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21-045 Hello Housing, Below Market Rate (BMR) Affordable Housing Fund (AHF) City Non-Profit Contract (Services Only) ASSIGNMENT & ASSUMPTION AGREEMENT WITH CONSENT & AGREEMENT TO AMEND This ASSIGNMENT , ASSUMPTION & AMENDMENT AGREEMENT (“Agreement”) is made this April 20, 2021, by and between Hello Housing hereinafter referred to as “Assignor”, Rise Housing Solutions hereinafter referred to as “Assignee”, and City of Cupertino (“City”). WHEREAS, Assignor entered into a contract, with the Contractor dated July 1, 2019, named Below Market Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract hereinafter referred to as “Contract”. WHEREAS, Assignor wishes to assign all of its rights and obligations under the Contract to Assignee. Assignee wishes to assume all of Assignor’s rights and obligations under the Contract. WHEREAS, the Contract permits the Assignor to assign its rights and obligations under the Contract with the consent of the City. WHERERAS the Assignor, Assignee and City desire to amend the terms of the Contract as set forth herein. NOW THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS, PROMISES, REPRESENTATITIONS AND AGREEMENTS SET FORTH HEREIN, AND FOR OTHER GOOD AND VALUABLE CONSIDERATION, THE RECEIPT SUFFICIENCY AND EXCHANGE OF WHICH ARE HEREBY ACKNOWLEDGED, THE PARTIES, INTENDING TO BE LEGALLY BOUND, AGREE AS FOLLOWS: 1. Assignor and Assignee acknowledge and confirm that both have read the Contract and understand all rights, title, interest, obligations, responsibilities and duties in and pursuant to the Contract. 2. Assignor by its signature below acknowledges and agrees that as of the date of this Agreement, all of Assignor’s rights, title, interest obligations, responsibilities and duties, in and pursuant to the Contract, are assigned to Assignee. 3. Assignee by its signature below acknowledges and agrees that as of the date of this Agreement, Assignee assumes all of Assignor’s rights, title, interest, obligations responsibilities and duties in and pursuant to the Contract. 4. City, by its signature below, consents to Assignor’s assignment and Assignee’s assumption of all rights, title, interest, obligations responsibilities and duties in and pursuant to the Contract. 5. City further consents to that all references in the Contract to Assignor will henceforth refer to Assignee and that Assignee shall provide appropriate Certificates of Insurance and Additional Insured Endorsements naming Contractor as an additional insured as required in accordance with the Contract. 6. Assignor, Assignee and City hereby acknowledge, consent and agree that the Contract shall be amended as follows:  The last sentence of Article XI Assignability is deleted in full and Assignor shall have no further liability or responsibility for any and all obligations and requirements under the Contract upon execution of this Agreement 7. This Agreement is governed by the laws of the state of California, without regard to California's conflict or choice of law provisions, and the parties expressly consent to jurisdiction in such courts. 8. If any provision of this Agreement or the application thereof to any entity, person or circumstance shall be invalid or unenforceable to any extent, the remainder of this Agreement and the application of such provisions to other entities, persons or circumstances shall not be affected thereby, and shall be enforced to the greatest extent permitted by law. IN WITNESS WHEREOF, the parties set their hands and seals as of the date first above written. ASSIGNOR ASSIGNEE By: ________________________ By: _______________________ Name: ______________________ Name: _____________________ Title: ______________________ Title: ______________________ CITY ATTORNEY CITY OF CUPERTINO By: ________________________ By: _________________________ Name: HEATHER M. MINNER Name: _______________________ Title: Cupertino City Attorney Title: ________________________ ATTEST: By: ________________________ Name: KIRSTEN SQUARCIA Title: City Clerk Date: _______________________ Mardie Oakes President Mardie Oakes Matthew Warner President Matthew Warner Heather M. Minner Director of Community Development Benjamin Fu Apr 21, 2021 04/19/2021 Bliss Sequoia Insurance P.O. Box 826 Salem OR 97308 Samantha Cox (503) 364-5401 (503) 364-5406 sam@blissinsurance.com Rise Housing Solutions, Inc. 1990 N California Blvd Suite 20 PMB 1074 Walnut Creek CA 94596 Berkley Human Services Hartford Insurance 21-22 A Y Y HSS8530308 04/14/2021 04/14/2022 1,000,000 500,000 20,000 1,000,000 2,000,000 2,000,000 A Y HSS8530308 04/14/2021 04/14/2022 1,000,000 B Y 52WECAL3CHM 04/14/2021 04/14/2022 1,000,000 1,000,000 1,000,000 A Professional Liability HSS8530308 04/14/2021 04/14/2022 Aggregate 2,000,000 Each Occurrence 1,000,000 30 Days Notice of Cancellation City of Cupertino, and members of the City Council, and their officers, agents and employes of the City of Cupertino, individually and collectively are named Additional Insured with respects to the work performed by the named insured and with regards to the written agreement. Coverage is Primary & Non-Contributory. Waiver of Subrogation Applies. City of Cupertino Community Development Dept 10300 Torre Avenue Cupertino CA 95014 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. $ $ $ $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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY COMMERCIAL GENERAL LIABILITY CG 83 91 12 19 CG 83 91 12 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ CAREFULLY. GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Throughout this endorsement, the The following is only a summary of the additional coverages provided by this endorsement and is provided only for your reference and convenience. For the Limits of Insurance and the additional coverages provided by this endorsement, read the provisions on the following pages and the Coverage Form, which this endorsement modifies. SUBJECTS OF INSURANCE Broadened Bodily Injury Broadened Personal and Advertising Injury Broadened Property Damage Broadened Fire, Lightning, Explosion, and Sprinkler Leakage - $500,000 Broadened Medical Payments - $20,000 Broadened Supplementary Benefits a. Bail Bonds - $1,000 b. Expenses Incurred to Assist in Defense - $500 per Day Broadened Newly Acquired or Formed Organization Broadened Non-Owned or Chartered Watercraft or Aircraft Broadened Commercial General Liability Conditions a. Duties in the Event of Occurrence, Offense, Claim, or Suit b. Liberalization Automatic Coverage If We Adopt Broader Coverages c. Notice to Company Automatic Additional Insureds a. Athletic Activity Participants b. Contractual Obligations c. Funding Sources d. Manager or Lessor of Premises e. f. Supervisors or Higher in Rank Co-Employee Exclusion Removed g. Limitations Blanket Waiver of Subrogation Priority of Application for Multiple Insureds The coverages listed in this endorsement are provided as extensions or additions to your insurance program. Page 2 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 83 91 12 19 A. BROADENED BODILY INJURY Paragraph 3. of Section V Definitions is deleted and replaced with the following: 3. injury, sickness, or disease sustained by a person, including death resulting sustained by a person, if directly resulting from physical injury, sickness, or disease sustained by that person. B. BROADENED PERSONAL AND ADVERTISING INJURY 1. Paragraph 14. of Section V - Definitions is deleted and replaced with the following: 14. more of the following offenses during the policy period. a. False arrest, detention, or imprisonment; b. Malicious prosecution or abuse of process; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling, or premises that a person occupies by or on behalf of its owner, landlord, or lessor; d. Oral, written, televised, videotaped, or electronic publication of material that slanders or libels a person or organization, e. of privacy; f. Misappropriation of advertising ideas or style of doing business; g. Infringement of copyright, title, or slogan; or h. Mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.g. above. 2. Exclusions 2.b. and 2.c. under Coverage B - Personal and Advertising Injury Liability are deleted and replaced with the following: b. Material Published with Knowledge of Falsity publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. Material Published Prior to Policy Period publication of material whose first publication took place before the beginning of the policy period; C. BROADENED PROPERTY DAMAGE Exclusion 2.a. under Coverage A - Bodily Injury and Property Damage Liability is deleted and replaced with the following: a. Expected Or Intended Injury persons or property. D. BROADENED FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE 1. Paragraph 6. under Section III - Limits Of Insurance is deleted and replaced with the following: 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under a. Any one premises while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner; and b. Personal property of others in your care, custody, or control, while at premises rented to you or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner, arising out of any one fire, lightning, explosion, or sprinkler leakage occurrence. CG 83 91 12 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 8 The Damage to Premises Rented to You Limit is the greater of: c. $500,000; or d. The amount shown in the Declarations for Damage to Premises Rented to You Limit. 2. Paragraph 2. Exclusions of Coverage A - Bodily Injury and Property Damage Liability is amended as follows: Paragraphs c. through n., do not apply to damage by fire, lightning, explosion, or sprinkler leakage 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 . 3. Paragraph 4. Other Insurance of Section IV - Commercial General Liability Conditions is amended as follows: Paragraph b.(1)(a)(ii) is deleted and replaced with the following: (ii) That is Fire, Lightning, Explosion, or Sprinkler Leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; or 4. Paragraph 9.a. under Section V - Definitions is deleted and replaced with the following: a. 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 or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an 5. This Broadened Coverage is subject to all the terms of Section III - Limits Of Insurance. 6. This Broadened Coverage does not apply if Fire Damage Liability of COVERAGE A (SECTION I) is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. E. BROADENED MEDICAL PAYMENTS 1. The following provision is added to Paragraph 2. of Section III - Limits Of Insurance: The Medical Expense Limit shall be the greater of: a. $20,000; or b. The amount shown in the Declarations for Medical Expense Limit. 2. This Medical Expense Limit is subject to all the terms of Section III - Limits Of Insurance. 3. This above Medical Expense Limit does not apply if Coverage C - Medical Payments is excluded either by the Declaration to this Coverage Part or by an endorsement to this Coverage Part. F. BROADENED SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. under Supplementary Payments - Coverages A and B are deleted and replaced with the following: b. Up to $1,000 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 bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense G. BROADENED NEWLY ACQUIRED OR FORMED ORGANIZATION Paragraph 3.a under Section II - Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is afforded only until the 120 th day after you acquire or form the organization or the end of the policy period, whichever is earlier. H. BROADENED NON-OWNED OR CHARTERED WATERCRAFT OR AIRCRAFT Exclusion 2.g. under Coverage A - Bodily Injury and Property Damage Liability is deleted and replaced by the following: g. rustment to Page 4 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 83 91 12 19 This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; (3) owned by or rented, or loaned to you or the insured; (4) (5) f the equipment listed in Paragraph f. (2) or f. (3) of Section V - Definitions, Paragraph 12 (6) An aircraft you do not own that is: (a) Hired, chartered, or loaned with a crew; and (b) Not owned in whole or in part by any insured. (7) This insurance does not apply, under Paragraph g.(1) and g.(2) above, if the insured has any other provision, whether the other insurance is primary, excess, contingent, or on any other basis. (8) This insurance is excess, under Paragraph g.(6) above, over any other insurance, whether the other insurance is primary, excess, contingent or on any other basis. I. BROADENED COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Paragraph 2. Duties in The Event Of Occurrence, Offense, Claims Or Suit under Section IV - Commercial General Liability Conditions is amended to add the following provision: e. Your obligation to notify us as soon as practicable of an 2.a. 2.a., 2.b., and 2.c above, is satisfied if you insurance managers, or legal representatives becomes aware of, or should have become aware of, 2. The following provisions are added to Section IV - Commercial General Liability Conditions : 10. Liberalization If we adopt any revision that would broaden the coverage under this coverage part without additional premium within 30 days prior to or during the policy period, the broadened coverage will immediately apply to this coverage part. 11. Notice To Company If y ion of the Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition, if you notify us as soon as practicable when you become aware J. AUTOMATIC COVERAGE FOR SPECIAL EVENTS 1. You a conduct during the term of this policy. 2. Section V - Definitions is amended to add the following paragraph: 23. a. The purpose of which is to raise funds for you; or b. CG 83 91 12 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 5 of 8 c. Which you, or an individual or organization with whom you have entered into a contract or agreement, organize, promote, administer, sponsor, or conduct for the purposes described in Paragraphs a. or b. above; and d. Which takes place on premises owned by you, or on premises while rented or leased to you or to that organization described in Paragraph c. above. K. AUTOMATIC ADDITIONAL INSURED(S) The following provisions are added to Section II - Who Is An Insured: 4. Automatic Additional Insured(s) a. Additional Insureds - Athletic Activity Participants (1) This policy is amended to include as an insured any person(s) [hereinafter called Additional Insured(s)] representing you while participating in amateur athletic activities that you sponsor. However, no such person is an insured for: (a) Coverage C - Medical Payments. (b) (i) A co- athletic activities that you sponsor; or (ii) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company); or (c) or control of, or over which physical control is being exercised for any purpose by: (i) A co- (ii) You, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Additional Insured - Contractual Obligations (1) This policy is amended to include as an insured any person or organization (hereinafter called an insured, subject to all of the following provisions: (a) Coverage is limited to liability arising out of: (1) Your ongoing operations performed for such Additional Insured; or (2) (3) The maintenance, operation or use by you of equipment leased to you by such Additional Insured; or (4) A permit issued to you by a state or political subdivision. (b) (i) Which took place before the execution of, or subsequent to the completion or expiration of, (ii) Which takes place after you cease to be a tenant in that premises. (c) With respect to architects, failure to render any professional services by or for you including: (i) The preparing, approving, or failing to approve or prepare maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (ii) Supervisory, inspection, or engineering services. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. Page 6 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 83 91 12 19 (e) In the event that you are engaged in the manufacture or assembly of any goods or products for the benefit or at the direction of another party, pursuant to a contract or agreement with that party, this paragraph (e). does not extend coverage to that party as an Additional Insured. Coverage for such a party will be extended only by a specific endorsement issued by us and naming such party. c. Additional Insured - Funding Sources (1) This policy is amended to include as an insured any Funding Source (hereinafter called Additional Insured) which requires you in a written contract to name such Additional Insured but only with to the extent set forth as follows: (a) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this policy and subject to all the terms, conditions and exclusions for this policy. The Limits of Insurance applicable to the Additional Insured are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. (b) The coverage provided to the Additional Insured is not greater than that customarily provided by the policy forms specified in and required by the contract. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. d. Additional Insured - Manager or Lessor of Premises (1) This policy is amended to include as an insured any person or organization (hereinafter called Additional Insured) from whom you lease or rent your premises and which requires you to add such person or organization as an Additional Insured in this policy under: (a) A written contract; or (b) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an Additional Insured; but only if the written or oral agreement is an (a) Currently in effect or to become effective during the term of this policy; and (b) (2) With respect to the insurance afforded the Additional Insured identified in Paragraph d.(1) immediately above, the following additional provisions apply: (a) This insurance applies only to liability arising out of the ownership, maintenance, or use of that portion of the premises leased to you; (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this policy and subject to all this Insurance applicable to the Additional Insured are inclusive of, not in addition to, the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Part be increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (3) This insurance does not apply to: (a) covered by this endorsement; or CG 83 91 12 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7 of 8 (b) Structural alterations, new construction, or demolition operations performed by or on behalf of the Additional Insured. e. Additional Insured - (1) This policy is amended to include as an insured any person or organization (hereinafter called is held, sponsored or conducted by you, or on your behalf, under: (a) A written contract; or (b) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an Additional Insured; but only if the written or oral agreement is an (i) Currently in effect or to become effective during the term of this policy; and (ii) (2) With respect to the insurance afforded the Additional Insured identified in Paragraph e. (1) of this endorsement, the following additional provisions apply: (a) This insurance applies only to liability arising out of the use of that portion of the premises while (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the contract or agreement pertaining to the use of the premises or in the Declarations for this Insurance applicable to the Additional Insured are inclusive of, not in addition to, the Limits of Insurance shown in the Declarations. (c) In no event shall the coverage or Limits of Insurance in this Coverage Form be increased by such contract or agreement. (d) Coverage provided herein shall be considered excess over any other valid and collectible insurance available to the Additional Insured whether that other insurance is primary, excess, contingent, or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (3) This insurance does not apply to: (a) occupant in the premises covered by this endorsement; or (b) attributable to the owner, manager, operator, or lessor f. Additional Insured - Supervisors or Higher in Rank (1) Additional Insured), designated as supervisor or higher in rank, who are authorized by you to exercise direct or only for acts within the scope of their employment by you or while performing duties related to the in rank, is an insured for: (a) (i) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if you are a limited liability company); (ii) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph (a)(i) above; or (iii) Arising out of his or her providing or failing to provide professional health care services. (b) (i) To a co- (ii) To the spouse, child, parent, brother or sister of that co- Paragraph (b)(i) above; or Page 8 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission CG 83 91 12 19 (iii) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (b)(i) or (b)(ii) above. (c) (i) Owned, occupied or used by; or (ii) Rented to, in the care, custody, or control of, or over which physical control is being you are a partnership or joint venture), or any member (if you are a limited liability company). g. Additional Insured - LIMITATIONS (1) The persons, entities, or organizations to which coverage is extended under Paragraphs a. (Athletic Activity Participants), b. (Contractual Obligations), c. (Funding Sources), d. (Managers or Lessors of Premises), and e. are Additional Insureds, but only: (a) (b) liability. (2) If an endorsement is attached to this policy and specifically names a person or organization as an Additional Insured, then the coverage extended under this paragraph 4. AUTOMATIC ADDITIONAL INSURED(S) does not apply to that person, entity, or organization. (3) The following is added to Section V - Definitions: 24. limitation, punitive damages, da (4) All other terms and conditions of this Coverage Part which are not inconsistent with this Paragraph h. apply to coverage extended to the above referenced Additional Insureds REGARDLESS OF WHETHER OR NOT A COPY OF THIS COVERAGE PART AND/OR ITS ENDORSEMENTS ARE DELIVERED TO AN ADDITIONAL INSURED. L. BLANKET WAIVER OF SUBROGATION Paragraph 8. under Section IV - Commercial General Liability Conditions is deleted and replaced with the following: 8. Transfer of Rights Of Recovery Against Others To Us And Blanket Waiver Of Subrogation a. If an 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 b. or organization because of payments we make for injury or damage arising out of your ongoing - M. PRIORITY OF APPLICATION FOR MULTIPLE INSUREDS Section III - Limits Of Insurance is amended to add the following paragraph: 8. we will apply the Limits of Insurance in the following order: a. You; b. c. Any other insureds in any order that we choose. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:04/15/21 Policy Expiration Date:04/14/22 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:52 WEC AL3CHM Endorsement Number: Effective Date:04/14/21 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:Rise Housing Solutions, Inc 1990 N CALIFORNIA BLVD SUITE WALNUT CREEK CA 94596 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 Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us 04/19/2021 Bliss Sequoia Insurance P.O. Box 826 Salem OR 97308 Samantha Cox (503) 364-5401 sam@blissinsurance.com Rise Housing Solutions, Inc. 1990 N California Blvd Suite 20 PMB 1074 Walnut Creek CA 94596 Federal Insurance Company 20281 21-22 A Crime Coverage 8261-8236 04/14/2021 04/14/2022 Employee Theft 2,000,000 ERISA Fidelity 2,000,000 Emp Thft of Client Prop 2,000,000 Coverage for the operations of the Named Insured as provided by the above policy(ies). City of Cupertino Community Development Dept 10300 Torre Avenue Cupertino CA 95014 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. $ $ $ $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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY BMR AHF Affordable Placement Program Final Audit Report 2021-04-21 Created:2021-04-20 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAzwrSmpYhZz_t_mOeKopCLcOedvmj5xka "BMR AHF Affordable Placement Program" History Document created by City of Cupertino (webmaster@cupertino.org) 2021-04-20 - 10:51:43 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2021-04-20 - 11:07:33 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2021-04-20 - 11:21:09 PM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to Mardie Oakes (mardie@hellohousing.org) for signature 2021-04-20 - 11:21:12 PM GMT Email viewed by Mardie Oakes (mardie@hellohousing.org) 2021-04-21 - 10:59:37 PM GMT- IP address: 104.47.55.126 Document e-signed by Mardie Oakes (mardie@hellohousing.org) Signature Date: 2021-04-21 - 10:59:58 PM GMT - Time Source: server- IP address: 24.5.85.179 Document emailed to Matthew Warner (matt@risehousing.com) for signature 2021-04-21 - 11:00:01 PM GMT Email viewed by Matthew Warner (matt@risehousing.com) 2021-04-21 - 11:00:27 PM GMT- IP address: 98.35.123.218 Document e-signed by Matthew Warner (matt@risehousing.com) Signature Date: 2021-04-21 - 11:02:25 PM GMT - Time Source: server- IP address: 98.35.123.218 Document emailed to Heather M. Minner (minner@smwlaw.com) for signature 2021-04-21 - 11:02:27 PM GMT Email viewed by Heather M. Minner (minner@smwlaw.com) 2021-04-21 - 11:10:14 PM GMT- IP address: 104.143.198.32 Document e-signed by Heather M. Minner (minner@smwlaw.com) Signature Date: 2021-04-21 - 11:10:56 PM GMT - Time Source: server- IP address: 52.39.49.65 Document emailed to Benjamin Fu (benjaminf@cupertino.org) for signature 2021-04-21 - 11:10:59 PM GMT Email viewed by Benjamin Fu (benjaminf@cupertino.org) 2021-04-21 - 11:16:40 PM GMT- IP address: 104.47.45.254 Document e-signed by Benjamin Fu (benjaminf@cupertino.org) Signature Date: 2021-04-21 - 11:23:41 PM GMT - Time Source: server- IP address: 24.130.171.172 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2021-04-21 - 11:23:43 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2021-04-21 - 11:26:59 PM GMT- IP address: 104.47.44.254 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2021-04-21 - 11:27:15 PM GMT - Time Source: server- IP address: 69.110.137.176 Agreement completed. 2021-04-21 - 11:27:15 PM GMT