HomeMy WebLinkAbout04016 - FIND FOOD IN NEED DISTRIBUTION CDBG SUBRECIPIENT Page: 4
Report: Expired Contracts: Oldest Date= / / and XREF= COMMUNITY&ECONOMIC DEV-Summary July 24, 2003
Contract Number Description _Approval Date Expiration Date Closed Date
A4016 1998-99 CDBG Subrecipient Agreement 08/11/1998 08/01/1999
Contractor:Food In Need Of Distribution
Insurance Status: A policy has Expired.
XREF: COMMUNITY& ECONOMIC DEVELOPMENT d
s
Service: In File } p
A4138- 1999-2000 CDBG Subrecipient 09/08/1999 09/01/2000
Contractor :Shelter From The Storm
Insurance Status: Certificate and Policies are OK <<
XREF: COMMUNITY& ECONOMIC DEVELOPMENT ? ' _=%
fr
Service: In File • f (f
A4145/ CDBG 1999/2000 Subrecipient Agreement 10/18/1999 10/01/2000
Contractor :Bo s & Girls Club f 'f r t mil
y Insurance Status: Certificate and Policies are OK t c+6
XREF: COMMUNITY& ECONOMIC DEVELOPMENT2f '`
Service: In File '
A4146,x CDBG 1999/2000 Subrecipient Agreement 10/11/1999 10/01/2000
Contractor :Mizell Senior Center ' f .- "` f.
Insurance Status: A policy will expire soon. � � � _
XREF: COMMUNITY& ECONOMIC DEVELOPMENTaL y?� %_ f
Service: In File 07,E
f�u f
A4147., 99-00 Subrecipient Agr 10/11/1999 10/01/2000
Contractor :P.S.Youth Center � � '
Insurance Status: policy will expire soon. �� �-- ,_ ,C,tea,
r —
XREF: COMMUNITY& ECONOMIC DEVELOPMENT `�-d,� �'.
Service: In File f
A4148v CDBG 1999-2000 Subrecipient Agreement 10/11/1999 10/01/2000 `
Contractor :Fair Housing Council Of Riversode County
tY Insurance Status: Certificate and Policies are OK o *'
XREF: COMMUNITY & ECONOMIC DEVELOPMENT "; E,c •
Service: In File
A4149F CDBG 1999-2000 Subrecipient Agreement 10/11/1999 10/01/2000 `
Contractor:Food In Need Of Distribution
Insurance Status:A policy has Expired.
XREF: COMMUNITY& ECONOMIC DEVELOPMENT
Service: In File f
• r
Food in Need of Distribution
Food Product Delivery
AGREEMENT #401.6
R19228, 4-15-98
CM Signed, 8-11-98
SUBRECIPIENT AGREEMENT
THI$ AGREEMENT (herein "Agreement") , is made and entered into
this �f�—day of — 19i,1, by and between the CITY OF
PALM SPRINGS, (herein 'City) , a municipal corporation, and the FOOD
IN NEED OF DISTRIBUTION, (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 seq. ) , as amended from time to time (the
"Act") , and the regulations promulgated thereunder (24 C.F.R.
Section 570 et seq. ("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 CONTRACTOR.
1.1 Scope of Services . In compliance with all terms
and conditions of this Agreement, the Provider .shall provide those
services specified in the "Scope of Services" attached hereto as
Exhibit "A" and incorporated herein by this reference. Provider
warrants that all services will be performed in a competent,
professional and satisfactory manner.
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. 4
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
ORIGINAL DID
ANDIOP ftGPEF,''i�`,-f
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 .
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 TEN
THOUSAND DOLLARS ($10, 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:
WAYNE ROBINSON
ROLLIE E. SLIPICH
3.2 Contract Officer. The Contract Officer shall be
such person as may be designated by the chief administrative
officer of City.
2
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 time as 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 Economic
Development Division monthly reports on
program status;
(b) Section 109 of the Housing and Community
Development Act of 1974, as amended and the
regulations issued pursuant theretd;
(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;
3
(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 labor standard requirements as set forth
in 24 CFR Part 570, Subpart K and HUD
regulations issued to implement and
requirements;
(j ) The Program Income requirements as set forth
in 24 C. F.R. 570.504 (c) and ,570.503 (b) (8) ;
M The Provider is to carry out each activity in
compliance with all Federal laws and
regulations described in 24 C.E.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;
(1) Executive Order 11988 relating to the
evaluation of flood -hazards and Executive
Order 11288 relating to the prevention,
control and abatement of water pollution;
(m) The flood insurance purchase requirements of
Section 102 (a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234,) ;
(n) 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.
4
(o) Title VI of the Civil Rights Act of 1964 (P.L.
88-352) and implementing regulations issued at
24 CFR Part 1;
(p) Title VI11 of the Civil Rights Act of 1968
(P.L. 90-284) as amended; and
(q) The lead-based paint requirements of 24 CFR
Part 35 issued pursuant to the Lead-Based
Paint Poisoning Prevention Act (42 U.S.C. 4801
et seq. ) ;
(r) 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.
(s) 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 C-Ity; 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 porttion 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. )
5
(t) 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 Five Hundred Thousand Dollars ($500, 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 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, color, creed, religion, sex, marital
status, physical or mental disability, national origin, or ancestry
in the performance of this Agreement. Provider shall take
affirmative action to insure that applicants are employed and that
6
employees are treated during employment without regard to their
race, color, creed, religion, sex, marital status, physical or
mental disability, national origin, or ancestry.
6.2 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
party 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, California 92263
Attn: City Manager
WITH COPY TO:
Rutan & Tucker
611 Anton Blvd. , Suite 1400
Costa Mesa, California 92626-1998
7
TO CONTRACTOR:
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 this Agreement
on the date first above written.
THE jCi
4Manage
SDated: /� By:
ATTEST:
i y Clerk
APPROVED A
APPR S TO FORM:
RUTAN & TUCKERy
City A torney
CONTRACTOR:
F. I.N.D. , INC. t
Dated: AUGUST 5 , 1998 By: �21 �� � ���,
Name: ROL E E. S IT
Title: CHAIRMAN OF THE BOARD
8
EXHIBIT "A"
SCOPE, OF SERVICES
F.I.N.D. IS THE ONLY CERT:IFIED FOOD BANK FOR EASTERN RIVERSIDE
COUNTY. WE SUPPLY FOOD PRODUCTS TO 33 SATES, RECOVERY HOMES AND
FIVE HOMELESS FOOD DISTRIBUTION SITES. WE MAINTAIN APPROXIMATELY
14, 000 SQUARE FEET OF WAREHOUSE SPACE LOCATED IN CATHEDRAL CITY.
WE ALSO SERVICE HOMEBOUND DISTRIBUTION'' FOOD BOXES AND PERSONAL
PRODUCTS TO EIGHT DESERT CITIES AND PROVIDE FOOD FOR LOW INCOME
DAY CARE, CATHEDRAL CITY LOW INCOME DAY CAMP AND ELEMENTARY SCHOOL
SNACK PROGRAM.
EXHIBIT "A"
9
EXHIBIT "B"
BUDGET
F. I .N.D. has an annual warehouse rental budget of $80, 712 .00.
Please see attached budget.
CDBG funds available - $10, 000.
Funds will be reimbursed at $2, 000/month intervals to assist with
rent payments.
10
;� • � • • • 1998 OPERATIONS BUDGET
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
450 FOOD PURCH 4338 4338 4338 4338 4338 4338 4338 4338 4338 4338 4338 4337 52,055
470 FREIGHT 800 800 800 800 800 800 800 800 800 800 800 800 9,600
500 AUTO GASOL 725 725 725 725 725 725 725 725 725 725 725 725 8,700
501 AUTO REPAIRS 774 774 774 774 3,096
l 3 AUTO LICENSE 500 68 387 240 948 2,143
�04 AUTO INSURAN 1000 1000 1000 1000 1000 1250 1250 1250 1250 1250 11,250
600 BLDG RENT 6726 6726 6726 6726 6726 6726 6726 6726 6726 6726 6726 6726 80,712
601 BLDG RPR&MN 1150 1150 1150 1150 4,600
602 EQUIP RPR 1300 1300 1300 1300 5,200
603 ELECTRIC 1200 1400 1400 1400 1400 2000 2000 2000 2000 1200 1200 1200 18,400
604 WATER-SPRKLT 15 15 15 15 15 15 15 15 15 14 14 14 177
605 TELEPHONE 200 200 200 200 200 200 200 200 200 200 200 200 2,400
606 WAST DISPOS 84 84 84 84 84 84 84 84 84 84 84 384 1,308
607 WRHS SUPPLY 375 375 375 375 1,500
701 UNIFORM RNT 77 77 77 77 77 77 77 77 77 77 77 77 924
703 FRNCH TX PRM 10 10
800 CONF-MTGS 3000 3,000
an! aoQkgQ&ao 1000 1,000
802 TRAVEL ADMN 1000 1,000
B03 POSTAGE 65 65 65 65 200 200 200 200 65 65 300 300 1,790
804 2ND HARVST D 313 313 313 313 1,252
40O5 OFFICE SUPPL 225 225 225 225 225 225 225 225 225 225 225 225 2,700
06 AUDIT 1400 1,400
807 TRAINING 1,000 1,000
808 OFFICE EQUIP 5,000 5,000
900 SALARIES 3,334 3,334 3,334 3,334 3,334 3,334 3,334 3,334 3,334 3,334 3,334 3,334 40,008
901 PAYROLL TAX 400 400 400 400 400 400 400 400 400 400 400 400 4,800
902 COMP INSURN 1,100 1,100 1,100 1,100 4,400
903 LIABILITY INS 4,000 4,000
904 MISC EXP 500 500
905 BANK CHARGS 10 10
TOTAL 20,289 19,389 25,201 20,489 19,602 24,673 21,474 20,374 24,391 21,486 18,423 38,144 273,935
ACORDR �F # d: k '47 EM. �7f"f' .. " Da E(MMroDlrv)
09/10/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Menne Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
71-301 HWY 111, SUITE 10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
RANCHO MIRAGE CA 92270 COMPANIES AFFORDING COVERAGE
COMPANY
A FIRST NATIONAL INS CO OF AMERICA
NsuaeD
COMPANY
FOOD IN NEED OF DISTRIBUTION B AIEUIVL I
DBA: FIND COMPANY
P.O. BOX 41 C 199F
CATHEDRAL CITY CA 92234 COMPANY
.77777
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION
LT
R DATE(MM,DDNY) DATE(MMUDNY) LIMBS
CEENF.RAL LIABILITY GENERAL AGGREGATE $2, 000, 000
A y COMMERCIAL GENERAL LIABILITY CP77504261' 12/15/97 12/15/98 PRODUCE-COMBORAGG $1, 000, 000
CLAIMS MADE Yl OCCUR PERSONAL 8 ADV INJURY $1, 000, 000
V OWNERS d CONTRACTOR'S PROT EACH OCCURRENCE $1, 0 0 0, 0 0 0
FIRE DAMAGE(Any one fire) $5 0, 000
MED EXP(Any one perm) $5, 000
lAUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Petr person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accldeM)
-- - — -- ---� PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION ANC/ WC STATU- OTH-
EMPLOYERS'LIABILITY - --- TORY LIMITS ER
EL EACH ACCIDENT- _
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT .$
PARTNERSFXECUTIVE
OFFICERS ARE, EXCL EL DISEASE-EA EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONSA-OCATUNSNEHICLESSPECW.ITEMS
CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED:
JOB DESCRIPTION: 1998-99 CDBG SUBRECIPIENT AGREEMENT
A4016
CERTIFICATE HOLDER :.', : .:.:F - .'�GiCNCB1 'Tri]N;;.
& ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY )fJYLx X0plPd wx TO MAIL
CITY OF PALM SPRINGS 3_0— DAYS WRRTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
CITY CLERK ffex` F(5(9Y"lLX"I;(. �Tl�ft 7Akixlk AOd4tB1FRDiR KR9 DQ9@�E7t
P.O. BOX 2743 pF XIgMX)U7(pW)6W>M >MX-AM14D X)OKXdp(9EH-?4FAM1 MX
PALM
. ..... :.. :.. .... AUTHOR2ED REPRESENTATIVE
SPRINGS CA 92263
ACORD 25 /
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- -------- -------
I. .
STATE �P.O. BOX 420807,SAN FRANCISCO, CA 94142-0807
COMPENSATION
I N S U R A N C E
FUND CERTIFICATE OF WORKrER& C(➢1VIPENSATiQiV INSURANCE.:
POLICY.NUMBER: -
CERTIFICATE EXPIRES:
L
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon fen days'advance written notice to the employer.
We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other- document with
respect to which this certificate of Insurance may be;issued or may pertain, the insurance afforded by the policies
described herein is subject to all theterms,^exclusions and conditions of such;policies. „
AUTHORIZED REPRESENTATIVE : - - ! PRESIDENT
CEP 2
EMPLOYER
L
THIS DOCUMENT . :
-STATE
COMPENSATION
INSURANCE
FUND
IN REPLY REFER TO
2065
CERTIFICATE HOLDERS' NOTICE
ENDORSEMENT AGREEMENT
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THIS POLICY SHALL NOT BE CANCELED UNTIL:
(SPECIFY NUMBER) 30 DAYS
AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED IN
THE MAIL BY STATE FUND TO CURRENT HOLDERS OF CERTIFICATE OF
WORKERS' COMPENSATION INSURANCE.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS,CONDITIONS,AGREEMENTS OR LIMITATIONS OF THIS
POLICY OTHER THAN AS ABOVE STATED NOTHING ELSEWHERE IN THIS POLICY SHALL BE
FIELD TO VARY,ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS,AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT
N-
6301 Day Street• Riverside,CA 92507-0902
(909)656-8300 Policy Fax(909)656-8359 Claims Fax(909)653-1597
Mailing Address P.O. Box 5025• Riverside, CA 92517-5025
I.