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HomeMy WebLinkAboutHuntington Beach Council on Aging (HBCOA) - 2016-04-18Dept ID CS 16-007 Page 1 of 2 Meeting Date 4/18/2016 CITY OF HUNTINGTON BEACH REQUEST FOR CITY COUNCIL ACTION MEETING DATE: 4/18/2016 SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Fred A Wilson, City Manager PREPARED BY: Janeen Laudenback, Director of Community Services SUBJECT: Approve a Memorandum of Understanding (MOU) between the City and the Huntington Beach Council on Aging (HBCOA) to enhance the dignity and quality of life of the Citv's senior citizens Statement of Issue City staff, together with the Huntington Beach Council on Aging (HBCOA), has been working to enhance the dignity and quality of life of Huntington Beach seniors through comprehensive services, education, and advocacy aimed to empower and meet the needs of the senior population The current Memorandum of Understanding (MOU) is scheduled to expire on May 2, 2016 Staff has worked closely with the HBCOA to update the existing MOU for the purpose of memorializing this ongoing collaborative partnership, and there is a need to continue this partnership with a new, updated MOU Financial Impact Not applicable Recommended Action Approve and authorize the Mayor and City Clerk to execute an updated "Memorandum of Understanding Between the City of Huntington Beach and the Huntington Beach Council on Aging " Alternative Action(s) Do not approve the Memorandum of Understanding between the City and The Huntington Beach Council on Aging and direct staff accordingly Analysis The City Council, at their September 17, 1973 meeting, voted unanimously to "sanction and officially recognize" the HBCOA, to formalize the relationship between the City and HBCOA, and to implement programs to benefit the community's senior citizens On November 5, 1973 the City Council voted to adopt the HBCOA bylaws and to appoint a Council delegate to the organization The HBCOA has been advocating on behalf of Huntington Beach senior citizens for more than 40 years Over the past decade City staff and HBCOA officials have worked together to better define the roles of each party through the development and adoption of an MOU This MOU provides a framework for the City to deliver comprehensive recreation and social service programs to the community while allowing the HBCOA to advocate and raise funds for programs and services benefitting Huntington Beach senior citizens Item 8. - I HB -484- Dept ID CS 16-007 Page 2 of 2 Meeting Date 4/18/2016 The main points of the MOU (Attachment 1) remain the same, and include the City's obligation to provide the HBCOA with access to the Senior Center to conduct business, including access to office space and various meeting rooms The City will also provide minimal staff support and building space as needed to produce the "Outlook on Active Aging" newsletter as well as for HBCOA board meetings and events With the new Senior Center in Central Park opening this summer, the City and the HBCOA anticipate the need to continue to work together to serve an even greater number of senior citizens The new Senior Center has created a great deal of enthusiasm and has become a catalyst for a renewed focus on HBCOA Board Membership and fundraising To address this, new points to the MOU include a requirement for DOJ background checks, as well as new parameters to manage additional donations for the new Senior Center in Central Park Under the conditions of this new MOU, the HBCOA, a 501(c)(3) non-profit charitable organization, will act in concert with the City to support county, state, and federal efforts on behalf of senior citizens of Huntington Beach, and to secure the aid afforded by public agencies In addition, the HBCOA shall continue to provide financial support to the City's senior services operation and programming at the new Senior Center in Central Park On May 2, 2011, the City Council approved the current MOU with the HBCOA With the expiration of this MOU next month, staff recommends City Council approval of this new, updated MOU with the Huntington Beach Council on Aging Environmental Status Not applicable Strategic Plan Goal Improve quality of life Attachment(s) 1 Memorandum of Understanding between the City of Huntington Beach and the Huntington Beach Council on Aging HB -485- Item 8. - 2 MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY OF HUNTINGTON BEACH AND THE HUNTINGTON BEACH COUNCIL ON AGING THIS MEMORANDUM OF UNDERSTANDING ("MOU") is made and entered into on 4!�q lc.. I , 2016, by and between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California (hereinafter referred to as "CITY"), and THE HUNTINGTON BEACH COUNCIL ON AGING, a California corporation (hereinafter referred to as "HBCOA") WHEREAS, the CITY of Huntington Beach City Council (hereinafter referred to as "CITY COUNCIL"). at their September 17, 1973 meeting. voted unanimously to "sanction and officially recognize" the HBCOA. so as to implement programs to benefit the community's senior citizens. and On November 5, 1973, CITY COUNCIL voted to adopt the HBCOA bylaws and to appoint a council delegate to the organization, and CITY is committed to the HBCOA Mission, "The Huntington Beach Council on Aging will create awareness of the evolving needs of Huntington Beach seniors and respond with resources for innovative services and programs," and shall provide staff through the Community Services Department/Senior Services to assist the HBCOA NOW, THEREFORE, for and in consideration of the proimses and covenants hereinafter contained and -intending to be legally bound, the parties covenant and agree as follows SECTION 1. TERM This MOU will become effective on the date it is approved by CITY COUNCIL and shall terminate five (5) years thereafter, except with respect to any obligations hereunder which are to be performed thereafter Upon mutual written consent of the parties, this Agreement may be extended for additional five (5) year terms 16-5144/ 133179 SECTION 2. OBLIGATIONS OF CITY The obligations of the CITY pursuant to this Agreement shall be as follows 1 CITY shall provide the use of an office area in the Senior Center in Central Park for HBCOA to maintain its records and correspondence and conduct official HBCOA business r and activities 2 CITY shall provide HBCOA the use of a city computer for the purpose of maintaining records, where required 3 CITY shall, with approval of the Center Supervisor, provide the HBCOA with use of conference/meeting rooms within the Senior Center in Central Park for holding support and committee meetings in which to conduct routine business for the HBCOA 4 CITY shall. with approval of the Center Supervisor. provide the HBCOA use of community halls within the Senior Center in Central Park for the purpose of holding corporate meetings. tournaments, senior dances, and other approved events as they occur 5 CITY shall provide staff support for the generation of Board meeting agendas and distribution of agendas and minutes and for the monthly HBCOA Board Meetings HBCOA's Recording Secretary shall take and prepare meeting minutes 6 CITY shall, based on availability, organize volunteer support for HBCOA events and for processing any donations made to the HBCOA through the Community Services Volunteer Program 7 CITY shall provide Staff support for the monthly HBCOA dance by providing custodial support for the room set-up and opening and closing the building 16-5144/133179 2 CITY shall provide staff and/or volunteer support, based on staff availability, for HBCOA fundraising events, including Senior Saturday, the HBCOA Golf Tournament, and other approved events 9 CITY shall work in concert with HBCOA to produce the monthly Outlook on Active Aging newsletter The newsletter will advise CITY seniors of events and opportunities provided by HBCOA and by the CITY at the Senior Center in Central Park and through the Senior Outreach program 10 CITY shall provide supervisory staff support, based on staff availability, to work closely with the HBCOA Executive Board on broad issues, such as event planning, Board development and organizational structure of HBCOA SECTION 3. OBLIGATIONS OF HBCOA The obhaations of the HBCOA pursuant to this Agreement shall be as follows HBCOA, as a 501(c)3 Charitable Organization, shall provide its services as an organization accepting public and private donations intended for CITY use in the furthering of senior activities within existing or future CITY programs, wherein the donor wishes to use the benefits of a charitable organization in lieu of a direct gift to the CITY Upon mutual agreement of both parties, donations received for specifically identified fundraising campaigns, including but not limited to Naming Opportunities and/or other events, will be transferred to the City and deposited into a donation account for use at City's discretion to support senior programs and services at the Senior Center in Central Park 2 HBCOA shall, from time to time with board approval, provide financial support to CITY's Community Services Department for its senior programs, within the scope of the HBCOA Charter and as negotiated with CITY This scope shall include, but is not limited to, 16-5144/133179 3 payment of salaries or partial salaries for CITY personnel through direct gifts to the CITY and/or funds to hire personnel through outside agencies Personnel hired by the CITY, through the use of HBCOA donated funds, shall be the sole responsibility of the CITY The HBCOA shall have no liability as to the actions of the CITY or its employees 4 HBCOA shall act in concert with city, county. state, and federal agencies to ensure the semor citizens of Huntington Beach are treated with respect and dignity and are provided the aid afforded by public agencies such as, but not linuted to, congregate meals and transportation 5 The HBCOA Board shall work in concert with CITY staff to produce and distribute a monthly newsletter, the Outlook on Active Aging, advising CITY seniors of events and opportunities at the Senior Center in Central Park Copies of this newsletter shall be distributed to HBCOA members and delivered to select facilities in the city for distribution 6 HBCOA may collect and deposit certain donations for the Semor Transportation Program These funds may be deposited into a CITY donation account on a periodic basis, or may be retained by the HBCOA to be used by CITY for semor transportation enhancements 7 HBCOA shall collaborate with the Community Services Volunteer Coordinator to provide volunteer support for HBCOA membership, correspondence, committees, events, and activities HBCOA Board of Director Members and HBCOA Non -Board Committee Members who have access to vulnerable populations through CITY Senior Services and/or HBCOA programs, including but not limited to community fundraisers, dances, and HBCOA sponsored events, must submit a set of fingerprints as required by California Education Code 16-5144/133179 4 Section 10911 5 at their own expense and shall submit proof of fingerprinting to CITY The Califorma Department of Justice performs a criminal background check and HBCOA Board of Director Members and HBCOA Non -Board Committee Members must pass a background check and receive approval of the CITY"s Human Resources Department pnor to having access to vulnerable populations SECTION 4. ACCESS TO CITY MARKS AND LOGOS HBCOA shall have the right to use the official Huntington Beach City logo, surfboard logo, and CITY"s "Surf City Huntington Beach" trademark with the pnor written approval of CITY's Director of Commumty Services before using any of these logos or trademark, which approval shall be at the sole discretion of the Director The surfboard logo is not the property of CITY HBCOA will use neither logo for commercial purposes SECTION 5. HOLD HARMLESS HBCOA shall protect, defend, indemmfy and hold harmless CITY, its officers, officials, employees, and agents (CITY) from and against any and all liability, loss, damage, expenses, costs (including without limitation, costs and fees of litigation of every nature) ansing out of or in connection with performance of this MOU or its failure to comply with any of its obligations contained in this MOU except such loss or damage which was caused by the sole negligence or willful misconduct of CITY SECTION 6. WORKERS' COMPENSATION INSURANCE Pursuant to California Labor Code Section 1861, HBCOA acknowledges awareness of Section 3700 et seq of said Code, which requires every employer to be insured against liability for workers' compensation, HBCOA covenants that it will comply with such provisions prior to commencing performance of the work hereunder 16-5144/ 13 3179 5 HBCOA shall maintain workers' compensation insurance in an amount of not less than One Hundred Thousand Dollars ($100,000) bodily injury by accident, each occurrence, One Hundred Thousand Dollars ($100,000) bodily injury by disease, each employee, Two Hundred Fifty Thousand Dollars ($250,000) bodily injury by disease, policy limit HBCOA shall require all subcontractors to provide such workers' compensation insurance for all of the subcontractors' employees HBCOA shall furnish to CITY a certificate of waiver of subrogation under the terms of the workers' compensation insurance and HBCOA shall similarly require all subcontractors to waive subrogation SECTION 7. GENERAL LIABILITY INSURANCE In addition to the workers' compensation insurance and HBCOA's covenant to indemnify CITY, HBCOA shall obtain and furnish to CITY, a policy of general public liability insurance, including motor vehicle coverage Said policy shall indemnify HBCOA, its officers, agents and employees, while acting within the scope of their duties, against any and all claims ansing out of or in connection with this Agreement, and shall provide coverage in not less than the following amount combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability. of $1,000.000 per occurrence If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than $1,000,000 Said policy shall name CITY, its agents, its officers, employees and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable shall be deemed excess coverage and that HBCOA's insurance shall be primary Under no circumstances shall the above -mentioned insurance contain a self -insured retention, or a "deductible," or any other similar form of limitation on the required coverage 16-5144/133179 6 SECTION 8. CERTIFICATES OF INSURANCE; ADDITIONAL INSURED ENDORSEMENTS Prior to commencement of this Agreement, HBCOA shall furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement, these certificates shall (a) provide the name and policy number of each carrier and policy, (b) state that the policy is currently in force, and (c) pronuse to provide that such policies shall not be canceled or modified without thirty (30) days' prior written notice of CITY, however. ten (10) days' prior written notice in the event of cancellation for nonpayment of premium HBCOA shall maintain the foregoing insurance coverage in force during the entire term of the Agreement or any renewals or extensions thereof or during any holdover period The requirement for carrying the foregoing insurance coverage shall not derogate from HBCOA's defense, hold harmless and indemnification obligations as set forth in this Agreement CITY or its representatives shall at all times have the right to demand the original or a copy of any or all the policies of insurance HBCOA shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required SECTION 9. ASSIGNING AS BREACH Neither party shall encumber, assign, or otherwise transfer this MOU, or any right or interest in this MOU, without the express written consent of the other party A consent by a party to one assignment or transfer to another person shall not be deemed to be a consent to any subsequent assignment or transfer to another person Any encumbrance, assignment or transfer, without the prior written consent of the other party, whether it is voluntary or involuntary, by 16-5144/ 13 3179 7 operation of law or otherwise, is void and shall, at the option of the other party, terminate this MOU SECTION 10. TERMS BINDING ON SUCCESSORS All the terms, covenants and conditions of this MOU shall inure to the benefit of and be binding upon the parties and their successors and assigns The provisions of this Section shall not be deemed as a waiver of any of the conditions against assignment herembefore set forth. SECTION 11. CONFLICT OF INTEREST HBCOA shall employ no CITY official or any regular CITY employee in the work performed pursuant to this MOU No officer or employee of CITY shall have any financial interest in this MOU in violation of the applicable provisions of the California Go>>ernment Code SECTION 12. PHOTOGRAPHY CITY may grant permits to persons engaged in the production of still and motion pictures, television programs, advertising and related activities, to take photographs and/or motion pictures of HBCOA activities However, consistent with good safety practices. CITY will endeavor to give 24-hour advance notification of such activities to HBCOA In addition, if CITY receives compensation from such persons for such production, CITY will grant 50% of such compensation to HBCOA for support of HBCOA's activities as set forth under this MOU SECTION 13. NONDISCLOSURES/PRESS RELEASES HBCOA shall consult with CITY prior to issuing any press releases or otherwise making any public statements with respect to this MOU, the transactions contemplated herein. or matters arising herefrom 16-5144/133179 8 SECTION 14. CUMULATIVE REMEDIES The remedies given to the parties in this MOU shall not be exclusive but shall be cumulative and in addition to all remedies now or hereafter allowed by law or elsewhere provided in this MOU SECTION 15. WAIVER OF BREACH The waiver by CITY of any breach by HBCOA of any of the provisions of this MOU, irrespective of the length of time for which such failure continues, shall not constitute a waiver of such breach or a waiver of any subsequent breach by HBCOA, either of the same or another provision of this MOU SECTION 16. FORCE MAJEURE - UNAVOIDABLE DELAYS Should the performance of any act required by this MOU to be performed by either CITY or HBCOA be prevented or delayed by reason of an act of God, strike. lockout, labor troubles, inability to secure materials, restrictive governmental laws or regulations, or any other cause (except financial inability) not the fault of the party required to perform the act, the time for performance of the act will be extended for a period equivalent to the period of delay and performance of the act during the period of delay will be excused SECTION 17. NOTICE Any written notice, given under the terms of this MOU, shall be either delivered personally or mailed, certified mail, postage prepaid, addressed to the party concerned, as follows CITY Director of Community Services City of Huntington Beach 2000 Main Street, P O Box 190 Huntington Beach. CA 92648 Phone (714) 536-5291 Huntington Beach Council on Aging Attn President 1706 Orange Avenue Huntington Beach, CA 92648 Phone (714) 374-1524 l 6-5 144/ 13 3179 9 If a party desires to change the address for notices set forth herein, said party shall provide 30 days advance written notice to the other party of any such change. SECTION 18. ATTORNEY'S FEES In the event suit is brought by either party to enforce the terms and provisions of this MOU or to secure the performance hereof, each party shall bear its own attorney's fees The prevailing party shall not be entitled to recover its attorney's fees from the non -prevailing party SECTION 19. CONTROLLING LAW AND VENUE The rights and liabilities of the parties, and the interpretation and construction of this MOU, shall be determined in accordance with the laws of the State of California. Any controversy arising out of or under this MOU, if litigated, shall be adjudicated in a court of competent jurisdiction In Orange County, California SECTION 20. SECTION TITLES The section titles in this MOU are inserted only as a matter of convenience and for reference. and in no way define, limit or describe the scope of intent of this MOU or in any way affect this MOU SECTION 21. TIME OF ESSENCE Time is of the essence with respect to all provisions of this MOU in which a definite time for performance is specified including, but not limited to, the expiration of this MOU SECTION 22. SURVIVAL OF INDEMNITIES Termination of this MOU shall not affect the right of CITY to enforce any and all indemnities given or made by HBCOA under this MOU, nor shall it affect any provision of this MOU that expressly states that the provision shall survive termination thereof 16-5 144/133179 10 SECTION 23. NONLIABILITY OF CITY OFFICIAL, EMPLOYEES OR AGENTS No elective or appointed CITY or CITY affiliated board, commission or member thereof. or officer, official. employee or agent of CITY shall be personally liable to HBCOA, its successors and assigns, of any default or breach by CITY under tlus MOU or for any amount which may become due to HBCOA, its successors and assigns, under tlus MOU or for any obligation of CITY under this MOU SECTION 24. TERMINATION This MOU may be terminated by either party with or without cause upon sixty (60) days notice in writing SECTION 25. MODIFICATIONS IN WRITING Tlus MOU contains and embraces the entire agreement between the parties hereto and neither it nor any part of it may be changed, altered, modified, limited or extended orally or by any other agreement between the parties unless such agreement be expressed in writing. signed and acknowledged by CITY and HBCOA, or their successors in interest. SECTION 26. PARTIAL INVALIDITY Should any provision of this MOU be held by a court of competent jurisdiction to be either invalid, void, or unenforceable. the remaining provisions of this MOU shall remain in full force and their effect unimpaired by the holding, so long as the reasonable expectations of the parties hereto are not materially impaired SECTION 27. MOU IN COUNTERPARTS This MOU may be executed in counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same document 16-5144/ 133179 11 SECTION 28. NO TITLE INTEREST No title interest of any kind is hereby given and HBCOA shall never assert any claim or title to the Senior Center in Central Park or any other public property Use of the Senior Center in Central Park by HBCOA is non-exclusive, and the Senior Center in Central Park shall at all times during its operating hours remain open for use by the public SECTION 29. ENTIRETY The foregoing sets forth the entire agreement between the parties IN WITNESS WHEREOF, the parties hereto have caused this MOU to be executed by and through their authorized officers the day. month and year first above written HUNTINGTON BEACH COUNCIL ON AGING a California cornoratietr, 0 print name title ATTEST ` �`� 0 r REVW i-� .fie• .... • • �� J /tjqManaaer 16-5144/ 13 3179 12 CITY OF HUNTINGTON BEACH, a municipal corporation of e State of California Mayor APPROVED A O FORM. City Attorney Vk-o J\ho�kd INITIAT D AND APPROVED. LA6irieoc�tor of Community Services A`I—�RI ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 10/5/2015 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(les) 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 Arthur J Gallagher & Co License # 0726293 Insurance Brokers of CA 505 N Brand Blvd, Suite 600 CONTNAME Danielle Danielle Diaz PHONE g18-539-8605 FAX 818-539-8705 EAIL -Mdanlelle_dlaz@ajg com INSURERS AFFORDING COVERAGE NAIC # Glendale CA 91203 INSURER A Nonprofits' Insurance Alliance of C INSURED HUNTBEA-05 INSURER B INSURER C Huntington Beach Council on Aging 1706 Orange Huntington Beach, CA 92648 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 1996912639 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 INSIR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 201515779NP0 /29/2015 9/29/2016 EACH OCCURRENCE $1 000,000 CLAIMS -MADE X❑ OCCUR ­15AMAGE —TO RENTED PREMISES (Ea occurrence) $500,000 ME EXP (Any one person) $20 000 PERSONAL & ADV INJURY $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000 000 PRO POLICY ❑ JEC LOC PRODUCTS - COMP/OPAGG $2,000000 OTHER I$ A AUTOMOBILE LIABILITY 201515779NPO 6/29/2015 9/29/2016 Ea accident $1 000 000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEAUTODULED BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS —PROPERTY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory In NH) EL DISEASE EA EMPLOYE $ If yes descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more spaipAL 1ED A S ®O FORM ® The City of Huntington Beach, its officers, elected or appointed officials, employees, agents.a with respect to the operations of the named insured per the attached CG 2012 endorsement If LICE:;: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Huntington Beach Community Services Department ACCORDANCE WITH THE POLICY PROVISIONS 2000 Main Street Huntington Beach CA 92648 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER 201515779NPO COMMERCIAL GENERAL LIABILITY CG 20 12 07 88 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision - Any State or Political Subdivision that issues a permit to the named insured The City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement ) Section II — Who Is An Insured is amended to include as an insured any state or political subdivi- sion shown in the Schedule, subject to the following provisions 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or political subdivision has issued a permit 2. This insurance does not apply to a "Bodily injury," "property damage" or "personal and advertising injury" arising out of opera- tions performed for the state or municipality, or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard" CG 20 12 07 98 Copyright, Insurance Services Office, Inc, 1997 Page 1 of 1 0 Kesolution No. 1UU8-bJ sCITY OF HUNTINGTON BEACH 2000 Main Street, Huntington Beach, CA 92648-2702 Hun w Declaration of Non -Employer Status i The State of California requires every enterprise or business to provide workers compensation insurance coverage. If you have no employees, you may make a declaration to that effect by completing and signing this form and returning to: i City of Huntington Beach i 2000 Main Street Huntington Beach, CA 92648-2702 I certify that in the performance of the activity or work for which this permit is issued, I shall not employ any person in any manner so as to become subject to California Workers' Compensation Insurance requirements. j I authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued under this declaration if I hire any employee(s) or become subject to the provision of the laws requiring Workers' Compensation Insurance. i Company / Organization: Huntington Beach Council of Aging Address: 1706 Orange Ave, Huntington Beach, CA 92648 Applicant [please print]: Robert Dettloff Title, if any: President, HuntirNon Beach Council on Aging i Applicant's Signature: Date Signed: { Telephone Number: ATTACHMENT #7 City of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov Office of the City Clerk Joan L. Flynn, City Clerk April 28, 2016 Huntington Beach Council on Aging Attn President 1706 Orange Avenue Huntington Beach, CA 92648 To Whom It May Concern Enclosed for your records is a copy of the fully executed "Memorandum of Understanding Between the City of Huntington Beach and the Huntington Beach Council on Aging " Sincerely, Joan L Flynn, CIVIC City Clerk J F pe Enclosure Sister Cities Anjo, Japan ♦ Waitakere, New Zealand