Respectfully Submitted,
WILLDAN ENGINEERING
John Hidalgo, RLA
Principal Project Manager
Landscape Architectural Services
5 EXHIBIT “B”
SCOPE OF WORK
September 10, 2026
Victor Maria Santiago
Parks and Recreation Manager
City of Cudahy
5220 Santa Ana Street
Subject: Fee Proposal for Additional Design Services for Cudahy Park Renovation Project - Design Phase Engineering Services for the Preparation of Plans, Specifications and Estimate
Amendment No. 5
Dear Mr. Santiago,
This proposal supplements our professional services agreement Dated December 6, 2022, for the preparation of PS&E for the Cudahy Park Renovation Project. Please find below our project understanding and fee for the above-mentioned subject title.
PROJECT UNDERSTANDING
This amendment is a result of our emails and teleconference meetings between City staff and Willdan during the Months of August 2025 through January 2026. Discussion items included a City provided marked-up park site plan attachment illustrating the City’s request for revisions to the construction plans and performing a value engineering request to bring the construction cost to within the City’s budget. Additional items include planning for future parking lot improvements and assisting with cost estimates for grant funding application. The following revisions and requested tasks are noted below.
A. Construction Plans Updates:
1. Revised construction drawings for the relocation of the tennis court and basketball court.
This resulted in changes for:
a) Court lighting plan and electrical plans.
b) Irrigation modifications.
c) Planting modifications.
d) Bio-swale modifications.
2. Adjustment of construction plans in delineating Phase 1 and Phase 2.
3. Update Phase 1 construction bid package specifically material quantities adjustments.
Fee: $6,931.00
B. Parking Lot Concepts:
4. Prepared conceptual plan for parking lot improvements and EV stations.
5. Cost estimate updates for grant funding application.
Fee: $1,731.00
Total Fee for ‘A’ and ‘B’ for above-mentioned items $8,662.00 September 10, 2026
Cudahy Park Renovation – Amendment No. 5
Respectfully Submitted,
WILLDAN ENGINEERING
John Hidalgo, RLA
Principal Project Manager
Landscape Architectural Services
Telephone 562-900-7151
RESOLUTION NO. 26-45
A RESOLUTION OF THE CITY OF CUDAHY CALIFORNIA,
APPROVING AN APPROPRIATION FOR DESIGN
ENGINEERING SERVICES FOR THE CUDAHY PARK
RENOVATION PROJECT PRE-001.
WHEREAS, on October 6, 2022, the City solicited a Request for Proposals (“RFP”) for Cudahy Park Renovation – Project No. PRE-001 (“Project”); and WHEREAS, on December 6, 2022, the City entered into a Professional Services Agreement (‘PSA”) with Willdan Engineering, Inc. to provide design engineering services for the Project, for a not-to-exceed amount of $318,900; and WHEREAS, on July 18, 2023, the City Council approved a First Amendment to the PSA to amend the scope of work and provide additional design engineering services in the amount of $40,866; and
WHEREAS, on November 7, 2023, the City Council approved a Second Amendment to the PSA to amend the scope of work and provide additional design engineering services in the amount of $94,400.00; and
WHEREAS, on September 3, 2024, the City Council approved a Third Amendment to the PSA to include additional soil analysis testing and new park electrical systems power supply upgrades in the amount of $34,900; and
WHEREAS, on October 7, 2025, the City Council approved a Fourth Amendment to the PSA to amend the scope of work and provide additional design engineering services in the amount of $20,606; and
WHEREAS, the City now requests certain Project modifications and cost estimates for a grant funding application that resulted in an additional design engineering cost of $8,662, which will be paid through the original Project budget and General Fund; and WHEREAS, the Project and design services will be funded by the Statewide Park Development and Community Revitalization (Proposition 68) and the General Fund.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Cudahy, California, as follows:
SECTION 1. The City Council hereby authorizes and directs the City Manager to execute the Fifth Amendment to the Master Agreement in a Form Approved by the City Attorney’s Office.
SECTION 2. The City Council hereby approves an appropriation of $6,931 in Proposition 68 funds and $1,731.00 from the City’s General Fund for a grand total of $8,662.
SECTION 3. The City Council now hereby authorizes the Finance Director, or designee, to appropriate these funds from available fund balance and amend the FY 2026-2027 budget.
Attachment B
Resolution No. 26-45
SECTION 4. This Resolution shall take effect immediately upon its adoption by the City Council and the City Clerk shall certify to the passage and adoption of this Resolution and enter it into the book of original Resolutions.
PASSED, APPROVED AND ADOPTED by the City Council of the City of Cudahy at its regular meeting on this 20th day of October 2026.
Cynthia Gonzalez
Mayor
ATTEST:
Richard Iglesias
City Clerk
Resolution No. 26-45
CERTIFICATION
STATE OF CALIFORNIA )
COUNTY OF LOS ANGELES ) SS:
CITY OF CUDAHY )
I, Richard Iglesias, City Clerk of the City of Cudahy, hereby certify that the foregoing Resolution No. 26-44 was passed and adopted by the City Council of the City of Cudahy at a regular meeting held on the 20th day of October 2026 and that said Resolution was adopted by the following vote, to-wit:
AYES:
NOES:
ABSENT:
ABSTAIN:
______________________________
Richard Iglesias
City Clerk
Blank Page
“Serving The People” "Sirviendo A La Comunidad"
Staff Report
10/20/2026 Page 1 of 3
STAFF REPORT
Date: October 6, 2026
To: Honorable Mayor/Chair and City Council/Agency Members From: Christopher R. Lopez, City Manager/Executive Director Estefania Zamora, Assistant to the City Manager
Subject: Adoption of Resolution No. 26-46 Approving a Waiver of the Temporary Use Permit Application Fee for Three Community Food Distribution Events Requested by Kaiser Permanente on Behalf of Bienestar Is Wellbeing
RECOMMENDATION
The City Council is requested to adopt Resolution 26-46 approving the waiver of the $1,359 Temporary Use Permit (“TUP”) application fee for three community food distribution events requested by Kaiser Permanente on behalf of Bienestar is Wellbeing (“Applicant”).
BACKGROUND
To obtain a TUP, applicants are required to submit an application to the Planning Division for review. In the process of reviewing TUP applications, the Planning Division routes applications to other departments soliciting feedback from Public Works, Building & Safety Division, Los Angeles County Fire, and the Sheriff’s.
On October 9, 2026, staff received a TUP application (Attachment A) from the Applicant for three community food distribution events at Kaiser Permanente, located at 7825 Atlantic Avenue, Cudahy, CA 90201.
On October 12, 2026, Ms. Sheri Bathurst, Community Health Senior Consultant submitted a formal fee waiver request. (Attachment B).
ANALYSIS
The Applicant is requesting approval to conduct three drive-through community food distribution events at Kaiser Permanente, located at 7825 Atlantic Avenue, Cudahy, CA 90201. The proposed events would operate from 9:00 a.m. to 11:00 a.m.
Item Number
12C
“Serving The People” "Sirviendo A La Comunidad"
Staff Report
10/20/2026 Page 2 of 3
Vehicles would enter the property from either Atlantic Avenue or Elizabeth Street. Event staff would direct vehicles and manage queues within the existing parking lot, including the areas beneath the solar panel canopies. The parking lot can accommodate a queue of more than 100 vehicles.
Figure 1 – Proposed Site Plan
The $1,359 TUP application fee covers the costs associated with Planning and Building and Safety staff review, inspections, coordination, and permit issuance for the proposed temporary uses.
The Applicant has requested a waiver of the $1,359 TUP application fee for the three proposed events. Approval of the request would waive the full application fee in support of the proposed community food distribution events.
CONCLUSION
The City Council is requested to adopt a resolution approving the Applicant’s request to waive the $1,359 TUP application fee for the three proposed community food distribution events.
STRATEGIC PLAN CORRELATION
None.
“Serving The People” "Sirviendo A La Comunidad"
Staff Report
10/20/2026 Page 3 of 3
FINANCIAL IMPACT
Approval of the fee waiver would result in foregone General Fund revenue of $1,359, which is the TUP application fee set by the City’s Master Fee Schedule. The staff time for reviewing, coordinating, inspecting and issuing the permit is already included in the FY 2026-27 Adopted Budget, so the waiver requires no additional appropriation.
The waiver covers only the City’s TUP application fee. Any charges from other agencies, such as the Los Angeles County Fire Department or Sheriff’s Department, remain the Applicant’s responsibility.
ATTACHMENTS
A. Resolution No. 26-46
B. Kaiser Permanente TUP Application
C. Fee Waiver Request
RESOLUTION NO. 26-46
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CUDAHY, CALIFORNIA, APPROVING A WAIVER OF THE
TEMPORARY USE PERMIT APPLICATION FEE FOR THREE
COMMUNITY FOOD DISTRIBUTION EVENTS REQUESTED BY
KAISER PERMANENTE ON BEHALF OF BIENESTAR IS
WELLBEING
WHEREAS, the City of Cudahy requires applicants proposing temporary uses of property to obtain a Temporary Use Permit (“TUP”), which requires review and processing by the City’s Planning Division and other applicable departments and agencies; and
WHEREAS, on October 9, 2026, the City received a TUP application from Kaiser Permanente, on behalf of Bienestar Is Wellbeing (“Applicant”), requesting approval to conduct three community food distribution events at Kaiser Permanente, located at 7825 Atlantic Avenue, Cudahy, California 90201; and WHEREAS, the proposed events are intended to provide community food distribution through a drive-through format, with each event proposed to operate from 9:00 a.m. to 11:00 a.m.; and
WHEREAS, the applicable TUP application fee is $1,359, as established by the City’s Master Fee Schedule, and covers costs associated with staff review, coordination, inspections, and permit issuance; and
NOW, THEREFORE BE IT RESOLVED, BY THE CITY COUNCIL OF THE CITY OF CUDAHY, AS FOLLOWS:
SECTION 1. The City Council hereby approves the waiver of the $1,359 Temporary Use Permit application fee for the three community food distribution events requested by Kaiser Permanente on behalf of Bienestar Is Wellbeing, to be conducted at Kaiser Permanente, located at 7825 Atlantic Avenue, Cudahy, California 90201, subject to applicable City requirements and permit approval.
SECTION 2. The City Manager, or designee, is authorized to take such administrative actions as may be necessary to implement the fee waiver approved by this Resolution, consistent with applicable law and City procedures.
PASSED, APPROVED, AND ADOPTED by the City Council of the City of Cudahy at their regular meeting of this 20th day of October 2026.
Attachment A
Cynthia Gonzalez
Mayor
ATTEST:
____________________________
Richard Iglesias
City Clerk
CERTIFICATION
STATE OF CALIFORNIA )
COUNTY OF LOS ANGELES ) SS:
CITY OF CUDAHY )
I, Richard Iglesias, City Clerk of the City of Cudahy, hereby certify that the foregoing Resolution No. 26-46 was passed and adopted by the City Council of the City of Cudahy, signed by the Mayor and attested by the City Clerk at a regular meeting of said Council held on the 20th day of October 2026 and that said Resolution was adopted by the following vote, to-wit:
AYES:
NOES:
ABSENT:
ABSTAIN:
___________________________
Richard Iglesias
City Clerk
TEMPORARY USE PERMIT
APPLICATION
Community Development Department | Planning Division | 5220 Santa Ana St. Cudahy CA 90201 | Phone: 323-773-5143 | Email: [email protected] Last updated: August 2026
Introduction: Temporary activities intended to occur outdoors or within a temporary building, when such uses are allowed within the applicable zone, require a Temporary Use Permit. The following temporary activities and uses may be allowed, subject to the issuance of a Temporary Use Permit prior to the commencement of the activity or use.
1. Construction yards, storage sheds, and construction offices in conjunction with an approved construction project, where the yard is located on a site different from the site of the approved construction project.
2. Entertainment and assembly events, including carnivals, circuses, concerts, fairs, festivals, food events, farmers markets, fundraisers, outdoor entertainment/sporting events, and similar events designed to attract large crowds and that are held either on private property when otherwise part of, or consistent with a permitted use. a. A maximum of three (3) days in any six-month period, unless the Community Development Department Director authorizes a fourth day.
3. Swap meets, including flea markets, rummage sales, and similar events held on private property.
4. Seasonal sales including (e.g., Pumpkin patch, Christmas tree lot). a. The sales of Christmas trees and wreaths shall only occur between December 1st to December 25th of any calendar year.
5. Outdoor display of merchandise as an accessory to current on-site business provided the sale of merchandise exceeds 25% of annual gross receipts.
6. Outdoor sales when such use(s) are allowed in the applicable zone. a. A maximum of four (4) outdoor sales, limited to a maximum of seven (7) days.
7. Other temporary activities subject to the Community Development Director determines to be similar in nature.
An application for a Temporary Use Permit (TUP) must be submitted and approved before any temporary use is conducted. Applications for a TUP must be submitted up to 30 days prior to the date of the event. Applications submitted with less than two weeks’ notice may not have enough time for processing. Please read the directions and requirements carefully and use the checklist provided before submitting the application.
If you have any questions, please contact the Planning Division by email, [email protected] or by phone, (323) 773-5143.
STAFF USE ONLY Assigned Project Manager: ___________________________ Temporary Use Permit No.:
Date/Time Received: Received by: Fee Received & Receipt Number:
☐ Completed Application
☐ $1,359 Application Fee (other fees apply as applicable) – Fees shall be paid in person at City Hall or mailed in by check, payable to “City of Cudahy”.
☐ Detailed Site Plan (location of structures such as tents, fencing, lighting fixtures, equipment, parking, etc.) ☐ Signage Plan
☐ Certificate of Insurance and Endorsement for applicant & vendors/contractors – See attached insurance information. ☐ Property Owner Approval
☐ Public Notification Mailing Labels for Temporary Carnival, Circus, Fair, or Similar Event (Owners and Tenants within 300 feet of the proposed site of the event must be notified 20 days in advance of event.) The applicant shall provide:
☐An area map indicating all properties within three hundred (300) foot radius of the subject parcel(s) ☐One typed list and two sets of gummed mailing labels addressed to property owners AND tenants within 300 feet of the subject site.
APPLICANT INFORMATION: (This is the person who will be contacted regarding this application. This person will be named the applicant in all documents related to this application.) Name of Applicant: ___________________________________________________________________________________________ Name of Organization: _________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ Phone Number: _______________________________________________________________________________________________ E-Mail: _____________________________________________________________________________________________________ EMERGENCY CONTACTS: (Two are required and should be available during the event.) Contact # 1 Contact # 2
Name Name
Cell phone number Cell phone number
EVENT INFORMATION:
Date(s) of Event: Hours of event: ____________________________________________ Hours of event setup (if applicable):___________________ Hours of event takedown (if applicable): __________________________ Location of Event: _____________________________________________________________________________________________ Temporary Use Permit Application Check List: (The following is considered the minimum requirements to submit a TUP application, additional information and fees may be required/requested.)
CHECK ANY ITEMS THAT APPLY:
☐Tent or Canopy (include how many and the aggregate size):____________________________ ☐Electrical hookups (electrical permit and inspection, such as temporary power pole and temporary generators; does not include extension cords to outlets)
☐Closures of public streets or alleys (subject to Public Works Encroachment Permit) ☐Temporary Signs such as: Banners, A-Frames, traffic control signs, etc. ☐Live Entertainment and/or PA system
DETAILED WRITTEN DESCRIPTION OF EVENT: Include streets, pedestrian and vehicle ingress/egress, structures, placement and location of tents, signs, banners, storage, generators, PA equipment, sanitary facilities, lighting, Number of employees, number of parking spaces to be occupied.
____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ PROPERTY OWNER INFORMATION:
Name of Property Owner: ______________________________________________________________________________________ Property Owner’s Address:
Property Owner’s Phone Number: _______________________________________________________________________________ Property Owner’s E-Mail:
PROPERTY OWNER APPROVAL
Must be read, filled in, and signed by the owner of the property or management company. (owner/prop. management) herby grants full permission and approval for (applicant) to hold (event) at
(location) on (date(s)).
Additionally, I have been notified of the full extent of the event proposed and agree to not hold the City of Cudahy responsible for any problems or concerns that may arise due to it.
Signature of owner or person authorized Date
INSURANCE REQUIREMENTS:
All vendors and contractors must submit a Certificate of Liability Insurance in the amounts detailed on Attachment A to this application.
These Insurance Certificates must be submitted for all vendors and contractors planned to participate in an event at the time a Temporary Use Permit application is submitted in order for the application to be deemed complete and to begin processing.
All Insurance Certificates MUST be approved by the City Clerk’s Office before any temporary use occurs. Vendors and contractors added to the event after application submittal must submit Insurance Certificates at least two (2) weeks in advance of the event in order to be reviewed by the City Clerk’s Office. Vendors and contractors that do not follow the requirements for Insurance Certificates will not be permitted to participate in the event.
☐ I, the Applicant, certify that I will ensure all vendors and contractors participating in my event submit Insurance Certificates consistent with the required insurance limits and that I have attached these certificates as supporting documentation. ☐ I, the Applicant certify that I understand these Insurance Certificates will be reviewed for eligibility requirements detailed in Attachment A. I have been advised that if required documentation is not submitted at least two (2) weeks in advance of an event, the City Clerk’s Office will not have sufficient time to review Insurance Certificates and will therefore be unable to provide approval for vendors and contractors to participate in an event. ____________________________________________________________ ___________________________ Applicant Signature (Required) Date
____________________________________________________________
APPLICANT DECLARATION
Must be read, filled in, and signed by the applicant.
I hereby certify and say, under penalty of perjury, that I am the applicant in the foregoing application for _______________________________ (proposed event) at _____________________________ (event address), that I have read this Application and know the content thereof, and that the herein stated information and all attachments hereto, are true and correct to the best of my knowledge and belief.
Signature of applicant Date
INSURANCE REQUIREMENTS
The City of Cudahy requires all Applicants to submit a Certificate of Liability Insurance in the following amounts:
MINIMUM SCOPE OF INSURANCE (see attached sample)
1. Commercial General Liability Insurance (CGL): Applicant shall obtain Commercial General Liability insurance, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, the general aggregate limit shall be twice the required occurrence limit. (Note – Aggregate limits can be supplemented by an accompanying Umbrella or Excess Liability policy.)
2. Automobile Liability: Applicant shall obtain Automobile Liability Insurance in the amount of $2,000,000 per occurrence. (Note – required only if auto is to be used in performance of the scope of work.)
3. Workers’ Compensation: As required by the State of California, with Statutory Limits, and Employer’s Liability Insurance with limits of no less than $1,000,000 per accident for bodily injury or disease. (Note – required only if vendor has employees, waiver available for sole proprietors.)
4. Professional Liability (Errors and Omissions): Insurance appropriates to the Applicant’s profession, with limits no less than $2,000,000 per occurrence or claim.
5. Applicant’s Pollution Legal Liability (IF APPLICABLE) and/or Asbestos Legal Liability and/or Errors and Omissions (if project involves environmental hazards) with limits no less than $2,000,000 per occurrence or claim, and $4,000,000 policy aggregate.
6. Description of Operations/Locations/Vehicles: Include address(es) and/or location(s) of work being performed
7. Endorsement Page: Must read, “The City of Cudahy, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds” on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of Applicant including materials, parts or equipment furnished in connection with such work or operations. General liability coverage is to be provided in the form of an endorsement to the Applicant’s insurance (at least as broad as ISO Form CG 20 10 11 85 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if later revisions used).
CITY OF CUDAHY CALIFORNIA Incorporated November 10, 1960 5220 Santa Ana Street
Cudahy, California 90201-6024
(323) 773-5143
ATTACHMENT A
8. Waiver of Subrogation: To the fullest extent permitted by law, the Applicant and its insurers waive all rights of recovery or subrogation against the City, its officers, officials, employees, agents, and volunteers for any claims, losses, or expenses arising out of or connected with the Applicant’s work under this agreement. This waiver shall apply to the General Liability, Automobile Liability, and Workers’ Compensation policies and shall be effective regardless of any other insurance or coverage maintained by the City.
9. Primary and Non-Contributory Clause: The Applicant’s insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, agents, and volunteers. Any insurance or self-insurance maintained by the City shall be excess of the Applicant’s insurance and shall not contribute with it. All required policies shall be endorsed to reflect this requirement.
10. Acord Forms: The GL needs to be on a current Acord form 2012 and current or will not be accepted.
NOTICE OF CANCELLATION
Each insurance policy required above shall provide that coverage and shall not be canceled, except with written notice to the Entity.
ACCEPTABILITY OF INSURERS
Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best’s rating of no less than A:VII, unless otherwise acceptable to the Entity.
SPECIAL RISKS OR CIRCUMSTANCES
City reserves the right to modify these requirements at any time, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances.
All Insurance Certificates MUST be approved by the City Clerk’s Office before beginning any work.
If the vendor is a sole proprietor with no employees or is unable to meet the above insurance requirements, please contact the City Clerk’s Office at (323) 773-5143 ext. 254 to see if any waivers or modifications will be permitted.
Contact:
Richard Iglesias, City Clerk
[email protected]
(323) 773-5143 ext. 227
SEE NEXT PAGE FOR SAMPLE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
DATE
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).
PRODUCER
AGENT OR BROKER
NAME & ADDRESS
CONTACT
NAME: MUST HAVE A CONTACT PHONE
(A/C, No, Ext): NAME & PHONE NUMBER OR FAX
(A/C, No):
E-MAIL ADDRESS: EMAIL ADDRESS
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :
INSURED
INSURED'S NAME & ADDRESS
INSURER B : INSURANCE COMPANY NAME(S) NAIC #
INSURER C : REQUIRED
INSURER D :
INSURER E :
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.
INSR
LTR TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
ADDL SUBR
INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)
EACH OCCURRENCE
LIMITS
$ 2,000,000
X CLAIMS-MADE X OCCUR POLICY NUMBER CURRENT
POLICY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
$ 1,000,000
$ 5,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PERIOD PERSONAL & ADV INJURY
GENERAL AGGREGATE
$ 1,000,000
$ 4,000,000
POLICY
OTHER:
PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 1,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
UMBRELLA LIAB
EXCESS LIAB
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
OCCUR
CLAIMS-MADE
POLICY NUMBER
CURRENT
POLICY
PERIOD
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
EACH OCCURRENCE
AGGREGATE
$ 2,000,000
$
$
$
$
$
$
DED RETENTION $ $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
Y / N
N / A POLICY NUMBER CURRENT
POLICY
PER
STATUTE
E.L. EACH ACCIDENT
OTH- ER
$ 1,000,000
(Mandatory in NH) If yes, describe under PERIOD E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INCLUDE ADDRESS(ES) AND/OR LOCATION(S) OF WORK BEING PERFORMED
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SIGNATURE
AUTHORIZED REPRESENTATIVE
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 CUDAHY
5220 SANTA ANA
CUDAHY, CA 90201
MUST MARK
EITHER "Y"
OR "X'
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
State Or Governmental Agency Or Subdivision Or Political Subdivision:
THE CITY OF CUDAHY, ITS OFFICERS, OFFICIALS,
EMPLOYEES, AGENTS, AND VOLUNTEERS ARE TO BE
COVERED AS ADDITIONAL INSUREDS.
POLICY NUMBER: POLICY NUMBER MUST MATCH
COMMERCIAL GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CG 20 12 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION – PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
A. Section II – Who Is An Insured is amended to
include as an additional insured any state or
governmental agency or subdivision or political
subdivision shown in the Schedule, subject to the
following provisions:
1. This insurance applies only with respect to
operations performed by you or on your behalf
for which the state or governmental agency or
subdivision or political subdivision has issued a
permit or authorization.
However:
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. 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.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or
"personal and advertising injury" arising out
of operations performed for the federal
government, state or municipality; or
b. "Bodily injury" or "property damage"
included within the "products-completed
operations hazard".
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.
CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 October 12, 2026
Dear Mr. Lopez,
On behalf of Kaiser Permanente Southern California Region, I am writing to request a waiver of the Temporary Use Permit fee for our community food distribution event planned for November 21, 2026.
The event is a community-serving food distribution being hosted by Kaiser Permanente in partnership with our nonprofit partner, Bienestar is Wellbeing, to provide food resources to local residents. This event is being offered as a community benefit and will not generate revenue for Kaiser Permanente or the participating organization.
Given the nonprofit, community-focused nature of the event and the fact that no revenue will be generated, we respectfully request that the City of Cudahy waive the applicable Temporary Use Permit fee.
We appreciate the City’s partnership and support as we work to provide this resource to the Cudahy community. Thank you for your consideration of this request.
Sincerely,
Sheri Bathurst, MS
Community Health Senior Consultant | Downey Medical Center Kaiser Permanente Southern California Region
@kp.org
Attachment C