Vallejo City Council
January 13, 2026


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ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

PRODUCER CONTACT
NAME:

FAXPHONE
(A/C, No):(A/C, No, Ext):

E-MAIL
ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is req uired)

AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT
OTHER: $

COMBINED SINGLE LIMIT
$(Ea accident)
ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED
BODILY INJURY (Per accident) $AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE
$AUTOS ONLY AUTOS ONLY (Per accident)
$

OCCUR EACH OCCURRENCE
CLAIMS-MADE AGGREGATE $
DED RETENTION $

PER OTH-

STATUTE ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)
$
$
$
$
$The ACORD name and logo are registered marks of ACORD
6/13/2025
License # 0C36861
(415) 946-7500
18058
Five Keys Schools and Programs
320 13th Street, 2nd Floor
Oakland, CA 94612
34630
A 1,000,000
XX PHPK2680750-005 4/23/2025 4/23/2026 1,000,000
20,000
1,000,000
3,000,000
3,000,000
EBL AGGREGATE 1,000,000
1,000,000
A
XX PHPK2680750-005 4/23/2025 4/23/2026
3,000,000A
XX PHUB909436-005 4/23/2025 4/23/2026 3,000,000
10,000
B
X FIWC522444 7/1/2024 7/1/2025 1,000,000
Y 1,000,000
1,000,000
A Professional Liab. PHPK2680750-005 4/23/2025 Each Occurence 1,000,000 A Professional Liab. PHPK2680750-005 4/23/2025 4/23/2026 Aggregate 3,000,000 SEE ATTACHED ACORD 101
City of Vallejo
Attn: Risk Manager
555 Santa Clara Street
Vallejo, CA 94590
FIVEKEY-01 TWANG2
Alliant Insurance Services, Inc.
560 Mission St 6th Fl
San Francisco, CA 94105
Philadelphia Indemnity Insurance Company
Oak River Insurance Company
X
4/23/2026
X
X
X
X
X
X
X
Re: leased Premises - 1937 Broadway Street, Vallejo, CA 94589 The City of Vallejo, its officers, officials, employees, agents and volunteers are included as additional insureds with respect to general liability and auto liability policies when required by written contract per the attached endorsement. A waiver of subrogation applies in favor of the City with respect to general liability, auto liability, and workers' compensation policies when required by written contract per the attached endorsement. U mbrella policy follows form over the underlying insurance general liability, auto liability, employer's liability, and professional liability. The City is inclu ded as Dloss payee with respect to property coverage per endorsement to follow from the insurer. 'RFXVLJQ(QYHORSH,'

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FORM NUMBER:

EFFECTIVE DATE:

The ACORD name and logo are registered marks of ACORD

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE
FORM TITLE:

Page of

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01)
AGENCY CUSTOMER ID:

LOC #:

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.

Alliant Insurance Services, Inc.

FIVEKEY-01
SEE PAGE 1
1 SEE PAGE 1
ACORD 25 Certificate of Liability Insurance
License # 0C36861
0 SEE P 1
Five Keys Schools and Programs
320 13th Street, 2nd Floor
Oakland, CA 94612
Alameda
SEE PAGE 1
TWANG2
1 Description of Operations/Locations/Vehicles:

Additional Lines of Coverage:

Employee Theft (Crime)
Insurer: Travelers Casualty and Surety Company of America Policy Term: 4/23/2025 to 4/23/2026
Policy Number: 108259936
Limits: $1,000,000; Deductible: $5,000
Commercial Property
Insurer: Philadelphia Indemnity Insurance Company
Policy Term: 4/23/2025 to 4/23/2026
Policy Number: PHPK2680750-005
Perils Insured - Special Form
Business Income: $31,818
Business Personal Property: $1,000
Replacement Cost Basis
Pollution Liability
Insurer: Tokio Marine Specialty Insurance Company
Policy Term: 6/4/2025 to 6/4/2026
Policy Number: PPK2715397-000
Limits: $1,000,000; Deductible: $25,000
This cancels and replaces certitficate previously issued on 6/6/2025. 'RFXVLJQ(QYHORSH,'

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POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page of ADDITIONAL INSURED – DESIGNATED

PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:

1. In the performance of your ongoing operations;
or

2. In connection with your premises owned by or
rented to you.

However:

1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and

2. If coverage 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 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.

Blanket when required by contract
11 PHPK2680750-005
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PI-GL-005 (07/12)
Page of
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED

PRIMARY AND NON-CONTRIBUTORY INSURANCE
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Effective Date:

Name of Person or Organization (Additional Insured):

SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” arising out of or relating to your negligence in the performance of “your work” for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule.

This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization.

This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or ”occurrence” we cover for this Additional Insured.

The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in SECTION III – LIMITS OF INSURANCE.

All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged.

Blanket when required by contract
11 04/23/2025
Policy #: PHPK2680750-005
Policy Term: 4/23/25-4/23/26
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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

GENERAL LIABILITY DELUXE ENDORSEMENT:

HUMAN SERVICES
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE
It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording.

Coverage Applicable Limit of Insurance Page #
Extended Property Damage Included 2
Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2
Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3
HIPAA Clarification 4
Medical Payments $20,000 5
Medical Payments ± Extended Reporting Period 3 years 5
Athletic Activities Amended 5
Supplementary Payments ± Bail Bonds $5,000 5
Supplementary Payment ± Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5
Key and Lock Replacement ± Janitorial Services Client Coverage $10,000 limit 6 Additional Insured ± Newly Acquired Time Period Amended 6 Additional Insured ± Medical Directors and Administrators Included 7 Additional Insured ± Managers and Supervisors (with Fellow Employee Coverage)
Included 7
Additional Insured ± Broadened Named Insured Included 7 Additional Insured ± Funding Source Included 7
Additional Insured ± Home Care Providers Included 7
Additional Insured ± Managers, Landlords, or Lessors of Premises Included 7 Additional Insured ± Lessor of Leased Equipment Included 7 Additional Insured ± Grantor of Permits Included 8
Additional Insured ± Vendor Included 8
Additional Insured ± Franchisor Included 9
Additional Insured ± When Required by Contract Included 9 Additional Insured ± Owners, Lessees, or Contractors Included 9 Additional Insured ± State or Political Subdivisions Included 10 Policy #: PHPK2680750-005
Policy Term: 4/23/25-4/23/26
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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10
Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11
Bodily Injury ± includes Mental Anguish Included 11
Personal and Advertising Injury ± includes Abuse of Process, Discrimination
Included 11
A. Extended Property Damage
SECTION I ± COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following:
a. Expected or Intended Injury
³%RGLO\LQMXU\´RUSURSHUW\GDPDJH´H[SHFWHGRULQWHQGHGIURPWKHVWDQGSRLQWRIWKHLQVXUHG This exclusion does not apply tR³ERGLO\LQMXU\´RU³SURSHUW\GDPDJH´UHVXOWLQJIURPWKHXVHRI reasonable force to protect persons or property.

B. Limited Rental Lease Agreement Contractual Liability SECTION I ± COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following:
(3) %DVHGRQWKHQDPHGLQVXUHG¶VUHTXHVWDWWKHWLPHRIFODLPZHDJUHHWRLQGHPQLI\WKH named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements.
7KLVFRYHUDJHLVH[FHVVRYHUDQ\UHQWHU¶V
liability insurance of the client.

C. Non-Owned Watercraft
SECTION I ± COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 58 feet long; and
(b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent.

D. Damage to Property You Own, Rent or Occupy

SECTION I
± COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE 'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
LIABILITY, Subsection 2. Exclusions, Paragraph j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following:
(1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury WRDSHUVRQRUGDPDJHWRDQRWKHU¶VSURSHUW\XQOHVVWKHGDPDJHWRSURSHUW\LVFDXVHGE\ your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision.

E. Damage to Premises Rented to You

1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the w
RUG³ILUH´LVFKDQJHGWR³ILUHOLJKWQLQJH[SORVLRQVPRNHRUOHDNDJHIURPDXWRPDWLFILUH SURWHFWLYHV\VWHPV´ZKHUHLWDSSHDUVLQ

a. The last paragraph of SECTION I ± COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following:

Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III
± LIMITS OF INSURANCE.
b. SECTION III ± LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following:

Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V
± DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following:

A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract";

2. SECTION IV
± COMMERCIAL GENERAL LIABILITY CONDITIONS , Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) is deleted in its entirety and replaced by the following:

That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner;

3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of:
'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
a. $1,000,000; or
b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit.

This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof.

F. HIPAA

SECTION I
± COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY , is amended as follows:

1. Paragraph 1. Insuring Agreement is amended to include the following:

We will pay those sums that the insured becomes legally obligated to pay as damages because RID³YLRODWLRQ
V
´RIWKH+HDOWK,QVXUDQFH3RUWDELO ity and Accountability Act (HIPAA). We have WKHULJKWDQGWKHGXW\WRGHIHQGWKHLQVXUHGDJDLQVWDQ\³VXLW´³LQYHVWLJDWLRQ´RU³FLYLOSURFHHGLQJ´ VHHNLQJWKHVHGDPDJHV+RZHYHUZHZLOOKDYHQRGXW\WRGHIHQGWKHLQVXUHGDJDLQVWDQ\³VXLW´ VHHNLQJGDPDJHV³LQYHVWLJDWLRQ´RU³FLYLOSURFHHGLQJ´WRZKLFKWKLVLQVXUDQFHGRHVQRWDSSO\

2. Paragraph 2. Exclusions is amended to include the following additional exclusions:

This insurance does not apply to:
a. Intentional, Willful, or Deliberate Violations
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b. Criminal Acts
$Q\³YLRODWLRQ´ZKLFKUHVXOWVLQDQ\Friminal penalties under the HIPAA. c. Other Remedies
Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits
Any compliance reviews by the Department of Health and Human Services.

3. SECTION V ± DEFINITIONS is amended to include the following additional definitions:
a. ³&LYLOSURFHHGLQJ´PHDQVDQDFWLRQE\WKH'HSDUWPHQWRI+HDOWKDQG+XPDQ6HUYLFHV ++6

DULVLQJRXWRI³YLRODWLRQV´
b. ³,QYHVWLJDWLRQ´PHDQVDQH[DPLQDWLRQRIDQDFWXDORUDOOHJHG³YLRODWLRQ V
´E\++6+RZHYHU
³LQYHVWLJDWLRQ´GRHVQRWLQFOXGHD&RPSOLDQFH5HYLHZ
c. ³9LRODWLRQ´PHDQVWKHDFWXDORUDOOHJHGIDLOXUHWRFRPSO\ZLWKWKH regulations included in the HIPAA.
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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
G. Medical Payments ± Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part:

1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of:
a. $20,000; or
b. The Medical Expense Limit shown in the Declarations of this Coverage Part.

2. SECTION I ± COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following:
(b) The expenses are incurred and reported to us within three years of the date of the accident.

H. Athletic Activities
SECTION I ± COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following:
e. Athletic Activities
To a person injured while taking part in athletics.

I. Supplementary Payments
SECTION I ± COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGE A AND B are amended as follows:

1. b. is deleted in its entirety and replaced by the following:

1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these.

1.d. is deleted in its entirety and replaced by the following:

1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work.

J. Employee Indemnification Defense Coverage
SECTION I ± COVERAGES, SUPPLEMENTARY PAYMENTS ± COVERAGES A AND B the following is added:

We will payRQ\RXUEHKDOIGHIHQVHFRVWVLQFXUUHGE\DQ³HPSOR\HH´LQDFULPLQDOSURFHHGLQJ occurring in the course of employment.
7KHPRVWZHZLOOSD\IRUDQ\³HPSOR\HH´ZKRLVDOOHJHGWREHGLUHFWO\LQYROYHGLQDFULPLQDO proceeding is $25,000 regardlHVVRIWKHQXPEHUVRI³HPSOR\HHV´FODLPVRU³VXLWV´EURXJKWRU SHUVRQVRURUJDQL]DWLRQVPDNLQJFODLPVRUEULQJLQJ³VXLWV . 'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
K. Key and Lock Replacement ± Janitorial Services Client Coverage SECTION I ± COVERAGES, SUPPLEMENTARY PAYMENTS ± COVERAGES A AND B is amended to include the following:

WHZLOOSD\IRUWKHFRVWWRUHSODFHNH\VDQGORFNVDWWKH³FOLHQWV´SUHPLVHVGXHWRWKHIWRURWKHU ORVVWRNH\VHQWUXVWHGWR\RXE\\RXU³FOLHQW,´ up to a $10,000 limit per occurrence and $10,000 policy aggregate.

We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that \RXRUDQ\RI\RXUSDUWQHUVPHPEHUVRIILFHUV³HPSOR\HHV´³PDQDJHUV´GLUHFWRUVWUXVWHHV authorized representatives or any one to ZKRP\RXHQWUXVWWKHNH\VRID³FOLHQW´IRUDQ\ purpose commit, whether acting alone or in collusion with other persons.

The following, when used on this coverage, are defined as follows:
a. "Client" means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means:
(1) Any natural person:
(a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you:
(a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or
(b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean:
(a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or
(b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee."
c. "Manager" means a person serving in a directorial capacity for a limited liability company.

L. Additional Insureds
SECTION II ± WHO IS AN INSURED is amended as follows:

1. If coverage for newly acquired or formed organizations is not otherwise excluded from this 'RFXVLJQ(QYHORSH,'

(%%)()%$&%))

PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following:
a. Coverage under this provision is afforded until the end of the policy period.

2. Each of the following is also an insured:
a. Medical Directors and Administrators ± Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient.
b. Managers and Supervisors ± Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and VXSHUYLVRUVZKRDUH\RXU³HPSOR\HHV´DUHDOVRLQVXUHGVIRU³ERGLO\LQMXU\´WRDFR - ³HPSOR\HH´ZKLOHLQWKHFRXUVHRIKLVRUKHU employment by you or performing duties related to the conduct of your business.

This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company.
c. Broadened Named Insured ± Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance.
d. Funding Source
± Any person or organization with respect to their liability arising out of:
(1) Their financial control of you; or
(2) Premises they own, maintain or control while you lease or occupy these premises.

This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers ± At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled.
f. Managers, Landlords, or Lessors of Premises ± Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions:

This insurance does not apply to:
(1)
$Q\³RFFXUUHQFH´ZKLFKWDNHVSODFHDIWHU\RXFHDVHWRE e a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization.
g. Lessor of Leased Equipment ± Automatic Status When Required in Lease Agreement With You ± Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or 'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
RUJDQL]DWLRQLVDQLQVXUHGRQO\ZLWKUHVSHFWWROLDELOLW\IRU³ERGLO\LQMXU\´³SURSHUW\GDPDJH´ or ³SHUVRQDODQGDGYHUWLVLQJLQMXU\´Faused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization.

A SHUVRQ¶VRURUJDQL]DWLRQ¶VVWDWXVDVDQDGGLWLRQDOLQVXUHGXQGHUWKLVHQGRUVHPHQWHQGV when their contract or agreement with you for such leased equipment ends.

With respect to the insurance afforded to these additional insureds, this insurance does not DSSO\WRDQ\³RFFXUUHQFH´ZKLFKWDNHVSODFHDIWHUWKHHTXLSPHQWOHDVHH[SLUHV h. Grantors of Permits ± Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision:
(1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures;
(b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. i. Vendors
±2QO\ZLWKUHVSHFWWR³ERGLO\LQMXU\´RU³SURSHUW\GDPDJH´DULVLQJRXWRI³\RXU SURGXFWV´ which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions:
(1) The insurance afforded the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or
(h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to:
(i) The exceptions contained in Sub-paragraphs (d) or (f);o r (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing.
j. Franchisor
± Any person or organization with respect to their liability as the grantor of a franchise to you.
k. As Required by Contract ± Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations
l. Owners, Lessees or Contractors
± Any person or organization, 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 when required by a contract.

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:
(a) 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
(b) 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.
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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
m. State or Political Subdivisions ± Any state or political subdivision as required, 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 political subdivision has issued a permit, and is required by contract.
(2) This insurance does not apply to:
(a) "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or
(b) "Bodily injury" or "property damage" included within the "products-completed operations hazard."
M. Duties in the Event of Occurrence, Claim or Suit
SECTION IV ± COMMERCIAL GENERAL LIABILITY CONDITIONS , Paragraph 2. is amended as follows:
a. is amended to include:

This conditionDSSOLHVRQO\ZKHQWKH³RFFXUUHQFH´RURIIHQVHLVNQRZQWR

(1) You, if you are an individual;
(2) A partner, if you are a partnership; or
(3) An executive officer or insurance manager, if you are a corporation. b. is amended to include:

This conditionZLOOQRWEHFRQVLGHUHGEUHDFKHGXQOHVVWKHEUHDFKRFFXUVDIWHUVXFKFODLPRU³VXLW´ is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership; or
(3) An executive officer or insurance manager, if you are a corporation.

N. Unintentional Failure To Disclose Hazards
SECTION IV ± COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following:

It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure.

O. Transfer of Rights of Recovery Against Others To Us
SECTION IV ± COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer of Rights of 'RFXVLJQ(QYHORSH,'

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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
Recovery Against Others To Us is deleted in its entirety and replaced by the following:

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them.

Therefore, the i
QVXUHGFDQZDLYHWKHLQVXUHU¶VULJKWVRIU ecovery prior to the occurrence of a loss, provided the waiver is made in a written contract.

P. Liberalization
SECTION IV ± COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following:

If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state.

Q. Bodily Injury
± Mental Anguish
SECTION V ± DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following:
³%RGLO\Lnjury´ means:
a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and
b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time.

R. Personal and Advertising Injury ± Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of ³SHUVRQDODQGDGYHUWLVLQJLQMXU\´LV amended as follows:

1. SECTION V ± DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following:
b. Malicious prosecution or abuse of process;

2. SECTION V ± DEFINITIONS, Paragraph 14. is amended by adding the following:

Discrimination based on race, color, religion, sex, age or national origin, except when:
a. Done intentionally by or at the direction of, or with the knowledge or consent of:
(1) Any insured; or
(2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured;
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PI-GLD-HS (10/11)

Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company
c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling.

The above does not apply to fines or penalties imposed because of discrimination. 'RFXVLJQ(QYHORSH,'

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PI-CA-003 (04/14)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

A. SECTION II – COVERED AUTOS LIABILITY COVE RAGE, A. Coverage, 1. Who Is An Insured is amended by adding the following:

The following are also "insureds":

Any person or organization for whom you are required by an “insured contract” to procure “bodily injury” or “property damage” liability insurance arising out of the operation of a covered "auto'' with your permission. However, this additional insurance does not apply to:

1. The owner or anyone else from whom you hire or borrow a covered "auto." This exception does not apply if the covered "auto" is a "trailer” connected to a covered "auto” you own;

2. Your "employee” if the covered “auto" is owned by that "employee” or a member of his or her household;

3. Anyone using a covered "auto” while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours;

4. Anyone other than your "employees," partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees," while moving property to or from a covered "auto''; or

5. A partner (if you are a partnership), or a member (if you are a limited liability company) for covered ''auto” owned by him or her or a member of his or her household.

B. The “insured contract” must be in effect during the policy period shown in the Declarations and must have been executed prior to the “bodily injury” or “property damage”.

C. This person or organization is an “insured” only to the extent you are liable due to your ongoing operations for that “insured”, whether the work is performed by you or for you, and only to the extent you are held liable for an “accident” occurring while a covered “auto” is being driven by you or one of your employees.

D. There is no coverage provided to this person or organization for “bodily injury” to its employees or for “property damage” to its property.

E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault.

F. The defense of any claim or “suit” must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or “suit”.

G. A person’s or organization’s status as an “insured” under this endorsement ends when your operations for that “insured” are completed.

Policy #: PHPK2680750-005
Policy Term: 4/23/25-4/23/26
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PI-CA-003 (04/14)

H. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached.

In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any “insured,” or to procure insurance.

I. The following additional exclusions apply:

The insurance afforded to any person or organization as an “insured” under this endorsement does not apply to “loss”:

1. Which occurs prior to the date your contract is effective with such person or organization;

2. Arising out of the sole negligence of any person or organization that would not be an “insured” except for this endorsement; or

3. Which occurs after you returned the leased or rented “auto” to the lessor or the policy period ends, whichever occurs first.
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PI-CA-023 (07/19)
PI-CA-023 (07/19)

Includes copyrighted material of Insurance Services Office, Inc., with permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE

CONDITION
This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

GARAGE COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and supersedes any provision to the contrary:

This Coverage Form’s Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an “insured” under your policy provided that:

1. Such “insured” is a Named Insured under such other insurance; and

2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such “insured”.

B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and the Garage Coverage Form and supersedes any provision to the contrary:

This Coverage Form’s Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an “insured” under your policy provided that:

1. Such “insured” is a Named Insured under such other insurance; and

2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such “insured”.

Policy #: PHPK2680750-005
Policy Term: 4/23/25-4/23/26
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Endorsement Effective : Policy No.:

Insured:

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WC 99 04 10 C
(Ed. 0119)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTCALIFORNIA

BLANKET BASIS
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Sched ule. (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 endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

Blanket Waiver

Person/Organization

Blanket Waiver ± Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

Waiver Premium (prior to ad justments)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement No.:

Premium $
Insurance Company:

WC 99 04 10 C

Countersigned by ______________________________________

(Ed. 0119)
Job Description
All CA Operations
Oak River Insurance Company
41,481
07/01/2024 FIWC522444
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COMMUNITY BENEFIT GRANT AGREEMENT

CITY OF VALLEJO
AND

NORTHBAY HEALTHCARE
This Community Benefit Grant, effective October 25, 2019, is awarded to the City of Vallejo by NorthBay Healthcare.

In response to community need, the city intends to build a homeless navigation shelter to alleviate homelessness in Vallejo and address the health care needs of this vulnerable population.

NorthBay Healthcare will contribute a total of $200,000 toward the construction and operation of the shelter in accordance with the terms of this one-time, three-year grant. In addition, the city will engage other Solano County health systems, state and federal agencies, non-profit foundations and other funders to participate in the project.

The city and NorthBay Healthcare, agree to the following:

The city will build a 125-bed homeless navigation shelter, located in Vallejo, which will be funded by NorthBay Healthcare and additional funds secured by the city. Exhibit A sets forth the objectives to be accomplished with grant funds, including the services to the community and Grant Objectives
NorthBay Healthcare will disburse to city three payments for a total of $200,000 during the grant period. Funds will be contingent upon the entity independently securing additional funding per year of the grant period.
a. NorthBay Healthcare shall disburse th e first payment of fifty thousand dollars ($100,000) to city on or before December 15, 2020;
b. NorthBay Healthcare shall disburse th e second payment of fifty thousand dollars ($50,000) to city on or before December 15, 2021; and
c. NorthBay Healthcare shall disburse th e third payment of fifty thousand dollars ($50,000) to city on or before December 15, 2022.

Reporting Requirements
City shall submit reports to NorthBay Healthcare or its designees, in accordance with the Reporting Guidelines, attached as Exhibit B.

Term
Subject to Section 5, the term of this Agreement will be from the effective date through December 31, 2022 Grant Period
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Early Termination
The parties may terminate this agreement upon mutual written agreement. If this agreement is terminated upon mutual written agreement, the city may retain any grant funds distributed prior to the date this agreement terminates.

Either party may terminate this agreement for cause if a party has materially breached the agreement where the defaulting party has been given written notice of its deficiencies and has failed to correct such deficiencies within 15 days after receipt of this notice or for an extended period of time, as agreed upon by the parties. Termination will be effective at the expiration of the cure period. If this agreement is terminated for cause by NorthBay Healthcare before the end of the grant period, It may recoup grant funds disbursed to city that have yet to be expended or committed by city for the grant objectives.

Publicity
NorthBay Healthcare and the city shall collaborate on the content and distribution of all public statements in which NorthBay Healthcare
homeless shelter are disclosed.

The parties agree to coordinate any press release or publications. The city grants to NorthBay Healthcare the right and license to use c
Notwithstanding the foregoing, the city may not use the name(s), trademark(s), or trade name(s) of NorthBay Healthcare, its subsidiaries or affiliates, except with the prior written consent of NorthBay Healthcare.

Budget and Use of Funds
The city shall use the funds solely to fulfill the grant objectives. Any significant changes within the final budget (i.e. >10% of total grant amount) must be approved in advance by NorthBay Healthcare. The city shall not use grant funds toward any partisan political activity, or to further the election or defeat of any candidate for public office. The city shall not include religious worship, instruction or proselytization as part of in or in connection to the homeless shelter.

Reversion of Funds
All funds not expended for the grant objectives during the grant period must be returned to NorthBay Healthcare at the conclusion of the grant period.

Inspections and Audits
The city will be subject, at any reasonable time, to produce for inspection, examination, review, audit, and copying, at any office or location of the city where such records may be found by NorthBay Healthcare
computer related or otherwise), including, without limitation, relevant accounting procedures and practices, financial statements and supporting documentation.

Period of Retention
All books, records, reports, and statements relevant to this agreement must be retained a minimum of five years from the end of the grant period. Retention time will be extended when an audit is scheduled or in progress for a period reasonably necessary to complete an audit or to complete any dispute resolution or litigation which may ensue.

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Communication and Collaboration
A city representative shall collaborate and communicate on a regular basis with NorthBay Healthcare. At the request of NorthBay Healthcare, the city shall participate in an evaluation study that will include all NorthBay Healthcare grantees, for the purpose of describing and communicating the collective impact of the grantee cohort. Collective impact will include a combination of quantitative and qualitative data collection and analysis by an independent contractor selected by NorthBay Healthcare. The city will do the following: (1) meet with NorthBay Healthcare
needs; (2) participate in development of an action plan for the ongoing evaluation; (3) coordinate data collection and comply with submission schedule; and (4) participate in a review of data findings to facilitate interpretation and reporting to NorthBay Healthcare. The city will also participate, as requested by NorthBay Healthcare, in periodic site visits, interviews with key staff or project management, and focus group discussions with staff or client groups. The city should factor these expectations into c
shelter to allow for staff and administrative
time required to participate in the evaluation study.

Indemnification
In accepting grant funds from NorthBay Healthcare, the city hereby irrevocably and unconditionally agrees, to the fullest extent permitted by law, to defend, indemnify and hold harmless NorthBay Healthcare, its officers, directors, affiliates, employees, representatives, agents, successors and assigns from and against any and all claims, liabilities, losses, and sing
from or in connection with any act or omission of the city, its employees, contractors, or agents, in applying for or accepting such grant, in expending or applying the funds furnished pursuant to such grant or in carrying out the program or project to be funded or financed by such grant, except to the extent that such claims, liabilities, losses or expenses result directly from any act or omission of NorthBay Healthcare, its officers, directors, employees or agents.

Notices
All written notices to be given in connection with this agreement will be sufficient if sent by certified or registered mail, postage prepaid or by national overnight delivery service addressed to the party entitled to receive such notice at the address specified by such party below. Either party may from time to time change its address for purpose of receipt of notice by a notice delivered in compliance with this subsection.

NorthBay Healthcare City of Vallejo
Attn: Steve Huddleston Attn: Judy Shepard-Hall
4500 Business Center Drive 555 Santa Clara St., 3
rd Floor
Fairfield, CA 94534 Vallejo, CA 94590

Waiver of Breach
Failure to declare a breach or the actual waiver of any particular breach of this Agreement or its material or nonmaterial terms by either party shall not operate as a waiver by such party of any of its rights or remedies as to any other breach.

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Severability
If any provision contained in this agreement is held to be unenforceable by an arbitrator or a court of law or equity, this agreement shall be construed as if such provision did not exist and the non-enforceability of such provision shall not be held to render any other provision or provisions of this agreement unenforceable.

Governing Law
This agreement and the rights and obligations of the parties hereto shall be governed by, and construed according to, the laws of the State of California.

Dispute Resolution
Any dispute arising out of or in connection with this agreement, including any question regarding its existence, interpretation, validity or termination, will be referred to and definitively resolved by binding arbitration pursuant to the California Code of Civil Procedure Section 1280, et seq., and the arbitration shall be administered in accordance with the Streamlined Rules of Judicial Arbitration and Mediation Service (JAMS) applicable to commercial arbitrations. The place of arbitration will be Sacramento, California. The judgment of the arbitration tribunal will be accompanied by a written statement of the basis for such judgment and may be enforced by any court having proper jurisdiction. The provisions of this section will not preclude the parties from seeking equitable remedies in aid of arbitration from a court of appropriate jurisdiction, and will survive the termination of this agreement.

Entire Agreement and Modification
This agreement and its exhibits constitute the entire agreement of the parties and such are intended as a complete and exclusive statement of the promises, representations, negotiations, discussions, and other agreements that may have been made in connection with the subject matter hereof. Unless otherwise expressly authorized by the terms of this agreement, no modification or amendment to this agreement shall be binding upon the parties unless the same is in writing and signed by the respective parties hereto.

Counterparts
This agreement may be executed in counterparts, each of which will be an original and which together will constitute one and the same instrument. A photocopy of the executed agreement may be used as if it were the original agreement.

No Third Party Beneficiary
Nothing contained in this agreement is intended nor shall it be construed to create rights running to the benefit of third parties.

The parties have executed this Agreement on the dates set forth below, to be effective as of the effective date.
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NORTHBAY HEALTHCARE CITY OF VALLEJO
By:1 By:2________________________________
Name: Aimee Brewer Name: _____________
Title: President, NorthBay Healthcare Group Title: _
Date:1October 25, 2019 Date: 2_______________________________ 'RFXVLJQ(QYHORSH,'

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EXHIBIT A

GRANT OBJECTIVES

The charitable purpose of this grant is to help address some of the social determinants of health for the population of the City of Vallejo and surrounding cities within the County of Solano, through the construction of the Homeless Shelter. The homeless shelter will be constructed, owned and operated by the city. The shelter has yet to be constructed, but the c target date for opening the shelter is the first half of the year 2020.

The shelter will be developed using a sustainable model where basic services are provided to people working to find housing and overcome issues contributing to their homelessness. This shelter will be the first in the region to provide the homeless with short term shelter (up to 3 months that can be extended based on a p helter
will make use of referrals for intake of homeless individuals, couples, and military veterans who will complete an orientation, sign a shelter agreement and immediately:
i. exit the street
ii. receive access to a bed
iii. access three meals per day
iv. receive mental health support, case management, and other services v. receive counseling services

The city anticipates that the shelter will intake over 600 vulnerable people who were living on the streets annually. The goal is to exit 75% of these guests annually from the shelter to some type of permanent arrangement including, housing, reunification with family, transitional program, etc.

The city has brought on board a part time homelessness and supportive services coordinator who will be dedicated to overseeing performance management software, including HMIS, which will be used to evaluate the program and get real time data about service delivery efforts and relate them directly to intended targets, milestones and outcomes. As a result, city will be able to see more precisely what is working, replicate or refine those efforts, and report successes immediately rather than days or weeks.

The city is committed to providing the highest quality programs for homeless families and individuals by carefully monitoring and evaluating all shelter programs on an ongoing basis to determine their effectiveness and to make improvements. The city plans to measure progress quantitatively and qualitatively by recording and tracking data by using the Homeless HMIS wide database that tracks
homeless housing and service outcomes in the region.

At a later date the city will select the preferred referral tool to be used by the city to -in to the shelter. After the
homeless client enters the shelter, the operator will use this tool to record and track data and outcomes for all programs operated by the city. Post move-in the shelter operator will be required to use the Vulnerability Index-
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will be in the criteria for bidders in the shelter operator RFP). Additionally, the shelter operator and city will track and evaluate program-level, organizational impact and outcomes. The shelter operator will be expected to use standard data collection forms at intake and exit; have data updated every month, or when a significant change occurs, such as an increase in income; and support and solicit feedback from other jurisdictions, Housing First Solano CoC providers and partner agencies to collaboratively seek ways to improve performance measures.

The project budget allows for full implementation of the Coordinated Entry System, including the annual licensing fee for HMIS. Participation in CES is an intentional part of the navigation project that we are proposing. One of the primary goals of regional collaboration is to improve communication and coordination with Resource Connect and the Housing First CoC in order to move more individuals out of homelessness in City and the surrounding cities within the County of Solano. This cannot be accomplished unless the shelter operator fully participates in the CoC. The shelter operator must work with CoC and coordinate with any agencies entering data into HMIS to evaluate changes in housing status, income change, length of tenancy to assess if the outcomes are being met for persons utilizing the Vallejo emergency shelter services.

Quarterly reviews of data reports will allow for evaluation of the quality and success of services being provided.

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EXHIBIT B

REPORTING GUIDELINES

A. At the request of NorthBay Healthcare, the city shall provide a report to update NorthBay Healthcare on the c omeless shelter.

B. Prior to the end of the second quarter of 2020 (June 30, 2020), the city and NorthBay Healthcare, along with its health care partners (Sutter Health and Kaiser Permanente) will the reporting format to be used in an annual assessment each year of the grant period.

C. In addition, the city shall submit financial reports on its use of the grant funds, at the request of NorthBay Healthcare.

D. The city shall send all of the above reports to a representative identified by NorthBay Healthcare.

NorthBay Healthcare retains the right to subsequently modify the reporting guidelines over the grant period and shall provide written notice to the city.

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Exhibit H
Program Policies
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Five Keys Grievance Policy
Plenty of copies of the Grievance Procedure should be available at the front desk. The purpose of the Grievance Procedure is to ensure that participants have a clear process to follow when they feel
that they have been treated unfairly by Five Keys staff or policies. This can be a great opportunity for us to get feedback from participants on how we are doing with our services. At times, it is a useful tool for having a conversation with participants about not only our responsibilities and actions, but also their responsibilities and actions as participants. For the procedure to be effective please follow these guidelines:

Ɣ The procedure must be posted at every building in a visible location. Copies of the procedure should be kept at the front desk to hand out upon request. English and Spanish copies of the grievance procedure are available in the front desk binder.

Ɣ The procedure must also be given to every participants to sign when they sign their intake paperwork. Please take the time to explain the procedure, and sign and date the form.

During the process, all information should be kept confidential. Should the Supervisor be unable to resolve a grievance directly with the participant, all information should be forwarded to the
Site Director responsible for the site. Once the Director receives the information, the Supervisor will be contacted for information and the process will continue as described below.

Please keep the grievance as confidential as possible. Participants who file grievances should not be discussed with other site staff unless the other staff members are directly involved. If a support services staff member is assisting the participants with a grievance, be sure to confirm with the participants if they want you to discuss the matter with the services staff.

Participants must never suffer any retaliation from staff or denial of services for requesting or filing a grievance. Evidence of retaliation against a participant for submitting a grievance may result in immediate termination from Five Keys employment. It is our job to ensure that all participants are provided with excellent customer service, and that participants are confident that they can have their concerns heard and addressed. Even if a participant’s claims are not valid, it is our responsibility to ensure that the process is conducted with respect and compassion for the participant. 'RFXVLJQ(QYHORSH,'

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Five Keys Grievance Procedure
Five Keys is committed to providing excellent customer service and fairness to our participants. If you think we have failed in our efforts to do so, or that we have policies and procedures that are unfair, we want to hear from you! If you think you have been treated unfairly your issue will be carefully considered by Five Keys management and that we will try to come to a satisfactory resolution for everyone.

Below are the steps you need to take if you have a grievance. This process only applies to grievances involving the policies and employees of Five Keys; if you have a grievance with one of the other agencies at your location you must follow their procedure.

FIRST: What is a grievance? Basically it is a complaint about our service. A grievance is officially defined as a condition of occupancy or application of policy that you as the participant believe is unjust or inequitable.

SECOND: What do I do if I have one? As the participant, you should take the following steps:

1. Discuss the grievance or problem first with the Supervisor on duty. There is a grievance form available at the front desk that you can complete. Or you can make an appointment with a Supervisor to provide your grievance verbally.

Within 2 days the Supervisor on duty will contact you to set up a meeting to attempt to resolve this issue, and may propose next steps, if necessary. If the issue can’t be resolved at the meeting, the Supervisor will provide you with a written determination based on Five Keys Policies and Procedures or respond with a plan of action within 5 working days of the final meeting.

2. If you cannot resolve your grievance with the Supervisor or are not satisfied with the determination made by the Supervisor, you may request a meeting with the Site Director. To request a meeting, call your site phone for an appointment. The Site Director will attempt to contact you within 5 working days in order to make an appointment at the earliest, mutually agreeable opportunity to discuss the issue(s). At this meeting, the Director will attempt to resolve this issue, and may propose next steps, if necessary. This may include meeting with other staff or other steps. If your issue isn’t resolved at the meeting, the Director will provide you with a written determination based on Five Keys Policies and Procedures or respond with a plan of action within 5 working days of the final meeting.
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Exhibit J
Vallejo Navigation Center Participant Agreement
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Welcome! Temporary Shelters do not provide permanent housing, and participants staying at these sites do not have tenancy rights. Nonetheless, all participants are entitled to fair, respectful, and equitable treatment.

The program guidelines described below apply to all participants staying at Temporary Shelter Program sites. Please read the following program guidelines and initial next to each one to indicate that you have read and fully understand each guideline.

The following Community Expectations apply to everyone on site – participants and ƐƚĂī alike.

1. We will treat everyone on site with respect, civility, and dignity.

2. We will participate in Wellness Checks, working with Care Managers for housing services, and ŚĞĂůƚŚƐĐƌĞĞŶŝŶŐƐĚĂŝůLJǁŚŝĐŚŵĂLJŝŶĐůƵĚĞƐŚĞůƚĞƌƐƚĂīĞŶƚĞƌŝŶŐƚŚĞparticipant’s space.

3. We will not invite or accept any visitors, except people who are delivering essential services.

4. We will respect quiet hours between 10:00 PM and 7:00 AM.

5. Any animals we bring on site will always be under our direct control.

6. We will smoke in designated smoking areas only.

7. We will relieve animals only in designated areas and pick up after them.

8. We will respect the property and keep it in good condition.

9. We will work on individualized goals that will include working toward a permanent housing solution.

I. WORKING ON HOUSING GOALS

Ɣ Vallejo Navigation Center is an interim supportive shelter program.

Ɣ All participants are expected to meet with their assigned Care Coordinator once a week or more. Participants are required to meet every 30 days for their progress check-ins.

Ɣ All participants will develop an individual housing plan and will be expected to follow the plan.

Ɣ All participants must supply necessary documentation to forward their goal of achieving permanent housing. The Care Coordinator can assist with securing needed documentation.

Participant Initials: 


VALLEJO NAVIGATION CENTER

PARTICIPANT AGREEMENT

COMMUNITY EXPECTATIONS

PROGRAM GUIDELINES
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II. MENTAL HEALTH SUPPORTS
Ɣ Mental health referrals will be ŽīĞƌĞĚ to those in need.

Participant Initials: 
III. RESPECTFUL INTERACTIONS WITH OTHERS
All participants are expected to behave respectfully when interacting with anyone at the site.

Participants must refrain from all forms of harassment, abusive language, or lewd behavior when interacting with others at the site. All site ƐƚĂī and participants are expected to treat others with dignity, civility, and courtesy.

Participant Initials:

IV. HEALTH SCREENINGS
Participant may be screened for any contagious infections or diseases if there is an active outbreak on the site.

Participant Initials:

V. VISITORS
No visitors are allowed, unless providing essential services to participants on-site. Participants ĂƌĞƌĞƋƵŝƌĞĚƚŽĐŽŽƌĚŝŶĂƚĞǁŝƚŚƐŝƚĞƐƚĂīŝĨƚŚĞLJŚĂǀĞĞƐƐĞŶƚŝĂůƐĞƌǀŝĐĞƐƉƌŽǀŝĚĞƌƐŶŽƚĂůƌĞĂĚLJ present on-site that need to assist them, and to share the service schedule as far in advance as possible. Service providers are required to sign in and out of the site.

Overnight visitors are prohibited.

Registered participants are prohibited from going to another registered participant’s bed area for any reason.

Participant Initials:

VI. REMOVAL OF PROPERTY
Participants must retrieve their personal belongings when they leave the program. Any property that remains onsite after the participant exits ²which includes by voluntarily giving up their placement, 48-hour absence from the site, or immediate denial of service ²will not be stored beyond 5 business days.

Participant Initials:

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VII. LEAVING THE SITE FOR MORE THAN 48 HOURS
Participants may not leave the site for more than 48 hours without notifying and receiving ƉƌŝŽƌĂƉƉƌŽǀĂůĨƌŽŵƐŝƚĞƐƚĂī͘ If a participant does not return within 48 hours, their bed will be considered abandoned.

If a participant would like to take a leave from their site for more than 48-hours, they should discuss the matter in advance with site ƐƚĂī͘ Participants must physically check in unless prior approval was established.

If a participant returns after being Žī site without prior approval for a period that results in loss of their placement, they may request readmission to the site. Site Operators should collect any written documentation that supports the participant’s absence due to:

Ɣ sĞƌŝĮĞĚ hospitalization.

Ɣ Illness or injury.

Ɣ Death of an immediate family member.

Ɣ Arrest.

Ɣ Incarceration.

Ɣ Other circumstances beyond the person’s control.

Participant Initials:

VIII. MASKS
All participants are encouraged to wear a mask. However, any participant who is ĐŽŶĮƌŵĞĚ COVID-19 positive in their COVID-19 isolation period must wear masks any time they are not actively eating, drinking, showering, on their bed or in their room.

Ɣ Masks must cover the nose and mouth and may be made from a variety of materials. The most ĞīĞĐƚŝǀĞ fabrics for cloth masks are tightly woven fabrics that are breathable and 2 or 3 layers.

Ɣ Cloth masks should be washed frequently with detergent and hot water and dried on a hot cycle.

Ɣ Masks with ventilation valves or vents may not be worn.

Participant Initials:

IX. SAFETY EQUIPMENT
Participants may not tamper with or remove onsite carbon monoxide detectors or smoke detectors. Participants also may not hang any items from sprinklers.

Participant Initials:

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X. VIOLENT BEHAVIOR
Violence is not permitted, including but not limited to pushing, shoving, slapping, kicking, or throwing things at. Threats of violence are also not permitted. Any participant who engages in violence or threats could be subject to immediate removal, as well as possible criminal prosecution.

Participant Initials:

XI. WEAPONS
Participants may not possess weapons on site. Firearms are not allowed onsite and will not be stored. Participants must turn in any Įrearms to safety and de-escalation personnel, who will send them immediately to the Police Department.

ƐŝĚĞĨƌŽŵĮƌĞĂƌŵƐ͕participants must turn in all weapons they possess at intake and every time they enter a site with safety and de-escalation personnel, who will store those weapons in a safe and secure lockbox. Participants may request their weapon be returned whenever they are leaving the program site.

Belongings that might be used as weapons, such as tent poles, chains, large bike locks, etc., may need to be checked in with safety and de-escalation personnel at intake. Such items will be returned as needed by the participant whenever they leave the program site.

Participant Initials:

XII. FIRE DAMAGE AND ARSON
Participants ƐŚŽƵůĚŶŽƚĞŶŐĂŐĞŝŶĂĐƚŝǀŝƚŝĞƐƚŚĂƚŵŝŐŚƚƌĞƐƵůƚŝŶĂĮƌĞƐƚĂƌƚŝŶŐŽŶƐŝƚĞ͘>ŝŐŚƚŝŶŐ candles and smoking indoors are not permitted. Any participant found responsible for starting ĂĮƌĞǁŝůůďĞƐƵďũĞĐƚƚŽŝŵŵĞĚŝĂƚĞƌĞŵŽǀĂůĂŶĚŵĂLJface legal repercussions.

Participant Initials:

XIII. PEST CONTROL
Participants must participate in pest inspection and treatment. Additional information, such as ƚŚĞƐĐŚĞĚƵůĞŽƌŝŶƐƚƌƵĐƚŝŽŶƐ͕ǁŝůůďĞƉƌŽǀŝĚĞĚďLJƐŝƚĞƐƚĂī͘ Participant Initials:

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XIV. ANIMALS
If a participants has service animals and/or pets at the time of referral, the participants may have those same animals onsite Additional service animals may be approved through the reasonable accommodation process. Participants are responsible for the behavior of their animals at all times. Participants with animals must comply with all the following rules:

Ɣ Animals must wear a muzzle and be on a leash or in a container in common areas.

Participants must have direct physical control of their animals at all times.

Ɣ The participants is responsible for the care and feeding of their animal, including properly disposing all animal waste.

Ɣ Participants may feed and water animals only in designated areas.

Ɣ Animals may not be aggressive or loud.

Ɣ If an animal attacks or bites another animal or a person, site ƐƚĂī will report the incident to Animal Care and Control, and the participant must remove the animal from the site.

Ɣ Participants must have current rabies vaccination for their animals and be in compliance with all other County requirements before being integrated with Participants or other animals. .

Participant Initials:

XV. SMOKING
Smoking is strictly prohibited in the dorm and in all common areas of the site. It is strictly prohibited to alter, damage, or disconnect smoke detectors in dorm or other areas of the site.

When smoking outside of the site, participants may smoke only in the designated smoking area,
Participant Initials:

XVI. QUIET HOURS
Quiet hours are between 10:00 PM and 7:00 AM. Participants are encouraged to be inside the dorm during this time.

Participant Initials:

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XVII. EGRESSES
Participants must maintain their space in a safe manner, including but not limited to ensuring there are clear pathways to exits.

Participant Initials:

XVIII. WELLNESS CHECKS
Participants must participate in daily wellness checks. These daily wellness checks include at ůĞĂƐƚŽŶĞŽƉƉŽƌƚƵŶŝƚLJĨŽƌƐƚĂīƚŽŽďƐĞƌǀĞ͕ĂŶĚĞŶƚĞƌ͕ĞĂĐŚparticipant’s space each day.

Participant Initials:

XIX. EMERGENCY SAFETY CHECKS
^ƚĂīŵĂLJĞŶƚĞƌĂ participant’s space when there is reason to believe a participant is at immediate and substantial risk due to a medical, psychiatric, or facilities-related emergency. ^ƚĂī performing an Emergency Safety Check will announce themselves and state the purpose of their visit.

Participant Initials:

XX. BED INSPECTIONS
Participants must participate in weekly bed inspections to maintain health and sanitation ƐƚĂŶĚĂƌĚƐ͘^ƚĂīŵƵƐƚďĞĂůůŽǁĞĚƚŽĞŶƚĞƌparticipant space to complete the inspections.

Participant Initials:

XXIV. MEALS

There will be no food allowed in the dorm area. All food must be consumed in the participant dining room or in the outside community area.

Participant Initials: 

XXI. MAIL
Participants may have mail delivered to the site while they are enrolled in the program. This does ŶŽƚĐŽŶĨĞƌƌĞƐŝĚĞŶƚƐƚĂƚƵƐ͕ĂŶĚŝƐŽīĞƌĞĚŽŶůLJĂƐĂĐŽƵƌƚĞƐLJƚŽparticipants during their stay. Participant mail will not be forwarded. Mail received after the participant concludes their stay at the program will be held for 30 days and then returned to sender.

Participant Initials: 

XXII. PROPERTY
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Participants may not hang, tape, or affix any items to the walls of the structure.

Participant Initials: 
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IMMEDIATE TERMINATION OF SERVICE + NON-IMMEDIATE DENIALS OF SERVICE

IMMEDIATE TERMINATION OF SERVICE
Participants who have been issued an Immediate Termination of Service must leave the site immediately.

Service ŝƐƚĞƌŵŝŶĂƚĞĚŝŶĚĞĮŶŝƚĞůLJ͘

Items belonging to a participant who has been issued an Immediate Termination of Service will be stored for at least 5 business days. After 12 business days items will be disposed of.

Site ƐƚĂī shall execute an Immediate Termination of Service when a participant commits one of the following rule violations:

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1a Acts of violence. PRQWKV
1b Credible threats of violence that include ƐƉĞĐŝĮĐ actions or plans PRQWKV 1c Possession or display of a weapon, including but not limited to Įrearms, and knives. Firearms will not be stored.
PRQWKV
1d Disruptive behavior that is ongoing, uncontrollable, and presents a clear risk to the safety of the facility.
PRQWKV
1e Arson. PRQWKV
1f Manufacturing and/or sale of illegal drugs not associated with a prescription or alcohol. PRQWKV 1g Property destruction or interference that endangers another participant’s ability to shelter-in-place safely, or results in a shutdown of vital site operations even for a brief period. PRQWKV
1h Intentional destruction of other participant personal property PRQWKV 1i Destruction of the facility or property of the Navigation Center (including but not limited to:
walls, furniture, appliances, restrooms, etc.)

For example: Utilizing showers, sinks, toilets, and any other drainage pipes in a way that jeopardizes the building plumbing system may cause damage to the infrastructure of the facility
PRQWKV
1j Use of photography, video, or audio recording on site that includes other ĐůŝĞŶƚƐŽƌƐƚĂī without their permission in a “private” space (including but not limited to: restrooms, beds, showers, etc.)
PRQWKV
1k Unwelcome sexual advances, request for sexual favors, and other verbal or physical ĐŽŶĚƵĐƚŽĨĂƐĞdžƵĂůŶĂƚƵƌĞŝŶĐůƵĚŝŶŐŶƵĚŝƚLJ͕ǁŚĞƌĞƚŚĞŽīĞŶƐŝǀĞďĞŚĂǀŝŽƌ creates an intimidating, abusive, or hostile environment.
PRQWKV
1l Theft of other shelter participants, ƐƚĂī members, or volunteers’ personal property. PRQWKV

Participant Initials: 

VALLEJO NAVIGATION CENTER

PARTICIPANT AGREEMENT
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NON-IMMEDIATE DENIALS OF SERVICE
A Shelter may deny service to a participant who violates an excessive number of Non-Immediate rules ĚĞĮŶĞĚ as violating Įve (5) ĚŝīĞƌĞŶƚ Non-Immediate rules or three (3) of the same Non-Immediate rules within a 30-ĚĂLJƉĞƌŝŽĚŽĨƚŚĞĮƌƐƚŝƐƐƵĞĚtĂƌŶŝŶŐEŽƚŝĐĞ͘ ŚĂǀĞbeWĂƌƚŝĐŝƉĂŶƚƐŚĂǀĞďĞĞŶ issued a Non- Immediate Denial of Service must leave the site immediately. Services are terminated for the length of the suspension.

Items belonging to a participant who has been issued a Non-Immediate Denial of Service will be stored for the length of the suspension in their assigned room.

Length of
Suspension
2a For a ĐŽŶĮƌŵĞĚ COVID-19 positive individual in their COVID-19 isolation period, repeated failure to wear a mask except when actively eating, drinking, showering, on their bed/mat, and/or in their room, regardless of the 30-day period (noted above).
1 month
2b General threats that lack ƐƉĞĐŝĮĐŝƚLJ (e.g., “I’m going to get you”). 1 month 2c Visible use on the property, purchase, or distribution of illegal drugs or alcohol. (Not including use of prescription drugs prescribed to the individual.) 1 month
2e Use of photography, video, or audio recording on site that includes other clients or ƐƚĂīǁŝƚŚŽƵƚƚŚĞŝƌƉĞƌŵŝƐƐŝŽŶ (in common areas).
1 month
2f Having unauthorized guests at the shelter. 1 month
2g Failure to pass bed inspection due to exceeding property limits, unsanitary conditions, trash, expired food, exposed needles, and other hazardous items.

Anything that can create a health and safety concern or attracts pests and rodents. Failure to ensure and maintain clear pathways to room exits 1 month
2h Verbal harassment, intimidation or bullying of other participants, ƐƚĂī͕ or volunteers.
1 month
2j Smoking outside of the designated area(s). 1 month
2k Being in an unauthorized area or being in an area at an unauthorized time. 1 month 2l Failure to cooperate with pest control or allow the cleaning in areas that are ŝĚĞŶƚŝĮĞĚ as health and safety hazards for other participants and ƐƚĂī͘ 1 month
2m No food allowed in any sleeping area. 1 month

VALLEJO NAVIGATION CENTER

PARTICIPANT AGREEMENT
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2n Altering or modifying a participant space, removing any furniture or Įxtures from the participant space, or tampering with any equipment, ĮdžƚƵƌĞŽƌĚŽŽƌ locks.

Tampering with or removing any carbon monoxide detector or smoke detector or hanging items from the sprinklers.
1 month
2o Creating “forts” in the dorm room – preventing visibility into the bed space. 1 month 2p Refusal to participate in daily wellness checks, and/or weekly inspections. 1 month 2q Failure to comply with quiet hours. There should be no loud noises, TV, or radio playing which disturbs other residents in sleeping area. 1 month
2r Theft of shelter property of minimal value (i.e. stapler, tape, door stops, etc.). 1 month V Utilizing showers, sinks, toilets, and any other drainage pipes in a way that becomes a nuisance or has the possibility to cause damage requiring repair. PRQWK

Participant Initials: 



By signing this document, you acknowledge that you are in receipt of the program guidelines and the program rules that can lead to a termination or a denial of service, understand how they work, and agree to comply with them.

Participant’s Name (Printed)

Participant’s Signature Date

Authorized Site ^ƚĂī͛Ɛ Name (Printed)

Authorized Site ^ƚĂī͛Ɛ Signature Date
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