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20-066 Amendment #1 06-22-20211
FIRST AMENDMENT
TO GENERAL FUND HUMAN SERVICES GRANT (HSG) FUNDS
CITY/NON-PROFIT CONTRACT
(Services Only)
This First Amendment to Contract is entered into between WEST VALLEY COMMUNITY
SERVICES ("CORPORATION") and the CITY OF CUPERTINO ("CITY") as of July 1,
2021 (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 Sixty Five Thousand Seven Hundred Eighty Dollars
and No. Cents ($65,780) 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.
Exhibit A: Program Description (FY 2020-21)
Exhibit B: Program Work Plan (FY 2020-21)
Exhibit C: Proposed Implementation Timeline Schedule (FY 2020-21)
Exhibit D: Program Budget (FY 2020-21)
Exhibit E: Basic Insurance and Bond Requirements For Non-Profit Contracts
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 Sixty Five Thousand Seven Hundred Eighty
Dollars and No. Cents ($65,780) 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.
Exhibit A-1: Program Description (FY 2021/2022)
Exhibit B-1: Program Work Plan (FY 2021/2022)
Exhibit C-1: Program Budget (FY 2021/2022)
Exhibit D-1: Basic Insurance and Bond Requirements for Non-Profit Contracts
2
Exhibits A, B, C, D, E, A-1, B-1, C-1, and D-1 are collectively referred to hereinafter as
“Program”.
The total allocation for July 1, 2020 through June 30, 2022 shall not exceed One hundred
thirty-one thousand five hundred sixty Dollars and No. Cents ($131,560.00).
2. Exhibits A-1, B-1, C-1, and D-1, including an updated Certificate of Insurance, are attached
hereto.
3. Section II, "Term," is deleted in its entirety and replaced with the following:
A. The purpose of this Contract is for the CITY to disburse the Grant for eligible
activities.
B. The term of this Contract (the "Term") will begin on July 1, 2020 and will end on
June 30, 2022, unless otherwise amended or terminated earlier pursuant to Section VII,Section
VIII, or Section XVI of this Contract.
4. 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
First Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract
IN WITNESS WHEREOF, the parties have executed this First Amendment as of the
Effective Date.
CORPORATION: CITY:
WEST VALLEY COMMUNITY CITY OF CUPERTINO, a municipal
SERVICES OF SANTA CLARA COUNTY, benefit corporation
a California nonprofit public corporation
___________________________________ __________________________________
Josh Selo Date Benjamin Fu Date
Executive Officer Director of Community Development
APPROVED AS TO FORM AND ATTEST:
LEGALITY:
___________________________________ _________________________________
Heather Minner Date Kirsten Squarcia Date
City Attorney City Clerk
EXPENDITURE DISTRIBUTION
PO # 2021-096
100-72-712-600-623
Original Contract: $65,780
Amendment #1: $65,780
Total: $131,560
Josh Selo
Jun 18, 2021
Heather M. Minner
Jun 22, 2021
Jun 22, 2021
Jun 22, 2021
Page 4 of 12
First Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract
EXHIBIT A-1
PROGRAM DESCRIPTION
FY 2021/2022
Agency Name:
West Valley Community Services of Santa Clara
County Inc.
DUNS:
Not Applicable (Only for CDBG)
Executive Officer:
Josh Selo
Program Manager:
Sujatha Venkatraman
Program # (For Office Use Only)
100-72-712 600-623
Street Address:
10104 Street Vista
City:
Cupertino
State:
CA
Zip Code:
95014
Telephone number:
408-255-8033
Fax Number:
Manager E-mail
sujathav@wvcommunityservices.
org
Name of Program:
Haven to Home
Program Location:
10104 Vista Drive. Cupertino, CA 95014
Program Description:
West Valley Community Services' (WVCS) Haven to Home (HTH) program is based on the
Housing-First methodology that vulnerable and at-risk homeless individuals are more responsive
to interventions and social services support after they are placed in their own housing, rather than
living in temporary/transitional facilities or housing. The main goals of this program are to help
homeless clients secure permanent housing, maintain employment, and enhance income
opportunities. The clients receive intensive case management designed to provide easy access to
resources at one location. Case Management uses a strength-based and mentoring approach in
helping struggling families and individuals move out of crisis towards self-sufficiency by helping
them build their own safety net. Haven to Home aims at ending homelessness by coordinating
multilevel services and leveraging resources in the community.
Page 5 of 12
First Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract
EXHIBIT B-1
PROGRAM WORK PLAN
FY 2021/2022
AGENCY NAME: West Valley Community Services of Santa Clara County Inc.
PROGRAM NAME: Haven to Home
Objectives Benchmarks for Each Quarter
1st 2nd 3rd 4th TOTAL
Supportive Services and Case Management 15 10 10 15 50
Outreach and Resource Fair 1 1 2
Transportation and other support 10 5 5 5 25
Total Beneficiaries 77
Page 6 of 12
First Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract
EXHIBIT C-1
PROPOSED IMPLEMETATION TIMELINE SCHEDULE
FY 2021/2022
AGENCY NAME: West Valley-Community Services of Santa Clara County Inc.
PROGRAM NAME: Haven to Home
Activity Number & Description
Activity
#
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
1.
2.
Page 7 of 12
First Amendment to Below Market Rate (BMR) Affordable Housing Fund (AHR) City/Non-Profit Contract
EXHIBIT D
PROGRAM BUDGET
FY 2021-22
AGENCY NAME: West Valley Community Services of Santa Clara County Inc.
PROGRAM NAME: Haven to Home
Proposed Program Expenses FY 21-22
Salaries/Benefits/Payroll/Taxes $52,280
Office Supplies Communication Publications/Printing/Advertising Travel Rent/Lease/Mortgage Utilities Insurance Equipment Rental/Maintenance Audit/Legal/Professional Services (for CDBG portion only) Direct Services (Funding for specific service such as a meal, ride) $7,500
Contracted Services Other
Total Expenses $65,780
Page 8 of 12
First 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
First 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
First 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
First 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
First 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.
1195114.2
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER:$
COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person)$
OWNED SCHEDULED
BODILY INJURY (Per accident)$AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
$
OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
6/16/2021
(408) 792-5400 (408) 792-3670
18058
West Valley Community Services of Santa Clara County, Inc.
10104 Vista Drive
Cupertino, CA 95014
39152
A 1,000,000
X PHPK2278591 6/1/2021 6/1/2022 100,000
5,000
1,000,000
3,000,000
1,000,000
SEXUAL ABUSE MO 1,000,000
1,000,000A
PHPK2278591 6/1/2021 6/1/2022
2,000,000A
PHUB769281 6/1/2021 6/1/2022 2,000,000
10,000
B
SATIS0387200 12/31/2020 12/31/2021 1,000,000
1,000,000
1,000,000
RE: Events under written contract
City of Cupertino, Its Officials & Employees named as an additional insured per form CG 2026 04/13 attached. Primary wording applies. Blanket Work Comp
waiver endorsement WC 04 03 06 attached- (Form CIR attached)
City of Cupertino, Its Officials & Employees
Attn: Recreation & Community Services/Facilities
10300 Torre Avenue
Cupertino, CA 95014
WESTVAL-05 LIUPENG
NFP Property & Casualty Services, Inc.
160 West Santa Clara Street
Suite 575
San Jose, CA 95113
Philadelphia Indemnity Insurance Company
Service American Indemnity Company
X
X
X
X
X
X
X
PI-GLD-HS (10/11)
Page 1 of 12
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
© 2011 Philadelphia Indemnity Insurance Company
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
Employee Coverage)
Included 7
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
PI-GLD-HS (10/11)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
© 2011 Philadelphia Indemnity Insurance Company
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,
Discrimination
Included 11
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
This exclusion does not apply t
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)
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.
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
PI-GLD-HS (10/11)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
© 2011 Philadelphia Indemnity Insurance Company
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
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 w
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:
PI-GLD-HS (10/11)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
© 2011 Philadelphia Indemnity Insurance Company
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
ity and Accountability Act (HIPAA). We have
2. Paragraph 2. Exclusions is amended to include the following additional exclusions:
This insurance does not apply to:
a. Intentional, Willful, or Deliberate Violations
b. Criminal Acts
riminal 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.
b.
c. regulations included in the
HIPAA.
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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
occurring in the course of employment.
proceeding is $25,000 regardl
.
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K. Key and Lock Replacement Janitorial Services Client Coverage
SECTION I COVERAGES, SUPPLEMENTARY PAYMENTS COVERAGES A AND B is
amended to include the following:
W
, 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
authorized representatives or any one to
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
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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
-
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) e 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
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or
aused, in whole or in part, by your maintenance, operation
or use of equipment leased to you by such person or organization.
A
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
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
which are distributed 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;
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(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
l. 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.
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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
(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
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
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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 i ecovery 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:
njury 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
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;
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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.
General Fund Human Services Grants Program-
Haven to Home
Final Audit Report 2021-06-22
Created:2021-06-18
By:City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAALzowy6BA8pIiU9S2ws656YjWH1Ezs4Vh
"General Fund Human Services Grants Program- Haven to Hom
e" History
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