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HomeMy Public PortalAboutC-21-035 - OFFICE OF SAMOAN AFFAIRSBRECIPIENT AGREEMENT This SUBRECIPIENT AGREEMENT (the "Agreement"), is made and entered into on this 1st day of July, 2021, by and between the CITY OF CARSON, a California municipal corporation (the "City"), and OFFICE OF SAMOAN AFFAIRS OF CALIFORNIA, INC., a California non-profit organization ("Subrecipient")(individually referred to herein as "Party" and collectively, the "Parties"). RECITALS WHEREAS, the City has entered into various funding agreements with the United States Department of Housing and Urban Development ("HUD"), which funding agreements provide Community Development Block Grant funds ("CDBG Funds") to the City pursuant to the Federal Housing and Community Development Act of 1974, codified at 42 U.S.C. Section 5301 et seq., as amended from time to time (the "Act"), and the regulations promulgated thereunder, codified at 24 Code of Federal Regulations Section 570 et seq. (the "Regulations"); and WHEREAS, the Act provides that the City may grant CDBG Funds to nonprofit organizations for certain purposes allowed under the Act; and WHEREAS, the Subrecipient is a nonprofit organization which operates a program which is eligible for a grant of CDBG Funds; and WHEREAS, the City desires to assist in the operation of the Subrecipient's program by granting CDBG Funds to the Subrecipient in order to pay for all or a portion of the costs incurred in operating the program, subject to the terms and conditions more particularly set forth in this Agreement; and WHEREAS, this Agreement is not intended to create, nor shall it be construed as creating, any rights in any third Parties not a Party to the same, but rather this Agreement is intended to assist Subrecipient in providing cost effective services to the community it serves, as described in this Agreement; and NOW, THEREFORE, the Parties hereto agree as follows: 1.0 SERVICES OF SUBRECIPIENT. 1.1 Scope of Services. Subrecipient agrees to provide to City all of the services specified and detailed in both its application for CDBG Funds (the "Application") and in the "Scope of Services" attached hereto and incorporated herein as Exhibit "A" to this Agreement. Subrecipient represents and warrants to City that it is able to and will use the CDBG Funds granted by the City for the purpose of providing the services set forth in its Application and Exhibit "A", and only for that purpose. Subrecipient further represents and warrants that it will adhere to the terms of the Application and this Agreement in providing said services. 1.2 National Objective. Subrecipient certifies that the services provided with the CDBG Funds will meet the CDBG program's national objective of benefitting low and moderate income persons, as defined in 24 CFR Part 570.208. 01007.0001/716861.1 1.3 Special Requirements. Additional terms and conditions of this Agreement, if any, are set forth in the "Special Requirements" attached hereto and incorporated herein as Exhibit "B" to this Agreement. 1.4 Standard of Care. Subrecipient hereby represents and warrants to City that all services rendered pursuant to this Agreement will be performed in a competent, professional, and satisfactory manner. As a material inducement to City to enter into this Agreement, Subrecipient hereby further represents and warrants that it has the experience and skills necessary to undertake the services to be provided herein. 1.5 Compliance with Laws. All services rendered by Subrecipient pursuant to this Agreement shall be performed in accordance with all ordinances, resolutions, statutes, rules, and regulations of City and/or any federal, state or local governmental agency having jurisdiction at the time such services are rendered. 1.6 Licenses, Permits, Fees and Assessments. Subrecipient shall obtain at its sole costs and expense such licenses, permits and approvals as may be required by law for the performance of the services required by the Agreement. 1.7 Reports. No later than ten (10) days prior to any payment date specified in Section 2.1 of this Agreement, within ten (10) days following the termination of this Agreement, and at such other times as the Contract Officer shall request, Subrecipient shall provide the Contract Officer with a written report describing the services provided during the period of time since the last report and accounting for the specific expenditures of any portion of the Contract Sum, if applicable. At the times and in the manner required by law, the Subrecipient shall provide to the City, HUD, the Comptroller General of the United States, and any other individual or entity, or their duly authorized representatives, any and all reports and information required for compliance with the Act and/or the Regulations. 1.8 Financial Reporting. Any Subrecipient receiving or due to receive $20,000.00 or more from the City during the current fiscal year (July 1, 2021 through June 30, 2022) (the "Fiscal Year") shall provide the City with a financial statement which has been completed within the most recent twelve (12) months and which shows that the Subrecipient's financial records have been kept in accordance with generally accepted accounting standards ("Financial Statement"). This Financial Statement shall be prepared by a recognized accounting firm that is approved by or satisfactory to City's Chief Financial Officer, and shall include a general ledger balance sheet which identifies revenue sources and expenses in sufficient detail to demonstrate compliance with this Agreement and which is balanced with Subrecipient's bank statements. Any organization receiving or due to receive less than $20,000.00 from the City in the Fiscal Year shall provide the City with a copy of the organization's most recent charitable trust report to the Attorney General, or other financial information satisfactory to the City's Chief Financial Officer. The financial information that must be provided pursuant to this paragraph shall be furnished to the City's Chief Financial Officer not later than January 31St of the current Fiscal Year. 1.9 Audits and Inspections. All Subrecipient records concerning any matter covered by this Agreement shall be made available to the City, HUD, and the Comptroller General of the United States, or any of their authorized representatives, at any time during normal business hours, as often as is deemed necessary by those entities in order to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within thirty (30) days after receipt of such 01007.0001/716861.1 2 reports by the Subrecipient. Failure by the Subrecipient to comply with these audit requirements will constitute a breach of this Agreement and may result in the withholding of future payments thereunder. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current City policy concerning Subrecipient audits and 2 CFR 200. 2.0 COMPENSATION. 2.1 Contract Sum. The City shall pay to Subrecipient for the services to be provided hereunder, on a reimbursable basis, a sum not to exceed FIFTEEN THOUSAND DOLLARS AND NO CENTS ($15,000.00) (the "Contract Sum"), in accordance with the "Schedule of Compensation" attached hereto and incorporated herein as Exhibit "C" to this Agreement, which sum shall constitute full and complete reimbursement for the implementation of this Agreement for the entire Term thereof. Subrecipient shall submit to the City monthly statements of reimbursable expenditures pursuant to the attached "Schedule of Compensation", along with pertinent supporting documentation. The City shall promptly review the monthly expenditure statements and, upon approval, reimburse Subrecipient for its authorized operating costs. 2.2 Payroll Records. In cases where the Contract Sum will reimburse payroll expenses as part of operations, Subrecipient shall establish a system for maintaining accurate payroll records which will track daily hours charged to the project by Subrecipient's employees, as set forth in 2 CFR 200.430. 2.3 Draw Downs. Failure by Subrecipient to request reimbursement or encumbrance of at least 25% of the Contract Sum by the end of each Fiscal Year quarter (i.e. by September 30, December 30, March 31, and June 30, respectively) shall result in the immediate forfeiture of 25% of the Contract Sum, unless this requirement is waived by the Contract Officer. The Contract Officer reserves the sole and unfettered right to determine whether the circumstances warrant such a waiver. Any such waiver by the Contract Officer shall not be deemed to waive or render unnecessary Subrecipient's compliance with this provision for the remainder of the Term of this Agreement. 2.4 Default. In the event that Subrecipient defaults under any of the terms and conditions of this Agreement, City shall have no obligation to continue compensating Subrecipient for any work performed after the date of such default. The City's consent to or approval of any default by the Subrecipient shall not be deemed to waive the City's rights under this provision with respect to any subsequent default. (See also Section 6.4 below.) 2.5 Completion of Work. City reserves the right to withhold 10% of the Contract Sum until a Certificate of Completion is issued by the City. 3.0 COORDINATION OF THE WORK. 3.1 Representative of Subrecipient. The following principal(s) and/or representative(s) of Subrecipient are hereby designated as the person(s) authorized to act on Subrecipient's behalf with respect to the services specified herein and to make all decisions in connection therewith: June Pouesi, Executive Director 01007.0001/716861.1 3.2 Contract Officer. The "Contract Officer" shall be such person as may be designated by the City's City Manager. 3.3 Prohibition Against Subcontracting or Assignment. Subrecipient shall not contract with any other entity to perform, in whole or in part, the services to be provided pursuant to this Agreement without the express written approval of the City. Neither this Agreement, nor any interest created by it, may be assigned or transferred by Subrecipient, voluntarily or by operation of law, without the prior written approval of the City. 3.4 Independent Contractor. Except as otherwise set forth herein, neither the City, nor any of its agents or employees, shall have any control over the manner, mode, or means by which Subrecipient, or its agents or employees, perform the services to be provided pursuant to this Agreement. Subrecipient shall perform all such services as an independent contractor of the City, and shall remain at all times as to the City a wholly independent contractor with only such obligations as are consistent with that role. Subrecipient shall not at any time or in any manner represent that it, or any of its agents or employees, are agents or employees of the City. 4.0 INSURANCE AND INDEMNIFICATION. 4.1 Insurance. (a) Subrecipient shall procure and maintain, at its sole cost and expense, in a form and content satisfactory to City, during the entire term of this Agreement including any extension thereof, the following policies of insurance which shall cover all elected and appointed officers, employees and agents of City: (i) Commercial General Liability Insurance (Occurrence Form C00001 or equivalent). Insurance Service Office Form CG 00 01 covering Commercial General Liability (CGL) on an "occurrence" basis including products and completed operations, property damage, bodily injury, and personal & advertising injury. A policy of comprehensive general liability insurance written on a per occurrence basis for bodily injury, personal injury and property damage. The policy of insurance shall be in an amount not less than $1,000,000.00 per occurrence or if a general aggregate limit is used, either the general aggregate limit shall apply separately to this contract/location, or the general aggregate limit shall be twice the occurrence limit. (ii) Worker's Compensation Insurance. A policy of worker's compensation insurance in such amount as will fully comply with the laws of the State of California and which shall indemnify, insure and provide legal defense for the Subrecipient against any loss, claim or damage arising from any injuries or occupational diseases occurring to any worker employed by or any persons retained by the Subrecipient in the course of carrying out the work or services contemplated in this Agreement. (iii) Automobile Insurance. ISO Form Number CA 00 01 covering any auto (Code 1), or if the Subrecipient has no owned autos, covering hired, (Code 8) and non -owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. (iv) Professional Liability. Professional liability insurance appropriate to the Subrecipient's profession. This coverage may be written on a "claims made" basis, and must 01007.0001/716861.1 include coverage for contractual liability. The professional liability insurance required by this Agreement must be endorsed to be applicable to claims based upon, arising out of or related to services performed under this Agreement. The insurance must be maintained for at least 5 consecutive years following the completion of Subrecipient's services or the termination of this Agreement. During this additional 5 -year period, Subrecipient shall annually and upon request of the City submit written evidence of this continuous coverage. (v) Additional Insurance. Policies of such other insurance, as may be required in the Special Requirements in Exhibit "B". (vi) If the Subrecipient maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader overage and/or higher limits maintained by the Subrecipient (vii) Subcontractors. Subrecipient shall include all subcontractors as insureds under its policies or shall furnish separate certificates and certified endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements stated herein. (b) General Insurance Requirements. All of the above policies of insurance shall be primary insurance and shall name the City, its elected and appointed officers, employees and agents as additional insureds and any insurance maintained by City or its officers, employees or agents may apply in excess of, and not contribute with Subrecipient's insurance. The insurer is deemed hereof to waive all rights of subrogation and contribution it may have against the City, its officers, employees and agents and their respective insurers. The insurance policy must specify that where the primary insured does not satisfy the self-insured retention, any additional insured may satisfy the self-insured retention. All of said policies of insurance shall provide that said insurance may not be amended or cancelled by the insurer or any party hereto without providing thirty (30) days prior written notice by certified mail return receipt requested to the City. In the event any of said policies of insurance are cancelled, the Subrecipient shall, prior to the cancellation date, submit new evidence of insurance in conformance with this section to the Contract Officer. No work or services under this Agreement shall commence until the Subrecipient has provided the City with Certificates of Insurance, additional insured endorsement forms or appropriate insurance binders evidencing the above insurance coverages and said Certificates of Insurance or binders are approved by the City. City reserves the right to inspect complete, certified copies of and endorsement to all required insurance policies at any time. Any failure to comply with the reporting or other provisions of the policies including breaches or warranties shall not affect coverage provided to City. The insurance required by this Agreement shall be satisfactory only if issued by companies qualified to do business in California, rated "A" or better in the most recent edition of Best Rating Guide, The Key Rating Guide or in the Federal Register, and only if they are of a financial category Class VII or better, unless such requirements are waived by the City's Risk Manager or other designee of the City due to unique circumstances. 4.2. Indemnification. To the full extent provided by law, Subrecipient agrees to indemnify, defend and hold harmless the City, its officers, employees and agents ("Indemnified Parties") against, and will hold and save them and each of them harmless from, any and all actions, either judicial, administrative, arbitration or regulatory claims, damages to persons or property, losses, costs, penalties, obligations, errors, omissions or liabilities whether actual or threatened (herein "claims or liabilities") that may be asserted or claimed by any 01007.0001/716861.1 person, firm or entity arising out of or in connection with the negligent performance of the work, operations or activities provided herein of Subrecipient, its officers, employees, agents, subcontractors, invitees, or any individual or entity for which Subrecipient is legally liable ("indemnitors"), or arising from Subrecipient's or indemnitors' negligent performance of or failure to perform any term, provision, covenant or condition of this Agreement, except claims or liabilities occurring as a result of City's sole negligence or willful acts or omissions. The indemnity obligation shall be binding on successors and assigns of Subrecipient and shall survive termination of this Agreement. 5.0 DISCRIMINATION. TERMINATION, AND ENFORCEMENT. 5.1 Covenant Against Discrimination. Subrecipient 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, sexual orientation, or any other basis pertaining to a Protected Characteristic under applicable federal, state, or local law. 5.2 Term. Unless earlier terminated in accordance with Section 5.3 of this Agreement, this Agreement shall continue in full force and effect until such time as Subrecipient has completed the services set forth in Exhibit "A", but for a term not to exceed June 30, 2022 ("Term"). (See also Exhibit B discussion of "Project Closeout.") 5.3 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 such notice of termination, Subrecipient shall immediately cease all services hereunder except as may be specifically approved by the Contract Officer. Subrecipient 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 that have been paid for but not rendered. 6.0 MISCELLANEOUS PROVISIONS. 6.1 Conflicts of Interest. Subrecipient, its agents and employees shall comply with applicable federal, state, and local laws and regulations governing conflict of interest. Subrecipient covenants that it presently has no interest and shall not acquire any interest, direct or indirect, that may be affected by the services to be performed by it under this Agreement, or that would conflict in any manner with the performance of its services hereunder. Subrecipient further covenants that, in performing this Agreement, no person having any such interest shall be employed by it. Furthermore, Subrecipient shall avoid the appearance of having any interest that would conflict in any manner with the performance of its services pursuant to this agreement. Subrecipient agrees not to accept any employment or representation during the term of this Agreement that is or may likely make Subrecipient "financially interested" (as provided in California Government Code Sections 1090 and 87100) in any decision made by City on any manner in connection with which Subrecipient has been retained pursuant to this Agreement. 6.2 Warranty and Representation of Non -Collusion. City hereby warrants and represents that no official, officer, or employee of the City has any financial interest, direct or indirect, in this Agreement, nor shall any official, officer, or employee of the City participate in any decision relating to this Agreement which may affect his/her financial interest or the financial 01007.0001/716861.1 interest of any corporation, partnership, or association in which (s)he is directly interested, or in violation of any state or municipal statute or regulation. The determination of "financial interest" shall be consistent with State law and shall not include interest found to be "remote" or "non interest" pursuant to California Government Code Sections 1091 and 1091.5. Subrecipient hereby warrants and represents that (s)he/it has not engaged in any act(s), omission(s), or other conduct or collusion that would result in the payment of any money, consideration, or other thing of value to any third Party including, but not limited to, any City official, officer, or employee, as a result or consequence of obtaining or being awarded any agreement. Subrecipient is aware of and understands that any such act(s), omission(s), or other conduct resulting in the payment of money, consideration, or other thing of value will render this Agreement void and of no force and effect. Subrecipient Representative Initials ` 6.3 Prohibited Activity. Subrecipient is prohibited from using CDBG Funds provided herein, or personnel employed in the administration of the program for which those funds have been granted, for any of the following activities: political activities, activities of an inherently religious nature, lobbying, political patronage, and nepotism activities. Religious entities may use CDBG funds for secular activities only in accordance with the federal regulations specified in 24 CFR 570.200 (j), regarding such activities as worship, religious instruction, or prose lytization. 6.4 Non -Waiver of Terms. Riahts and Remedies. A. Waiver. The failure of a non -defaulting Party to enforce any right, provision, or remedy shall not impair such right, provision, or remedy, and shall not constitute a waiver of such right, provision, or remedy, and shall not constitute waiver of such right or provision in the absence of a written confirmation of waiver signed by the defaulting Party. In no event shall the making by City of any payment to Subrecipient constitute or be construed as a waiver by City of any breach or covenant, or any default that may then exist on the part of Subrecipient, an the making of any such payment by City shall in no way impair or prejudice any right or remedy available to City with regard to such breach or default. Failure on the part of City to act with respect to a breach by Subrecipient shall not constitute a waiver of City's right to act with respect to subsequent or similar breaches. B. Waiver by either Party of any of the conditions of performance under this Agreement shall not be a waiver of any other condition of performance under this Agreement. A Party's consent to or approval of any act by the other Party requiring that Party's consent or approval shall not be deemed to waive or render unnecessary the other Party's consent to or approval of any subsequent act. Any waiver b either Party of any default must be in writing and shall not be a waiver of any other default concerning the same or any other provision of this Agreement. 6.5 Attorney's Fees. In the event that either Party to this Agreement shall commence any legal action or proceeding to enforce or interpret the provisions of this Agreement, the prevailing Party in such action or proceeding shall be entitled to recover its costs of suit, including reasonable attorney's fees. The venue for any such litigation shall be Los Angeles County. 01007.0001/716861.1 6.6 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. City: Keith Bennett Community Development Department City of Carson 701 East Carson Street Carson, California 90745 With a Copy to: City Attorney City of Carson 701 East Carson Street Carson, California 90745 Subrecipient: June Pouesi Executive Director Office of Samoan Affairs of California, Inc. 454 East Carson Plaza Drive, Suite 109 Carson, California 90746 6.7 Exhibits. All documents referenced as exhibits in this Agreement are hereby incorporated into this Agreement as if set forth fully herein. 6.8 Entire Agreement. This Agreement, and any other documents incorporated herein by specific reference, represents the entire and integrated agreement between City and Subrecipient. This Agreement supersedes all prior oral or written negotiations, representations, or agreements. This Agreement may not be amended, nor any provision outreach hereof waived, except in a writing signed by the Parties that expressly refers to this Agreement. 6.9 California Law. This Agreement shall be interpreted, construed and governed both as to validity and to performance of the Parties in accordance with the laws of the State of California. Legal actions concerning any dispute, claim or matter arising out of or in relation to this Agreement shall be instituted in the Superior Court of the County of Los Angeles, State of California. In the event of litigation in a U.S. District Court, venue shall lie exclusively in the Central District of California, in the County of Los Angeles, State of California. 6.10 Severability. In the event that part of this Agreement shall be declared invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining portions of this Agreement which are hereby declared as severable and shall be interpreted to carry out the intent of the Parties hereunder unless the invalid provision is so material that its invalidity deprives either Party of the basic benefit of their bargain or renders this Agreement meaningless. 6.11 Corporate Authority. The persons executing this Agreement on behalf of the Parties hereto warrant that (i) such Party is duly organized and existing, (ii) they are duly authorized to execute and deliver this Agreement on behalf of said Party, (iii) by so executing this Agreement, such Party is formally bound to the provisions of this Agreement, and (iv) the 01007.0001/716861.1 entering into this Agreement does not violate any provision of any other Agreement to which said Party is bound. [SIGNATURES ON THE FOLLOWING PAGE] 01007.0001/716861.1 9 IN WITNESS WHEREOF, the Parties have executed this Agreement on the date first above written. Dated: November 30, 2021 CITY OF CARSON, CALIFORNIA By h..., Lula Davis -Holmes, Mayor City Clerk \*� Printed Name: John W. Carroll, Sr. Title: Chief Deputy City Clerk APPROVED AS TO FORM: Aleshire & Wynder, LLP City Attorney Printed Name: Sunny K. Soltani Title: City Attorney [ndp] SUBRECIPIENT:** *** OFFICE OF SAMOAN AFFAIRS OF CALIFORNIA, INC. By: d -A-" Name: w �o uC y Title: u,. ID,v'e�V0,r ' , cytuQ _t Date: '�;l -31 1il By. A1 '&::�� Name: t- i wk; U � Title: Gk—trwv --- a Date: C6 / ; t / -,7 _ **SUBRECIPIENT'S SIGNATURES SHALL BE DULY NOTARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO SUBRECIPIENT'S BUSINESS ENTITY. *** If Subrecipient is a Corporation, one signature is required from each of the following groups: 1) Chairman of the Board, President or any Vice President; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant Treasurer. 01007.00011716861.1 10 CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. COUNTY OF LOS ANGELES (,AI�4Kt R.v b � On ( , 2021 before me,� ,personally ap eared y I a 1 L r (A ,proved to me on the basis of satisfactory evidence to be the persons) whose names( is a subscribed to the within instrument and ac edged to me that h sh they executed the same in his er/ eir authorized capacity(ies), and that by hisqjErAeir signature(s) on the instrument the person(s), or the a >, upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. TIFFANY NEWTON Notary Public - Catifornia Signature: Los Angeles County 9 G' Commission #,2,260687 My Comm. Expires Mar 12, 2023 OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER 01007.0001/716861.1 11 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES July 1, 2021 DATE OF DOCUMENT OTHER THAN NAMED ABOVE TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING: (NAME OF PERSON(S) OR ENTITY(IES)) 01007.0001/716861.1 11 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES July 1, 2021 DATE OF DOCUMENT OTHER THAN NAMED ABOVE CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. COUNTY OF LOS ANGELES (A/v-.v t Alkotlt On �° 2021 befor6/sh:e/ personally a ared proved to me on the basis of satisfactory evidebe the rson(s) whose names( ,is re subscribed to the within instrument and ac ledged to me that hey executed the same in his e / eir authorized cap acity (les ), and that by hi /her/ eir signature(s) on the instrument the person(s), or the e pon behalf of which the person(s) acted, ex the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m hand and official seal. TIFFANY NEWTON y o Signature: Los Angeles County Commission # �22&pyg7 — Notary6y Comm. Expires Mar i2, 2n�i OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER 01007.0001/716861.1 12 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES July 1, 2021 DATE OF DOCUMENT OTHER THAN NAMED ABOVE TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING: (NAME OF PERSON(S) OR ENTITY(IES)) 01007.0001/716861.1 12 DESCRIPTION OF ATTACHED DOCUMENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES July 1, 2021 DATE OF DOCUMENT OTHER THAN NAMED ABOVE SCOPE OF SERVICES EXHIBIT "A" Subrecipient shall utilize the CDBG Funds provided by the City pursuant to this Agreement to provide counseling tutoring, employment assistance, and other resource services to at risk or homeless individuals and families in the city of Carson, and after-school youth services to Carson residents. Services shall be available Mondays through Fridays between the hours of 8:00 A. M. and 5:00 P. M. 2. Services rendered by Subrecipient shall include the following: • Intake and assessment, development of service plans, referral to appropriate services, and case management services for persons and families who are homeless or at risk of homelessness; • Counseling and advocacy services to enable at -risk and homeless residents to access resources available in the City of Carson and Los Angeles County to improve their quality of life; • Career and education planning, assistance with job-related services and placement for at -risk or homeless persons or families; • Tutorial assistance for youth to build critical self-discipline, self-esteem, communication and inter -personal skills, and general life skills, 3. Costs for which Subrecipient shall be reimbursed from the CDBG Funds shall be limited to the costs (including wages, salaries, and benefits) of the administrative personnel associated with the provision of the services provided in (2) above, (specifically, the Program Manager); costs of educational materials office supplies, and printing costs associated with the aforementioned services; and costs for space rent and land -line telephone service costs for Subrecipient's facility located at 454 East Carson Plaza Drive, Suite 109, Carson, California]. 4. The primary location for services provided in accordance with this Agreement shall be Subrecipient's facility located at 454 East Carson Plaza Drive, Suite 109, Carson, California 90746. 5. Subrecipient anticipates providing services to approximately 66 Carson residents. 6. Recognizing Subrecipient's acknowledgement in Section 1.2 of this Agreement that the activities carried out with the CDBG Funds shall meet the CDBG program's national objective of benefitting low and moderate income individuals, Subrecipient shall ensure that at least fifty-one per cent (51%) of clients meet the standard of low and moderate income, as determined by the City. Subrecipient shall verify participants' total household income by requesting to see documentation that shows income information for all household members, and shall keep records reflecting the verification of such income on file and available for inspection by representatives of City and/or HUD. Subrecipient shall also, to the extent practicable, obtain information regarding the racial, ethnic, and female -headed household status of participants. Subrecipient shall report the income, race, ethnicity, and female - headed household status of participants to City in accordance with Section 2, Program Evaluation and Review, and Section 3, Reporting Requirements, of the attached Exhibit "B", "Special Requirements". 01007.0001/716861.1 13 7. City will monitor the performance of Subrecipient against goals and performance standards including, but not limited to, those stated above. Substandard performance as determined by City will constitute noncompliance with this Agreement. If action to correct such substandard performance is not taken by Subrecipient within a reasonable period of time after being notified by City, procedures to suspend or terminate this Agreement will be initiated. [END OF EXHIBIT "A"] 01007.0001/716861.1 14 EXHIBIT "B" SPECIAL REQUIREMENTS The provisions of this Exhibit B are hereby added to the Agreement. To the extent any of the provisions of Exhibit B conflict with provisions elsewhere in the Agreement, the provisions of Exhibit B shall govern. This Agreement is subject to and incorporates the terms of the Housing and Community Development Act of 1974, as amended; 24 Code of Federal Regulations ("CFR") Chapter V, Part 570; City's CDBG Program Guidelines; and all amendments or successor regulations or guidelines thereto. 1. Federal Contracting Provisions. Subrecipient agrees to comply with the following federal requirements in the performance of this Agreement: A. Subrecipient shall comply with Executive Order 11246, as amended by Executive Orders 11375 and 12086, and implementing regulations at 41 CFR Chapter 60, which requires that during the performance of this Agreement, Subrecipient agrees not to discriminate against any employee or applicant for employment because of race, religion, sex, color, or national origin. Subrecipient shall consider all applicants without respect to their race, religion, sex, or national origin with respect to the following without limitation: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Subrecipient agrees to post in conspicuous places, available to employees and employment applicants, notices setting forth the provisions of this nondiscrimination clause. B. In its solicitations or advertisements for employees, Subrecipient shall state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. C. Subrecipient shall comply with all restrictions against discrimination, as required by Executive Order 11063, as amended by Executive Order 12259 and implementing regulations at 24 CFR Part 107. D. Subrecipient shall comply with Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 et seq., which requires that to the greatest extent feasible, opportunities for training and employment be given to lower income residents of the project area and contracts for work in connection with the project be awarded to business concerns that are located in, or owned in substantial part by, persons residing in the project area. E. Subrecipient shall comply with Title VI of the Civil Rights Act of 1964, and Section 109 of the Housing and Community Development Act of 1974, which provides that no person shall, on the grounds of race, color, national origin, or sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. 01007.0001/716861.1 15 F. Subrecipient shall comply with Section 504 of the Rehabilitation Act of 1973 (P.L. 93- 112), as amended, and implementing regulations. G. Subrecipient shall comply with the Age Discrimination Act of 1975 (P.L. 94-135), as amended, and implementing regulations. H. Subrecipient shall comply with the relocation requirements of Title II and the acquisition requirements of Title III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act at 24 CFR Part 42. I. Subrecipient shall comply with the restrictions prohibiting the use of funds for the benefit of a religious organization or activity as set forth in 24 CFR 570.2000). J. Subrecipient shall comply with the labor standard requirements as set forth in 24 CFR Part 570, Subpart K and HUD regulations issued to implement said requirements. K. Subrecipient shall comply with the Program Income requirements as set forth in 24 CFR 570.504(c) and 570.503(b)(8). L. Subrecipient shall comply with all federal laws and regulations described in 24 CFR 570, Subpart K, except that the Subrecipient does not assume the City's environmental responsibilities as described at 24 CFR 570.604, nor does the Subrecipient assume the City's responsibility for initiating the review process under the provisions of 24 CFR Part 52. M. Subrecipient shall comply with Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11988 relating to the prevention, control, and abatement of water pollution. N. Subrecipient shall comply with the flood insurance purchase requirement of Section 102(a) of the Flood Disaster Protection Act of 1978 (P.L. 93-234). O. Subrecipient shall comply with the regulations, policies, guidelines and requirements of 24 CFR 570; the "Common Rule," 24 CFR Part 85 and Subpart J; and 2 CFR 200 (which revises and supersedes OMB Circulars No. A-87, A-102, Revised, A-110, and A-122) as they relate to the acceptance and use of federal funds under the federally assisted program. P. Subrecipient shall comply with Title VII of the Civil Rights Act of 1968 (P. L. 90-284), as amended. Q. Subrecipient shall comply with 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. Subrecipient shall comply with current City policy concerning the purchase of equipment and shall maintain inventory records of all non -expendable personal property as defined by such policy as may be procured with funds provided herein. Unless specified otherwise within this Agreement, Subrecipient shall procure all 01007.0001/716861.1 16 materials, property, or services in accordance with the provisions and requirements of 24 CFR 84.40-48. S. Subrecipient shall maintain a property inventory system to numerically identify HUD purchased property and document its acquisition date, as set forth in 2 CFR 200.312 Federally -Owned and Exempt Property. T. The use and disposition of real property and equipment by Subrecipient under this Agreement shall be in accordance with the provisions and requirements of 24 CFR Part 84 and 24 CFR 570.502, 570.503, and 570.504. Upon 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: L Used to meet one of the national objectives in Section 570.208 (formerly Section 570.901) until five years after expiration of the agreement, or for such longer period of time as determined to be appropriate by the City; or iii. Not used in accordance with paragraph (T)(i) above, in which event the Subrecipient shall pay to the City an amount equal to the current market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for the acquisition of, or improvement to, the property. The payment is program income to the City. (No payment is required after the period of time specified in subsection (T)(i) immediately above.) U. Subrecipient shall comply with such other City, County, State, or Federal laws, rules and regulations, executive orders or similar requirements which might be applicable. V. As City will use federal funds to pay Subrecipient for the services to be performed under this Agreement, Subrecipient shall comply with 31 U.S.C. Section 1352, which prohibits any recipient or subrecipient of federal funds from: using such funds to influence or attempt to influence an officer or employee of any federal agency, a Member of Congress or an officer or employee of Congress, or any employee of a Member of Congress in connection with the awarding of any federal contract; making any federal grant; making any federal loan; entering into any cooperative agreement; and/or the extending, continuing, renewing, amending or modifying any federal contract, grant, loan or cooperative agreement. W. Every person who requests or receives a federal contract, grant, loan or cooperative agreement from a federal agency or receives or requests from a federal agency a commitment that would provide for the United States to insure or guarantee a loan must file with that agency a written declaration and certify that he or she has not made and will not make any prohibited expenditure. Further, any person who requests or receives from a person referred to above, a subcontract under a federal contract, a subgrant or contract under a federal grant, a contract or subcontract to carry out any purpose for which a particular federal loan is made, or contract under a federal cooperative agreement, is required to file a written declaration with the person who received the federal contract, grant, loan or commitment to insure or guarantee a loan. 01007.0001/716861.1 17 X. Subrecipient shall not receive any program income as defined in 24 CFR Section 570.500(a). 2. Program Evaluation and Review. Subrecipient shall make performance, financial, and all other records pertaining to this Agreement available to all City and HUD personnel. City and HUD personnel may inspect and monitor Subrecipient's facilities and program operations, including the interview of Subrecipient's staff and program participants. Subrecipient agrees to submit to City or HUD all data necessary to complete the Annual Grantee Performance Report in accordance with HUD requirements and in the format and at the time designated by City or HUD Project Directors or their designees. 3. Reporting Requirement. Subrecipient shall submit to City a quarterly statistical status report, using the forms shown in Exhibit "D" attached hereto, setting forth its activities for each reportable quarter. Such reports shall be filed with City not later than the 10th day of the month following the reportable quarter. The quarterly activity reports shall contain without limitation ethnic group, income level, female -headed household status and any other data as may be requested by City, of each person assisted and the result of such assistance. In addition to the monthly statistical status report, Subrecipient shall, on or before July 10, 2022, furnish City with a summary of Subrecipient's activities for the fiscal year commencing July 1, 2021. Such summary shall include an annual statistical report. 4. Documentation and Record Keeping. Subrecipient shall maintain all records required by the Federal regulations specified in 24 CFR 570.506, that are pertinent to the activities to be funded under this Agreement. Such records shall include but not be limited to: A. Records providing a full description of each activity undertaken; B. Records demonstrating that each activity undertaken meets one of the national objectives of the CDBG program; C. Records required to determine the eligibility of activities; D. Records documenting all CDBG funds received from the City; E. Records documenting expenses as identified in the monthly activity reports and reimbursement requests submitted to the City, as well as the relationship of these expenses to the CDBG-funded program; F. Records required to document the acquisition, improvement, use, or disposition of real property acquired or improved with CDBG assistance; G. Records documenting compliance with the fair housing and equal opportunity components of the CDBG program; H. Financial records as required by 24 CFR 570.502 and 24 CFR 84.21-28, and as otherwise stated within this Agreement; and I. Other records necessary to document compliance with Subpart K of 24 CFR Part 570. Subrecipient shall maintain separate accounting records for the CDBG Funds provided by the City. The City, HUD, Comptroller General of the United States, or any of their duly authorized representatives shall have access to all books, documents, papers, and records maintained by Subrecipient, as well as any of its own subrecipients or subcontractors, which directly relate to the project that is the subject of this Agreement for the purpose of audit, examination, excerpts, and transcriptions. Subrecipient shall also maintain client data demonstrating client eligibility for services provided. Such data shall include, but not be limited to, client name, address, income level or other basis for determining eligibility, and description of service provided. Such 01007.0001/716861.1 18 information shall be available to City or HUD monitors or their designees for review upon request. 5. Disclosure Requirement. Subrecipient shall make available all books and records pertaining to each project or business activity that is funded by CDBG funds under this Agreement for inspection and audit by HUD's representatives, upon request, at any time during the term of this Agreement and for a period of five (5) years thereafter. All such books and records shall be maintained by Subrecipient at a location in Los Angeles County. Failure by Subrecipient to comply with the requirements of this section shall constitute a material breach for which City may terminate or suspend this Agreement. Subrecipient understands that client information collected under this Agreement is private and the use or disclosure of such information, when not directly connected with the administration of City's or Subrecipient's responsibilities with respect to services provided under this Agreement, is prohibited by applicable State and Federal law, unless written consent is obtained from such person receiving service and, in the case of a minor, that of a responsible parent/guardian. 6. Project Close -Out. Notwithstanding Section 5.2. Term, of the Agreement, an except as otherwise stated in this Agreement, this Agreement expires upon the Subrecipient's complete performance of all obligations described in this Agreement. The Subrecipient's obligation to the City shall not end until all close-out requirements are completed. Activities during this close-out period shall include, but are not limited to: submission of final requests for payment, making final payments, disposing of program assets in accordance with other provisions of this Agreement, and determining the custodianship of records. The City's funding obligation to the Subrecipient, however, shall be limited to the amount stated in Section 2.0 of the Agreement, and shall only apply to Subrecipient performance during Fiscal Year 2021-2022, ending on June 30, 2022. 7. Suspension, Recovery of Funds. A. In accordance with 24 CFR Section 85.43, suspension or termination may occur if Subrecipient materially fails to comply with any term of the award. B. If the funding source demands reimbursement for prior payments to Subrecipient due to Subrecipient's failure to comply with any applicable term of this Agreement, regulation or statute, Subrecipient shall reimburse City in the amount of such disallowed payments. C. The award may be terminated for convenience in accordance with 24 CFR Section 85.44. D. Upon expiration of this Agreement, Subrecipient shall transfer to City any funds paid pursuant to this Agreement that are on hand at the time of expiration and any accounts receivable attributable to the use of such funds. [END OF EXHIBIT "B"] 01007.0001/716861.1 19 01007.0001/716861.1 20 BUDGET (SCHEDULE OF COMPENSATION) EXHIBIT "C" For the services rendered pursuant to this Agreement, Subrecipient shall be reimbursed in an amount not to exceed the Contract Sum of FIFTEEN THOUSAND DOLLARS AND NO CENTS ($15,000.00) during the term of this Agreement. City shall reimburse Subrecipient for expenses that are documented to the satisfaction of the City and are incurred by Subrecipient in the expense categories as detailed in Exhibit "A" to this Agreement. City shall have the right to disapprove reimbursement for specific expenditures and expense categories that the City finds to be ineligible under the CDBG guidelines. There shall be no changes to the Scope of Services set forth in Exhibit "A" to this Agreement unless the same is requested in writing by Subrecipient, and approved in writing by the City. Provided that Subrecipient is not in default hereunder, the Subrecipient shall be reimbursed in accordance with the terms of this Agreement within thirty (30) days after the City's receipt of an invoice from Subrecipient. [END OF EXHIBIT "C"] 01007.0001/716861.1 21 OP ID: JU CERTIFICATE OF LIABILITY INSURANCE 7OT8/30/2021 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 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 Pennbrook Insurance Services License #0622553 CONTACT NAME: Judy Sanchez PHONE FAX ac No Ell: : 415-820-2223 A/c No): 142 Sansome Street, 4th Floor San Francisco, CA 94104 Pennbrook - House A/C ADDRESS: jsanchez@pennbrookins.com PRODUCER CUSTOMER ID M OFFIC-6 INSURER(S) AFFORDING COVERAGE NAIC # Carson, CA 90745 INSURED Office of Samoan Affairs of INSURER A: Nonprofits' Ins Alliance 10023 California Inc. 454 Cason Plaza Dr. #109 INSURER B X COMMERCIAL GENERAL LIABILITY Carson, CA 90746 INSURER C: 2021-17762NPO 07/01/2021 INSURER D, INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 NUMBER POLICPOLICY MMIDDYEFF i /YYYY MMIDD CY EXP LIMITS Community Development Block GENERAL LIABILITY AUTHORIZED REPRESENTATIVE 701 E. Carson Street ��/ZD L { Carson, CA 90745 EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X 2021-17762NPO 07/01/2021 07/01/2022 ETOR D AGE occu ante $ 500,00 CLAIMS -MADE [XI OCCUR MED EXP (Any one person) $ 20,00 PERSONAL &ADV INJURY $ 1,000,00 A X Professional Liab 2021-17762NPO 07/01/2021 07/01/2022 X Improper Sexual GENERAL AGGREGATE $ 3,000,00 A 2021-17762NPO 07/01/2021 07/01/2022 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 X POLICY PROT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ A X SCHEDULED AUTOS HIRED AUTOS �2021--17762NPO 07/01/2021 07/01/2022 PROPERTY DAMAGE (PER ACCIDENT) $ A X NON -OWNED AUTOS 12021--17762NPO 07/01/2021 07/01/2022 S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 A EXCESS LIAB CLAIMS -MADE 2021-17762-UMB-NPO 07/01/2021 07/01/2022 Improper $ 1,000,00 HDEDUCTIBLE x RETENTION $ 10000 Sexual S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE ! WC STATU- OTH- TO RY LIMITS i ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ! E.L. DISEASE - POLICY LIMIT $ A Employ Dishonesty 12021 -17762 -PROP 07/01/2021 07/01/2022 $500 ded 100,00 A Business property 12022 -17762 -PROP 07/01/2021 07/01/2022 special f 40,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The certificate of insurance is issued as evidence of coverage and names the City of Carson, its elected and appointed officers, employees, volunteers and agents are additional insuredwithrespect to funding. The insurance is Primary and Noncontributory CERTIFICATE HOLDER CANCELLATION © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD n„�, q„� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE /`i-'11/�' �/� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Carson Community Development Block AUTHORIZED REPRESENTATIVE 701 E. Carson Street ��/ZD L { Carson, CA 90745 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2021-17762 COMMERCIAL GENERAL LIABILITY Named Insured: Office of Samoan Affairs, Inc. CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations The City of Carson, its elected and appointed All insured premises and operations. officials, employees, volunteers and agents Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. 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 10 12 19 © Insurance Services Office, Inc., 2012 Page 2 of 2 NONPROFITS POLICY NUMBER: 2021-17762 FORM: NIAC-E26 11 17 INSURANCE NAMED INSURED: Office of Samoan Affairs, Inc. ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: The City of Carson, its elected and appointed officials, employees, volunteers and agents. Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. NIAC-E26 11 17 Page 1 of 1 ACORb®DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 08/31/2021 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 UUNIACI NAME: Lina Sanchez Global Shield Insurance Agency g y P CNE 877 303-6425I FAX AIC, No, Ext : (AIC, No): ADDRESS: Business@GlobalShieldAgency.com 511 E. 1st St. Suite H INSURER(S) AFFORDING COVERAGE NAIC # Tustin CA 92780 INSURER A: State Compensation Insurance Fund 35076 INSURED INSURER B Office of Samoan Affairs of Califomia, Inc. INSURER C: INSURER D : $ 454 E CARSON PLAZA DR INSURER E: CARSON CA 90746 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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. LTR TYPE OF INSURANCE INSD _WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR EACH OCCURRENCE S PREMISES (Ea occurrence) S MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ ETLOC OTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY RGUETTNITF (Ea accident) $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S (Per accident) $ S UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR 1 EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PRO PRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F7 Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA X 926380520 11/07/2020 11/07/2021 )CISTATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 I E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A Waiver of Subrogation exists in favor of the Certificate Holder, City of Carson, as their interest may appear UCK I It-n.A I t MULUtK GANGtLLATION City of Carson 701 E. Carson Street Carson CA 90745 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD