert, CA 92260-2309 _ 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 - _ I a municipal corporation f / Bye' 1r�1 G Cledc ( z! y Cfty Manager AP*ney FORM: ArPPyR�OOV�E BY(CITYCOUNCIL1�By �Fy�"L ! �('� tadCity PROVIDER: Check one: _Individual `Partnership _Corporation (Corporatichs 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�ecretag, Treasurer,Assistant Treasurer, or Chief Financial Officer)." 1 By: gy:U&&jb 9WL4-.� died Signature of Chai an of ard, I Notarized Signature Se Lary,Asst Secretary, ref sident or any Vice President Treasurer,Asst Treasurer or Chief Financial Officer Name: Vl 15Viln r-7 � I Name: - p �T'1 _P")Q04 Title: �C YyiiCl ill ]r]C�Ct lrll/f�iS�C�f ne CJ✓U 6��CI�LP State of 7��'- ,}l State of e A l county of �^WL!be-' ,,n plss �Q[ County of u 6��Jss ry On dog, vv.�V �U�J bc:Foreme, on, f�100e-iLLkfv7 �GD before me. personally appeared JU4 ,personally appeared P —R I who proved to ri(JrJ1.)'] �&Qa1`1 who proved to me on the basis of satisfactory evidencY14 be the person(s) me on the basis of saWacory evidence t0 be the pamon(s) whose name(s)Ware subscribed to the within instrument and whose name(s)islare Subscribed to the within instrument and acknowledged to me that ha(sheAhey exaWtad the Same in admvwledged to me that helshelthey executed the same in hislher/their authorized capacity(ies),and that by his/herRheir his/hedfheir authorized capacity(tes),and that by hislhedtheir sgnatura(s) an the instrument the person(s), or the entity signaturo(s) an the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the upon hehaff of which the pamon(s) acted, executed the instrument instrument. I certify under PENALTY OF PERJURY under the laws of the 1 certify under PENALTY OF PERJURY under She laws of the State of Cali mr that the foregoing paragraph Is true and State of Calrromla that the foregoing paragraph is true and correct - correct- WITNESS my h qd ar d Idal Seal. WITNESS my he official seal. Notary ---� Notary Signature: Signature= I / j Notary Seal: Notary Seal: , n I SO R. FRY R-FRY Commission # 1743799 ' "' Commission # 1743799 Notary Public -Callrornlo •c. =* NotaryPu611C -CallfornioRiverside County Riverside County MyComm.l3tplros 6,2011 Mycomm_px * ryl Z2a11 Deser W RC_subreGp4gnnLost0s -7- CITY OF PALM SPRINGS EXHIBIT A Scope of Services Prolect/Actiyity Title: Project Number: DesertArc/ 0003 Safety, Security S ADA Improvements Name/Address of Provider: DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 Obi ectives/Activities The intent of this program is to provide the needed services for mentally and/or physically challenged adults to reach their highest level of independence in work and in community. This will be accomplished through facility improvements to increase the safety and accessibility for all clients walking from building to building. DesertArc primarily covers the Southern California desert regions of the Coachella Valley and Morongo Basin, serving 604 clients of which 81 are Palm Springs' residents. 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 City by timely providing any additional information requested. TARGET DATE ACTIVITY#1 On-Going Make readily available any information relative to the successful implementation of the activity. Objective 2: Establish and maintain a programmatic and financial record keeping process. TARGET DATE ACTIVITY#1 On-Going Establish and maintain an efficient program process/procedure for proper record keeping- Set-up a filing system for CDBG files only. Document and maintain all records related to this program in a stable and secure location. Objective 3: Advertise, market and publicize the Program to facilitate Positive promotion for all parties (i.e., Provider. City CDBG etc.). TARGET DATE ACTIVITY#1 On-Going Draft a promotional piece and submit to City for approval. Advertise in the Desert Sun. Submit final publication to City. Objective 4: Enroll and income gualify at least a total of 81 extremely low and moderate-income Palm Springs residents. TARGET DATE ACTIVITY#1 On-Going Provide direct client programming for Palm Springs 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 ACTIVITY 91 On-Going Document and maintain all records related to this program, including those required, in accordance with HUD Regulations, in a stable and secure location. ACTIVITY#2 Monthly Submit Semi-Annual reports—referenced Exhibit E. Objective 6: Manage/monitor program activities. TARGET DATE ACTIVITY#1 On-Going PerForm monitoring activities necessary to ensure that the program is being conducted in compliance with the CDBG policies, federal regulations, and local statues, including Davis-Bacon Act, Copeland Act, and Non-discrimination/EEO requirements. Objective 7: Upgrade and improve the walkway safety on the campus as ADA and safety items are eliminated by addressing walkway trip hazards and installing detectable raised truncated warning domes in accordance with an 'open competitive' procurement process as outlined in proposal. TARGET DATE ACTIVITY 91 On-Going Conduct program activities, as stipulated in the proposal and in consultation with the City. Objective 8: Provide an evaluation within fifteen (15) calendar days of the program completion or final reimbursement. TARGET DATE ACTIVITY#1 07 5/5/09 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(Le.,clerical, monitoring, etc.) CITY OF PALM SPRINGS EXHIBIT B Budget Summary Proiect/Activity Title: Project Number. DesertArc! 0003 Safety, Security&ADA Improvements Name/Address of Provider: DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 BUDGET SUMMARY COST CATEGORY CDBG OTHER TOTAL SHARE SOURCES COST 1 Personnel $ - 0 - $ - 0 - $ -0 - 2 Consultant/Contract Services $ - 0 - $ - 0 - 3 Travel $ - 0 - $ - 0 - $ - 0 - 4 Space Rental $ - 0 - $ - 0 - $ - 0 - 5 Consumable Supplies $ - 0 - $500, $500. 6 Rental, Lease or Purchase of $ - 0 - $ _ 0 - $- 0 - Equipment 7 Insurance $ - D - $ - 0 - $ -0 - 8 Other $15,000. $1,000. $11,000. Work Contracts $ - 0 - $ - 0 - $ - 0 - $15,000. $1,500. $16,500. TOTALS `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 primarily are DesrtArc's in-kind services to oversee the project management. The Subrecipient shall submit Request for Reimbursement in accordance with the aforementioned cost categories. 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 301°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. Services are to be performed over the twelve-month period of this 2008-09 Program Year —July 1, 2008 through June 30,2009. CITY OF PALM SPRINGS EXHIBIT C Insurance Inventory ProieQ2&aivity Title: Project Number. DeserlArc/ 0003 Safety, Security &ADA Improvements Name/Address of Provider, DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 INSURANCE INVENTORY LIABILITY INSURANCE POLICY Name of Provider's Insurance Philadelphia Insurance Companies Effective Dates of Policy 04/25/08 to 04/25/09 Claims Made Policy / / Per Occurrence Policy ( / Limits of Liability 3M General Aggregate Deductibles: Per Occurrence $ M Annual Aggregate $ M Additional Insured Endorsement (Certificate Holder) C Yes ❑ No Original Certificate of Insurance Attached ❑ Yes d No WORKER'S COMPENSATION POLICY Name of Provider's Insurance Company Crum & Forster Effective Dates 12/31/07 to 12/31/09 Limits of Liabilit §1M Per Occurrence Underlying Coverage Limits Per Statute as set by State Law Original Certificate of Insurance Attached ❑ Yes 0 No ACORDm CERTIFICATE OF LIABILITY INSURANCE iVO4/2008 PRODUCER (909)484-2456 FAX (909)484-2491 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cumbre Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lic# 0708981 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3333 Concours Suite 5100 Ontario, CA 91764 INSURERS AFFORDING COVERAGE NAIC M INSURED Desert Arc INSURERA. Philadelphia Ins Companies 23850 73-255 Country Club Drive iNSURERB CrumBrForster Palm Desert, CA 92260 INSURER INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR;VP'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY PHPK308574 04/25/2008 04/25/2009 EACH OCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 100,000 PRFMI7F9 fr. CI-AIMS MADE OCCUR MED EXP(Any one eersen) 5 5,000 A PERSONAL&ADV INJURY 5 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMFIOP AGC 5 3,000,000 P0UCYF—j PE LOC AUTOMOGILE LIABILITY PHSD34243-6 07/01/2008 07/01/2009 OOMBINEO SINGLE LIMIT X ANYAUTO (ka acnecnq S 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) 5 A X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per=mdenQ 5 PROPERTY DAMAGE (Peracddentl GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGO 5 EXCESSIUMSRELLA LIABILITY PHU8237924 04/25/2008 04/25/2009 EACH OCCURRENCE z 5,000,000 X OCCUR CLAIMS MADE AGGREGATE 5 5,000,000 A $ DEDu�TIgLE S X RETENTION S 10,00C IS WORKERS COMPENSATION AND 4086948087 12/31/2007 12/31/2008 X we STAiU- DTH- EMPLOYERS LIABILITY E L EACH ACCIDENT 5 1,000,000 B ANY PROPRIE- ORPARTNEI'LEYECUTIVE OFFICERrMEMBER EXCLUDED? E L DISEASE-EA EMPLOYE 5 1,000,000 SPECIAL dL PROVISIONS EL DISEASE-POLICY LIMIT S 1,000,000 SPECF�IAiL PROVISIONS pcicw POR essiopal Liability PHPK308574 04/25/2008 04/25/2009 $3,000,000 Aggregate A $1,000,000 Each Professional Incident DESCRIPTION OF OPERATIONS I LOCATIONS IVEHCLES IEXC USI NS ADDED BY FHDORSEMENT I SPECIALPROVISIONS t 1s further understood an agree t e certificate holder is to be named as Additional Insured per farm CG2010 07/04 on file with Certificate Holder. Waiver of Transfer of Rights of Recovery gainst Others reads per the attached endorsement CG2404 10/93. 0 Day Notice of Cancellation Provision To apply for non-payment of premium CERTIFICATE HOLDER CANCELLATION 5HOULP ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL MMY) LVU MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Palm Springs XtYIXKIbX➢C)Q8WA6}Glel{ 1fYdElE:G7fW1[1ltdcaflhxa6xYlXaiMxdeXX City Clerk P.O. Box 2743 E(PW6N.XMXx00T'll Y24114=K4 GCr]fXTr9OOGYYIXKrMOOkXXXXXXXXX Palm Springs, CA 92262-6959 AUTHORIZED REPRESENTATIVE Ruben Medina LC ACORID 25(2001108) bACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed.A statement on this certifcate does not confer rights to the certificate holder in lieu of such endorsement(s). 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) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25(2001103) POLICY NUMBER- PHPK308574 COMMERCIAL GENERAL_LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organ lzation s The City of Palm Springs, its officers, officials, employees and volunteers are to be covered as additional insureds. Information re ulred to complete this Schedule if not shown above,will be shown in the Dc-darations. Section II — Who Is An Insured is amended to in- elude as an additional insured the person(s) or or- ganization(s) shown In the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: A, In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 II POLICY NUMBER: PHPK308574 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the foilowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: COVERAGE PROVIDED UNDER THIS FORM IS PRIMARY AND NON-CONTRIBUTORY EXCEPT FOR GROSS NEGLIGENCE OR WILLFUL MISCONDUCT BY THE ADDITIONAL INSURED. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of this following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work" done under a contract with that person or organization and Included In the "products-Gompleted operations hazard"- This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 Q CITY OF PALM SPRINGS EXHIBIT ❑ Beneficiary Qualification Statement ProieCUACtivity Title: Proiect Number: DesertArc/ 0003 Safety, Security&ADA Improvements Name/Address of Provider: DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 BENEFICIARY QUALIFICATION STATEMENT This statement must be completed and signed by each person or head of household (legal guardian)receiving benefits form the described project/activity. Plaase answer each of the following quostions. 1. How many persons are in your household? Far LYis question a nouseiloid 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(RiversideSan Bemardino-Ontarlo,CA MSA—0211311na) AREA MEDIAN NUMBER OF PERSONS IN YOUR HOUSEHOLD: INCOME(AMI) 1 2 3 4 5 6 7 8 LEVEL EXTREMELY LDIA INCOME $14,000 $16,000 S18,000 $20,000 $21,600 $23,200 $24,800 $26,400 0-30V ofAMI VERY LOW INCOME $23.300 $26,650 $29,950 $33,300 $35,950 538,650 S41,300 $43,950 31-50%ofAMI LOW INCOME S37,300 S42,650 $47,950 $53,300 $57,550 $61,850 $66100 $70,350 51-80%of AMI MODERATE INCOME $52,100 $59,500 $67,000 S74,400 $80,400 $85,300 $92,300 598,200 81-120% 3. What mostathnicity,do you identify yoursolf as;ploaso note that this self-identification is voluntary in accordance with equal opportunity laws? ❑ White ❑ American Indian or Alaska Native AND White ❑ Nack/Afdcan American ❑ Asian AND White 0 Asian 0 BlacklAfrimn American AND White ❑ American Indian or Alaskan Native ❑ American Indian/Alaska Native AND Black/African American ❑ Native Hawaiian or Other Pacific Islander 0 Other. HISPANICIIATINO ETHNICITY ❑ Yes ❑ No If yes,check one:0 Mexican/Chicano ❑ Puerto Rican ❑ Cuban ❑ Other: A. Please check,VPS or n�if you are a female Head of Household? ❑ YES ❑ NO 5- Do you have a disability? ❑ YES ❑ NO If YES,please doscribe: 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 fomn Is confiderntial end u only utilized for Community Development Stock Grant(CD5G)program purposes,a Federally-funded program governmental reporting purposes to monitor mmphancg, CITY OF PALM SPRINGS EXHIBIT E Semi-Annual Program Progress Report Pro ecUActivity Title: Pralect Number: DesertArc1 0003 Safety,Security&ADA Improvements Name/Address of Provider: DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 PROGRAM PROGRESS REPORT Period: DIRECT BENEFIT REPORT ♦ Number of First-Time Program Beneficiaries Serviced. #of Households #of Persons 0-30%below 31-50%below:_ 51-60%below„_ 120%below ♦ Number of First-Time Female Headed Households: • Counts by Race/Ethnicity: White i American Indian or Alaska Native AND White Black/Afncan American Asian AND White— Asian — BlacloAfrican American AND White American Indian or Alaskan Native American Indian/Alaska Native AND Black/Afrlcan American Native Hawaiian or Other Pacific Islander —Other. HISPANICILATINO ETHNICITY: Mexlranlchicano Puerto Rican Cuban Other: • Number of Disabled: ACCOMPLISHMENT NARRATIVE LEVERAGING RESOURCES NARRATIVE Signed Title Date CITY OF PALM SPRINGS EXHIBIT F Request for Reimbursement Project/Activity Title: Proiect Number: DesertArc/ 0003 Safety, Security&ADA Improvements Name/Address of Provider: DesertArc 73-255 Country Club Dr Palm Desert, CA 92260-2309 BENEFICIARY QUALIFICATION STATEMENT Approved current Prior Tom Gmm UcaG'Ipfion Grant nelmbmscment Ralm6ursemem Yi➢ Balanco Amount Period Period(s) Reimbursement (Gvorl Under) Work Contracts $15,000. TOTAL $15'000. 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;(e) 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. Lobar 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 Copeland "Anti-Kekback"Act (40 U,S-C- 276a-276a-5;40 USC 327 and 40 USC 276c)and all 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 journeyworkers;provided,that if wage rates higher than those required under the regulations are imposed by slate 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 cortlfies 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 Houaing and Urban Development Act of 1968, as amended, 12 U-5.0 1701.Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low-inceme residents of the projed area and contracts for work in connection with the project be awarded to business concems 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 Coa(-- 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 CDB&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 N 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. ACOR" DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE a/sD/D THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 (WC) Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek CA 94596 CONTACT Walnut Creek AMS Team PHONE FAX Ex : 925-934-8500 �IAlc,MM:925-934-8278 ADDRESS: WainutCreekAMS@heffins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Company 18058 LicenseM 0 249 INSURED DESEARC-01 Desert Arc 73-255 Country Club Drive INSURER B : Care West Insurance Company 10520 INSURERC: Travelers Casualty and Surety Company of America 31194 INSURERD: Palm Desert CA 92260 INSURER E : INSURER F : GUVtKAGtS CFRTIFICATF NIIaaRFR' 1097Rrt7r.7d 0C1N42If1aJ all RAMCO. 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 ADDL SUER Y POLICY NUMBER PHPK2681688 POLICY EFF MMMDNYYY) 4/25/2024 POLICY EXP (MM/DD1YYYYJ 4/25/2025 LIMITS EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE LxlU OCCUR Y TO REMIDAMAES( RENTED PREMISES Ea occurrence) $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE $ 3,000.000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y PHPK2681688 4/25/2024 4/25/2025 COMBINED SINGLE LIMIT Ea a" dent $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS ) BODILY INJURY (Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY(Pero X FIRPER' DAMAGE a.dent $ a A X UMBRELLA LIAB X OCCUR PHUB909806 4/25/2024 4/25/2025 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA Y W-12312002040 12/31/2023 12/31/2024 PER X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A C Abuse Crime PHPK2681688 107431452 4/25/2024 4/25/2024 4/25/2025 4/25/2025 Limits Limits $1M/$3M 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Pickup of shredding services. City of Palm Springs, its elected officials, officers, employees, agents, and volunteers are included as an additional insured (Primary and Non -Contributory) on General Liability and additional insured on Automobile Liability policies per the attached endorsements, if required. Waivers of Subrogation are included on General Liability, Automobile Liability policies per the attached endorsements, if required. Waiver of Subrogation is included on Workers Compensation policy, if required. The Waiver endorsement has been requested for the Workers Compensation policy from the insurance company and if approved will be forwarded when received. Cancellation notice endorsements have been requested for the General Liability and Automobile Liability policies from the insurance companies and if approved Will be forwarded when received. This Certificate replaces and supersedes all previously issued certificates. CERTIFICATE HOI nFR pgrt_I"IVtI I r'AmrFI I ATIf11J MAY 0 8 2024 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Palm Springs 3200 E. Tahquitz Canyon OffICE OF THE CITY CMIMED Palm Springs, CA 92262 REPRESENTATIVE / ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I - 0 POLICY NUMBER: PHPK2681688 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13ME THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Blanket per written contract (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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: PHPK2681688 PI-CA-003 (04/14) •ti -�i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended by adding the following: The following are also "insureds": Any person or organization for whom you are required by an "insured contract" to procure "bodily injury" or "property damage" liability insurance arising out of the operation of a covered "auto" with your permission. However, this additional insurance does not apply to: 1. The owner or anyone else from whom you hire or borrow a covered "auto." This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own; 2. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household; 3. Anyone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours; 4. Anyone other than your "employees," partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees," while moving property to or from a covered "auto'; or 5. A partner (if you are a partnership), or a member (if you are a limited liability company) for covered "auto" owned by him or her or a member of his or her household. B. The "insured contract' must be in effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or "property damage". C. This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that "insured", whether the work is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by you or one of your employees. D. There is no coverage provided to this person or organization for "bodily injury" to its employees or for "property damage" to its property. E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault. F. The defense of any claim or "suit' must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or "suit". G. A person's or organization's status as an "insured" under this endorsement ends when your operations for that "insured" are completed. Page 1 of 2 POLICY NUMBER: PHPK2681688 PI-CA-003 (04/14) H. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any "insured," or to procure insurance. I. The following additional exclusions apply: The insurance afforded to any person or organization as an "insured" under this endorsement does not apply to "loss": 1. Which occurs prior to the date your contract is effective with such person or organization; 2. Arising out of the sole negligence of any person or organization that would not be an "insured" except for this endorsement; or 3. Which occurs after you returned the leased or rented "auto" to the lessor or the policy period ends, whichever occurs first. Page 2 of 2 POLICY NUMBER: PHPK2681688 PI-GL-005 (07/12) tip. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 4/25/2024 Name of Person or Organization (Additional Insured): Blanket per written contract SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury' arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. r J � _ __ - _ � -.� �� .� � - _ _ i - �-'.. .. .�_'_ .i _�:�_�'_'��.��� .�- �-. � - i_._ � .._ � '.i '. ��._ .� _� .. __�� ��.-� .�--_�._-_�i -cam POLICYNUMBER: PHPK2681688 PI-CA-023 (07/19) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "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 such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and the Garage Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "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 such "insured". PI-CA-023 (07/19) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with permission. EKC 1' h POLICY NUMBER: PHPK2681688 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 N. - WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Blanket per written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 x I POLICY NUMBER: PHPK2681688 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Desert Arc Endorsement Effective Date: 4/25/2024 SCHEDULE Name(s) Of Person(s) Or Organization(s): Blanket per written contract Information required to complete this Schedule if not shown above will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the 'loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 ❑ f