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HomeMy WebLinkAboutMercy House - 2024-07-01 (3) AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND MERCY HOUSE (Program No.B-24-MC06-0506) FOR PROGRAM YEAR 2024/2025 COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG)FUNDS THIS AGREEMENT is made and entered into on the 1st of July, 2024 by and between the CITY OF HUNTINGTON BEACH a municipal corporation, hereinafter referred to as "City," and MERCY HOUSE,hereinafter referred to as "Subrecipient." RECITALS WHEREAS,the City has applied for and received funds from the United States Government under Title I of the Housing and Community Development Act of 1974, Public Law 93-383; and WHEREAS,the City wishes to engage the Subrecipient to assist the City in utilizing such funds; and WHEREAS,the City has environmental clearance to release the funds for this project; NOW, THEREFORE, in consideration of these recitals, and the mutual covenants contained herein, City and Subrecipient agree as follows: 1) National Objective The Subrecipient certifies that the activities carried out with funds provided under this Agreement will meet the CDBG program's National Objective of benefit to low/moderate income persons as defined in 24 CFR Part 570.208. The Subrecipient shall adhere to the terms of the City's CDBG Application and Subrecipient Agreement and with assurances and agreements made by the City to the United States Department of Housing and Urban Development. 2) Subrecipient Grant Amount and Scope of Services The City has allocated Federal 2024-2025 CDBG funds in the amount of Sixty Five Thousand Dollars ($65,000)to the Subrecipient to assist with the program costs for activities described in the Scope of Services and Budget(Attachment 1). 3) Time of Performance The services described above are generally provided on a weekly basis to eligible persons.Reimbursable activities per this Grant Agreement may begin on July 1, 2024 and shall end on June 30, 2025. 1 24-14277/344706 4) Personnel Assigned Subrecipient personnel assigned to carry out the Scope of Services shall, if required by the standards of their profession, maintain all licenses and permits necessary to remain in compliance with State and Federal requirements governing the profession. The City shall be notified of all personnel assigned to carry out the Scope of Services and shall be notified if there is a change in personnel. 5) Levels of Performance The Subrecipient agrees to provide the levels of program service as described in the Scope of Services and Budget(Attachment 1). 6) Budget The budget as proposed in the Subrecipient Grant application(Attachment 2) shall be the governing budget for this grant agreement and is incorporated herein by reference unless modified and approved in writing by the City prior to this agreement. In addition, the City may request a more detailed budget breakdown than originally proposed and the Subrecipient shall provide such supplementary budget information in a timely fashion in the form and content prescribed by the City. Both the City and Subrecipient must approve any amendments to the budget in writing. 7) Project Schedule/Milestones Services of the Subrecipient shall start no sooner than on the first day of July 2024 and end on the thirtieth day of June 2025. Every effort shall be made by the Subrecipient to expend the allocated funds in their entirety by June 30, 2025. If the Subrecipient does not expend all funds by June 30, 2025, the City may reallocate the funds not yet drawn to another eligible CDBG projects. 8) Compensation and Method of Payment The City shall reimburse the Subrecipient with CDBG funds for program costs related to eligible services to not exceed the grant amount for the period beginning July 1, 2024 and ending June 30, 2025. The City shall not provide any payments/reimbursements in advance of actual expenditures by the Subrecipient. Funding is contingent upon the City receiving Community Development Block Grant funds from HUD. The Subrecipient shall submit to the City a monthly "Payment Request" within fifteen (15) calendar days after the end of the first month with the final report for 2024/2025 fiscal year delivered by July 15, 2025. The reimbursement requests shall include documentation to verify that the expenditure of funds is consistent 2 24-14277/344706 consistent with the project description/definition as approved. Prior to reimbursing the Subrecipient,the City will verify that the Subrecipient has met all applicable regulations for the project. Payroll records, receipts,paid invoices including an itemized statement of all costs are samples of appropriate methods of reimbursement documentation. A Monthly Accomplishment Report(Section 11) is due at the same time as the monthly payment request. A monthly reporting of activities must also be provided with the monthly reimbursement request. 9) Program Income The Subrecipient shall report to the City any interest or other income earned as a direct result of the use of Federal CDBG funds for the program outlined within this agreement. All reported program income may be retained by the Subrecipient for services in connection with providing housing, utilities, funds for medications, computer training and food to the homeless or those who are at risk of homelessness. All provisions of this Agreement shall apply to these activities. The program income,retained by the Subrecipient, must be expended before additional funds are requested from the City. Any program income on hand when the Agreement expires or received after the Agreement's expiration shall be paid to the City. The requirements are set forth in the Code of Federal Regulations, Title 24, Section 570.504(c). 10) Record Keeping Requirements The Subrecipient shall, at minimum,maintain the following records and reports to assist the City in complying with its record keeping requirements. a) Documentation of the income level, ethnicity, age of persons and/or households participating in or benefiting from the Subrecipient's program; b). Documentation of the number of persons and/or households participating in or benefiting from the Subrecipient's program; c) Documentation of all CDBG funds received from the City; d) Documentation of expenses as identified in the monthly report and reimbursement requests; e) Documentation of how and when a determination was made as to the eligibility status of persons assisted, and f) Any such other related records as the City shall require. The Subrecipient shall maintain separate accounting records for the Federal CDBG funds provided by the City. The City, Federal Grantor Agency, 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 the Subrecipient which directly 3 24-14277/344706 pertain to the above project for the purpose of audit, examination, excerpts and transcriptions. 11) Reporting Requirements The Subrecipient shall submit "Monthly Accomplishment Reports" within fifteen (15) calendar days of the end of the month. The final monthly report is due no later than July 15, 2025. Monthly reports shall be provided by the Subrecipient to the City indicating the number of persons assisted, income and ethnicity of persons assisted, how/what assistance was provided, and a description of how and when determination of eligibility status was made for persons assisted. The report must include sufficient information to assist the City in monitoring the Subrecipient's performance. The Subrecipient must demonstrate satisfactory performance prior to reimbursement for expenditures. 12) Public Access to Program Records The Subrecipient shall furnish and cause each of its own subrecipients or subcontractors to furnish all information and reports required hereunder and will permit access to its books,records and accounts by the City, HUD or its agent, or other authorized Federal officials for purposes of investigation to ascertain compliance with the rules, regulations and provisions stated herein. 13) Records Retention Unless otherwise notified by the City,the Subrecipient shall retain all financial records, supporting documents and statistical reports related to the project identified under this Agreement until September 30, 2030. All records subject to an audit finding must be retained for five (5) years from the date the finding is made or until the finding has been cleared by appropriate officials and the Subrecipient has been given official written notice. 14) Grant Closeout Procedures 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: making final payments, disposing of program assets (including the return of all unused materials, equipment,unspent cash advances,program income balances, and accounts receivable to the City), and determining the custodianship of records. Notwithstanding the foregoing,the terms of this Agreement shall remain in effect during any period that the Subrecipient has control over CDBG funds, including program income. 15) Uniform Administrative and Program Management Standards The Subrecipient shall comply with applicable Uniform Administrative Requirements as described in Section 570.502 of the federal regulations for the CDBG Program. The Federal requirements are incorporated herein by reference. 4 24-14277/344706 16) Use and Reversion of Assets Upon expiration of this 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. The Subrecipient shall be required to use any real property under the Subrecipient's control that was acquired or improved in whole or in part with CDBG funds in excess of$25,000 as follows: a) Used to meet one of the National Objectives in 24 CFR, Section 570.208 until five (5) years after expiration of this Agreement; or, b) Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property less any portion of the value attributable to expenditure ofnon-CDBG funds for acquisition or improvement to the property, Reimbursement is not required after the period of time specified in paragraph(a) of this section. 17) Real Property The use and disposition of real property and equipment under this Agreement shall be in compliance with the requirements of 24 CFR Part 84 and 24 CFR 570.502, 570.503, and 570.504, as applicable, which include but are not limited to the following: The Subrecipient shall transfer to the City any CDBG funds on hand and any accounts receivable attributable to the use of funds under this Agreement at the time of expiration, cancellation, or termination. Real property under the Subrecipient' s control that was acquired or improved, in whole or in part, with funds under this Agreement in excess of$25,000 shall be used to meet one of the CDBG National Objectives pursuant to 24 CFR 580.208 until five (5)years after expiration of this Agreement [or such longer period of time as the City deems appropriate]. If the Subrecipient fails to use CDBG- assisted real property in a manner that meets a CDBG National Objective for the prescribed period of time,the Subrecipient shall pay the City an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to, the property. Such payment shall constitute program income to the City. The Subrecipient may retain real property acquired or improved under this Agreement after the expiration of the five-year period [or such longer period of time as the City deems appropriate]. In all cases in which equipment acquired, in whole or in part,with funds under this Agreement, is sold,the proceeds shall be program income)prorated to reflect the extent to that funds received under this Agreement were used to acquire the equipment). Equipment not needed by the Subrecipient for activities under this Agreement shall be (a) transferred to the City for the CDBG program or(b)retained after compensating the City [an amount equal to the current fair market value of the equipment less'the percentage of non-CDBG funds used to acquire the equipment]. 5 24-14277/344706 18) Other Program Reguiremenl Reserved. 19) Suspension and Termination In accordance with Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations,this Agreement may be suspended or terminated if the Subrecipient fails to comply with any term(s) of the award and/or the award is terminated for convenience. Title 24, Sections 85.43 and 85.44 of the Code of Federal Regulations are incorporated herein by reference as provisions of the Agreement. 20) Compliance with Laws and Regulations The Subrecipient agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants (CDBG) including subpart K (Attachment 3), except that: a) The Subrecipient will not assume the City's environmental responsibilities as described on Section 570.604; and b) The Subrecipient will not assume the City's responsibility for initiating the review process required under the provisions of 24 CFR Part 52. The Subrecipient also agrees to comply with all other applicable Federal, state and local laws, regulations, and policies governing the funds provided under this contract, including those regulations and requirements outlined in Attachment 2 of this subrecipient Agreement insofar as they are applicable to the performance of this contract. The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. 21) Antidiscrimination/Affirmative Action&Equal Employment Opportunity The Subrecipient shall comply with all State and Federal laws regarding nondiscrimination in the provision of services and the equal opportunity employment of personnel. 22) Financial Management Accounting Standards. The Subrecipient agrees to comply with 24 CFR 84.21-28 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. Cost Principles. The Subrecipient shall administer its program in conformance with OMB Circulars A-122, "Cost Principles for Non-Profit Organizations," or A- 21, "Cost Principles for Educational Institutions," as applicable. These principles shall be applied for all costs incurred whether charged on a direct or indirect basis. 6 24-14277/344706 23) Audit Requirement If the Subrecipient shall receive more than$300,000 in total federal funds in one fiscal year from the City of Huntington Beach and/or any.other city or agency,the Subrecipient is required to submit a Single Audit Report. As required by the Federal Single Audit Act, the Subrecipient shall be required to submit to the City, a comprehensive financial audit prepared by an independent, neutral third party auditor. The audit shall cover financial operations of the Subrecipient for the period beginning July 1, 2024 and ending June 30, 2025 and is due not later than one year after expiration of this Agreement. 24) Religious and Lobbying Activities Religious Activities. The Subrecipient agrees that funds provided under this contract will not be utilized for religious activities or to promote religious interests. Religious entities may use CDBG funds for secular activities only in accordance with the Federal regulations specified in 24 CFR 570.200G), such as worship, religious instruction, or proselytization. Lobbying. The Subrecipient hereby certifies that: (1) No Federal appropriated funds have been paid or will be paid,by or on behalf of it,to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement; (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with this Federal contract, grant loan, or cooperative agreement, it will complete and submit Standard Form- LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and (3) It will require that the language of paragraph(d) of this certification be included in the award documents for all subawards at all tiers (including subcontracts, • subgrants, and contracts under grants, loans, and cooperative agreements) and that all Subrecipients shall certify and disclose accordingly: Lobbying Certification. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352,title 31, U.S.C. Any person who fails to file the required certification shall 7 24-14277/344706 be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. 25) Budget Modifications If the Subrecipient desires to modify the use of the CDBG funds following approval of this agreement, a written request must be submitted to the City for review.No change in use of the CDBG funds will permitted without prior written approval by the City, subject to the provisions of the City's adopted Citizen Participation Plan. 26) Performance Monitoring The City will monitor the performance of the Subrecipient against goals and performance standards required herein. Substandard performance as determined by the City will constitute non-compliance with this Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a reasonable period of time after being notified by the City, contract suspension or termination procedures will be initiated. 27) Conflict of Interest The Subrecipient agrees to abide by the provisions of 24 CFR 84.42 and 570.611, which include (but are not limited to)the following: 1) The Subrecipient shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. 2) No employee, officer or agent of the Subrecipient shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest, real or apparent,would be involved. 3) No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of one (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City,the Subrecipient, or any designated public agency. 28) Procurement Standards and Methods 1) Compliance. The Subrecipient shall comply with current City policy concerning the purchase of equipment and shall maintain inventory records of all non- 8 24-14277/344706 expendable personal property as defined by such policy as may be procured with funds provided herein. All program assets (unexpended program income, property, equipment, etc.), shall revert to the City upon termination of this Agreement. 2) OMB Standards. Unless specified otherwise within this Agreement,the Subrecipient shall procure all materials,property, or services in accordance with the requirements of24 CFR 84.40-48. 3) Travel. The Subrecipient shall obtain written approval from the City for any travel outside the metropolitan area with funds provided under this agreement. 29) Environmental Issues 1) Air and Water. The Subrecipient agrees to comply with the following requirements insofar as they apply to the performance ofthis Agreement: a) Clean Air Act, 42 U.S.C., 7401, et seq.; b) Federal Water Pollution Control Act, as amended, 33 U.S.C., 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry,reports, and information, as well as other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder; c) Environmental Protection Agency(EPA)regulations pursuant to 40 CFR Park 50, as amended. 2) Flood Disaster Protection. In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4001), the Subrecipient shall assure that for activities located in an area identified by the Federal Emergency Management Agency(FEMA) as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes (including rehabilitation). 3) Lead-Based Paint. The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this Agreement shall be subject to HUD Lead-Base Paint Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to all CDBG-assisted housing and require that all owners,prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead-based paint. Such notification shall point out the hazards of lead-based paint and explain the symptoms,treatment and precautions that should be taken when dealing with lead-based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead- based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied 9 24-14277/344706 to a property,paint testing, risk assessment,treatment and/or abatement may be conducted. 4) Historic Preservation. The Subrecipient agrees to comply with the Historic Preservation requirements set forth in the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36 CFR Part 800,Advisory Council on Historic Preservation Procedures for Protection of Historic Properties, insofar as they apply to the performance of this agreement. In general,this requires concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a Federal, state, or local historic property list. 30) Notices Communication and details concerning this contract shall be directed to the following contract representatives: Community Development/NED Mercy House Steve Holtz, Deputy Director Attn: Larry Haynes 2000 Main Street, 5th Floor P.O. Box 1905 Huntington Beach, CA 92648 Santa Ma, CA 92702 Phone: (714) 374-1626 31) Independent Contractor Nothing contained in this Agreement is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/employee between the parties. The Subrecipient shall at all times remain an "independent contractor" with respect to the services to be performed under this Agreement. The City shall be exempt from payment of all Unemployment Compensation, FICA,retirement, life and/or medical insurance and Workers' Compensation Insurance, as the Subrecipient is an independent contractor. 32) Insurance General Liability. In addition to the workers' compensation and employer's liability insurance and Subrecipient's covenant to indemnify City, Subrecipient shall obtain and furnish to City, a policy of general public liability insurance, including motor vehicle coverage covering the program/project. This policy shall indemnify Subrecipient, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out or in connection with the program, 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 One Million Dollars ($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 One Million Dollars ($1,000,000) for the program/project. This 10 24-14277/344706 policy shall name City, its officers, elected or appointed officials, employees, agents, and • volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the program/project shall be deemed excess coverage and that Subrecipient's insurance shall be primary. Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a "deductible" or any other similar form of limitation on the required coverage. Workers Compensation and-Employers' Liability. Pursuant to California Labor Code Section 1861, Subrecipient acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; Subrecipient covenants that it will comply with such provisions prior to commencing performance of the work hereunder. Subrecipient shall maintain workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. Subrecipient shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Subrecipient shall furnish to City a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and Subrecipient shall similarly require all subcontractors to waive subrogation. Certificate of Insurance. Prior to commencing performance of the work hereunder, Subrecipient shall furnish to City certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverages as required by this Agreement; the certificates shall: 1. provide the name and policy number of each carrier and policy; 2. state that the policy is currently in force; and 3. promise to provide that such policies will not be canceled or modified without thirty(30) days'prior written notice of City. Subrecipient shall maintain the foregoing insurance coverages in force until the work under this Agreement is fully completed and accepted by City. The requirement for carrying the foregoing insurance coverages shall not derogate from the provisions for indemnification of City by Subrecipient under the Agreement. City or its representative shall at all times have the right to demand the original or a copy of all the policies of insurance. Subrecipient shall pay, in a prompt and timely manner, the premiums on all insurance hereinabove required. Subrecipient shall provide a separate copy of the additional insured endorsement to each of Subrecipient's insurance policies, naming City, its officers, elected and appointed 11 24-14277/344706 officials, employees, agents and volunteers as Additional Insureds,to the City Attorney for approval prior to any payment hereunder. 33) Hold Harmless and Indemnity Agreement Subrecipient hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all, claims, damages, losses, expenses,judgments, demands defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Subrecipient's employees and damage to Subrecipient's property, arising directly or indirectly out of the obligations or operations herein undertaken by Subrecipient, caused in whole or in part by any negligent act or omission of the Subrecipient, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Subrecipient will conduct all defense at its sole cost and expense and City shall approve selection of Subrecipient's counsel. City shall be reimbursed for all costs and attorney's fees incurred by City in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Subrecipient. 34) Severability If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be affected thereby and all other parts of this Agreement shall nevertheless be in full force and effect. 35) Assignment of Agreement The Subrecipient shall not assign this Agreement or any monies due thereunder without the prior written consent of the City. 36) Successors and Assigns Subject to the provisions of the Subrecipient Agreement Paragraph 16, "Hold Harmless and Indemnity Agreement," all terms, conditions, and provisions hereof shall inure to and shall bind each of the parties hereto, and each of their respective heirs, executors, administrators, successors, and assigns. 37) Section Headings and Subheadings The section headings and subheadings contained in this Agreement are included for convenience only and shall not limit or otherwise affect the terms of this Agreement. 38) Waiver The City's failure to act with respect to a breach by the Subrecipient does not waive its right to act with respect to subsequent or similar breaches. The failure of the City to 12 24-14277/344706 exercise or enforce any right or provision shall not constitute a waiver of such right or provision. 39) Authority to Execute this Agreement The person or persons executing this Agreement on behalf of Subrecipient warrants and represents that he/she has the authority to execute this Agreement on behalf of the Subrecipient and has the authority to bind Subrecipient to the performance of its obligations hereunder. 40) Entire Agreement This agreement constitutes the entire agreement between the City and the Subrecipient for the use of funds received under this Agreement and it supersedes all prior or contemporaneous communications and proposals, whether electronic, oral, or written between the City and the Subrecipient with respect to this Agreement. MERCY HOUSE, CITY OF HUNTINGTON BEACH, a municipal corporation and charter city By: By: Larry Hanes Director of Community Development print name ITS:Executive Director APPROVED AS TO FORM: AND By: By; e117-- 1 City Attorney 1� Robyn Willis print name ITS: (circle one) Secretary Chief Financial Officer/Asst. Secretary—Treasurer COUNTERPART 13 24-14277/344706 exercise or enforce any right or provision shall not constitute a waiver of such right or provision. 39) Authority to Execute this Agreement The person or persons executing this Agreement on behalf of Subrecipient warrants and represents that he/she has the authority to execute this Agreement on behalf of the Subrecipient and has the authority to bind Subrecipient to the performance of its obligations hereunder. 40) Entire Agreement This agreement constitutes the entire agreement between the City and the Subrecipient for the use of funds received under this Agreement and it supersedes all prior or contemporaneous communications and proposals, whether electronic, oral, or written between the City and the Subrecipient with respect to this Agreement. MERCY HOUSE, CITY OF HUNTINGTON BEACH, a municipal corporation and charter city By: By: A, .;:k re tor of Community Development print name ITS:Executive Director APPROVED FORM: AND By: City Attorney By: 1 print name ITS: (circle one)Secretary/ Chief Financial Officer/Asst. Secretary—Treasurer Receive and File COUNTERPART 6A-01.) e&Y-11417-41,4 City Clerk Si 3/'/1/ 13 24-14277/344706 MERCY HOUSE ATTACHMENT 1 SCOPE OF SERVICES AND BUDGET 14 MERCY HOUSE ATTACHMENT 2 SUMMARY OF CDGB LEGAL REQUIREMENTS 15 ATTACHMENT 1 FY 2024-25 CDBG TENANT BASED RENTAL ASSISTANCE (TBRA) SCOPE OF SERVICES AND BUDGET MERCY HOUSE A. SCOPE OF SERVICES Outcome Statement: This project is designed to assist households experiencing housing insecurity by providing Tenant Based Rental Assistance to Huntington Beach residents who are experiencing homelessness or are at risk of homelessness. This project furthers Priority #1 in the City of Huntington Beach's adopted Housing and Community Development Consolidated Plan (HUD 5-year plan), which is to create new affordable housing opportunities and sustain and strengthen neighborhoods. Principal Task: Between July 1, 2024 and June 30, 2025, Mercy House will: 1. Administer the Tenant Based Rental Assistance Program for 15 Huntington Beach households. Mercy House will submit a monthly Grantee Performance Report (GPR) on these goals on the form attached hereto by the 15th of each month over the duration of this agreement. B. PROJECT FUNDING & COST ESTIMATES With the submission of monthly invoices together with proper support documentation, for the services and authorized budget items described in Section A of this Attachment, Mercy House will be reimbursed on a monthly basis in accordance with the following annual project budget: Case Manager: $11,540 Leasing Agent: $12,900 Supervisor: $5,512 Benefits: $7,488 Supplies: $2,500 Administrative Costs: $25,060 Total Mercy House Budget: $65,000 MERCY HOUSE ATTACHMENT 2 SUMMARY OF CDGB LEGAL REQUIREMENTS 15 ATTACHMENT 2 SUMMARY OF LEGAL REQUIREMENTS In addition to the requirements set forth in other provisions of the Subrecipient Agreement, Subrecipient("Participant")shall comply,and shall cause all participant personnel to comply,with the following regulations and requirements insofar as they are applicable with the performance of the Subrecipient Agreement.' 1. Equal Opportunity and Nondiscrimination. a. Title VI of the Civil Rights Act of 1964, as amended, including Public Law 88-352 implemented in 24 C.F.R.Part 1. This law provides in part that no person shall, on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. In regard to the sale or lease of the Site, Participant shall cause or require a covenant running with the land to be inserted in the deed and leases prohibiting discrimination under this Title, and providing that City and the United States are beneficiaries of and entitled to enforce such covenants. Participant shall enforce such covenant and shall not itself so discriminate. b. Fair Housing Act, Title VIII of the Civil Rights Act of 1968, as amended, including Public Law 90-234. The Fair Housing Act provides in part that there shall be no discrimination in housing practices on the basis of race, color, religion, sex, and national origin. The Fair Housing Act was amended in 1988 to provide protections from discrimination in any aspect of the sale or rental of housing for families with children and persons with disabilities. The Fair Housing Act also establishes requirements for the design and construction of new rental or for-sale multi-family housing to ensure a minimum level of accessibility for persons with disabilities. c. Section 109 of Title I of the Housing and Community Development Act of 1974, as amended,including 42 U.S.C. 5301 et. seq., 42 U.S.C. 6101 et. seq., and 29 U.S.C. 794. This law provides in part that no person on the grounds of race, color, national origin, sex, or religion shall be excluded from participation in,be denied the benefits of,or otherwise be subject to discrimination under any activity funded in whole or part with funds under this Title. d. Section 104(b) of Title I of the Housing and Community Development Act of 1974, as amended, including 42 U.S.C. 5301 et. seq. This law provides in part that any grant under Section 106 shall be made only if the grantee certifies to the satisfaction of the Secretary of HUD that the grantee will, among other things, affirmatively further fair housing. ' This exhibit is a list and summary of some of the applicable legal requirements and is not a complete list of all participant requirements. The description set forth next to a statute or regulation is a summary of certain provisions in the statute or regulation and is in no way intended to be a complete description or summary of the statute or regulation. In the event of any conflict between this summary and the requirements imposed by applicable laws,regulations,and requirements,the applicable laws, regulations, and requirements shall apply. ATTACHMENT 2 June 2020 -1- e. Executive Order 11246, as amended. This order includes a requirement that grantees and subrecipients and their contractors and subcontractors not discriminate against any employee or applicant for employment because of race,color,religion, sex, or national origin. f. Executive Order 11063,as amended,including 24 C.F.R Part 107. This order and its implementing regulations include requirements that all actions necessary be taken to prevent discrimination because of race, color, religion, sex, or national origin in the use, occupancy, sale, leasing, rental, or other disposition of property assisted with Federal loans, advances, grants, or contributions. g. Section 504 of the Rehabilitation Act of 1973, as amended. This Act specifies in part that no otherwise qualified individual shall solely by reason of his or her disability or handicap be excluded from participation (including employment), denied program benefits, or subjected to discrimination under any program or activity receiving Federal assistance.Participant must ensure that its programs are accessible to and usable by persons with disabilities. h. The Americans with Disabilities Act (ADA) of 1990, as amended. This Act prohibits discrimination on the basis of disability in employment by state and local governments and in places of public accommodation and commercial facilities. The ADA also requires that facilities that are newly constructed or altered,by, on behalf of, or for use of a public entity, be designed and constructed in a manner that makes the facility readily accessible to and usable by persons with disabilities. The Act defines the range of conditions that qualify as disabilities and the reasonable accommodations that must be made to assure equality of opportunity,full participation, independent living, and economic self-sufficiency for persons with disabilities. i. The Age Discrimination Act of 1975, as amended. This law provides in part that no person shall be excluded from participation in, be denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal assistance. j. EEO/AA Statement. Participant shall, in all solicitations or advertisements for employees placed by or on behalf of Participant, state that it is an Equal Opportunity or Affirmative Action employer. k. Minority/Women Business Enterprise. Participant will use its best efforts to afford small businesses and minority and women-owned business enterprises the maximum practicable opportunity to participate in the performance of the Agreement. As used in the Agreement,the term"small business"means a business that meets the criteria set forth in Section 3(a) of the Small Business Act, as amended (15 U.S.C. 632), and "minority and women-owned business enterprise" means a business at least fifty-one percent (51%) owned and controlled by minority group members or women. For the purpose of this definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish-surnamed or Spanish-heritage Americans,Asian- Americans, and American Indians. Participant may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation. ATTACHMENT 2 June 2020 -2- 2. EnvironmentaL a. Air and Water. Participant shall comply with the following regulations insofar as they apply to the performance of the Agreement: Clean Air Act,42 U.S.C. 7401,et seq.; Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308,and all regulations and guidelines issued thereunder; and the U.S.Environmental Protection City regulations pursuant to 40 C.F.R.Part 50,as amended. b. Flood Disaster Protection Act of 1973. Participant shall assure that for activities located in an area identified by FEMA as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained. c. Lead-Based Paint. Participant shall comply with the Lead-Based Paint Regulations referenced in 24 C.F.R. § 570.608, including 24 C.F.R. Part 35, et. al. d. Historic Preservation. Participant shall comply with the historic preservation requirements set forth in the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set forth in 36 C.F.R. Part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic Properties and related laws and Executive Orders, insofar as they apply to the performance of the Agreement. In general, this requires concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a federal, state, or local historic property list. e. Limitation on Activities Pending Clearance. In accordance with 24 C.F.R. § 58.22 entitled "Limitations on activities pending clearance, "neither a recipient nor any participant in the development process, including public or private nonprofit or for-profit entities, or any of their contractors, may commit HUD assistance under a program listed in 24 C.F.R. § 58.1(b) on an activity or project until HUD or the state has approved the recipient's Request for Release of Funds (RROF) and the related certifications have been approved. Neither a recipient nor any participant in the development process may commit non-HUD funds or undertake an activity or project that would have an adverse environmental impact or limit the choice of reasonable alternatives. Upon completion of environmental review or receipt of environmental clearance, City shall notify Participant. HUD funds shall not be utilized before this requirement is satisfied. The environmental review or violation of the provisions may result in approval, modification of cancellation of the City Grant. If a project or activity is exempt under 24 C.F.R. § 58.34, or is categorically excluded (except in extraordinary circumstances) under 24 C.F.R. § 58.35(b), no RROF is required and the recipient may undertake the activity immediately after the City has documented its determination that each activity or project is exempt and meets the conditions specified for such exemption under this section by issuing a Notice to Proceed. 3. Uniform Administrative Requirements. The uniform administrative requirements described in 24 C.F.R. § 570.502. 4. Other Program Requirements. Participant shall carry out each activity under the Agreement in accordance with all applicable federal laws and regulations described in Subpart K ATTACHMENT 2 June 2020 -3- of 24 C.F.R. § 570 except for City's environmental responsibilities under 24 C.F.R. § 570.604 and City's responsibility for initiating the review process under the provisions of 24 C.F.R. Part 52. 5. Reversion of Assets. Upon the expiration of the Funding Period or sooner termination of the Agreement, Participant shall transfer to City (a) any and all CDBG Funds, (b) any accounts receivable attributable to the use of CDBG Funds. In all cases in which equipment acquired,in whole or in part,with funds under the Agreement is sold,the proceeds shall be program income(prorated to reflect the extent to that funds received under the Agreement were used to acquire the equipment). Equipment not needed by Participant for activities under the Agreement shall at the election of City either be (a)transferred to City for the CDBG program, or (b) retained by Participant after compensating City an amount equal to the current fair market value of the equipment less the percentage of non-CDBG Funds used to acquire the equipment. 6. Relocation. City shall not be responsible for relocating any occupants from the Site in connection with the Program or Project. If required, Participant shall have the sole and exclusive responsibility for providing relocation assistance and paying all relocation costs required to comply with all applicable federal and state laws,rules, and regulations, including the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. § 4601 et seq., as amended, and implementing regulations, and HUD Handbook 1378. Participant shall indemnify, defend, and hold City harmless from and against any claims, liabilities, damages, or losses made against it by tenants or occupants of the Site, including without limitation claims for relocation assistance,inverse condemnation,and claims otherwise arising from any act or omission of Participant pursuant to the provision of relocation assistance. 7. Allowable Costs and Audits. Participant shall comply with and administer the Project and Program in accordance with the requirements of The Office of Management and Budget (OMB)"Super Circular" 2 CFR Part 200, which includes the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for federal awards, as applicable. 8. Records and Reports. Participant shall provide to City and shall cause each of its contractors, subcontractors and subrecipients to provide to City all records and reports relating to the Project and Program that may be reasonably requested by City in order to enable it to perform its record keeping and reporting obligations pursuant to the CDBG Requirements, including but not limited to those described in the Agreement and 24 C.F.R. § 570.506. 9. Religious Organizations. If Participant is a religious organization as defined by the CDBG Requirements, Participant shall comply with all conditions prescribed by HUD for the use of CDBG Funds by religious organizations, including the First Amendment of the United States Constitution regarding church/state principles and the applicable constitutional prohibitions set forth in 24 C.F.R. § 570.200(j). 10. Conflict of Interest. Participant will comply with 24 C.F.R. § 570.611 regarding the avoidance of conflict of interest,which provisions include(but are not limited to)the following: i. Participant shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. ATTACHMENT 2 June 2020 -4- ii. No employee, officer or agent of the Participant shall participate in the selection, or in the award, or administration of, a contract supported by Federal funds if a conflict of interest,real or apparent, would be involved. iii. No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG-assisted activities, or who are in a position to participate in a decision-making process or gain inside information with regard to such activities,may obtain a financial interest in any contract,or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG-assisted activity, or with respect to the proceeds from the CDBG-assisted activity, either for themselves or those with whom they have business or immediate family ties,during their tenure or for a period of one(1)year thereafter. For purposes of this paragraph, a"covered person"includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the Grantee,the Participant, or any designated public agency. 11. Political Activity (24 C.F.R. § 570.207(a)(3)). Participant is prohibited from using CDBG Funds to finance the use of facilities or equipment for political purposes or to engage in other partisan political activities, such as sponsoring candidate forums, distributing brochures, voter transportation, or voter registration. 12. Anti-Lobbying Certification. By its execution of the Agreement, Participant hereby certifies that: i. No Federal appropriated funds have been paid or will be paid, by or on behalf of it,to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. ii. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,it will complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. iii. It will require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants,loans,and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. This certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.C. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than ATTACHMENT 2 June 2020 -5- $100,000 for each such failure. At the request of City, Participant shall execute a separate document that contains the certifications set forth above. 13. Drug-Free Workplace Requirements. Participant shall comply with and be subject to the requirements of the federal drug-free workplace requirements, which include the following actions be taken: i. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition. ii. Establishing an ongoing drug-free awareness program to inform employees about: (a) the dangers of drug abuse in the work place; (b) the grantee's policy of maintaining a drug-free workplace; (c) any available drug counseling, rehabilitation, and employee assistance programs; and (d) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. iii. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph(i). iv. Notifying the employee in the statement required by paragraph(i)that, as a condition of employment under the grant,the employee will: (a)abide by the terms of the statement; and(b)notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five(5)calendar days after such conviction. v. Notifying the agency in writing, within ten (10) calendar days after receiving notice under sub-paragraph (iv)(b) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title,to every grant officer or other designee on whose grant activity the convicted employee was working,unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant. vi. Taking one of the following actions, within thirty (30) calendar days of receiving notice under subparagraph (iv)(b), with respect to any employee who is so convicted: (a) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (b) requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local health, law enforcement, or other appropriate agency. vii. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (i), (ii), (iii), (iv), (v), and(vi). ATTACHMENT 2 June 2020 -6- 14. Procurement. Participant will comply with the procurement standards under 2 C.F.R. §§ 200.317-200.326. Participant shall comply with all existing and future City policies concerning the purchase of equipment. 15. Labor Provisions. a. Section 3 of the Housing and Community Development Act of 1968. Participant shall comply with and cause its contractors and subcontractors to comply with the requirements of Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. § 1701u), the HUD regulations issued pursuant thereto at 24 C.F.R, Part 135, and any applicable rules and orders of HUD issued thereunder. The Section 3 clause, set forth in 24 C.F.R § 135.38 provides: i. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. § 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by Section 3, shall,to the greatest extent feasible,be directed to low-and very low-income persons,particularly persons who are recipients of HUD assistance for housing. ii. The parties to this contract agree to comply with HUD's regulations in 24 C.F.R. Part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations. iii. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding if any,a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause,and will post copies of the notice - in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions,the qualifications for each;and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. iv. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 C.F.R.Part 135,and agrees to take appropriate action,as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 C.F.R. Part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 C.F.R. Part 135. v. The contractor will certify that any vacant employment positions,including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 C.F.R. ATTACHMENT 2 June 2020 -7- Part 135 require employment opportunities to be directed,were not filled to circumvent the contractor's obligations under 24 C.F.R. Part 135. vi. Noncompliance with HUD's regulations in 24 C.F.R. Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. Participant shall abide by the Section 3 clause set forth above and will also cause this Section 3 clause to be inserted in all contracts relating to the construction of the Project. b. Labor Standards. Participant shall comply with the provisions of 24 C.F.R. 570.603 and related requirements. Participant shall include in all applicable construction contracts the provisions of federal law imposing labor standards on federally assisted contracts. Participant shall comply with the requirements of the Secretary of Labor in accordance with the Davis-Bacon Act as amended (40 U.S.C. 3141 through 3148), the provisions of Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq. and implementing regulations), the Copeland Anti-Kick Back Act (40 U.S.C. 276c and 18 U.S.C. 874 et seq.), the implementing regulations of the U.S. Department of Labor including 29 C.F.R. Parts 1, 3, 5, 6 and 7, and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of the Agreement. Participant shall maintain documentation that demonstrates compliance with these provisions and such documentation shall be made available to City and HUD for review upon request. Participant shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph. c. HUD Form 4010. Participant shall comply and cause Participant Personnel to comply with the provisions of HUD Form 4010 attached hereto. HUD Form 4010 must be included in the bid packet and construction contract and subcontracts for the Project. ATTACHMENT 2 June 2020 -8- Federal Labor Standards Provisions U.S.Department of Housing and Urban Development Office of Labor Relations Applicability (1) The work to be performed by the classification The Project or Program to which the construction work requested is not performed by a classification in the wage covered by this contract pertains is being assisted by the determination;and United States of America and the following Federal Labor (2) The classification is utilized in the area by the Standards Provisions are included in this Contract construction industry;and pursuant to the provisions applicable to such Federal (3) The proposed wage rate, including any bona fide assistance. fringe benefits, bears a reasonable relationship to the A. 1. (I) Minimum Wages. All laborers and mechanics wage rates contained in the wage determination. employed or working upon the site of the work,will be paid (b) If the contractor and the laborers and mechanics to be unconditionally and not less often than once a week, and employed in the classification (if known), or their without subsequent deduction or rebate on any account representatives, and HUD or its designee agree on the (except such payroll deductions as are permitted by classification and wage rate (including the amount regulations issued by the Secretary of Labor under the designated for fringe benefits where appropriate), a report Copeland Act (29 CFR Part 3), the full amount of wages of the action taken shall be sent by HUD or its designee to and bona fide fringe benefits(or cash equivalents thereof) the Administrator of the Wage and Hour Division, due at time of payment computed at rates not less than Employment Standards Administration, U.S.Department of those contained in the wage determination of the Labor,Washington, D.C. 20210. The Administrator, or an Secretary of Labor which is attached hereto and made a authorized representative, will approve, modify, or part hereof, regardless of any contractual relationship disapprove every additional classification action within 30 which may be alleged to exist between the contractor and days of receipt and so advise HUD or its designee or will such laborers and mechanics. Contributions made or notify HUD or its designee within the 30-day period that costs reasonably anticipated for bona fide fringe benefits additional time is necessary. (Approved by the Office of under Section l(b)(2) of the Davis-Bacon Act on behalf of Management and Budget under OMB control number 1215- laborers or mechanics are considered wages paid to such 0140,) laborers or mechanics,subject to the provisions of 29 CFR 5.5(a)(1)(iv); also, regular contributions made or costs (c) In the event the contractor, the laborers or mechanics incurred for more than a weekly period(but not less often rto e be employed in the classification or their than quarterly) under plans, funds, or programs, which representatives, and HUD or its designee do not agree hon e cover the particular weekly period, are deemed to be the proposed classification and wage rate (including the constructively made or incurred during such weekly period. amount designated for fringe benefits,where appropriate), HUD or its designee shall refer the questions, including Such laborers and mechanics shall be paid the appropriate the views of all interested parties and the recommendation wage rate and fringe benefits on the wage determination of HUD or its designee, to the Administrator for for the classification of work actually performed, without determination. The Administrator, or an authorized regard to skill, except as provided in 29 CFR 5.5{a)(4). representative,will issue a determination within 30 days of Laborers or mechanics performing work in more than one receipt and so advise HUD or its designee or will notify classification may be compensated at the rate specified for HUD or its designee within the 30-day period that each classification for the time actually worked therein: additional time is necessary. (Approved by the Office of Provided, That the employers payroll records accurately Management and Budget under OMB Control Number set forth the time spent in each classification in which 1215-0140.) work is performed. The wage determination(including any (d) The wage rate (including fringe benefits where additional classification and wage rates conformed under appropriate) determined 29 CFR 5.5(a)(1)(ii) and the Davis-Bacon poster {WH- pursuant to subparagraphs 1321)shall be posted at all times by the contractor and its (1)(firers or (c) of this paragraph, shall be paid to all subcontractors at the site of the work in a prominent and workers performing work in the classification under this accessible, place where it can be easily seen by the contract from the first day on which work is performed in workers. the classification. (if) (a) Any class of laborers or mechanics which is not (iii) Whenever the minimum wage rate prescribed in the Listed in the wage determination and which is to be contract for a class of laborers or mechanics includes a employed under the contract shall be classified in fringe benefit which is not expressed as an hourly rate,the conformance with the wage determination. HUD shall contractor shall either pay the benefit as stated in the approve an additional classification and wage rate and wage determination or shall pay another bona fide fringe fringe benefits therefor only when the following criteria benefit or an hourly cash equivalent thereof. have been met: (iv) If the contractor does not make payments to a trustee or other third person,the contractor may consider as part fcmi HUD-4010(06/2009) Previous editions are obsolete Page 1 of 5 ref.Handbook 1344.1 ATTACHMENT 2 -9- of the wages of any laborer or mechanic the amount of any communicated in writing to the laborers or mechanics costs reasonably anticipated in providing bona fide fringe affected, and records which show the costs anticipated or benefits under a plan or program, Provided, That the the actual cost incurred in providing such benefits. Secretary of Labor has found, upon the written request of Contractors employing apprentices or trainees under the contractor, that the applicable standards of the Davis- approved programs shall maintain written evidence of the Bacon Act have been met. The Secretary of Labor may registration of apprenticeship programs and certification of require the contractor to set aside in a separate account trainee programs. the registration of the apprentices and assets for the meeting of obligations under the plan or trainees, and the ratios and wage rates prescribed in the program. (Approved by the Office of Management and applicable programs. (Approved by the Office of Budget under OMB Control Number 1215-01403 Management and Budget under OMB Control Numbers 2. Withholding. HUD or Its designee shalt upon its own 1215-0140 and 1215-0017.) action or upon written request of an authorized (ii) (a) The contractor shall submit weekly for each week representative of the Department of Labor withhold or in which any contract. work Is performed a copy of all cause to be withheld from the contractor under this payrolls to HUD or its designee if the agency is a party to contract or any other Federal contract with the same prime the contract, but if the agency is not such a party, the contractor, or any other Federally-assisted contract contractor will submit the payrolls to the applicant subject to Davis-Bacon prevailing wage requirements, sponsor,or owner,as the case may be,for transmission to which is held by the same prime contractor so much of the HUD or its designee. The payrolls submitted shall set out accrued payments or advances as may be considered accurately and completely all of the information required necessary to pay laborers and mechanics, including to be maintained under 29 CFR 5.5(a)(3)(i)except that full apprentices, trainees and helpers, employed by the social security numbers and home addresses shall not be contractor or any subcontractor the full amount of wages included on weekly transmittals. Instead the payrolls shall required by the contract In the event of failure to pay any only need to include an individually identifying number for laborer or mechanic, including any apprentice, trainee or each employee(e.g.,the last four digits a the employee's helper, employed or working on the site of the work, all or social security number). The required weekly payroll part of the wages required by the contract, HUD or its information may be submitted in any form .desired- designee may, after written notice to the contractor, Optional Form WH-347 is available for this purpose from sponsor,applicant,or owner,take such action as may be the Wage. and Hour Division Web site at; necessary to cause the suspension of any further htto:/twww.dotrrovlesalsvhdfforms/'vh347instr.htm or its payment, advance,: or guarantee of funds until such successor site. The prime contractor is responsible for violations have.ceased. HUD or its designee may, after the submission of copies of payrolls by all subcontractors. written notice to the contractor; disburse such.amounts Contractors and subcontractors shall maintain the full withheld for and on account of the contractor or social security number and current address of each subcontractor to the respective employees to whom they covered worker, and shall provide them upon request to are due_ The Comptroller General shall make such HUD or its designee if the agency is a party to the disbursements in the case of direct Davis-Bacon Act contract, but if the agency is not such a party, the contracts. contractor will submit the payrolls to the applicant 3. (i) Payrolls and basic records. Payrolls and basic sponsor,or owner,as the case may be,for transmission to records relating thereto shall be maintained by the HUD or its designee,the contractor,or the Wage and Hour contractor during the course of the work preserved for a Division of the Department of Labor for purposes of an period of three years thereafter for all laborers and investigation or audit of compliance with prevailing wage mechanics working at the site of the work. Such records requirements. it Is not a violation of this subparagraph for shall contain the name, address, and social security a prime contractor to require a subcontractor to provide number of each such worker, his or her correct addresses and social security numbers to the prime classification, hourly rates of wages paid (including rates contractor for its own records, without weekly submission of contributions or costs anticipated for bona fide fringe to HUD or its designee. (Approved by the Office of benefits or cash equivalents thereof of the types described Management and Budget under OMB Control Number in Section l(b)(2)(B) of the Davis-bacon Act), daily and 1215-0149.) weekly number of hours worked, deductions made and (b) Each payroll submitted shall be accompanied by a actual wages paid. Whenever the Secretary of Labor has "Statement of Compliance,' signed by the contractor or found under 29 CFR 5.5 (a)(1)(iv) that the wages of any subcontractor or his or her agent who pays or supervises laborer or mechanic include the amount of any costs the payment of the persons employed under the contract reasonably anticipated in providing benefits under a plan and shall certify the following: or program described in Section l(b)(2)(B) of the Davis- (1) That the payroll for the payroll period contains the Bacon Act, the contractor shall maintain records which information required to be provided under 29 CFR 5.5 show that the commitment to provide such benefits is (a)(3)(ii), the appropriate information is being maintained enforceable, that the plan or program is financially under 29 CFR 5.5(a)(3)(i), and that such information is responsible, and that the plan or program has been correct and complete; Previous editions am obsolete form HUD-4010(0612009) Page 2 of 5 ref.Handbook 1344.1 ATTACHMENT 2 -10- (2) That each laborer or mechanic(including each helper, is not registered or otherwise employed as stated above, apprentice, and trainee) employed on the contract during shall be paid not less than the applicable wage rate on the the payroll period has been paid the full weekly wages wage determination for the classification of work actually earned, without rebate, either directly or indirectly, and performed. in addition,any apprentice performing work on that no deductions have been made either directly or the job site in excess of the ratio permitted under the indirectly from the full wages earned, other than registered program shall be paid not less than the permissible deductions as set forth in 29 CFR Part 3; applicable wage rate on the wage determination for the (3) That each laborer or mechanic has been paid not less work actually performed. Where a contractor is performing than the applicable wage rates and fringe benefits or cash construction on a project in a locality other than that in equivalents for the classification of work performed, as which its program is registered,the ratios and wage rates specified in the applicable wage determination (expressed in percentages of the journeyman's hourly incorporated into the contract rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice (c) The weekly submission of a properly executed must be paid at not less than the rate specified in the certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the registered program for the ohe ice's level of progress, "Statement of Compliance required by subparagraph expressed as a percentage off the journeymen hourly rate A.3{ii)(b). specified In the applicable wage determination. Apprentices shall be paid fringe benefits in accordance (d) The falsification of any of the above certifications may with the provisions of the apprenticeship program If the subject the contractor or subcontractor to civil or criminal apprenticeship program does not specify fringe benefits, prosecution under Section 1001 of Title 18 and Section apprentices must be paid the full amount of fringe benefits 231 of Title 31 of the United States Code. listed on the wage determination for the applicable (iii) The contractor or subcontractor shall make the classification. If the Administrator determines that a records required under subparagraph A.3.(i) available for different practice prevails for the applicable apprentice inspection, copying, or transcription by authorized classification,fringes shall be paid in accordance with that representatives of HUD or its designee or the Department determination. In the event the Office of Apprenticeship of Labor, and shall permit such representatives to Training, Employer and Labor Services, or a State interview employees during working hours on the job. If Apprenticeship Agency recognized by the Office, the contractor or subcontractor fails to submit the required withdraws approval of an apprenticeship program, the records or to make them available, HUD or its designee contractor will no longer be permitted to utilize may, after written notice to the contractor, sponsor, apprentices at less than the applicable predetermined rate applicant or owner, take such action as may be necessary for the work performed until an acceptable program is to cause the suspension of any further payment, advance, approved. or guarantee of funds. Furthermore,failure to submit the (ii) Trainees. Except as provided in 29 CFR 5.16, required records upon request or to make such records trainees will not be permitted to work at less than the available may be grounds for debarment action pursuant to predetermined rate for the work performed unless they are 29 CFR 5.12. employed pursuant ',to and individually registered In a 4. Apprentices and Trainees. program which has received prior approval, evidenced by (i) Apprentices. Apprentices will be permitted to work at format certification by the U.S. Department of Labor, less than the predetermined rate for the work they Employment and Training Administration. The ratio of performed when they are employed pursuant to and trainees to journeymen on the Job site shall not be greater individually registered in a bona fide apprenticeship than permitted under the plan approved by the program registered with the U.S. Department of Labor, Employment and Training Administration. Every trainee Employment and Training Administration, Office of must be paid at not less than the rate specified in the Apprenticeship Training, Employer and Labor Services, or approved program for the trainee's level of progress, with a State Apprenticeship Agency recognized by the expressed as a percentage of the journeyman hourly rate Office, or if a person is employed in his or her first 90 specified in the applicable wage determination. Trainees days of probationary employment as an apprentice in such shall be paid fringe benefits in accordance with the an apprenticeship program, who is not individually provisions of the trainee program. If the trainee program registered in the program, but who has been certified by does not mention fringe benefits, trainees shall be paid the Office of Apprenticeship Training, Employer and Labor the full amount of fringe benefits listed on the wage Services or a State Apprenticeship Agency (where determination unless the Administrator of the Wage and appropriate)to be eligible for probationary employment as Hour Division determines that there is an apprenticeship an apprentice. The allowable ratio of apprentices to program associated with the corresponding journeyman journeymen on the job site in any craft classification shall wage rate on the wage determination which provides for not be greater than the ratio permitted to the contractor as less than full fringe benefits for apprentices. Any to the entire work force under the registered program. Any employee listed on the payroll at a trainee rate who is not • worker listed on a payroll at an apprentice wage rate,who registered and participating in a training plan approved by Previous editions are obsolete form HUD-4010(0612009) Page 3 of 5 ref.Handbook 1344.1 ATTACHMENT 2 -11- the Employment and Training Administration shall be paid awarded HUD contracts or participate in HUD programs not less than the applicable wage rate on the wage pursuant to 24 CFR Part 24. determination for the work actually performed. an addition, (II) No part of this contract shall be subcontracted to any any trainee performing work on the job site in excess of person or firm ineligible for award of a Government the ratio permitted under the registered program shall be contract by virtue of Section 3(a) of the Davis-Bacon Act paid not less than the applicable wage rate on the wage or 29 CFR 5.12(a)(1) or to be awarded HUD contracts or determination for the work actually performed. In the participate in HUD programs pursuant to 24 CFR Part 24. event the Employment and Training Administration withdraws approval of a training program, the contractor (iii) The penalty for making false statements is prescribed will no longer be permitted to utilize trainees at less than in the U.S. Criminal Code, 18 U.S.C. 1001. Additionally, the applicable predetermined rate for the work performed U.S. Criminal Code, Section 1 01 0, Title 18, U.S.C., until an acceptable program is approved. "Federal Housing Administration transactions', provides in part: "Alhoever, for the purpose of. . . influencing in any (iii) Equal employment opportunity. The utilization of way the action of such Administration makes,utters or apprentices,trainees and journeymen under 29 CFR Part 5 publishes any statement knowing the same to be false shall be in conformity with the equal employment shall be fined not more than $5,000 or imprisoned not opportunity requirements of Executive Order 11246, as more than two years,or both.' amended,and 29 CFR Part 30. 11. Complaints, Proceedings, or Testimony by 5. Compliance with Copeland Act requirements. The Employees. No laborer or mechanic to whom the wage, contractor shalt comply with the requirements of 29 CFR salary,or other labor standards provisions of this Contract Part 3 which are incorporated by reference in this contract are applicable shall be discharged or in any other manner 6. Subcontracts. The contractor or subcontractor will discriminated against by the Contractor or any insert in any subcontracts the clauses contained in subcontractor because such employee has filed any subparagraphs 1 through 11 in this paragraph A and such complaint or instituted or caused to be instituted any other clauses as HUD or its designee may by appropriate proceeding or has testified or is about to testify in any instructions require, and a copy of the applicable proceeding under or relating to the labor standards prevailing wage:decision, and also a clause requiring the applicable under this Contract to his employer. subcontractors to include these clauses in any lower tier B. Contract Work Hours and Safety Standards Act. The subcontracts. The prime contractor shall be responsible provisions of this paragraph B are applicable where the amount of the for the compliance by any subcontractor or lower tier prime contract exceeds$100,000. As used in this paragraph, the subcontractor with all the contract clauses in this teams Raborers and'mechanics'include watchmen and guards. paragraph. (1) Overtime requirements. No contractor or subcontractor 7. Contract termination; debarment. A breach of the contracting for ay part of the contract work which may require or contract clauses in 29 CFR 5.5 may be grounds for involve the employment of laborers or mechanics shall require or termination of the contract and for debarment as a permit any such laborer or mechanic in any workweek in which the contractor and a subcontractor as provided in 29 CFR intavlduai is employed on such work to work in excess of 40 hours in 5.12. such workweek unless such laborer or mechanic receives 8. Compliance with Davis-Bacon and Related Act Requirements. compensation at a rate not less than one and one-half tines the basic All rulings and interpretations of the Davis-Bacon and rate of pay for all hours worked in excess of 40 bows in such Related Acts contained in 29 CFR Parts 1, 3, and 5 are w rkweek. herein incorporated by reference in this contract (2) Violation; liability for unpaid wages; liquidated 9. Disputes concerning labor standards. Disputes damages. In the event of any violation of the clause set arising out of the labor standards provisions of this forth in subparagraph(1)of this paragraph, the contractor contract shalt not be subject to the general disputes and any subcontractor responsible therefor shall be liable clause of this contract. Such disputes shall be resolved in for the unpaid wages. In addition, such contractor and accordance with the procedures of the Department of subcontractor shall be liable to the United States (in the Labor set forth in 29 CFR Parts 5, 6, and 7. Disputes case of work done under contract for the District of within the meaning of this clause include disputes between Columbia or a territory, to such District or to such the contractor(or any of its subcontractors) and HUD or territory), for liquidated damages. Such liquidated its designee, the U.S. Department of Labor, or the damages shall be computed with respect to each individual employees or their representatives. laborer or mechanic, including watchmen and guards, 10. (i) Certification of Eligibility. By entering into this employed in violation of the clause set forth in contract the contractor certifies that neither it(nor he or subparagraph(1)of this paragraph,in the sum of$10 for each she) nor any person or firm who has an interest in the calendar day on which such individual was required or permitted to contractors firm is a person or firm ineligible to be wok in access of the standard workweek of 40 hours without payment awarded Government contracts by virtue of Section 3(a)of the overtime wages required by the clause set forth in sub the Davis-Bacon Act or 29 CFR 5.12(a)(1) or to be paragraph(1)of this paragraph. Previous editions are obsolete fonn HUD-4010(06/2009) Page 4 of 5 ref.Handbook 1344.1 ATTACHMENT 2 -12- (3) Withholding for unpaid wages and liquidated damages. HUD or its designee shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contract, or any other Federally-assisted contract subject to the Contract Work Hours and Safety Standards Act which is held by the same prime contractor such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in subparagraph(2)of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in subparagraph(1)through(4)of this paragraph and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in subparagraphs (1) through (4) of this paragraph. C. Health and Safety. The provisions of this paragraph C are applicable where the amount of the prime contract exceeds 6160,000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health and safety as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The Contractor shall comply with all regulations issued by the Secretary of Labor pursuant to Title 29 Part 1926 and failure to comply may result in imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91-54, 83 Stat 96). 40 USC 3701 et sea. (3) The contractor shall include the provisions of this paragraph in every subcontract so that such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Previous edit are obsolete form HUD-4010(0612009) Page 5 of 5 ref.Handbook 1344.1 ATTACHMENT 2 -13- c,,L, A`aRL® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/2/2024 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 pollcy(les)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 CONTACT NAME: Brittany Andrakowicz Burnham WGB Insurance Solutions PHONE FAX CA Insurance License OF69771 E.NLo.EXtk 714-505-7000 UUC,Nol:714-573-1770 15901 Red Hill Avenue ADDREss; brittany.andrakowicz@wgbib.com Tustin CA 92780 INSURER(S)AFFORDING COVERAGE NAIC• INSURER A:Philadelphia Indemnity Insuran 18058 INSURED MERCY-1 INSURER B:Berkshire Hathaway Homestate I 20044 Mercy House Living Centers,Inc. PO Box 1905 INSURER C: Santa Ana CA 92702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:560976526 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 TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXPLI LIMITS LTR INSD WVo POLICY NUMBER (MM/DLJYYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY PHPK2683655 5/2/2024 5/2/2025 EACH OCCURRENCE $1,000,000 GE TO CLAIMS-MADE n OCCUR PREMISES(EaENTED occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PECRO'7 LOC PRODUCTS-COMP/OP AGG $2,000,000 J OTHER: $ A AUTOMOBILE LIABILITY PHPK2683655 5/2/2024 5/2/2025 COMBINED ntlSINGLELIMIT 61,000,000 lEe eedde X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS xHIRED X NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ A X UMBRELLA LJAB X OCCUR PHUB910653 5/2/2024 5/2/2025 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 4,000,000 DED X RETENTIONS 1(I,nnr a WORKERS COMPENSATION MEWC544885 2/8/2024 2/8/2025 X S7ATUrE ERH AND EMPLOYERS'LIABILITY AM./PROPRIETOR/PARTNER/EXECUTIVEY/N N/A E.L.EACH ACCIDENT $1,000,000 IM OFFICEREMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UNIT $1,000,000 A Professional Liability PHPK2683655 5/2/2024 5/2/2025 Per Occurrence/ 0 $1000000/$2000000 A D&O/EPLJ PHSD1871491 5/2J2024 5/2/2025 Each Policy Period 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Abuse/Molestation- Policy Number.PHPK2683655;Carrier:Philadelphia Indemnity;Limits:Each Abusive Conduct$1,000,000/Aggregate$2,000,000 Umbrella Liability Schedule of Underlying:General Liability Policy:PHPK2683655;Auto Liability Policy:PHPK2683655;Professional Liability Policy: PHPK2683655 TO FO M Certificate holder is named as additional insured on the General Liability per attached PI-GLD-HS(10/11)as requir:@b'lia�c ct sub ct to he e s and conditions of the policy. Waiver of Subrogation applies to the General Liability per attached CG24040509 See Attached... Ryt peg t= TES CERTIFICATE HOLDER CANCELLATION ^tT( e) NEY r ter: }}''ff T( GTON BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Huntington Beach 2000 Main St AUTHORIZED REPRESENTATIVE Huntington Beach CA 92646 . ----• I � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: MERCY-1 LOC#: A D ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Burnham WGB Insurance Solutions Mercy House Living Centers,Inc. PO Box 1905 POLICY NUMBER Santa Ma CA 92702 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Waiver of Subrogation applies to the Workers Compensation per attached WC 99 04 10C 01 19 Certificate Holder Vesting:The City of Huntington Beach,its agents,officers,employees and volunteers Primary and Non-Contributory applies on the General Liability per attached endorsement • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PHPK2683655 PI-GL-005(07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 05/02/2024 Name of Person or Organization(Additional insured): City of Huntington Beach, Its officers, elected or appointed officials, employees, agents and volunteers SECTION II—WHO IS AN INSURED is amended to include as an additional Insured the person(s)or organization(s)shown in the endorsement Schedule,but only with respect to liability for"bodily injury," "property damage"or"personal and advertising injury"arising out of or relating to your negligence in the performance of"your work"for such person(s)or organization(s)that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured),except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III—LIMITS OF INSURANCE. All other terms,conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Policy No. PHPK2683655 Pi-GLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the Indicated loss exposure is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own,Rent,or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional insured—Managers and Supervisors(with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers,Landlords,or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional insured—Vendor included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners,Lessees,or Contractors Included 9 Additional Insured—State or Political Subdivisions included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company f' PI-GLD-HS(10/11) Duties In the Event of Occurrence,Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury includes Mental Anguish Included 11 Personal and Advertising Injury—Includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a.is deleted In its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury"or property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage"resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES,COVERAGE A.BODILY INJURY AND PROPERTY DAMAGE• LIABILITY,Subsection 2. Exclusions, Paragraph b, Contractual Liability is amended to Include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client,up to$50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY,Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long;and (b) Not being used to carry persons or property for a charge; This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible Insurance available to the insured whether primary,excess or contingent. D. Damage to Property You Own,Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 includes copyrighted,material of Insurance Services Office, Inc.,with Its permission. ©2011 Philadelphia Indemnity Insurance Company P1-GLD-HS(10/11) LIABILITY,Subsection 2. Exclusions, Paragraph j. Damage to Property, Item (1)is deleted in its entirety and replaced with the following: (1) Property you own, rent,or occupy, including any costs or expenses incurred by you,or any other person,organization or entity,for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property,unless the damage to property is caused by your client, up to a$30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word"fire"is changed to"fire,lightning, explosion, smoke,or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions;is deleted in Its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning,explosion, smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5.above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you,or in the case of damage by fire,lightning,explosion, smoke,or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., Is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that Indemnifies any person or organization for damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,Subsection 4.Other Insurance, Paragraph b. Excess Insurance,(1)(a)(ii) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning, explosion,smoke,or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) a. $1,000,000;or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire,lightning, explosion,smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES,COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, Is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the Insured against any"suit,""investigation,"or"civil proceeding" seeking these damages. However,we will have no duty to defend the Insured against any"suit" seeking damages,"investigation,"or"civil proceeding"to which this Insurance does not apply. 2. Paragraph 2. Exclusions is amended to Include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful, or Deliberate Violations Any willful,intentional,or deliberate"violation(s)"by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS Is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services(HHS) arising out of"violations." b. "Investigation"means an examination of an actual or alleged"violation(s)"by HHS. However, "investigation"does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III-LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION i—COVERAGE,COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement,a.(3)(b)is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS,Subsection 2.Exclusions, • Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part In athletics. I. Supplementary Payments SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows: 1.b.Is deleted in Its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit",including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf,defense costs Incurred by an"employee"in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved In a criminal proceeding is$25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing "suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION 1—COVERAGES,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client,"up to a$10,000 limit per occurrence and$10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners,members,officers,"employees","managers",directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or In collusion with other persons. The following,when used on this coverage,are defined as follows: • a. "Client"means an individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you;or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above,who is on leave;or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent,broker,person leased to you by a labor leasing firm,factor,commission merchant,consignee, independent contractor or representative of the same general character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own,maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition • operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option,any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers,Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership,maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises;or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for"bodily injury,""property damage"or "personal and advertising injury"caused, in whole or in part, by your maintenance,operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this Insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own,rent or control and to which this insurance applies: (a) The existence,maintenance, repair,construction,erection, or removal of advertising signs,awnings,canopies,cellar entrances,coal holes, driveways, manholes, marquees, hoist away openings,sidewalk vaults,street banners or decorations and similar exposures; (b) The construction,erection, or removal of elevators;or (c) The ownership, maintenance, or use of any elevators covered by this insurance. i. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distr€buted or sold in the regular course of the vendor's business,subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily Injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging,except when unpacked solely for the purpose of inspection, demonstration,testing, or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to make such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which,after distribution or sale by you, have been labeled or relabeled or used as a container, part or Ingredient of any other thing or substance by or for the vendor;or (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs(d)or(f);or (ii) Such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make In the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization,from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. J. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization Is an additional insured for"bodily injury,""property damage"or"personal and advertising injury"but only for liability arising out of the negligence of the named insured.The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown In the Declarations I. Owners, Lessees or Contractors—Any person or organization, 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 when required by a contract. 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: (a) 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 (b) 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. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. @ 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) m. State or Political Subdivisions—Any state or political subdivision as required,subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. • (2) This Insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality;or (b) "Bodily injury"or"property damage"Included within the"products-completed operations hazard." M. Duties In the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2.is amended as follows: a.is amended to include: This condition applies only when the"occurrence"or offense is known to: (1) You,if you are an Individual; (2) A partner, if you are a partnership;or (3) An executive officer or insurance manager, if you are a corporation. b.is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You,if you are an Individual; (2) A partner, If you are a partnership;or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part,we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Recovery Against Others To Us is deleted in Its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us.The insured must do nothing after loss to impair them. At our request, the insured will bring"suit"or transfer those rights to us and help us enforce them. Therefore, the Insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge,we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury"means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these;and b. Except for mental anguish,includes death resulting from the foregoing(Item a.above)at any time. R. Personal and Advertising Injury—Abuse of Process,Discrimination • If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of"personal and advertising injury'is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race,color, religion,sex, age or national origin,except when: a. Done Intentionally by or at the direction of,or with the knowledge or consent of: (1) Any insured;or (2) Any executive officer, director, stockholder,partner or member of the Insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment,or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company • • PI-GLD-HS(10/11) c. Directly or indirectly related to the sale,rental,lease or sublease or prospective sales,rental, lease or sub-lease of any room,dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling, The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed.01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of$350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium(prior to adjustments) All CA Operations 21891.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective: 02/08/2024 Policy No.: MEWC544885 Endorsement No.: Insured: Mercy House Living Centers Inc. Premium$ Insurance Company: Berkshire Hathaway Homestate Ins Co Countersigned by WC 99 0410 C (Ed.Oi-19) POLICY NUMBER: PHPK2683655 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and Included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. • CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 CI