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HomeMy WebLinkAbout25-197 CDBG Grant Program_Amendment #1 dated 10-15-26 for FY25_261 FIRST AMENDMENT TO AGREEMENT 25-197 BETWEEN THE CITY OF CUPERTINO AND LIVE OAK ADULT DAY SERVICES FOR COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CITY/NON-PROFIT CONTRACT This First Amendment to Agreement 25-197 is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and Live Oak Adult Day Services, a California nonprofit corporation (“Corporation”) whose address is 1147 Minnesota Avenue, San Jose, CA 95125, and is made with reference to the following: RECITALS: A. On July 1, 2025 Agreement 25-197 (“Agreement”) was entered into by and between City and Corporation for a portion of its CDBG funds for the Program (as described below) to be operated within the City for the benefit of low and very low-income households and meeting at least one (1) of the National Objectives of the CDBG program as outlined in Title 24 of the Code of Federal Regulations, Section 570.208; B. City and Contractor desire to continue Contractor’s services to the City under the Agreement and hereby affirm their intent that it remain in full force and effect as amended by this First Amendment; C. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. Paragraph I, entitled Program, of the Agreement is modified to read as follows: For the period of July 1, 2025 to June 30, 2026, City agreed to allocate a portion of its current CDBG entitlement, and/or program income as defined in 24 CFR 570 Subpart J, “Grant Administration,” to Corporation, in the sum of Sixteen Thousand Eight Hundred Dollars ($16,800) (the “CDBG Funds”) for the purpose of implementing the Corporation’s program, as more particularly described in Exhibits A-F to the Contract (the “Program”), and said Exhibits set forth below, as they may be amended or modified, are attached to this Contract and incorporated herein by reference. For the period of July 1, 2026 to June 30, 2027 City agrees to allocate a portion of its current CDBG Funds to Corporation, in the sum of Fifteen Thousand Dollars ($15,000) (the “CDBG Funds”) for the purpose of implementing the Corporation’s program. Exhibits A-1 through F-1 attached hereto are added to the Agreement and apply to the period July 1, 2026, to June 30, 2027. Exhibits A through F remain in effect for the period July 1, 2025, to June 30, 2026. 2 Exhibit A-1: Program Description Exhibit B-1: Program Work Plan Exhibit C-1: Proposed Implementation Timeline Schedule Exhibit D-1: Program Budget Exhibit E-1: Basic Insurance and Bond Requirements for Non-Profit Contracts Exhibit F-1: CDBG Regulations 2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. SIGNATURES CONTINUE ON THE FOLLOWING PAGE 3 IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY: CORPORATION: CITY OF CUPERTINO LIVE OAK ADULT DAY SERVICES ___________________________________ __________________________________ Benjamin Fu Date Izumi Yaskawa Date Director of Community Development Executive Director APPROVED AS TO FORM ATTEST: ___________________________________ ___________________________________ Michael K. Woo Date Lauren Sapudar Date Senior Assistant City Attorney City Clerk EXPENDITURE DISTRIBUTION Item PO Number Amount Base Contract FY 26 $16,800 1st Amendment FY 27 $15,000 Total $31,800 10/09/2026 Michael K Woo 10/14/2026 Benjamin Fu 10/15/2026 Lauren Sapudar 10/15/2026 4 EXHIBIT A-1 PROGRAM DESCRIPTION FY 2026-27 Agency Name: Live Oak Adult Day Services UEI #:TEDLHF5SDAS3 Chief Executive Officer: Izumi Yaskawa Program Manager: Izumi Yaskawa Program # (For Office Use Only) 260-72-710-600-623 Street Address: 1147 Minnesota Ave City: San Jose State: CA Zip Code: 95125 Telephone number: 408-971-9363 Fax Number: Manager E-mail izumi@liveoakadc.org Name of Program: Senior Adult Day Care/Caregiver Respite Program Location: 1147 Minnesota Ave, San Jose, CA 95125 Program Description: The specialized program of adult day care for frail, dependent low-income Cupertino seniors is geared to maximize the social experience and mental stimulation of elderly clients, improve/sustain innate resilience and mental and physical functioning, and enhance their overall quality of life through recreation, exercise, companionship and nutritious meals. Cupertino seniors with chronic age-related disorders (dementia, Alzheimers, Parkinsons, stroke, etc.) attend the center every weekday, receiving special care and individualized attention from professional staff and devoted volunteers who schedule daily activities, serve meals and snacks and assist those with special needs. Caregiver respite services, i.e., counseling, in-home assessments, information and referrals, and Caregiver Support Workshops, are provided to client families to reduce stress and help them care for and maintain their senior loved ones at home. 5 EXHIBIT B-1 PROGRAM WORK PLAN FY 2026-27 AGENCY NAME: Live Oak Adult Day Services PROGRAM NAME: Senior Adult Day Care/Caregiver Respite HUD National Objective: LMC: Low/mod limited clientele benefit Low/Mod Income type: 5A: Senior Services Objectives Benchmarks for Each Quarter 1st 2nd 3rd 4th TOTAL Enroll 15 appropriate, low-income Cupertino seniors in adult day care program 4 4 4 3 15 6 EXHIBIT C-1 PROPOSED IMPLEMENTATION TIMELINE SCHEDULE FY 2026-27 AGENCY NAME: Live Oak Adult Day Services PROGRAM NAME: Senior Adult Day Care/Caregiver Respite Activity Number and Description: Activity # Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 1. 2. 7 EXHIBIT D-1 PROGRAM BUDGET FY 2026-27 AGENCY NAME: Live Oak Adult Day Services PROGRAM NAME: Senior Adult Day Care/Caregiver Respite Proposed Program Expenses FY 2026-27 Salaries/Benefits/Payroll/Taxes $15,000 Total Expenses $15,000 8 EXHIBIT E-1 BASIC INSURANCE AND BOND REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as the word is used in this Exhibit E-1 is the party contracting with the City of Cupertino for the direct distribution of CDBG funds. Indemnity The Contractor shall indemnify, defend, and hold harmless the City of Cupertino (hereinafter "City"), its officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performance of this Contract by Contractor and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City. The Contractor shall reimburse the City for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the Contractor is obligated to indemnify, defend and hold harmless the City under this Contract. Insurance Without limiting the Contractor's indemnification of the City, the Contractor shall provide and maintain at its own expense, during the term of this Contract, or as may be further required herein, the following insurance coverages and provisions: A. Evidence of Coverage Prior to commencement of this Contract, the Contractor shall provide on the City's own form or a form approved by the City's Insurance Manager an original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and program name must be stated on the Certificate of Insurance. The City's Special Endorsement form shall accompany the certificate. Individual endorsements executed by the insurance carrier may be substituted for the City's Special Endorsement form if they provide the coverage as required. In addition, a certified copy of the policy or policies shall be provided by the Contractor upon request. This verification of coverage shall be sent to the address as shown on the City's Certificate of Insurance form and to the Community Development Department at the address set forth in this Contract at Section VI. PROGRAM COORDINATION, Paragraph C., NOTICES. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance has been approved by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. B. Notice of Cancellation or Reduction of Coverage All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. C. Qualifying Insurers 9 All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII, according to the current Best's Key Rating Guide, unless otherwise approved by the City's Insurance Manager. D. Insurance Required 1. Comprehensive General Liability Insurance - for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence. OR 2. Commercial General Liability Insurance - for bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate - $2,000,000 c. Products/Completed Operations- $1,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commercial General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require additional coverage to be purchased by the Contractor to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/ aggregate to be maintained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. d. Personal Injury liability. e. Independent Contractors' (Protective) liability. f. Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City: a. Additional Insured Endorsement: 10 Such insurance as is afforded by this policy shall also apply to the City of Cupertino, and members of the City Council, and the officers, agents and employees of the City of Cupertino, individually and collectively, as additional insureds. b. Primary Insurance Endorsement: Such insurance as is afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino, its officers, agents, and employees shall be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: This policy may not be cancelled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino at the address shown on the Certificate of Insurance. d. Contractual Liability Endorsement: This policy shall apply to liability assumed by the insured under written contract with the City of Cupertino. e. Personal Injury Endorsement: The provisions of this policy shall provide Personal Injury coverage. f. Severability of Interest Endorsement: The insurance afforded by this policy shall apply separately to each insured that is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Worker's Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all-states endorsement. b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. c. Inclusion of the City and its governing board(s), officers, representatives, agents, and employees as additional insureds, or a waiver of subrogation. 7. Professional Errors and Omissions Liability Insurance This type of insurance should be provided by persons/entities you contract with to provide you with professional services. 11 a. Limits of not less than one million dollars ($1,000,000). b. If this policy contains a self retention limit, it shall not be greater than ten thousand dollars ($10,000) per occurrence/event. c. This coverage shall be maintained for a minimum of two (2) years following termination of this Contract. The City must first approve any exceptions to the above requirements. 8. Bond Requirements Fidelity Bond - Before receiving compensation under this Contract, Contractor will furnish City with evidence that all officials, employees, and agents handling or having access to funds received or disbursed under this Contract, or authorized to sign or countersign checks, are covered by a BLANKET FIDELITY BOND in an amount of AT LEAST fifteen percent (15%) of the maximum financial obligation of the City cited herein. If such bond is cancelled or reduced, Contractor will notify City immediately, and City may withhold further payment to Contractor until proper coverage has been obtained. Failure to give such notice may be cause for termination of this Contract, at the option of the City. 9. Special Provisions The following provisions shall apply to this Contract: a. The foregoing requirements as to the types and limits of insurance coverage to be maintained by the Contractor and any approval of said insurance by the City or its insurance consultant(s) are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Contractor pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The City acknowledges that some insurance requirements contained in this Contract may be fulfilled by self-insurance on the part of the Contractor. However, this shall not in any way limit liabilities assumed by the Contractor under this Contract. The City shall approve any self-insurance in writing. c. The City reserves the right to withhold payments to the Contractor in the event of material noncompliance with the insurance requirements outlined above. d. If the Contractor fails to maintain such insurance as is called for herein, the City must order the Contractor to immediately suspend work at Contractor's expense until a new policy of insurance is in effect. 12 ADDENDUM TO EXHIBIT E-1 BASIC INSURANCE AND BOND REQUIREMENTS FOR CONSTRUCTION PROJECTS USING CITY FUNDS If your organization will be contracting for construction work (such as general contractors building rental apartments) to undertake a Program (as defined in this Non-Profit/City Contract) then the requirements set forth in this Addendum to Exhibit "E-1" shall be complied with by the party contracted with for construction work protecting both the non-profit and the City. Indemnity The General Contractor (hereinafter referred to as "General") shall indemnify, defend, and hold harmless the City of Cupertino (hereinafter "City"), its officers, agents and employees, and the Contractor, it's officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performance of this Contract by General and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City or the Contractor. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City and the Contractor. The General shall reimburse the City and the Contractor for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the General is obligated to indemnify, defend and hold harmless the City and the Contractor under this Contract. Insurance Without limiting the General's indemnification of the City and the Contractor, the General shall provide and maintain at its own expense, during the Term of this Contract, or as may be further required herein, the following insurance coverages and provisions: A. Evidence of Coverage Prior to commencement of this Contract, the General shall provide an original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and project name must be stated on the Certificate of Insurance. Individual endorsements executed by the insurance carrier shall accompany the Certificate. This verification of coverage shall be sent to the Contractor at the address stated below and to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance has been approved by the Contractor and final approval by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. B. Notice of Cancellation or Reduction of Coverage All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department as stated above, and the Contractor at the following address: 1147 Minnesota Ave, San Jose, CA 95125 C. Qualifying Insurers 13 1. All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII, according to the current Best 's Key Rating Guide, unless otherwise approved by the City. 2. Surety coverage (including bid, performance and payment bonds) shall be required as follows: a. For projects in excess of $100,000: 1. Either a California Admitted Surety OR a current Treasury Listed Surety (Federal Register); and either a current A.M. Best A IV rated Surety OR a current Standard and Poors (S&P) rating of A; 2. An admitted surety insurer which complies with the provisions of the Code of Civil Procedure, Section 995.660*; OR 3. In lieu of 1 & 2, a company of equal financial size and stability that is approved by the City's Insurance/Risk Manager. b. For projects between $25,000 and not exceeding $100,000: 1. A California Admitted Surety and either a current A.M. Best B rated Surety OR a current Standard and Poors (S&P) rating of B B; OR 2. An admitted surety insurer which complies with the provisions of the Code of Civil Procedure, Section 995.660; OR 3. In lieu of 1 & 2, a company of equal financial size and stability that is approved by the City's Insurance/Risk Manager. D. Insurance Required 1. Comprehensive General Liability Insurance - for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence. OR  California Code of Civil Procedure Section 995.660 in summary, states that an admitted surety must provide: 1) the original, or a certified copy of instrument authorizing the person who executed the bond to do so; 2) a certified copy of the Certificate of Authority issued by the Insurance Commissioner; 3) a certificate from City Clerk of Cupertino City that Certificate of Authority has not been surrendered, revoked, canceled, annulled or suspended; 4) a financial statement showing the assets and liabilities of the insurer at the end of the quarter calendar year, prior to 30 days next preceding the date of the execution of the bo nd. 14 2. Commercial General Liability Insurance - for bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate - $2,000,000 c. Products/Completed Operations- $1,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commercial General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require additional coverage to be purchased by the General to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/aggregate to be maintained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. d. Personal Injury liability. e. Independent Contractors' (Protective) liability f. Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City and the Contractor: a. Additional Insured Endorsement: Insurance afforded by this policy shall also apply to the City of Cupertino and Contractor as additional insureds. b. Primary Insurance Endorsement: Insurance afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino and the Contractor shall be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: 15 This policy may not be canceled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino C DBG Program, and the Contractor at the addresses set forth on page 12 of this Addendum. d. Severability of Interest Endorsement: The insurance afforded by this policy shall apply separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Workers' Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all- states endorsement. b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. 7. Work and Materials Insurance (including but not limited to Builder's Risk, Course of Construction, Installation Floater or similar first party property insurance for covering the interest of the Contractor and the City) shall be provided by the Contractor. The Contractor's coverage shall provide the following: a. Coverage shall be provided on an "all-risk" basis. b. Coverage shall be provided on the work and materials which are the subject of this Contract, whether in process or manufacture or finished, including "in transit" coverage to the final agreed upon destination of delivery, and including loading and unloading operations, and such coverage shall be in force until the work and materials are accepted by the City. c. City and non-profit shall be named as additional insured as its interests may appear at the time of loss. d. Coverage shall be in an amount no less than the full replacement value of the property at the time of loss. e. The deductible shall not exceed $1,000 per occurrence unless otherwise approved by the City and shall be borne by the Contractor. f. If the construction contractor fails to maintain such insurance as is called for herein, the City shall have cause to terminate this Contract in accordance with Section VII, paragraph B. 8. Bond Requirements The following bond requirements apply: 16 a. Contract Bonds - Prior to execution of the Contract, Contractor shall file with the City on the approved forms, the two surety bonds in the amounts and for the purposes noted below, duly executed by a reputable surety company satisfactory to City, and Contractor shall pay all premiums and costs thereof and incidental thereto. Both Contractor and the sureties shall sign each bond. b. The "payment bond for public works" shall be in an amount of one hundred percent (100%) of the Contract price, as determined from the prices in the bid form, and shall insure to the benefit of persons performing labor or furnishing materials in connection with the work of the proposed Contract. This bond shall be maintained in full force and effect until all work under the Contract is completed and accepted by the City, and until all claims for materials and labor have been paid. c. The "performance bond" shall be in an amount of one hundred percent (100%) of the Contract price as determined from the prices in the bid form. and shall insure the faithful performance by Contractor of all work under the Contract. It shall also insure the replacing of, or making acceptable, any defective materials or faulty workmanship. Should any surety or sureties be deemed unsatisfactory at any time by the City notice will be given Contractor to that effect, and Contractor shall forthwith substitute a new surety or sureties satisfactory to the City. No further payment shall be deemed due or will be made under the Contract until the new sureties qualify and are accepted by the City. All alterations, time extensions, extra and additional work, and other changes authorized by the Specifications, or any part of the Contract, may be made without securing consent of the surety or sureties on the contract bonds. 9. Special Provisions The following provisions shall apply to this Contract: a. The foregoing requirements as to the types and limits of insurance coverage to be maintained by the General and any approval of said insurance by the City or the Contractor are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the General pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The Contractor reserves the right to withhold payments to the General in the event of material noncompliance with the insurance requirements outlined above. c. The Contractor shall notify the City Community Development Department promptly of all losses or claims over $25,000 resulting from work performed under this contract, or any products/completed operations loss or claim against the contractor resulting from any of the contractor's work. 17 EXHIBIT F-1 CDBG REGULATIONS CORPORATION hereby assures and certifies that it will comply with all regulations, policies, guidelines and requirements applicable to the acceptance and use of Federal funds for this Federally- assisted Program and will be responsible for implementing and complying with all relevant future changes to Federal Regulations or OMB Circulars. Specifically, CORPORATION gives assurances and certifies with respect to the Program that it is in compliance with the following CDBG regulations set forth in 24 CFR Part 570 (the "CDBG Regulations"), including all subsections set forth below. 1. 570.601. Public Law 88-352 and Public Law 90-284; affirmatively furthering fair housing; Executive Order 11063. The Program shall be conducted and administered in conformity with the Fair Housing Act (42 U.S.C. 3601 et seq.) and implementing regulations at 24 C.F.R. Part 100; Title VI of the Civil Rights Act of 1964, as amended; Title VIII of the Civil Rights Act of 1968, as amended; Section 104(b) and Section 109 of Title I of the Housing and Community Development Act of 1974, as amended; Section 504 of the Rehabilitation Act of 1973 (29 USC 794 et seq.); the Age Discrimination Act of 1975 (42 USC 6101 et seq.); Executive Order 11063, as amended by Executive Order 12259 and implementing regulations at 24 C.F.R. Part 107; Executive Order 11246, as amended by Executive Orders 11375, 12086, 11478, 12107; Executive Order 11625 as amended by Executive Order 12007; Executive Order 12432; Executive Order 12138 as amended by Executive Order 12608; and Executive Order 13672 concerning gender identity. 2. 570.602. Section 109 of the Act. 3. 570.603. Labor Standards. 4. 570.604. Environmental Standards. 5. 570.605. National Flood Insurance Program. 6. 570.606. Relocation, Displacement and Acquisition. 7. 570.607. Employment and Contracting Opportunities. 8. 570.608. Lead-Based Paint. 9. 570.609. Use of Debarred, Suspended, or Ineligible Contractors or Subrecipients. 10. 570.610. Uniform Administrative Requirement and Cost Principles. The CITY, its Subrecipients, agencies or instrumentalities, shall comply with the policies, guidelines, and requirements of 2 CFR Part 200, as applicable, as they relate to the acceptance and use of Federal funds under this part. The applicable sections of 24 CFR, Part 85 and OMB Circular A- 100 are set forth at 570.502. 11. 570.611. Conflict of Interest. 12. 570.612. Executive Order 12372. Permits states to establish its own process for review and comment on proposed Federal financial assistance programs, specifically the use of CDBG funds for the construction or planning of water or sewer facilities. 13. 570.613. Eligibility restrictions for certain resident aliens. 18 14. 570.614. Architectural Barriers Act and the Americans with Disabilities Act. Federal regulations issued pursuant thereto, which prohibit discrimination against the disabled in any federally assisted program, the requirements of the Architectural Barriers Act of 1968 (42 U.S.C. 4151-4157) and the applicable requirements of Title II and/or Title III of the Americans with Disabilities Act of 1990 (42 U.S.C. 12131 et seq.), the requirements of Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), and federal regulations issued pursuant thereto. 15. Drug Free Work Place. The requirements of the Drug Free Workplace Act of 1988 (P.L. 100- 690) and implementing regulations at 24 C.F.R. Part 24. 16. Religious Organizations. If the CORPORATION is a religious organization, as defined by the CDBG program, all conditions prescribed by HUD for the use of CDBG Funds by religious organizations, including the First Amendment of the United States Constitution regarding church/state principles and the applicable constitutional prohibitions set forth in 24 C.F.R. Section 570.200(j). 17. Flood Disaster Protection. The Flood Disaster Protection Act of 1973 (P.L. 93-234). No portion of the assistance provided under this Agreement is approved for acquisition or construction purposes as defined under Section 3(a) of said Act, for use in an area identified by HUD as having special flood hazards which is located in a community not then in compliance with the requirements for participation in the national flood insurance program pursuant to Section 201(d) of said Act. The use of any assistance provided under this Agreement for such acquisition or construction in such identified areas in communities then participating in the national flood insurance program is subject to the mandatory purchase of flood insurance requirements of Section 102(a) of said Act. Any contract or Agreement for the sale, lease, or other transfer of land acquired, cleared or improved with assistance provided under this Agreement is to contain certain provisions. These provisions will apply if such land is located in an area identified by HUD as having special flood hazards and in which the sale of flood insurance has been made available under the National Flood Insurance Act of 1968, as amended, 42 U.S.C. 4001 et seq. These provisions obligate the transferee and its successors or assigns to obtain and maintain, during the ownership of such land, such flood insurance as required with respect to financial assistance for acquisition or construction purposes under -Section 102(s) of the Flood Disaster Protection Act of 1973. Such provisions are required notwithstanding the fact that the construction on such land is not itself funded with assistance provided under this Agreement. 18. Environmental and Historic Preservation. 24 C.F.R. Part 58, which prescribe procedures for compliance with the National Environmental Policy Act of 1969 (42 U.S.C. 4321-4361), and the additional laws and authorities listed at 24 C.F.R. 58.5. 19. Violence Against Women Act. The requirements of the Violence Against Women Reauthorization Act of 2013 (Pub. L. 113–4, 127 Stat. 54) applicable to HUD-funded programs. 20. Anti-Lobbying; Disclosure Requirements. The disclosure requirements and prohibitions of 31 U.S.C. 1352 and implementing regulations at 24 C.F.R. Part 87. 21. HUD Regulations. Any other HUD regulations present or as may be amended, added, or waived in the future pertaining to the CDBG grant funds, including but not limited to HUD regulations as may be promulgated regarding subrecipients. 19 ADDITIONAL FEDERAL REGULATIONS, REQUIREMENTS, PROVISIONS AND CITATIONS Provisions Federal Regulations* OMB Circulars for Non Gov't. Subrecipients OMB Circulars for Gov't. Subrecipients Other Federal Regulations** 1. National Objective Compliance/Eligibility 570.200(a)(1)+(2), 570.201-570.209, 570.506 2. Scope of Work 570.503 3. Time of Performance 570.503 4. Compensations and Method of Payment 570.502, 570.513 A-122, A-21 A-87 24 CFR Part 85 5. Program Income 570.500(a), 570.503(b)(3), 570.504 6. Record-Keeping Requirements 570.502, 570.503(b)(2), 570.506 24 CFR Parts 84 and 85 7. Reporting Requirements 570.502, 570.507 24 CFR Parts 84 and 85 8. Public Access to Program Records 570.502, 570.508 24 CFR Parts 84 and 85 9. Grant Closeout Procedures 570.502, 570.509 10. Uniform Administrative and Program Management Standards 570.502, 570.503(b)(4), 570.610 A-122, A-21, A- 133 A-87, A-133 24 CFR Parts 84 and 85 11. Reversion of Assets 570.502, 570.503, 570.505 12. Real Property 570.502, 570.503(b)(7), 570.505 13. Other Program Requirements 570.503(b)(5), 570.600- 603, 570.605-614 14. Termination 570.502,570.503 24 CFR Part 84.43 15. Compliance with Laws/Regulations 570.501 A-122 24 CFR Parts 84 and 85 16. Antidiscrimination/ Affirmative Action and EEO 570.601, 570.602, 570.607 17. Financial Management 570.502, 570.610 24 CFR Parts 84.20 and 85.20 and Treasury Cir. 1075 18. Audits 570.502, 570.610 A-133 A-133 24 CFR Parts 84.26 and 85.26 19. Religious and Political Activities 570.200(j), 570.207 20. Budget Modifications 570.502. 570.503(b)(1) 21. Monitoring 570.501(b), 570.502(b)(vii), 570.503(b)(1) 24 CFR Parts 84 and 85 22. Conflict of Interest 570.611 24 CFR Parts 84 and 85 23. Procurement Methods 570.502 24 CFR Parts 84.40-48 and 85.36 20 24. Budget 570.503 25. Program Schedule/Milestones 570.503 26. Environmental Review 570.503(b)(3)(1) * Unless otherwise noted, citations are from Title 24 of the Code of Federal Regulations (CFR). ** Part 84 applies to institutions of higher education, hospitals, and other non-profit organizations; Part 85 applies to state, local, and federally recognized Tribal governments. Requirements Federal Regulations Other References 1. Federal Labor Standards 1. Davis-Bacon 2. Copeland Act (Anti-kickback) 3. Contract Work Hours and Safety Standards 24 CFR 570.603; 29 CFR Parts 1, 3, and 5 Section 110, Housing and Community Development Act of 1974 (HCDA); 40 U.S.C. 276a-276a- 5; 40 U.S.C. 276c; 40 U.S.C. 327 et seq. 2. Equal Employment Opportunity 24 CFR 570.601-602, 24 CFR 570.607, 41 CFR 60 Executive Orders 11246 and 12086, 12 U.S.C. 1701u 3. List of Debarred or Ineligible Contractors 24 CFR 570.609, 24 CFR 24 4. Non-Discrimination 24 CFR Part 8, 24 CFR 570.601, 24 CFR 570.602 Section 504 of Rehab. Act of 1973, Americans with Disabilities Act of 1990, Exec. Order 11063 5. Fire Safety Codes Local 6. Building, Housing, and Zoning Codes; Housing Quality Standards 24 CFR 570.208(b)(1)(iv) and (b)(2) Local 7. Lead-Based Paint 24 CFR 570.608, 24 CFR 35 42 U.S.C. 4821 et seq. 8. Lump Sum Drawdowns 24 CFR 570.513 9. Environmental/Historic Preservation/National Environmental Policy Act/Flood Insurance Requirements 1. Siting Near Airports and Coastal Barrier Resources 2. Fish and Wildlife Protection 3. Flood Plain 4. National Historic Preservation 5. Noise Abatement & Control 6. Wetlands 7. Air Quality 8. Coastal Zones 9. Endangered Species 10. Thermal/Explosive Hazards 11. Flood Insurance 24 CFR 570.503(b)(5)(i), 24 CFR 570.604, 570.202, 24 CFR 58 Ref. At 24 CFR 58.6 See reference at 24 CFR 58.5570.605, 58.6 Sec. 104(g), HCDA 42 U.S.C. 4001 et seq. 10. Relocation, Real Property Acquisition, and One- For-One Housing Replacement B. Uniform Relocation Act C. Residential anti-displacement and relocation assistance D. One-For-One Replacement 24 CFR 570.201(i), 570.606, 49 CFR 24, 24 CFR 570.606(c)(1) Sect. 104(d) and 105(a)(11) of HCDA, www.hud.gov/relocation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2025/12)© 1988-2025 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/25/2026 Reliance Insurance Brokers 140 Mayhew Way Suite 606 Pleasant Hill CA 94523 Robert Silva (925) 378-2800 Robert@getreliance.com Live Oak Adult Day Services 1147 Minnesota Ave San Jose CA 95125 NATL ALLIANCE OF NONPROFITS FOR INS 11384 TECHNOLOGY INS CO INC 42376 A Y Y 01-CP-0001332-01-28 09/10/2026 09/10/2027 1,000,000 500,000 20,000 1,000,000 3,000,000 3,000,000 A Y Y 01-CP-0001332-01-28 09/10/2026 09/10/2027 1,000,000 B Y TWC4822598 07/01/2026 07/01/2027 1,000,000 1,000,000 1,000,000 A Professional Liability Sexual Conduct & Physical Abuse 01-CP-0001332-01-28 09/10/2026 09/10/2027 Each Claim/Aggregate $1M/$3M Each Claim/Aggregate $1M/$3M 30 days notice of cancellation except 10 days for non-payment of premium. Additional insured status, waiver of subrogation and primary and non-contributory status applies where required by written contract per the attached policy forms regarding General Liability. Additional insured status, waiver of subrogation and primary and non-contributory wording apply to any parties as required by written contract per the attached policy forms regarding Auto liability. Waiver of subrogation applies where required by written contract regarding Workers Compensation. Adult day care and related services. The City of Cupertino is named as additional insured and said insurance is primary and non contributory as (See ACORD 101) City of Cupertino 10300 Torre Avenue Cupertino CA 95014 EFFECTIVE DATE: NAMED INSURED POLICY NUMBER NAIC CODECARRIER AGENCY LOC #: AGENCY CUSTOMER ID: ofPageADDITIONAL REMARKS SCHEDULE ADDITIONAL REMARKS FORM TITLE:FORM NUMBER: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 101 (2008/01) 1 1 Reliance Insurance Brokers TWC4822598, 01-CP-0001332-01-28 TECHNOLOGY INS CO INC 42376, 11384 Live Oak Adult Day Services 25 Certificate Of Liability Insurance required by written contract Waiver of subrogation applies in favor of The City of Cupertino under Blanket Waiver As Required by Contract *10 day cancellation for nonpayment of premium POLICY NUMBER: 01-CP-0001332-01-28 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 – ADDITIONAL INSURED OWNERS, LESSEES OR – CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations 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 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. – A. Section II Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. NIA-061B GL 01 25 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Any person or organization that you are required to include on this policy, under written contract or agreement currently in effect or becoming effective during the term of this policy, applicable under the terms and conditions of this endorsement, and consistent with the description below that the parties intend. A. 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. 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: 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 insurance is also primary, we will share with all that other insurance as described in c. below; or NIA-061B GL 01 25 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)’ own insurance. 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, excess, 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) 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. (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: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any 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. 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. POLICY NUMBER: 01-CP-0001332-01-28 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 – ADDITIONAL INSURED OWNERS, LESSEES OR – CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations 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 under written contract 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" 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. NIA-026B GL 01 25 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Any person or organization as required under a written contract or agreement currently in effect, or becoming effective during the term of this policy 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. NIA-102 BA 01 25 Nonprofits Insurance Alliance™ and NONPROFITS OWN® are brands of Alliance Member Services™ (AMS). © AMS. All rights reserved. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. – AI - PRIMARY AND NON-CONTRIBUTARY DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In consideration of the premium charged, it is understood and agreed that the following is added as an additional insured: Any person or organization that you are required to include on this policy, under written contract or agreement currently in effect or becoming effective during the term of this policy, applicable under the terms and conditions of this endorsement, and consistent with the description below that the parties intend. 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 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to which this endorsement applies. It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in no event shall the company's limits of liability exceed the occurrence or aggregate limits as applicable by policy definition or endorsement. Such insurance as is afforded by this endorsement for the additional insured shall apply as primary insurance. Any other insurance maintained by the additional insured or its officers and employees shall be excess and non- contributing with the insurance afforded by this endorsement. POLICY NUMBER: 01-CP-0001332-01-28 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM 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. Named Insured:Live Oak Adult Day Services, Inc. Endorsement Effective Date:09/10/2026 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization as required under a written contract or agreement currently in effect, or becoming effective during the term of this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. NIA-061 GL 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Policy Number: 01-CP-0001332-01-28 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: City of Cupertino A. 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. 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: 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 insurance is also primary, we will share with all that other insurance as described in c. below; or NIA-061 GL 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)’ own insurance. 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, excess, 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) 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. (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: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any 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. 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. CDBG Grant Program FY25/26 Final Audit Report 2026-10-15 Created:2026-10-09 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAf-ioEGAbX5Km8v3M39sTWv5j1j0RIqRO "CDBG Grant Program FY25/26" History Document created by Webmaster Admin (webmaster@cupertino.org) 2026-10-09 - 0:58:16 AM GMT- IP address: 35.229.54.2 Document emailed to aracelia@cupertino.org for approval 2026-10-09 - 1:00:59 AM GMT Email viewed by aracelia@cupertino.org 2026-10-09 - 1:01:33 AM GMT- IP address: 54.221.69.109 Signer aracelia@cupertino.org entered name at signing as Araceli Alejandre 2026-10-09 - 3:17:18 AM GMT- IP address: 71.202.76.156 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2026-10-09 - 3:17:20 AM GMT - Time Source: server- IP address: 71.202.76.156 Document emailed to Izumi Yaskawa LOADS (izumi@liveoakadc.org) for signature 2026-10-09 - 3:17:22 AM GMT Email viewed by Izumi Yaskawa LOADS (izumi@liveoakadc.org) 2026-10-09 - 3:47:23 PM GMT- IP address: 74.125.209.199 Document e-signed by Izumi Yaskawa LOADS (izumi@liveoakadc.org) Signature Date: 2026-10-09 - 3:53:27 PM GMT - Time Source: server- IP address: 66.206.162.138 - Signature Appearance Selected: IMAGE Document emailed to michaelw@cupertino.org for signature 2026-10-09 - 3:53:30 PM GMT Email viewed by michaelw@cupertino.org 2026-10-09 - 3:53:42 PM GMT- IP address: 3.236.125.216 Email viewed by michaelw@cupertino.org 2026-10-14 - 11:15:15 PM GMT- IP address: 54.85.197.26 Signer michaelw@cupertino.org entered name at signing as Michael K Woo 2026-10-15 - 1:54:12 AM GMT- IP address: 69.181.158.199 Document e-signed by Michael K Woo (michaelw@cupertino.org) Signature Date: 2026-10-15 - 1:54:14 AM GMT - Time Source: server- IP address: 69.181.158.199 - Signature Appearance Selected: TYPE Document emailed to Benjamin Fu (benjaminf@cupertino.org) for signature 2026-10-15 - 1:54:17 AM GMT Email viewed by Benjamin Fu (benjaminf@cupertino.org) 2026-10-15 - 1:54:24 AM GMT- IP address: 54.234.195.230 Document e-signed by Benjamin Fu (benjaminf@cupertino.org) Signature Date: 2026-10-15 - 4:42:54 PM GMT - Time Source: server- IP address: 64.165.34.3 - Signature Appearance Selected: TYPE Document emailed to laurens@cupertino.org for signature 2026-10-15 - 4:42:59 PM GMT Email viewed by laurens@cupertino.org 2026-10-15 - 4:43:18 PM GMT- IP address: 100.54.192.18 Signer laurens@cupertino.org entered name at signing as Lauren Sapudar 2026-10-15 - 5:38:50 PM GMT- IP address: 69.149.42.28 Document e-signed by Lauren Sapudar (laurens@cupertino.org) Signature Date: 2026-10-15 - 5:38:52 PM GMT - Time Source: server- IP address: 69.149.42.28 - Signature Appearance Selected: TYPE Agreement completed. 2026-10-15 - 5:38:52 PM GMT