CityofNapa
Agreementam
AGREEMENT BETWEEN THE CITY OF NAPA
AND
FAMILY SERVICE OF THE NORTH BAY
FOR
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
THIS AGREEMENT, entered this day of 20th day of June, 1995 by and between the CITY OF NAPA ( herein called the " Grantee") and FAMILY SERVICE OF THE NORTH BAY herein called the " Subrecipient").
WHEREAS, the Grantee has applied for and received funds from the United States Government under Title I of the Housing and Community Development Act of 1974, Public Law 93- 383; and
WHEREAS, the Grantee wishes to engage the Subrecipient to assist the Grantee in utilizing such funds;
NOW, THEREFORE, it is agreed between the parties hereto that; I. SCOPE OF SERVICE
A. Activities
The Subrecipient will be responsible for administering a mental health clinic to serve County program referred City of Napa Satellite Housing clients, outpatient counseling, Family Service of the North Bay Napa administration office, Napa Big Brothers/ Big Sisters participants, and Big Brother' s/ Big Sister' s Napa offices through the acquisition of one 1) Mental Health Clinic during the CDBGYear 1995- 1996 in a manner satisfactory to the Grantee and consistent with any standards required as a condition of providing these funds. Such a program will include the following activities eligible under the Community Development Block Grant Program:
Program Delivery
Activity 111: Acquisition of one ( 1) mental health clinic for County program referred City of Napa satellite housing clients, outpatient counseling, Family Service of the North Bay Napa administration office, Napa Big Brothers/ Bib Sisters
participants, and Napa Big Brother' s/ Big Sister' s offices.
General Administration
Subrecipient shall provide ongoing guidance and support for the County referred satellite housing program and oversight of the mental health clinic.
B. National Objectives
The Subrecipient certifies that the activities carried out with funds provided under this Agreement will meet one or more of the CDBG program' s National Objectives - 1) benefit low/ moderate income persons, 2) aid in the prevention or elimination of slums or blight, 3) meet community development needs having a particular urgency - as defined in 24 CFR Part 570. 208
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
C. Levels of AccomDlishment
In addition to the normal administrative services required as part of this Agreement, the Subrecipient agrees to provide the following levels of program services:
Acquisition of one ( 1) mental health clinic servicing no less than 609 City of Napa, low- income residents for County referred satellite housing clients, outpatient counseling, Family Service of the North Bay administration office, Napa Big Brothers/ Big Sisters participants, and Big Brother' s/ Big Sister' s offices.
D. Staffing
See Exhibit " B", Budget Worksheets.
E. Performance Monitoring
The Grantee will monitor the performance of the Subrecipient against goals and performance standards required herein. Substandard performance as determined by the Grantee will constitute non- compliance with this Agreement. If action to correct such substandard performance is not taken by the Subrecipient within a specified period of time after being notified by the Grantee, contract suspension or termination procedures will be initiated.
II. TIME OF PERFORMANCE
Contract of the Subrecipient shall start on the 1st day of July, 1995 and end on the 30th day of June, 1996. The term of this Agreement and the provisions herein shall be extended to cover any additional time period during which the Subrecipient remains in control of CDBGfunds or other assets, including program income.
III. BUDGET
Any indirect costs charged must be consistent with the conditions of Paragraph VIII( C)( 2) of this Agreement. In addition, the Grantee may require a more detailed budget breakdown than the one contained herein, and the Subrecipient shall provide such supplementary budget information in a timely fashion in the form and content prescribed by the Grantee.
Any amendments to this budget must be approved in writing by the Grantee and the Subrecipient.
W MMMOOPM
It is expressly agreed and understood that the total amount to be paid by the Grantee under this contract shall not exceed $ 150, 000. 00.
Drawdowns for the payment of eligible expenses shall be made against the line item budgets specified in Paragraph III herein and in accordance with performance and using the form as supplied in Exhibit " C".
Expenses for general administration shall also be paid against the line item budgets specified in Paragraph III and in accordance with performance.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
Payments may be contingent upon certification on the Subrecipient' s financial management system in accordance with the standards specified in OMB Circular A- 110.
V. NOTICES
Communication and details concerning this contract shall be directed to the following contract representatives:
Grantee Subrecipient
Katrina Schlyer, Management Analyst Dr. Ken Merritt, Executive Director City of Napa Family Service of the North Bay
1100 West Street 1157 Division Street
Napa, CA 94559 Napa, California 94559
707) 257- 9529 ( 707) 255- 0966
707) 257- 9532
VI. SPECIAL CONDITIONS
None
VII. GENERAL CONDITIONS
A. General Compliance
The Subrecipient agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 ( the Housing and Urban Development regulations concerning Community Development Block Grants CDBG). The Subrecipient also agrees to comply with all other applicable Federal, state and local laws, regulations, mitigation measures and policies governing the funds provided under the contract.
The Subrecipient further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available.
B. " Independent Contractor"
Nothing contained in this Agreement is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer/ employee between the parties. The Subrecipient shall have control of the work and the manner of performance at all times and shall remain an " independent contractor" with respect to the services to be performed under this Agreement. The Subrecipient shall not be entitled to participate in Grantee' s employee benefits plans including without limitation Unemployment Compensation, FICA, retirement, life and/ or medical insurance and Workers' Compensation Insurance.
C. Hold Harmless
The Subrecipient shall hold harmless, defend, release and indemnify the Grantee from any and all claims, actions, suits, charges and judgments, liabilities, and penalties, including attorney' s fees and witness costs that may be asserted by any person or entity, including Subrecipient, from any cause whatsoever excluding the sole negligence or willful misconduct of Grantee, which in whole or in part arise out of the ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
Subrecipient' s performance or nonperformance of the services or subject matter called for in this Agreement.
D. Workers' Compensation
In the event the Subrecipient has employees, the Subrecipient shall, throughout the period of this Agreement maintain in full force and effect a policy of Worker' s Compensation insurance meeting statutory limits of Labor Code covering all its employees and volunteers. The insurance shall include a waiver of subrogation endorsement.
E. Insurance & Bonding
The Subrecipient shall take out and maintain, throughout the period of this Agreement, commercial ( ISO Form G10002, Ed. 1/ 73) or broad form comprehensive general ( ISP Form GL0404) liability insurance with minimum limits of $ 1, 000, 000. 00 per occurrence, covering all bodily injury or death and property damage arising out of its activities under this Agreement.
The Subrecipient shall provide automobile insurance for all owned, hired or non - owned vehicles covering bodily injury or death and property liability incurred during the performance of this Agreement with minimum coverage of not less than $ 500, 000. 00 per accident combined single limit CSL).
All policies shall name City as an additional insured and shall provide for thirty ( 30) days prior written notice to City of cancellation or material reduction in coverage. The public liability and automobile insurance shall provide or be endorsed to provide cross liability among insureds and shall state that it shall constitute primary insurance as to City, its officers, agents and employees, so that any other policies held by City shall not contribute to any loss under said insurance.
This Agreement shall not be executed by City until certificates and endorsements, or other sufficient proof that these insurance provisions have been complied with, are filed with the City.
F. Grantor Recognition
The Subrecipient shall insure recognition of the role of the grantor agency in providing services through this contract. All activities, facilities and items utilized pursuant to this contract shall be prominently labeled as to funding source. In addition, the Subrecipient will include a reference to the support herein in all publications made possible with funds made available under this contract.
G. Amendments
The Grantee or Subrecipient may amend this Agreement at any time provided that such amendments make specific reference to this Agreement, and are executed in writing, signed by a duly authorized representative of both organizations, and approved by the Grantee' s governing body.
Such amendments shall not invalidate this Agreement, nor relieve or ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
release the Grantee or Subrecipient from its obligations under this Agreement.
The Grantee may, in its discretion, unilaterally amend this Agreement to conform with Federal, state or local governmental guidelines, policies and available funding amounts, or for other reasons upon written notification to Grantee. If such amendments result in a change in the funding, the scope of services, or schedule of the activities to be undertaken as part of this Agreement, such modifications will be incorporated only by written amendment by both Grantee and Subrecipient.
H. Suspension or Termination
Either party may terminate the contract at any time by giving written notice to the other party of such termination. Partial terminations of the Scope of Service in Paragraph I. A. above may only be undertaken with the prior approval of the Grantee. In the event of any termination for convenience, all finished or unfinished documents, data, studies, surveys, maps, models, photographs, reports or other materials prepared by the Subrecipient under this Agreement shall, at the option of the Grantee, become the property of the Grantee, and the Subrecipient shall be entitled to receive just and equitable compensation for any satisfactory work completed on such documents or materials prior to the termination.
The Grantee may also suspend or terminate this Agreement, in whole or in part, if the Subrecipient materially fails to comply with any term of this Agreement, or with any of the rules, regulations or provisions referred to herein; and the Grantee may declare the Subrecipient ineligible for any further participation in the Grantee' s contracts, in addition to other remedies as provided by law. In the event there is probable cause to believe the Subrecipient is in noncompliance with any applicable rules or regulations, the Grantee may withhold up to fifteen 15) percent of said contract funds until such time as the Subrecipient is found to be in compliance by the Grantee, or is otherwise adjudicated to be in compliance.
A. Financial Management
1. Accounting Standards
The Subrecipient agrees to comply with Attachment F of OMB Circular A- 110 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate controls, and maintain necessary source documentation for all costs incurred.
2. Cost Principles
The Subrecipient shall administer its program in conformance with OMB A- 122 " Cost Principles for Non - Profit Organizations," as applicable. These principles shall be applied for all costs incurred whether charged on a direct or indirect basis.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
B. Documentation and Record - Keeping
1. Records to be Maintained
The Subrecipient shall maintain all records required by the Federal regulations specified in 24 CFR Part 570. 506, that are pertinent to the activities to be funded under this Agreement. Such records shall include but not be limited to:
a. Records providing a full description of each activity undertaken;
b. Records demonstrating that each activity undertaken meets one of the National Objectives of the CDBG program;
C. Records required to determine the eligibility of activities; d. Financial records as required by 24 CFR Part 570. 502 and OMB Circular A- 110; and
e. Other records necessary to document compliance with Subpart K of 24 CFR 570.
f. Records required to document the acquisition, improvement, use or disposition of real property acquired or improved with CDBG assistance;
2. Retention
The Subrecipient shall retain all records pertinent to expenditures incurred under this contract for a period of three ( 3) years after the termination of all activities funded under this Agreement.
Records for non - expandable property acquired with funds under this contract shall be retained for three ( 3) years after final disposition of such property. Records for any displaced person must be kept for three ( 3) years after he/ she has received final payment.
Notwithstanding the above, if there is litigation, claims, audits, negotiations or other actions that involve any of the records cited and that have started before the expiration of the' three- year period, then such records must be retained until completion of the actions and and resolution of all issues, or the expiration of the three- year period, whichever occurs later.
3. Client Data
The Subrecipient shall maintain client data demonstrating client eligibility for services provided. Such data shall. include, but not be limited to, client name, address, income level or other basis for determining eligibility, and description of service provided. Such information shall be made available to Grantee monitors or their designees for review upon request.
4. Disclosure
The Subrecipient understands that client information collected under this contract is private and the use or disclosure of such information, when not directly connected with the administration of the Grantee' s or Subrecipient' s responsibilities with respect to services provided under this contract, is prohibited unless written ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
consent is obtained from such persons receiving service and, in the case of a minor, that of a responsible parent/ guardian.
5. Property Records
The Subrecipient shall maintain real property inventory records which clearly identify properties purchased, improved or sold.
Properties retained shall continue to meet eligibility criteria and shall conform with the " changes in use" restrictions specified in 24 CFR Parts 570/ 503( b)( 8), as applicable.
6. Close - Outs
The Subrecipient' s obligation to the Grantee shall not end until all close- out requirements are completed. Activities during the close- out period shall include, but are not limited to: making final payments, disposing of program assets ( including the return of all unused materials, equipment, unspent cash advances, program income balances, and accounts receivable to the Grantee), and determining the custodianship of records.
7. Audits and Inspections
All Subrecipient records with respect to any matters covered by this Agreement shall be made available to the Grantee, grantor agency, their designees or the Federal Government, at any time during normal business hours, as often as the Grantee or grantor agency deems necessary, to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the Subrecipient within 30 days after receipt by the Subrecipient. Failure of the Subrecipient to comply with the above audit requirements will constitute a violation of this contract and may result in the withholding of future payments. The Subrecipient hereby agrees to have an annual agency audit conducted in accordance with current Grantee policy concerning subrecipient audits and, as applicable, OMB Circular A- 133.
C. Reporting and Payment Procedures
1. Program Income
The Subrecipient shall report quarterly all program income as defined at 24 CFR 570. 500( a) generated by activities carried out with CDBG funds made available under this contract. The use of program income by the Subrecipient shall comply with the requirements set forth at 24 CFR 570. 504. By way of further limitations, the Subrecipient may use such income during the contract period for activities permitted under the contract and shall reduce requests for additional funds by the amount of any such program income balances on hand. All unused program income shall be returned to the Grantee at the end of the contract period. Any interest earned on cash advances from the U. S. Treasury is not program income and shall be remitted promptly to the Grantee.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-( Mental Health Clinic Site Acquisition
2. Indirect Costs
If indirect costs are charged, the
indirect cost allocation plan for
Subrecipient' s share of administrative
plan to the Grantee for approval, in
Grantee.
3. Payment Procedures
Subrecipient will develop an
determining the appropriate
costs and shall submit such
a form specified by the
The Grantee will pay the Subrecipient funds available under this contract based upon information submitted by the Subrecipient and consistent with any approved budget and Grantee policy concerning payments. Payments will be made for eligible expenses actually incurred by the Subrecipient, and not to exceed actual cash requirements. Payments will be adjusted by the Grantee in accordance with advance fund and program income balances available in Subrecipient accounts. In addition, the Grantee reserves the right to liquidate funds available under this contract for costs incurred by the Grantee on behalf of the Subrecipient.
4. Progress Report
The Subrecipient shall submit regular quarterly Progress Reports to the Grantee in the form and content as required by the Grantee.
D. Procurement
1. Compliance
The Subrecipient shall comply with current Grantee policy concerning the purchase of equipment and shall maintain inventory records of all non - expendable personal property as defined by such policy as may be procured with funds provided herein. All program assets unexpended program income, property,
equipment, etc., shall revert
to the Grantee upon termination of this contract.
2. OMB Standards
The Subrecipient shall procure all materials, property, or services in accordance with the requirements of Attachment 0 of OMB Circular A- 110, Procurement Standard, and shall subsequently follow Attachment N, Property Management Standards as modified by 24 CFR 570. 502( b)( 6), covering utilization and disposal of property.
3. Travel
The Subrecipient shall obtain written approval from the Grantee for any travel outside the metropolitan area with funds provided under this contract.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
IX. RELOCATION REAL PROPERTY ACQUISITION AND ONE- FOR- ONE HOUSING REPLACEMENT The Subrecipient agrees to comply with ( a) the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended ( URA), and implementing regulations at 49 CFR Part 24 and 24 CFR 570. 606( b); ( b) the requirements of 24 CFR 570. 606( c) governing the Residential Antidisplacement and Relocation Assistance Plan under section 104( d) of the HCD Act; and ( c) the requirements in Section 570. 606( d) governing optional relocation policies. The Subrecipient shall provide relocation assistance to persons ( families, individuals, businesses, nonprofit organizations and farms) that are displaced as a direct result of acquisition, rehabilitation, demolition or conversion for a CDBG- assisted project. The Subrecipient also agrees to comply with applicable Grantee ordinances, resolutions and policies concerning the displacement of persons from their residences.
X. PERSONNEL AND PARTICIPANT CONDITIONS
A. Civil Rights
1. Compliance
The Subrecipient agrees to comply with Title VI of the Civil Rights Act of 1964 as amended, Title VII of the Civil Rights Act of 1968 as amended, Section 104( b) and Section 109 of Title I of the Housing and Community Development Act of 1974 as amended, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1976, Executive Order 11063, and with Executive Order 11246 as amended by Executive Orders 11375 and 12086.
2. Nondiscrimination
The Subrecipient will not discriminate against any employee or applicant for employment because of race, color, creed, religion, ancestry, national origin, sex, disability or other handicap, age, marital/ familial status, or status with regard to public assistance.
The Subrecipient will take affirmative action to insure that all employment practices are free from such discrimination. Such employment practices include but are not limited to the following:
hiring, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff, termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship.
The Subrecipient agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting agency setting forth the provisions of this nondiscrimination clause.
3. Land Covenants
The contract is subject to the requirements of Title VI of the Civil Rights Act of 1964 ( P. L. 88- 352) and 24 CFR 570. 601 and 602. In regard to the sale, lease, or other transfer of land acquired, cleared or improved with assistance provided under this contract, the Subrecipient shall cause or require a covenant running with the ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
land to be inserted in the deed or lease for such transfer, prohibiting discrimination as herein defined, in the sale, lease or rental, or in the use or occupancy of such land, or in any improvements erected thereon, providing that the Grantee and the United States are beneficiaries of and entitled to enforce such covenants. The Subrecipient, in undertaking its obligation to carry out the program assisted hereunder, agrees to take such measures as are necessary to enforce such covenant, and will not itself so discriminate.
4. Section 504
The Subrecipient agrees to comply with any Federal regulations issued pursuant to compliance with Section 504 of the Rehabilitation Act of 1973 ( 29 U. S. C. 706), which prohibits discrimination against the handicapped in any Federally assisted program. The Grantee shall provide the Subrecipient with any guidelines necessary for compliance with that portion of the regulations in force during the term of this contract.
B. Affirmative Action
1. ADDroved Plan
The Subrecipient agrees that it shall be committed to carry out pursuant to the Grantee' s specifications an Affirmative Action Program in keeping with the principles as provided in President' s Executive Order 11246 of September 24, 1965. The Subrecipient has submitted a plan for an Affirmative Action Program for approval as required by the CDBG application and by Section 3 of the Housing and Urban Development Act of 1968.
2. W/ MBE
The Subrecipient will use its best efforts to afford minority - women - owned business enterprises the maximum practicable opportunity to participate in the performance of this contract. As used in this contract, the term " minority and female business enterprise" means a business at least fifty- one ( 51) percent owned and controlled by minority group members or women. For the purpose of this definition, " minority group members" are Afro- Americans, Spanish- speaking, Spanish surnamed or Spanish - heritage Americans, Asian - Americans, and American Indians. The Subrecipient may rely on written representations by businesses regarding their status as minority and female business enterprises in lieu of an independent investigation.
3. Access to Records
The Subrecipient shall furnish and cause each of its own subrecipients to furnish all information and reports required hereunder and will permit access to its books, records and accounts by the Grantee, HUD or its agent, or other authorized Federal officials for purposes of investigation to ascertain compliance with the rules, regulations and provisions stated herein.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
4. Notifications
The Subrecipient will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer, advising the labor union of worker' s representative of the Subrecipient' s commitments hereunder, and shall post copies of the notice in conspicuous places available to employees and applicants for employment.
5. EEO/ AA Statement
The Subrecipient will, in all solicitations or advertisements for employees place by or on behalf of the Subrecipient, state that it is an Equal Opportunity or Affirmative Action employer.
6. Subcontract Provisions
The Subrecipient will include the
Civil Rights, and B, Affirmative
purchase order, specifically or
provisions will be binding upon
subcontractors.
C. Employment Restrictions
1. Prohibited Activity
provisions of Paragraphs X A,
Action, in every subcontract or
by reference, so that such
each of its own subrecipients or
The Subrecipient is prohibited from using funds provided herein or personnel employed in the administration of the program for:
political activities; sectarian or religious activities; lobbying, political patronage, and nepotism activities.
2. Labor Standards
The Subrecipient agrees to comply with the requirements of the Secretary of Labor in accordance with the Davis - Bacon Act as amended, the provisions of Contract Work Hours and Safety Standards Act, the Copeland " Anti - Kickback" Act ( 40 U. S. C. 276a - 276a- 5; 40 USC 276c) and all other applicable Federal, state and local laws and regulations pertaining to labor standards insofar as those acts apply to the performance of this contract. The Subrecipient shall maintain documentation which demonstrates compliance with hour and wage requirements of this part. Such documentation shall be made available to the Grantee for review upon request.
The Subrecipient agrees that, except with respect to the rehabilitation or construction of residential property containing less than eight ( 8) units, all contractors engaged under contracts in excess of $ 2, 000. 00 for construction, renovation or repair work financed in whole or in part with assistance provided under this contract, shall comply with Federal requirements adopted by the Grantee pertaining to such contracts and with the applicable requirements of the regulations of the Department of Labor, under 29 ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
CFR Parts 1, 3, 5 and 7 governing the payment of wages and ratio of apprentices and trainees to journey workers; provided, that if wage rates higher than those required under the regulations are imposed by state or local law, nothing hereunder is intended to relieve the Subrecipient of its obligation, if any, to require payment of the higher wage. The Subrecipient shall cause or require to be inserted in full, in all such contracts subject to such regulations, provisions meeting the requirements of this paragraph.
3. " Section 3" Clause
a. Compliance
Compliance with the provisions of Section 3, the regulations set forth in 24 CFR 135, and all applicable rules and orders issued hereunder prior to the execution of this contract, shall be a condition of the Federal financial assistance provided under this contract and binding upon the Grantee, the Subrecipient and any of the Subrecipients and subcontractors. Failure to fulfill these requirements shall subject the Grantee, the Subrecipient and any of the Subrecipient' s subrecipients and subcontractors, their successors and assigns, to those sanctions specified by the Agreement through which Federal assistance is provided. The Subrecipient certifies and agrees that no contractual or other disability exists which would prevent compliance with these requirements.
The Subrecipient further agrees to comply with these " Section 3" requirements and to include the following language in all subcontracts executed under this Agreement:
The work to be performed under this contract is a project assisted under a program providing direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U. S. C. 1701. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to low- and very low- income residents of the project area and contracts for work in connection with the project be awarded to business concerns that
provide economic opportunities for low- and very low- income persons residing in the metropolitan area in which the
project is located."
The Subrecipient further agrees to ensure that opportunities for training and employment arising in connection with a housing rehabilitation ( including reduction and abatement of lead- based paint hazards), housing construction, or other public
construction project are given to low- and very low- income persons residing within the metropolitan area in which the CDBG- funded project is located; where feasible, priority should be given to low- and very low- income persons with the service area of the project or the neighborhood in which the project is located, and to low- and very low- income participants in other HUD programs; and award contracts for work undertaken in ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
connection with a housing rehabilitation ( including reduction and abatement of lead- based paint hazards), housing
construction, or other public construction project are given to business concerns that provide economic opportunities for low - and very low- income residing within the metropolitan area in which the CDBG- funded project is located; where feasible, priority should be given to business concerns which provide economic opportunities to low- and very low- income residents within the service area or the neighborhood in which the project is located, and to low- and very low- income participants in other HUD programs.
The Subrecipient certifies and agrees that no contractual or other legal incapacity exists which would prevent compliance with these requirements.
b. Notifications
The Subrecipient agrees to send to each labor organization or representative of workers with which it has a collective bargaining agreement or other contract or understanding, if any, a notice advising said labor organization or worker' s
representative of its commitments under the Section 3 clause and shall post copies of the notice in conspicuous places available to employees and applicants for employment or training.
C. Subcontracts
The Subrecipient will include the Section 3 clause in every subcontract and will take appropriate action pursuant to the subcontract upon a finding that the subcontractor is in violation of regulations issued by the grantor agency. The Subrecipient will not subcontract with any entity where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR 135 and will not let any subcontract unless the entity has first provided it with a preliminary statement of ability to comply with the requirements of these regulations.
D. Conduct
1. Assignability
The Subrecipient shall not assign or transfer any interest in this contract without the prior written consent of the Grantee thereto; provided, however, that claims for money due to become due to the Subrecipient from the Grantee under this contract may be assigned to a bank, trust company, or other financial institution without such approval. Notice of any such assignment or transfer shall be furnished to the Grantee.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
2. Subcontracts
a. Approvals
The Subrecipient shall not enter into any subcontracts with any agency or individual in the performance of this contract without the written consent of the Grantee prior to the execution of such agreement.
b. Monitoring
The Subrecipient will monitor all subcontracted services on a regular basis to assure contract compliance. Results of monitoring efforts shall be summarized in written reports and supported with documented evidence of follow- up actions taken to correct areas of noncompliance.
C. Content
The Subrecipient shall cause all of the provisions of this contract in its entirety to be included in and made a part of any subcontract executed in the performance of this Agreement. d. Selection Process
The Subrecipient shall undertake to insure that all subcontracts let in the performance of this Agreement shall be awarded on a fair and open competition basis. Executed copies of all subcontracts shall be forwarded to the Grantee along with documentation concerning the selection process.
3. Hatch Act
The Subrecipient agrees that no funds provided, nor personnel employed under this contract, shall be in any way or to any extent engaged in the conduct of political activities in violation of Chapter 15 of Title V United States Code.
4. Conflict of Interest
The Subrecipient agrees to abide by the provisions of 24 CFR 570. 611 with respect to conflicts of interest, and covenants that it presently has no financial interest and shall not acquire any financial interest, direct or indirect, which would conflict in any manner or degree with the performance of services required under this Agreement. The Subrecipient further covenants that in the performance of this Agreement no persons having such a financial interest shall be employed or retained by the Subrecipient hereunder. These conflict of interest provisions apply to any person who is an employee, agent, consultant, officer, or elected official or appointed official of the Grantee, or of any designated public agencies or subrecipients which are receiving funds under the CDBG Entitlement program.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
5. Lobbying
The Subrecipient hereby certifies that:
a. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative
agreement;
b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or
cooperative agreement, it will complete and submit Standard Form - LLL, " Disclosure Form to Report Lobbying," in
accordance with its instructions;
C. It will require that the language of paragraph ( d) of this certification be included in the award documents for all subawards at all tiers ( including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly; and
d. Lobbying Certification - Paragraph d
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by section 1352, title 31, U. S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $ 10, 000 and not more than $ 100, 000 for each such failure.
6. Copyright
If this contract results in any copyrightable material or inventions, the Grantee and/ or grantor agency reserves the right to royalty - free, non- exclusive and irrevocable license to reproduce, publish or otherwise use and to authorize others to use, the work or materials for government purposes.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
7. Religious Organization
The Subrecipient agrees that funds provided under this contract will not be utilized for religious activities, to promote religious interests, or for the benefit of a religious organization in accordance with the Federal regulations specified in 24 CFR 570. 200( j).
XI. ENVIRONMENTAL CONDITIONS
A. Air and Water
The Subrecipient agrees to comply with the following requirements insofar as they apply to the performance of this contract:
Clean Air Act, 42 U. S. C., 7401, et seq.
Federal Water Pollution Control Act, as amended, 33 U. S. C. 1251, et seq., as amended, 1318 relating to inspection, monitoring, entry, reports, and information, as well as other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder.
Environmental Protection Agency ( EPA) regulations pursuant to 40 C. F. R., Part 50, as amended.
B. Flood Disaster Protection
In accordance with the requirements of the Flood Disaster Protection Act of 1973 ( 42 USC 4001), the Subrecipient shall assure that for activities located in an area identified by FEMA as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes ( including rehabilitation).
C. Lead - Based Paint
The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this contract shall be subject to HUD Lead - Based Paint Regulations at 24 CFR 570. 608, and 24 CFR Part 35. Such regulations pertain to all HUD - assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead- based paint. Such notification shall point out the hazards of lead- based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead- based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead- based paint is found on the property, abatement measures may be undertaken.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
D. Historic Preservation
The Subrecipient agrees to comply with the Historic Preservation requirements set forth in the National Historic Preservation Act of 1966, as amended ( 16 U. S. C. 470) and the procedures set forth in 36 CFR, part 800, Advisory Council on Historic Preservation Procedures for Protection of Historic Properties, insofar as they apply to the performance of the contract.
In general, this requires concurrence from the State Historic Preservation Officer for all rehabilitation and demolition of historic properties that are fifty years old or older or that are included on a Federal, state, or local historic property list.
XII. SEVERABILITY
If any provision of this Agreement is held invalid, the remainder of the Agreement shall not be affected thereby and all other parts of the Agreement shall nevertheless be in full force and effect.
ATTACHMENT 1
CDBG 1995- 1996 Subrecipient Agreement
FSNB-/ Mental Health Clinic Site Acquisition
IN WITNESS WHEREOF, the Parties have executed this contract as of the date first written above.
Grantee)
By: i// i i//
MAYOR
Attest:
Subrecipient)
Title: i4:
By:
CITY CLE K
Titl
Counet` e i ned:
IV FINANCEDIRECTO
FSNBCLSITE/ CDBG7/ TXTLIB7
ATTACHMENT 1
EXHIBITS " A"
CDBG GRAND APPLICATION - 1995- 1996
III. PROPOSAL/ PROJECT DESCRIPTION
A. Give the measurable goals of the overall project and the community need( s) the project proposes to address. Explain how the project is intended to benefit primarily low and moderate income persons.
The primary goal of this project is to purchase a clinic which will provide a suitable treatment center, lower costs and allow FSNB to continue to meet the goals previously set forth, ie; 1) To provide affordable counseling to low income families and children, and 2) To develop and maintain stability in the life of the patient while they are assisted in solving interpersonal problems which have created dysfunction in their lives.
The community need( s) the project proposes to address are: 1) To acquire an adequate clinical setting in which to provide services; 2) To provide low cost mental health counseling services; 3) To reduce the potential number of mentally ill dysfunctional families. This project will also save the community considerable dollars because of psychiatric
hospitalization prevention. All citizens of the City of Napa are eligible for Outpatient services. Currently, approximately 80% of the patients seen for Counseling services are low income families. Family income is verified at the point of entry.
B. Specify the proposed services and/ or activities to be carried out with this funding request. Please prioriti% e your proposed services/ activities from " most important" to not as critical". Indicate the timetable for completion of these activities. Timetable must include activity
description, measurable goal for the activity and time
frame in which activity is expected to be complete.
The major thrust of this request is to acquire enough revenue to make a " down payment" for a clinic that will serve Outpatients, Satellite Housing Program residents, and people that are involved with the Big Brothers / Big Sisters program. The most important activity of this organization is to continue to provide a variety of mental health services to the citizens of the Napa community.
Related to this project would be the activities as follows:
1) Identification of a suitable site with a minimum of
seven consultation rooms with a waiting room and
reception area;
2) Negotiation of an acceptable offer for the site;
3) Site acauisition and relocation.
C. How many individuals, by the following categories, are expected to benefit from this project in this fiscal year? 6 -
ATTACHMENT 1
250 Low Income
125 Moderate Income
550 City of Napa Residents
75 Youth ( under 18 yearp of age)
50 Elderly
50 Disabled
1100 Total Un - duplicated Individuals
D. How is eligibility determined and tracked? Please provide a sample application.
All citizens of City of Napa and Napa County are eligible for services of this organization. For specific record keeping forms please see the appendix for Counselor forms ranging from intake to ongoing counseling record keeping notations.
CDBG GRANT APPLICATION - 1995- 1996
E. Please provide a detailed organizational chart for the proposed project. Include, at minimum: Name/ position of person responsible for project management; Staff positions and job titles; non - paid staff who will support this
project. Indicate with asterisks (*) all positions to be partially or fully funded with CDBG funds and primarily — funded. Indicate any other job responsibilities that any fully/ partially funded CDBG position would be required to complete.
Responsible for project management:
Ken Merritt, Ph. D.; Executive Director, FSNB;
Sue Workman; Director, Satellite Housing Program;
Tara Arnold; Clerical Support;
CDBG funds are not being requested to fund staff positions for this porject.)
F. For funding of new positions, please provide a timeline for hiring and anticipated start date.
This project does not include the addition of new positions.
G. Has a similar project been attempted by your agency or or another local organization in previous years? Please describe.
FSNB has been providing professional psychotheraputic services for the past forty five years. We are not aware of other agencies attempting a project such as we are proposing. There are, however, other organizations that provide paraprofessional services and temporary types of services that do not always meet 7 -
ATTACHMENT 1
EXHIBITS " B"
ORGANIZATION/ AGENCY BUDGET
Revissed 2121 / 95 City of Napa 1995- 1996 Grant Appficaticn euticet Woricimet # 1
A I
NORTH BAY YEAR YEAR YEAR YEAR
PROJECT: COMBINED. 1592- 1993 1993. 1994 1994- 1995 1995. 19%
INCOMEIREVENUE - ALL SOURCES ACTUAL ACTUAL ESTIMATED ESTIMATED 1 Napa COBG 160.000 162000 183636 174000
2 Napa- Solano United Way 759003 711035 52103 112000
3 Contnbutions/ Donations 14842 1( 1785 3150 1500
4 City of Napa 0 0 0
5 County of Napa 71, 051 73051 73051
6 Other Grants/ Fees 3403 6961 12200 25, 000
7 Membership Dues 0 0 0
e Sales/ Fundraisers 2547 3769 2200 2500
9 Investment Income or Gains 527 169 500 600
10 Service Fees 127, 284 103967 102000 102000
t1 Miscellaneous Revenue 62941 50.063 1 511000 53500
1114 10 96942 I W100
EXPENSES
12 Salaries 194549 17& 831 179, 946 171, 800
13 Employee Benefits 8. 630 11, 965 9, 483 12500
14 Payroll Taxes, etc. 15560 16079 15, 500 17, 500
15 Profressional Fees/ ConV2ct 6780 9, 409 9, 353 9, 400 16 Supplies 5,682 3, 211 3000 3303
17 Telephone 17, 046 1$ 789 1(1214 1QSoo
18 Postage/ Shipping 2292 11500 1, 414 1, 500
19 Occupancy ( rent, etc.) 34, 500 3(1983 35. 643 3& 000 20 Utilities 3707 3343 3. 400 3500
21 All Insurance 13715 16589 16849 1Qoo0
22 Equip. Rental/ Maintenance 2628 7, 093 4, 260 000
23 Equip. Purchase 2300 6, 943 2242 4, 000
24 PrintlngtPubtications 11096 2086 2200 2100
25 Local Travel 1, 738 2013 2100 2600
23 Conferences, Meetings 400 400 400 1, 000
27 Individual Assistance
28 Membership Dues 1, 100 1, 100 1, 100 1,210
29 Site Purchase 150, 090 154000 171, 53e 154000
30 Subsidies 47, 506 2& 215 13000 16000
31 Fundraising 1, 549 1, 549 1, 500 2000
32 1Miscellaneous 3220 I 3285 1 5500 5700
TOTAL EXPENSES 514100 I $ 497, 3e4 I $ 496,742 I $ 483510 EXCESS ( DEFICIT) REVENUE $ 11398 1 $ 1, 416 $ 200 1 $ 490 ATTACHMENT 1
GUMC. AC)WNISTRATNEOFFICES. BIGBRCTHERS/BIGS -rm 8 SATELUTEHOUSWGACCUISTTICN
PRCJECTBUDGET
Revised 4/ 18/ 95 Qty of Napa 19851WS Grant Appicadort
NCRTH SAY
I
YEAR
PROJECT: CLNC PURCHASE 1992. 1983
1 Nada CCBG
2 NaoaSclarm United Way
3 ContnbutlonsMonaCdns
4 City of Napa
5 County cf Napa
6 Other Grants/ Fees
7 Membership Dues
8 Uss/ Funoraisers
9 Investment Income ar Gans
10 Service Fees
11 Miscellaneous Revenue
12 Salaries
13 Employee Benefits
14 Payroll Taxes, etc
15 Prcfrassidnal Fees/ Contract
to Supplies
17 Telephone
19 Postage/ Shipping
19 Occucancy ( ren[ ata)
20 UNltles
21 As Insurance
22 Equio. Rema/ Maimerence
23 Equib. Purchase
24 PrtMMg/FJWCaIJCM
25 Local Travel
25 Conferences, Meetings
27 Individual Assistance
29 Membership Oues
9 Clinic Purchase
30 Subsidles
31 Funcraising
32 Miscellaneous
Le
YEAR
19831994
YEAR YEAR
19941965 I 199& 19a
11, 234
641
7, 436
z300
200
1,500
75 1QSSQ
5M
t 500
Soo
800
i•
ATTACHMENT 1
I
CJNIC, ADSANISTRATMEOFFICES, BIGBROTHERS/BIGSGTER5. & SATEUTEHOUSINGACCU4WON
STAFF AND NON -STAFF COSTS ,
CONIC PURCHASE
Palmed 4118195 CW of Naha 19951988 Gran[ APOMIon
Bud= WaMsheet # 3
NAME TMLE FTE
1992- M
ACTUAL
1993- 94
BUDGETED
1590. 95
PROPOSED
MMMMVIT
CDBG
BfT1IL ME= 11
re
As needed Equip. Purchase 9
Sue Worlow Program Olreclar 01
is SM
3,0. 8 N/ A
Tara Amald Admirsst Assist Ot 1, 978 WA
NON - STAFF COSTS
BUDGET TOTAL
MEWS) BUDGET CIASSIF. COST EXPI-ANATTCN OF NEED
nor repays 72 re
As needed Equip. Purchase 9 600 Equips purchases
Praf. assistance Prof. fees/ conram is SM Boo* eeper, Audit Bark charges.
Mortgage & Rem Occupant."/ 19 t4s60 Sacmamhs rent 8
sat marrir* mortgage.
ATTACHMENT 1
1. SUE
Name:
A=
Number & Streec
City. State &' a C
4. STATUS CF
FM E?. AL
FUNCS
C. -i - Y OF NAPA MIBIT " C"
COMMUNITY OEVE° OPME T. BLOCKGRANT (COSL:) PROGRAM
RECUEST FOR FUNDS
IZA
Ucnm, day. yam)
Ia. Cash on hand beginning at rewning oedcd
b. Beginning advaaCe
c Tata) cash available (sum of a and b)
d Cross
E erctse. Fadera; ragraii: ln= me `
f. Ner d1stursements (Ule d minus fine e)
gg. Adius.- nems of Cncr aerlcds
h. C< sz on hand and of reccrt* ericd
S. e .SAMCUNT3-:CWNCNLSNE4Hnc FcBcrfISCASHAS :UME-lAE4T3FCRTriEz-NS:ilNr.2 LAYS CR i HS ? A- V CAPS OFA REMSUFSEUE" f i )
1C I1VG .. G' lJ1 r': N_ L" &
r
Wales and Satanea
Benefits
C er materials and ser/ ices
Ce-: utiFaCA i CCN
t caraty ca S .aes GNATJRc
cweega
2c,
ct
aery
AL77- 1csc=
Crisreaarta ,^.:a in altra-
SawG anC ,^. s au esvrsa- I czRTIF, NC l' F CR ? tN utME LVC , Tu mw= Mwe eeart Mata fee
a cureca am cnataw= CF - CAL
at tre GZnr er ac- eemenr I - C E
ccer• v1 , v. CA
3ALANCS CF' :. YAC' AmCum
ATTACHMENT 1
STATE: CALIFORNIA
PREPARED: 12- 10- 94 PROGRAM
NSA San Diego, CA
1 FY 1995 MEDIAN FAMILY VERY LOW- INCOME
L I M I T
INCOME: 45400 LOW- INCOME
PMSA
3 PERSON
Sen Francisca, CA
5 PERSON 6 PERSON
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
18150
INCOME: 58800 LOW- INCOME
PMSA
20150
Sen Jose, CA
25400 29050
FY 1995 MEDIAN FAMILY VERY LOW- tNCOME
42150
INCOME: 84200 LOW- INCOME
PMSA
26600
t San Lula Oblspo- Alascadaro- Pas
32200
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
28150
INCOME: 42300 LOW- INCOME
NSA
46650
I Santa Barbara - Santa Marle- Lomp
22450
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
34650
INCOME: 47500 LOW- INCOME
PMSA
32150
Santa Crus- Watsonvllls, CA
43400
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
14800
INCOME: 51500 LOW- INCOMk
PMSA
24550
Santa Rosa, CA
27900
23700
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
36550
INCOMEi 48400 LOW- INCOME
NSA
19800
Stockton - Lodi, CA
24750 26750
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
27700
INCOMES 40200 LOW- INCOME
PMSA 1 Vallelo- Hlrt Nld- Napa, CA
52250
FY 1998 MEDIAN FAMILY VERY LOW- INCOME
28000
INCOMES 47800 LOW- INCOME
PMSA
28180
t Ventura, CA
36200 40200
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
53050
INCOME: 57900 LOW- INCOME
NSA
28150
Vlealls- lulare- Portsrvllls, CA
30000
FY 1995 MEDIAN FAMILY VERY LOW- INCOME
34650
INCOME: 31200 LOW- INCOME
PMSA
51100
t Y¢$ o, Cfi
16100 18100
FV G99.5 MENCAM PAMILY VERY L"- ARl rwklE
24900
I A+ri3M', : 44y+ s: LOIS- 9 NCOME
A
1 N C 0 M E L I M I T S --------------------------
I PERSON2 PERSON3 PERSON4 PERSON5 PERSON6 PERSON7 PERSON6 PERSON 15900 18150 20450 22700 24500 26350 20150 29950
25400 29050 32700 36300 39200 42150 45050 47950
20650 23850 26600 29800 32200 34550 36950 39350
28150 32150 36200 40200 43400 46650 49850 53050
22450 25700 28900 32100 34650 37250 39800 42350
26150 32150 36200 40200 43400 46650 49850 53050
14800 16900 19050 21150 22850 24550 28250 27900
23700 27050 30450 33850 36550 39250 41950 44650
17350 19800 22250 24750 26750 38700 30700 32650
27700 31700 35650 39600 42750 45950 49100 52250
19600 22400 25200 28000 30250 32500 34700 36950
28180 32150 36200 40200 43400 46650 498150 53050
16950 19350 21600 24200 28150 26050 30000 31950
27100 31000 34650 38700 41800 44900 46000 51100
14050 16100 18100 20100 21700 23300 24900 26560
22500 25750 26950 32150 34750 37300 39900 42450
16750 19100 21600 23900 25800 27700 29650 31660
26760 30600 34400 39250 41300 44350 47400 50500
20250 23150 26050 26950 31260 33600 35900 36200
28150 32150 36200 40200 43400 46650 49650 53050
11950 13700 15400 17100 18450 19850 21200 22550
19150 21900 24600 27350 29550 31750 33950 36100
1544 t7 a.^v0 9£ l 2215Y 2175Q 25500 27300 29050
24650 i1150 7117:' 10 3520^ 3601170 40650 43650 46450
ATTACHMENT 1
EXHIBIT " E"
570. 504 Program income.
c) Disposition of program income received by, subrecipients. The written agreement between the recipient and the subrecipient, as required by § 570. 503, shall specify whether program income received is to be returned to the recipient or retained ' my the subrecipient. Where program income is to be retained by the subrecipient, the agreement shall specify the activities that will be undertaken with the program income and that all provisions of the written agreement shall apply to the
specified activities. When the subrecipient retains program income, transfers of grant funds by the recipient to the subrecipient shall be adjusted according to the prir. iciples described in paragraphs ( b)( 2)( i) and ( ii) of this € cctici.
Any program income on hand when the agreement expiyeas, or received after the agreement' s expiration, shall be i;>ei, d to the recipient as required by § 570. 503( b)( 8).
ATTACHMENT 1
S70. 502 Applicability of uniform administrative requirements..
EXHIBIT " F" ( a) Recipients and subrecipients which are governmental entities including public agencies) shall. comply with the requirements and standards of OMB ' Circular * No. A- 87, ' Principles for Determining Costs Applicable to Grants and Contracts with State, Local and Federally recognized Indian Tribal
Governments", OMB Circular A- 128, " Audits of State and Local Governments" ( implementedat 24 CFR Part 44) and with the following sections of 24 CFR Part 85 " Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments":
1) Section 85. 3, " Definitions";
2) Section 85. 6, " Exceptions";
3) Section 85. 12, " Special grant or subgrant conditions for high- risk' grantees";
4) Section 85. 20, " Standards for financial management systems," except paragraph ( a);
5) Section 85. 21, " Payment," except as modified by § 570. 513; 6) Section 85. 22, " Allowable costs";
7) Section 85. 26, " Non- federal audits";
8) Section 85. 32, " Equipment," except in all cases in which the equipment is sold, the proceeds shall be program
income;
t9), Section 85. 33, " Supplies";
10) Section 85. 34, " Copyrights";
11) Section 85. 35, " Subawards to debarred and suspended parties";
12) Section 85. 36, " Procurement," except paragraph ( a); 13) Section 85. 37, " Subgrants";
14) Section 85. 40, " Monitoring and reporting program
performance," except paragraphs ( b) through ( d) and
paragraph ( f);
15) Section 85. 41, " Financial reporting," except paragraphs a),( b), and ( e);
16) Section 85. 42, " Retention and access requirements for records",
17) Section 85. 43, " Enforcement";
18) Section 85. 44, " Termination for convenience";
19) Section 85. 51, " Later disallowances and adjustments" and 20) Section 85. 52, " Collection of amounts due."
b) Subrecipients, except subrecipients which are governmental entities, shall comply with the requirements and standards of OMB Circular No. A- 122, " Cost Principles for Non Profit Organizations" or OMB Circular No. A- 21, " Cost Principles for Educational Institutions," as applicable, and with the
following Attachments to OMB Circular No. A- 110:
1) Attachment A. " Cash Depositories", except for paragraph 4 concerning deposit insurance:
2) Attachment B, " Bonding and Insurance";
ATTACHMENT 1
3) Attachment C, " Retention and Custodial Requirements for Records", except that in lieu of the provisions in
paragraph 4, the retention period for records pertaining to individual CDBG activities starts from the date of
submission of the annual performance and evalueuicn
report, as prescribed in § 570. 507, in which the specific activity is reported on for the final time;
4) Attachment F, " Standards for Financial Management
Systems";
5) Attachment H, " Monitoring and Reporting Program
Performance," paragraph 2,-
6) 6) Attachment N, " Property Management Standards", except for paragraph 3 concerning the standards for real prop(, r ty, and except that paragraphs 6 and 7 are modified so cfirat = i) In all cases in which personal property is sold, the proceeds shall be program income, and
Personal property not needed by the subrecipie?> t. for CDBG activities shall be transferred to the recz.> i-c•; t' for the CDBG program or shall be retained <:£ tc— r
compensating the recipient; and
7) Attachment O, " Procurement Standards."
12/ as
ATTACHMENT 1
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ATTACHMENT 1
RECORDING REQUESTED BY
Fidelity National Title Company
When Recorded Mail To:
The City of Napa
P. O. Box 660
Napa, CA 94559
Escrow No. 115106 - JM
Title Order No. 115106
APN: 003- 206004
JPN
AEC p9
F9 1996 008777
OFFICIAL RECORDS OF
9A y NAPA COUNTY
q
00UNTl
GP
H. KATHLEENBONDS
ATREOUESTOF:
FIDELITYNATIONALTITLE04/ 12/ 1996 08: 00 AMFee: $ 20. 00 PgS:TT 3 00 SPACE ABOVE THIS UNE FOR RECORDER' S USE
SHORT FORM DEED OF TRUST AND ASSIGNMENT OF RENTS
THIS DEED OF TRUST, made April 1, 1996 , between
Family Service of the North Bay, A California Non - Profit Corporation herein called TRUSTOR, whose address is
709 Franklin Street, Napa, CA 94559
FIDELITY NATIONAL TITLE COMPANY, a corporation, herein called TRUSTEE, and The City of Napa
herein called BENEFICIARY,
WITNESSETH: That Trustor IRREVOCABLY GRANTS, TRANSFERS AND ASSIGNS to TRUSTEE IN TRUST, WITH POWER OF SALE, that property in NAPA County, California, described as:
COMMONLY KNOWN AS: 709 Franklin Street, Napa, CA 94559
Legal Description Attached Hereto Marked Exhibit " A" and Made a Part Hereof TOGETHERWITH the rents, issues and profits thereof, SUBJECT, HOWEVER, to the right, power and authority given to and conferred upon Beneficiary by paragraph (10) of the provisions incorporated herein by reference to collect and apply such rents, issues and profits.
For the Purpose of Securing: 1. Performance of each agreement of Trustor incorporated by reference or contained herein, 2. Payment of the indebtedness evidenced by one promissory note of even date herewith, and any extension or renewal thereof, in the principal sum of $ 150, 000. 00 executed by Trustor in favor of Beneficiary or order. 3. Payment of such further sums as the then record owner of said property hereafter may borrow from Beneficiary, when evidenced by another note ( or notes) reciting it is so secured. 1 INITIALS
FPS Rev. 3/ 98 SHORT FORM DEED OF TRUST Page No. 1 of 4 ATTACHMENT 1
APN: 003- 206004 Escrow No. 115106 - JM
To Protectthe Security of this Deedof Trust, TrustorAgrees: Bythe executionanddeliveryof this Deedof Trustandthe notasecuredhereby, thatprovisions (1) to (14), inclusive, ofthefictitiousdeedoftrustrecordedin SantaBarbaraCounty andSonomaCountyOctober18, 1961, andinallothercountiesOctober23, 1961, inthebookandatthepageof Official Recordsinthe officeof the countyrecorderof thecountywheresaidpropertyislocated, notedbelowoppositethe nameof such county, viz:
COUNTY BOOK PAGE COUNTY BOOK PAGE COUNTY BOOK PAGE COUNTY BOOK PAGE Alameda 435 684 Kings 792 833 Placer 895 301 Sierra 29 334 Alpine 1 250 Lake 362 39 Plumas 151 5 Siskiyou 468 181
Amador 104 348 Lassen 171 471 Riverside 3005 523 Solano 1105 182 Butte 1145 1 Los Angeles T2055 899 Sacramento 4331 62 Sonoma 1851 689 Calaveras 145 152 Madera 810 170 San Benito 271 383 Stanislaus 1715 456 Colusa 296 617 Marin 1508 339 San Bernardino 5567 61 Sutter 572 297 Contra Costa 3978 47 Mariposa 77 292 San Francisco A332 905 Tehama 401 289 Del Norte 78 414 Mendocino 579 530 San Joaquin 2470 311 Trinity 93 366 EI Dorado 568 456 Merced 1547 538 San Luis Obispo 1151 12 Tulare 2294 275 Fresno 4626 572 Modoc 184 851 San Mateo 4078 420 Tuolumne 135 47 Glenn 422 184 Mono 52 429 Santa Barbara 1878 860 Ventura 2062 386 Humboldt 657 527 Monterey 2194 538 Santa Clara 5336 341 Yolo 653 245 Imperial 1091 501 Napa 639 86 Santa Cruz 1431 494 Yuba 334 486 Inyo 147 598 Nevada 305 320 Shasta 684 528
Kern 3427 60 Orange 5889 611 San Diego Series 2 Book 1961, Page 183887 which provisions, identical in all counties, ( printed on the attached unrecorded pages) are hereby adopted and incorporated herein and made a part hereof as fully as though set forth herein at length; that Trustor will observe and perform said provisions; and that the referencesto property, obligations and parties in said provisions shall be construed to referto the property, obligations, and parties set forth in this Deedof Trust.
The undersigned Trustor requests that a copy of any Notice of Defaultand of any Notice of Sale hereunder be mailed to him at his address hereinbefore set forth.
personally known to me ( or proved to me on the basis of satisfactory evidence) to be the person( s) whose name(-' is/are- subscribed to the within instrument and acknowledfed to me that - ga/ she/ AhW executed the same in -his/ her/ 1 - authorized capacitylYper, and that by his/ her/ thel - signatul pw on the instrumentthe person, or the entityuponbehalfof
whichtheperson(o acted, executedtheinstrument.
WITNESS my hand and official seal.
Signature
0 tit: 1 4- 4 -
family ervice of the N rth Bay A CAaF
by: Sigri C. Price, Pres.
M°"`' P'"
JANE MURPHY
COMM. # 1017193 z
Z Notary Public — California Z
Z NAPA COUNTY
My Comm. Expires OCT 17, 1997
FD - 221 B ( Rev 3/ 94) SHORT FORM DEED OF TRUST Page No. 2 of 4 ATTACHMENT 1
END gFDOCUMENT
rder No.: 115106 - SP
LEGAL DESCRIPTION
EXHIBIT " A"
The land herein referred to is situated in the State of California, County of Napa, City of Napa and is
described as follows:
COMMENCING at a point formed by the intersection of the Northern line of Fourth Street with the Southwestern line of Franklin Street; and running thence Northwesterly along said line of Franklin Street, 70 feet; thence at right angles Southwesterly 100 feet; thence at right angles Southeasterly in a direct line to the aforesaid Northern line of Fourth Street; and thence Easterly along said last mentioned line to the point of commencement.
Being a portion of Block P as the same is laid down and delineated upon a certain map entitle, " Supplemental Map of Napa City", filed January 7, 1873 in Book 1 of Maps, at page 40 in the office of the County Recorder of said Napa County.
APN: 003- 206- 004
ATTACHMENT 1
APM 003- 206004 _,
crow No. 115106— JM
DO NOT RECORD
Thefollowingisacopyofprovisions (1) to (14), inclusive, ofthefictitiousdeedoftrust, recordedineachcountyinCalifornia, asstatedintheforegoing DeedofTrustandincorporatedbyreferenceinsaidDeedofTrustasbeingapartthereofasifsetforthatlengththerein.
To Protectthe Security of this Deedof Trust, Trustoragrees:
1) Tokeepsaidpropertyingoodconditionandrepair; nottoremoveordemolishanybuildingthereon; tocompleteorrestorepromptlyandingood andworkmanlikemanneranybuildingwhichmaybeconstructed, damagedordestroyedthereonandtopaywhendueallclaimsforlaborperformed andmaterialsfurnishedtherefor; tocomplywithalllawsaffectingsaidpropertyorrequiringanyalterationsorimprovementstobemadethereon; not tocommitorpermitwastethereof; nottocommit, sufferorpermitanyactuponsaidpropertyinviolationoflaw; tocultivate, irrigate, fertilize, fumigate, pruneanddo all otheractswhichfromthecharacteror useof saidpropertymaybereasonablynecessary, the specificenumerationshereinnot excluding the general.
2) To provide, maintainand deliverto Beneficiaryfire insurancesatisfactoryto andwith losspayableto Beneficiary. Theamountcollectedunderany fireorotherinsurancepolicymaybeappliedbyBeneficiaryuponanyindebtednesssecuredherebyandinsuchorderasBeneficiarymaydetermine, oratoptionofBeneficiarytheentireamountsocollectedoranypartthereofmaybereleasedtoTrustor. Suchapplicationorreleaseshallnotcureor waiveanydefaultor noticeof defaulthereunderor invalidateanyactdonepursuantto suchnotice. 3) Toappearinanddefendanyactionorproceedingpurportingto affectthesecurityhereofortherightsor powersof BeneficiaryorTrustee; andto payallcostsandexpenses, includingcostofevidenceoftitleandattorney'sfeesinareasonablesum, inanysuchactionorproceedinginwhich BeneficiaryorTrusteemayappear, andinanysuitbroughtbyBeneficiarytoforeclosethisDeed. 4) Topay: atleasttendaysbeforedelinquencyalltaxesandassessmentsaffectingsaidproperty, includingassessmentsonappurtenantwaterstock; whendue, allincumbrances, chargesandliens, withinterest, onsaidpropertyoranypartthereof, whichappeartobepriororsuperiorhereto; allcosts, fees and expenses of this Trust.
ShouldTrustorfailto makeanypaymentorto do anyactashereinprovided, thenBeneficiaryor Trustee, butwithoutobligationsoto doand withoutnoticeto or demanduponTrustorandwithoutreleasingTrustorfromanyobligationhereof, may: makeor do thesamein suchmannerandto suchextentaseithermaydeemnecessaryto protectthesecurityhereof, BeneficiaryorTrusteebeingauthorizedtoenteruponsaidpropertyforsuch purposes; appearin anddefendanyactionorproceedingpurportingtoaffectthesecurityhereofortherightsorpowersofBeneficiaryorTrustee; pay, purchase, contestor compromiseanyincumbrance, chargeor lienwhichinthejudgmentof eitherappearsto beprioror superiorhereto; and, in exercisinganysuchpowers, paynecessaryexpenses, employcounselandpayhisreasonablefees. 5) TopayimmediatelyandwithoutdemandallsumssoexpendedbyBeneficiaryorTrustee, withinterestfromdateofexpenditureattheamount allowedbylawineffectatthedatehereof, andto payforanystatementprovidedforbylawineffectatthedatehereofregardingtheobligation securedherebyanyamountdemandedbytheBeneficiarynottoexceedthemaximumallowedbylawatthetimewhensaidstatementisdemanded. 6) Thatanyawardofdamagesinconnectionwithanycondemnationforpublicuseoforinjurytosaidpropertyoranypartthereofisherebyassigned and shall be paid to Beneficiarywho may apply or releasesuch moneysreceivedby him in the samemannerand with the sameeffectas above provided for disposition of proceeds of fire or other insurance. 7) Thatby acceptingpaymentofanysumsecuredherebyafteritsduedate, Beneficiarydoesnotwaivehisrighteitherto requirepromptpayment when due of all other sums so secured or to declare fault for failure so to pay. 8) Thatatanytimeorfromtime -to -time, withoutliabilitythereforandwithoutnotice, uponwrittenrequestof BeneficiaryandpresentationofthisDeed andsaidnoteforendorsement, andwithoutaffectingthepersonalliabilityofanypersonforpaymentoftheindebtednesssecurehereby, Trusteemay:
reconveyonlypartof saidproperty; consenttothemakingofanymaporplotthereof; joiningrantinganyeasementthereon; orjoininanyextension agreementoranyagreementsubordinatingthelienorchargehereof. 9) Thatuponwrittenrequestof Beneficiarystatingthatallsumssecuredherebyhavebeenpaid, anduponsurrenderofthisDeedandsaidnoteto Trusteefor cancellationand retentionand upon paymentof its fees, Trusteeshallreconvey, withoutwarranty, the propertythenheld hereunder. The recitalsin suchreconveyanceof anymattersorfactsshallbeconclusiveproofofthetruthfulnessthereof. Thegranteeinsuchreconveyancemaybe describedas "the personor personslegallyentitlethereto." Fiveyearsafterissuanceof suchfull reconveyance, Trusteemaydestroysaid noteandthis Deed ( unless directed in such request to retain them). 10) Thatas additionalsecurity, Trustorherebygivesto and confersupon Beneficiarythe right, powerand authority, duringthe continuanceof these Trusts, to collect the rents, issues and profits of said property, reserving unto Trustor the right, prior to any default by Trustor in payment of any indebtednesssecuredherebyorinperformanceofanyagreementhereunder, to collectandretainsuchrents, issuesandprofitsastheybecomedue andpayable. Uponanysuchdefault, Beneficiarymayatanytimewithoutnotice, eitherinperson, byagent, orbya receivertobeappointedbyacourt, and without regard to the adequacy of any security for the indebtedness hereby secure, enter upon and take possession of said property or any part thereof, in his own name sue for or otherwise collect such rents, issues and profits, including those past due and unpaid, and apply the same, less costsand expensesof operationand collection, includingreasonableattorney's fees, uponany indebtednesssecuredhereby, and in suchorderas Beneficiarymay determine. The entering upon and taking possessionof said property, the collectionof such rents, issuesand profits and the applicationthereofasaforesaid, shallnotcureor waiveanydefaultor noticeofdefaulthereunderor invalidateanyactdonepursuantto suchnotice. 11) ThatupondefaultbyTrustorin paymentof anyindebtednesssecuredherebyorin performanceof anyagreementhereunder, Beneficiarymay declareall sums securedherebyimmediatelydue and payableby deliveryto Trusteeof writtendeclarationof default and demandfor saleand of written notice of default and of election to cause to be sold said property, which notice Trustee shall cause to be filed for record. Beneficiary also shall deposit with Trustee this Deed, said note and all documents evidencing expenditures secured hereby.
INITIALS
FD - 221 B ( Rev 3/ 94) SHORT FORM DEED OF TRUST Page No. 3 of 4 ATTACHMENT 1
APN: O( X3- 206004 DO NOT RECORD Escrow No. 115106— JM
Afterthelapseofsuchtimeasmaythenberequiredbylawfollowingtherecordationofsaidnoticeofdefault, andnoticeofsalehavingbeengiven asthenrequiredbylaw, Trustee, withoutdemandonTrustor, shallsellsaidpropertyatthetimeandplacefixedbyitinsaidnoticeofsale, eitherasa wholeorinseparateparcels, andinsuchorderasit maydetermine, atpublicauctiontothehighestbidderforcashinlawfulmoneyoftheUnited States, payableattimeof sale. Trusteemaypostponesaleof allor anyportionof saidpropertybypublicannouncementatsuchtimeandplaceof sale, andfromtime -to -timethereaftermaypostponesuchsalebypublicannouncementatthetimefixedbytheprecedingpostponement. Trustee shalldelivertosuchpurchaseritsdeedconveyingthepropertysosold, butwithoutanycovenantorwarranty, expressorimplied. Therecitalsinsuch deedofanymattersorfactsshallbeconclusiveproofofthetruthfulnessthereof. Anyperson, includingTrustor, Trustee, orBeneficiaryashereinafter defined, may purchase at such sale.
Afterdeductingallcosts, feesandexpensesofTrusteeandofthisTrust, includingcostofevidenceoftitleinconnectionwithsale, Trusteeshall applytheproceedsofsaletopaymentof: allsumsexpendedunderthetermshereof, notthenrepaid, withaccruedinterestattheamountallowedby lawIneffectatthedatehereof; allothersumsthensecuredhereby; and theremainder, ifany, tothepersonorpersonslegallyentitledthereto. 12) Beneficiary, oranysuccessorinownershipofanyindebtednesssecuredhereby, mayfromtime -to -time, byinstrumentinwriting, substitutea successororsuccessorstoanyTrusteenamedhereinoractinghereunder, whichinstrument, executedbytheBeneficiaryanddulyacknowledgedand recordedin the officeof the recorderof the countyor countieswheresaidpropertyissituated, shallbe conclusiveproofof propersubstitutionof such TrusteeorTrustees, whoshall, withoutconveyancefromtheTrusteepredecessor, succeedto all itstitle, estate, rights, powersandduties. Said instrumentmustcontainthenameoftheoriginalTrustor, TrusteeandBeneficiaryhereunder, thebookandpagewherethisDeedisrecordedandthe name and address of the new Trustee.
13) ThatthisDeedappliesto, inurestothebenefitof, andbindsallpartieshereto, theirheirs, legatees, devisees, administrator, executors, successors andassigns. ThetermBeneficiaryshallmeanthe ownerandholder, includingpledgees, of the notesecuredhereby, whetheror notnamedas Beneficiaryherein. InthisDeed, wheneverthecontextsorequires, themasculinegenderincludesthefeminineand/orneuter, andthesingularnumber includes the plural.
14) ThatTrusteeacceptsthisTrustwhenthis Deed, dulyexecutedandacknowledged, is madepublicrecordasprovidedby law. Trusteeis not obligatedto notifyanypartyheretoofpendingsaleunderanyotherDeedofTrustorofanyactionorproceedinginwhichTustor, Beneficiaryor Trustee shall be a party unless brought by Trustee.
INITIALS
REQUEST FOR FULL RECONVEYANCE
To FIDELITY NATIONAL TITLE COMPANY, Trustee:
TheundersignedisthelegalownerandholderofallindebtednesssecuredbythewithinDeedofTrust. AllsumssecuredbysaidDeedofTrusthave beenfullypaidandsatisfied; andyouareherebyrequestedanddirected, onpaymenttoyouofanysumsowingtoyouunderthetermsofsaidDeed of Trust, to cancelallevidencesof indebtedness, securedbysaidDeedofTrust, deliveredtoyouherewithtogetherwithsaidDeedofTrust, andto reconvey, withoutwarranty, tothepartiesdesignatedbythetermsofsaidDeedofTrust, theestatenowheldbyyouunderthesame.
Dated
By: By:
Please mail Reconveyance to:
DonotloseordestroythisDeedofTrustORTHENOTEwhichitsecures. BothoriginaldocumentsmustbedeliveredtotheTrusteeforcancellation before reconveyance will be made.
STATE OF CALIFORNIA
COUNTY OF
ON before me, personally appeared
personallyknownto me (or provedto meonthebasisof satisfactoryevidence) to betheperson(s) whosename(s) is/aresubscribedto thewithin instrumentand acknowledgedto me that he/she/they executedthe same in his/her/their authorizedcapacity(ies), and that by his/her/their signature(s) onthe instrumenttheperson(s), or theentityuponbehalfof whichtheperson(s) acted, executedtheinstrument.
WITNESS my hand and official seal.
Signature
FPS Rev. 3/ 88 SHORT FORM DEED OF TRUST Page No. 4 of 4 ATTACHMENT 1
DO NOT DESTROY THIS NOTE: When paid, this note, with Deed Escrow No. 115106— JM of Trust securing same, must be surrendered to Trustee for cancellation before reconveyance will be made.
STRAIGHT NOTE
DUE ON SALE CLAUSE
150, 000. 00 Napa, , California April - 1 , 19 96
Upon the sale of the property securing the within note or** after date, for value received, we, or either of. us, promiseto pay in lawful money of the United Statesof America, to The City of Napa upon failure to comply with any provision contained in that certain Agreement betweenthe City of Napaand Family Service of the North Bay for CommunityDevelop- ment Block Grant Program dated June 20, 1995 ( City of Napa " Grantee", Family Service of the North Bay " Subrecipient"), the terms of which are incorporated herein by reference
or order, at place designated by payee, the principal sum of ** One Hundred Fifty Thousand and no/ 100' s Dollars** payable as follows: As long as the security within is used for the acquisition of a mental health clinic for ( a) Napa County Program referred City of Napa satellite housing clients, ( b) outpatient counseling for City of Napa resi- dents by Family Service of the North Bay, ( c) Family Service of the North Bay City of Napa administration office, ( d) City of Napa Big Brothers/ Big Sisters partici- pants, and ( e)
City of Napa Big Brothers/ Big Sisters offices or the within security is not sold, this note will remain intact; however, should either of the above situ- ations occur, the City of Napa is entitled to and shall receive $ 150, 000. 00 plus
73. 17% of any and all equity in the subject property after standard and customary closing costs.
It is further understood by all parties that in the event the within security is sold or conveyed at an established appraised value less than the balance due herein, payment of all equity will fully satisfy the obligations contained in the within note.
The Deed of Trust securing the within Note contains the following provisions: " In the event the herein described property or any part thereof, or any interest therein is sold, agreed to be sold, conveyed or alienated by the Trustor, or by the opera- tion of law or otherwise, all obligations secured by this instrument, irrespective of the maturity dates expressed therein, at the option of the holder hereof and without demand or notice shall immediately become due and payable." THE FOLLOWING PARAGRAPH IS ONLY APPLICABLE ON ONE TO FOUR RESIDENTIAL UNITS:
This note is subject to Section 2966of the Civil Code, which provides that the holder of this note shall give written notice to the Trustor, or his successor in Interest, of prescribed information at least 90and not more than 150days before any balloon payment is due.
Principal and interest payable in lawful money of the United States of America. Should default be made in paymentof interestwhenduethewholesumof principal andinterestshallbecomeimmediatelydueattheoption of theholderofthis note. If actionbeinstitutedonthisnoteI promiseto paysuchsumastheCourtmayfix as attorney' s fees. This note is secured by a Deed of Trust in which the undersigned is named as " Trustor." Family ice o t rth
by• Si C. Price, President
FD - 30H
DO NOT DESTROY
THIS ORIGINAL NOTE
WHEN PAID, SAID ORIGINAL NOTE, TOGETHER
WITH THE DEED OF TRUST SECURING SAME,
MUST BE SURRENDERED TO TRUSTEE FOR
CANCELLATION BEFORE RECONVEYANCE
WILL BE MADE
ATTACHMENT 1
Fidelity National Title Company
707 Randolph Street
Napa, CA 94559
707) 255- 5800 * FAx ( 707) 252- 2875
BUYER/ BORROWER CLOSING STATEMENT
ESCROW NUMBER: 115106 ESCROW OFFICER COE: 04/ 12/ 96
ESCROW STATEMENT OF: Family Service of the North Bay
PROPERTY ADDRESS: 709 Franklin Street, Napa CA 94559
DEBITS CREDITS
TOTAL CONSIDERATION 205, 000. 00
DEPOSITS 3, 366. 92
NEW IST Trust Deed to:
The City of Napa 150, 000. 00
NEW 2ND Trust Deed to:
Carole A. Terry Inc. Pension Fund 52, 000. 00
PRORATIONS/ ADJUSTMENTS: FROM TO:
Taxes for 6 months @ $ 1, 358. 57 04/ 12/ 96 07/ 01/ 96 596. 26 Credit Re Repairs 8, 000. 00
Hold Re Repairs 5, 795. 00
MISCELLANEOUS ADJUSTMENTS:
TITLE CHARGES:
Owners Title Policy for $ 205, 000. 00 443. 75
RECORDING CHARGES:
Deed 10. 00
Trust Deed( s) 20. 00
ESCROW CHARGES:
Escrow Fee 250. 00
Notary Fee 20. 00
char. Contribut. Notary Fee by Jane Murphy 20. 00
ASSUMPTION CHARGES:
FIRST NEW LOAN CHARGES:
Loan Origination Fee
Discount Fee
Appraisal Fee
Credit Report Fee
Tax Service
Document Fee
Mortgage Broker
Loan Processing
Underwriting Fee
SECOND NEW LOAN CHARGES:
Prepaid Interest @ $ 15. 8900 Per Day
From: 04/ 01/ 96 To: 05/ 01/ 96 476. 70
Charitable Contribution Interest 04/ 01/ 96- 04/ 11/ 96 by 174. 79 Carole A. Terry, Inc. Pension Fund
LOAN PAYOFFS:
ADDITIONAL DISBURSEMENTS:
Fire Insurance Premium to: Bloomfield Insurance 950. 00 TOTALS 213, 561. 71 213, 561. 71
1 By:
SAVE THIS STATEMENT FOR TAB INFORMATION
ATTACHMENT 1
DFidelity National Title Company
707 Randolph Street
Napa, CA 94559
707) 255- 5800 * FAX ( 707) 252- 2875
SELLER' S CLOSING STATEMENT
ESCROW NUMBER: 115106 ESCROW OFFICER COE: 04/ 12/ 96
ESCROW STATEMENT OF: Ballati, Carbone & Drago, P. O. Box 583, Napa and CA PROPERTY ADDRESS: 709 Franklin Street, Napa CA 94559
TOTAL CONSIDERATION
Deposit
PRORATIONS/ ADJUSTMENTS: FROM
Taxes for 6 Months @ $ 1, 358. 57 04/ 12/ 96
Credit Re Repairs
TITLE CHARGES:
County Transfer Tax
Delinquent Taxes
RECORDING CHARGES:
Reconveyance( s)
ESCROW CHARGES:
Drawing Deed
Notary Fee
Doc Prep Fee( s)
Federal Express
COMMISSION•
Coldwell Banker/ Brokers of the
ASSUMPTION CHARGES:
NEW LOAN LENDER CHARGES:
LOAN PAYOFFS:
Payoff Due to: Howard R. Nunn and Anna R. Nunn
Principal Amount
Interest Per Diem @ $ 40. 3600 02/ 08/ 96
Late Charge( s)
Payoff Due to: Bruce L Ahnfeldt/ Cynthia R Ahnfeldt
Principal Amount
Interest Per Diem $ $ 4. 1600 03/ 01/ 96
ADDITIONAL DISBURSEMENTS:
ASSOCIATION/ MANAGEMENT CHARGES:
BALANCE DUE YOU
TOTALS
DEBITS $ CREDITS
205, 000. 00
TO:
07/ 01/ 96 596. 26
8, 000. 00
225. 50
4, 503. 26
30. 00
25. 00
20. 00
50. 00
40. 00
12, 300. 00
132, 089. 92
04/ 13/ 96 2, 623. 40
12. 11
13, 619. 78
04/ 13/ 96 178. 88
31, 878. 41
205, 596. 26 205, 596. 26
7 Went t0 be
3 By
SAVE THIS STATEMENT FOR TAX INFORMATION
ATTACHMENT 1
r- n -- d nuR ti Ra. Rnsm
HUD4 . 5 78
B. TYPE OF LOAN
A.
FIDELITY NATIONAL TITLE COMPANY
1. FHA 2. O FMHA 3. O NV. UNIN .
4. OVA 5. O CONV. INS.
6. File Number: ( Escrow) 7. Loan Number:
Adjustments for items paid by seller in advance
115106 - JM
107. Cour taxes 04/ 12/ 96 07/ 01/ 96 596. 26
8. Mortgage Insurance LASO ;Number. SETTLEMENT STATEMENT C. NOTE: Thisformisfurnishedtogiveyouastatementofactualsettlementcosts. Amountspaidtoandbythesettlementagentareshown. itemsmarked o.c. ' werepaidoutsidetheclosin ; theyareshownherefor informationpurposesandarenotincludedin thetotals.
D. NAME OF BORROWER:
Family Service of the North
E. NAME OF SELLER:
Ballati, Carbone & Drago
F. NAME OF LENDER:
The Citv of Napa
113.
P. O. Box 583
115.
709 Franklin Street Napa P. O. Box 660
Napa, CA 94559 CA Napa, CA 94559
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
709 Franklin Street Fidelity National Title Company 04/ 12/ 96 Napa, CA 94559
205.
206.
PLACE OF SETTLEMENT: ESCROW NO.:
707 Randolph Street
Napa, CA 94559 115106 - JM
J. SUMMARY OF BORROWER' S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
101. Contract sales price 205 000. 00
102. Personal property
103. Settlement charges to borrower ( line 1400) 1, 995. 66 104.
Adjustmentsfor itemspaidby sellerin advance
106. Ci own taxes
107. Cour taxes 04/ 12/ 96 07/ 01/ 96 596. 26
404.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117. Additional Debit Adjustments 51795. 00
118.
120. GROSS AMOUNT DUE
FROM BORROWER
213, 386. 92
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
201. Deposit Agearnest mono 3 000. 00 3, 366. 92
202. Principal amount of new loan( s) 150 000. 00
203. Existing loan( s) taken subject to
417.
418.
204. Second mortgage loan 52 000. 00
205.
206.
500. REDUCTIONS IN AMOUNT DUE TO SELLER
501. Excess de osit( see inst.)
Credit Re Repairs 81000. 00
17 193. 76
503. Existing loans) taken subject to
Adjustments for items unpaid by seller
210. Ci Town taxes
211. County taxes
212.
213.
214 - Escrow Credit( s) 20. 00
215.
216.
217.
218.
219.
220. TOTAL PAID BY/ FOR
BORROWER 213 386. 92
300. CASH AT SETTLEMENT FROMITO BORROWER
301. Gross amount due from borrower ( line 120) 213 386. 92 302. Less amounts paid by for borrower ( line 220) 213 386. 92 303. CASH ([] FROM) ( EITO) BORROWER
FPS Rev. 3/ 96
K. SUMMARYOF SELLER'STRANSACTION
400. GROSS AMOUNT DUE TO SELLER:
401. Contract sales price _ 205 000. 00
402. Personal property
403. Impound credit
404.
Adjustments for items paid by seller in advaice
406. Ci Town taxes
407. Cour taxes 04/ 12/ 96 07/ 01/ 96 5961. 26
408.
409.
410. he "' 1011,
411.
412. 8
413. 4
t1ito e
414. AA
415.
416.
417.
418.
420. GROSS AMOUNT DUE
SELLER
205, 596. 26.
500. REDUCTIONSIN AMOUNTDUE TO SELLER
501. Excessde osit( see inst.)
502. Settlement charges to seller ( line 1400) 17 193. 76 503. Existing loans) taken subjectto
504. Payoff of first mortgage loan Howard R. N 134 725. 43 Interest adjustment $ 2 f 623. 40
Interest deficit
Loan Payoff Detail - see attached
5. Payoff of second mortgage loan Bruce L 13 798. 66
Interest adjustment $ 178. 88
507.
508.
509.
Adjustments for items unpaid by seller
510. Cityown taxes
511. County taxes
512.
513.
514. Credit Re Repairs 8, 000. 00
515.
516.
517.
518.
519.
520. TOTAL REDUCTION AMOUNT
DUE SELLER 173 717. 85
600. CASH AT SETTLEMENT TO FROM SELLER
601. Gross amount due to seller ( line 420) 205 596. 26 602. Less reduction in amount due seller ( line520) 173 717. 85 603. CASH (® TO) ([] FROM) SELLER 31, 878. 41
ATTACHMENT 1
FPS 1/ 91 MUD - 1 Rev. 5/ 76
L. SETTLEMENT CHARGES
700. TOTAL SALES BROKERS COMMISSION based on rice $ 205, 000. 009 6. 000 96= 12 300. 00 PAID FROM
BORROWER' S
FUNDS AT
SETTLEMENT
PAID FROM
SELLER' S
FUNDS AT
SETTLEMENT
Division of Commission ( line 700) as follows:
701.$ to Coldwell Banker Brokers of the
702.$ 12 300. 00 to Coldwell Banker Brokers of the
703. Commission paid at settlement 12 300. 00
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan origination fee %
802. Loan discount %
803. Appraisal fee to
804. Credit report to
805. 1
806. r I'
807. Assumption fee
808. Tax service contract
809. Lender' s document preparation fee
810. Broker Fee
811. Loan Processing Fee
812. Underwriting Fee
813.
814. 2nd NEW LOAN CHARGES TOTAL see detail 301. 91
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from to @$ day
902. Mortgage insurance premium for months to
903. Hazard insurance premium for yearsto Bloomfield Insurance 9550. 00 905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance months @ $ per month
1002. Mortgage insurance months @ $ per month
1003. City property taxes - months @.$ per month
1004. County rope taxes months @ $ per month
1005. Annual assessments months @ $ per month
1006. months @ $ per month
1007. months @ $ per month
1008. AGGREGATE ADJUSTMENT M[ 19) CQXXI POKOD 010
1100. TITLE CHARGES
1101. Settlement or closing fee to Fidelity National Title Com an 250. 00 1105. Document preparation to Fidelity National Title Com an 75. 00 1106. Notary fees
1107.
FedEx ress Fees 40. 00
NotarV Fee Char. Contribut. 20. 00 20. 00
1108. Title insurance to Fidelity National Title Com an 443. 75 includes above items numbers:
1109. Lender' s coverage
1110. Owner' s coverage 205 000. 00
1111.
1112 - Taxes: County - Second 95/ 96 + Delinquent 4 503. 26 1113. Sub - escrow fee
1114.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 10. 00 ; Mortgage $ 20. 00 ; Release $ 30. 00 30. 00 30. 00 1202. City County tax stamps: Deed $ 225. 50 ; Mortgage $ 225. 50 1203. State tax/ stamps: Deed $ Mortgage $
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301.
1302. Pest inspection to
1303.
1304.
1305.
1306.
1307.
1308.
1309.
1310.
1311.
1312.
1313.
1314.
1315.
1316.
1317.
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K) 1, 995. 66 17, 193. 76 FPS 1/ 91 MUD - 1 Rev. 5/ 76
ATTACHMENT 1
0Fidelity NationalTitle Company
707 Randolph Street
Napa, CA 94559
707) 255- 5800 * FAX ( 707) 252- 2875
Escrow No.: 115106 - JM
BUYER: Family Service of the North
Closing Date: 04/ 12/ 96
HUD ATTACHMENT PAGE - BUYER
THE ITEMS ON THE ATTACHED HUD INDICATED BY P. O. C. OR * HAVE BEEN INCLUDED AT THE DIRECTION OF THE LENDER FOR DISCLOSURE PURPOSES ONLY. THE ESCROW HOLDER/ SETTLEMENT AGENT HEREIN HAS NO KNOWLEDGE OF THESE EXPENDITURES, EXCEPT AS PROVIDED BY THE LENDER.
THEY HAVE NOT AND CANNOT BE VERIFIED AS TO THE AMOUNT, THE PAYEE, NOR ACTUAL PAYMENT,
AND NO LIABILITY IS ASSUMED BY THE CLOSING AGENT AS TO THE VALIDITY AND/ OR SUFFICIENCY THEREOF.
INTEREST/ PRORATIONS/ ADJUSTMENTS: FROM
Credit Re Repairs
Hold Re Repairs
RENTS•
ASSUMPTION CHARGES:
FIRST NEW LOAN CHARGES/ CREDITS:
SECOND NEW LOAN CHARGES:
Carole A. Terry Inc. Pension Fund
Prepaid Interest @ $ 15. 8900 Per Day
From: 04/ 01/ 96 To: 05/ 01/ 96
Charitable Contribution
LOAN PAYOFFS•
ADDITIONAL DISBURSEMENTS 11- 23:
ASSOCIATION/ MANAGEMENT CHARGES:
201. SOURCE OF FUNDS:
DEBITS
TO:
5, 795. 00
DATE RCPT # RECEIVED FROM RECEIPT TYPE
01/ 24/ 96 74586 Family Service of the North Ba Initial Deposit 04/ 10/ 96 74930 Family Service of the North Ba Additional Deposit 476. 70
THIS IS A DETAILED LIST USED IN CONJUNCTION WITH THE RESPA FORM.
CREDITS
8, 000. 00
174. 79
AMOUNT
3, 000. 00
366. 92
ATTACHMENT 1
0 Fidelity National Title Company
707 Randolph Street
Napa, CA 94559
707) 255- 5800 * FAX ( 707) 252- 2875
Escrow No.: 115106 - JM
SELLER: Ballati, Carbone & Drago
Closing Date: 04/ 12/ 96
HUD ATTACHMENT PAGE - SELLER
THE ITEMS ON THE ATTACHED HUD INDICATED BY P. O. C. OR * HAVE BEEN INCLUDED AT THE DIRECTION OF THE LENDER FOR DISCLOSURE PURPOSES ONLY. THE ESCROW HOLDER/ SETTLEMENT AGENT HEREIN HAS NO KNOWLEDGE OF THESE EXPENDITURES, EXCEPT AS PROVIDED BY THE LENDER.
THEY HAVE NOT AND CANNOT BE VERIFIED AS TO THE AMOUNT, THE PAYEE, NOR ACTU: II. PAYMENT,
AND NO LIABILITY IS ASSUMED BY THE CLOSING AGENT AS TO THE VALIDITY AND/ OR SUFFICIENCY' THEREOF.
DEBITS CREDITS
INTEREST/ PRORATIONS/ ADJUSTMENTS: FROM TO:
Credit Re Repairs 8, 000. 00
RENTS:
ASSUMPTION CHARGES:
FIRST NEW LOAN CHARGES/ CREDITS:
LOAN PAYOFFS:
Principal Due to: Howard R. Nunn and Anna R. Nunn 132, 089. 92 Interest Per Diem @ $ 40. 3600 02/ 08/ 96' 04/ 13/ 96 2, 623. 40 Late Charge( s) 12. 11
Principal Due to: Bruce L Ahnfeldt/ Cynthia R Ahnfeldt 13, 619. 78 Interest Per Diem $ $ 4. 1600 03/ 01/ 96 04/ 13/ 96 178. 88 ADDITIONAL DISBURSEMENTS 11- 23:
ASSOCIATION/ MANAGEMENT CHARGES:
THIS IS A DETAILED LIST USED IN CONJUNCTION WITH THE RESPA FORM.
ATTACHMENT 1
TYPE OF AGREEMENT: CONSTRUCTION CONSULTANT SUBDIVISION
DEFERRED IMBAOVz= NT OTHER ( LIST)
NAME OF SIGNATORY: g d lj 411&
t - NAME OF OWNER ( IF DIFFERENT)
NOTES ( IF ANY) RE DOCUMENT:
EXECUTION OF AGREEMENT:
ACKNOWLEDGEMENT:
TITLE REPORT:
ssasaazsassaassaszsssssssssssss
sssssssssasssss
INSURANCE 1ST REVIEW 23M REVIEW
workers Comp.
d k -
General Liability:
A. Coverage: 0
B. Endorsements: 6/ L
C. Other:
Auto
A. Coverage:
B. Endorsements: 6/C
C. Other:
Professional/ E & O /
A. Coverage: ! ti
B. Endorsements:
C. Other:
Security: /
A. Performance Security: i' t/
B. Payment Security ( Labor & Materials):
C. Other:
D. Maintenance/ Guarantee Bond:
STAFF COORDINATOR:
DATE SUBMITTED:
1ST REVIEW DATE:
2ND REVIEW DATE:
3D REVIEW DATE:
APPROVED DATE:
NOTE: PLEASE XEEP THIS TRANSMITTAL FORM WITH CONTRACT AT ALL TIMES. odor IImm)
cwpSI: r,,-% K. CbeLdLGm
ATTACHMENT 1
1, rocesseabr:
3etional Flood seri«$
O, Box 2057 Kalispell, MT 59903-2057
fo repo" a ejaim call., 1-800- 759-8656
irHTTXORD
FLOOD POLICY DECLARATIONS
pOLICY N: 99013375882002
Policy Renewal
TYPE: DWELLING
pOLIC! PERIOD= 8/ 03/ 2007 to 8/ 03/ 2003
These Declarations are effective as of: 8/ 03/ 2002 at 12: 01 AM INSURED NA= is ADDRESS
FAMILY SVC OF THE NORTH BAY
709 FRANKLIN BT
NAPA, CA 94559- 2920
POLICY INFORMATION
PREMIUM PAYOR: Insured
IXSVMW PROPERTY ADDRESS
713 CAROLINA ST
NAPA, CA 94558- 5105
BUILDING DESCRIPTION
Single Family
One Floor
No Basement
pRODQCIM NAM A ADDRESS
PRODUCER** 00601- 00000- 000
NORTKWS6T INSVWCE AGENCY
PO box 1180
BANTA ROSA, CA 95402- 1180
PRONE# ( 707) 573- 1300
CO$!' MTTY NAMg
NAPA, CITY OF
Coverage Limitations May APPly, Refer
to your standard Flood Insurance
Policy for details.
PROGRAM FLOOD ZONE
Regular At
COVERAGE & RATING INFORMATION
NG CONTENTS
Cgveragp: $ 204, 500 Coverage: $ 33, 100
Deductible: $ 1, 000 Deductible: $ 1, 000
Rates: . 680/ . 250 Rates$ . 790/ A50
FIRST MORTGAGP. 1&
CITY OF NAPA
ATTN LISA HARPER
PO BOX 660
NAPA, CA 94559- 0660
COMMMTY NUMBER
06070700000
POLICY TEM: One Year
CO* rENT9 LOCATION
Lowest Floor Only Above
Ground Level
CONSTRUCTION
Fre- Firm
COnbtrllCtiOn
PMIUM PAID
Premium Subtotal: 943. 00
Previous Premium Subtotal: 943. 00
ICC Premium: 75. 00
CRS Discount: 153. 00
Expense Constant: 50. 00
Federal Policy fee: 30. 00
Endors* sMnt Amount: 00
Total Premium: 945. 00
21M MORTGAGEE
This DeClarationSPage, in ConjunCionWith the DoliCy. ConStitutesyOUrFloodInsurancePolicy.
IN WITNESS WHEREOF. We h%a signed this policy below and hereb anter into this InsuranCe Agreement.
INSURED COPY
Pre, - no 7/ 24/ 2002
RLD Hartford Fire Insurance Cc i- ip; uiv 11
ATTACHMENT 1
Processed by:
Nadoual Flood Services
z fly
POLICY #: 99013375882002
P. O. Bos 2057 halispell, tifT 59903- 2057
To report a claim call: 1- 800- 759- 8656
TaF, it
H%x' ioRD
FLOOD POLICY DECLARATIONS
Policy Renewal
TYPE: DWELLING
POLICY PERIOD: 8/ 03/ 2002 to 8/ 03/ 2003
These Declarations are effective as of: 8/ 03/ 2002 atM Am EIVE
FIRST MORTGAGEE NAME & ADDRESS
D
PRODUCER NAME & ADDRESS
JUL 3 0 2002
CITY OF NPA PRODUCER#:
ATTN LLISAAHARPER NORTHWEST INSUORANOCE. p,4EVC l i
r ® '
PO BOX 660 PO BOX 1180
NAPA, CA 94559- 0660 SANTA ROSA, CA 95402- 1180
POLICY INFORMATION
PREMIUM PAYOR: Insured
INSURED PROPERTY ADDRESS
713 CAROLINA ST
NAPA, CA 94558- 5105
BUILDING DESCRIPTION
Single Family
One Floor
No Basement
PHONE# ( 707) 573- 1300
COMMUNITY NAME
NAPA, CITY OF
Coverage Limitations May Apply, Refer
to your Standard Flood Insurance
Policy for details.
PROGRAM
Regular
COVERAGE & RATING INFORMATION
BUILDING
Coverage: $ 204, 500 Coverage:
Deductible: $ 1, 000 Deductible
Rates: . 680/ . 250 Rates:
INSURED NAME & ADDRESS
FAMILY SVC OF THE NORTH BAY
709 FRANKLIN ST
NAPA, CA 94559- 2920
COMMUNITY NUMBER
06020700000
POLICY TERM: One Year
CONTENTS LOCATION
Lowest Floor Only Above
Ground Level
FLOOD ZONE CONSTRUCTION
AE Pre - Firm
Construction
CONTENTS PREMIUM PAID
33, 100 Premium Subtotal:
1, 000 Previous Premium Subtotal:
ICC Premium:
790/ . 450 CRS Discount:
Expense Constant:
Federal Policy Fee:
Endorsement Amount:
Total Premium:
2ND MORTGAGEE
943. 00
943. 00
75. 00
153. 00
50. 00
30. 00
00 945. 00
This Declarations Page, in conjuncion with the policy, constitutes your Flood Insurance Policy.
IN WITNESS WHEREOF, we ha signed this policy below and hereby 4 enter into this Insurance Agreement.
1ST MORTGAGEE COPY
1 rest - Secret wy
BLD
Hartford Tire Insurance Company-
7/ 2418002
ATTACHMENT 1
Processed by:
POLICY #: 99013, 379a
NFS NATIONAL FLOOD SERVICES
fLy
rp
P. O. Box 2057 Kalispell, MT 59903- 2057 JUN 1
THE
HARTFORD '" `¢ riIFit16iSD"•"'
FLOOD POLICY DECLARATIONS Policy Renewal
TYPE: DWELLING
POLICY PERIOD: 8/ 03/ 2001 to 8/ 03/ 2002
These Declarations are effective as of: 8/ 03/ 2001 at 12: 01 AM
FIRST MORTGAGEE NAME & ADDRESS
PRODUCER NAME & ADDRESS
CITY OF NAPA
PRODUCER#: 00601- 00000- 000
ATTN LISA HARPER
NORTHWEST INSURANCE AGENCY
PO BOX 660
PO BOX 1180
NAPA, CA 94559- 0660 SANTA ROSA, CA 95402- 1180
POLICY INFORMATION
PREMIUM PAYOR: Insured
INSURED PROPERTY ADDRESS
713 CAROLINA ST
NAPA, CA 94558- 5105
BUILDING DESCRIPTION
Single Family
One Floor
No Basement
PHONE# ( 707) 573- 1300
COMMUNITY NAME
NAPA, CITY OF
Coverage Limitations May Apply, Please
See Reverse Side For Details.
PROGRAM
Regular
COVERAGE & RATING INFORMATION
BUILDING
Coverage: $ 204, 500 Coverage:
Deductible.: $ 1, 000 Deductible:
Rates: . 680/ . 230 Rates:
INSURED NAME & ADDRESS
FAMILY SVC OF THE NORTH BAY
709 FRANKLIN ST
NAPA, CA 94559- 2920
COMMUNITY NUMBER
0602070000C
POLICY TERM: One Year
CONTENTS LOCATION
Lowest Floor Only Above
Ground Level
FLOOD ZONE CONSTRUCTION.
AE Pre - Firm
Construction
CONTENTS PREMIUM PAID
33, 100 Premium Subtotal: 966. 00
1, 000 Previous Premium Subtotal: 907. 00
ICC Premium: 6. 00
790/ . 410 CRS Discount: 137. 00
Expense Constant: 50. 00
Federal Policy Fee: 30. 00
Endorsement Amount: 00
Total Premium: 915. 00
2ND MORTGAGEE
This Declarations Page, in conjuncion with the policy, constitutes your Flood Insurance Policy.
IN WITNESSWHEREOF, wehave signed this policy below and hereby enter into this Insurance Agreement.
O 1ST MORTGAGEE COPY
BLD Presi - Secretai- v- 6/ 01/ 2001
3R
Hartford Fire InsuranCompany. Compan
ATTACHMENT 1
NOTICE: This policy provides only
LIMITED COVERAGE in basements and
for the enclosedareasbelow elevatedPost -
FIRM rated buildings, as set forth below.
Refer to your Standard Flood Insurance
Policyenclosedwiththisdeclarationspage.
SCOPE OF BASEMENT AND
ELEVATED BUILDING ENCLOSURE
COVERAGE
BUILDING AND CONTENT ELEMENTS
COVERED:
FOUNDATION ELE IENTS
REQUIRED UTILITY
CONNECTIONS
SUMP PUMPS
WELL WATER TANKS AND
PL'-\ IPS
OIL TANKS AND THE OIL IN
THEM
CISTERNS AND THE WATER IN
THEM
NATURAL GAS TANKS AND THE
GAS IN THEM
PU IPS AND/ OR TANKS USED IN
CONJUNCTION XVITH SOLAR
ENERGY
FURNACES
HOT XX'ATER HEATERS
CLOTHES WASHERS AND
DRYERS
FOOD FREEZERS AND THE
FOOD IN THEM
AIR CONDITIONERS
HEAT PUMPS
ELECTRICAL JUNCTION AND
CIRCUIT BREAKER BOXES
ELEVATORS, DUMBXX7AITERS AND
EQUIPMENT EXCEPT FOR SUCH
EQUIPMENT LOCATED BELOW
THE BASE FLOOD LEVEL, IF SUCH
EQUIPMENT WAS INSTALLED ON
OR AFTER OCTOBER 1, 1987.
ELEMENTS COVERED IN BASEMENTS
ONLY:
UNPAINTED DRYWALLS AND
SHEETROCK WALLS, INCLUDING
FIBERGLASS INSULATION, AND
CEILINGS ( REPLACE, AND IN
SLrBSTITUTION FOR FINISHED
XA'_ALLS.)
ELEMENTS NOT COVERED IN
BASEMENTS AND ELEVATED
BUILDING ENCLOSURES ( SEE NOTE):
CONTENTS
IMPROVE - LENTS SUCH AS
FINISHED WALLS, FLOORS AND
CEILINGS
BUILDING EQUIP'\ IENT AND
FIXTURES NOT SPECIFICALLY
COVERED
NOTE: IN THE CASE OF ELEVATED
BUILDINGS, COVERAGE LIMITATION
APPLIES ONLY TO POST -FIRM RATED
ELEVATED BUILDINGS IN SPECIAL
HAZARD AREAS DESIGNATED AS ZONES
Al A30 ( A), AH, AND V1 — V30 ( VE).
FORQUESTIONSORADDITIONALCLARIFICATIONONTHEABOVE, PLEASECALLYOUR AGENT.
ATTACHMENT 1
NC
RECEIVED
STATE P.O. BOX 807, SAN FRANCISCO, CA 94101- 0807
tCOMPENSATION
INSURANCE
J :! N Z 7 ZOQO
FUND CERTIFICATEOF WORKERS' COMPENSATIONINSURANCE
POLICY NUMBER: 0706400 C Clerk' s Dept.
ISSUE DATE: 07- 31- 00
CERTIFICATE EXPIRES: 07- 31- 01
ThisistocertifythatwehaveissuedavalidWorkers' CompensationinsurancepolicyinaformapprovedbytheCaliforniaInsuranceCommissionerto theemployernamedbelowforthepolicyperiodindicated.
ThispolicyisnotsubjecttocancellationbytheFundexceptupon10days' advancewrittennoticetotheemployer.
Wewillalsogiveyou10days' advancenoticeshouldthispolicybecancelledpriorto itsnormalexpiration.
Thiscertificateof insuranceisnotaninsurancepolicyanddoesnotamend, extendoralterthecoverageafforded bythepolicieslistedherein. Notwithstandinganyrequirement, term, orconditionofanycontractorotherdocumentwithrespecttowhichthiscertificateofinsurancemaybeissuedormaypertain, theinsuranceaffordedbythepoliciesdescribedhereinis subjectto alltheterms, exclusionsandconditionsof suchpolicies.
PRESIDENT
EMPLOYER' S LIABILITY LIMIT : INCLUDING DEFENSE ' COSTS: $ 1, 000. x• 00 PER OCCURRENCE.
FAMILY SERVICE OF THE NORTH BAY
709 FRANKLIN ST
NAPA CA 94539
FAMILY SERVICE OF THE NORTH BAY
A NON- PROFIT CORP.)
08- 19- 00
PRINTED: P0408
ATTACHMENT 1
Processedby:
NFS NATIONALFLOODSERVICES
1W
P. O. Box 2057 Kalispell. MT 59903- 2057
THE
HaWORD
FLOOD POLICY DECLARATIONS
POLICWC
0,
Vg
2000
AUG - 8 2000
City Clerk' s Dept.
TYPE: Dwelling
POLICY PERIOD: 8/ 03/ 2000 to 8/ 03/ 2001
These Declarations are effective as of: 8/ 03/ 2000 at 12: 01 AM
FIRSTMORTGAGEENAME & ADDRESS
PRODUCER NAME & ADDRESS
CITY OF NAPA
PRODUCER#: 00601- 00000. 000ATTN LISA HARPER
PO BOX 660 NORTHWEST INSURANCE AGENCY
NAPA, CA 94559- 0660 PO BOX
1180SANTAROSA, CA 95402. 1180
POLICY INFORMATION
PREMIUM PAYOR: Insured
INSURED PROPERTY ADDRESS
713 CAROLINA ST
NAPA, CA 94558. 5105
BUILDING DESCRIPTION
Single Family
One Floor
No Basement
COMMUNITY NAME
NAPA, CITY OF
CoverageLimitations MayApply, Please
See Reverse Side For Details.
PROGRAM FLOOD ZONE
Regular AE
COVERAGE & RATING INFORMATION
BUILDING CONTENTS
Coverage: $ 185, 900 Coverage: $ 31, 500
Deductible: $ 1, 000 Deductible: $ 1, 000
Rates: . 680/ . 200 Rates: . 790/ . 360
INSURED NAME & ADDRESS
FAMILYSVCOF THENORTHBAY
709 FRANKLIN ST
NAPA, CA 94559. 2920
2ND MORTGAGEE
PHONE# ( 707) 573- 1300
POLICY TERM: One Year
COMMUNITY NUMBER
06020700000
CONTENTS LOCATION
N/ A
CONSTRUCTION DATE
7/ 01/ 1959
PREMIUM PAID
Premium Subtotal: $ 811. 00
Previous Premium Subtotal: $ 811. 00
ICC Premium: $ 75. 00
CRS Discount: $. 00
Expense Constant: $ 50. 00
Federal Policy Fee: $ 30. 00
Endorsement Amount: $. 00
Total Premium: $ 966. 00
ThisDeclarationsPage, inconjunctionwiththepolicy, constitutesyourFloodInsurancePolicy.
INWITNESSWHEREO , wehavesignedthispolicybelowandherebyenterintothisInsuranceAgreement.
BLD
asiT HartfordFreInsuranceCompany
x
1St MORTGAGEE COPY
8/ 03/ 2000
30 ATTACHMENT 1
NOTICE: This policy provides only LIMITED COVER— ELEVATORS, DUMBWAITERS, AND AGE in basements and for the enclosed areas below EQUIPMENT, EXCEPT FOR SUCH EQUIPMENT elevated Post— FIRM rated buildings, as set forth below. LOCATED BELOW THE BASE FLOOD LEVEL, IF Refer to your Standard Flood Insurance Policy enclosed
SUCH EQUIPMENT WAS INSTALLED ON ORwith this declarations page.
AFTER OCTOBER 1, 1987.
SCOPE OF BASEMENT AND ELEVATED BUILDING
ENCLOSURE COVERAGE
BUILDING AND CONTENTS ELEMENTS COVERED:
FOUNDATION ELEMENTS
REQUIRED UTILITY CONNECTIONS
SUMP PUMPS
WELL WATER TANKS AND PUMPS
OIL TANKS AND THE OIL IN THEM
CISTERNS AND THE WATER IN THEM
NATURAL GAS TANKS AND THE GAS IN THEM
PUMPS AND/ OR TANKS USED IN
CONJUNCTION WITH SOLAR ENERGY
FURNACES
HOT WATER HEATERS
CLOTHES WASHERS AND DRYERS
FOOD FREEZERS AND THE FOOD IN THEM
AIR CONDITIONERS
HEAT PUMPS
ELECTRICAL JUNCTION AND CIRCUIT
BREAKER BOXES
CLEAN— UP
ELEMENTS COVERED IN BASEMENTS ONLY:
UNPAINTED DRYWALLS AND SHEETROCK
WALLS, INCLUDING FIBERGLASS INSULA—
TION, AND CEILINGS ( REPLACE, AND IN SUB—
STITUTION FOR FINISHED WALLS.)
ELEMENTS NOT COVERED IN BASEMENTS AND
ELEVATED BUILDING ENCLOSURES ( SEE NOTE):
CONTENTS
IMPROVEMENTS SUCH AS FINISHED WALLS,
FLOORS, AND CEILINGS
BUILDING EQUIPMENT AND FIXTURES NOT
SPECIFICALLY COVERED
NOTE: IN THE CASE OF ELEVATED BUILDINGS,
COVERAGE LIMITATION APPLIES ONLY TO POST—
FIRM RATED ELEVATED BUILDINGS IN SPECIAL
HAZARD AREAS DESIGNATED AS ZONES Al — A30
AH, AND V1— V30 ( VE).
FOR QUESTIONS OR ADDITIONAL CLARIFICATION ON THE ABOVE, PLEASE CALL YOUR AGENT.
ATTACHMENT 1
NATIONAL FLOOD INSURANCE PROGRAM
FLOOD INSURANCE EXPIRATION INVOICE
THIS FLOOD INSURANCE POLICY EXPIRED AT 12: 01 A. M. ON: 8/ 03/ 1999 PAYOR IS: INSURED
LENDER NAME & MAILING ADDRESS
CITY COUNTY OF NAPA
955 SCHOOL ST
NAPA CA 94559
Policy #: 2 0 3 513 4 5 8 0
RECEIVED
INSURED PROPERTY LOCATION:
713 CAROLINA ST
AUG 1 11999
NAPA CA 94558
DATE ISSUED: 8/ 03/ 1999 City Clerk' s Dept.
AGENT/ BROKER NAME & MAILING ADDRESS
FERNEST BLOOMFIELD & ASSOC.
22 BATTERY ST
SAN FRANCISCO CA 94111
Special Instructions: THE RENEWALPREMIUMFORTHIS POLICY HASNOTBEENRECEIVEDAS OF THE EXPIRATION DATE SHOWN. INSURANCE COVERAGE FOR THE BENEFIT OF THE MORTGAGEEONLYWILL REMAININ FORCEFOR 30 DAYS.
SEE REVERSE SIDE OF BILL FOR IMPORTANT MESSAGES
OPTION CURRENT COVERAGE OPTION INCREASED COVERAGE
COVERAGE DEDUCTIBLE PREMIUM COVERAGE DEDUCTIBLE PREMIUM Building
185, 900
Building
1, 000
I Yr
945. 00
Building
204, 500
Building
1, 000
1 Yr
988. 00
Contents Contents 3 Yr
NOT *
Contents
33, 100
Contents
1, 000
3 Yr
NOT
31, 500 1, 000
AVAILABLE
AVAILABLE
MAXIMUM COVERAGE AVAILABLE THROUGH
THE NATIONAL FLOOD INSURANCE PROGRAM: BUILDING: 250, 000 CONTENTS: 100, 000
THIS IS NOT A BILL
MORTGAGEE COPY
RETAIN TOP PORTION FOR YOUR RECORDS
DETACH HERE _
DETACHHERE
FLOOD INSURANCE EXPIRATION INVOICE
POLICY #: 2035134580 MORTGAGE LOAN NO: EXPIRATION DATE: 8/ 03/ 1999 DATE ISSUED: 8/ 03/ 1999
OPTION A COVERAGE OPTION B COVERAGE
ONE YEAR: $ 945. 00 Bldg 185, 900 ONE YEAR: $ 988. 00 Bldg 204, 500 THREE YEAR: N/ A Cont 31, 500 THREE YEAR: N/ A ] Cont 33, 100 Check desired coverage & return bottom section of notice with check or money order made payable to: INSURED NAME & MAILING ADDRESS
NATIONAL FLOOD INSURANCE PROGRAM FAMILY SVC OF THE NORTH BAY P. O. BOX 105656 709 FRANKLIN ST
ATLANTA, GEORGIA, 30348- 5656 NAPA CA 94559
RETURN WITH PAYMENT DO NOT FOLD, STAPLE, OR WRITE BELOW THIS LINE 9999920351345800000094500000267500000098800000280400
ATTACHMENT 1
NATIONAL FLOOD INSURANCE PROGRAM (NFIP) INSTRUCTIONS
1. THEPOLICYWILLEXPIREAT12: 01A.M. ONTHEDATESHOWNUNLESSTHERENEWALPAYMENTISRECEIVEDBYTHENFIPWITHIN30DAYSOFTHEEXPIRATIONDATE. IFTHERENEWALPAYMENTWASMADEBYCERTIFIEDMAILTOTHENFIPPRIORTOTHEEXPIRATIONDATE, THECERTIFIEDMAILINGDATEWILL ASSURE RENEWAL WITHOUT LAPSE OF COVERAGE.
2. IFYOURRENEWALPAYMENTISRECEIVEDBYTHENFIPFROM31TO90DAYSFOLLOWINGTHEEXPIRATIONDATEOFYOURPOLICY, THERENEWALWILLBEISSUEDWITHANEWEFFECTIVEDATE (30DAYSAFTER RECEIPT BY THE NFIP). THEMAILINGDATEOFCERTIFIEDLETTERSWILLBECONSIDEREDASTHEDATEOF RECEIPT BY THE NFIP.
3. IFAPOLICYHASBEENEXPIREDMORETHAN90DAYS, ANEWAPPLICATIONANDPREMIUMPAYMENTMUST BE SUBMITTED.
4. THE AMOUNTS OF INSURANCE AVAILABLE ARE SHOWN AS " MAXIMUM INSURANCE AVAILABLE". CONTACT YOURAGENTTOINCREASECOVERAGEABOVETHELIMITSPROVIDEDBYOPTIONS "A" OR "B". 5 IF A
SHALLORTGAGEE
CONTINUE
IOR
TRUSTEE)
N FORCE FORITHE BENEFIT
AS A
ONLY
ONAMED
THIS
HE MORTGAGEE TRUSTEE) OR 0 DAYS
AFTER THE MAILING OF THIS NOTICE.
6. IFYOUWEREREQUIREDTOBUYTHISPOLICYBECAUSEYOURECEIVEDADISASTERLOANORGRANT, YOU MUSTMAINTAINIT ORYOUMAY NOTGETFUTUREDISASTERASSISTANCE.
7. QUESTIONSOR WRITTEN INQUIRIES SHOULD BE DIRECTED TO:
NationalFloodInsuranceProgram, P.O. BOX6468, ROCKVILLE, MD20849-6468
8. THE FOLLOWING OPTIONS ARE AVAILABLE:
OPTION A: TO RENEW WITH NO CHANGE IN COVERAGE
OPTIONB: INCREASEDCOVERAGEDUETOINCREASEDPROPERTYVALUES
BOTHRENEWALOPTIONSREFLECTTHEPREMIUMCHARGEASSOCIATEDWITHCOVERAGED, INCREASED COST OF COMPLIANCE, IF APPLICABLE.
9. IFYOURPOLICYWASPREVIOUSLYISSUEDWITHA $750STANDARDDEDUCTIBLE, RECENTMANDATORYCHANGESREQUIRETHATTHESTANDARDDEDUCTIBLEBEINCREASEDTO $1,000. IFDESIRED, YOUMAYBUYBACKYOURDEDUCTIBLETO $500FORANADDITIONALAMOUNTOFPREMIUM. PLEASECONTACTYOUR AGENT FOR DETAILS.
10. IFTHISPOLICYISAPREFERREDRISKPOLICY (PRP), ANDTHEFLOODZONELISTEDONYOURPOLICYISNOTTHEZONEONTHECURRENTFLOODINSURANCERATEMAP, YOUMAYNOLONGERBEELIGIBLEFORTHEPRP.
PLEASE CONTACT YOUR AGENT FOR DETAILS.
203513458099999
ATTACHMENT 1
Northwest Insurance Agency -N
975B First Street
Napa, CA 94559
Phone: 707- 255- 7203
City of Napa
Attn Lisa Harper
POBox 660
Napa, CA 94559- 0660
MEMO Page 1
ACCOUNT NO. --- OP -.--. ATE --- ---.
FAMIL- 3 VF 07/ 24/ 00
POLICY INFORMATION
POLICY X
99013375882000
TYPE
EFFECTIVE EXPIRATION
08/ 03/ 00 08/ 03/ 01Zr LD
i
RECEIVED
JUL 2 6 2000
CityClerk's Dep,.
Lisa,
Re: Family Svco/t North Bay
Here is a copy of the renewal declarations showing your mortgagee interest. We have requested an endorsement to change your mailing address to appear as above.
I
Please call if you have any questions.
I I
II I
2- UGw
Vinni Fulton, CIC
ATTACHMENT 1
FLOOD SERVICES POLICYNUMBER: 882035134580
1rvr aw a uy nrr sus- suts
HARTFORj FIRE INSURANCE COMPANY
FLOOD INSURANCE EXPIRATION NOTICE
4 IMPORTANT NOTICE: THIS FLOOD INSURANCE POLICY EXPIRED: 8/ 03/ 1999 NO FURTHERNOTICEWILLBESENT. See reversesidefor Informationthat mightaifect this policy.)
AGEE NAME & MAILING ADDRESS
V1! COUNTY OF NAPA
SCHOOL ST
he' CA 94559- 2825
NAME
Y SVC OF THE NORTH BAY
RECEIVED
AUG 1 2 1999
C ity Clerk' s Dept.
PRODUCER NAME & MAILNG ADDRESS
Producer#: 00601- 00000- 000- 00001
NORTHWEST INSURANCE AGENCY
PO BOX 1180
SANTA ROSA, CA 95402- 1180
707) 573- 1300
LOCATION OF NSURED PROPERTY
713 CAROLINA ST
NAPA, CA 94558- 5105
Option 1 provides coverage at amounts of
COVERAGE DEDUCTIBLE PREMIUM OPTIONS
BUILDING BUILDING
insurance currently in force. 185, 900 1, 000
CONTENTS CONTENTS 945. 00
31, 500 1, 000
COVERAGE DEDUCTIBLE PREMIUM OPTIONS
Option 2 includes an increase in insurance BUILDING BUILDING g'
I to allow for increased property value. 204, 500 1, 000t a CONTENTS CONTENTS 2 $ 988. 00
33, 100 1, 000
FORANYQUESTIONSREGARDINGDEDUCTIBLEORCOVERAGEAMOUNTSPLEASECONTACTYOURAGENT. s
MINIMUM DEDUCTIBLE AMOUNT AVAILABLE IS $ 500.
MAXNAUM INSURANCE AVAILABLE - BUILDING: $ 2 5 0, 0 0 0 CONTENTS: $ 100, 000 882035134580 MORTGAGEE COPY - RETAIN FOR YOUR RECORDS
If you are now responsible for the payment of this premium, please contact your insuranceagentand changethe payorstatusof this policy.
M'
NAME & MAILING ADDRESS INSURED NAME & MAILING ADDRESS
ILY SVC OF THE NORTH BAY FAMILY SVC OF THE NORTH BAY
FRANKLIN ST 709 FRANKLIN STASI CA 94559- 2920 NAPA, CA 94559- 2920 k
8/ 04/ 1999
ATTACHMENT 1
INFORMATION
1. Thepolicyindicatedonthereversesideexpired12:01A.M. onthedateshownunlesstherenewalpaymentismailedtoNationalFloodServices (NFS) andthepaymentisRECEIVEDbyNFSwithin30daysfollowingtheexpirationdate, inwhichcasethepolicywillberenewedwithoutanylapseincoverage. Ifpaymentisnotreceivedwithin30daysoftheexpirationdate, thepolicymayberenewedanda30daywaitingperiodwillapplybeforecoverageiseffective. IftherenewalpaymentismadebycertifiedmailtoNFSpriortotheexpirationdate, thecertifiedmailingdatewill also assure renewal without any lapse of coverage.
2. Toobtainareissueofanexpiredpolicywitharevisedeffectivedate, youoryouragentmaymailPartBofthisnoticeoryouragentcanmailanewapplication) togetherwiththepremiumpaymentforinsuranceoptionselected ("1" or12" ofPartA), toNationalFloodServiceswithin90daysfollowingtheexpirationdateofthispolicy. IfPartBofthisoranapplicationandpremiumpaymentarereceivedbyNFSwithin30daysfollowingthedateandtimeoftheexpirationexpirationdateplus29days), thenewpolicyisplacedinforcewithnolapseofcoverage. IfPartBofthisnotice oranapplicationandpremiumpaymentarereceivedbyNFSbeyondthe30dayperiodbutwithinthe90daysfollowingthedateandtimeofexpiration (expirationplus89days), thepolicyisplacedinforce30daysfollowingreceipt. Forexample, ifreceivedonthethirty—secondday (dateofexpirationplus31days) followingtheexpiration, the insurancebecomeseffectiveonthethirty—seventhday (dateofexpirationplus36).
CERTIFIED MAIL — InthosecaseswherePartBoftheExpiration/ReissueNoticeandthepremiumpaymentaremailedto NFSbycertifiedmail, thecertifiedmailingdateisconsideredtobethedateofreceiptbyNFS.
IFMORETHAN90DAYSHAVEPASSEDSINCETHEPOLICYEXPIRATIONDATE, ANEWAPPLICATIONMUST BE SUBMITTED BY THE AGENT.
3. Theamountsofinsuranceavailableareshownas "MaximumInsuranceAvailable" onthefrontofthisform.
ToincreasecoverageabovethelimitsprovidedbyOptions "1" or "2", aftermailingPartBofthisformoranapplication togetherwiththepremiumpayment, contactyouragentconcerninganendorsementto increasecoverage.
4. IfaMortgagee (orTrustee) isincludedasanamedpayeeonthispolicy, theinsuranceshallcontinuein—force forthebenefitonlyoftheMortgagee (orTrustee) for30daysafterthemailingofthisnotice.
5. PLEASEREMEMBER: IFYOUWEREREQUIREDTOBUYTHISPOLICYBECAUSEYOURECEIVEDADISASTERLOAN ORGRANT, YOUMUSTMAINTAINITORYOU MAYNOTGETFUTUREDISASTERASSISTANCE.
NATIONAL FLOOD SERVICES
PO BOX 2057
Kalispell, MT 59903- 2057
ATTACHMENT 1
Processed b3r
NFS NATIONAL FLOOD SERVICES
P.OJbx2057BaUgwff, MT 599613-2057
f"' , POLICY NUMBER:
HARTFORD FIRE INSURANCE COMPANY
FLOOD INSURANCE RENEWAL PREMIUM NOTICE
8820,¢} 34580
IMPORTANT: THIS CURRENT FLOOD INSURANCE POLICY WILL EXPIRE: 8/ 03/ 1999
SEE REVERSEFOR NOTICE THAT MIGHT AFFECT THIS POLICY) /
MORTGAGEE NAME & MAILING ADDRESS
PRODUCER NAME & MAILING ADDRESS
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIuIIIIIIIIIIIIIIIIIiuIIII CITY COUNTY OF NAPA Producer#: 00601- 00000- 000- 00001 955 SCHOOL ST NORTHWEST INSURANCE AGENCY
NAPA, CA 94559- 2825 PO BOX 1180
SANTA ROSA, CA 95402- 1180
707) 573- 1300
INSURED NAME LOCATION OF INSURED PROPERTY
FAMILY SVC OF THE NORTH BAY 713 CAROLINA ST
NAPA, CA 94558- 5105
1 Option 1 provides coverage at amounts of
insurance currently in force.
COVEMUE DEDUCTIBLE - IUM OPTIONS
BUILDING
185, 900
CONTENTS
BUILDING
1, 000
CONTENTS
1 $ 945. 00
31, 500 1, 000
COVERAGE DEDUCT13L. E PREMIUM OPTIONS
BUILDING BUILDING
2 Option 2 includes an increase in insurance
to allow for increased property value. 204, 500
CONTENTS
1, 000
CONTENTS 2 $ 988. 00
33, 100 1, 000
FORANYQUESTIONSREGARDINGDEDUCTIBLEORCOVERAGEAMOUNTSPLEASECONTACTYOURAGENT.
MINIMUM DEDUCTIBLE AMOUNT AVAILABLE IS $ 500.
MAXIMUM INSURANCE AVAILABLE — BUILDING: $ 2 5 0, 0 0 0 CONTENTS: $ 100, 000 POUCY#: 882035134580 MORTGAGEE COPY - RETAIN FOR YOUR RECORDS RENEWAL EFFECTIVE DATE: 8/ 03/ 1999
THIS IS NOT A BILL
If you are now responsible for the payment of this premium, please contact your insurance agent and change the payor status of this policy.
PAYOR NAME & MAILING ADDRESS
FAMILY SVC OF THE NORTH BAY
709 FRANKLIN ST
NAPA, CA 94559- 2920
INSURED NAME & MALNG ADDRESS
FAMILY SVC OF THE NORTH BAY
709 FRANKLIN ST
NAPA, CA 94559- 2920
LLY P 7/ 22/ 1999
ATTACHMENT 1
INFORMATION
1. Thepolicyindicatedonthereversesidewillexpireat12:01A.M. onthedateshownunlesstherenewalpaymentismailedtoNationalFloodServices (NFS) andthepaymentisRECEIVEDbyNFSwithin30daysfollowingtheexpirationdate, inwhichcasethepolicywillberenewedwithoutanylapseofcoverage. Ifpaymentisnotreceivedwithin30daysofthe expirationdate, thepolicymayberenewedandathirtydaywaitingperiodwillapplybeforecoverageiseffective.
2. Ifthepremiumwasnotreceivedbytheexpirationdate, anymortgageeofrecordfortheinsuredproperty, asindicaded onthe PolicyDeclarationspage, hasbeenprovidedwrittennoticeofthe policyexpiration.
CERTIFIED MAIL" — Inthosecaseswheretherenewalpremiumpaymentandthisnoticearemailedto NFSprior totheexpirationdatebycertifiedmail, thecertifiedmailingdaleisconsideredtobethedateofreceiptbyNFS.
S. Theamountofinsuranceofferedundertherenewaloptionsmaynotbesufficienttofullyinsurethevalueofyour property or may not reflect increases in coverage recently applied for. ( The amounts of insurance available are shown as " Maximum Insurance Available" on the front of this form.) Contact your insurance agent for higher amounts of insurance.
ItyourcommunityrecentlyenteredtheRegularProgram, youmaywishto increaseyourbuildingcoveragetoassure replacement cost coverage. ( See item 4 below.) ***
4. Replacementcostcoverageisprovidedunderbuildingcoveragefora SINGLEFAMILYDWELLINGwhichisthePRINCIPLE RESIDENCE OF THE INSURED if the AMOUNT OF BUILDING INSURANCE IS AT FAST 80% OF THE REPLACEMENT COST ofthestructureattimeoflossoristhemaximumavailableundertheNationalFloodInsuranceProgram, whicheverisless.
Contact your insurance agent for details.
5. Shoulda mortgageereceivethe "Payor' Noticeandthe mortgageeis notresponsiblefor the premiumpayment, thisnoticeshouldbeforwardedto the insuredfor payment. Also, the insuranceagentshouldbe advisedto provide NFS with the correct payor name.
6. PLEASEREMEMBER "IFYOUWEREREQUIREDTOBUYTHISPOLICYBECAUSEYOURECEIVEDADISASTERLOAN ORGRANT, YOUMUSTMAINTAINITORYOUMAYNOTGETFUTUREDISASTERASSISTANCE."
NATIONAL FLOOD SERVICES
PO BOX 2057
Kalispell, MT 59903- 2057
ATTACHMENT 1
z POLICY DECLARATIONS AUENT COPYFLOOD
07/ 28/ 1998 - NO. 2035134580
NAiCONAL FLOOD INSURANCE PROGrAM
MROCKVILLE MD 20849- 6468+
3Z RECEIVED
0 0 AUG 1 01998 RENEWAL
Clerk' s Depl:
SUE DATE 7/ 28/ 1998 RNE
Cit
AGENT' S NAME AND ADDRESS NAMED INSURED AND MAILING ADDRESS ERNEST BLOOMFIELD & ASSOC. FAMILY SVC OF THE NORTH BAY
22 BATTERY ST 709 FRANKLIN ST
SAN FRANCISCO CA 94111 NAPA CA 94559
POLICY TERM: 1 YEAR( S) INCEPTION: 8/ 03/ 1998 EXPIRATION: 8/ 03/ 1999 THESE DECLARATIONS ARE EFFECTIVE 8/ 03/ 1998 12: 01 A. M. LOCAL TIME AT THE DESCRIBED LOCATION COVERED BY THIS POLICY LOCATED AT THE ABOVE MAILING ADDRESS, UNLESS OTHERWISE STATED BELOW. ' 713 CAROLINA ST
NAPA CA 94558
RATING INFORMATION
CONSTRUCTION DATE: 07/ 01/ 59 COMMUNITYNAME: NAPA, CITY OF BUILDING DESCRIPTION: SINGLE FAMILY COMMUNITY NO.: 0 6 02 0 7 0 0 0 0 C COMMUNITY RATING: 10 NO. OF FLOORS: ONE PROGRAM STATUS: REGULAR RISK ZONE: AE BASEMENT DESCRIPTION: NONE CONDO TYPE: NOT A CONDO NO. OF UNITS: N/ A CONTENTS LOCATION: LOWEST FLOOR ONLY ELEVATED BUILDING: NO LOWEST FLOOR ELEVATION: N/ A BASE FLOOD ELEVATION: N/ A RATING ELEVATION: N/ A LIMITS OF BUILDING $ 185, 900 DEDUCTIBLE BUILDING $ 1, 000 LIABILITY CONTENTS $ 31, 500 AMOUNTS CONTENTS $ 1, 000
RATES AND AMOUNT OF INSURANCE IN FORCE FOR BUILDING AND CONTENTS
TYPE OF BASIC ADDITIONAL DEDUCTIBLE TOTAL
AMT. OF INS. RATE PREMIUM AMT. OF INS. RATE PREMIUMCOVERAGE BUYBACKIDISC. PREMIUM BUILDING 50, 000 x . 68 = $ 340 135, 900 x . 20 = $ 272 00 612. 00 CONTENTS 15, 000 x . 79 = $ 119 16, 500 x . 36 = $ 59 00 178. 00 FIRST MORTGAGEE NAME AND ADDRESS PREMIUM SUBTOTAL 790. 00 CITY COUNTY OF NAPA COVERAGE D ( ICC) 75. 00
955 SCHOOL ST EXPENSE CONSTANT 50. 00
NAPA CA 94559 FEDERAL POLICY FEE 30. 00
TOTAL PREMIUM $ 945. 00
OTHER PAYOR NAME AND ADDRESS
ENDORSEMENTS:
ERNEST BLOOMFIELD & ASSN
22 BATTERY ST STE 503 ENDI: ICC
SAN FRANCISCO CA 94111 END2: DED
AGENCY NO. PRODUCER NO. AGENT PHONE NO. PAYOR COUATURE
0551445023 I INSURED
7E
rr _ '/
ATTACHMENT 1
AUG - 21- 1997 23: 47 P. 01/ 01
ACORD
FROmma
Northwest Insurance agency - N
1827 Clay Street
Napa CA 94589
08/ 22/ 97
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO
ONLYANDCONFERSNORIGHTSUPONTHECERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, GXTEW OR
ALTER THE COVERAGE AFFORDED BY THINPOLIO BELOW.
COMPANIES AFFORDING COVRRAGE
COMPANY
A Saleeo Insurance CompaniesSteve Reinbolt
Pmmm. 797- 255- 7203 070 - 40
INSURED COMPANY
B
COMPANY
CFamily service of the
North asyy
COMPANY
D
709 a' rMlin Street
Napa CA 95590
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THISisTOCERTIFYTHATTHEPOLICIESOFMSIMANCELISTEDBELOWHAVE BEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED, N07WTHSTANDING ANYREQUIREMENT, TERMOR CONDITIONOF ANYCONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICHTm CERTIfICATE MAY BE ISSUED OR MAY PERTAIN, THE IAESURANCI APFCMED BY THE POLICE$ DESCRIBED HEREIN ( S SUBJECT TO ALL THE TO", EXCLUSIONS AND CONDITIONS Of SUCK POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . r
CO
TYPE OF INSURANCE POLICY NUMBER
POLICY
O IMI
VOW POLICY EXPIRATION LIMITS
GENERAL LUWRJTT GENERAL AGGREGATE $ 1000000
PRoDUGTB- COMPA) PAGG $ 1000000A X COMMERCIALGONQRALLIAEILITY RNWL OF CP7730000E 00/ 12/ 97 09/ 12/ 98 aAIMSMADE ® 00" PERSONAL IL ADV INJURY 11000000
OWNERS 4CONIRACTOR' SPROT EACH OCCURRENCE S1000000
FIRE DAMAGr. 0my om fln) $ 30000
MED RXP WW) $ 5000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO PJM OF CP775000OZ 09/ 12/ 97 09/ 12/ 98
coMBnlEDBauGLELBerr $ 1, 000, 000
BODLa
RY
f
w
ALL OWNED AUTOS
SCHEDULED AUTOS
IMRED AUTOS
NON - OWNED AUTOS
POMY INJURY
PoI lmldw
f
PROPERTY DAMAGE S
EARAOE LIABILITY AUTO ONLY, EA ACGDENT I
07WE2 THAN AUTO ONLY: ANY AUTO
CACI ACCIDENT $
AGORWATE f
EXCESS LIABILITY EACH OCCURRENCE $
AGGRiGAYE fUMBRELLA FORM
sOTHER THAN UMBRELLA FORM
WOWWCOMPENSATIONAND
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ie:": i: i::' i;".•, :.;'i -;;::i
EMPLOYERS' LIABILITY
Q EACH ACGDENY f
THE PROPRIETOR) INCL
PARTNERwfixECunvr.
EL DIWEAN - POLICY LIMIT f
EL DISEASE - PA EMPLOYEE sOFFICERS ARC: ECCL
OTHER
A Frofoesional LP775008OR 09/ 12/ 97 09/ 12/ 90 Limit 1, 000, 000 Liability
DESCRIPTION OF OPCRATIONSILOCA` n5—m* ICLE3Y3PEGML ITEMS Certificate holder its ogieers, p loyees, agents and volunteers are amed additiotpI insuired as eir intes st may appear as a m, ndiug source for e Insure
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s
XISC:- 01 SHOULD ANY OF THE ABOVE DEN7RBE) POLIOIEB BE CANCELLED BEFORE THE City of Napa EXPIRATION DATE THERGOF, THE K& UING COMPANY WILL ENDEAVOR TO MAIL Community Resources
Lisa Harper
1100 West street PO Box 660
sa DAYS WRRTRINOTICE TOTHE CWMPV— ATE1101. RNAMEDToTHE LEFT.
BUT FAILURETO MAILWON NOTICESHALL IMPOSENo OBLIBATION
Napa CA 94669 of ANY NINDwoN AGSM IR REPRESENTATIVES.
A
s. a., s$< s.; a::: s} s,.: xs• a:: f<« s:::. x:;,:;: x:,:::.:;..:; It
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TOTAL P. 01
ATTACHMENT 1
D rLOOD POLICY DECLARA , IONS
1ViCUt( P C AU-.,-! h COPY i
08/ 05/ 1997 NO. 2035134580
NATIONAL, I L-001) INSURANCE PROGRAM ?
GtiyGYN( g.N9 ROCKVIL, LE MIS 20849- 6468
REdEIVE®
y
RENEWAL AUG121997
ISSUE DATE 8/ 05/ 1997
city CIem'SV1110E
FIRST MORTGAGEE NAME AND ADDRESS NAMED INSURED AND MAILING ADDRESS
CITY COUNTY OF NAPA FAMILY SVC OF THE NORTH BAY
955 SCHOOL ST 709 FRANKLIN ST
NAPA CA 94559 NAPA CA 94559
POLICY TERM: 1 YEAR( S) INCEPTION: 8/ 03/ 1997 EXPIRATION: 8/ 03/ 1998 THESE DECLARATIONS ARE EFFECTIVE 8/ 03/ 1997 12: 01 A. M. LOCAL TIME AT THE DESCRIBED LOCATION COVERED BY THIS POLICY LOCATED AT THE ABOVE MAILING ADDRESS, UNLESS OTHERWISE STATED BELOW. 713 CAROLINA ST
NAPA CA 94558
RATING INFORMATION
CONSTRUCTION DATE: 07/ 01/ 59 COMMUNITYNAME: NAPA, CITY OF BUILDING DESCRIPTION: SINGLE FAMILY COMMUNITY NO.: 06020700000 COMMUNITY RATING: 10 NO. OF FLOORS: ONE PROGRAM STATUS: REGULAR RISK ZONE: AE BASEMENT DESCRIPTION: NONE CONDO TYPE: NOT A CONDO NO. OF UNITS: N/ A CONTENTS LOCATION: LOWEST FLOOR ONLY ELEVATED BUILDING: NO LOWEST FLOOR ELEVATION: N/ A BASE FLOOD ELEVATION: N/ A RATING ELEVATION: N/ A LIMITS OF BUILDING 169, 000 DEDUCTIBLE BUILDING $ 750
LIABILITY CONTENTS 30, 000 AMOUNTS CONTENTS $ 750
RATES AND AMOUNT OF INSURANCE IN FORCE FOR BUILDING AND CONTENTS
TYPE OF BASIC ADDITIONAL DEDUCTIBLE TOTAL
AMT. OF INS. RATE PREMIUM AMT. OF INS. RATE PREMIUMCOVERAGE DISCOUNT PREMIUM BUILDING 50, 000 x . 68 = $ 340 119, 000 x . 20 = $ 238 00 578. 00 CONTENTS 15, 000 x . 79 = $ 119 15, 000 x . 36 = $ 54 00 173. 00 AGENT' S NAME AND ADDRESS PREMIUM SUBTOTAL 751. 00
ERNEST BLOOMFIELD & ASSOC. COVERAGE D ( ICC) 75. 00
22 BATTERY ST EXPENSE CONSTANT 45. 00
SAN FRANCISCO CA 94111 FEDERAL POLICY FEE 30. 00
TOTAL PREMIUM $ 901. 00
OTHER PAYOR NAME AND ADDRESS
ENDORSEMENTS:
ERNEST BLOOMFIELD & ASSN
22 BATTERY ST STE 503 ENDI: ICC
SAN FRANCISCO CA 94111
I
AGENCY NO. j PRODUCER NO. AGENT PHONE NO. PAYOR COUNTERSIGNATURE 0551445023 INSURED
ATTACHMENT 1
11\ 67-- _
FLOOD POLICY DECLARATIONS
NO. 2035134580
08/ VS/ 1997
NATIONAL FL ) Or
9EPOGPRORoCgvlGRAM
RENIMAL
LME DAA 8/ 05/ 1997
NORTB BAY =
21N! TERY ST
FRANCISCO CA 94111
POLICY TERM: 1 YEAR( S) INCEPTION: 8//
003(/,
1997 EXppIRpATTIIO
Nj:-_
8/ 03/ 1998
S pLICY IO ATEAA I rnABgVE
0 3
t DURESS, t SS OTii1rRWISb SLATEDBEWw
D LOCATION COVFAFO
713 CAROLINA ST
NASA CA 94558
RATING INFORMATION
CONSTRUCTION DATE: 07/ 01/ 59
COMMUNMYNAME NAPA, CITY OF
BUILDING DESCRIPTION: SINGLE FAKILY COMMUNITYNO. c 0602070000C COMMUNITY RATING: 10 NO, Of FLOORS: ONE PROGRAM STATUS: REGULAR RISK ZONE: AS BASEMENT DESCRIPTION: MONS CONDO TYPE- NOT A CONDO NO. OF UNITS: N/ A CONTENTS LOCATION: LOM[ ST FLOOR ONLY ELEVATED BUILDING: NO LOWEST FLOOR ELEVATION: N/ A BASE FLOOD ELEVATION: N/ A RATING ELEVATION: N/ A LIMrMOF BUILDING $ 169. 000
I DEDUCTIBLEI
BUILDING $
750
LIABILITY CONTENTS $ 30, 000 AMOUNTS CONTENTS
TYPE OF BASIC
COVERAGE AMT. OF INS. RATE P1
BUILDING 30, 000 x . 60
OONTENTS 15, 000 x . 79
FIRST MORTGAGEE NAM AND ADDRW
CITY COUNTY OF NAPA
955 SCHOOL ST
NAPA CA 94559
OTHER PAYOR NAM AND ADDRIMS
ERNEST SLOQD [ FIRLD & ASSN
22 BATTERY ST BTB 503
SAN FRANCISCO CA 94111
AGCY NO.
I
PRODUCER NO.
0551445023
ADDITIONAL DEDUCTIBLE TOTAL
IIUM AMT. OP INS. RATE PREMIUM DISCOUNT PREMIUM
340 119, 000 x . 20 238 $. 00 1578. 00
119 15, 000 x . 36 pS4 #. 00 173. 00
PREMIUM SUBTOTAL 751. 00
COVERAGE D ( ICC) 7 5. 0 0
EXPENSE CONSTANT 45. 00
FEDERAL POLICY FEE 30- 00
TOTAL PREMMM 901. 00
ENDORSEMgNTS:
RNDIiICC
rpHONE - NO. PAYOR coIGNA
INStIARD
ATTACHMENT 1
AlhPh a , A .,... a•, CUMMANIMS APPURL] INU CUV@KAUE
i
ASRFECO ( 13LACK/ WHITE)
COMPANY
iYRED
FAMILY SERVICE
OF THE NOR 11 { BAY
LG rTER
709 FRANKLIN STREET COMPANY ANV
NAPA,
Lt I TER
CA 94559-
OMPANYELETTRR
THISISTOCERTIFYTHATTHEPOLICIESor INSURANCELISTEDor -LOWHAVEBEENISOL1E17> TOTHEIfJSURLDNAMEDINDICATEO, NOTWITHSTANDING ANY R5QUIREMENT, TERM AlSOYE Fort
QR CONDIVION OF 1wNYCONTRACT OR OTHER DOCUMENT WITH RESFM GFRTIFICATEMAYBEISSUEOORMAYPERTAIN, THEINSURANCEAFFORDEDNYTHEPOLK:IE60ES(:R:0FD HEREINISSVOJECT'M EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES. LIMITSSHOWNMAYI4AVEBEENREDUCEDBYPAIDCLAIMS.
SSZ LQIZ T
TYPF_ OF IMSURA4cE POLICY NUMBER F•OUCY EFF LV. Tr ' PDLICY ERPMATN Y DATE{ MMM) nfVYj, OATMMWDrdYY LNR4
CIENERAL LJAIILjft
y cnnp
IGGOMMCRC:IAI. ciCNCRAL 1'7750080E
Gti NERAL. An< R _ L3A t' r
09/ 12196 05/ 12/ 97
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DEECRIPTKM OF OPERATIONS&& ; A I I0" WV044C&%" ft4 NAL ITEIAM CERTIFICATE HOLDER, ITS OFFTCTERS,EMPLOYFES, AGENTS & VOLUNTFk: RS ARE NAKIED AS ADDITIONALINSIIRFI)SAST'NFIRINTERESTMAYAPPEARASAFUNDINGSOURCEFORTHE; IN'SURE•D.
CITY OF NAPA
COMMUNITY RESOURCES DEPT.
i IW Wt: V STKEET P,0. 80X664
NAPA, CA 94559
T7
0' d 0t• T SSZ LQIZ T
SHOULDANY OF THEASCVE 0Q%CRI8ED AOLICIFGHE CANCEL6E0 BEPC FXPifRATIONDATE THEREOF, THE ISSUINGCC.wf' ANY MLL ENOFAVORT, MAIL30--. DAYSWRiTTGNNOTICETOTlJEOERTIP-IgATEtIVLukI( NAMED I, BFT, DW I t AILLIRF_ TO MAI4 OUCH NOT" SHALL IMrOEG NQ 09LIGATlo LIAQILITY OF ANY KIND t) Fs
MPANY, ! T ENT$ OR REPREseN
WTHC 92CO R& PReseMrATRK
STEVEN M. RETNSOLT A< l /
170gNI3? J: NHN3 J8 Wd ST : Le 96— es- 03Q
ATTACHMENT 1
4, 10 ' 96 16: 16 1D J P IN` I, Jk( iNl(
A t "m 9651- 4/ 101
THISISEVIDENCETHATINSURANCEAS IDENTIFIEDBELOWHASBEENISSUED, 13INFORCE, ANDCONVEYSALLTHE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
415- 9911- 21130
ERNEST BLOOMFIELD & ASSOCIATES/
FIRST NATIONAL INS. COMPANY OF AMERICAREHABILITATION & RECOVERY INSURANCE AGENCY. INC. 22 BATTERY STREET. STH FLOOR
SAN FRANCISCO. CA 94111
sus coca,
AGENCY
CusTOMfix io or.
IMAURED LOAN NUME[ R POLICY MESSER
FAMILY SERVICE OF THE NORTH BAY
BIG BROTHERS/ BIG SISTERS OF THE NORTH
BAY
1157 DIVISION STREET
NAPA, CA 94559
LOICATIOPUD68CRIPT1100
709 FRANKLIN STREET
NAPA CA 94559
CP 77500808
MFFZCTr. M DATE GAPMATION OAT!
CONTINUED UNTIL
9/ 12/ 95 9112/ 96 TER& MATED OFCHEC^ Eo
T" m RWPLAcps PRIOR WMKINCE MATI! D-
SPECIAL FORM PROPERTY, SUBJECT TO EXCLUSIONS, RCV, 90% COINSURANCE
BUILDINGLIMIT BUILDING
CONTENTS LIMIT
AMOIJUT OF WOURANCE M01C;'; Li
205, 000 Soo
S 7, OW 500/ 1. 000
THEFT
xV- 1 -44;
MORTGAGEESINTEREST, WHEREAPPLICABLEISINACCORDANCEWITHCP1218ATTACHEDTOTHEPOLICYREGARDINGESCROW No 115106 THEPOLICYISSUBJECTTOTHEPREMIUMS, FORMS, ANDRULESINEFFECTFOREACHPOLICYPERIOD. SHOULDTHEPOLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYSWRITTEN NOTICES, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT
THATDAYS
INTEREST. INACCORDANCEWITHTHEPOLICYPROVISIONSORASREQUIREDBYLAW.
NAME AND ADORN"
NIORTGADEE I ADorTpckAL L49uREo
THE CITY OF NAPA I
I
LOSS PAYEE
P 0 BOX 660 LOAN 0
NAPA CA 94559
ATTACHMENT 1
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PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ERNEST BLOOMFIELD & ASSOCIATES/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE REHABILITATION & RECOVERY INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POLICIESALTERHE COVERAGE AFFORDED BY THE
22 BATTERY STREET, 5TH FLOOR COMPANIES AFFORDING COVERAGE SAN FRANCISCO, CA 94111
COMPANY
FIRST NATIONAL INS. CO. OF AMERICA
A
INSURED
FAMILY SERVICE OF THE NORTH BAY
COMPANY
B
SAFECO SURPLUS LINES INSURA ANY
BIG BROTHERS/ BIG SISTERS OF THE NORTH BAY
1157 DIVISION STREET COMPANY vizrl
NAPA, CA 94559 C
COMPANY
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T MTOINDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPICH THISce
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y 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.
CO
LTR
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
I DATE WIDDIYY) DATE ( NBNDD/ YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 1, 000, 000
A X COMMERCIALGENERALLIABILITYCP 7750080D 09/ 12/ 95 09/ 12/ 96 PRODUCTS - COMP/ OP AGG S 1, 000, 000 CLAMS MADE [ X OCCUR PERSONAL & ADV INJURY S 1, 000 000 OWNER' S & CONTRACTOR' S PROT EACH OCCURRENCE $ 1, 000,000 FIRE DAMAGE ( My one fire) $ 50, 000
MED EXP ( Anyone person) $ 5, 000
AUTOMOBILE LIABILITY
A ANY AUTO BA 7750080D 09/ 12/ 95 09/ 12/ 96
COMBINED SINGLE LIMIT S 1, 000, 000
BODILY INJURY iALL OWNED AUTOS
SCHEDULED AUTOS P- Person)
BODILY INJURY $
X HIRED AUTOS
X NON -OWNED AUTOS
ht,
Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY
wrw
AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $ ti
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
SOTHER THAN UMBRELLA FORM
WORKER' S COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY EACH ACCIDENT S
THE PROPRIETOR/ INCL DISEASE - POLICY LMR S
PARTNERS/ EXECUTIVE
DISEASE - EACH EMPLOYEE $ OFFICERS ARE: EXCL
OTHER
B PROFESSIONAL LIABILITY LP 7750080D 09/ 12/ 95 09/ 12/ 96 AGGREGATE - $ 1, 000, 000 EACH OCCURRENCE - $ 1, 000, 000
DESCRIPTION OF O H
THE CERTIFICATE HOLDER , ITS OFFICERS, EMPLOYEES, AGENTS, & VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS THEIR INTEREST MARY APPEAR AS A FUNDING SOURCE FOR THE INSURED.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF NAPA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COMMUNITY RESOURCES DEPARTMENT 30 DAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHELEFT, 1100 WEST STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P. O. BOX 660
NAPA, CA 94559- 0660
F ANY D UPON THE COMPANY S GENTS OR REPRESENTATIVES.
AUTO REP
ATTENTION: HEATHER STANTON
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ATTACHMENT 1
FAMILY SERVICE NiB TEL: 1- 707- 255- 3110 Dec 01 95 17: 30 No. 006 P. 05 Atf1OlfoBtLlt LZASILIT9 SMIAi. ZXDORS>clf:llT lOR
CITY or NAPA (" the City") Endorsement Nose_
P. O. Sox 660
Effective Dat s' e/ z . j" Napa, CA 94559
Attus Direator of Public works
A. POLICY INFORMATION.
FIRST NATIONAL INS.
1. Insurance company _ CO. OF AMERICA (" the Company") s Policy number BA
seat Rating:
2. Policy Term ( from) O-IJI/ 12/ 9-') to) 6
3. Named Insured FAMILY SERVICE
4. Address of Named Insured 1157 DIVISION ST., NAPA, CA
5. Limit of Liability Any one occurrence/ Aggregate S„ 1t 000, 000 CSL
6. 0 deductible O self- insured retention ( nil unless
otherwise : specified) s $
7. Loam Adjustment Expenses included in limits Clin addition to limits
a. Type of insurances ® commercial auto, O business auto, D other
9. Applicability: ® This insurance pertains to the operators of the named insured under all written agreements/ permits with City; Only the following specific agreements/ permits with City are covereds
1!! i=! iliiiiiii!!! i!!!! ft! l. t7gKliilki!! ii! liRRiliiiiRililiii!!!!!!! liiiiliiii!! n. POLICY AMENDMENTS.
This endorsemant is issued in consideration of the policy premium.
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follower
1. INSURED. the City, its elected or appointed officials, employees and volunteers are included as additional insured with regard to damages and defense of claims arising from the operational activities performed by or on behalf of the Named Insured.
2. CONTRIBUTION NOT REQUIRED. As respects: work performed by the Named Insured for or on behalf of the City; the insurance afforded by this policy shall, be primary insurance as respects the City, its elected or appointed officials, employees or volunteerel or stand in an unbroken chain of coverage excess of the Named Insured' s scheduled underlying primary coverage. In either event, any other insurance maintained by the City, its elected or appointed officials, employees or volunteers shall be excess of this insurance and shall not contribute with it.
3. SCOPE OF COVERAGE. The policy: ( 1) if primary, affords coverage at least as broad as Insurance services Office form number CA0001 ( Ed 1/ 87) Code 1, any auto; or ( 2) if excess, affords coverage which is at least as broad as the primary insurance form referenced in the preceding unction ( 1).
4. SEVURABILITY OF INTEREST. The inqurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit in brought. The inclusion of EXHIBIT ” "
ATTACHMENT 1
FAMILY SERVICE NiB TEL: 1- 707- 255- 3110 Dec 01 95 17: 30 No. 006 P. 04 C.
officials, employees or volunteers; or stand in an unbroken chain of coverage excess of the Named Insursd' s scheduled underlying primary coverage. In either event,
any other insurance maintained by the
City, its elected or appointed officials, employees or volunteers shall be excess of this insurance and shall not contribute with it.
3. SCOPE OF COVERAGE. The policy: ( 1) if primary, affords coverage at least as broad as ( a) Insurance Services Office form number GL0002 Ed 1/ 73) Comprehensive General Liability Insurance and Insurance Services Office form number OL0404 Broad Form Comprehensive General Liability endorsement= or ( b) Insurance Services office Commercial General Liability coverage form number 000001; or ( 2) if excess, affords coverage which is at least as broad as the primary insurance form referenced in the preceding sections ( a) and ( b).
4. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit in brought. The inclusion of more than one insured shall not operate to impair the rights of one insured against another insured.
S. PROVISIONS REGARDING THE INSURBD' S DUTIES AFTER ACCIDENT OR LOSS.
Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City, its elected or appointed officials, employees or volunteers.
6. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended, voided, cancelled, materially reduced in coverage or in limits except after thirty ( 30) days prior written notice by certified mail, return receipt requested, has been given to the City. Such notice shall be addressed as shown in the heading of this endorsement.
i!! i!!!!! lK. ssiiiilri! len. asrte,!!!! i!!!!!! i!!!!! i!!! liiili!!!! r rMrrsKFsii I.( name), warrant that I have
authority o nd" above - listed insurance company and by my signature hereon do so bi this company.*
Signature oft
Authorized Representative ( or g na a gnature require
on endorsement furnished to the City)
REHABILITATION
AGENCY OR BROKERAGE: i& RECOVERY INS, AGENCY TITLE:
ADDREss, 22 BATTERY ST # 503 S. F. CA. 94111 TELZPHONE:( 415 ) 956- 2130 FAX:( )
i!!!! lfq, 4 a pssiiiiiii!! a= Ctrl. Rcssslsssiissilsslsscc cissssa!! s! s!!!!!!^ RRiirisi
0. CLAIMS: UNDERWRITER'S REPRESENTATIVE FOR CLAIMS PURSUANT TO THrj INSURANCE EJAs set forth in C. above
Q Other: Name:
Company:
Address
Telephone ax:(_)
Awhodzedsignaturesmaybeagcnrsif agar hu placedim m osshsnughanagencya2mm mwishsheinimmr. it iummnceisbskerad, sur M671 d sigMWro must be that of oAtcisi of inmfee.
o..: r; xev. zb vaisl EXHIBIT " '
ATTACHMENT 1
FAMILY SERVICE N/ B TEL: 1- 707- 255- 3110 Dec 01 95 17: 29 No. 006 P. 03
GENERAL LIABILITY SPECIAL UNDORSNUMM FOR
CITY OF NAPA (" the City") Endorsement Not
P. O. Box 660
Napa, CA 914559 Effective Dates - 09/ 12/ 95
Attnt Director of Public works
A. POLICY INFDEMTIONI
1. Insurance CompanyFIRST NATIONAL INS. CO. OF ER C*" the Company"):
Policy Number CP 7750055n _
Best Rating: ++
2. Policy Term ( f rom) ( to)__ QJL12/ q6 lig
3. Named In. ttred FAMILY SERVICE OF THE NORTH BAY
lie& e
4. AddressofNamedlnsured115, 7 DIVISION STREET, NAPA. CA 94559
5. Limit of Liability Any one Occurrence/ Aggregate 81, 000, 00Q 1, 000 3000 O Applies per location/ project F-1 Is twice the occurrence limit
6. O veductible 0 5elf- Insured Retention ( nil unless otherwise specified) t S O Per occurrence CDPer claim
7. Loss Adjustment Expense: 0 Included in limits 0 in addition to limits
8. Type of insurance:
0 Commercial General Claims Mads
Retroactive date:
l Comprehensive General
O W/ BFCGL Coverage .__.
i
Occurrence
other:
9. Coverage: General [-] Personal Injury ElXCU
10. Applicability:.
Q This insurance pertains to the operators of the named insured under all written agreements/ permits with City
Only the following specific agreements/ permits with City are covered:
S. POLICY AMENDMENTS.
This endorsement is issued in consideration of the policy premium.
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows,
1. INSURED. The City, its elected or appointed officials, employees and volunteers are included as additional insured with regard to damages and defense of claims arising from: ( a) activities performed by or on behalf of the Named Insured; ( b) products and completed operations of the Named Insured; or ( c) premises owned, leased or used by the Named Insured.
2. CONTRIBUTION NOT REQUIRED. As respects: ( a)
work performed by theNamed Insured for or on behalf of the Cityt or ( b) products sold bythe Named Insured to the City; or ( c) premises leased by the NamedInsured from the City, the insurance afforded by this policy shallbe primary insurance as respects the City, its elected or appointed covww Nov. st. IM) EXHIBIT
0:.* i1* fW4ie.. r• M Page 1 of 2
0 ATTACHMENT 1
FRMILY SERVICE N/ D TEL: 1- 707- 255- 3110 Dec 01 95 17. 31 No. 006 P. 06 morethan one insured shall not operate to impair the -rights of oneinsured against another ineared.
S.
PROVISIONSREGARDINGTHEINSURED'S DUTIESAFTERACCIDENTORUM8. Anyfailure to complywith reportingprovisionsof the policy shallnot affect Coverage provided to the City, its elected or appointedOfficials, employses or volunteers. 6• CANCELLATION NOTICE.
The insurance afforded by this policy shallnot be suspended, voided, cancelled, materially reduced in coverageor in limits except after thirty ( 30) days prior written notice bycertified mail, return receipt requested, has been given to theCity.
Suchnotice shall be addressedas shownin the headingofthis endorsement. ssaarysraaasas Rsssrr" ersass airssasrrasss
Rrassssaaa rraarraarrsaaarwrsrraaarC. 8IGNATLlRE' oF StJ_4rssFs110-- author (
print/ type name), warrant that I haveY o in ove-
sted insurance companyand by my signaturehereon do so bi i.$ company.+ Signature of:
14thorized Representat ve (
OrL9Ln& l signature reQu re
On endorsement furnished to the city)
AGENCY OR SROXERAGEI
REHARTLITATION
ECOVERY INS, AGENCY TITLE,
ADDRESSs22 BATTERY ST # 503, S. F., CA..: 94111TZLMPRONzs(415) 956- 2130s+.. sarrsassasaaaaaerraas. aa.. a. ssaa# rrrarraaaaaaarssaaaaaaaarrsar sssaaaaaaaaa r
D p CLAIMS PUR U
EJ AN set forth in C. above
0 Other: Name:
Companyt_ '
Addresst
Telephone ax:() t
AuthorizedeiMmulsmyhe118enuif11800hupl110edinwnaoedulu8hana8etaya8oeememwiththeituwror. Ni:twtwaeeisbl end, N11h0fi%W11i`nawnmumbedot of offiai11iOfimumr, EXHIBIT " "
ATTACHMENT 1
N-gx$gk%'% lk-
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0 DATE MWD D" a
1 1001,
11% I'll 11/ 13/ 95
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ERNEST BLOONTIEELD & ASSOCIATES/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE REHABILITATION & RECOVERY INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22 BATTERY STREET, 5TH FLOOR
A HE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANIES AFFORDING COVERAGESAN FRANCISCO, CA 94111
COMPANY
FIRST NATIONAL INS. CO. OF AMERICAA
INSURED
FAMILY SERVICE OF THE NORTH BAY
COMPANY
B
BIG BROTHERS/ BIG SISTERS OF THE NORTH BAY COMPANY
NOV 1419951157 DIVISION STREET C
NAPA, CA 94559 COMPANY
D city ClerWs U111cez
R 'Wl
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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
CERTIFICATEMAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE ( NNNDDNY) DATE POWD15"
GENERAL LIABILITY GENERAL AGGREGATE $ 1, 000, 000
X X COMMERCIALGENERALLIABILITYCP7750080D 09/ 12/ 95 09/ 12/ 96 PRODUCTS - COMP/ OP AGG S 1, 0w,wo 1]
CLAM MADEFy7A iOCCUR PERSONAL & ADV INJURY $ 1, 000w o
EACH OCCURRENCE $ 1, 000, 000
OWNER' S & CONTRACTOR' S PROT
FIRE DAMAGE ( Any one fire) $ 50, 000
MED EXP ( Anyone person) $ 5, 000
AUTOMOBILE LIABILITY
A ANY AUTO BA 7750080D 09/ 12/ 95 09/ 12/ 96
COMBINED SINGLE LIMIT $ 1, 000, 000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS Per person)
X HIRED AUTOS
X
BODILYNJURY $
NON- OWNED AUTOS Per accident).)
DAMAGE $ RPROPERTY
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER' S COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT $
THE PROPRIETOR/ INCL
PARTNERS/ EXECUTFVE
Fl
DISEASE - POLICY LIMIT $
OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE S
OTHER
I
DESCRIPTION OC HI SECIAL ITEMS
CERTIFICATEHOLDER IS NAMED ADDITIONAL INSURED AS A FUNDING SOURCEFORINSURED.
Ell
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF NAPA EXPIRATIONDATETHEREOF, THEISSUINGCOMPANYAVM3F*W* Wr To MAIL 955 SCHOOL STREET 30 DAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHELEFT, P. O. BOX 660
NAPA, CA 94559- 0660
Orly
AUTHORIMD 3PVTATFVE
m
ATTACHMENT 1
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QMDATE ( MMIDONY)
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THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER415- 956- 2130AIC No E
COMPANY
REC
ERNEST BLOOMFIELD & ASSOCIATES/ FIRST NATIONAL INSURANCE COMPANY OF AMERICA REHABILITATION & RECOVERY INSURANCE AGENCY, INC.
22 BATTERY STREET, 5TH FLOOR NOV151995SAN FRANCISCO, CA 94111 r
City Clerk -s- offsl JJ)
CODE: SUB CODE:
CUSTOMER ID 0:
INSURED LOAN NUMBER POLICY NUMBER
FAMILY SERVICE OF THE NORTH BAY CP 7750080D
BIG BROTBERS/ BIG SISTERS OF THE NORTH BAY EFFECTIVE DATE EXPIRATION DATE
CONTINUED
1157 DIVISION STREET 09/ 12/ 95 09/ 12/ 96 TERMINATED
IFTIL
CHECKED
NAPA, CA 94559 THIS REPLACES PRIOR EVIDENCE DATED:
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718 CAROLINA STREET
NAPA, CA 94559
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COVERAGEIPERILS/ FORMS AMOUNT OF INSURANCE DEDUCTIBLE
BUILDING, SPECIAL FORM, REPLACEMENT COST, 90% COINSURANCE 150, 000 500 t:::
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THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICES, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
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NAME AND ADDRESS
X MORTGAGEE ADDITIONAL INSURED
PAYEE
THE CITY OF NAPA, IT' S OFFICERS,
LOANS
AGENTS AND EMPLOYEES
955 SCHOOL STREET
NAPA, CA. 94559 AU PRP" TATIVE
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2 ATTACHMENT 1
STATE P. O. BOX 420807, SAN FRANCISCO, CA 94142- 0807 JUL141995 COMPENSATION ;},`
yINSURANCE Cj'ews
f
ttic; eFUND CERTIFICATE OF WORMERS' COMPENSATION INSURANCE JULY 12, 1995 POLICYNUMBER: 706400- 95
CERTIFICATEEXPIRES: 07- 31- 96
CITY OF NAPA
CITY CLERK OFFICE
ATTN: PAT LAWSEN
955 SCHOOL STREET
L_ NAPA CA 94559
Thisis to certifythatwe haveissueda validWorkers' Compensationinsurancepolicyin a form approvedbythe California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer.
We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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.
X. VA"
PRESIDENT
EMPLOYER' S LIABILITY LIMIT INCLUDING DEFENSE COST: $ 1, 000, 000. 00 PER OCCURRENCE.
ENDORSEMENT # 2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 07- 12- 95 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
THIRD PARTY NAME: CITY OF NAPA
FAMILY SERVICE OF THE NORTH BAY
BIG BROTHERS/ BIG SISTERS OF THE NORTH BAY
1157 DIVISION STREET
NAPA CA 94559
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SaF 10262 ( REV. 5- 94) ATTACHMENT 1
FAMILY SERVICE N/ B TEL: 1- 707- 255- 3110 Jun 02 95 15: 03 No. 002 P. 02 Cz" MrxC1= or rmormsssamz. .
T=. 1 is To CSAT' FT TOs CI% T OF '" A
40"'"
C4.tyw
P, 0_ Box 660
Napa. Ch 94559
1tlnt
TM rommuc 033= mm P== au no rgs To:
Tzsuxod:
FAMILY SERVICE OF NORTHBAY
xddresss 57
U== OK MW DaSCRXr =ONOr PFalLCT/AGAR=
Cf
ga, ie, S
TYPF OS INSURANCE: Profs¢ iossal Liab3. lity/ Lrr° ti and oa: issioas = nauranae Mbccurrsncs Clal, ms Made
ZITS OF LIASILIT7Cs
1 0000- 000. s, ch occurrenceCombined ingls LimitSPropss y paa gs LiabilityDO—My mDeductible Qself- Insured Retentions S l
Ynsurance C= P&
nYSAFECO SURPLUS LINES TNS". CO.
policy Number IPI
RBest Rating:
Policy Term ( roar) 9 NO nor materially altsrsd without 30 days The policy willnot s CaLce
addrsssr.
written notice to the Cit Of DTapa At the above
ZT Z5 WMBY CEITIFIED the above Policy p., Ids* Las=" ce as required by the contract dated between the City of Napw an les ' asured.
Dates Ghes-- siguedt
Fixers
hddrsrls:
Phone:
N0161 Audwcbwdaiyoaausamarbe $ foamif09atMbaa ¢iffied11"Im, thm5bmGodwy •fes wishtheWmuw. [riaauoaNis brokstod. •whotiWd signalue mea bs chatof of GWOfUW W'
WWS2 W. aa9m E= ZBIT
0td# P- 4MWKPk—
Page I of 1
ATTACHMENT 1
FAMILY SERVICE N/ B TEL: 1- 707- 255- 3110 Jun 02 95 15: 00 No. 001 P. 06 cam num LIAN== = W= L Fm
C= or IWA. (" the city') made xa ment 11os T,
P. O. Box 660
Napa, CA 94559 89fective Dates %
Anus 3lseatror of ae" Uc Works
1. Insmrance company RST NAT' L INS, CO (" th* CO° 4Pm= y") s Policy Number Q Z7S n n Ra(;
Desk Rot— :
2. POLLCyTOM ( ronin)
3. OTaA04 ZWWx* d FAMILY SERVICE OF NORTH BAY
4. Address o5 Named Iasurod 1157 DIVISION ST. , MAPA , CA.
S. Lisai t of Liability Any One Ocaur rence/ Aggregate S 1, 000, 000 . / 1, 000 , 000 .
OApplias per location/ project Q Is twice the occurrence 11mit
6. Deductible ID6elf- Insured Retention ( nil unless otherwise & I Lr spec if ied) s $ Per occurrence Per claim
7. Loss Adjustment Expens.: CoIncluded in limits 0 In addition to limits
8. Type of insuranca:
QCommerCial General © Claims Hada
Retroactive dates
ClComprehensiveGeneral
EIW/ DFCCI, Coverage m occurrence
9. Coverage: fizdanarai SaPerso" I Injury 1:3 = U
10. Applicability:
AThis insurance pertains to the operators of the named insured under all written agreements/ pexmita with city
only the following specific agreements/ permits with City ate covered:
mom----........... u. .... ir.-....... a
D. QL c c Ar Nna NTs. ..
This endorsement is issued in consideration of the policy Premium.
Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other andorsement attached thereto, it is agreed as follows:
1. INSMMD. The City, its elected or appointed officials, employees and volunteers axe included as additional insured with regard to damaggs and defense of claims arising from: ( a) activities performed by or on behalf of the Named Insured; ( b) products and completed operations of the Named Insured; or ( c) premises owned, leased or used by the Named Lnsuxed.
Z. COHTRIBUTiON NOT REQIIIRED. As rompecte: ( a) work performed by the Named Insured for or on behalf of the City# or ( b) products sold by the Named Insured to the City; or ( C) Promises leased by the Nerved Insured from the city, the insurance afforded by this policy shallbs primary inauranc as, respects the City, its elsectsd or appointed pw1. d, Nw. a. NIA 9= 131T " "
W" A- w a-
11 -
page 1 of 2
ATTACHMENT 1
FAKILY SERVICE N/ B TEL: 1- 707- 255- 3110 Jun 02 95 15: 00 No. 001 P. 07 olficia• I, s, employes or voiuntowar or stand U an unk zoko: chainat oovarage excess of the Useed Insured' s scheduled un& MLY Ag y' iA7 coverage. Za itbar
i
vena, any other insuranas aaA,ntaiaed br- tha
city, its elected or appointed officials, ewployeae or voLvausers shall be excess of this insurance and shall not contribute Nit&. it«
3. sc= of = mat=. The policy$ ( 1) if primary, affords coverage at leant as broad as ( A) ZASW CM S& CVioes Office toren M mbar 0= 02 ltd 1/ 73) Ccmprehsasive General Liability Insurance and ZasuCAM l services Office toren number OL0404 D= ad Poem CMDreh" sive QQMWAL Liability e4doxs0M* fttt Or ( b) Zusu= aace Ssxvices Office mos., General Liability Coverage to= number 000001 i* or ( Z) i9 ssoess, affords coverage which is at least as broad as the primary insatmumm loran refexeaced in the preceding sectl. ans ( a) and ( b) .
4. SlrT = ZXLITY Of = REST. The insurance afforded by % WA poLlay applies separately to seat& insured who is seeking coverage or against whom a claim is made or a suit is brought. The inclusion of more than one insured shall nor. operate to impair the rights of • f7a<Ie insured against anothax insured.
S. PROVISIONS REGARDING THS INSM=- S DUTIES AFTER AC= ZNT OR LOST.
AnY failure to comply with. reportinq provisions of the policy shall not affect coverage provided to the city, its elected or appointed officials, employees or volunteers.
S. CANCELLATION NOTICE. The insurance attordad by this policy shall not be suspended, voided, cancelled, materially reduced it: coverage or in limits except after thirty ( 30) days prior written notice by certified mail, return receipt requested, has been given to the City. Such $ satire shall be addressed as shown in the heading of this endorsement.
eaw wwwssUtllip111tsswwwwwwwwww wwwwwwwwwsw. fM11tMM1YMMNMsftlwlA C. SIONATURTQ„ QF , rNSQRERa- AUTHORIZED = HXSZNTATT"__ 0F _ THE__ ZNSMUM , I, z`' T y / o o rt7 l ( prim/ a name) , warrant that I have authority to ve— istsd ncs c by nay signwtura
bareon deso b thi .
Sigxxature o#:
Authartzed Represent( orLginals gnazurs raqu
on ondorasmant f dto the City)
AGENCY OR B" 3MPAGE: 1`Z'IS. E/
ADDRESS iZL. + 7%' " S,s .• t> G f / PHONE ( y/ -
FAX:
s, www ewwwwwwwwwwa„. wwaww Rwwwwwwgwwwwwwwwwwwwwwwrrw ww • D • Q AI j% t MME 8I RXTER', S PZMSENTAT= FOR CLAYMs pfiFES l. 4. s sxsmaNca% M" not forth in c. above
QCther: Name:
Company:
Addrenot
Telephone ax:()_ (
r)
Authuiroad signawres m. r be s= pre if . gust has pieeod iosunnCe * mgk = agesmy * jn; cn ; M TA* dw iawrer. u Ipwrsuee ie Wakfted, uwhotved ti* nuwr nrta be Chet o[ oflloial of insurer.
u. rr. wiM+. n. EXUIBIT " "
0000 Page 2 a 2
ATTACHMENT 1
FAMILY SERVICE N/ B TEL: 1- 707- 255- 3110 Jun 02 95 15: 01 No. 001 P. 08 C= or mph ( " the city")
P. C. Box 660
Napa,, Ca 94339
btsas DL" ator of Public Works
Sodcrssment no: - r-, C -
Effective oastes—
A.
1. Insurance company FIRST NAT' L INS. CO OF AMERICA (" the Company") Policy Number
Beat Plating:
2. policy Testa ( rCM), 09 ( Coles , a, 1.( 5
3. Named Insured FAMILY SERVICE OF NORTH BAY
4. address of Named Insured 1157 DIVISION ST. NAPA CA.
S. Limit of Liability Any One QaaurrsssCe/ Aggregate S 1, 000, 000.
G. Q deductible self- ieaurad retention ( nil unless `' ) athsswi(( A specified) sS ! t i l,
7. Loss Adjustment Expense: JA iaicluded is limits Qin addition to limits
a. Type of insurance: ® commercial auto, d business auto, Mother
9. Applicability! M This Insurance pmstains to the operatars Of the named insured under all written Agreements/ permits with City; Q Qnly the following specific agrsamonts/ permits with city are Covered:
MMMONIMMMO
WW= 980 rr
This endorsement is issued in consideration of the policy premium.
Notwithstanding any inconsistent stntsment in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as followss
1. INSURED. the City, its elected or appointed officials, employees and volunteers are included as additionAl insured with regard to damages and defense of claims arising from the operational activities performed by or on behalf of the Named Insured. . i
2. CONTRIBUTION NOT REQUIRED. Xs respeatss work performed by the Named Insured for or an behalf of the City; the insurance afforded by this policy shall be primary insurance as respects the City, its elected or appointed officials, employess or volunteerni or staid in an unbroken chain of coverage excess of the Named Insured' s scheduled underlying primary coverage. Xn either event, any other insurance maintained by the City, its elected os appointed olfiaials, employees or volunteers shall be excess of this Insurance and shall not contribute with it.
3. SCOPE or COVERAGE. The policy: ( 1) if primary, affords coverage at least as broad as Insurance Services Office form number CA0001 ( Ed 1/ 87) Code 1, any auto; or ( 2) if excess, affords coverage which is at least as broad as the primary insurance foram referenoed in the pr cadinq section ( 1).
4. SEVERA8ILITY Or INTEREST. The insurance afforded by this policy applies separately to mach insured who is seeking coverage or against whom a claim is made or a Suit is brought. The inclusion of
ATTACHMENT 1
FRMTLI' SERVICE NiB TEL: 1- 707- 255- 3110 Jun 02 95 15: 02 No. 002 P. 01 mous than ane iazsusrd shall aot Operate to ' 0941s _ the zighto ot,. a inmuLmd maminsr. another' iaasuasd.
5. pYlDVISYO tB Ra DIi1G THZ' tFxwSD'* V= Ms Am= Ac= xm OR Um. naytailu rs to aoaaply with tttpost" g Pions OX the policy ohm" not &; eta t aovwmge Provi ed to the City, its elected Or appoinerd 092tcials, e: aployeas or voluntmacs.
6. CA it S TX( M WTX=. The ia>snrsa3cs afi' orded by this policy shad]. net be suspended, voided, O& OCelled,
matsrislliywritten byor in limits except atter thirty ( 30) days prior certified sail. return WWAipt requested• bas bOOn gLVOO to- C3, ty. such notice Meal.! be addressed as sha+a is the badis q . Of tlxis endorsement.
INSIJM oil'•,'"
r., r/ sin +++ n . O1 ' YNSMUM,
PrLnt / type Same) # wa=& At that I have
awttio' tityto 04Aa Une ova— . sated ins s Y si
hereon do so biasd any-
signaturs of:
AU rs. z • esentiats r q " gaature requss
on endorsement turnix o the City)
AGENCY OR sRO1CMFt] IOE: gR- C, tt'' j•;-,,
2<_ —
TITLS; s I fL' s / car
z 3
ADDRZSSs.?? iyTiC'• y s%, 5, / yL!/(. TG g pNR: ( ) S a / d r+ r ru.. wirrr< rr rwr a rrrrorrr+ rrrrw r
D • [* r.±? ±,' MMXRWRT= , S REPRjj9MM1kTrM gQ$—=rM§ PURSURNT TO 321S SNSMUCZ AAs set ! Orth in Co, above
0 Othat : Nese:
Companyt
Addrass:
Telephone axe (_,,,._,
AUdm* ibW aigmumra may bo creme if $ goo baa plac" jnmmnm ibmgb m al— y ai" unm wiahthe invAm- N Idunaea u bn* woit sudmKiowd aipmaa num be tbae of oMGW of Inma r.
EXHIBIT "
ATTACHMENT 1
LOW
x
DATE ( NIMMONY)
NINE 01 N
11111M 06/ 06/ 95Ilk
0,
ME
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ERNEST BLOOM[ FIELID & ASSOCIATES/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE REHABILITATION & RECOVERY INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22 BATTERY STREET, 57H FLOOR THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGESAN FRANCISCO, CA 94111
COMPANY
FIRST NATIONAL INSURANCE COMPANY OFA
INSURED
FAMILY SERVICE OF THE NORTH BAY
COMPANY
SAFECO SURPLUS LINES INSURANCE COMPANY
1157 DIVISION STREET B
COMPANYNAPA, CA 94559
C
COMPANY
D
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 B Y 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. co
LTR
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS I DATE ( MMIDDIM DATE ( MMfDDlM
GENERAL LIABILITY GENERAL AGGREGATE 3 1, 000, 000
A COMMERCIAL GENERAL LIABILITY CP 7750080C 09/ 12/ 94 09/ 12/ 95X 7 PRODUCTS - COMP/ OP AGG S 1, 000, 000
CLAIMSMADEFX] OCCUR PERSONAL & ADV INJURY S 1, 000, wo
EACH OCCURRENCE $ 1, 000, 000OWNER' S & CONTRACTOR' S PROT FIRE DAMAGE ( Anyone fire) 111 50, 000
MED EXP ( Anyone person) $ 5, 000
AUTOMOBILE LIABILITY
A ANY AUTO BA 7750080C 09/ 12/ 94 09/ 12/ 95
COMBINED SINGLE LIMIT $ 1, 000, 000
ALL OWNED AUTOS
X
BODILY INJURY $
SCHEDULED AUTOS Per person)
X HIRED AUTOS
X
BODILY INJURY
NON- OWNED AUTOS Per accident)
PROPERTY DAMAGE $
NQUIN5
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER' S COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT
THE PROPRIETOR/
PARTNERS/ EXECUTFVE
INCL
d
DISEASE - POLICY LIMIT $
OFFICERS ARE EXCL DISEASE - EACH EMPLOYEE
OTHER
B PROFESSIONAL LIABILITY LP 7750080C 09/ 12/ 94 09/ 12/ 96 AGGREGATE - $ 1, 000, 000 EACH OCCURRENCE - $ 1, 000, 000
DEECRIPTION OF OPE RATIONSILOCAInON" ENIOLESISPECAL ITEMS
THE CERTIFICATE HOLDER, ITS OFFICERS, EMPLOYEES, AGENTS, & VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS THEIR INTEREST MAY APPEAR REGARDING OPERATIONS OF THE NAMED INSURED. 110111=
011 a ' m" 1:12:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF NAPA - EXPIRATIONDATETHEREOF, THEISSUINGCOMPANYWILLWW*) R,&CTAtCMAIL COMMUNITY RESOURCES DEPARTMENT 30 DAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHELEFT, 1100 WEST STREET
P. O. BOX 660
NAPA, CA 94559- 0660
ATTN: HEATHER STANTON
AUTH072MIREPREl NTA
ZZ, %WK: v\W* WM-zM •KvIK, ........... ----% xx
PgMklk \ X11k."MKO
ATTACHMENT 1
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t:
06/ 06/ 9 5
v::. w::::::::::.::::::::. ttvw:.::::?. :. tttw: •. v •?: •: x::?: iU. ii; i•? J
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ERNEST BLOOMFIELD & ASSOCIATES/
REHABILITATION & RECOVERY INSURANCE AGENCY, INC.
22 BATTERY STREET, 5TH FLOOR
SAN FRANCISCO, CA 94111
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER HE COVERAGE AFFORDED Y THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
FIRST NATIONAL INSURANCE COMPANY OF
A
AMERICA
INSURED
FAMILY SERVICE OF THE NORTH BAY COMPANY
SAFECO SURPLUS LINES INSURANCE COMPANY
1157 DIVISION STREET B
COMPANYNAPA, CA 94559
C
COMPANY
D
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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 B Y 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.
CO
LTR
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE ( MM/ DD/ YY)
POLICY EXPIRATION
DATE ( MWDDNY)
LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $ 1, 000, 000
A X COMMERCIAL GENERAL LIABILITY CP 7750080C 09/ 12/ 94 09/ 12/ 95 PRODUCTS - COMP/ OP AGG $ 1, 000, 000 CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1, 000, 000 OWNER' S & CONTRACTOR' S PROT EACH OCCURRENCE $ 1, 000, 000 FIRE DAMAGE ( Anyone fire) $ 50, 000
MED EXP ( Anyone person) $ 51000
A
AUTOMOBILE LIABILITY
ANY AUTO BA 77500800 09/ 12/ 94 09/ 12/ 95 COMBINED SINGLE LIMIT $ 1, 000, 000 X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY E
Per person)
X
X
HIRED AUTOS
NON- OWNED AUTOS
BODILY INJURY $
Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER' S COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT, ;
THE PROPRIETOR/ INCL
PARTNERS/ EXECUTIVE DISEASE - POLICY LIMIT E
DISEASE - EACH EMPLOYEE $ OFFICERS ARE: EXCL
OTHER
B PROFESSIONAL LIABILITY LP 7750080C 09/ 12/ 94 09/ 12/ 95 AGGREGATE - $ 1, 000, 000 EACH OCCURRENCE - $ 1, 000, 000
DESCRIPTION OF OPERATIONS/ O ONSNEHICL P CIAL
THE CERTIFICATE HOLDER, ITS OFFICERS, EMPLOYEES, AGENTS, & VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS THEIR INTEREST MAY APPEAR REGARDING OPERATIONS OF THE NAMED INSURED. 0}: v.: v ...... .,...
tt• t ititiv tv:\
tti: ii.:'.::•
nt.::::::.::::::.. a:;` i*.::.:: o•;: o:.>; c: i;•;: iiiii: i•:;•:;?, r::• i:::::: a?;>:?:•::: ;: is;. ::•:::::?:^::::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORETHE
CITY OF NAPA - EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL COMMUNITY RESOURCES DEPARTMENT 30 DAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHELEFT, 1100 WEST STREET
P. O. BOX 660
NAPA, CA 94559- 0660 AUTHORIZED REPR" TAT
ATTN: HEATHER STANTON
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ATTACHMENT 1
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142- 0807
COMPENSATION
NS U R A N C E
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
JUNE 8, 1995 POLICY NUMBER: 706400- 94
CERTIFICATEEXPIRES: 07- 31- 95
F -
CITY OF NAPA
COMMUNITY RESOURCES
ATTN: KATRINA SCHLYER
P 0 BOX 660
NAPA CA 94559
L
ThisistocertifythatwehaveissuedavalidWorkers' CompensationinsurancepolicyinaformapprovedbytheCalifornia Insurance Commissioner to the employer named below for the poll? period indicated.
Thispolicyis notsubjectto cancellationbythe FundexceptuponXWdays' advancewrittennoticeto the employer. 30 Wewill also giveyowl days' advancenoticeshouldthis policybe cancelledpriorto its normalexpiration.
Thiscertificateof insuranceisnotaninsurancepolicyanddoesnotamend, extendoralterthecoverageaffordedbythe policies listed herein. Notwithstandingany requirement, term, or condition of any contract or other document with respectto whichthis certificateof insurancemaybe issuedor maypertain, the insuranceaffordedby the policies described herein is subject to.all the terms, exclusions and conditions of such policies.
PRESIDENT
THIS CORRECTS AND SUPERCEDES PREVIOUSLY ISSUED' CERTI= ATE DATED JUNE 5, 1995.
ENDORSEMENT # 2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 6/ 8/ 95 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT # 2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 6/ 8/ 95 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
THIRD PARTY NAME: CITY OF NAPA COMMUNITY RESOURCES
EMPLOYER' S LIABILITY LIMITS:
EMPLOYER
3, 000, 000. 00 PER OCCURRENCE.
FAMILY SERVICE OF THE NORTH BAY
1157 DIVISION ST
NAPA CA 94559
ATTACHMENT 1
P.W4
7/11017
CITYof NAPA
August 2, 2002
Family Services of the North Bay
709 Franklin Street
Napa, CA 94559- 2920
Re: Insurance Renewal, Agreement No. 6766
Dear Sir/ Madam:
CITY CLERK
955 School Street
Mailing Address:
P.O. Box 660
Napa, California 94559- 0660
707) 257- 9503
FAX M ( 707) 257- 9534
www. cityofnapa. org
This letteris to officiallynotify you that the certificateof insurancefor AgreementNo. 6766 with the City of Napa for the CDBG Program will expire August 3, 2002. Proof of insurance is required for Flood insurance.
Enclosed are copies of certificate pertaining to your insurance requirements. Please be sure that yourinsurancecompanyis notifiedof theserequirements, whicharethesameas originally required at the time of approval of the agreement. ( Please also ensure if renewing the workers' compensation insurance, that a waiver of subrogation endorsement (# 2570) is renewed with the policy if required in your agreement.)
It is importantthat you or yourinsurancecompanyrespondwithin 30 daysfrom receiptof this letter. I appreciate your prompt attention to this matter, and please feel free to contact me if you have specific questions relating to the requirements of your agreement.
Pleaseensure that all required insurance certificates be faxed or mailed to the attention of, and certificate holder listed as:
Lisa Hamer, Deputy City Clerk
City of Napa
PO Box 660
Napa, CA 94559- 0660
Sinrely,
Facsimile: 707- 257- 9534
Lisa Harper, CMC
Deputy City Clerk
Encls.
C: Northwest Insurance Agency, PO Box 1180, Santa Rosa, CA 95402-1180 Q:\ 1cirkadm\ insuranc\ le tters\ 6766. doc
ATTACHMENT 1
CITYof NAPA
RECEIVED
AUG 1 5 2000
City Clerk's Dept.
July 19, 2000
CITY INSURANCE REQUESTED
Family Service of the North Bay
PLEASE ADVISE
709 Franklin Street
Napa, CA 94559
Re: Insurance Renewal, Agreement No. 6766
Dear Sir/ Madam:
CITY CLERK
955 School Street
PO Box 660
Napa, California 94559- 0660
707) 257- 9503
FAX ( 707) 257- 9534
S L
Thisletteris to officiallynotifyyouthat the certificatesof insurancefor CityAgreementNo. 6766with theCityof Napafor propertyacquisitionandoperationat 709FranklinStreet hasexpiredonAugust 3, 1999. The City requires that you provide proof of active and current Flood Insurance.
Enclosed are copies of certificate pertaining to your insurance requirements. Please be sure that your insurance company is notified of these requirements which are the same as originally required at the time of approval of the agreement. Please also ensure if renewing the workers' compensation insurance, that a waiver of subrogation endorsement (# 2570) is renewed with the policy. This renewal for insurance is due inthe CityClerk's Officewithin 30daysof receiptof this letter.
It is important that you or your insurance company respond within a reasonable time period. We regretfullymustinformyouthat non-compliancewiththis contractrequirementwill requirethe Cityto as applicable):
Red -tag" the project that means that all work must cease immediately Refer the violation to the City's Code Enforcement Officer Withhold payment on any outstanding invoices owed by the City Initiate agreement termination proceedings
Please ensure that all required insurance certificates be sent to the attention of and listed under certificate holder as:
Lisa Harper, Deputy City Clerk
City of Napa
PO Box 660
Napa, CA 94559- 0660
Facsimile: 707- 257- 9534
4iscerely,
a Harper, CMC
Deputy City Clerk
C: Emest Bloomfield & Associates, 22 Battery Street, San Francisco, CA 94111 q. 1 clrkadmVnsurancVetters\ 6766. doc
ATTACHMENT 1
W-04
llll\\\M
CITYof NAPA
July 15, 1998
Family Services of the North Bay
709 Franklin Street
Napa, CA 94559
Re: Insurance Renewal, Agreement No. 6766
Dear Sir/ Madam:
CITY CLERK
955 School Street
PO Box 660
Napa, California 94559- 0660
707) 257- 9503
FAX ( 707) 257- 9534
Thisletteristo officiallynotifyyouthatthecertificatesofinsuranceforAgreementNo. 6766withthe CityofNapaforadministrationofamentalhealthclinictoserveNapaSatelliteHousingclientswill expire August 3, 1998 ( Flood insurance).
Enclosedarecopiesofcertificatespertainingto yourinsurancerequirements. Pleasebesurethat yourinsurancecompanyis notifiedof theserequirementswhicharethe sameasoriginally requiredatthetimeof approvalof theagreement. ThisrenewalisdueintheCityClerk's Office within 30 days of receipt of this letter.
Itisimportantthatyourespondwithinthetimeperiodspecified. Weregretfullymustinformyouthat non-compliancewiththis contractrequirementwill requiretheCityto (as applicable):
Red -tag" theprojectwhichmeansthatallworkmustceaseimmediately Refer the violation to the City's Code Enforcement Officer WithholdpaymentonanyoutstandinginvoicesowedbytheCity
Initiate termination proceedings
Please ensure that all required insurance certificates are sent to the attention of:
Lisa Harper, Deputy City Clerk,
City of Napa
PO Box 660
Napa, CA 94559- 0660
Facsimile: 707- 257- 9534
Sincerely,
A N" F__' Lisa Harper
Deputy City Clerk
Encl.
q:\ 1 cirkadmNnsurancVetters16766. doc
ATTACHMENT 1
CONTRACT COMPLETION/ TERMINATION FORM
TO: CITY CLERK
FROM: Katrina Schlyer Community Resources
Name Department
DATE: August 19, 1997
Contract # 6766 Contractor Family Service of the North Bay Has been completed:
Has terminated:
Has been extended to:
date)
Date: 6/ 30/ 96
Date:
Date:
Notes: This Agreement consisted of a one time lump sum payment of $ 150, 000. 00 for the property acquisition at 709 Franklin Street, Napa. Finance issued a check for the total on April 11, 1996, and we hold a Promissory Note with Family Service. The house on this sight serves as an Outpatient Clinic and houses their main office. We no longer need the company service insurance; however, our office requests proof of flood insurance and general liability insurance on an annual basis. cAcdbg9798\ termform. doc
ATTACHMENT 1
W..-4
VNAM
CIN of NAPA
August 15, 1997
Family Service of the North Bay
709 Franklin Street
Napa, CA 94559
C717 CLOM
955 School Street
PO Box 660
Napa, California 945594660
707) 257- 9503
FAX ( 707) 257- 9534
RE: Insurance Renewal, Agreement No. 6766; Agreement for CDBG Program; administration of mental health clinic to serve Napa Satellite Housing clients, etc.
Dear Sir/ Madam:
This letter is to officially notify you that the certificate of insurance for Agreement No. 6766 with the City of Napa will expire on September 12, 1997.
Enclosed is that section of the agreement pertaining to your insurance requirements. Please be sure that your insurance company is notified of these requirements which are the same as originally required at the time of approval of the agreement. This renewalis due intheCity Clerk' s Office within 30 days of receipt of this letter.
It is important that you respond within the time period specified. We regretfully must inform you that non- compliance with this contract requirement will require the City to ( as applicable):
Red -tag" the project which means that all work must cease immediately Withholdpaymenton anyoutstandinginvoicesowedbythe City
Initiate termination proceedings
Sincerely,
Use Harper
DEPUTY CITY CLERK
Encl.
cc: Community Resources Department
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P 159 633 930
US Postal Service
Receipt for Certified Mail
No InsuranceCoverageProvided.
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FamilyServiceoftheNorthBay
709 Franklin Street
Napa, CA 94559
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
ATTACHMENT 1
Fidelity National Title Company
707 Randolph Street
Napa, CA 94559
707) 255- 5800 * FAX ( 707) 252- 2875
April 12, 1996
The City of Napa
P. O. Box 660
1100 West Street
Napa, CA 94559
Attention: Katrina Schlyer
RE: Loan No.
Escrow No. 115106 - JM
Borrower: Family Service of the North Bay and
709 Franklin Street, Napa, CA
Gentlemen:
RECEIVED
APR 151996
itv CIPrk` s Off icp
We enclose the following documents and/ or papers in connection with your above captioned loan:
X) Certified copy of closing statement/ RESPA Settlement Statement X) Conformed copy of Deed of Trust
X) Original Promissory Note
X) Copy of Evidence of Insurance
Escrow has closed and all documents have been recorded as of this date.
Your Policy of Title Insurance will follow under separate cover.
We trust that this transaction has been handled to your satisfaction and that we may have the pleasure of serving you again in the future.
Sincerely,
111a" u
Escrow Officer
enclosures
6 '7( G
ATTACHMENT 1
N.
11MM"',
CITY of NAPA
November 29, 1995
CITY CLERK
955 School Street
PO Box 660
Napa, California 94559- 0660
707) 257- 9503
CITY MANAGER
257- 9501
CITY CLERK Dr. Ken Merritt, Executive Director
257- 9503
FamilyServiceof theNorthBay
1157 Division Street
CITY ATTORNEY
Napa, CA 94559257- 9516
BUILDING Subject: Insurance for Agreements 6766 and 6767 257- 9540
Dear Sir:
COLLECTIONS
257- 9508
Wehavereceivedacertificateofinsurancefromyourinsurancecompany; however, it does not meet the requirements of the contracts. I haveincludedour forms asthey wereusedfor
FINANCE
the original insurance provided and they meet the requirements in the contract. Please 257- 9510
forward them to your insurance carrier.
FIRE
ADMINISTRATION
Pleasenotethefollowingrequirementsascontainedin theagreement. 257- 9593
1) TheCityof Napaistobenamedasadditionalinsuredonaseparateendorsement. FIRE PREVENTION 257- 9590
2) Providethatcoverageisprimaryto otherinsuranceheldbytheCity.
HOUSING
257- 9543 3) Provide for cross -liability.
PARKS &
4) Coveragewill notbe cancelled, nonrenewedor reducedwithout30daysprior written
RECREATION
257- 9529 notice.
PERSONNEL Pleasesubmitrenewalcertificatewithin 10daysof receiptof thisletter. 257- 9505
Sincerely,
PLANNING
257- 9530
POLICE
257- 9550 Pat Lawson
Assistant City Clerk
PUBLIC WORKS
257- 9520
REDEVELOPMENT
257- 9502
a. fawrance\ FamilyS R. rnw
TDD
257- 9506
ATTACHMENT 1
PRO
CITY of NAPA
November 7, 1995
CITY CLERK
955 School Street
PO Box 660
Napa, California 94559- 0660
707) 257- 9503
CITY MANAGER
257- 9501
CITY CLERK Dr. Ken Merritt, Executive Director
257- 9503 1157 Division Street
Napa, CA 94559
CITY ATTORNEY
257- 9516
Subject: Insurance for Agreements 6766 and 6767
BUILDING
257- 9540 Dear Sir:
COLLECTIONS
ThisletteristoofficiallynotifyyouthatthecertificateofinsuranceforAgreements6766and 257- 9508
6767withtheCityof Napafor CDBGfundsexpiredonSeptember12, 1995.
FINANCE
Thegeneralliability andautomobileliability bothareto berenewed. 257- 9510 FIRE Pleasenotethefollowingrequirementsascontainedin theagreement.
ADMINISTRATION
257- 9593
1) TheCity of Napais to benamedasadditionalinsuredonaseparateendorsement.
FIRE PREVENTION
2) Providethatcoverageis primaryto otherinsuranceheldby theCity. 257- 9590 HOUSING 3) Provide for cross -liability.
257- 9543
4) Coveragewill not be cancelled, nonrenewedor reducedwithout 30 daysprior written PARKS & notice.
RECREATION
257- 9529
Pleasesubmitrenewalcertificatewithin 10daysof receiptof thisletter.
PERSONNEL
257- 9505
Sincerely,
PLANNING
257- 9530
POLICE Pat Lawson
257- 9550 Assistant City Clerk
PUBLIC WORKS
257- 9520
REDEVELOPMENT
257- 9502
a: rnnuaoceW milySR. rnw
TDD
257- 9506
ATTACHMENT 1