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HomeMy WebLinkAboutBayside Housing Service, Amendment No. 2 re: Fairgrounds Meal Services; $56,350 (ins attached)- 032221 ovn re6i0 �ca7 AMENDMENT No. 2 TO THE GRANTEE AGREEMENT WITH BAYSIDE HOUSING AND SERVICES FOR MEAL SERVICES FOR CERTAIN TEMPORARY RESIDENTS HOUSED AT THE JEFFERSON COUNTY FAIRGROUNDS This Grantee Agreement Amendment ("Amendment") is by and between Jefferson County, a Washington political subdivision("County") and Bayside Housing and Services, ("Grantee"). WHEREAS, on December 21, 2020, the Jefferson County Board of Commissioners approved a grant to Bayside Housing and Services for meal services for certain temporary residents housed at the Jefferson County Fairgrounds; and WHEREAS, the grant was funded in the amount of$15,200; and WHEREAS, the grant amount was subsequently increased to $30,000 by Amendment; and WHEREAS, the need for these services will continue at least until June 30, 2021; and WHEREAS, the county has funds available for an increase to the grant amount; WHEREAS, the Parties want to amend the Grantee Agreement entered into between them; NOW, THEREFORE, the Parties agree to further amend the amended grant agreement, as follows: Paragraph 1. Paragraph 1., which now reads: 1. Effective Date and Term. This Agreement shall commence on when last executed by the parties and remain in effect until March 31,2021,unless terminated earlier by the County in writing. Eligible expenses incurred prior to contract execution but not prior to November 1, 2020 are hereby ratified. is amended to read: 2. Effective Date and Term. This Agreement shall commence on when last executed by the parties and remain in effect until June 30, 2021, unless terminated earlier by the County in writing. Eligible expenses incurred prior to contract execution but not prior to November 1, 2020 are hereby ratified. Paragraph 2. Paragraph 2., which now reads: Grant Amount and Grantee's Use of Grant Funds. The Grantee shall ensure that the any funds expended are eligible in accordance with the terms of the grant, to include the grant Scope of Work. The Grant amount is $30,000. is amended to read: 1 Grant Amount and Grantee's Use of Grant Funds. The Grantee shall ensure that the any funds expended are eligible in accordance with the terms of the grant, to include the grant Scope of Work. The Grant amount is $56,350. An amended scope of work is attached to this amendment as Attachment A. 2 ATTACHMENT A - SCOPE OF WORK The Board of County Commissioners is authorizing up to $56,350 to reimburse Bayside Housing and Services ("Grantee") costs and expenditures related to providing one daily nutritionally balanced meal (dinner) for eligible recipients housed temporarily at the Jefferson County Fairgrounds. These funds are available until June 30, 2021. The Grantee will be responsible for providing documentation and other proof of payment of eligible costs directly related to providing one daily nutritionally balanced meal for eligible recipients housed temporarily at the Jefferson County Fairgrounds. Eligible Costs and Expenditures Costs eligible for reimbursement under this grant must be invoiced and fully documented by the Grantee. The Grantee may submit invoices to the County once per month for eligible expenditures on the project. The Grantee will submit invoices and appropriate supporting documentation such as payroll records, canceled checks, records of supplies orders, payments or other documentation of eligible expenditures. Upon review and approval of each submitted invoice by the County, payment will be made to the Grantee using the County's normal bill paying process and cycle. Funds are available to reimburse eligible costs incurred between November 1, 2020 through June 30, 2021. The Grantee MAY NOT use the funding for any activity or cost not directly related to providing one nutritionally balanced meal (dinner) to eligible recipients temporarily housed at the Jefferson County Fairgrounds: Program Funding and Award Amount The County shall make available$56,350 to reimburse Bayside Housing and Services("Grantee") costs and expenditures related to providing one nutritionally balanced meal (dinner) for eligible recipients housed temporarily at the Jefferson County Fairgrounds. The Grantee will use these funds to providing one daily nutritionally balanced meal (dinner) for eligible recipients housed temporarily at the Jefferson County Fairgrounds. (SIGNATURES FOLLOW ON NEXT PAGE) 3 FOR BAYSIDE H rce�USING AND SERVICES: .1 --) Name and SignatureC 1 C1cA feS , Devc lo?ol-T✓t-f- „);we c t-6 v" 2j/"2.47l I Z1 Date FOR JEFFERSON COUNTY: \(-4j. Kate Dean, Chair Board of County Commissioners 37z.h i Date APPROVED AS TO FORM ONLY: rcipik .7/0 2,a2./ Philip C. insucker, Chief Civil Deputy Prosecuting Attorney Date Attest: V 6"k,l+ I ' 1 / Carolyn Gallaway J� Date Clerk to the Board 4 U `a ysi u CG Auk i � GS 3' 2, QAA GRANTEE AGREEMENT WITH BAYSIDE HOUSING AND SERVICES FOR MEAL SERVICES FOR CERTAIN TEMPORARY RESIDENTS HOUSED AT THE JEFFERSON COUNTY FAIRGROUNDS This Grantee Agreement ("Agreement") is by and between Jefferson County, a Washington political subdivision ("County") and Bayside Housing and Services(UBI Number 603 435 297, `Bayside" or "Grantee"). WHEREAS, on February 29,2020, Governor Jay Inslee declared a State of Emergency in all Counties in Washington State to due to the public health emergency caused by the COVID- 19 virus; and WHEREAS, on March 10, 2020, the Jefferson County Health Officer issued a Public Health Order to control and prevent the spread of the COVID-19 virus; and WHEREAS, on March 11, 2020, the World Health Organization declared the outbreak of COVID-19 to be a pandemic; and WHEREAS, on March 13,2020,the President of the United States declared the COVID- 19 outbreak a national emergency; and WHEREAS, on March 16,2020,the Jefferson County Board of Commissioners approved a Declaration of Emergency in Jefferson County due to the COVID-19 pandemic in Resolution 12-20, stating in part that"human life may be threatened and the local economy disrupted as a result of this unprecedented pandemic, and immediate extraordinary action must be taken to respond to this crisis and mitigate its impacts,"and further stating"Jefferson County is authorized to exercise such other actions authorized by state law during a state of emergency as may be necessary to combat this emergency;" and WHEREAS, on March 19, 2020, the Port Townsend City Council approved a Declaration of Emergency due to the COVID-19 pandemic; and WHEREAS, on March 23, 2020, Governor Jay Inslee signed Proclamation 20-25 declaring that a State of Emergency continues to exist in all Counties in Washington State due to COVID-19; and that his prior proclamations are amended and superseded by a Proclamation to impose a Stay Home—Stay Healthy Order throughout Washington State,which prohibits all people in Washington State from leaving their homes or participating in social, spiritual and recreational gatherings of any kind regardless of the number of participants, and all non-essential businesses in Washington State from conducting business,within the limitations provided in Proclamation 20-25; and WHEREAS, Proclamation 20-25 has been amended several times,most recently in Proclamation 20-25.7, issued on July 24, 2020, which makes clear that Proclamation 20-25 1 remain in effect until rescinded, and requires people to wear face masks both while at work and while not at work; and WHEREAS, as a result of the continued worldwide spread of COVID-19, its significant progression in Washington State, and the high risk it poses to our most vulnerable populations, Governor Jay Inslee subsequently issued amendatory Proclamations 20-06 through 20-53, 20-55 through 20-67,20-69 through 20-71 and 20-74, and exercising his emergency powers under RCW 43.06.220 by prohibiting certain activities and waiving and suspending specified laws and regulations; and WHEREAS, Health professionals and epidemiological modeling experts advise that Washington is still in a state of COVID-19 outbreak; and WHEREAS,the COVID-19 pandemic is both a health emergency and a financial emergency, resulting in the worst global economic crisis since the Great Depression; and WHEREAS, as a result of the COVID-19 financial emergency,the largest economic stimulus legislation in American history, a$2 trillion package in Section 601(a)of the Social Security Act, as amended by Section 5001 of the Coronavirus Aid, Relief,and Economic Security Act, called the CARES Act,was signed into law on 27 March 2020; and WHEREAS, in May 2020, Governor Jay Inslee announced that the State of Washington would award$300 million of State's CARES Act Coronavirus Relief Fund (CRF) funding to reimburse local governments for eligible COVID-19 costs and economic support in connection with the COVID-19 public health emergency; and WHEREAS, on August 31, 2020, Governor Inslee announced that Washington State was awarding an additional $125 million of CARES Act CRF funding to local governments for the same purposes; and WHEREAS,the City of Port Townsend has been awarded up to $144,150 from the State's additional CRF award,which the City intends to receive by submitting an invoice to the State for the City's prior eligible expenditures,thereby freeing up City general fund moneys which the City wishes to deploy to address the COVID-19 public health emergency; and WHEREAS, Jefferson County has been awarded up to $638,000 from the State's additional CRF award, which the County intends to receive by submitting an invoice to the State for the County's prior eligible expenditures; and after combining those funds with available funds from the County's first CARES Act CRF award, and after reimbursing the County for its own direct eligible COVID-19 costs, makes available an estimated $633,515 of County general fund moneys which the County plans to deploy to address the COVID-19 public health emergency; and 2 WHEREAS, the proposed uses will aid the economic recovery and public good of Jefferson County following the economic downturn caused by the COVID-19 pandemic; and WHEREAS, the Grantee is a recognized public nonprofit entity or private 501(c)(3)non- profit organization in the State of Washington; and WHEREAS,the Grantee desires to provide needed services to a vulnerable population and seeks funding assistance to cover costs associated with providing these services; and WHEREAS,Jefferson County desires to provide funding for the needed services, as necessary to combat the COVID-19 pandemic and recession,protecting the health and safety of persons and property, and providing emergency assistance to the victims of such disaster; and WHEREAS, RCW 38.52.070(2)grants to counties in which a disaster occurs,the power to enter into contracts and incur obligations necessary to combat such disaster,protecting the health and safety of persons and property, and providing emergency assistance to the victims of such disaster; and WHEREAS, the economic support provided to Grantee pursuant to this Agreement is necessary and appropriate given the Grantee's critical role and ability to provide services to community members in response to the COVID-19 public health emergency, and such assistance represents an eligible use of county funds consistent with RCW 38.52.070(2); and WHEREAS,Jefferson County has an acute and chronic shortage of affordable housing; and WHEREAS,winter weather is fast approaching and those without housing need a place to live and be safe during such weather; and WHEREAS, Jefferson County has land at the Jefferson County Fairgrounds suitable for such temporary housing; and WHEREAS, the Jefferson County Board of Commissioners desires that sufficient resources be committed to provide such temporary housing and related services; and NOW, THEREFORE, in consideration of the foregoing recitals, which are incorporated herein by reference, and the terms and conditions set forth below,the parties agree as follows: 1. Effective Date and Term. This Agreement shall commence on when last executed by the parties and remain in effect until March 31, 2021, unless terminated earlier by the County in writing. Eligible expenses incurred prior to contract execution but not prior to November 1, 2020 are hereby ratified. 2. Grant Amount and Grantee's Use of Grant Funds. The Grantee shall ensure that the any funds expended are eligible in accordance with the terms of the grant, to include the grant Scope of Work. The Grant amount is $15,200, which may be increased to $30,000 by a Grant amendment, given a demonstrated need and depending on availability of funds. 3 3. Termination. The County may terminate this Agreement, for convenience or otherwise and for no consideration or damages, upon prior notice to the Grantee. 4. Independent Grantee. Each party under this Agreement shall be for all purposes an independent Grantee. Nothing contained herein will be deemed to create an association, a partnership, a joint venture, or a relationship of principal and agent, or employer and employee between the parties. The Grantee shall not be, or be deemed to be, or act or purport to act, as an employee, agent, or representative of the County for any purpose. 5. Indemnification.The Grantee agrees to defend, indemnify and hold the County, its officers,officials, employees,agents and volunteers harmless from and against any and all claims, injuries, damages, losses or expenses including without limitation personal injury, bodily injury, sickness, disease, or death, or damage to or destruction of property, which are alleged or proven to be caused in whole or in part by an act or omission of the Grantee, its officers, directors, employees, and/or agents relating to the Grantees' performance or failure to perform under this Agreement. The section shall survive the expiration or termination of this Agreement. 6. Insurance. Prior to commencing work,the Grantee shall obtain at its own cost and expense the following insurance coverage specified below and shall keep such coverage in force during the terms of the Agreement. Commercial Automobile Liability Insurance providing bodily injury and property damage liability coverage for all owned and non-owned vehicles assigned to or used in the performance of the work for a combined single limit of not less than$1,000,000 combined single limit with the County named as an additional insured in connection with the Consultant's performance of his Agreement. This insurance shall indicate on the certificate of insurance the following coverage: (a) Owned automobiles; (b) Hired automobiles; and, (3)Non-owned automobiles. Commercial General Liability. Insurance in an amount not less than a single limit of $1,000,000 per occurrence and an aggregate of not less than two(2)times the occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and property damage, unless a greater amount is specified in the contract specifications. The commercial general liability insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum coverage: a. Broad Form Property Damage, with no employee exclusion; b. Personal Injury Liability, including extended bodily injury; c. Broad Form Contractual/Commercial Liability — including coverage for products and completed operations; d. Premises—Operations Liability (M&C); e. Blanket Contractual Liability. The County shall be named as an"additional named insured"under all insurance policies required by this Agreement, except Professional Liability Insurance when not allowed by the insurer, and 4 shall include a provision prohibiting cancellation of said policy except upon thirty (30)days prior written notice to the County. Such insurance coverage shall be evidenced by one of the following methods: (a) Certificate of Insurance;or, (b) Self-insurance through an irrevocable Letter of Credit from a qualified financial institution. The Grantee shall furnish the County with properly executed certificates of insurance that, at a minimum, shall include: (a) The limits of overage; (b) The project name to which it applies; (c) The certificate holder as Jefferson County, Washington and its elected officials, officers, and employees with the address of Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368, and, (d) A statement that the insurance policy shall not be canceled or allowed to expire except on thirty (30) days prior written notice to the County. If the proof of insurance or certificate indicating the County is an "additional insured" to a policy obtained by the Consultant refers to an endorsement(by number or name)but does not provide the full text of that endorsement, then it shall be the obligation of the Consultant to obtain the full text of that endorsement and forward that full text to the County. Certificates of coverage as required by this section shall be delivered to the County within fifteen (15) days of execution of this Agreement. Failure of the Grantee to take out or maintain any required insurance shall not relieve the Grantee from any liability under this Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification of the County. The Grantee's insurers shall have no right of recovery or subrogation against the County (including its employees and other agents and agencies), it being the intention of the parties that the insurance policies, with the exception of Professional Liability Insurance, so affected shall protect all the parties and shall be primary coverage for all losses covered by the above described insurance. Insurance companies issuing the Grantee's insurance policy or policies shall have no recourse against the County (including its employees and other agents and agencies) for payment of any premiums or for assessments under any form of insurance policy. All deductibles in the Grantee's insurance policies shall be assumed by and be at the sole risk of the Grantee. Any deductibles or self-insured retention shall be declared to and approved by the County prior to the approval of this Agreement by the County. At the option of the County, the insurer shall reduce or eliminate deductibles or self-insured retention, or the Consultant shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Any judgments for which the County may be liable, in excess of insured amounts required by this Agreement, or any portion thereof, may be withheld from payment due, or to become due,to the Grantee until the Grantee shall furnish additional security covering such judgment as may be determined by the County. 5 Any coverage for third party liability claims provided to the County by a "Risk Pool" created pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any insurance policy the Grantee shall provide to comply with this Agreement, The County may, upon the Grantee's failure to comply with all provisions of this Agreement relating to insurance, withhold payment or compensation that would otherwise be due to the Grantee. The Grantee shall provide a copy of all insurance policies specified in this Agreement. Written notice of cancellation or change in the Grantee's insurance required by this Agreement shall reference the project name and agreement number and shall be mailed to the County at the following address: Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA 98368. The Grantee's liability insurance provisions shall be primary and noncontributory with respect to any insurance or self-insurance programs covering the County, its elected and appointed officers, officials, employees, and agents. Any failure to comply with reporting provisions of the insurance policies shall not affect coverage provided to the County, its officers, officials,employees, or agents. The Grantee's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. The Grantee shall include all Sub-Grantees as insured under its insurance policies or shall furnish separate certificates and endorsements for each Sub-Grantee. All insurance coverage for Sub- Grantees shall be subject to all the requirements stated in this Agreement. The insurance limits mandated for any insurance coverage required by this Agreement are not intended to be an indication of exposure nor are they limitations on indemnification. The Grantee shall maintain all required insurance policies in force from the time services commence until services are completed. Certificates, insurance policies, and endorsements expiring before completion of services shall be promptly replaced. All the insurance policies required by this Agreement shall provide that thirty (30) days prior to cancellation, suspension, reduction or material change in the policy, notice of same shall be given to the County Risk Manager by registered mail, return receipt requested. The Grantee shall place insurance with insurers licensed to do business in the State of Washington and having A.M. Best Company ratings of no less than A-, with the exception that excess and umbrella coverage used to meet the requirements for limits of liability or gaps in coverage need not be placed with insurers or re-insurers licensed in the State of Washington. The County reserves the right to request additional insurance on an individual basis for extra hazardous contracts and specific service agreements. 6 7. Worker's Compensation (Industrial Insurance). If and only if the Consultant employs any person(s)in the status of employee or employees separate from or in addition to any equity owners, sole proprietor, partners, owners or shareholders of the Consultant, the Grantee shall maintain workers' compensation insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to Jefferson County Risk Management, upon request. Worker's compensation insurance covering all employees with limits meeting all applicable state and federal laws. This coverage shall include Employer's Liability with limits meeting all applicable state and federal laws. This coverage shall extend to any Sub-Grantee that does not have their own worker's compensation and employer's liability insurance. The Grantee expressly waives by mutual negotiation all immunity and limitations on liability, with respect to the County, under any industrial insurance act, disability benefit act, or other employee benefit act of any jurisdiction which would otherwise be applicable in the case of such claim. If the County incurs any costs to enforce the provisions of this subsection, all cost and fees shall be recoverable from the Grantee. 8. Compliance with Laws. Guidelines. The Grantee shall comply with all federal, state, and local laws and all requirements (including certifications and audits), to the extent applicable, when seeking Reimbursement. 9. Maintenance and Audit of Records. The Grantee shall maintain records, books, documents, and other materials relevant to its performance under this Agreement. These records shall be subject to inspection, review and audit by the County or its designee, the Washington State Auditor's Office. If it is determined during the course of the audit that the Grantee was reimbursed for unallowable costs under this Agreement or any, the Grantee agrees to promptly reimburse the County for such payments upon request. 10. Notices. Any notice desired or required to be given hereunder shall be in writing, and shall be deemed received five(5)days after deposit with the U.S. Postal Service,postage fully prepaid, certified mail, return receipt requested, and addressed to the party to which it is intended at its last known address, or to such other person or address as either party shall designate to the other from time to time in writing forwarded in like manner: Grantee Greer Gates Bayside Housing and Services P.O. Box 927 Port Hadlock, WA 98339 7 Jefferson County Mark McCauley Central Services Director Jefferson County Courthouse 1820 Jefferson Street Port Townsend, WA 98368 11. Improper Influence. Each party warrants that it did not and will not employ, retain, or contract with any person or entity on a contingent compensation basis for the purpose of seeking, obtaining, maintaining, or extending this Agreement. Each party agrees, warrants, and represents that no gratuity whatsoever has been or will offered or conferred with a view towards obtaining, maintaining, or extending this Agreement. 12. Conflict of Interest. The elected and appointed officials and employees of the parties shall not have any personal interest, direct or indirect, which gives rise to a conflict of interest. 13. Time. Time is of the essence in this Agreement. 14. Survival, The provisions of this Agreement that by their sense and purpose should survive expiration or termination of this Agreement shall so survive. Those provisions include without limitation Indemnification and Maintenance and Audit of Records. 15. Amendment. No amendment or modification to this Agreement will be effective without the prior written consent of the authorized representatives of the parties. 16. Governing Law; Venge. This Agreement will be governed in all respects by the laws of Washington state,both as to interpretation and performance, without regard to conflicts of law or choice of law provisions. Any action arising out of or in connection with this Agreement may be instituted and maintained only in a court of competent jurisdiction in Jefferson County, Washington or as provided by RCW 36.01.050. 17. Non-Waiver. No failure on the part of the County to exercise, and no delay in exercising, any right hereunder shall operate as a wavier thereof; nor shall any single or partial exercise by the County of any right hereunder preclude any other or further exercise thereof or the exercise of any other right.The remedies herein provided are cumulative and not exclusive of any remedy available to the County at law or in equity. 18. Binding Effect.This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors. 19. Assignment. Neither party shall assign or transfer any of its interests in or obligations under this Agreement without the prior written consent of the other party. 20. Entire Agreement. This Agreement constitutes the entire agreement between the County and the Grantee for the use of funds received under this Agreement and it supersedes all prior or contemporaneous communications and proposals, whether electronic, oral, or written between the parties with respect to this Agreement. 21. No Third Party Beneficiaries. Nothing herein shall or be deemed to create or confer 8 any right, action, or benefit in, to, or on the part of any person or entity that is not a party to this Agreement.This provision shall not limit any obligation which either party has to the Washington State Department of Commerce of these grant funds, including the obligation to provide access to records and cooperate with audits as provided in this Agreement. 22. Severability.In the event that one or more provisions of this Agreement shall be determined to be invalid by any court of competent jurisdiction or agency having jurisdiction thereof,the remainder of this Agreement shall remain in full force and effect and the invalid provisions shall be deemed deleted. 23. Counterparts. This Agreement may be executed in counterparts, any of which shall be deemed an original but all of which together shall constitute one and the same instrument. 24. Authorization, Each party warrants to the other party, that the person executing this Agreement on its behalf has the full power and authority to do so. 25. Public Records Act.Notwithstanding any provisions of this Agreement to the contrary, to the extent any record, including any electronic, audio, paper or other media, is required to be kept or indexed as a public record in accordance with the Washington Public Records Act,Chapter 42.56 RCW (as may be amended), the Grantee agrees to maintain all records constituting public records and to produce or assist the County in producing such records, within the time frames and parameters set forth in state law. The Grantee also agrees that upon receipt of any written public record request, Grantee shall, within two business days, notify the County by providing a copy of the request per the notice provisions of this Agreement. (SIGNATURES APPEAR ON THE NEXT PAGE) 9 IN WITNESS WHEREOF, this Agreement is executed and shall become effective as of the last date signed below. BOARD OF COUN Y COMMISSIONERS BAYSIDE HOUSING D SERVICES JEFFERSON TY,WASHINGTON By: f Name: By: /2, 2 /�J7.0 .�F,�STS�+ DATE //l 2,/Z / Greg Brot erton, air DATE ? / By: —�';-at/� t�2 -t he)2-0 David Sullivan, Commissioner DATE ° v a „..._ By: � j /z(12-0 arii aa,Comrtnssioner DATE ( . v' ', SE: U J • 1 \ v 1 t E - ATTEST: 1 .v (_... /At (_aetPI war, 11_.jG /l-02.0 Carolyn G,1 way DATE° Deputy Clerk of the Board Approved as to form only: 12/18/2020 Philip C.Hunsucker DATE Chief Civil Deputy Prosecuting Attorney ATTACHMENT A SCOPE OF WORK The Board of County Commissioners is directing up to $15,200, which may be increased to $30,000 by a Grant amendment,given a demonstrated need and depending on availability of funds,to reimburse Bayside Housing and Services ("Grantee") costs and expenditures related to providing one daily nutritionally balanced meal(dinner)for eligible recipients housed temporarily at the Jefferson County Fairgrounds. These funds are available until March 31, 2021. The Grantee will be responsible for providing documentation and other proof of payment of eligible costs directly related to providing one daily nutritionally balanced meal for eligible recipients housed temporarily at the Jefferson County Fairgrounds. Eligible Costs and Expenditures Costs eligible for reimbursement under this grant must be invoiced and fully documented by the Grantee. The Grantee may submit invoices to the County once per month for eligible expenditures on the project. The Grantee will submit invoices and appropriate supporting documentation such as payroll records, canceled checks, records of supplies orders, payments or other documentation of eligible expenditures. Upon review and approval of each submitted invoice by the County,payment will be made to the Grantee using the County's normal bill paying process and cycle. Funds are available to reimburse eligible costs incurred between November 1, 2020 through March 31, 2021. The Grantee MAY NOT use the funding for any activity or cost not directly related to providing one nutritionally balanced meal (dinner) to eligible recipients temporarily housed at the Jefferson County Fairgrounds: Program Funding and Award Amount The County shall make available$15,200,which may be increased to $30,000 by a Grant amendment, given a demonstrated need and depending on availability of funds, to reimburse Bayside Housing and Services ("Grantee") costs and expenditures related to providing one nutritionally balanced meal (dinner) for eligible recipients housed temporarily at the Jefferson County Fairgrounds. The Grantee will use these funds to providing one daily nutritionally balanced meal(dinner)for eligible recipients housed temporarily at the Jefferson County Fairgrounds. March 29, 2021 Jefferson County Commissioner's Office PO Box 1220 Port Townsend WA 98368 Dear Adiel, BAYSI D E Please find the signed Agreement Amendment No. 2 re: Meal Services for Temporarily HOUSING&SERVICES Housed Residents at the Jefferson County Fairgrounds enclosed. Members of our accounting team will continue to be in touch with necessary statements baysidehousing.org and reports. 310 Hadlock Bay Rd Port Hadlock,WA 98339 Best, (360) 881-7140 Board of Directors Rich Conrad, President Greer Gates Steve Moore,Treasurer Development Director Susan Keister,Secretary Chris Eagan, Director Jean Camfield, Director Joe Johnson, Director Rita Kerr, Director Joanne Rittmueller, Director Terry Umbreit, Director Vince Verneuil, Emeritus JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Board of County Commissioners FROM: Mark McCauley, Central Services Director DATE: March 22, 2021 RE: Amendment No. 2 re: AGREEMENT re: Fairgrounds Meal Services; An additional amount of$26,350, bringing the total amount to$56,350; Bayside Housing and Services STATEMENT OF ISSUE: On December 21, 2020, the Board of County Commissioners approved funding to Bayside Housing and Services for providing meal services for certain temporary residents housed at the Jefferson County Fairgrounds in the amount of$15,200, which was subsequently increased to $30,000 by Amendment. The term of the grant was through March 31, 2021. The need for these services will continue well past March 31, 2021 and will require additional funding. ANALYSIS: The attached contract amendment proposes adding an additional $26,350 to the contract and extending the term to June 30, 2021. FISCAL IMPACT: This request is for $26,350 from the General Fund. This is an expense eligible for reimbursement from federally appropriated Covid-19 relief funds. RECOMMENDATION: That the Board of County Commissioners approve the attached contract amend nt increasing the grant amount and extending the term. E B 7;''sg/0"-/ P !lip Morle , unty • ' rator Date CONTRACT REVIEW FORM CONTRACT WITH: Bayside Housing and Services TRACKING NO.: (Contractor/Consultant) CONTRACT FOR: Fairgrounds Meal Service - 2nd Amendment TERM: Thru 6-30-21 COUNTY DEPARTMENT: Central Services RECEIVED® For More Information Contact: Mark McCauley Contact Phone Ai: 360-385-9130 MAR {�� RETURN TO: Mark McCauley RETURN BY: AW F R ON CO NTY (Person in Department) I►�1NlpRS ONI AMOUNT: $26,350 PROCESS: E Exempt from Bid Process ❑ Consultant Selection Process Revenue N/A ❑ Cooperative Purchase Expenditure $ 26,350 ❑ Competitive Sealed Bid Matching funds Required N/A ❑ Small Works Roster Source(s) of Matching Funds N/A ❑ Vendor List Bid ❑ RFP or RFQ ❑ Other Step 1 : REVIEW BY RISK Review by: ? //%/ 2!, Date Reviewed• XAPPROVED FORM ❑ Returne r revision(See Comments) Comments Step 2: REVIEW BY PROSECU I ZG ATTORNEY Review by: � hilip C. Hunsucker Date Reviewed: Chief Civil Deputy Prosecuting Attorney 'P ROVED AS TO FORM 0 Returned for revision(See Comments) Comments 9�44 w� 01-- is . Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF ORIGINALS Step 5: SUBMIT TO BOCC FOR APPROVAL Submit original Contract(s),Agenda Request,and Contract Review form. Also,please send 2 copies of just the Contract(s)(with the originals)to the BOCC Office. Place"Sign Here"markers on all places the BOCC needs to sign. MUST be in BOCC Office by 4:30 p.m. TUESDAY for the following Monday's agenda. (This form to stay with contract throughout the contract review process.) roN� COM/4fs�f Board of County Commissioners ,Q �oG o� 1820 Jefferson Street C PO Box 1220 Port Townsend, WA 98368 \ .... -ey°I1ING'S Kate Dean,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3 March 26, 2021 Bayside Housing and Services Cherie Gottschalk P.O. Box 927 310 Hadlock Bay Road Port Hadlock,WA 98339 Dear Ms. Gottschalk, Enclosed for signature are two (2) originals for AGREEMENT,Amendment No. 2 re: Meal Services for Temporarily Housed Residents the Jefferson County Fairgrounds; Additional Amount of$26,350, for a Project Total Amount of$56,350 appropriated Covid-19 Relief Funds; Jefferson County Central Services; Bayside Housing and Services Please sign both, keep one and return the second to: Jefferson County Commissioner's Office Attn: Adiel McKnight P.O. Box 1220 Port Townsend, WA 98368 • Please remember that on or before April 30; July 31; October 31, 2021 and January 31, 2022 you are required to provide to the County: A quarterly report of the use, services,programs and activities under this agreement for the prior quarter. • A quarterly financial statement detailing revenues, expenses and cash balances for the prior quarter; and for the final quarter report, the financial statement shall also include a detailed financial statement by February 28th of each year. • The Strongertowns (dba The Production Alliance) shall obtain insurance as outlined in the terms of the Agreement and provide a copy to this office. • Payment will be provided upon invoice, subject to the terms of the Agreement. Thank you for your assistance. Sincerely, Adiel McKnight Executive Assistant Phone (360) 385-9100 Fax (360) 385-9382 jeffbocc@co.jefferson.wa.us ay ,ta-it InALLIANCE OF NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance,A Heart for Nonprofits. COMMERCIAL LINES COMMON POLICY DECLARATIONS PRODUCER: POLICY NUMBER: 2020-42793 RSC Insurance Brokerage, Inc RENEWAL OF NUMBER: 2019-42793 160 Federal St Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Bayside Housing&Services P.O. Box 927 Port Hadlock, WA 98339 POLICY PERIOD: FROM 12/02/2020 TO 12/02/2021 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED.THESE PREMIUMS MAY BE SUBJECT TO ADJUSTMENT. PREMIUM COMMERCIAL GENERAL LIABILITY COVERAGE PART-OCCURRENCE $2,090 COMMERCIAL AUTO LIABILITY COVERAGE PART $250 IMPROPER SEXUAL CONDUCT AND PHYSICAL ABUSE COVERAGE PART $1,853 SOCIAL SERVICE PROFESSIONAL COVERAGE PART $690 COMMERCIAL LIQUOR LIABILITY COVERAGE PART INCLUDED TERRORISM COVERAGE (Certified Acts) Not Covered TOTAL: $4,883 FORM(S)AND ENDORSEMENT(S)MADE A PART OF THIS POLICY AT TIME OF ISSUE:* ANI-E003 GL 08 20, ANI-E069 GL 02 19, ANI-E078 12 18, ANI-E120 09 19, ANI-E123 09 19, ANI-RRG-AL 04 01, ANI-RRG-E11 GL 09 19, ANI-RRG-E15 09 20, ANI-RRG-E22 09 19, ANI-RRG-E25 12 15, ANI-RRG-E26 11 17, ANI-RRG-E27 GL 02 17, ANI-RRG-E28 01 99, ANI-RRG-E29 12 09, ANI-RRG-E33 GL 09 19, ANI-RRG-E34 09 18, ANI-RRG-E42 GL 09 19, ANI-RRG-E44 04 07, ANI-RRG-E5 07 15, ANI-RRG-E56 01 17, ANI-RRG-E59 02 12, ANI-RRG-E60 07 12, ANI-RRG-E61 02 19, ANI-RRG-E67 08 17, ANI-RRG-E70 03 19, ANI-RRG-E72 01 17, ANI-RRG-E74 03 14, ANI-RRG-GL 04 01, ANI-RRG-LL 04 01, ANI-RRG-NPO-001 05 20, ANI-RRG-SC 04 01, ANI-RRG-X1 06 18, CG 00 01 04 13, CG 00 33 04 13, CG 01 81 05 08, CG 20 10 04 13, CG 20 12 04 13, CG 20 18 04 13, CG 20 20 11 85, CG 20 21 07 98, CG 20 26 04 13, CG 20 34 04 13, CG 20 37 04 13, CG 21 09 06 15, CG 21 47 12 07, CG 21 73 01 15, CG 21 96 03 05, CG 24 07 01 96, CG 28 99 01 96, IL 00 17 11 98, IL 01 46 08 10, IL 01 98 09 08, SCHEDULE BA 01 80, SCHEDULE G 01 80, SCHEDULE L 01 80 *Omits applicable forms and endorsement if shown in specific coverage part/coverage form declarations. These declarations and the common policy declarations,if applicable,together with the common policy conditions,coverage form(s)and forms and endorsements,if any,issued to form a part thereof,complete the above numbered policy. "NOTICE This policy is issued by your risk retention group.Your risk az-na retention group may not be subject to all of the insurance laws BY and regulations of your State. State insurance insolvency (AUTHORIZED REPRESENTATIVE) guaranty funds are not available for your risk retention group." 11/05/2020 ANI-RRG-CO i I ALLIANCE OF ❑ NON PROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE 11111 INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2020-42793 RSC Insurance Brokerage, Inc 160 Federal St RENEWAL OF NUMBER: 2019-42793 Floor 4 Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Bayside Housing&Services P.O. B x 0 927 Port Hadlock, WA 98339 POLICY PERIOD: FROM 12/02/2020 TO 12/02/2021 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: GENERAL AGGREGATE LIMIT(OTHER THAN PRODUCTS-COMPLETED OPERATIONS) $2,000,000 PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT $2,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $1,000,000 EACH OCCURRENCE LIMIT $1,000,000 DAMAGE TO PREMISES RENTED TO YOU $500,000 any one premises MEDICAL EXPENSE LIMIT $20,000anyoneperson ADDITIONAL COVERAGES: PREMIUM $2,780 FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY ARE INCLUDED IN COMMERCIAL LINES COMMMON POLICY DECLARATIONS 11/05/2020 BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI-RRG-GL S r ALLIANCE OF ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE NSURA[VCE RISK RETENTION GROUP(ANI) I www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Schedule G POLICY NUMBER: 2020-42793 Page 1 NAME OF INSURED: Bayside Housing &Services PREMISES *LOC PREMIUM RATE *ADVANCED CODE/CLASS BASIS PREMIUM 47474/Schools-trade or vocational-includes products 1 20 8.168 $164 and/or completed operations 60015/Apartment Hotels less than 4 stories 1 35 53.337 $1,867 ADDITIONAL COVERAGES Event# #of people Description 1 24 October Community Build,Assemble Tiny Incl. home/tents Increased Aggregate $59 *See Common Declarations for Total Advanced Premium and Schedule 'L'for locations. 11/5/2020 BY (AUTHORIZED REPRESENTATIVE) "NOTICE : This Policy is issued by your risk retention group. Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG -SCHEDULE G * I illALLIANCE ri NONPROFITS FOROF ALLIANCE OF NONPROFITS FOR INSURANCE IIII INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits, COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS Schedule L POLICY NUMBER: 2020-42793 Page 1 NAME OF INSURED: Bayside Housing &Services PREMISES DESIGNATED PREMISES ADDITIONAL INSUREDS LOC/BLDG ADDRESS, CITY, STATE, ZIP AND OTHER INTERESTS 1 310 Hadlock Bay Rd Port Hadlock,WA 98339 ALL LOCATIONS ADDITIONAL INSURED-CG 20 12 Jefferson County and its elected officials, officers and employees PO Box 1220 Port Townsend, WA 98368 ONLY AS RESPECTS TO Grant Agreement- Affordable Housing/Homelessness Services 11/05/2020 BY 1P�-� Q 4. (AUTHORIZED REPRESENTATIVE) "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI-RRG -SCHEDULE L f r IMO ALLIANCE OF ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE 111111 INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits, IMPROPER SEXUAL CONDUCT AND PHYSICAL ABUSE LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2020-42793 RSC Insurance Brokerage, Inc RENEWAL OF NUMBER: 2019-42793 160 Federal St Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Bayside Housing&Services P.O. Box 927 Port Hadlock,WA 98339 POLICY PERIOD: FROM 12/2/2020 TO 12/2/2021 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: PREMIUM GENERAL AGGREGATE LIMIT $1,000,000 $1,853 EACH CLAIM LIMIT $1,000,000 NOTE:The limit of liability available to pay judgements or settlements shall be reduced by amounts incurred for Defense Costs. TOTAL PREMIUM: $1,853 FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: ANI-E069 ISC 02 19, ANI-E131 ISC 05 20, ANI-RRG-E27 ISC 01 17, ANI-RRG-E57 02 12, ANI-RRG-ISCET 05 20 ae„., ce. /62._ 11/5/2020 BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI-RRG-ISC I I ALLIANCE OF © NON PROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE 111 INSURANCE RISK RETENTION GROUP(ANI) www.i nsurancefornonprofits.org A Head for Insurance,A Heart for Nonprofits. SOCIAL SERVICE PROFESSIONAL COVERAGE FORM DECLARATIONS PRODUCER: POLICY NUMBER: 2020-42793 RSC Insurance Brokerage, Inc RENEWAL OF NUMBER: 2019-42793 160 Federal St Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Bayside Housing &Services P.O. Box 927 Port Hadlock,WA 98339 POLICY PERIOD: FROM 12/2/2020 TO 12/2/2021 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: PREMIUM SOCIAL SERVICE PROFESSIONAL AGGREGATE LIMIT $2,000,000 $690 SOCIAL SERVICE PROFESSIONAL EACH EVENT LIMIT $1,000,000 TOTAL PREMIUM: $690 FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: ANI-E069 SSP 02 19, ANI-E125 11 19, ANI-RRG-E02 01 17, ANI-RRG-E11 SSP 09 19, ANI-RRG-E27 SSP 01 17, ANI-RRG-E32 01 17, ANI-RRG-E33 SSP 09 19, ANI-RRG-E42 SSP 09 19 al,ha Ell. /62 . COUNTERSIGNED: BY (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. "NOTICE : This Policy is issued by your risk retention group. Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI-RRG-SSP I f ALLIANCE OF FinalMO NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE 11111 INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. COMMERCIAL LIQUOR LIABILITY COVERAGE PART DECLARATIONS PRODUCER: POLICY NUMBER: 2020-42793 RSC Insurance Brokerage, Inc RENEWAL OF NUMBER: 2019-42793 160 Federal St Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Bayside Housing &Services P.O. Box 927 Port Hadlock, WA 98339 POLICY PERIOD: FROM 12/2/2020 TO 12/2/2021 AT 12:01 A.M.STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. LIMITS OF COVERAGE: GENERAL AGGREGATE LIMIT $ 1,000,000 EACH COMMON CAUSE LIMIT $ 1,000,000 PREMIUM: Included FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: CG 00 33 04 13 THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. 1,(2:it-1.--,,,e C:57 /e2 - 11/5/2020 BY (AUTHORIZED REPRESENTATIVE) "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG - LL , I ALLIANCE OF ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE INSURANCE RISK RETENTION GROUP(AN!) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. INDEX OF FORMS ATTACHED TO THE POLICY POLICY NUMBER: 2020-42793 NAME OF INSURED: Bayside Housing &Services Page: 1 LIABILITY FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE Member Criteria ANI-E003 GL 08 20 Fiscal Sponsor Limitation ANI-E069 GL 02 19 Fiscal Sponsor Limitation ANI-E069 ISC 02 19 Fiscal Sponsor Limitation ANI-E069 SSP 02 19 Professional Services Exclusion ANI-E078 12 18 Lead Liability- Exclusion ANI-E120 09 19 Firearms Sublimit Endorsement ANI-E123 09 19 Disciplinary Action ANI-E125 11 19 Al - Designated Person or Organization (ET) ANI-E131 ISC 05 20 Business Auto Coverage Part Declarations ANI-RRG-AL 04 01 Additional Insured - Primary and Non-Contributory-for Designated Person or Organization ANI-RRG-E02 01 17 Fireworks Exclusion ANI-RRG-E11 GL 09 19 Fireworks Exclusion ANI-RRG-E11 SSP 09 19 Blood Testing Exclusion ANI-RRG-E15 09 20 Asbestos Exclusion ANI-RRG-E22 09 19 Additional Insured- Designated Person or Organization ANI-RRG-E25 12 15 Waiver of Transfer of Rights of Recovery Against Others ANI-RRG-E26 11 17 Designated Premises or Operations Exclusion ANI-RRG-E27 GL 02 17 Designated Premises or Operations Exclusion ANI-RRG-E27 ISC 01 17 Designated Premises or Operations Exclusion ANI-RRG-E27 SSP 01 17 Property Damage to Personal Property in the Care, Custody or Control of the Insured ANI-RRG-E28 01 99 Employee Personal Auto Reimbursement ANI-RRG-E29 12 09 Social Service Professional Liability Coverage Form ANI-RRG-E32 01 17 Mold, Fungus Exclusion ANI-RRG-E33 GL 09 19 Mold, Fungus Exclusion ANI-RRG-E33 SSP 09 19 Construction and Conversion Exclusion ANI-RRG-E34 09 18 Nuclear, Chemical and Biological Hazard Exclusion ANI-RRG-E42 GL 09 19 Nuclear, Chemical and Biological Hazard Exclusion ANI-RRG-E42 SSP 09 19 Exclusion - Medical Payments Coverage (Patients or Clients) ANI-RRG-E44 04 07 Trampoline Bounce House Exclusion ANI-RRG-E5 07 15 Liberalization -GL, SSP, EBL ANI-RRG-E56 01 17 Liberalization - ISC ANI-RRG-E57 02 12 Liberalization - LL ANI-RRG-E59 02 12 Volunteer Medical Payments ANI-RRG-E60 07 12 Additional Insured -Primary and Non-Contributory Endorsement for Public Entities ANI-RRG-E61 02 19 Additional Insured -Managers or Lessors of Premises ANI-RRG-E67 08 17 Fundraiser and Event Endorsement ANI-RRG-E70 03 19 Other Insurance-Coverage C ANI-RRG-E72 01 17 Mental Anguish Endorsement ANI-RRG-E74 03 14 Commercial General Liability Coverage Part Declarations ANI-RRG-GL 04 01 Improper Sexual Conduct and Physical Abuse Liability Coverage Form ANI-RRG-ISCET 05 20 Commercial Liquor Liability Coverage Part Declarations ANI-RRG-LL 04 01 This list of forms is not part of the actual policy, but is for your information only. Please refer to the policy(s) for actual limits, coverages and exclusions. ALLIANCE OF ®©• NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE IIIIINSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Heat/for Insurance.A Heart for Nonprofits. INDEX OF FORMS ATTACHED TO THE POLICY POLICY NUMBER: 2020-42793 NAME OF INSURED: Bayside Housing &Services Page: 2 LIABILITY FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE Nonprofits' OWN Enhancement Endorsement ANI-RRG-NPO-001 05 20 Improper Sexual Conduct Liability Coverage Part Declarations ANI-RRG-SC 04 01 Improper Sexual Conduct and Physical Abuse Exclusion-GL ANI-RRG-X1 06 18 Commercial General Liability Coverage Form CG 00 01 04 13 Liquor Liability Coverage Form CG 00 33 04 13 Washington Changes CG 01 81 05 08 Additional Insured -Owners, Lessees or Contractors CG 20 10 04 13 Additional Insured-State or Political Subdivisions- Permits CG 20 12 04 13 Additional Insured - Mortgagee,Assignee or Receiver CG 20 18 04 13 Additional Insured -Charitable Institutions CG 20 20 11 85 Additional Insured -Volunteers CG 20 21 07 98 Additional Insured - Designated Person or Organization CG 20 26 04 13 Additional Insured - Lessor of Leased Equipment-Automatic Status- Lease CG 20 34 04 13 Additional Insured -Owners, Lessees or Contractors-Completed Operations CG 20 37 04 13 Exclusion - Unmanned Aircraft CG 21 09 06 15 Employment-Related Practices Exclusion CG 21 47 12 07 Exclusion of Certified Acts of Terrorism CG 21 73 01 15 Silica-Exclusion CG 21 96 03 05 Products/Completed Operations Hazard Redefined CG 24 07 01 96 Washington Changes (LL) CG 28 99 01 96 Common Policy Conditions IL 00 17 11 98 Washington Common Policy Conditions IL 01 46 08 10 Nuclear Energy Liability Exclusion Endorsement(Broad Form) IL 01 98 09 08 Business Auto Coverage Schedule SCHEDULE BA 01 80 Commercial General Liability Class Code Schedule SCHEDULE G 01 80 Commercial General Liability Location Schedule SCHEDULE L 01 80 This list of forms is not part of the actual policy, but is for your information only. Please refer to the policy(s) for actual limits, coverages and exclusions. ALLIANCE OF I 0 NONPROFITS FOR 1111111 INSURANCE A Head for insurance.4 Heart for Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PREMISES OR OPERATIONS EXCLUSION INSURED: Bayside Housing &Services POLICY NUMBER: 2020-42793 EFFECTIVE DATE: 12/02/2020 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Description and Location of Premises: B. Description of Operations: Excluding and all operations of Old Alcohol Plant/Inn Properties (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) This insurance does not apply to"bodily injury", "property damage", "personal injury and advertising injury" arising out of: A. 1. The ownership, maintenance or use of the premises shown in Item A of the Schedule or any property located on these premises; or 2. Operations on those premises shown in Item A of the Schedule or elsewhere which are necessary or incidental to the ownership, maintenance or use of those premises; or 3. Goods or products manufactured at or distributed from the premises shown in Item A of the Schedule. B. 1. Operations described in Item B of the Schedule; or 2. The "products-completed operations hazard"arising from those operations. ANI-RRG-E27 GL 02 17 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing&Services CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): 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 B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds,the following is added to organization(s)shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property damage"or"personal and advertising injury" If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement,the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. 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. CG 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 ALLIANCE OF ❑ NONPROFITS FOR 11111 INSURANCE A Head for Insurance,A Heart for Nonprofits. POLICY NUMBER: 2020-42793 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. 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 ANI-RRG-E61 02 19 Page 1 of 2 ALLIANCE OF NONPROFITS FOR III INSURANCE A Head for Insurance.A Heart for Nonprofits. POLICY NUMBER: 2020-42793 (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. ANI-RRG-E61 02 19 Page 2 of 2 Ir.411111ALLIANCE OF POLICY NUMBER: 2020-42793 FORM:ANI-RRG-E25 12 15 ►1 / NONPROFITS FOR NAMED INSURED: Bayside Housing &Services Ell INSURANCE A Head for Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION - FOOD CONTRIBUTIONS OR CLIENT REFERRALS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy, in consideration of food contributions or client referrals you receive from them. A. Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations;whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ANI-RRG-E25 12 15 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing &Services CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 All insured premises and operations. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following is added to organization(s)shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury"or "property damage"caused, in whole or in part, by If coverage provided to the additional insured is "your work"at the location designated and required by a contract or agreement, the most we described in the Schedule of this endorsement will pay on behalf of the additional insured is the performed for that additional insured and amount of insurance: included in the"products-completed operations hazard". 1. Required by the contract or agreement; or 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable Limits of Insurance shown in the 2. If coverage provided to the additional insured is Declarations. 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ALLIANCE OF ❑ NONPROFITS FOR IIIII INSURANCE A Head for Insurance.A Heart for Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises(Part Leased To You): Name Of Person(s)Or Organization(s)(Additional Insured): Any person or organization acting as a manager or lessor of a premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy. Additional Premium: Included 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 arising out of the ownership, maintenance or use of that part of the premises leased to you, and only with respect to liability for"bodily injury", "property damage", or"personal and advertising injury", caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf, subject to the following additional exclusions: This insurance does not apply to: 1. Any"occurrence"which takes place after you cease to be a tenant in that premises. 2. Any offense which constitutes "personal and advertising injury"which is committed after you cease to be a tenant in that premises; or 3. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s)or organization(s)shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insured,the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ANI-RRG-E67 08 17 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing &Services CG 20 34 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT - AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II—Who Is An Insured is amended to A person's or organization's status as an include as an additional insured any person(s)or additional insured under this endorsement ends organization(s)from whom you lease equipment when their contract or agreement with you for such when you and such person(s)or organization(s) leased equipment ends. have agreed in writing in a contract or agreement that such person(s)or organization(s) be added as B. With respect to the insurance afforded to these an additional insured on your policy. Such additional insureds,this insurance does not apply person(s)or organization(s) is an insured only with to any"occurrence"which takes place after the respect to liability for"bodily injury", "property equipment lease expires. advertisinginj ury" e"or"personal and 9 P caused, in whole or in art byyour maintenance p C. With respect to the insurance afforded to these operation or use of equipment leased to you by additional insureds,the following is added to such person(s) or organization(s). Section III—Limits Of Insurance: However, the insurance afforded to such additional The most we will pay on behalf of the additional insured: 1. Only applies to the extent permitted by law; insured is the amount of insurance: and 1. Required by the contract or agreement you 2. Will not be broader than that which you are have entered into with the additional insured; required by the contract or agreement to or provide for such additional insured. 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 34 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing&Services CG 20 18 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE OR RECEIVER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Person(s)Or Organization(s) Designation Of Premises Any person or organization acting as mortgagee, assignee, or receiver with respect to locations scheduled on the policy. 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 C. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds,the following is added to organization(s)shown in the Schedule, but only Section III—Limits Of Insurance: with respect to their liability as mortgagee, assignee, or receiver and arising out of the If coverage provided to the additional insured is ownership, maintenance, or use of the premises by required by a contract or agreement, the most we you and shown in the Schedule. will pay on behalf of the additional insured is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted by Insurance shown in the Declarations; law; and whichever is less. 2. If coverage provided to the additional insured is required by a contract or agreement, the This endorsement shall not increase the insurance afforded to such additional insured applicable Limits of Insurance shown in the will not be broader than that which you are Declarations. required by the contract or agreement to provide for such additional insured. B. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. CG 20 18 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing &Services CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization that you are required to All insured premises and operations. 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 2. If coverage provided to the additional insured include as an additional insured the person(s)or is required by a contract or agreement, the organization(s)shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for"bodily injury", "property will not be broader than that which you are damage"or"personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to "bodily injury"or the additional insured(s)at the location(s) "property damage"occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such 1. The insurance afforded to such additional work, on the project(other than service, insured only applies to the extent permitted maintenance or repairs)to be performed by by law; and or on behalf of the additional insured(s)at the location of the covered operations has been completed; or CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of"your work"out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization whichever is less. other than another contractor or subcontractor engaged in performing operations for a This endorsement shall not increase the principal as a part of the same project. applicable Limits of Insurance shown in the Declarations. 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 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing&Services CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any state or political subdivision that issues a permit or authorization to the named insured. 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 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury", "property damage"or governmental agency or subdivision or political "personal and advertising injury"arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or b. "Bodily injury"or"property damage" 1. This insurance applies only with respect to included within the "products-completed operations performed by you or on your behalf operations hazard". for which the state or governmental agency or subdivision or political subdivision has issued a B. With respect to the insurance afforded to these permit or authorization. additional insureds,the following is added to Section III—Limits Of Insurance: However: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most we by law; and will pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such 2. Available under the applicable Limits of additional insured will not be broader than Insurance shown in the Declarations; that which you are required by the contract whichever is less. or agreement to provide for such additional insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2020-42793 COMMERCIAL GENERAL LIABILITY Named Insured: Bayside Housing&Services CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Jefferson County and its elected officials, officers and employees Grant Agreement-Affordable Housing/Homelessness Services 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 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury", "property damage"or governmental agency or subdivision or political "personal and advertising injury"arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or b. "Bodily injury"or"property damage" 1. This insurance applies only with respect to included within the"products-completed operations performed by you or on your behalf operations hazard". for which the state or governmental agency or subdivision or political subdivision has issued a B. With respect to the insurance afforded to these permit or authorization. additional insureds,the following is added to Section III—Limits Of Insurance: However: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most we by law; and will pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such 2. Available under the applicable Limits of additional insured will not be broader than Insurance shown in the Declarations; that which you are required by the contract whichever is less. or agreement to provide for such additional insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ® ALLIANCE OF POLICY NUMBER: 2020-42793 FORM:ANI-RRG-E26 11 17 0 NONPROFITS FOR NAMED INSURED: Bayside Housing &Services INSURANCE A Head for insurance.A Heart for Nonprofits, 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 PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: 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. ANI-RRG-E26 11 17 Page 1 of 1 1,1 ALLIANCE OF 16.411 NONPROFITS FOR 1111 INSURANCE A Head for Insurance.A Heart for Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PREMISES OR OPERATIONS EXCLUSION INSURED: Bayside Housing & Services POLICY NUMBER: 2020-42793 EFFECTIVE DATE: 12/02/2020 This endorsement modifies insurance provided under the following: IMPROPER SEXUAL CONDUCT AND PHYSICAL ABUSE LIABILITY COVERAGE FORM SCHEDULE A. Description and Location of Premises: B. Description of Operations: Excluding and all operations of Old Alcohol Plant/Inn Properties (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) This insurance does not apply to any"claim"for"damages"for"bodily injury": A. 1. Arising out of"improper sexual conduct"or"physical abuse"which takes place at the premises shown in Item A of the Schedule or any property located on these premises; or 2. Arising out of"improper sexual conduct"or"physical abuse"which takes place on premises which are necessary or incidental to the ownership, maintenance or use of the premises shown in Item A of the Schedule. B. 1. Arising out of"improper sexual conduct"or"physical abuse"which arises out of the operations described in Item B of the Schedule. ANI-RRG-E27 ISC 01 17 Page 1 of 1 ALLIANCE OF 1111 NONPROFITS FOR INSURANCE A Head for Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PREMISES OR OPERATIONS EXCLUSION INSURED: Bayside Housing &Services POLICY NUMBER: 2020-42793 EFFECTIVE DATE: 12/02/2020 This endorsement modifies insurance provided under the following: SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE A. Description and Location of Premises: B. Description of Operations: Excluding and all operations of Old Alcohol Plant/Inn Properties (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) This insurance does not apply to liability for any"damages"arising out of: A. 1. The ownership, maintenance or use of the premises shown in Item A of the Schedule or any property located on these premises; or 2. Any act, error or omission committed on the premises shown in Item A of the Schedule or elsewhere which are necessary or incidental to the ownership, maintenance or use of those premises. B. 1. Operations described in Item B of the Schedule. ANI-RRG-E27 SSP 01 17 Page 1 of 1 ALLIANCE OF El NON PROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE 11111 INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance,A Heart for Nonprofits. BUSINESS AUTO COVERAGE PART DECLARATIONS PRODUCER: RSC Insurance Brokerage, Inc POLICY NUMBER: 2020-42793 160 Federal St RENEWAL OF NUMBER: 2019-42793 Boston, MA 02110 NAME OF INSURED AND MAILING ADDRESS: Item One: Bayside Housing&Services P.O. Box 927 Port Hadlock,WA 98339 POLICY PERIOD: FROM 12/02/2020 TO 12/02/2021 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Emergency housing for those in need IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. Item Two: SCHEDULE OF COVERAGES AND COVERED AUTOS. This policy provides only those coverages where a charge is shown in the premium column below.Each of these coverages will apply only to those"autos" shown as covered"autos"."Autos"are shown as covered"autos"for a particular coverage by the entry of one or more of the symbols from the COVERED AUTOS Section of the Business Auto Coverage Form next to the name of the coverage. COVERED AUTOS LIMIT COVERAGES Entry of one oDAUTO the symbolsfrom THE MOST WE WILL PAY FOR ANY PREMIUM the COVERED AUTOS Section of the Business Auto Coverage Form shows ONE ACCIDENT OR LOSS which autos are covered autos. LIABILITY CSL N/A EXCLUDED N/A PERSONAL INJURY SEPARATELY STATED IN EACH P.I.P. PROTECTION(or equivalent N/A ENDORSEMENT. N/A No-fault Coverage) ADDED PERSONAL INJURY SEPARATELY STATED IN EACH P.I.P. PROTECTION(or equivalent N/A ENDORSEMENT. N/A added No-fault Coverage) HIRED AUTO 8 $1,000,000 CSL $50 NONOWNED AUTO 9 INCLUDED $200 AUTO MEDICAL PAYMENTS N/A EXCLUDED N/A UNDERINSURED MOTORIST N/A EXCLUDED N/A PHYSICAL DAMAGE COMPREHENSIVE/ N/A N/A N/A COLLISION ESTIMATED TOTAL PREMIUM $250 FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: CA 00 01 10 13, CA 01 35 10 13, CA 04 44 10 13, CA 20 54 10 13, CA 20 55 10 13, CA 23 92 10 13, CA 23 93 10 13, CA 99 23 10 13, CA 99 33 10 13, CA 99 34 10 13 THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. 11/05/2020 BY (AUTHORIZED REPRESENTATIVE) "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG -AL ALLIANCE OF D NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE MN INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. BUSINESS AUTO COVERAGE FORM POLICY NUMBER: 2020-42793 SCHEDULE BA Page 1 NAME INSURED: Bayside Housing &Services Item Three: SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION DEDUCTIBLES apply only if coverage is provided as indicated below. COVERED YEAR, MODEL,TRADE NAME, CLASS AUTO BODYTYPE,SERIAL NUMBER(S) VIN TERR. STATE CODE OTHER THAN COLLISION NO. COLLISION NO OWNED AUTOS PREMIUMS:COVERAGE IS PROVIDED ONLY IF A PREMIUM CHARGE IS INDICATED. COVERED PHYSICAL DAMAGE ADDITIONAL INSURED/LOSS PAYEE: AUTO NON- MED UM/ Except for towing,all physical damage loss is payable to you and the Loss NO. OWNED HIRED LIABILITY PIP PAY UIM COLL. COMP. Pay.naamAed below as interest may appear at the time ofloss.See attached SchedNO/H 200 50 /6 - 11/05/2020 (AUTHORIZED REPRESENTATIVE) Date "NOTICE : This Policy is issued by your risk retention group.Your risk retention group may not be subject to all the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group." ANI - RRG -SCHEDULE BA ALLIANCE OF ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE INSURANCE RISK RETENTION GROUP(ANI) www.insurancefornonprofits.org A Head for Insurance.A Heart for Nonprofits. INDEX OF FORMS ATTACHED TO THE POLICY POLICY NUMBER: 2020-42793 NAME OF INSURED: Bayside Housing&Services Page 1 AUTO FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE Business Auto Coverage Form CA 00 01 10 13 Washington Changes CA 01 35 10 13 Waiver of Transfer of Rights of Recovery Against Others to us (Waiver of Subrogation) CA 04 44 10 13 Employee Hired Autos CA 20 54 10 13 Fellow Employee Coverage CA 20 55 10 13 Exclusion of Terrorism -Washington CA 23 92 10 13 Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism Washington CA 23 93 10 13 Rental Reimbursement Coverage CA 99 23 10 13 Employees as Insureds CA 99 33 10 13 Social Service Agencies-Volunteers as Insureds CA 99 34 10 13 This list of forms is not part of the actual policy, but is for your information only. Please refer to the policy(s)for actual limits, coverages and exclusions. POLICY NUMBER: 2020-42793 COMMERCIAL AUTO CA99231013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RENTAL REIMBURSEMENT COVERAGE 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:Bayside Housing&Services Endorsement Effective Date: 12/2/2020 SCHEDULE Maximum Payment Designation or Description of Each Covered "Auto" Covered "Autos"to which this Any One No. of Any One Coverage insurance applies Premium Day Days Period Comprehensive Any Covered "Auto" 30 $1500 Incl. Collision Any Covered "Auto" 30 $1500 Incl. Specified N/A Causes of Loss Total Premium Incl. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. This endorsement provides only those coverages where C. We will pay only for those expenses incurred a premium is shown in the Schedule. It applies only to a during the policy period beginning 24 hours after covered "auto"described or designated in the Schedule. the"loss"and ending, regardless of the policy's expiration,with the lesser of the following number B. We will pay for rental reimbursement expenses incurred of days: by you for the rental of an "auto"because of"loss"to a 1. The number of days reasonably required to covered "auto". Payment applies in addition to the repair or replace the covered "auto". If"loss" is otherwise applicable amount of each coverage you have caused by theft,this number of days is added on a covered "auto". No deductibles apply to this to the number of days it takes to locate the coverage. covered "auto"and return it to you. Page 1 of 2 ©Insurance Services Office, Inc., 2011 CA 99 23 10 13 POLICY NUMBER: 2020-42793 COMMERCIAL AUTO CA99231013 2. The number of days shown in the Schedule. E. This coverage does not apply while there are D. Our payment is limited to the lesser of the following spare or reserve"autos"available to you for your operations. amounts: F. If"loss" results from the total theft of a covered 1. Necessary and actual expenses incurred. "auto"of the private passenger type, we will pay 2. The maximum payment stated in the Schedule under this coverage only that amount of your applicable to "any one day"or"any one period". rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. Page 2 of 2 ©Insurance Services Office, Inc., 2011 CA 99 23 10 13 l i ALLIANCE OF ❑ NONPROFITS FOR MI INSURANCE A Head for Insurance.A Heart fo,Nonprofits. EVIDENCE OF MEMBERSHIP Alliance of Nonprofits for Insurance, Risk Retention Group (ANI) Pursuant to the Articles of Incorporation and Amended and Restated Bylaws ["Bylaws"] of Alliance of Nonprofits for Insurance Risk Retention Group, Inc. ["the Corporation"], this Certificate evidences the membership of Bayside Housing & Services as a Member of the Corporation during such time as it satisfies all the requirements for eligibility for membership as set forth in Article II, Section 1 of the Bylaws. The term of membership is set forth in Article II, Section 2 of the Bylaws. A Member may not transfer its membership or any rights arising therefrom except in accordance with Article II, Section 4 of the Bylaws. The rights of Members to elect Directors, to vote on matters submitted to the membership of the Corporation for decision and to attend meetings of the Corporation are all as further set forth in Article II of the Bylaws. A copy of the Bylaws of the Corporation is available online at www.insurancefornonprofits.org Offered with reference to Policy No 2020-42793 December 02, 2020 Alliance of Nonprofits for Insurance, Risk Retention Group, Inc. Issuing Office: Santa Cruz, CA