AMENDMENT NO. 2 TO
PROFESSIONAL SERVICES AGREEMENT
PROVISION OF PROFESSIONAL SERVICES WITH PEOPLE ASSISTING THE
HOMELESS (PATH)
This Amendment No. 2 ("Amendment") to Professional Services Agreement is made and entered into effective the 26th day of March, 2024 by and between the CITY OF PLACENTIA, a Charter City and Municipal Corporation ("CITY"), and PEOPLE ASSISTING THE HOMELESS (PATH), a non-profit corporation (hereinafter "CONTRACTOR"). CITY and CONTRACTOR are sometimes hereinafter individually referred to as "Party" and or collectively referred to as the "Parties."
A. Recitals.
(i). CITY and CONTRACTOR entered into a Professional Services Agreement ("Agreement") effective March 25, 2020 through which CONTRACTOR has been providing professional services as more fully explained in the Scope of Services attached to the Agreement as Exhibit "A."
(ii). As authorized in Section 4.1 of the Agreement, the Parties have mutually agreed to amend the Agreement to extend the term an additional four (4) Months until July 31, 2024, with a month to month contract after the four (4) initial months with the potential to extend up to six (6) months until September 30, 2024 and to also increase the compensation paid for a total cost not to exceed of $916,495 for the period of April 1, 2024 through July 31, 2024. If the contract is extended two additional months the compensation paid would total an amount not to exceed of $458,255 for the period of August 1, 2024 — September 30, 2024. (iii). All legal prerequisites to the making of this Amendment have occurred.
NOW, THEREFORE, in consideration of the mutual covenants and conditions set forth herein, the Parties agree as follows:
B. Amendment to Agreement.
1. Section 2, Paragraph 1 of the Agreement is hereby amended to read as follows:
2.1 Compensation.
During the period of April 1, 2024 through July 31, 2024, Contractor's total compensation shall not exceed Nine Hundred and Sixteen Thousand, Four Hundred and Nintey Five and 00/100 Dollars ($916,495.00) per year. This compensation shall remain firm for the duration of the current contract term.
If an extension is done, for the period of August 1, 2024 through September 30, 2024, Contractor's total compensation for that period shall not exceed Four Hundred and Fifty Eight Thousand, Two Hundred and Fifty Five and 00/100 Dollars ($458,255).
The actual amount of compensation paid shall be based on actual costs as documented in monthly invoices.
2. Section 4, Paragraph 1 of the Agreement is hereby amended to read as follows:
4.1. Term.
The term of this Agreement originally commenced on March 25, 2020. The parties subsequently agreed to exercise an option to extend the Agreement for 2 additional years, with a new term ending March 25, 2024, as authorized in the Agreement.
The adoption of this amendment shall extend the term of the agreement for a period of four (4) months until July 31, 2024. At the election of the City the agreement may be extended up to 2 months ending on September 30, 2024.
3. Except as specifically modified herein, all of the terms, conditions and provisions of the Agreement shall remain in full force and effect.
4. The Agreement, together with Amendment No.1, this Amendment No. 2 and all Exhibits attached thereto, constitutes the entire Agreement between the Parties and supersedes all prior negotiations, arrangements, representations, and understandings, if any, made by or between the Parties with respect to the subject matter hereof. No amendment or other modification of the Agreement, as modified by this Amendment No. 2 shall be binding unless executed in writing by both Parties hereto, or their respective successors, assigns, or grantees.
5. Each of the undersigned represents and warrants that he or she is duly authorized to execute and deliver this Amendment No. 2 and that such execution is binding upon the entity for which he or she is executing this document.
IN WITNESS WHEREOF, the Parties have caused Amendment No.2 to the Consulting Services Agreement are to be executed as of the day and year first above written.
CONSULTANT CITY OF PLACENTIA
By: By:
Tescia Uribe Damian R. Arrula
Chief Program Officer City Administrator
ATTEST:
By:
Robert S. McKinnell, City Clerk
APPROVED AS TO FORM:
By:
Christian L. Bettenhausen, City Attorney
ACORD®
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
12/27/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
NAME: Michelle Gonzalez
PHONE Ext): 818-539-8630
AD�f]RESS: [email protected]
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: Quality Comp Inc
INSURER B : Nonprofits' Insurance Alliance of CA 10023
INSURER c : Travelers Casualty and Surety Co of America 31194 INSURER D :
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1711564113 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PRODUCER
Arthur J. Gallagher Risk Management Services, LLC
500 N Brand Boulevard, Suite 100
Glendale CA 91203
INSURED
People Assisting the Homeless (PATH)
340 N. Madison Avenue
Los Angeles, CA 90004
License#: OD69293
PEOPASS-02
FAX
(A/C, No):
INSR
LTR TYPE OF INSURANCE
ADDL SUBR
INSD WVD
POLICY EFF POLICY EXP
POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY)
BCOMMERCIAL GENERAL LIABILITY
tY 2023-01280 8/1/2023 8/1/2024
CLAIMS -MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT
JECT
X
LOC
OTHER:
B AUTOMOBILE LIABILITY Y 2023-01280
X - ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
B X UMBRELLA LIAB
X
EXCESS LIAB
DED RETENTION $
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
C Cyber Liability
C Crime
B Professional Liability
OCCUR
CLAIMS -MADE
Y/N
NIA
2023-01280-U MB
Y 0150451112
107150444
107150444
2023-01280
8/1/2023 8/1/2024
8/1/2023 8/1/2024
1/1/2024 1/1/2025
8/1/2023
8/1/2023
8/1/2023
8/1/2024
8/1/2024
8/1/2024
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL 8, ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
EACH OCCURRENCE
AGGREGATE
$ 1,000,000
$ 500,000
$ 20,000
$ 1,000,000
$ 3,000,000
$ 3,000,000
$
$1,000,000
$ 4,000,000
$ 4,000,000
s
X I STATUTE I I ERH
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
Aggregate: $2,000,000
Limit: See below
Limit: S1,000,000 Agg.: $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy Name- Crime
Policy #- 107150444
Policy Term- 8/1/2023 to 8/1/2024
Carrier- Travelers Casualty and Surety Co of America.
Employee Theft- Limit: $2,000,000; Deductible: $15,000
ERISA- Limit: $2,000,000
Forgery or alteration- Limit: $2,000,000; Deductible: $15,000 Theft of money and securities- Limit: $2,000,000; Deductible: $15,000 See Attached...
CERTIFICATE HOLDER CANCELLATION
City of Placentia
401 E. Chapman
Placentia, CA 92870
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
An
AUTHORIZED'REP ESENTATIVE
I
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ACO OR
AGENCY
Arthur J. Gallagher Risk Management Services, LLC
POLICY NUMBER
AGENCY CUSTOMER ID: PEOPASS-02
LOC #:
ADDITIONAL REMARKS SCHEDULE
CARRIER
ADDITIONAL REMARKS
NAIC CODE
NAMED INSURED
People Assisting the Homeless (PATH)
340 N. Madison Avenue
Los Angeles, CA 90004
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Money and securities- Limit: $2,000,000; Deductible: $15,000 Computer fraud- Limit: $2,000,000; Deductible: $15,000
Funds transfer fraud- Limit: $2,000,000; Deductible: $15,000 Money orders and counterfeit paper currency- Limit: $2,000,000; Deductible: $15,000 Employee Theft of Client's Property- Limit: $2,000,000; Deductible: $15,000 Policy Name- D&O/EPL
Policy #- 2023 -01280 -DO -NPO
Policy Term- 8/1/2023 to 8/1/2024
Carrier- Nonprofits' Insurance Alliance of CA.
Limit: $1,000,000; Aggregate: $2,000,000; Retention: $50,000 Policy Name- Improper Sexual Conduct and Physical Abuse Liability Policy #- 2023-01280
Policy Term- 8/1/2023 to 8/1/2024
Carrier- Nonprofits' Insurance Alliance of CA.
Limit: $1,000,000; Aggregate: $3,000,000
Abuse Limits combined with a $1,000,000 umbrella limit (2023-01280-UMB) provides a Per claim $2,000,000 / Aggregate $4,000,000
RE: Grant# 800 Certificate holder is named additional on General Liability and Auto Liability insured with respect to the operations of the named insured. The insurance provided in the Commercial General Liability policies are primary and any other insurance shall be excess only and not contributing. Waiver of Subrogation on Worker Compensation applies in favor of certificate holder.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
•
MONUMENT
vis
QUALITY COMP
RE: Quality Comp, Inc.—Self-Insured Workers' Compensation Group To Whom It May Concern:
As proof of workers' compensation coverage, I would like to provide you with the attached Certificate of Consent to Self -Insure issued to Quality Comp, Inc. by the California Department of Industrial Relations, Office of Self -Insurance Plans. This Certificate carries an effective date of December 1, 2004 and does not have an expiration date. The Quality Comp, Inc. program has excess insurance coverage with Safety National Casualty Corporation. Safety National is a fully licensed and admitted writer of Excess Workers' Compensation Insurance in the State of California (NAIC #15105). The company is rated "A++ Superior" Category "XV" by A.M. Best & Company.
Specific Excess Insurance
Excess Workers' Compensation: Statutory per occurrence excess of $500,000 Employers Liability: $1,000,000 Limit
Term of Coverage
Effective Date: January 1, 2024
Expiration: January 1, 2025
Please contact me if you have any questions or require additional information. Thank you.
Sincerely,
?J.lh�^
Jacqueline Harris
Director of Underwriting
RPS Monument
7 Great Valley Parkway 1 Suite 290
Malvern, PA 19355 1 T 610.647.4466 1 F 610.647.0662 1 www.RPSins.com
NUMBER 4515
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
OFFICE OF THE DIRECTOR
CERTIFICATE OF CONSENT TO SELF INSURE
Quality Comp, Inc.
THIS IS TO CERTIFY, That._, (a CA,,‘„ r�regon)
has complied with the requirements of the Director of Industrial Relations under the provisions of Sections 3700 to 3705, inclusive, of the Labor Code of the State of California and is hereby granted this Certificate of Consent to Self -Insure.
This certificate may be revoked at any time for good cause shown. *
EFFECTIVE:
mg_ 1st _DAY oFDecember 8004
MARK T. JOHNSOi's,
of Certificate.—"A certificate of consent to self/insure may be revoked by the Director of Industrial Relations at any time for flood cause after a cause includes, among other things, the impairment of the solvency of such employer, the inability of the employer to fulfill his obligations, or the practice by such employer or his agent in charge of the administration of obligations under this division of any or the following: (a) Habitually and as a matter of practice and custom inducing claimant; for compensation to accept less than the compensation due or making it necessary for them to resort to proceedings against the employer to secure the compensation due; (b) Discharging his compensation obligations in a dishonest manner: (c) Discharging his compensation obligations in such a manner as to cause injury to the public or those dealing with him." (Section 3702 of Labor Code.) The Certificate may be revoked for noncompliance with Title 8, California Administrative Code, Group 2—Administration of Self -Insurance.
C.3AMA GER
DEPARTMENT�.�OF INDUSTRIAL RELATIONS
Ov 7Hp STATE tF CALIFORNIA
JOHtif4J. REA
DinccT011
NORM A -4. -TO A
r
•
57 45547
STATE OF CALIFORNIA Gavin Newsom, Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
OFFICE OF SELF-INSURANCE PLANS
11050 Olson Drive, Suite 230
Rancho Cordova,CA 95670
Phone No. (916) 464-7000
FAX (916) 464-7007
CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION TO WHOM IT MAY CONCERN:
This certifies that Certificate of Consent to Self -Insure No. 4515 was issued by the Director of Industrial Relations to:
Quality Comp, Inc.
under the provisions of Section 3700, Labor Code of California with an effective date of December 1, 2004. The certificate is currently in full force and effective.
Dated at Sacramento, California
This day the 13th of December 2023
Lyn Asio Booz, Chief
ORIG: Jackie Harris
Director Of Underwriting
Risk Placement Services Rps Monument
7 Great Valley Parkway
Malvern, Pa 19355
NUMBER : 4515 - 0044
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
OFFICE OF THE DIRECTOR
CERTIFICATE OF CONSENT TO SELF -INSURE
THIS IS TO CERTIFY , That
PATH
(Name of Affiliate )
STATE OF INCORPORATION CA
Quality Comp, Inc.
(Master CertificateHolder )
STATE OF INCORPORATION CA
has complied with the requirements of the Director of Industrial Relations under the provisions of Sections 3700 to 3705, inclusive, of the Labor Code of the State of California and is hereby granted this Certificate of Consent to Self -Insure, holder of Master Certificate No, 4515.
This certificate may be revoked at any time for good cause shown.* EFFECTIVE DATE : November 1, 2012 DEPARTMENT OF INDUSTRIAL RELATIONS
OF THE STATE OF CALIFORNIA
n
Jon Wroten, Chief Christine Baker, Director
*Revocation of Certif c1Qte.— "A certificate of consent to self -insure may be revoked by the Director of Industrial Relations at any time for good cause after a hearing. Good cause includes, among other things, the impairment of solvency of such employer, the inability of the employer to fulfill his obligations, or the practice of such employer or his agent in charge of the administration of obligations, under the this division of any of the following: (a) Habitually and as a matter of practice and custom inducing claimants for compensation to accept less than the compensation due or making it necessary for them to resort to proceedings against the employer to secure the compensation duc; (b) Discharging his compensation obligations in a dishonest manner; (c) Discharging his compensation obligations in such a manner as to cause injury to the public or those dealing with him."(Section 3702 of Labor Code.) The Certificate may be revoked for non compliance with Title 8, California Administrative Code, Group 2 -- Administration of Self Insurance
Bps164 QUALITY COMP
MONUMENT
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
Quality Comp, Inc. is a Group Self -Insurance Program authorized by the Office of Self - Insurance Plans to provide workers' compensation to approved members. The Board of Directors of Quality Comp, Inc. has authorized the Program Administrator to waive rights of subrogation in certain instances.
This change in coverage, effective 12:01 AM January 1, 2024, forms part of the member's coverage in Self -Insurance Group No. 4515.
Issued to PATH
By Quality Comp, Inc.
The Program has the right to recover our payments from anyone liable for an injury covered by this employer. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this change shall be $2,500
Schedule
Person or Organization
ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS
PROVIDED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER
,Job Description
BLANKET WAIVER OF SUBROGATION
Countersigned by
Vicki Eberwein, Program Administrator, Authorized Representative 7 Great Valley Parkway 1 Suite 290
Malvern, PA 19355 1 T 610.647.4466 1 F 610.647.0662 1
POLICY NUMBER: 2023-01280 COMMERCIAL GENERAL LIABILITY
Named Insured: People Assisting the Homeless* CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Any person or organization that you are required to
add as an additional insured on this policy, under a
written contract or agreement currently in effect, or
becoming effective during the term of this policy. The
additional insured status will not be afforded with
respect to liability arising out of or related to your
activities as a real estate manager for that person or
organization.
Location(s) Of Covered Operations
All insured premises and operations.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
CG 20 10 12 19
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
© Insurance Services Office, Inc., 2012 Page 1 of 10
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section 111 — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
CG 20 10 12 19
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
© Insurance Services Office, Inc., 2012 Page 2 of 10
NONPROFITS
INSURANCE
A11 IANcE 01 (.A11FORNIA
A
Nead for Insurance. A Heart for Nonprofits,
NONPROFITS INSURANCE ALLIANCE
OF CALIFORNIA (NIAC)
www.insurancefornonprofitsorg
BUSINESS AUTO COVERAGE
ADDITIONAL INSURED/LOSS PAYEE EXTENSION
POLICY NUMBER: 2023 -01280 -NPO
Schedule Al
NAME OF INSURED: People Assisting the Homeless; PATH Partners
ADDITIONAL INSUREDS /
LASS PAYEE
Additional Insured - CA2001/Loss Payee - CA9944
P.O. Box 16805
Saint Louis, MO 63105
As respects vehicle(s): ALL
Additional Insured - NIAC Al
Brookfield Properties
3200 Park Dr Ste 1000
Costa Mesa, CA 92626
As respects vehicle(s): N/A
Additional Insured - NIAC Al
City Of Carson
701 East Carson St.
Carson, CA 90745
As respects vehicle(s): ALL
Additional Insured - NIAC Al
City of Garden Grove, its officers, officials, agents,
employees and volunteers
P.O. Box 100085 -GV
Duluth, GA 30098
As respects vehicle(s): ALL.
Additional Insured - NIAC Al
City of San Diego, the San Diego Housing Commission &
the Housing Authority of the City of San Diego, and their employees & agents
1122 Broadway, Ste.300-cfo San Diego Housing Co
San Diego, CA 92101
As respects vehicle(s): ALL
Additional Insured - NIAC Al
City of San Jose - Finance Risk Management
200 E Santa Clara St., 14th Floor Tower
San Jose, CA 95113
As respects vehicle(s): ALL
COUNTERSIGNED: 8/4/2023 BY
MAC - SCHEDULE Al - NPO
(AUTHORIZED REPRESENTATIVE)
I
❑ NONPROFITS
INSURANCE
Al 11ANCF OF CALIFORNIA
A Henri for insurance. A Heart for Nonprofits,
NONPROFITS INSURANCE ALLIANCE
OF CALIFORNIA (NIAC)
www.insurancefornonprofits.org
BUSINESS AUTO COVERAGE
ADDITIONAL INSURED/LOSS PAYEE EXTENSION
POLICY NUMBER: 2023 -01280 -NPO
NAME OF INSURED: People Assisting the Homeless; PATH Partners
ADDITIONAL INSUREDS /
LOSS PAYEE
Additional Insured - NIAC Al
City of San Jose, its officers. employees, agents and
contractors
200 E Santa Clara St., 13th Floor
San Jose, CA 95113
As respects vehicle(s): ALL
Additional Insured - NIAC Al
Enterprise Community Partners, Inc.
70 Corporate Center
Columbia, MD 21044
As respects vehicle(s): ALL
Additional Insured - NIAC Al
Enterprise FM Trust
P.O. Box 16805.
Saint Louis. MO 63105
As respects vehicle(s): ALL
Loss PaN,(ee - CA9944
Hyundai Lease Titling Trust
P.O. Box 105299
Atlanta, GA 30348
As respects vehicle(s)• 57
Additional Insured - NIAC Al
Maguire Properties - 755 S. Figueroa, LLC; Brookfield
DTLA Fund Properties H, LLC,
3200 Park Dr.. Ste 1000
Costa Mesa, CA 92626
As respects vehicle(s): ALL
Additional Insured - NIAC Al
Santa Barbara County, its officers, officials, employees, agents and volunteers
300 N San Antonio Rd, Bldg, 3
Santa Barbara, CA 93110
As respects vehicle(s): ALL
COUNTERSIGNED: 8/4/2023 BY
NIAC - SCHEDULE Al - NPO
Schedule Al
ce.
(AUTHORIZED REPRESENTATIVE)
MilNONPROFITS
INSURANCE
Al 1 IANCE Or CAI JMRN I•\
A Head far Insurance. A Heart for Nonprofits.
NONPROFITS INSURANCE ALLIANCE
OF CALIFORNIA (MAC)
www.insurancefornonprofitsorg
BUSINESS AUTO COVERAGE
ADDITIONAL INSURED/LOSS PAYEE EXTENSION
POLICY NUMBER: 2023 -01280 -NPO
Schedule Al
NAME OF INSURED: People Assisting the Homeless; PATH Partners
ADDITIONAL INSUREDS /
LOSS PA EE
Additional Insured - NIAC Al
The Cities of Placentia; Brea; Buena Park: Cypress
Fullerton; La Habra; La Palma: Los Alamitos; Orange:
Stanton, Yorba Linda; Villa Park,
401 E. Chapman - Attn: City Administrator
Placentia, CA 92870
As respects vehicle(s): ALL
Additional Insured - MAC Al
The City of Santa Barbara, its officers, employees and
agents
P.O. Box 1990
Santa Barbara. CA 93102
As respects vehicle(s): ALL
Additional Insured - MAC Al
The City of Santee, its City Council and each member
thereof, its officers, employees, and agents
10601 Magnolia Ave.
Santee. CA 92071
As respects vehicle(s): ALL
COUNTERSIGNED: 814/2023 BY
NIAC - SCHEDULE Al - NPO
(AUTHORIZED REPRESENTATIVE)