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16-093 General Fund Human Service Grants (HSG) Program City_Non-Profit Contract (Services Only), Senior Adults Legal AssistanceFIRST AMENDMENT TO GENERAL FUND HUMAN SERVICE GRANTS (HSG) PROGRAM CITY /NON-PROFIT CONTRACT (Services Only) The First Amendment to Contract is entered into between SENIOR ADULTS LEGAL ASSISTANCE (SALA) (CORPORATION) and the CITY OF CUPERTINO (CITY) to amend the General Fund Human Service Grants (HSG) Program Contract (CONTRACT) dated July l, 2016. WITNESS ETH 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 and will benefit low and very low- income households ; THEREFORE, the parties agree as follows: 1. Section I, entitled "Project," is rev ised to r ead as follo ws: For the period of July l, 2016 to June 30, 2017, CITY agreed to allocate a portion of its HSG budget to CORPORATION, being the sum of Ten Thousand One Hundred Dollars and No Cents ($10,100.00) for the purpose of implementing the CORPORATION'S project (hereinafter "Project"), as more particularly described in Exhibits A-E . For the period of July l, 2017 to June 30, 2018 , CITY agrees to allocate a portion of its current HSG budget to CORPORATION as a subrecipient in the sum of Ten Thousand One Hundred Dollars and No Cents ($10,100.00) for the purpose of implementing the CORPORATION'S project, as more particularly described in Exhibits A-E as noted herein, attached to this First Amendment. The total allocation for July 1, 2016 through June 30 , 2018 shall not exceed Twenty Thousand Two Hundred Dollars and No Cents ($20,200.00). 2. Section II , "Term," is amended to read as follows , the purpose of this Contract is for the CITY to disburse HSG funds for eligible activities. Unless amended prior to its expiration, the term of this Contract for disbursement purposes will begin on July l, 2017 and will end on June 30, 2018 , unless terminated earlier pursuant to Section VI or Section VII of the Contract. 3 . The following Exhibits to the Contract are hereby added to read as shown in the attachments to this Amendment: 1. 2. Exhibit A : Program Description; Exhibit B: Program Work Plan; 3. 4. Exhibit C: Proposed Implementation Timeline Schedule ; Exhibit D: Program Budget; 5 . Contracts Exhibit E: Basic Insurance and Bond Requirements For Non-Profit 4. All terms, covenants and conditions stated in the CONTRACT, which are not herein amended , remain in full force and effect. [N WITNESS WHEREOF , the parties have executed this First Amendment effective on the later date shown below . AGENCY: By : ~%(~fuc-(\ (pnnt name) Executive Director APPROVED AS TO FORM AND LEGALITY: CITY OF CUPERTINO, a municipal corporation: By: ,f'/l/Zrl ?J!RIJl/171/J///; (print name) ~~ Kartisfu.ivasta va Assistant City Manager ATTEST: JON\ ll /R.an'dolph Stevenson Hom d?-'lUt- (}f ~ity Attorney Date ~1 City Clerk EXPENDITURE DISTRIBUTION PO # I 00-72-712 700-702 Original Contract: $10,100 Amendment #I $10,100 Total: $20,200 PROGRAM DESCRIPTION Agency Name: DUNS: Senior Adults Legal Assistance (SALA) Executive Director: Project Manager: Project# (For Office Use Only) Georgia Bacil Georgia Bacil I 00-72-712 700-702 Street Address: City: State: J Zip Code: 1425 Koll Circle, Suite 109 San Jose CA 95112 Telephone number: Fax Number: Manager E-mail 408-295-5991 gbacil~sala.org Name of Project/Program: Legal Assistance to Cupertino Elders (CDBG Request) Project/Program Location: 1425 Koll Circle, Suite 109 San Jose, CA 95112 Project Description: SALA will provide free Legal Assistance to Cupe1tino seniors (age 60 or older) by continuing our expanded appointments at Cupertino Senior Center and by serving seniors by phone that are homebound or with emergencies . A minimum of 40 Cupertino seniors annually will be served , targeting clients that are low income or at risk of abuse , isolation , homelessness, or institutionalization. SALA will provide a full range of legal services (advice/referrals , brief service/document preparation, attorne y representation) specializing in these areas: Public Benefits ; Housing; Elder Abuse/Domestic Violence ; Nursing Homes/ Alternatives; Advance Health Directives/Incapacity Planning; Consumer; Simple Wills. Annually SALA will also make one Education/Outreach presentation at a site in Cupertino . SALA 's project suppo1ts Aging in Place and prevents seniors ' isolation (a need identified in the 2015-20 CON Plan). We close by noting that references to seniors throughout include persons age 60 or older. EXHIBIT B PROGRAM WORK PLAN FY 2017/2018 AGENCY NAME : Senior Adults Legal Assistance (SALA) PROGRAM NAME: Legal Assistance to Cupertino Elders (CDBG Request) Objectives Benchmarks for Each Quarter 1st 2nd 3rd 4th TOTAL Legal Services -Number of Cupe1iino clients served 10 10 10 10 40 Community Education/Outreach -Number of I I presentations EXHIBIT C PROPOSED IMPLEMENTATION TIMELINE SCHEDULE FY 2017/2018 AGENCY NAME: Senior Adults Legal Assistance (SALA) PROGRAM NAME: Legal Assistance to Cupertino Elders (CDBG Request) Activity Number & Description: Activity Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr # 1. 2. May Jun EXHIBIT D PROGRAM BUDGET FY 2017/2018 AGENCY NAME: Senior Adults Legal Assistance (SALA) PROGRAM NAME: Legal Assistance to Cupertino Elders (CDBG Request) p rogram B d (F " I Y u get lSCa ear 2017 2018) - Proposed Project Expenses 2017 -2018 Request Salaries/Benefits/Payroll/Taxes $10,10( Office Supplies Communication Pub I ications /Pri nting/ Advertising rrravel 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) Contracted Services Other Total Expenses $10,100 EXHIBIT E BASIC INSURANCE AND BOND REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as the word is used in this Exhibit Eis the patty 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 ce1tifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and project name must be stated on the Certificate of Insurance. The City's Special Endorsement form shall accompany the ce11ificate. 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 COORDfNATION , 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 A venue, Cupertino , CA 95014. 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 repoti 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: 2. Premises and Operations 3. 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. 4 . Contractual Liability expressly including liability assumed under this Contract. 5. Personal Injury liability. 6. Independent Contractors' (Protective) liability . f. Severability ofinterest 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: 5. 6. a. Additional Insured Endorsement: Such insurance as is afforded by this policy shall also apply to the City of Cupe1tino, and members of the City Council, and the officers, agents and employees of the City of Cupe1tino, 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 Cupe1tino. 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. 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. 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. 7. c . Inclusion of the City and its governing board(s), officers , representatives , agents, and employees as additional insureds , or a waiver of subrogation. 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 selfretention limit, it shall not be greater than ten thousand dollars ($10 ,000) per occurrence/event. c. This coverage shall be maintained for a m1111mum 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. 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. ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM IDD IYYYY ) ~ 6/23/2017 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 holde r is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED , subject to the terms and conditions of the policy, certain pol i cies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endor sement(s). PROD UC ER ~~~tCT Jason Cheung ISU/San Franci sco iA~~N~~ "•"· (415) 788-9810 I FAX IA/C No\: (415) 248 -35 34 201 California St ., Suite 200 ~t1D~~SS: jcheung@isusf.com License# 0778092 INSURER/SI AFFORDING COVERAGE NAIC # San Francisco CA 94111-5098 INSURER A Nonprofits Ins Alliance of CA INSURED INSURER B :MARKEL FIRSTCOMP 0131 Senior Adults Legal Assistance , DBA : SALA INSURER C : 1425 Koll Circle #109 INSURER D : INSURER E : San Jose CA 95112 INSURER F : COVERAGES CERTIFICATE NUMBER:17-18 REVISION NUMBER: T HI S IS TO CERTIFY THAT T HE POLI CIES OF INSURANC E LI STED BEL OW HAV E BEEN ISS UED TO THE INS UR ED NAM ED A BOV E FOR THE POLI CY PE RIOD INDI CATED . NOTWI TH STANDI NG A NY REQU IRE MENT, TERM OR CONDITION OF AN Y CONTRACT OR OTHER DO CUM ENT WITH RESPECT TO W HI CH TH IS C ERTIFI CAT E MA Y BE ISSUED O R MAY PE RT A IN , THE INSURANC E AFF ORDED BY THE POLI CIES DES CRIBED HE REI N IS SUB J ECT T O ALL THE TER MS , EXC LUSI ONS A ND CONDITION S OF S UC H POLI CIE S. LI MITS SH OWN MAY HAV E BEEN REDUCED BY PAID CLAIM S. INSR ADDL SUB R rime\%~\ 1~2Tc\5~1 LTR TYPE OF INSURAN CE ,.,o n >A n m POLIC Y NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EAC H OCCURRENCE $ 1 ,000,000 -D CLAIMS-MADE w OCCUR DAMAG E TO RENT ED A PREMISES tEa occurrence\ $ 50 0,00 0 201704545NPO 6/30/201 7 6/30/2018 -MED EXP (Any one person) $ 20,0 00 PERSONAL & ADV INJURY $ Ex clude d -GEN'L AGGREGATE ·LIM IT APP LIE S PER : GENERA L AGGREGAT E $ 2,00 0,00 0 zi D PRO-O Loc PRODUC TS -COMP/OP AGG $ 2,00 0,00 0 POLICY JECT OTH ER : Li quo r Liability $ 1 ,0 0 0,000 AUTO MOBILE LIABILITY COMBINED SING LE LI MI T $ 1 ,000 ,0 0 0 /Ea acc ident\ - ANY AUTO BODILY INJURY (Per person) $ A -ALL OWNE D -SC HEDU LED 201704 5 45NPO 6/30/2017 6/30/2018 BODILY INJURY (Per acciden t) $ -AUTOS -AUTO S X X NON-OW NED PROPERTY DA MAG E $ HIR ED AUTOS AUTOS /Per accident\ --$ X UMBRELLA LIAB H OCCUR EACH OCCURR ENCE $ 1 000 0 00 - A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 0 0 0 0 00 DED I I RETENTION$ TBD 6/30/2017 6/30/2018 $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS ' LIABILITY X STATUT E ER YIN ANY PROPRIETOR/PARTNER/EX ECUTIVE D NIA E.L EACH ACC IDENT $ 1,00 0,000 OFFICER/MEMBER EXCLUDED? B (Mandatory in NH ) MWC006622504 7/1 /20 17 7/1/201 8 E.L. DISEASE -EA EMP LOY EE $ 1 ,000 00 0 If yes , describe under DESCRIPT ION OF OPERAT IONS below E.L. DISEASE -POLICY LIMIT $ 1 0 00 0 00 'DESCRIPTION OF OPERAT IONS I LOCATI ONS I VEHI CLE S (ACO RD 101, Ad ditiona l Re marks Schedul e, may be attache d if more sp ace is required) RE : Account#: 110-7406-7102 Certificate Holder is named as Additional Insured a s r e spects to Liability as required by written contract only as pertains to Insured's operations as per Form CG 2026 . Cancellation Clause: 30 day written notice except 10 days f or nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD AN Y OF THE ABOVE DESCRIBED POLICIES BE CA NCELLED BEFORE C ity of Cupertino THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN Commun ity Deve l opme nt Dept . ACCO RDANCE WITH THE POLICY PROVIS ION S. At tn :Chri stoph e r Va l e n z u ela 1 0300 T o r re Ave nue AU THORIZ ED RE PRES ENT AT IVE Cuper ti no, CA 950 1 4 -Jason Cheung © 198 8 -201 4 A C ORD CORPORATION . All righ ts r ese rved. AC ORD 25 (2 0 14/0 1) I NS0 25 (20 1401 ) The AC ORD name and l ogo a r e reg i stered marks o f ACO R D POLICY NUMBER: 2017-04545 Named Insured : Senior Adults Legal Assistance dba : SALA COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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): 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 . 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 prov ided 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 . 8. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -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 . CG 20 26 04 13 © In surance Services Office , In c ., 20 12 Pa ge 1 of 1 GENERAL FUND HUMAN SERVICE GRANTS (HSG) PROGRAM CITY/NON-PROFIT CONTRACT (Services Only) THIS G eneral Fund Human Services Grants (HSG) Program City/Non-Profit Contract (the "Contract") is entered into between the CITY OF CUPERTINO, a political subdivision of the State of California (hereinafter "CITY"), and SENIOR ADULTS LEGAL ASSISTANCE a non-profit public benefit corporation (hereinafter "CORPORATION"). The allocation of funds pursuant to this Contract will be a grant. CITY approved the allocation and disbursement of General Fund Human Service Grants (HSG) funds (hereinafter "Grant") to CORPORATION on April 19, 2016. WITNESS ETH WHEREAS , CITY has reserved a portion of its HSG funds to be used on acti v ities that benefit Cupertino 's residents; and , WHEREAS , CITY ha s 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 and will benefit low and very low-income households; NOW, THEREFORE , the parties agree as follows ; I. PROGRAM CITY agrees to allocate a portion of its current HSG budget to CORPORATION, being the sum of Ten Thousand and One Hundred Dollars and No Cents ($10,100.00) for the purpose of implementing the CORPORATION 'S program (hereinafter "Program "), as more particularly described in numerous exhibits marked as noted herein , attached to this Contract , incorporated by this reference , as though fully set forth , as follows: Exhibit "A " (Program Description), E xhibit "B " (Program Work Plan), Exhibit "C " (Proposed Implementation Time Schedule), Exhibit "D " (Program Budget), and Exhibit "E " (Insurance and Bond Requirements). II. TERM A. The purpose of this Contract is for the CITY to disburse HSG funds for eligible acti v ities. Unless amended prior to its expiration , the term of this Contract for disbursement purposes will begin on July 1, 2016 and will end on June 30, 2017 unless te1minated earlier pursuant to Section VII or Section VIII of this Contract. B . The term of the expenditure by CORPORATION of the allocation provided for herein will begin on July 1, 2016 and terminate on the earlie st of the following dates as set fo1ih herein : June 30, 2017 , or later date per amendment to this Contract ; or upon the termination date established pursua nt to Se ction VII or Section VIII of this Contract. Pag e I of 2 I FY 20 16-1 7 Ge nera l Fund Human Serv ice Grant s (HSG) Cit y/No n-Pro fit Co nt rac t III. SECOND YEAR RENEW AL OPTIONS The term of this Contract may be extended by an amendment to disburse the CITY 'S Grant funds authorized by City Council for the fiscal year subsequent to the initial term of this Contract, contingent on the following requirements and process: A. Authorization by CITY to expend funds for the purposes of this Contract; B . CITY'S appropriation of funds for this Program; C. CORPORATION'S satisfactory performance, as determined by the CITY, of all it's obligations as stated in this Contract; D. Submission to CITY of Proof of Insurance. IV. OBLIGATIONS OF CORPORATION A. Organization of CORPORATION. CORPORATION will: 1. Provide CITY with copies of the following documents, evidencing filing with the appropriate governmental agency: a) Its Articles of Incorporation under the laws of the State of California; b) A copy of the current Bylaws of CORPORATION; c) Documentation of its Internal Revenue Service non-profit status; d) Names and addresses of the current Board of Directors of CORPORATION; and, e) An adopted copy of CORPORATION'S personnel policies and procedures. 2. During the Contract term, immediately report any changes, subsequent to the date of this Contract, in CORPORATION'S Articles oflncorporation, Bylaws, Board of Directors, personnel policies and procedures, or tax exempt status to DIRECTOR. 3. Maintain no member of its Board of Directors as a paid employee , agent, independent contractor, or subcontractor under this Contract. 4. Open to the public, meetings of its Board of Directors , if required by California's open meeting laws, except meetings, or portions thereof, dealing with personnel or litigation matters or as otherwise provided by law. 5. Keep minutes of all its regular and special meetings. 6. Comply with all provisions of California and Federal Non-Profit Corporation Laws. Page 2 of21 FY 2016-17 General Fund Human Service Grants (HSG) City/Non-Profit Co ntract 7. Provide to the CITY a copy of a resolution authorizing the CORPORATION's execution of this Contract. The CORPORATION hereby wanants to the CITY that this Contract is a legal , valid, and binding obligation of the CORPORATION enforceable in accordance with its terms, and that the execution and delivery of this Contract and the performance of the CORPORA TIO N's obligations have been duly authorized by the CORPORATION. B. Program Performance by CORPORATION. CORPORATION shall: 1. Conduct the PROGRAM within the City of Cupertino, for the purpose of benefiting low and very low-income households. 2. File quarterly reports as required by CITY on the type and number of services rendered through the operation of the PROGRAM, and a description of the beneficiaries of these services, and which rep01is will evaluate the manner in which the PROGRAM is achieving its objectives and goals according to the standards established by CITY. The progress reports will be due ten days after the close of each reporting period and must cover the three months immediately preceding the date on which the report is filed. 3. Coordinate its services with other existing organizations providing similar services in order to foster community cooperation and to avoid unnecessary duplication of services. 4. Seek out and apply for other sources of revenue in support of its operation or services from local , state, federal and private sources and, in the event of receipt of such award, inform CITY within ten days. 5. Include an acknowledgement of CITY funding and support on CORPORATION stationery and on all appropriate program-related publicity and publications using words to the effect: "funded in whole or in part by the City of Cupertino General Funds." C. Fiscal Responsibilities of CORPORATION. CORPORATION will: 1. Appoint and submit the name of a fiscal agent who will be responsible for the financial and accounting activities of CORPORATION, including the receipt and disbursement of CORPORATION funds. The CITY must immediately be notified in writing of the appointment of any new fiscal agent and that agent's name. 2. If the term of this Contract is extended by an amendment for a second fiscal year, submit a satisfactory Audit within 150 days of CORPORA TION's fiscal year encompassed by the first year of this Contract. 3. Document all PROGRAM costs by maintaining records in accordance with Section III, Paragraph D below. Page 3 of2 I FY 20 16-1 7 General Fund Human Servi ce Gra nt s (HSG) Ci ty/Non -Profit Co nt rac t 4. Submit to the CITY, based on an agreed upon schedule, a request for payment, together with all supporting documentation . Invoices requesting disbursements submitted after the expiration of the Contract will be honored only for eligible charges incuned during the Contract term. All invoices must be submitted by the Contract expiration date or within such other tim e period specified by the CITY for this Contract term. Funds not disbursed will be returned to the City for future reallocation . 5 . Certify current and continuous insurance coverage, subject to CITY approval and in accordance with requirements as outlined in Exhibit E, "Insurance and Bond Requirements." 6. Items 1) through 5) above are express conditions precedent to disbursement of any CITY funding and failure to comply with these conditions will , at discretion of CITY , result in suspension of funding or termination of this Contract. 7 . If CORPORATION does not use Grant funds in accordance with the requirements of this Contract; CORPORATION is liable for repa yment of all disallowed costs. Disallowed costs may be identified through audits, monitoring or other sources. CORPORATION is required to respond to an y adverse findings , which may lead to disallowed costs subject to provisions of OMB Circular A-122 , "Cost Principles for Non- Profit Organizations." D. Establishment and Maintenance of Records. CORPORATION shall: 1. Maintain complete and accurate records of all its transactions including, but not limited to , contracts , invoices, time cards , cash receipts , vouchers, canceled checks , bank statements , client statistical records , personnel, property and all other pertinent records sufficient to reflect proper! y (a) all direct and indirect costs of whatever nature claimed to have been incurred or anticipated to be incuned to perform this Contract or to operate the PROGRAM, and (b) all other matters covered by this Contract. 2. Maintain client data demonstrating client eligibility for services provided for the Program . Such data will include, but not be limited to , client name , address, income level or other basis for determining eligibility, and description of service provided. Such information will be made available to CITY monitors for review upon request. E. Preservation of Records . CORPORATION will preserve and make available its records: 1. Until five years following date of final payment of this contract, or 2 . For such longer period, if any as is required by applicable law; or 3. If this Contract is completely or partially terminated, the records relating to the work terminated will be preserved and made available for a period of five years from the date of termination. Page 4 of21 FY 20 I 6-1 7 Ge nera l Fund Human Service Gra nt s (HSG) City/Non -P rofi t Co nt rac t F . Examination of Records and Facilities. At any time during normal business hours , and as often as may be deemed necessary, CORPORATION agrees that the CITY , and/or any duly authorized representatives may until expiration of (a) five years after final payment under this Contract, (b) five years from the date of termination of this Contract , or ( c) such longer period as may be described by applicable law, have access to and the right to examine its plants , offices and facilities used in the performance of this Contract or the operation of the PROGRAM, and all its records with respect to the PROGRAM and all matters covered by this Contract. CORPORATION also agrees that CITY or any duly authorized representatives will have the right to audit, examine, and make excerpts or transactions of and from, such records and to make audits of all contracts and subcontracts , invoices , payrolls , records of personnel , conditions of employment, materials and all other data relating to the PROGRAM and matters covered by this Contract. CORPORATION will be notified in advance that an audit will be conducted. CORPORATION will be required to respond to any audit findings , and have the responses included in the final audit report. The cost of any such audit will be borne by CITY . G. Compliance with Law. CORPORATION will become familiar and comply with and cause all its subcontractors , independent contractors , and employees , if any, to become familiar and comply with all applicable federal, state and local laws, ordinances, codes, regulations and decrees . H. Suspension and Termination. Suspension or termination of this Contract may occur if the CORPORATION materially fails to comply with any term of the award , and that the award may be terminated for convenience. I. Reversion of Assets. Upon expiration or termination of this Contract, the CORPORATION will transfer to the CITY any HSG funds on hand at the time of expiration and any accounts receivable attributable to the use of funds. V. OBLIGATIONS OF CITY A. Method of Payment. During the term of this Contract, CITY shall disburse HSG funds to CORPORATION on a reimbursement basis unless otherwise provided herein for all allowable costs and expenses incurred in connection with the PROGRAM, not to exceed the total sum of Ten Thousand and One Hundred Dollars and No Cents ($10,100.00). CITY may, at any time in its absolute discretion, elect to suspend or terminate payment to CORPORATION, in whole or in part, pursuant to this Contract based on CORPORATION'S non-compliance , including, but not limited to , incomplete documentation of expenses, failure to substantially meet goals and objectives as required in Exhibit B , ("Program Work Plan"), failure to submit adequate progress repo1is as required herein or other incidents of non-compliance as described in Section VII, Paragraph B of this Contract or based on the refusal by CORPORATION to accept any additional conditions that may be imposed by City at any time to ensure compliance with the terms of this Contract. Pag e5of 2 1 FY 20 16-17 Ge nera l Fun d Human Serv ice Grants (HSG) C ity/Non -Profit Cont ract VI. PROGRAM COO RD INA TION A. CITY. The CITY E xecutive will assign a single DIRECTOR for CITY who will render overall supervision of the progress and performance of this Contract by CITY. All services agreed to be performed by CITY will be at the overall direction of the DIRECTOR. B . CORPORATION. As of the date hereof, CORPORATION has designated Georgia Bacil to serve as EXECUTIVE DIRECTOR and to assume overall responsibility for the progress and execution of this Contract. The CITY will be immediately notified in writing of the appointment of a new EXECUTIVE DIRECTOR. C . NOTICES. All notices or other correspondence required or contemplated by this Contract shall be sent to the parties at the following addresses: CITY: CORPORATION: City of Cupertino Attn: Senior Housing Planner 10300 Torre Avenue Cupertino, CA 95014 Senior Adults Legal Assistance Attn: Executive Director 160 E. Virginia Street, Suite 260 San Jose, CA 95112 All notices will either be hand delivered or sent by United States mail , registered or certified, postage prepaid. Notices given in such a manner will be deemed received when hand delivered or seventy-two (72) hours after deposit in the United States mail. Any party may change his or her address for the purpose of this section by giving five days written notice of such change to the other party in the manner provided in this section . VII. CONTRACT COMPLIANCE A. Monitoring and Evaluation of Services . Evaluation and monitoring of the PROGRAM performance is the mutual responsibility of both CITY and CORPORATION. CORPORATION must furnish all data, statements, records , information and reports necessary for DIRECTOR to monitor, review and evaluate the performance of the PROGRAM and its components . CITY will have the right to request the services of an outside agent to assist in any such evaluation. Such services shall be paid for by CITY. B . Contract Noncompliance. If CORPORATION fails to comply with any provision of this Contract ; CITY will have the right to require corrective action to enforce compliance with such provision as well as the right to suspend or terminate this Contract. Examples of noncompliance include , but are not limited to : 1. If CORPORATION (with or without knowledge) has made any material misrepresentation of any nature with respect to any information or data furnished to CITY in connection with the PROGRAM. Pa g e 6 of21 FY 20 16-17 Ge neral Fund Hum an Se rvice Grant s (HSG) City/No n-Profit Co nt rac t 2. If there is pending litigation with respect to the performance by CORPORATION if any of its duties or obligations under this Contract, which may materially jeopardize or adversely affect the undertaking of or the carrying out of the PROGRAM. 3 . If CORPORATION has taken any action pertaining to the PROGRAM, which action required CITY approval , and such approval was not obtained. 4. If CORPORATION is in default under any provision of this Contract. 5. If CORPORATION makes illegal use of CITY funds. 6. If CORPORATION submits to CITY any report which is incorrect or incomplete in any material respect. 7. If CORPORATION fails to meet the stated objectives in Exhibit B ("Program Work Plan"). C. Corrective Action Procedure. CITY, in its absolute discretion and in lieu of immediately terminating this Contract upon occurrence or discovery of noncompliance by CORPORATION pursuant to this Contract, will have the right to give CORPORATION notice of CITY'S intention to consider corrective action to enforce compliance. Such notice must indicate the nature of the non-compliance and the procedure whereby CORPORATION will have the opportunity to participate in formulating any corrective action recommendation. CITY will have the right to require the presence of CORPORATION'S officer(s) and EXECUTIVE DIRECTOR at any hearing or meeting called for the purpose of considering corrective action. In the event that CORPORATION does not implement the corrective action recommendations in accordance with the corrective action timetable , CITY may suspend payments hereunder or terminate this Contract as set forth in Section VIII below. VIII. TERMINATION A. Termination for Cause. CITY may terminate this Contract by providing written notice to CORPORATION, for any of the following reasons: uncorrected Contract non-compliance as defined in Section VII , Paragraph B; CORPORATION is in bankruptcy or receivership; a member of the CORPORATION'S Board of Directors or the executive director is found to have committed fraud or; there is reliable evidence that CORPORATION is unable to complete the Program as described in the attached Exhibits. The date of termination will be as specified in the notice. B . Termination for Convenience. In addition to the CITY 'S right to terminate for cause set fo11h in Section VII , either CITY or CORPORATION may suspend or terminate this Contract for any reason by giving thirty (30) days prior written notice to the other party. Upon receipt of such notice, performance of the services hereunder will be immediately discontinued . C. In the event that this Contract is terminated , CORPORA TON may be required to return funds to the CITY. Pa g e 7 of2 I FY 201 6-17 Ge neral Fun d Human Service Grant s (HSG ) C ity/No n-Profit Co nt rac t D. Upon termination of this Contract, CORPORATION must immediately provide CITY access to all documents, records, payroll, minutes of meetings, correspondence and all other data pertaining to Grant made to CORPORATION pursuant to this Contract. IX. PROGRAM INCOME Income generated by the Program , is considered Program Income. CORPORATION will annually report all program income generated by activities carried out with grant funds made available under this Contract. By way of further limitations , CORPORATION may use such income during the Contract period for activities permitted under this Contract and shall reduce requests for additional funds by the amount of any such program income balance on hand. All unused program income shall be returned to the CITY at the end of the Contract period. X. INDEPENDENT CONTRACTOR This is a Contract by and between independent contractors and is not intended and will not be construed to create the relationship of agent, servant, employee, partnership, joint venture or association between CORPORATION and CITY. CORPORATION, including its officers, employees, agents or independent contractors or subcontractors, shall not have any claim under this Contract or otherwise against CITY for any Social Security, Worker's Compensation, or employee benefits extended to employees of CITY. XI. ASSIGNABILITY CITY is entering into this Contract based on the experience , skill, and ability to perform of the CORPORATION. The CORPORATION recognizes that its qualifications and identify are of particular concern to the CITY in view of the CITY's interest in providing services to lower income persons and the CITY's reliance on the unique qualifications of the CORPORATION. Consequently, this Contract may not be assigned to another CORPORATION, person, partnership or any other entity without the prior written approval of CITY. None of the work or services to be performed hereunder may be assigned, delegated or subcontracted to third parties without the prior written approval of CITY, which the CITY may withhold in its sole discretion. Copies of all third party contracts shall be submitted to CITY at least ten days prior to the proposed effective date . In the event CITY approves of any such assignment, delegation or sub- contract, the subcontractors, assignees or delegates CORPORATION shall remain fully liable for all obligations and requirements under this Contract , including the performance and any liabilities attaching to the assignees' actions or omissions. Page 8 of21 FY 2016-17 General Fund Human Service Gra nt s (HSG ) C ity /No n-P rofi t Co ntra ct XII. CLIENT INFORMATION CORPORATION agrees to maintain client records consistent with applicable laws regarding personal privacy and obligations of confidentiality .. XIII. HOLD HARMLESS In addition to the indemnity obligations set forth in Exhibit E , "Insurance and Bond Requirements ," CORPORATION will indemnify and hold harmless the CITY , its employees , agents, and officials, members of boards and commissions, from any and all claims , actions, suits , charges and judgments whatsoever, with respect to any damages, including attorney 's fees and court costs, arising out of the failure of the CORPORATION 's Program to comply with applicable laws, ordinances, codes, regulations and decrees, including without limitation those set forth in Exhibit E , "Certifications ." XIV. WAIVER OF RIGHTS AND REMEDIES In no event will any payment by CITY constitute or be construed to be a waiver by CITY of any breach of the covenants or conditions of this Contract or any default which may then exist on the part of CORPORATION, and the making of any such payment while any such breach or default will in no way impair or prejudice any right or remedy available to CITY with respect touch breach or default. In no event will payment to CORPORATION by CITY in any way constitute a waiver by CITY of its rights to recover from CORPORATION the amount of money paid to CORPORATION on any item, which is not eligible for payment under the PROGRAM or this Contract. XV. NON-DISCRIMINATION CORPORATION will comply with all applicable Federal , State and local laws and regulations including the City of Cupertino's policies concerning nondiscrimination and equal opportunity in contracting . Such laws include but are not limited to the following: Title VII of the Civil Rights Act of 1964 as amended ; Americans with Disabilities Act of 1990 ; The Rehabilitation Act of 1973 (Sections 503 and 504); California Fair Employment and Housing Act (Government Code sections 12900 et seq .); and California Labor Code sections 1101and1102. CORPORATION will not discriminate against any subcontractor, employee , or applicant for employment because of age , race , color, national origin , ancestry , religion , sex/gender, sexual orientation, mental disability, physical disability, medical condition , political beliefs , organizational affiliations , or marital status in the recruitment, selection for training including apprenticeship , hiring , employment, utilization, promotion, layoff, rates of pay or other forms of compensation. Nor shall CORPORATION discriminate in provision of services provided in this Contract because of age, race, color, national origin, ancestry, religion , sex /gender, sexual orientation, mental disability, physical disability, medical condition, political beliefs , organizational affiliations, or marital status. This non-discrimination provision must be included in CORPORA TION 's contracts with sub- contractors and vendors when utilizing the grant funds disbursed for this program . Pa ge 9 of2 l FY 201 6-l 7 Ge neral Fund Hum an Servi ce Grant s (HS G) Cit y/No n-Profit Co ntra ct XVI. AMENDMENTS Other than the amendment related to a second year renewal option as stated in Section III. above, amendments to the terms or conditions of this Contract must be requested in writing by a duly authorized representative of the party desiring such amendments, and any such amendment shall be effective only upon the mutual agreement in writing of the parties hereto. XVII . INTEGRATED DOCUMENT This Contract contains the entire agreement between CITY and CORPORATION with respect to the subject matter hereof. No written or oral agreements with any officer, agent or employee of CITY prior to execution of this Contract shall affect or modify any of the terms of obligations contained in any documents comprising this Contract. XVIII. MISCELLANEOUS A. Headings. The captions and section headings used in this Contract are for convenience of reference only , and the words contained herein will, in no way, be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the provisions of this Contract. B. Exhibits. All Exhibits attached hereto and referred to in this Contract are incorporated herein by this reference as if set forth fully herein . Exhibits are as follows : Exhibit "A " (PROGRAM Description), Exhibit "B" (PROGRAM Work Plan), Exhibit "C" (Proposed Implementation Time Schedule), Exhibit "D" (Program Budget), and Exhibit "E " (Insurance and Bond Requirements). C. Conflict of Interest. In accordance with Government Code Section 1090 and the Political Reform Act , Government Code Section 87100 et seq ., except for approved eligible administrative or personnel costs, no person who is an employee , agent, consultant, officer, or any immediate family member of such person , or any elected or appointed official of the CITY who exercises or has exercised any functions or responsibilities with respect to the activities funded by this Contract or who is in a position to participate in a decision-making process , may obtain a personal or financial interest or benefit from the activity , or have an interest in any contract, subcontract or agreement with respect thereto, or the proceeds thereunder, during, or at any time after , such person's tenure. The CORPORATION shall exercise due diligence to ensure that the prohibition in this section is followed. Further, no person who is a director, officer, partner, trustee or employee or consultant of the CORPORATION , or immediate family member of any of the preceding, shall make or participate in a decision , made by the CITY or a CITY board, commission or committee, if it is reasonably foreseeable that the decision will have a material effect on any source of income , investment or interest in real property of that person or the CORPORATION . Interpretation of this section shall be governed by the definitions and provisions used in the Political Reform Act, Government Code Section 87100 et seq., its implementing regulations manual and codes, and Government Code Section 1090 . Page I 0 of2 l FY 20 16-17 Ge neral Fund Hum an Service Gra nt s (HSG) C ity/No n-Profit Co nt ract D . Interpretation. Each party to this Contract has had an oppmiunity to review the Contract , confer with legal counsel regarding the meaning of the Contract, and negotiate re v isions to the Contract. A ccordingly , neither paiiy shall rely upon Civil Code Section 1654 in order to inte rpret any uncertainty in the meaning of the Contract. E . Third-Party Beneficiary. There shall be no third paiiy benefici aries to this Contract. F . Choice of Law and Venue. This Contract shall be governed by and construed in accordance with California law. Venue shall be Santa Clara County. G. Severability. If an y term of this Contract is held by a court of competent jurisdiction to be invalid , void or unenforceable , the remainder of the provisions shall continue in full force and effect unless the rights and obligations of the parties have been materially altered or abridged by such invalidation , voiding or unenforceability. Page 11 of 2 1 FY 20 16-17 Ge nera l Fun d Hum an Serv ice Gra nts (HSG) Ci ty/Non -Profi t Co nt rac t IN WITNESS WHEREOF, the parties have executed this Contract the day and year above written . The parties signing below hereby wairnnt that they are dul y authorized to execute this Contract. AGENCY: Senior Adults Legal Assistance By ~\~~,,'\ int name) APPROVED AS TO FORM AND LEGALITY: Randolph Stevenson Hom City Attorney EXPENDITURE DISTRIBUTION ACCOUNT NUMBER 100-72-712-700-702 PO#: Original Contract (1 s t Yr.): Contract Amendment (2na Yr.): Total: CITY OF CUPERTINO, a municipal corporation: City Manager ATTEST: Grace Schmidt City Clerk AMOUNT $10 ,100.00 $0.00 $10, 100 .00 (print name) Date 7-2-f .-ffo Date Page 12 of21 FY 20 16-17 General Fund Human Serv ice Grant s (HSG) City/Non-Profi t Co ntract Agency Name: Senior Adults Legal Assistance Executive Director: Georgia Bacil Street Address: 160 E. Virginia Street, Suite 260 Telephone number: 408.295.5991 x 202 Name of Project/Program: Legal Assistance to Cupe11ino Elders Project/Program Location: EXHIBIT A PROGRAM DESCRIPTION Project Manager : Georgia Bacil City: San Jose Fax Number: 408.295.7401 Cupertino Senior Center, 21251 Stevens Creek Blvd., Cupe11ino, CA 95014 Project Description : Grant# (For Office Use Onl y) HSG-2016-3 State: / Zip Code: CA 95112 Project Manager E-m ai l Address: gbacil@sala.org SALA will provide free Legal Assistance to Cupe11ino seniors (age 60 or older) by continuing our expanded appointments at Cupertino Senior Center and by serving seniors by phone that are homebound or with emergencies. A minimum of 40 unduplicated Cupertino seniors annually will be served, targeting clients that are low income or at risk of abuse, isolation , homelessness , or institutionalization. SALA will also make one Education /Outreach presentation annually at a site in Cupe11ino. These activities are cuJTently funded by Cupertino HSG and Senior Services are again eligible for HSG in 2016-17. Our project also qualifies as a CDBG Public Service as our services are targeted to Seniors (a Limited Clientele Activity/special need s population) and they prevent seniors' isolation (a need in the 2015-20 CON Plan). SALA is applying for CDBG and HSG funding to give us a greater chance of being funded, but total Cupe11ino funding requested for our project is $I 0 , I 00 regardless of source. The annual goal of 40 elders to be served by the project includes Cupertino clients age 60 or older served at the Cupertino Senior Center as well as homebound Cupe11ino clients served through home visits and those seniors served by phone intake for urgent matters or because they are dis a bled or homebound . The goal also includes unduplicated Cupertino elders seen at SALA intake s ites in other cities. All of these clients will be Cupertino residents age 60 or older, with an emphasis upon clients (I) who have lower incomes (at/below 80% of the medi a n defined by HUD) or (2) who are at risk of abuse, exploitation, isolation , or premature institutionalization (defined as age 75 or older, disabled, or living alone according to O lder Americas Act criteria). We note that the Older Americans Act, our major funder, prohibits the use of any other eligibility criteria for our services, including a means (income) test to restrict services. SALA's statistics for Cupe11ino clients in 2014-15 indicate the following about the low income and at risk status of our target population: 47% were very low income (at/below 50% of median), 53% were age 75 or older, and 21 % were disabled . Also, 61 % were female and 43% identified themselves as minority elders . Due to their low income status, our target clientele are also underserved , because they cannot afford to pay a private Elder Law attorney $400 -$5 00 an hour for legal services similar to those offered by the SALA project attorneys at no cost. The gender statistic for clients served in 2014-15 (61 % were female) is also significant in terms of contributing to our target clients underserved status because of low incomes . Specifically, in the Area Plan on Aging for 2005-09 the Council on Aging notes women generally have fewer financial resources than do men , particu larly in older age . If our project is funded for 2016-17 SALA expects similar demographics for Cupertino elders we will target and serve. Finally we note that the statistics in Section 6 below for th e Project Client Breakdown in the category of Seniors includes persons age 60 or older because the age threshold for SALA's senior clientele is age 60 or older and not age 63 or older. Page 13 of21 FY 2016-17 Ge neral Fund Human Serv ice Grant s (HSG) City/No n-P rofi t Co nt rac t EXHIBIT B PROGRAM WORK PLAN FY 2016/17 AGENCY NAME: Senior Adults Legal Assistance PROGRAM NAME: Legal Assistance to Cupertino Elders Benchmarks for Each Quarter Objectives l st 2"d 3rd 4th Legal Services 10 10 10 10 Community Education/Outreach 0 0 0 1 Pag el4of21 FY 201 6-17 Ge nera l Fund Human Se rvi ce Grant s (HS G) C ity/No n-Profit Co ntra ct TOTAL 40 1 EXHIBIT C PROPOSED IMPLEMENT A TI ON TIMELINE SCHEDULE FY 2016/17 AGENCY NAME: Senior Adults Legal Assistance PROGRM NAME: Legal Assistance to Cupe1iino Elders Activit Number & Descri tion: I.) Le al Services 2.) Communit Education/Outreach Activity# Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total I 3 3 4 3 3 4 3 3 4 3 3 4 40 2 0 0 0 0 0 0 0 0 0 0 0 I I Page 15 of21 FY 20 16-17 Ge neral Fund Hum an Service Gra nt s (HSG) C ity/No n-P ro fit Co nt rac t EXHIBIT D PROGRAM BUDGET FY 2016/17 Agency Name: Senior Adults Legal Assistance Project Name: Legal Assistance to Cupe1iino Elders Proposed Project Expenses Salaries/Benefits/Payroll/Taxes Other rrotal Expenses Page 16 of2 l FY 20 16-17 Ge nera l Fund Hum an Servi ce Grant s (HSG) C ity/No n-P ro fit Co nt rac t FY 2016/17 $10 , 100.00 $0 .00 $10,100.00 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 emplo yed 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 Cit y 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 project 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 Page 17 of2 l FY 20 16-1 7 Gen eral Fund Hum an Se rvice Grant s (HSG) City/No n-Pro fit Co nt rac t 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 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. Page 18 of21 FY 2 01 6-1 7 Gene ral Fund Human Servi ce Grants (HS G) C ity/No n-P ro fit Co ntract 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: a. Additional Insured Endorsement: Such insurance as is afforded by this policy shall also apply to the City of Cupe1iino , 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: Pa ge 19 of2 I FY 20 16-1 7 Ge nera l Fun d Hum an Se rvice Gra nt s (HSG) C ity/No n-Profi t Co nt rac t 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. 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 rece1vmg 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 b y 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. Pa ge 20 of2 l FY 20 16-17 Ge nera l Fu nd Human Serv ice Gra nt s (HSG) City/No n-Profi t Contract 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 . 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. Pa ge 21 of21 FY 20 16-17 Ge nera l Fund Hum an Serv ice Grant s (HSG) City/No n-Profi t Co ntr ac t NORTH COUNTY (650) 969-8656 SOUTH COUNTY (408) 847 -7252 July 12 , 2016 Attn: Julia Kinst City of Cupe1iino SALA Senior Adults Legal Assistance Community Development & Public Works 10300 Torre A venue Cupertino, CA 95014-3202 Re: SALA's Human Service Grant (HSG) Contract for FY 2016-17 Dear Ms. Kinst, Enclosed is three signed copies of SALA ' s HSG Contract for FY 2016-17. Please let me know if you need anything more from SALA. Partiall y funded by: Sourcewise ·Lega l Sen,ices Trust Fund Program ·Equal Access Fu nd · CENTRAL OFFICE 160 EAST \'IRGI IA ST. S !TE 260 SAN J OSE, CA 95112 (408) 295-5991 FA)C: (408) 295-7401 California Department of Aging · County o f Sa nta Cla ra · City of Camp bell · City of Cup ertino · City of Milpita s · City of Mo untain View · City of P alo Alto ·City of San J ose· City of Sa nta Clara· City of Sunnyva le· Silicon Va ll ey Campaign for Lega l Services CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER COMPI^TE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dbaComplate Equity MaM hwirence Aoenoy, inc. rOTTOrr NAME: PRODUCER COMPI^TE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dbaComplate Equity MaM hwirence Aoenoy, inc. KIEX,,: (847)541-0900 K5,NO,:(847) 541-0444 PRODUCER COMPI^TE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dbaComplate Equity MaM hwirence Aoenoy, inc. E-MAIL ADDRESS: PRODUCER COMPI^TE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dbaComplate Equity MaM hwirence Aoenoy, inc. IN3URER1S) AFFORDING COVERAGE NAICff PRODUCER COMPI^TE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dbaComplate Equity MaM hwirence Aoenoy, inc. INSURER A at Lloyd's, London INSURED Senior Adults Legal Assistance 160 East Virginia Street Suite 260 San Jose, CA 95112 INSURER B INSURED Senior Adults Legal Assistance 160 East Virginia Street Suite 260 San Jose, CA 95112 INSURER C INSURED Senior Adults Legal Assistance 160 East Virginia Street Suite 260 San Jose, CA 95112 INSURER D INSURED Senior Adults Legal Assistance 160 East Virginia Street Suite 260 San Jose, CA 95112 INSURER E INSURED Senior Adults Legal Assistance 160 East Virginia Street Suite 260 San Jose, CA 95112 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER COMMERCIAL GENERAL LIABILITY i CLAIMS-MADE OCCUR GEN-L AGGREGATE LIMIT APPLIES PER: PRO- JECT POLICY OTHER: LOG -R5nc7-EFr (MM/DormT) POLlCV EXP (MM/DD/TVYY] LIMITS EACH OCCURRENCE UAMAGb lUHbNlbU PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS HIRED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accidenl) PROPERTY DAMAGE (Per accident) UMBRELLA LIAS EXCESS LIAB DED OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE RETENTION $ •PER STATUTE IF WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOfVPARTNER/EXECUTrVE OFFlCHfVMeMSER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L. EACH ACCIDENT E L. DISEASE - EA EMPLOYE! $ E L DISEASE - POLICY LIMIT Professional Liability 927723 11/01/15 11/01/16 $1,000,000 Each Claim $1,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) See pages two, three and four for additional information. CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 Torre Avenue Cupertino, CA 95050 i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Cupertino 10300 Torre Avenue Cupertino, CA 95050 i AUTHORIZED REPRESENTATIVE ACORD25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2 SENIOR ADULTS LEGAL ASSISTANCE (SALA) Policy Number: 927723 Subject to all policy terms, conditions, exclusions and endorsements of the policy. City of Cupertino is listed as an additional insured but only per the terms & conditions of the endorsement generated and subject to all policy terms, conditions, exclusions, and endorsements. *30 Day Notice of Cancellation applies. SURPLUS LINES NOTICE TO POLICYHOLDER - PLEASE SEE ATTACHED By Lawrence T.P. Molloy bindersias NOTICE: 1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWINO TOLL-FREE TELEPHONE NUMBER: 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORO. 5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. 6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. binclers*138 7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV. 8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS OOINO TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAOE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAOE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAOE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. D-2 (Effective July 21, 2011) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECT PRO-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) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS PER STATUTE OTH- ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe under DESCRIPTION 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-OWNED AUTOS AUTOS 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. INSD ADDL WVD SUBR 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 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): CONTACT NAME: 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. INS025 (201401) 6/29/2016 ISU/San Francisco 201 California St., Suite 200 License # 0778092 San Francisco CA 94111-5098 Jason Cheung (415)788-9810 (415)248-3534 jcheung@isugroup.com Senior Adults Legal Assistance, DBA: SALA 160 E. Virginia #260 San Jose CA 95112 Nonprofit's Ins Alliance of CA MARKEL FIRSTCOMP 0131 16-17 A X X X 201604545NPO 6/30/2016 6/30/2017 1,000,000 500,000 20,000 Excluded 2,000,000 2,000,000 Liquor Liability 1,000,000 A X X 201604545NPO 6/30/2016 6/30/2017 1,000,000 B MWC006622503 7/1/2016 7/1/2017 X 1,000,000 1,000,000 1,000,000 RE: Account#: 110-7406-7102 Certificate Holder is named as Additional Insured as respects to Liability as required by written contract only as pertains to Insured's operations as per Form CG 2026. Cancellation Clause: 30 day written notice except 10 days for nonpayment of premium. Jason Cheung City of Cupertino Community Development Dept. Attn:Christopher Valenzuela 10300 Torre Avenue Cupertino, CA 95014 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION CG 20 26 04 13 2016-04545 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. 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. 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. © Insurance Services Office, Inc., 2012 Page 1 of 1CG 20 26 04 13