CITY OF RICHMOND
CONTRACT AMENDMENT
Department: Project Manager:
Project Manager E-mail:
Project Manager Phone No:
P.R. No: Vendor No: P.O./Contract No:
Description of Services:
Amendment No. ___ modifies the: (2nd or subsequent amendments attach Amendment History page)
Term, Payment Limit and Service Plan
Payment Limit and Service Plan
Term and Service Plan
Service Plan
The parties to this Contract Amendment do mutually agree and promise as follows:
1. Parties. The parties to this Contract Amendment are the City of Richmond, California, a municipal corporation (City), and the following named Contractor:
Company Name:
Street Address:
City, State, Zip Code:
Contact Person:
Telephone: Email:
Business License No: / Expiration Date:
A California [ ] corporation, [ ] limited liability corporation [ ] general partnership, [ ] limited partnership, [ ] individual, [ ] non-profit corporation, [ ] individual dba as [specify:]
[ ] other [specify:]
2. Purpose. This Contract Amendment is being entered into to amend the Contract between City and Contractor which was approved by the City Council of the City of Richmond or executed by the City Manager on , which original term commenced on and terminates with an original contract payment limit of $ . Said contract shall hereinafter be referred to as the "Original Contract" and is incorporated herein by reference.
3. Original Contract Provisions. The parties hereto agree to continue to abide by those terms and conditions of the Original Contract, and any amendments thereto, which are unaffected by this Contract Amendment.
Contract Amendment/EJ/TE 09-26-07
4. Amendment Provisions. This Contract Amendment is subject to the Amendment Provisions attached hereto, which are incorporated herein by reference, and which control over any conflicting provisions of the Original Contract, or any amendment thereto.
5. City of Richmond Business License Active Status Maintained. Pursuant to Municipal Code Section 7.04.030, the Contractor must maintain its City of Richmond business license for this Contract Amendment to be deemed to be in effect.
6. Insurance Coverage Updated and Maintained. Pursuant to the Original Contract, the Contractor shall provide the City with updated insurance certificates, and the Contractor shall maintain insurance coverage, for this Contract Amendment to be deemed to be in effect.
7. Signatures. These signatures attest the parties’ agreement hereto:
CITY OF RICHMOND, CALIFORNIA
a municipal corporation
By _______________________
Title:
I hereby certify that the Original Contract
and this Amendment have been approved
by the City Council or executed by the City
Manager.
By _______________________
City Clerk
Approved as to form:
By_______________________
City Attorney
List of Attachments:
1. Amendment Provisions
2. Updated Insurance Certificates
CONTRACTOR:
______________________________
(*The Corporation Chairperson of the Board, President or Vice-President should sign on the line below.)
By____________________________
Title:________________________
(*The Corporation Chief Financial Officer, Secretary or Assistant Secretary should sign on the line below.)
By:___________________________
Title:________________________
(NOTE: Pursuant to California Corporations
Code Section 313, if Contractor is a
corporation or nonprofit organization, this
Contract (1) should be signed by the
Chairperson of the Board, President or
Vice-President
and the Chief Financial
Officer, Secretary or Assistant Secretary; (2)
should have both signatures conform to
designated representative groups pursuant
to Corporations Code Section 313.
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (TERM, PAYMENT LIMIT AND SERVICE PLAN)
1. Paragraph 2 (Term) of the Original Contract is hereby amended to extend the Contract term. Paragraph 2 of the Original Contract is amended to read as follows:
"2. Term. The effective date of this Contract is
____________________________________________________________ (Insert original contract commencement date)
and it terminates
___________________________________________________.
(Insert new contract termination date)
unless sooner terminated as provided herein."
2. Paragraph 3 (Payment Limit) of the Original Contract is hereby amended to increase the payment limit by $ . Paragraph 3 of the Original Contract is amended to read as follows:
"3. Payment Limit. City's total payments to Contractor under this Contract shall not exceed $ including expenses."
“The City of Richmond shall not pay for services that exceed the Contract Payment Limit without the prior written approval of the City Manager if the total Contract amount does not exceed $10,000 or without the prior approval of the City Council if the total Contract amount is over $10,000.”
3. The Service Plan (Exhibit A) of the Original Contract is hereby amended to include the following tasks and/or services:
Contract Amendment/EJ/TE 9-26-07
Exhibit A
Scope of Work
Naviga�on Center and Site Services
Contractor shall, to the sa�sfac�on of the City’s Community Development Department, perform the following services and be compensated as outlined below. The City reserves the right to adjust the Service Specifica�ons, Timeline, and Project Outcomes of the Contractor as the Project’s performance is regularly evaluated.
Services Detail
1. Naviga�on Center Facility:
• Provision of a naviga�on center doe ERF 2R unhoused clients with 26 rooms. • One room designated as an onsite office.
• Facili�es equipped to accommodate residents' basic needs (e.g., bedding, restroom facili�es).
• Overflow site that can house a minimum of 5 clients.
2. Staffing:
• Two part-�me staff members for overnight shi�s. (On site supervisor and Security) • Overnight shi� coverage
• Du�es include:
• Providing assistance and support to residents as needed. • Ensuring the safety and security of the facility and its occupants. • Conduc�ng regular checks of the premises to address any issues or concerns. • Serving as onsite supervisors for overnight opera�ons.
3. Security Measures:
• Implementa�on of security measures to maintain a safe environment for residents and staff.
• Regular patrols and monitoring of the facility during overnight hours. • Response protocols in place to address any security incidents or emergencies. • Collabora�on with local law enforcement agencies as needed.
4. Support Services:
• Coordina�on with partnered agencies to provide support services to residents. • Access to case management, counseling, and other suppor�ve resources to assist residents.
• Contractor is to ensure payment for meals. Clients will receive two meals a day: one provided by the hotel and the other by an outside contractor, seven days per week.
5. Opera�onal Protocols:
• Development and implementa�on of opera�onal protocols to govern the day-to-day func�oning of the naviga�on center.
• Clear guidelines for staff responsibili�es, resident intake procedures, and emergency response protocols.
• Regular training and staff development ini�a�ves to ensure high-quality service delivery and compliance with opera�onal standards.
6. Collabora�on and Partnerships:
• Collabora�on with community organiza�ons, government agencies, and other stakeholders to enhance service delivery and support for residents. • Engagement with local service providers to facilitate referrals and access to addi�onal resources for residents.
7. Repor�ng and Evalua�on:
• Regular repor�ng on facility opera�ons, including occupancy rates, service u�liza�on, and any notable incidents or developments.
• Ongoing evalua�on of program effec�veness and iden�fica�on of areas for improvement.
• Feedback mechanisms in place to solicit input from residents, staff, and stakeholders.
Timeline
TASKS TIME /MONTH
Nego�ate contract with local motel operator
for up to 26 rooms for ini�al period of six
months
February 2024
Transfer clients from other motels and place
addi�onal unhoused clients at the motel
February through July 2024
Provide caseworker and security to provide
oversight at motel evenings through next day
morning
February 2024 and ongoing
Exhibit B
Budget
Budget
1. Contractor shall comply with the atached Budget.
2. With prior writen approval from City, Contractor may modify budget line items of up to fi�een (15%) percent of the indicated line item provided that the total compensa�on amount is not exceeded.
3. Budget line-item modifica�ons shall not alter any terms of this Agreement, including but not limited to the scope of services, �me of performance, or compensa�on amount.
4. All email requests for budget line-item modifica�ons should be accompanied by a brief note reques�ng and explaining the changes, including a descrip�on of the specific line items and the reasons for the requested change. The email reques�ng a budget line - item modifica�on should be accompanied by a revised budget with a column for the original budget, a column for the modifica�on amount by line item, and a final column lis�ng the final budget with modifica�on.
5. ADVANCE: Upon execu�on of this Agreement, City may provide an advance in the amount of $500,000 or less to pay the six months’ rent for the motel rooms.
Contract Amendment between the City of Richmond and
Amendment No. P.O./Contract No.
AMENDMENT PROVISIONS (AMENDMENT HISTORY)
The first Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The second Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The third Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fourth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
The fifth Contract Amendment was approved by City Council of the City of Richmond or executed by the City Manager on for one or more of the following provisions (check those that apply):
Increased contract payment limit by $ ________________for a payment limit not to exceed $ _________________________.
Term Amendment (insert new termination date):________________________
Service Plan
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 1 of 3
Revised: September 2011
In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, consultants, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.
CONTRACTOR shall procure and maintain for the duration of the contract, agreement, or other order for work, services or supplies, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the CONTRACTOR, its agents, representatives, employees or subcontractors. Maintenance of proper insurance coverage is a material element of the contract. Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.
CONTRACTOR agrees that in the event of loss due to any of the perils for which it has agreed to provide Commercial General Liability insurance, CONTRACTOR shall look solely to its insurance for recovery.
CONTRACTOR hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either CONTRACTOR or CITY with respect to the services of CONSULTANT herein, a waiver of any right to subrogation which any such insurer of said CONTRACTOR may acquire against the CITY by virtue of the payment of any loss under such insurance.
Original, signed certificates and original, separate policy endorsements, naming the City as an additional insured for general liability coverage, as well as a waiver of subrogation for Workers’ Compensation insurance, shall be received and approved by the City before any work may begin. However, failure to do so shall not operate as a waiver of these insurance requirements.
City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of CONTRACTORS work.
Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of CONTRACTOR.
Minimum Scope of Insurance – the following forms shall be provided and coverage shall be at least as broad as the following:
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for bodily and personal injury, property damage, and products and completed operations (if applicable).
2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).
3. Original and Separate Additional Insured Endorsement for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.
4. Workers’ Compensation Insurance as required by the State of California including Employer’s Liability coverage.
5. Original and Separate Waiver of Subrogation for Workers’ Compensation insurance.
6. Professional Liability or Errors & Omissions Liability Insurance appropriate to the CONTRACTOR’s profession (if required.)
Required Coverage Minimum Limits
Workers’ Compensation and
Employers’ Liability
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease.
If CONTRACTOR is self-insured, provide a certificate of Permission to Self- Insure, signed by the California Department of Industrial Relations and Self- Insurance. If contractor is a sole proprietor (has no employees) than contractor must sign “Contractor Release of Liability” found at:
http://www.ci.richmond.ca.us/index.aspx?nid=61.
General Liability
(primary and excess limits
combined)
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the general aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit ($4 million aggregate limit).
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 2 of 3
Revised: September 2011
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.
PROJECT COST R EQUIRED LIMIT
$0 - $1 million $1 million p/o
$1 million - $5 million $2 million p/o
Over $5 million $5 million p/o
Professional Liability or Errors &
Omissions Liability –
Required for all professionals
including architects, engineers,
consultants, construction
management, counselors, medical
professionals, hospitals, clinics,
attorneys and accountants, & other
consultants as may be required by
the City.
Required Policy Conditions
Additional Insured Endorsement
Applicable to General Liability coverage.
The City of Richmond, its officers, officials, employees, agents and volunteers are to be named as additional insureds for all liability arising out of the operations by or on behalf of the named insured including bodily injury, deaths and property damage or destruction arising in any respect directly or indirectly in the performance of this contract.
ISO form CG 20 10 (11/85) or its equivalent is required. If the Contractor is supplying their product or providing a service then the endorsement must not
exclude products and completed operations
coverage. If it does, then CG 20 37 (10/01) is also required.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61
.
Primary and Noncontributory The contractor’s insurance coverage must be primary coverage as it pertains to the City, its officers, officials, employees, agents and volunteers. Any insurance or self insurance maintained by the City is wholly separate from the insurance of the contractor and in no way relieves the contractor from its responsibility to provide insurance.
Waiver of Subrogation
Endorsement Form
Contractor’s insurer will provide a Waiver of Subrogation in favor of the City for Workers’ Compensation Insurance during the life of this contract.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.
Deductibles and Self-Insured
Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At the option of the City either the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the CONTRACTOR shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administration and defense expenses.
Contractor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
A. M. Best Rating A:VII or Better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City.
Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverage’s and cover those insured in the underlying policies.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements - Type 2:
Professional Services
Type 2 – Page 3 of 3
Revised: September 2011
Claims-Made Policies
If any insurance policy is written on a claims-made form: 1) the retroactive date must be shown, and must be before the date of the contract or the beginning of contract work. 2) Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, the Contractor must purchase an extended period coverage for a minimum of five (5) years after completion of contract work.
Subcontractors
CONTRACTOR
shall include all subcontractors as insured under its policies or shall furnish to the City for review and approval, separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein.
CONTRACTOR agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either CONTRACTOR or any subcontractor to take out or maintain the required insurance policies.
The fact that
insurance is obtained by CONTRACTOR, and/or CONTRACTOR’s subcontractors, will not be deemed to release or diminish the liability of CONTRACTOR, including, without limitation, liability under the indemnity provisions of this contract. Damages recoverable by CITY from CONTRACTOR or any third party will not be limited by the amount of the required insurance coverage.
Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before work may begin .
The City of Richmond reserves the right to require complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
Insurance certificates and endorsements may be faxed to the Designated Project Manger. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed.
Continuous Coverage
CONTRACTOR shall maintain the required insurance for the life of the contract. Should the CONTRACTOR cease to have insurance as required during this time, all work by the CONTRACTOR pursuant to this agreement shall cease until insurance acceptable to the City is provided. In the event that CONTRACTOR fails to comply with the City’s insurance requirements, the City may take such action as it deems necessary to protect the City’s interests. Such action may include but is not limited to termination of the contract, withholding of payments, or other actions as the City deems appropriate.
If services or the scope of work extend beyond the expiration dates of the required insurance policies initially approved by the City, CONTRACTOR must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements shall be mailed to the Designated Project Manager.
Cancellation
CONTRACTOR shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice has been given to the City.
Reporting Requirements
Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.
Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.
Way 2 Love, Inc.
NAME OF INSURED AND MAILING ADDRESS:
M. A. Hays Co.
232 Broadway
Richmond, CA 94804
RENEWAL OF NUMBER: 2022-74944
POLICY NUMBER:
2023-74944 PRODUCER:
COMMERCIAL LINES COMMON POLICY DECLARATIONS
3609 Wall Ave.
Richmond, CA 94804
POLICY PERIOD:
FROM TO 08/01/2024 08/01/2023
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Feeding the unhoused providing living needs and tutoring
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE A S STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THESE PREMIUMS MAY BE SUBJECT TO ADJUSTMENT.
PREMIUM
.............................. $650 COMMERCIAL GENERAL LIABILITY COVERAGE PART - OCCURRENCE ................................................... ............. $250 COMMERCIAL AUTO LIABILITY COVERAGE PART .............................................. Not Covered COMMERCIAL AUTO PHYSICAL DAMAGE COVERAGE PART Not Covered .......................... IMPROPER SEXUAL CONDUCT AND PHYSICAL ABUSE COVERAGE PART SOCIAL SERVICE PROFESSIONAL COVERAGE PART Not Covered ................................................... .......
COMMERCIAL LIQUOR LIABILITY COVERAGE PART
TERRORISM COVERAGE (Certified Acts)
TOTAL: $900
Not Covered
INCLUDED
................................................... ........................... ................................................... .......
FORM(S) AND ENDORSEMENT(S) MADE A PART OF THIS POLICY AT TIME OF ISSUE:* CG 00 01 04 13, CG 00 33 04 13, CG 20 10 12 19, CG 20 11 12 19, CG 20 12 04 13, CG 20 18 04 13, CG 20 20 11 85, CG 20 21 07 98, CG 20 26 12 19, CG 20 34 12 19, CG 20 37 12 19, CG 21 09 06 15, CG 21 47 12 07, CG 21 73 01 15, CG 21 96 03 05, CG 22 44 04 13, CG 24 07 01 96, IL 00 17 11 98, IL 00 21 09 08, IL 02 70 07 20, NIAC-A L 01 80, NIAC-E003 GL 08 20, NIAC-E069 GL 02 19, NIAC-E078 1 1 20, NIAC-E11 GL 09 19, NIAC-E120 09 19, NIAC-E123 09 19, NIAC-E15 09 20, NIAC-E180 GL 01 21, NIAC-E180 LL 01 21, NIAC-E195 G L 05 21, NIAC-E22 09 19, NIAC-E25 12 15, NIAC-E26 1 1 17, NIAC-E28 01 99, NIAC-E282 GL 12 21, NIAC-E29 12 09, NIAC-E33 GL 09 19, NIAC-E34 09 18, NIAC-E342 GL 08 22, NIAC-E42 GL 09 19, NIAC-E5 07 15, NIAC-E56 01 17, NIAC-E59 02 12, NIAC-E60 07 12, NIA C-E61 02 19, NIAC-E70 03 19, NIAC-E72 01 17, NIAC-E 74 03 14, NIAC-GL 01 80, NIAC-LL 01 80, NIAC-NPO-001 05 20, N IAC-X1 06 18, SCHEDULE BA 01 80, SCHEDULE G 01 80, SCHEDULE L 01 80 *OMITS APPLICABLE FORMS AND ENDORSEMENTS IF SHOWN IN
SPECIFIC COVERAGE PART / COVERAGE FORM DECLARATIONS.
COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE)
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
NIAC-CO
06/22/2023
Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code Section 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of California and is not subject to regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay claims in the event the risk pool becomes insolvent.
M. A. Hays Co.
232 Broadway
Richmond, CA 94804
2022-74944
2023-74944
RENEWAL OF NUMBER:
POLICY NUMBER: PRODUCER:
COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS NAME OF INSURED AND MAILING ADDRESS:
Way 2 Love, Inc.
................................................... .... DAMAGE TO PREMISES RENTED TO YOU any one premises 3609 Wall Ave.
Richmond, CA 94804
POLICY PERIOD: 08/01/2024 TO 08/01/2023 FROM
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE Feeding the unhoused providing living needs and tutoring BUSINESS DESCRIPTION:
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE A S STATED IN THIS POLICY.
LIMITS OF COVERAGE:
$2,000,000 GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED OPERATIONS) $2,000,000 .......................... PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT $1,000,000 ................................................. PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 ................................................... ............................. EACH OCCURRENCE LIMIT $500,000
any one person
ADDITIONAL COVERAGES:
MEDICAL EXPENSE LIMIT $20,000 ................................................... ...................................
CLASSIFICATION(S) SEE ATTACHED SUPPLEMENTAL DECLARATIONS SCHEDULE G
PREMIUM
FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE)
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
NIAC-GL
$650
06/22/2023
COMMERCIAL GENERAL LIABILITY
EXTENSION OF DECLARATIONS
POLICY NUMBER:
NAME OF INSURED:
2023-74944-NPO
Schedule G
1Page
Way 2 Love, Inc.
PREMISES
CODE/CLASS
*LOC PREMIUM
BASIS
RATE *ADVANCED
PREMIUM
$1 12361/Distributors - food or drink - NOC .236
Prod. .486 $2
3,600 1
3,600.00
$29 12362/Distributors - no food or drink - NOC 5.962
Prod. 6.402 $31
4,800 1
4,800.00
$69 61227/Buildings or Premises - office - NFP 346.765 200 1
ADDITIONAL COVERAGES
Increased Aggregate $59
Additional Premium to Meet Minimum $459
*See Common Declarations for Total Advanced Premium and Schedule 'L' for locations.
COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE)
NIAC - SCHEDULE G - NPO
6/22/2023
COMMERCIAL GENERAL LIABILITY
EXTENSION OF DECLARATIONS
POLICY NUMBER:
NAME OF INSURED:
2023-74944-NPO
Schedule L
PREMISES
LOC/BLDG
DESIGNATED PREMISES
ADDRESS, CITY, STATE, ZIP
ADDITIONAL INSUREDS
AND OTHER INTERESTS
Way 2 Love, Inc.
3609 Wall Ave.
Richmond, CA 94804
1 COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE)
NIAC - SCHEDULE L
06/22/2023
- NPO
COMMERCIAL LIQUOR LIABILITY COVERAGE PART DECLARATIONS
PRODUCER:
NAME OF INSURED AND MAILING ADDRESS:
POLICY NUMBER:
M. A. Hays Co.
232 Broadway
Richmond, CA 94804
RENEWAL OF NUMBER: 2022-74944
2023-74944
Way 2 Love, Inc.
3609 Wall Ave.
Richmond, CA 94804
EACH COMMON CAUSE LIMIT..............................................................
CG 00 33 04 13
1,000,000
1,000,000
POLICY PERIOD: FROM TO
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION:
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE A S STATED IN THIS POLICY.
LIMITS OF COVERAGE:
GENERAL AGGREGATE LIMIT............................ .................................. $ $
Included PREMIUM:
FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF IS SUANCE:
8/1/2023 8/1/2024
Feeding the unhoused providing living needs and tutoring
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE)
Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code Section 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of California and is not subject to regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay claims in the event the risk pool becomes insolvent.
NIAC - LL
6/22/2023
INDEX OF FORMS ATTACHED TO THE POLICY
POLICY NUMBER: 2023-74944
Way 2 Love, Inc. NAME OF INSURED: Page: 1
LIABILITY FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE Commercial General Liability Coverage Form CG 00 01 04 13 Liquor Liability Coverage Form CG 00 33 04 13
Additional Insured - Owners, Lessees or Contractors CG 20 10 12 19 Additional Insured - Managers or Lessors of Premises CG 20 11 12 19 Additional Insured - State or Political Subdivisions - Permits CG 20 12 04 13 Additional Insured - Mortgagee, Assignee or Receiver CG 20 18 04 13 Additional Insured - Charitable Institutions CG 20 20 11 85 Additional Insured - Volunteers CG 20 21 07 98
Additional Insured - Designated Person or Organization CG 20 26 12 19 Additional Insured - Lessor of Leased Equipment - Automatic Status - Lease CG 20 34 12 19 Additional Insured - Owners, Lessees or Contractors - Completed Operations CG 20 37 12 19 Exclusion - Unmanned Aircraft CG 21 09 06 15
Employment-Related Practices Exclusion CG 21 47 12 07
Exclusion of Certified Acts of Terrorism CG 21 73 01 15 Silica - Exclusion CG 21 96 03 05
Health or Cosmetic Services Exclusion CG 22 44 04 13
Products/Completed Operations Hazard Redefined CG 24 07 01 96 Common Policy Conditions IL 00 17 11 98
Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 00 21 09 08 California Changes - Cancellation and Nonrenewal IL 02 70 07 20 Business Auto Coverage Part Declarations NIAC-AL-NPO
Member Criteria NIAC-E003 GL 08 20
Fiscal Sponsor Limitation NIAC-E069 GL 02 19
Professional Services - Exclusion NIAC-E078 11 20
Fireworks Exclusion NIAC-E11 GL 09 19
Lead Liability - Exclusion NIAC-E120 09 19
Firearms Sublimit Endorsement NIAC-E123 09 19
Blood Testing Exclusion NIAC-E15 09 20
Communicable Disease - Exclusion NIAC-E180 GL 01 21
Communicable Disease - Exclusion NIAC-E180 LL 01 21
Discrimination Exclusion NIAC-E195 GL 05 21
Asbestos Exclusion NIAC-E22 09 19
Additional Insured - Designated Person or Organization NIAC-E25 12 15 Waiver of Transfer of Rights of Recovery Against Others NIAC-E26 11 17 Property Damage to Personal Property in the Care, Custody or Control of the Insured NIAC-E28 01 99 Cyber Incident - Exclusion NIAC-E282 GL 12 21
Employee Personal Auto Reimbursement NIAC-E29 12 09
Mold, Fungus Exclusion NIAC-E33 GL 09 19
Construction and Conversion Exclusion NIAC-E34 09 18
This list of forms is not part of the actual policy, but is for your information only.
Please refer to the policy(s) for actual limits, coverages and exclusions.
INDEX OF FORMS ATTACHED TO THE POLICY
POLICY NUMBER: 2023-74944
Way 2 Love, Inc. NAME OF INSURED: Page: 2
LIABILITY FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE Anti-Stacking Condition NIAC-E342 GL 08 22
Nuclear, Chemical and Biological Hazard Exclusion NIAC-E42 GL 09 19 Trampoline Bounce House Exclusion NIAC-E5 07 15
Liberalization - GL, SSP, EBL NIAC-E56 01 17
Liberalization - LL NIAC-E59 02 12
Volunteer Medical Payments NIAC-E60 07 12
Additional Insured - Primary and Non-Contributory Endorsement for Public Entities NIAC-E61 02 19 Fundraiser and Event Endorsement NIAC-E70 03 19
Other Insurance - Coverage C NIAC-E72 01 17
Mental Anguish Endorsement NIAC-E74 03 14
Commercial General Liability Coverage Part Declarations NIAC-GL-NPO Commercial Liquor Liability Coverage Part Declarations NIAC-LL 01 80 Nonprofits' OWN Enhancement Endorsement NIAC-NPO-001 05 20 Improper Sexual Conduct and Physical Abuse Exclusion NIAC-X1 06 18 Business Auto Coverage Schedule SCHEDULE BA 01 80
Commercial General Liability Class Code Schedule SCHEDULE G 01 80 Commercial General Liability Location Schedule SCHEDULE L 01 80 This list of forms is not part of the actual policy, but is for your information only.
Please refer to the policy(s) for actual limits, coverages and exclusions.
POLICY NUMBER: 2023-74944
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY
ENDORSEMENT FOR PUBLIC ENTITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
A.
C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following:
Section II – WHO IS AN INSURED is amended to include:
4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by:
a. Your negligent acts or omissions; or
b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations.
No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. 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.
B. Section III – LIMITS OF INSURANCE is amended to include:
8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy.
4. Other Insurance
a. Primary Insurance
This insurance is primary if you have agreed in a written contract or written agreement:
(1) That this insurance be primary. If other insuran ce is also primary, we will share with all that other insurance as described in c. below; or
POLICY NUMBER: 2023-74944
Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance
This insurance is excess over:
1. Any of the other insurance, whether primary, exce ss, contingent or on any other basis:
(a) That is Fire, Extended Coverage, Builder’s Risk, Installation Risk or similar coverage for "your work";
(b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner;
(c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d)
If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE .
(e)
(1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)’ rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of:
(3) We will share the remaining loss, if any, with a ny other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. (a) The total amount that all such other insurance w ould pay for the loss in the absence of this insurance; and
(b) The total of all deductible and self-insured amo unts under all that other insurance. c. Methods of Sharing
If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first.
If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer’s share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.
Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (2) The coverage afforded by this insurance is prima ry and non-contributory with the additional insured(s)’ own insurance.
NAMED INSURED:
POLICY NUMBER: 2023-74944
Way 2 Love, Inc.
FORM: NIAC-E25 12 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZATION -
FOOD CONTRIBUTIONS OR CLIENT REFERRALS
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, in consideration of food contributions or client referrals you receive from them.
Name of Person or Organization:
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In the performance of your ongoing operations; or
2. In connection with your premises owned by or rente d to you.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be br oader than that which you are required by the contract or agreement to provide for such additional insured.
A.
With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limi ts of Insurance shown in the Declarations.
B. Page 1 of 1 NIAC-E25 12 15
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
CG 20 26 12 19
2023-74944
Named Insured: Way 2 Love, Inc.
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.
Name Of Additional Insured Person(s) Or Organization(s):
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
A. B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
© Insurance Services Office, Inc., 2012
ADDITIONAL INSURED - LESSOR OF LEASED
EQUIPMENT - AUTOMATIC STATUS WHEN
REQUIRED IN LEASE AGREEMENT WITH YOU
Way 2 Love, Inc. Named Insured:
2023-74944
CG 20 34 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY POLICY NUMBER:
With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
The most we will pay on behalf of the additional
insured is the amount of insurance:
1. Required by the contract or agreement you
have entered into with the additional insured;
or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
C.
With respect to the insurance afforded to these
additional insureds, this insurance does not apply
to any "occurrence" which takes place after the
equipment lease expires.
B.
A. A person's or organization's status as an
additional insured under this endorsement ends
when their contract or agreement with you for such
leased equipment ends.
Section II – Who Is An Insured is amended to
include as an additional insured any person(s) or
organization(s) from whom you lease equipment
when you and such person(s) or organization(s)
have agreed in writing in a contract or agreement
that such person(s) or organization(s) be added as
an additional insured on your policy. Such
person(s) or organization(s) is an insured only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your maintenance,
operation or use of equipment leased to you by
such person(s) or organization(s).
However, the insurance afforded to such additional
insured:
1. Only applies to the extent permitted by law;
and
2. Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
© Insurance Services Office, Inc., 2012
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – MANAGERS OR
LESSORS OF PREMISES
CG 20 11 12 19
2023-74944
Named Insured: Way 2 Love, Inc.
Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy.
Name Of Person(s) Or Organization(s) (Additional Insured):
Designation Of Premises (Part Leased To You):
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability arising out of the
ownership, maintenance or use of that part of the
premises leased to you and shown in the
Schedule and subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you
cease to be a tenant in that premises.
2. Structural alterations, new construction or
demolition operations performed by or on
behalf of the person(s) or organization(s)
shown in the Schedule.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
A.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance :
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Additional Premium: Included
© Insurance Services Office, Inc., 2012
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
CG 20 37 12 19
2023-74944
Named Insured: Way 2 Love, Inc.
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.
All insured premises and operations.
Location And Description Of Completed Operations
Name Of Additional Insured Person(s)
Or Organization(s)
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products-completed operations
hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
A. B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
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.
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
© Insurance Services Office, Inc., 2012
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
CG 20 10 12 19
2023-74944
Named Insured: Way 2 Love, Inc.
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.
All insured premises and operations.
Location(s) Of Covered Operations
Name Of Additional Insured Person(s)
Or Organization(s)
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:
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
A.
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
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.
© Insurance Services Office, Inc., 2012
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 III – Limits Of Insurance :
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
© Insurance Services Office, Inc., 2012
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED –
MORTGAGEE, ASSIGNEE OR RECEIVER
2023-74944
CG 20 18 04 13 Named Insured: Way 2 Love, Inc.
Any person or organization acting as mortgagee,
assignee, or receiver with respect to locations scheduled on the policy.
Designation Of Premises Name Of Person(s) Or Organization(s)
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
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 their liability as mortgagee,
assignee, or receiver and arising out of the
ownership, maintenance, or use of the premises by
you and shown in the Schedule.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
A.
B.
With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
C.
This insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for that person or
organization.
© Insurance Services Office, Inc., 2012
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION – PERMITS OR AUTHORIZATIONS
CG 20 12 04 13
2023-74944
Named Insured: Way 2 Love, Inc.
Any state or political subdivision that issues a permit or authorization to the named insured.
State Or Governmental Agency Or Subdivision Or Political Subdivision:
Subdivision:
SCHEDULE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the following:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to
include as an additional insured any state or
governmental agency or subdivision or political
subdivision shown in the Schedule, subject to the
following provisions:
1. This insurance applies only with respect to
operations performed by you or on your behalf
for which the state or governmental agency or
subdivision or political subdivision has issued a
permit or authorization.
However:
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. If coverage provided to the additional
insured is required by a contract or
agreement, the insurance afforded to such
additional insured will not be broader than
that which you are required by the contract
or agreement to provide for such additional
insured.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or
"personal and advertising injury" arising out
of operations performed for the federal
government, state or municipality; or
b. "Bodily injury" or "property damage"
included within the "products-completed
operations hazard".
A.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
© Insurance Services Office, Inc., 2012
Way 2 Love, Inc. NAMED INSURED:
FORM: NIAC-E26 11 17 POLICY NUMBER: 2023-74944
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS (WAIVER OF SUBROGATION)
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM
This endorsement modifies insurance provided under the following:
Name of Person or Organization:
SCHEDULE
Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage.
M. A. Hays Co.
232 Broadway
Richmond, CA 94804 RENEWAL OF NUMBER: 2022-74944
2023-74944 POLICY NUMBER: PRODUCER:
BUSINESS AUTO COVERAGE PART DECLARATIONS
NAME OF INSURED AND MAILING ADDRESS: Item One: Way 2 Love, Inc. 3609 Wall Ave.
Richmond, CA 94804
POLICY PERIOD: FROM TO
08/01/2024
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION:
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE A S STATED IN THIS POLICY.
SCHEDULE OF COVERAGES AND COVERED AUTOS.
This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTOS Section of the Business Auto Coverage Form next to the name of the coverage.
Item Two:
08/01/2023
Feeding the unhoused providing living needs and tutoring
COVERED AUTOS
COVERAGES
Entry of one or more of the symbols from
the COVERED AUTOS Section of the
Business Auto Coverage Form shows
which autos are covered autos.
THE MOST WE WILL PAY FOR ANY
ONE ACCIDENT OR LOSS
PREMIUM
LIABILITY CSL
HIRED AUTO
NONOWNED AUTO
AUTO MEDICAL PAYMENTS
UNINSURED MOTORIST
N/A
8 9
N/A
N/A
EXCLUDED
$1,000,000 CSL
INCLUDED
EXCLUDED
EXCLUDED
N/A
$50
$200
N/A
N/A
LIMIT
UNINSURED MOTORIST-PD EXCLUDED N/A N/A
PHYSICAL DAMAGE
N/A $N/A for each disablement of a private passenger "auto" N/A TOWING AND LABOR FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF IS SUANCE:
ESTIMATED TOTAL PREMIUM $250
$500
$500
Deductible shown on
supplemental declaration
for each covered auto. See ITEM
THREE for hired or borrowed
autos.
Deductible shown on
supplemental declaration
for each covered auto
applies to loss except caused by
fire or lightning. See ITEM
THREE for hired or borrowed
autos.
Actual
cash value or
cost of repair
whichever
is less
minus
8 8
COLLISION
COVERAGE
COMPREHENSIVE
COVERAGE Incl.
Incl.
CA 00 01 10 13, CA 01 43 05 17, CA 04 44 10 13, CA 20 54 10 13, CA 20 55 10 13, CA 23 84 10 13, CA 23 85 10 13, CA 99 23 10 13, CA 99 33 10 13, CA 99 34 10 13, NIA C-E180 BA 01 21, NIAC-E342 BA 08 22
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
COUNTERSIGNED: BY
(AUTHORIZED REPRESENTATIVE NIAC - AL
Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code Section 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of California and is not subject to regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay claims in the event the risk pool becomes insolvent.
06/22/2023
BUSINESS AUTO COVERAGE FORM
POLICY NUMBER: SCHEDULE BA
NAME INSURED:
Way 2 Love, Inc.
2023-74944
DEDUCTIBLES apply only if
coverage is provided as
indicated below.
OTHER THAN
COLLISION
COLLISION
CLASS
CODE TERR.
DESCRIPTION
COVERED
AUTO
NO.
YEAR, MODEL, TRADE NAME,
BODYTYPE, SERIAL NUMBER(S) VIN
SCHEDULE OF COVERED AUTOS YOU OWN
TOWING
& LABOR
Limit per
Disablement
Item Three:
N/A NO OWNED AUTOS
PREMIUMS: COVERAGE IS PROVIDED ONLY IF A PREMIUM CHARGE IS INDICATED.
COVERED
AUTO
NO.
NON-
OWNED HIRED LIABILITY MED
PAY
UM/
UIM
PHYSICAL DAMAGE
COLL. COMP.
ADDITIONAL INSURED / LOSS PAYEE:
Except for towing, all physical damage loss is payable
to you and the Loss Payee named below as interest
may appear at the time of loss. See attached
Schedule AI.
TOWING
AND
LABOR
N/A
NO/H 201 50
Hired PD Hired Physical Damage Deductibles:
Comprehensive: $500 Collision: $500
Signature Date
06/22/2023
1Page NAME OF INSURED:
POLICY NUMBER: 2023-74944
INDEX OF FORMS ATTACHED TO THE POLICY
Way 2 Love, Inc.
AUTO FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE
Business Auto Coverage Form CA 00 01 10 13
California Changes CA 01 43 05 17
Waiver of Transfer of Rights of Recovery Against Others to us (Waiver of Subrogation) CA 04 44 10 13 Employee Hired Autos CA 20 54 10 13
Fellow Employee Coverage CA 20 55 10 13
Exclusion of Terrorism - Auto CA 23 84 10 13
Exclusion of Terrorism - Auto - Involving Nuclear, Biological or Chemical Terrorism CA 23 85 10 13 Rental Reimbursement Coverage CA 99 23 10 13
Employees as Insureds CA 99 33 10 13
Social Service Agencies - Volunteers as Insureds CA 99 34 10 13 Communicable Disease - Exclusion NIAC-E180 BA 01 21
Anti-Stacking Condition NIAC-E342 BA 08 22
This list of forms is not part of the actual policy, but is for your information only.
Please refer to the policy(s) for actual limits, coverages and exclusions.
COMMERCIAL AUTO POLICY NUMBER: 2023-74944
CA 99 23 10 13
Way 2 Love, Inc. Named Insured:
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
This endorsement modifies insurance provided under the following:
RENTAL REIMBURSEMENT COVERAGE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Endorsement Effective Date: 8/1/2023
SCHEDULE
Designation or Description of
Covered "Autos" to which this
insurance applies Coverage Premium
Maximum Payment
Each Covered "Auto"
Any One
Day
No. of
Days
Any One
Period
Comprehensive
Collision
30 30 Incl. $1500
$1500 Incl.
Specified
Causes of Loss
Any Covered "Auto"
Any Covered "Auto"
N/A
Total Premium Incl.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A.
This endorsement provides only those coverages where
a premium is shown in the Schedule. It applies only to a covered "auto" described or designated in the Schedule.
C. We will pay only for those expenses incurred
during the policy period beginning 24 hours after
the "loss" and ending, regardless of the policy's
expiration, with the lesser of the following number
of days: We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the
otherwise applicable amount of each coverage you have
on a covered "auto". No deductibles apply to this
coverage.
The number of days reasonably required to
repair or replace the covered "auto". If "loss" is
caused by theft, this number of days is added
to the number of days it takes to locate the
covered "auto" and return it to you.
B.
1.
CA 99 23 10 13
COMMERCIAL AUTO POLICY NUMBER: 2023-74944
CA 99 23 10 13
2. The number of days shown in the Schedule.
D. Our payment is limited to the lesser of the following amounts:
E. This coverage does not apply while there are
spare or reserve "autos" available to you for your
operations.
F. If "loss" results from the total theft of a covered
"auto" of the private passenger type, we will pay
under this coverage only that amount of your
rental reimbursement expenses which is not
already provided for under the Physical Damage
Coverage Extension.
1. Necessary and actual expenses incurred.
2. The maximum payment stated in the Schedule
applicable to "any one day" or "any one period".
CA 99 23 10 13