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18-073 Amendment #3 dated 7-11-23 General Fund Human Services Grants Program (HSG) 1 THIRD AMENDMENT TO GENERAL FUND HUMAN SERVICES GRANT (HSG) FUNDS CITY/NON-PROFIT CONTRACT (Services Only) This Third Amendment to Contract is entered into between MAITRI ("CORPORATION") and the CITY OF CUPERTINO ("CITY") as of July 1, 2023 (the "Effective Date") to amend the General Fund HSG City/Non-Profit Contract (the "Contract") dated July 1, 2020. WITNESSETH WHEREAS, CITY has reserved a portion of its HSG funds to be used on activities that benefit Cupertino’s residents; and, WHEREAS, CITY has agreed to the use by CORPORATION of a portion of CITY’S HSG budget for the Program (as described below) to be operated within CITY for the benefit of low and very low-income households; THEREFORE, the parties agree as follows: 1. Section I, entitled "Program", is deleted in its entirety and replaced with the following: For the period of July 1, 2020 to June 30, 2021, CITY agreed to allocate a portion of its HSG funds to CORPORATION in the sum of Twenty Five Thousand Dollars and No. Cents ($25,000) for the purpose of implementing the CORPORATION'S program, as more particularly described in Exhibits A-D to the Contract, and said Exhibits set forth below, as they may be amended or modified, are attached to this Contract and incorporated herein by reference. For the period of July 1, 2021 to June 30, 2022 CITY agrees to allocate a portion of its current HSG funds to CORPORATION in the sum of Twenty Five Thousand Dollars and No. Cents ($25,000) for the purpose of implementing the CORPORATION'S Program, as more particularly described in Exhibits A-1, B-1, C-1, and D-1 to the Contract, and said Exhibits set forth below, as they may be amended or modified, are attached to this Contract and incorporated herein by reference. For the period of July 1, 2022 to June 30, 2023 CITY agrees to allocate a portion of its current HSG funds to CORPORATION in the sum of Twenty Five Thousand Dollars and No. Cents ($25,000) for the purpose of implementing the CORPORATION'S Program, as more particularly described in Exhibits A-2, B-2, C-2, and D to the Contract, and said Exhibits set forth below, as they may be amended or modified, are attached to this Contract and incorporated herein by reference. For the period of July 1, 2023 to June 30, 2024 CITY agrees to allocate a portion of its current HSG funds to CORPORATION in the sum of Twenty Four Thousand Six Hundred Seventy Eight Dollars and Eleven Cents ($24,678.11) for the purpose of implementing the CORPORATION'S Program, as more particularly described in Exhibits A-3, B-3, C-3, and D-3 to the Contract, and said Exhibits set forth below, as they may be amended or modified, are 2 attached to this Contract and incorporated herein by reference. Exhibit A-3: Program Description Exhibit B-3: Program Work Plan Exhibit C-3: Proposed Implementation Timeline Schedule Exhibit D-3: Program Budget Exhibit E: Basic Insurance and Bond Requirements For Non-Profit Contracts The total allocation for July 1, 2020, through June 30, 2024 shall not exceed Seventy Five Thousand Dollars and No. Cents ($99,678.11). 2. Exhibits A-3, B-3, C-3, and D-3, including an updated Certificate of Insurance, are attached hereto and hereby added to the Contract. 3. Section II, "Term," is deleted in its entirety and replaced with the following: The Term of this Contract has been extended once per this Section II.B to end on June 30, 2024, unless otherwise amended or terminated earlier pursuant to Section VII or Section VIII of this Contract. 4. Exhibit E to the CONTRACT is replaced with Exhibit E attached hereto. 5. All terms, covenants and conditions stated in the CONTRACT, which are not herein amended, remain in full force and effect. [Signatures on following page.] Page 3 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract IN WITNESS WHEREOF, the parties have executed this Second Amendment as of the Effective Date. CORPORATION: CITY: MAITRI, a California CITY OF CUPERTINO, a municipal nonprofit public corporation benefit corporation ___________________________________ __________________________________ Rama Dharmarajan Date Benjamin Fu Date Executive Officer Director of Community Development APPROVED AS TO FORM AND ATTEST: LEGALITY: ___________________________________ _________________________________ Christopher Jensen Date Kirsten Squarcia Date City Attorney City Clerk EXPENDITURE DISTRIBUTION PO # 2021-116 100-72-712-600-623 Original Contract: $25,000.00 Amendment #1: $25,000.00 Amendment #2: $25,000.00 Amendment #3: $24,678.11 Total: $99,678.11 Jul 11, 2023 Christopher D. Jensen Jul 11, 2023 Jul 11, 2023 Page 4 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract EXHIBIT A-3 PROGRAM DESCRIPTION FY 2023/2024 Agency Name: Maitri DUNS: Not Applicable (Only for CDBG) Chief Executive Officer: Rama Dharmarajan Program Manager: Rama Dharmarajan Program # (For Office Use Only) 100-72-712 600-623 Street Address: P.O. Box 697 City: Santa Clara State: CA Zip Code: 95052 Telephone number: (408) 956-6081 Fax Number: Manager E-mail rama@maitri.org Name of Program: MTH-Direct Client Services Program Location: P.O. Box 697, Santa Clara, CA 95052 Program Description: Maitri seeks the support of the city of Cupertino in the amount of $25,000 to support 10 women and children impacted by domestic violence (DV) who are residing at Maitri's Anjali Transitional House (TH) in a secure location in Santa Clara County. Maitri's TH provides safe and confidential housing, and trauma-informed supportive services to women and children who for the most part were previously homeless. These services will help Maitri TH clients achieve self- sufficiency, permanent housing, and employment, as well as help them overcome barriers that resulted from DV. Page 5 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract EXHIBIT B-3 PROGRAM WORK PLAN FY 2023/2024 AGENCY NAME: Maitri PROGRAM NAME: MTH-Direct Client Services Objectives Benchmarks for Each Quarter 1st 2nd 3rd 4th TOTAL Provide self-sufficiency sessions to 8 Cupertino residents 2 2 2 2 8 Total 2 2 2 2 8 EXHIBIT C-3 PROPOSED IMPLEMETATION TIMELINE SCHEDULE Page 6 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract FY 2023/2024 AGENCY NAME: Maitri PROGRAM NAME: MTH-Direct Client Services Activity Number & Description Activity # Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 1. Page 7 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract EXHIBIT D-3 PROGRAM BUDGET FY 2023-24 AGENCY NAME: Maitri PROGRAM NAME: MTH-Direct Client Services Proposed Program Expenses FY 23-24 Salaries/Benefits/Payroll/Taxes $20,715.11 Office Supplies $0.00 Communication $163.00 Publications/Printing/Advertising $0.00 Travel $0.00 Rent/Lease/Mortgage $3,200.00 Utilities $0.00 Insurance $0.00 Equipment Rental/Maintenance $0.00 Audit/Legal/Professional Services (for CDBG portion only) $380.00 Direct Services (Funding for specific service such as a meal, ride) $0.00 Contracted Services $220.00 Other $0.00 Total Expenses $24,678.11 Page 8 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract EXHIBIT E BASIC INSURANCE AND BOND REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as the word is used in this Exhibit E is the party contracting with the City of Cupertino for the direct distribution of HSG funds. Indemnity The Contractor shall indemnify, defend, and hold harmless the City of Cupertino (hereinafter "City"), its officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performance of this Contract by Contractor and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City. The Contractor shall reimburse the City for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the Contractor is obligated to indemnify, defend and hold harmless the City under this Contract. Insurance Without limiting the Contractor's indemnification of the City, the Contractor shall provide and maintain at its own expense, during the term of this Contract, or as may be further required herein, the following insurance coverages and provisions: A. Evidence of Coverage Prior to commencement of this Contract, the Contractor shall provide on the City's own form or a form approved by the City's Insurance Manager an original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and program name must be stated on the Certificate of Insurance. The City's Special Endorsement form shall accompany the certificate. Individual endorsements executed by the insurance carrier may be substituted for the City's Special Endorsement form if they provide the coverage as required. In addition, a certified copy of the policy or policies shall be provided by the Contractor upon request. This verification of coverage shall be sent to the address as shown on the City's Certificate of Insurance form and to the Community Development Department at the address set forth in this Contract at Section VI. PROGRAM COORDINATION, Paragraph C., NOTICES. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance has been approved by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. B. Notice of Cancellation of Reduction of Coverage All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. Page 9 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract C. Qualifying Insurers All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII, according to the current Best's Key Rating Guide, unless otherwise approved by the City's Insurance Manager. D. Insurance Required 1. Comprehensive General Liability Insurance - for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence. OR 2. Commercial General Liability Insurance - for bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate - $2,000,000 c. Products/Completed Operations- $1,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commercial General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require additional coverage to be purchased by the Contractor to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/ aggregate to be maintained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. d. Personal Injury liability. e. Independent Contractors' (Protective) liability. f. Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. Page 10 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City: a. Additional Insured Endorsement: Such insurance as is afforded by this policy shall also apply to the City of Cupertino, and members of the City Council, and the officers, agents and employees of the City of Cupertino, individually and collectively, as additional insureds. b. Primary Insurance Endorsement: Such insurance as is afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino, its officers, agents, and employees shall be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: This policy may not be cancelled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino at the address shown on the Certificate of Insurance. d. Contractual Liability Endorsement: This policy shall apply to liability assumed by the insured under written contract with the City of Cupertino. e. Personal Injury Endorsement: The provisions of this policy shall provide Personal Injury coverage. f. Severability of Interest Endorsement: The insurance afforded by this policy shall apply separately to each insured that is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Worker's Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all- states endorsement. Page 11 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. c. Inclusion of the City and its governing board(s), officers, representatives, agents, and employees as additional insureds, or a waiver of subrogation. 7. Professional Errors and Omissions Liability Insurance This type of insurance should be provided by persons/entities you contract with to provide you with professional services. a. Limits of not less than one million dollars ($1,000,000). b. If this policy contains a self retention limit, it shall not be greater than ten thousand dollars ($10,000) per occurrence/event. c. This coverage shall be maintained for a minimum of two (2) years following termination of this Contract. The City must first approve any exceptions to the above requirements. 8. Bond Requirements Fidelity Bond - Before receiving compensation under this Contract, Contractor will furnish City with evidence that all officials, employees, and agents handling or having access to funds received or disbursed under this Contract, or authorized to sign or countersign checks, are covered by a BLANKET FIDELITY BOND in an amount of AT LEAST fifteen percent (15%) of the maximum financial obligation of the City cited herein. If such bond is cancelled or reduced, Contractor will notify City immediately, and City may withhold further payment to Contractor until proper coverage has been obtained. Failure to give such notice may be cause for termination of this Contract, at the option of the City. 9. Special Provisions The following provisions shall apply to this Contract: a. The foregoing requirements as to the types and limits of insurance coverage to be maintained by the Contractor and any approval of said insurance by the City or its insurance consultant(s) are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Contractor pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The City acknowledges that some insurance requirements contained in this Contract may be fulfilled by self-insurance on the part of the Contractor. Page 12 of 12 Second Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract However, this shall not in any way limit liabilities assumed by the Contractor under this Contract. The City shall approve any self-insurance in writing. c. The City reserves the right to withhold payments to the Contractor in the event of material noncompliance with the insurance requirements outlined above. d. If the Contractor fails to maintain such insurance as is called for herein, the City must order the Contractor to immediately suspend work at Contractor's expense until a new policy of insurance is in effect. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 6/9/2023 CalNonprofits Insurance Services 1500 41st Avenue Suite 228 Capitola CA 95010 Cyndi Skelton 831-824-5013 831-824-5037 cyndi@cal-insurance.org Nonprofits Insurance Alliance of California 10023 MAITCHA-01 Travelers Casualty and Surety Company of America 19038MaitriCharitableTrust 1435 Koll Circle,Ste 111 San Jose CA 95112 Hartford Casualty Insurance Company 1913052698 A X 1,000,000 X 500,000 20,000 1,000,000 3,000,000 X Y Y 2022-52790 9/5/2022 9/5/2023 3,000,000 A 1,000,000 X X 2022-52790 9/5/2022 9/5/2023 A X X 1,000,0002022-52790-UMB 9/5/2022 9/5/2023 1,000,000 X 0 C X N Y 57WECAT4T3P 9/1/2022 9/1/2023 1,000,000 1,000,000 1,000,000 B Crime/Fidelity 107111389 7/1/2023 7/1/2024 Limit $5,000 The City of Cupertino,its officers,officials,employees,and volunteers are included as Additional Insured with respect to General Liability as required by written contract per Endorsement Form(s)CG 20 26 and CG 20 11 attached.Blanket Waiver of Subrogation applies,per form NIAC-E26 attached.Waiver of Subrogation applies to Worker's Compensation,per form WC 04 03 attached.30 Day Notice of Cancellation applies. City of Cupertino 10300 Torre Avenue Cupertino CA 95014 Maitri Charitable TrustNAMED INSURED: FORM: NIAC-E26 11 17 POLICY NUMBER: 2022-52790 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM This endorsement modifies insurance provided under the following: Name of Person or Organization: SCHEDULE Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. Page 1 of 1NIAC-E26 11 17 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION CG 20 26 04 13Named Insured: 2022-52790 Maitri Charitable Trust Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Name Of Additional Insured Person(s) Or Organization(s): SCHEDULE COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance provided under the following: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1.In the performance of your ongoing operations; or 2.In connection with your premises owned by or rented to you. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A.B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1CG 20 26 04 13 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION CG 20 26 12 19 2022-52790 Named Insured: Maitri Charitable Trust Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Name Of Additional Insured Person(s) Or Organization(s): SCHEDULE COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance provided under the following: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:09/02/22 Policy Expiration Date:09/01/23 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:57 WEC AT4T3P Endorsement Number: Effective Date:09/01/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:Maitri Charitable Trust PO Box 697 SANTA CLARA CA 95052 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us CRIME DECLARATIONS Travelers Casualty and Surety Company of America POLICY NO.107111389 Hartford, Connecticut (A Stock Insurance Company, herein called the Company) ITEM 1 NAMED INSURED: MAITRI INC. D/B/A: Principal Address: PO BOX 697 SAN JOSE, CA 95112 Inception Date:July 1, 2023 Expiration Date:July 1, 2024 ITEM 2 POLICY PERIOD: 12:01 A.M. standard time both dates at the Principal Address stated in ITEM 1. ITEM 3 ALL NOTICES OF CLAIM OR LOSS MUST BE SENT TO THE COMPANY BY EMAIL, FACSIMILE, OR MAIL AS SET FORTH BELOW: BSIclaims@travelers.com ITEM 4 COVERAGE INCLUDED AS OF THE INCEPTION DATE IN ITEM 2: Crime CRI-2001 Ed. 01-09 Printed in U.S.A. Page 1 of 4 ©2009 The Travelers Companies, Inc. All Rights Reserved 1-888-460-6622 Travelers Bond & Specialty Insurance Claim P.O. Box 2989 Hartford, CT 06104-2989 Travelers Bond & Specialty Insurance Claim One Tower Square, S202A Hartford, CT 06183 Mail: Overnight Mail: For questions related to claim reporting or handling, please call 1-800-842-8496. Email: Fax: CRI-2001 Ed. 01-09 Printed in U.S.A. Page 2 of 4 ©2009 The Travelers Companies, Inc. All Rights Reserved ITEM 5 CRIME Single Loss Limit of Insurance Single Loss Retention Insuring Agreement A. Fidelity B. Forgery or Alteration C. On Premises D. In Transit E. Money Orders and Counterfeit Money F. Computer Crime 1. Computer Fraud 2. Computer Program and Electronic Data Restoration Expense G. Funds Transfer Fraud H. Personal Accounts Protection 1. Personal Accounts Forgery or Alteration 2. Identity Fraud Expense Reimbursement I. Claim Expense $5,000 $5,000 Not Covered $5,000 $0 $0 $0 $5,000 $5,000 $5,000 $5,000 Not Covered $0 $5,000 Not Covered Not Covered $5,000 $0 $0 $0 $0 $0 1. Employee Theft 2. ERISA Fidelity 3. Employee Theft of Client Property ITEM 5. (Cont’d) If “Not Covered” is inserted above opposite any specified Insuring Agreement, or if no amount is included in the Limit of Insurance, such Insuring Agreement and any other reference thereto is deemed to be deleted from this Crime Policy. Policy Aggregate Limit of Insurance: If a Policy Aggregate Limit of Insurance is applicable, then the Policy Aggregate Limit of Insurance for each Policy Period for Insuring Agreements A through H, inclusive, is: Not Applicable If a Policy Aggregate Limit of Insurance is not included, then this Crime Policy is not subject to a Policy Aggregate Limit of Insurance as set forth in Section V. CONDITIONS B. PROVISIONS AFFECTING LOSS ADJUSTMENT AND SETTLEMENT 1. Limit of Insurance a. Policy Aggregate Limit of Insurance. Cancellation of Prior Insurance: By acceptance of this Crime Policy, the Insured gives the Company notice canceling prior policies or bonds issued by the Company that are designated by policy or bond numbers ,Not Applicable such cancellation to be effective at the time this Crime Policy becomes effective. INSURED’S PREMISES COVERED: All Premises of the Insured in the United States of America, its territories and possessions, Canada, or any other country throughout the world, except: Not Applicable ITEM 6 ITEM 7 FORMS AND ENDORSEMENTS ATTACHED AT ISSUANCE: PREMIUM FOR THE POLICY PERIOD: $67.00 Policy Premium N/A ACF-7006-0511; CRI-3001-0109; CRI-19060-0713; CRI-19072-0315; CRI-19101-1117; CRI-19115-0519; CRI-19085-0919; CRI-19122-1120; CRI-5005-0810 Applicable Not Applicable Annual Installment Premium CRI-2001 Ed. 01-09 Printed in U.S.A. Page 3 of 4 ©2009 The Travelers Companies, Inc. All Rights Reserved CRI-2001 Ed. 01-09 Printed in U.S.A. Page 4 of 4 ©2009 The Travelers Companies, Inc. All Rights Reserved THE DECLARATIONS, THE APPLICATION, THE CRIME TERMS AND CONDITIONS, ANY PURCHASED INSURING AGREEMENTS, AND ANY ENDORSEMENTS ATTACHED THERETO, CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE COMPANY AND THE NAMED INSURED. _____________________________ Countersigned By IN WITNESS WHEREOF, the Company has caused this policy to be signed by its authorized officers. President Corporate Secretary General Fund Human Services Grants Program Final Audit Report 2023-07-11 Created:2023-07-11 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAehUVEEZGe63dz1m0ihgeOnKOgPIZiGXN "General Fund Human Services Grants Program" History Document created by City of Cupertino (webmaster@cupertino.org) 2023-07-11 - 8:24:51 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2023-07-11 - 8:26:29 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2023-07-11 - 8:40:49 PM GMT - Time Source: server- IP address: 73.170.104.117 Document emailed to rama@maitri.org for signature 2023-07-11 - 8:40:51 PM GMT Email viewed by rama@maitri.org 2023-07-11 - 8:48:26 PM GMT- IP address: 66.249.88.33 Signer rama@maitri.org entered name at signing as Rama Dharmarajan 2023-07-11 - 8:50:12 PM GMT- IP address: 99.57.138.126 Document e-signed by Rama Dharmarajan (rama@maitri.org) Signature Date: 2023-07-11 - 8:50:14 PM GMT - Time Source: server- IP address: 99.57.138.126 Document emailed to christopherj@cupertino.org for signature 2023-07-11 - 8:50:19 PM GMT Email viewed by christopherj@cupertino.org 2023-07-11 - 8:56:31 PM GMT- IP address: 104.28.123.109 Signer christopherj@cupertino.org entered name at signing as Christopher D. Jensen 2023-07-11 - 9:36:37 PM GMT- IP address: 136.24.22.194 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2023-07-11 - 9:36:39 PM GMT - Time Source: server- IP address: 136.24.22.194 Document emailed to Benjamin Fu (benjaminf@cupertino.org) for signature 2023-07-11 - 9:36:40 PM GMT Email viewed by Benjamin Fu (benjaminf@cupertino.org) 2023-07-11 - 9:58:25 PM GMT- IP address: 104.47.74.126 Document e-signed by Benjamin Fu (benjaminf@cupertino.org) Signature Date: 2023-07-11 - 9:58:34 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2023-07-11 - 9:58:36 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2023-07-11 - 10:37:47 PM GMT- IP address: 104.47.74.126 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2023-07-11 - 10:37:54 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2023-07-11 - 10:37:54 PM GMT