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20-084 Amendment #2 Community Development Block Grant Program1 SECOND AMENDMENT TO COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CITY/NON-PROFIT PUBLIC SERVICE CONTRACT This Second Amendment to Contract is entered into between REBUILDING TOGETHER SILICON VALLEY ("CORPORATION") and the CITY OF CUPERTINO ("CITY") as of July 1, 2022 (the "Effective Date") to amend the Community Development Block Grant Program City/Non-Profit Public Service Contract (the "Contract") dated July 1, 2020. WITNESSETH WHEREAS, CITY has applied for and received CDBG Entitlement program funds from the United States Department of Housing and Urban Development ("HUD") as an entitlement jurisdiction pursuant to the provisions of Title I of the Housing and Community Development Act of 1974, as amended; and, WHEREAS, CITY has granted CORPORATION a portion of its CDBG funds for the Program (as described below) to be operated within the City for the benefit of low and very low-income households and meeting at least one (1) of the National Objectives of the CDBG program as outlined in Title 24 of the Code of Federal Regulations, Section 570.208; 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 current CDBG entitlement, and/or program income as defined in 24 CFR 570 Subpart J, "Grant Administration," to CORPORATION in the sum of Eighty Three Thousand Three Hundred Sixty Three Dollars and Forty Cents ($83,363.40) (the "CDBG Funds") for the purpose of implementing the CORPORATION'S program, as more particularly described in Exhibits A-D to the Contract (the "Program"), 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 & A-2: Program Description Exhibit B & B-2: Program Work Plan Exhibit C & C-2: Program Budget Exhibit D: Basic Insurance and Bond Requirements For Non-Profit Contracts Exhibit E: CDBG Regulations Exhibit F: Project Scope of Work For the period of July 1, 2021, to June 30, 2022 CITY agrees to allocate a portion of its current CDBG entitlement, and/or program income as defined in 24 CFR 570 Subpart J, "Grant Administration," to CORPORATION in the sum of Ninety Eight Thousand Five Hundred Eleven Dollars and Eighty-Eight Cents ($98,511.88) for the purpose of implementing the CORPORATION'S Program. For the period of July 1, 2022 to June 30, 2023 CITY agrees to allocate a portion of its current CDBG entitlement, and/or program income as defined in 24 CFR 570 Subpart J, "Grant 2 Administration," to CORPORATION in the sum of Eighty Eight Thousand Nine Hundred Sixty Six Dollars and Zero Cents ($88,966.00) for the purpose of implementing the CORPORATION'S Program. The total allocation for July 1, 2020, through June 30, 2023 shall not exceed Two Hundred Seventy Dollars Eight Hundred Forty One and Twenty Eight Cents ($270,841.28). 2. The first sentence of Section II, “Term,” is deleted and replaced with the following: The term of this Contract (the “Term”) will begin on July 1, 2020 and will end on June 30, 2023, unless otherwise amended or terminated earlier pursuant to Section VI or Section VII of this Contract. 3. Exhibits A-2, B-2, and C-2, attached hereto, are added to the Contract. 4. Exhibit D to the Contract is replaced with the new Exhibit D, 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 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment IN WITNESS WHEREOF, the parties have executed this First Amendment as of the Effective Date. CORPORATION: CITY: REBUILDING TOGETHER SILICON CITY OF CUPERTINO, a municipal VALLEY, California nonprofit benefit public corporation corporation ___________________________________ __________________________________ Deanne Everton Date Jim Throop Date Executive Director City Manager APPROVED AS TO FORM AND ATTEST: LEGALITY: ___________________________________ _________________________________ City Attorney Date Kirsten Squarcia Date City Clerk EXPENDITURE DISTRIBUTION PO # 2021-102 260-72-709-600-623 Original Contract: $83,363.40 Amendment #1: $98,511.88 Amendment #2 $88,966.00 Total: $270,841.28 Jun 27, 2022 Christopher D. Jensen Jun 27, 2022 Jun 27, 2022 Jun 28, 2022 Page 4 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment EXHIBIT A-2 PROGRAM DESCRIPTION FY 2022-23 Agency Name: Rebuilding Together Silicon Valley DUNS #: Chief Financial Officer: Deanne Everton Program Manager: Deanne Everton Program # (For Office Use Only) 260-72-709-600-623 Street Address: 1701 S 7th Street, #10 City: San Jose State: CA Zip Code: 95112 Telephone number: 408-578-9519 Fax Number: Program Manager E-mail Address: deanne@rtsv.org Name of Program: Housing Repair & Rehabilitation Project Program Location: City-wide Program Description: Rebuilding Together Silicon Valley (RTSV) is dedicated to repairing homes, revitalizing communities and rebuilding lives with a vision for safe homes and communities for every person. RTSV preserves affordable housing by providing safety, accessibility and mobility repairs and critical home repairs for low income homeowners and non-profit facilities in Cupertino, at no cost to the recipient. The project will strengthen the resiliency of low- income residents as well as the neighborhoods in which they live. A home and community environment have a tremendous impact on health and well-being. At a time when the income inequality gap continues to grow and the cost of homeownership continues to rise, too many of our neighbors suffer from the health and economic consequences of living in substandard housing and unsafe communities. RTSV helps transform these communities into vibrant places, restoring pride, dignity and hope. Page 5 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment EXHIBIT B-2 PROGRAM WORK PLAN FY 2022-23 AGENCY NAME: Rebuilding Together Silicon Valley PROGRAM NAME: Housing Repair & Rehabilitation Project HUD National Objectives: 14A Rehab: Single-Unit Residential Low/Mod Income Type: LMH: Low/Mod Housing Benefit Objectives Benchmarks for Each Quarter 1st 2nd 3rd 4th TOTAL Unduplicated addresses 1 2 2 2 7 Repairs 4 8 8 8 28 Total Beneficiaries 35 Page 6 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment EXHIBIT C-2 PROGRAM BUDGET FY 2022-23 AGENCY NAME: Rebuilding Together Silicon Valley PROGRAM NAME: Housing Repair & Rehabilitation Project Proposed Program Expenses FY 2022-23 Salaries/Benefits/Payroll/Taxes $23,295.00 Publications/Printing/Advertising $187.00 Office Supplies $83.00 Communication $73.00 Travel $439.00 Rent/Lease/Mortgage $2,688.00 Utilities $499.00 Insurance $614.00 Equipment Rental/Maintenance $61.00 Other (Staff Training & Depreciation) $994.00 Audit/Legal/Professional Services (for CDBG Capital Housing portion only) $847.00 Direct Services (Funding for specific service such as a meal, ride) $0 Contracted Services $59,186.00 Total Expenses $88,966.00 Page 7 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment EXHIBIT D BASIC INSURANCE AND BOND REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as the word is used in this Exhibit D is the party contracting with the City of Cupertino for the direct distribution of BMR AHF 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. C. Qualifying Insurers Page 8 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment 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. 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City: Page 9 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment 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. 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. Page 10 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment 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. 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. Page 11 of 11 FY 2022-2023 Community Development Block Grant Program City/Non-Profit Public Service Contract Amendment 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. © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSDADDL WVDSUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Acct#:2895333 1/27/2022 Lockton Companies, LLC 888-828-8365 3657 Briarpark Dr., Suite 700 Houston, TX 77042 Ace American Insurance Co.22667 REBUILDING TOGETHER SILICON VALLEY 1701 S 7TH ST STE 10 SAN JOSE, CA 95112-6000 NA X C70218823 10/1/2021 10/1/2022 X 1,000,000 1,000,000 1,000,000 WAIVER OF SUBROGATION IN FAVOR OF City of Cupertino Community Development Dept. WHEN REQUIRED BY WRITTEN CONTRACT. CITY OF CUPERTINO COMMUNITY DEVELOPMENT DEPT. 10300 TORRE AVENUE CUPERTINO, CA 95014 Workers' Compensation and Employers' Liability Policy Named Insured Insperity, INC. L/C/F REBUILDING TOGETHER SILICON VALLEY 19001 Crescent Springs Drive Kingwood, TX 77339 Endorsement Number Policy Number Symbol: RWC Number: C70218823 Policy Period 10/1/2021 TO 10/1/2022 Effective Date of Endorsement 1/27/2022 Issued By (Name of Insurance Company) Ace American Insurance Co. Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule ( X )1.Specific Waiver Name of person or organization: City of Cupertino Community Development Dept. 10300 Torre Avenue Cupertino, CA 95014 ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Operations:2. Premium:3. The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. Minimum Premium :4.INCLUDED Authorized Representative WC 99 03 22 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 3/14/2022 Arthur J.Gallagher &Co.Insurance Brokers of CA.,Inc. 595 Market Street Suite 2100 San Francisco CA 94105 Darby Hughes 415-546-9300 415-536-8499 Darby_Hughes@ajg.com License#:0726293 Philadelphia Indemnity Insurance Company 18058 REBUTOG-92 Tokio Marine Specialty Ins Co 23850RebuildingTogether,Inc.(Affiliates) Rebuilding Together Silicon Valley 999 N.Capitol St.,NE,Suite 701 Washington DC 20002 1965685624 A X 1,000,000 X 100,000 5,000 1,000,000 2,000,000 X X Stop Gap Liab PHPK2389341 3/15/2022 3/15/2023 2,000,000 STP GAP/ND OH WA WY 1,000,000 A 1,000,000 X X X PHPK2389341 3/15/2022 3/15/2023 A X X 10,000,000PHUB8064263/15/2022 3/15/2023 10,000,000 X 10,000 B B Contractors Pollution/Prof Liab Commercial Crime (Fidelity)PPK2389330 PSD1699056 3/15/2022 3/15/2022 3/15/2023 3/15/2023 $1,000,000 Limit $25,000 $50,000 The City of Cupertino,its Officers,Agents &Employees are Included as Additional Insured/Funding Source with respect to the Operations of the Named Insured. City of Cupertino Attn:Housing Manager Community Development Department City of Cupertino 10300 Torre Avenue Cupertino CA 95014 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page of ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by 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. 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. PHPK2246006 03/15/2021 Community Development Block Grant Program Final Audit Report 2022-06-28 Created:2022-06-27 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAtfVUjZXQOpMJafK4qyeF7OQ6BTbKdICn "Community Development Block Grant Program" History Document created by City of Cupertino (webmaster@cupertino.org) 2022-06-27 - 11:01:17 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2022-06-27 - 11:03:00 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2022-06-27 - 11:21:23 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to deanne@rtsv.org for signature 2022-06-27 - 11:21:25 PM GMT Email viewed by deanne@rtsv.org 2022-06-28 - 0:00:13 AM GMT- IP address: 69.181.92.178 Document e-signed by Deanne Everton (deanne@rtsv.org) Signature Date: 2022-06-28 - 0:02:31 AM GMT - Time Source: server- IP address: 69.181.92.178 Document emailed to christopherj@cupertino.org for signature 2022-06-28 - 0:02:33 AM GMT Email viewed by christopherj@cupertino.org 2022-06-28 - 0:16:21 AM GMT- IP address: 104.47.73.126 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2022-06-28 - 0:42:22 AM GMT - Time Source: server- IP address: 136.24.42.212 Document emailed to Jim Throop (jimt@cupertino.org) for signature 2022-06-28 - 0:42:24 AM GMT Email viewed by Jim Throop (jimt@cupertino.org) 2022-06-28 - 1:59:26 AM GMT- IP address: 104.28.123.181 Document e-signed by Jim Throop (jimt@cupertino.org) Signature Date: 2022-06-28 - 1:59:47 AM GMT - Time Source: server- IP address: 174.194.135.181 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2022-06-28 - 1:59:49 AM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2022-06-28 - 6:16:28 AM GMT- IP address: 104.28.123.113 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2022-06-28 - 3:22:27 PM GMT - Time Source: server- IP address: 104.28.123.173 Agreement completed. 2022-06-28 - 3:22:27 PM GMT