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GRANT AGREEMENT
THIS, BUSINESS GRANT AGREEMENT is entered into as of the day of
My, 201-t by and between the CITY OF MIAMI, a Florida municipal corporation, whose
address is 3500 Pan American Drive, Miami, Florida 33133 (hereinafter, the "CITY"), and
CAMILLUS HOUSE, INC. (FEIN# 65-0032862), a not -for -profit corporation organized,
and existing under the law of the State of Florida, having its principal office at 1603 NW
7th Avenue, Miami, Florida 33136 (hereinafter; "GRANTEE").
RECITALS
WHEREAS, GRANTEE submitted a grant application and proposal's to the CITY
requesting One Hundred Thousand Dollars ($100,000.00) to underwrite the costs associated
with providing services to the homeless in the CITY, and
WHEREAS, GRANTEE and the CITY wish to enter into this Agreement to set forth
the terms and conditions relating to the use of said Grant;
NOW; THEREFORE, in consideration of the promises and the mutual covenants
contained herein, the parties agree to as follows:
THE GRA,NT
1. RECITALS,The recitals and all statements contained thereiii. are. true and eared and
are hereby incorporated into this Agreement.
2. GRANT. Subject to the terms and conditions set forth -herein and GRANTEE's
compliance with all of its obligations hereunder, the 'CITY hereby agrees to, make available
to the GRANTEE the Grant to be used for the p.urpose and disbursed in the manner
hereinafter provided.
3. USE OF GRANT. The Grant shall be used to underwrite the costs associated with the
operation of the GRANTEE'S Day Center Services Program wherein the GRANTEE will
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provide the following services including but not limited to:
a. Showers;
Clothing;
c. Mail;
Referrals and linkage to care for mental health, medical treatment and
housing;
e. Groups and Activities;
Meals; and
g. ID services to assist with re-establishing personal identification.
The program will serve approximately about 175 homeless men and women a day,
Monday through Friday, in the City of Miami,
4. COMPLIANCE WITII POLICIES AND PROCEDURES. GRANTEE understands
that the use of the Grant is subject to specific reporting, record keeping, administrative and
contracting guidelines, and other requirements affecting the activities funded by the Grant.
GRANTEE covenants and agrees to comply with such requirements, and represents and
warrants to the CITY that the Grant shall be used in accordance with all of the requirements,
terms and conditions contained therein, as the same may be amended during the term hereof.
Without limiting of the foregoing, GRANTEE represents and warrants that it will comply
with, and the Grant will be used in accordance with, all applicable federal, state, and local
codes, laws,,rules and regulations.
5. RECORDS AND REPORTS/AUDITS AND EVALUATION.
a. GRANTEE agrees to maintain all records as required by the CITY:
b. At the CITYrs, request, and no later than thirty (30) days thereafter,
GRANTEE shall deliver to the CITY such written statements relating to the
use of the Grant as the CITY may require*
c. The CITY shall have the right to conduct audits of GRANTEE'S records
pertaining to the Grant and to visit the Project, in order to conduct its
monitoring and evaluation activities. GRANTEE agrees to cooperate with
the CITY in the performance of these activities.
d. GRANTEE& failure to comply with these requirements or the receipt or
discovery (by monitoring or evaluation) by the CITY of any inconsistent,
incomplete, or inadequate information shall be grounds for the immediate
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termination of this Agreement by the CITY.
6. REVERSION OF ASSETS. Upon the expiration, termination, or cancellation of the
term of this Agreement, GRANTEE shall transfer to the CITY any unused Grant fimds at
the time of such expiration.
7. DISBURSEMENT OF GRANT. Subject to the terms and conditions contained in this
Agreement,. and at the time of execution of this Agreement, the CITY shall make available
to GRANTEE up to One Hundred Thousand Dollars •6 100„000.00). Payments will be
made only after receipt and approval of project specific invoices, submitted to the CITY.
In no event shall payments to GRANTEE under this Grant agreement exceed One. Hundred
Thousand Dollars ($100,000.00), nor shall they be in any form other than through
reimbursement or a form inconsistent with the terms contained herein.
8. TERM. The term of this Agreement shall commence on October 1, 2017, and shall
terminate upon full disbursement of One Hundred Thousand Dollars ($100,000.00);
provided, however, that all rights of the CITY to audit or inspect, to require reversion of
assets, to enforce representations, warranties and certifications, to default remedies, to
limitation of liability and indemnification, and to recovery of fees and costs shall survive
the expiration or earlier termination of this agreement
9.. REMEDIES FOR NON-COMPLIANCE. If GRANTEE fails to perform any of its
obligations or covenants hereunder, or materially breaches any of the terms contained
herein, then the CITY shall have the right to take one or more of the following actions,
irrespective of any remedies available to it in law and/or equity:
a. Withhold cash payments, pending correction of the deficiency by
GRANTEE;
b. Recover payments made to GRANTEE;
c, Disallow (that is, deny the use of the Grant for) all or part of the cost for the
activity or action not itieornpriance;
d. Withhold further awards; or
e. Take such other remedies that may be legally permitted.
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10. NON-DISCRIMINATION. GRANTEE, for itself and on behalf of its contractors
and sub -contractors, agrees that it shall not discriminate as to race, sex, color, religion,
national origin, age, marital status, or disability in connection with its performance under
this Agreement, Furthermore, GRANTEE represents that no otherwise qualified individual
shall, solely, by reason of his/her race, sex, color, religion, national origin, age, marital
status, or disability be excluded from the participation in, be denied benefits of, or be
subjected to discrimination under any program or activity receiving financial assistance
pursuant to this Agreement.
11. CONFLICT OF INTEREST. GRANTEE has received copies of, and is familiar
with, the following provisions regarding conflict• of interest in the performance of this
Agreement by GRANTEE. GRANTEE covenants, represents and warrants that it will
comply with all such conflict of interest provisions:
a. Code of the City of Miami, Florida, Chapter 2, Article V.
b. Miami -Dade County Code, Section 2-11.1.
12. CONTINGENCY CLAUSE. Funding .for this Agreement is centingent on the
availability of funds and is subject to amendment or termination due to lack .of funds or
authorization, reduction of funds, and/or change in regulations.
13. CERTIFICATIONS RELATING TO THE GRANT. GRANTEE certifies that:
a.. All expenditures of the Grant will be made in accordance with the provisions
of this Agreement.
b. Reasonable accounting records wilt be maintained.
c. The expenditures of the Grant will be properly documented and such
documentation will be maintained on file.
d. Periodic progress reports will be provided to the CITY, as requested.
e‘ No expenditure of Grua 'Rinds shall be used for political activities.
GRANTEE will be liable to the CITY for any amount of the Grant expended
in a manner inconsistent With this Agreement.
14. DEFAULT. If GRANTEE fails to comply with any term or condition of this
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Agreement, or fails to perform any of its obligations hereunder, then GRANTEE shall be
in default. Upon the occurrence of a default hereunder the CITY, in addition to all remedies
available to it by law, may immediately, upon written notice to GRANTEE,terminate this
Agreement whereupon all payments, advances, or other compensation paid by the CITY to
GRANTEE while GRANTEE was in default shall be immediately returned to the CITY.
GRANTEE understands and agrees that termination of this Agreement under this section
shall not release GRANTEE from any obligation accruing prior to the effective date of
termination.
15. LIABILITY OF THE CITY. No officer, employee, agent, or principal, whether
disclosed or undisclosed, of the CITY Shall have any personal liability with respect to any
of the provisions of this Agreement.
16. ISPECJFIC PERFORMANCE In the event of breach of the Grant Agreement by the
CITY, the GRANTEE may only seek specific performance of the Grant Agreement and any
recovery shall be limited to the grant funding authorized for the Project, In no event shall
the CITY be liable to GRANTEE for any additional compensation, other than that provided
herein, or for any consequential or incidental damages,
17. INDEMNIFICATION OF THE, CITY. GRANTEE hereby agrees to indemnify,
protect, defend, and hold harmless the CITY and its agents from and against any and all
claims, actions, damages, liability and expense (including fees of attorneys, investigators
and experts) in connection with loss of life, personal injury, or damage to property arising
out of the performance or non-performance of this Agreement, except to the extent such
loss, injury or damage was caused by the gross negligence of the CITY or its agents,
18. INSURANCE. At all times: duringthe term hereof; the Licensee shall maintain
insurance acceptable to the CITY. Hot to commencing any activity under this
Agreement, the Licensee shall furnish to the CITY original certificates of insurance
indicating that the Licensee is in compliance. with the provisions described in Exhibit "A"
attached hereto, and incorporated into this Agreement.
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19. DISPUTES. In the event of a dispute between the Executive Director of the CITY and
GRANTEE as to the terms and conditions of this Agreement, the Executive Director of the
CITY and GRANTEE shall notify each of the dispute and proceed in good faith to resolve
the dispute within thirty (30) days of such written notice. If the dispute is not resolved
within such thirty (30) days, the dispute shall be submitted to the CITY's Board of
Commissioners for resolution within ninety (90) days thereof, or such longer period as may
be agreed to by the parties to this Agreement. The Board's decision shall be deemed final
and binding on the parties
20. CAPTIONS. The captions in this Agreement are for convenience only and are not a
part of this Agreement and do not in any way define, limit, describe, or amplify the terms
and pi ovisiOns of this Agreement or the scope or intent thereof,
21. ENTIRE AGREEMENT. This instrument constitutes the sole and only agreement of
the parties hereto relating to the Grant, and correctly set forth the rights, duties, and
obligations of the parties. There are no collateral or oral agreements or understandings
between the CITY and GRANTEE relating to this Agreement or the Grant and/or Project.
Any promises, negotiations, or representations not expressly set forth in this Agreement are
of no force or effect. This Agreement shall not be modified in any manner except by an
instrument in writing executed by the parties,
22. CONSTRUCTION. Should the provisions of this Agreement require judicial or
arbitral interpretation, it is agreed that the judicial or arbitral body interpreting or construing
the same shall riot apply the assumption that the terms hereof .shall be More strictly
construed against one party by reason of the rule of construction that an instrument is to be
construed more strictly against the party which itself OT through its agents prepared sante, it
being agreed that the agents of both parties have equally participated in the preparation of
this Agreem.ent.
23. COVENANTS. Each covenant, agreement, obligation, term, condition or other
provision herein contained shall be deemed and construed as a separate and independent
covenant of the party bound by, undertaking or making the same, not dependent on any
other provision of this Agreement unless otherwise expressly provided. All Of the terms and
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conditions set forth in this Agreement shall apply throughout the term of this Agreement
unless otherwise expressly set forth herein.
24. CONFLICTING TERMS. In the event of conflict between the teiins of this
Agreement and any terms or conditions contained in any attached documents, the terms of
this Agreement shall govern.
25. WAIVER. No waiver or breach of any provision of this Agreement shall constitute a
waiver of any subsequent breach of the same or any other provision hereof, and no waiver
shall be effective unless made in writing by the non -breaching party.
26. SEVERABILJTY. Should any provision contained in this Agreement be determined
by a court of competent jurisdiction to be invalid, illegal, or otherwise unenforceable under
the laws of the State of Florida, then such provision shall be deemed modified to the extent
necessary in order to conform with such laws, or if not modifiable to conform with such
laws, that same shall be deemed severable, and in either event, the remaining terms and
provisions of this Agreement shall remain unmodified and in full force and effect.
27. NO THIRD -PARTY BENEFICIARY RIGIITS. No provision of this Agreement
shall, in any way,, inure to the benefit of any third patties so as to constitute any such third
party a beneficiary of this Agreement, or of anyone or more of the terms hereof, or otherwise
give rise to any cause of action in any party not a party hereto.
28. .AMENDMENTS. No amendment to this. Agreement shall be binding on either party,
unless in writing and signed by both parties.
29. OWNERSHIP OF DOCUMENTS, Upon request by the CITY, all documents
developed by GRANTEE shall be delivered to the CITY upon coinpletion of this
Agreement, and may be used by the CITY, without restriction or limitation GRANTEE
agrees that all documents maintained and generated pursuant to this Agreeinent shall be
subject to all provisions of the Public Records Law, Chapter 119, Florida Statutes. It is
further understood by and between the parties that any document which is given by the
CITY to GRANTEE pursuant to this Agreement shall at all times remain the property of
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the CITY, and shall not be used by GRANTEE for any other purposes whatsoever, without
the written consent of the CITY.
30. AWARD OF AGREEMENT. GRANTEE warrants that it has not employed or
retained any person employed by the CITY to solicit or secure this Agreement, and that it
has not offered to pay, paid, or agreed to pay any person employed by the CITY any fee,
commission percentage, brokerage fee, or gift of any kind contingent upon or resulting from
the award of the Grant.
31. NON-DELEGABILITY. The obligations of GRANTEE under this Agreement shall
not be delegated or assigned to any other party without the CITY's prior written consent
which may be withheld by the CITY„ in its sole discretion.
32, CONSTRUCTION OF AGREEMENT- AND VENUE.. This Agreement shall be
construed and enforced in accordance with Florida law. In the event of litigation as a result
of this agreement, the venue shall be Miami -Dade County, Florida. Each party shall be
responsible for its own attomey's fees.
33. TERMINATION OF CONTRACT FOR CONVENIENCE, The CITY retains the
right to terminate this Agreement at any time for convenience, without penalty to the CITY,
In that event, the CITY shall give five (5) days written notice of termination to GRANTEE.
34. NOTICE. All, notices or other communications which shall or may be given pursuant
to this Agreement shall he in writing and shall be delivered by personal set -vice, or by
registered mail, addressed to the party at the address indicated herein or as the same tnay be
changed from time to time. Such notice shall be deemed given on the day on which
personally served, or, if by mail, on the fifth day after being posted,. or the date of actual
receipt, whichever is earlier.
To GRANTEE:
CAMILLUS HOUSE, INC.
2129 NW Pt Court
8
Miami, Florida 33127
Attn: Hilda M. Fernandez
To CITY:
City of Miami
3500 Pan American Drive
Miami, Florida 33133
Attn: Emilio T. Gonzalez
City Manager
With a copy to:
Office of the City Attorney
444 S.W. 2nd Avenue
9th Floor, Miami, FL 33130
Attn: Victoria Mendez, City Attorney
35. INDEPENDENT CONTRACTOR. GRANTEE, its contractors, subcontractors,
employees, and agents shall be deemed to be independent contractors, and not agents or
employees of the CITY, and shall not attain any rights or benefits under the civil service or
pension programs of the CITY, or any rights generally afforded its employees; further, they
shall not be deemed entitled to Florida Workers' Compensation benefits as employees of
the CITY.
36. SUCCESSORS AND ASSIGNS. This Agreement shall be binding upon the parties
hereto, and their respective heirs, executors, legal representatives, successors, and assigns.
37. AUTHORITY. Both the CITY and GRANTEE certify that each possesses the legal
authority to enter into this Agreement. A resolution, motion or similar action has been duly
adopted as an official act of each party as a governing body, authorizing the execution of
this Agreement, and identifying the official representative of each to act in connection
herewith and to provide such additional information as may be required by the terms of this
Agreement
38. PUBLIC RECORDS. GRANTEE understands that the public shall have access, at
all reasonable times, to all documents and information pertaining to the CITY, subject to
the provisions of Chapter 119, Florida Statutes, and any specific exemptions therefrom,
and GRANTEE agrees to allow access by the CITY and the public to all documents subject
to disclosure under applicable law unless there is a specific exemption from such access.
GRANTEE' s failure or refusal to comply with the provisions of this section shall result in
immediate termination of the: Agreement by the CITY. Pursuant to the provisions of
Section 119.0701, Florida Statutes, GRANTEE must comply with the Florida Public
Records Laws, specifically the GRANTEE must:
a. Keep and maintain public records that ordinarily and necessarily would be
required by the public agency in order to perform the service.
b. Provide the public with access to public records on the same terrns and
conditions that the public agency would provide the records and at a cost that
does not exceed the cost provided in this chapter or as otherwise provided
by law.
c. Ensure that public records that are exempt or confidential and exempt from
public records disclosure requirements are not disclosed except as authorized
by law.
d. Meet all requirements for retaining public records and transfer, at no cost, to
the public agency all public records in possession of the GRANTEE -upon
termination of the contract and destroy any duplicate public records that are
exempt or confidential and exempt from public records diselosure
requirements,
e. All records stored electronically must be provided to the CITY in a format
compatible with the information technology systems of the public agency.
GRANTEE agrees that all of the obligations in this section will survive the term4
termination and cancellation hereof.
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[SIGNATURES APPEAR. ON THE FOLLOWING PAGE]
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IN WITNESS WHEREOF, the parties hereto have caused this instrument to be
executed by their respective officials thereunto duly authorized as of the day and year
above written,
CAM LLUS HOUSE, INC.
HIL A M. FERNANDEZ
CEO
CAMILLUS HOUSE, INC.
Date:
CITY OF MIAMI
EMIL T. GONZALEZ, PHD.
CTTYIMANAGER
CITY OF MIAMI, FLORIDA
Date: 7 3- ci ce)
Attest:
TODD B. H
CITY .CLERIC
APPROVED AS
AND CORT,CTINyASS:
VIC
CIT
EY
Z 61,w
PROVE‘
INSVIIAN
R9QtJIR
ANN-IARIE SHARPE
RISK MANAGEMENT
12
EXHIBIT A
INSURANCE REQUIREMENTS-CAMILLUS HOUSE
Commercial General Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Each Occurrence $1,000,000
General Aggregate Limit $ 2,000,000
Personal and AdV. Injury $ 1;000,000
Products/Completed Operations $ 1,000,000
B. Endorsements Required
City of Miami listed as additional insured
Contingent & Contractual Liability
Premises and Operations Liability
Primary Insurance Clause Endorsement
11, Business Automobile Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Combined Single Lirnit
Owned/Scheduled Autos
Including Hired, Borrowed or Non -Owned Autos
Any One,Accident $ 1,000,000
B. Endorsements Required
City of Miami listed as an additional insured
111. Worker's Compensation
Limits of Liability
Statutory -State of Florida
Waiver of Subrogation
Employer's Liability
A. Limits of Liability
$100,000 for bodily injury caused by an accident, each accident
$100,000 for bodily injury caused by disease, each employee
$500,000 for bodily injury caused by disease, policy limit
IV. Professional Liability/Errors and Omissions Coverage
Combined Single Limit
Bach Claim $1,000,000
General. Aggregate Limit .$1,0.00,000
Retro Date Included
V. Umbrella Liability
Each Occurrence
Policy Aggregate
$1,000,000
$1,000,000
City of Miami listed as additional insured. Excess over all applicable liability
policies contained herein.
The above policies shall provide the City of Miami with written notice of
cancellation or material change from the insurer in accordance to policy provisions.
Companies authorized to do business in the State of Florida, with the following
qualifications, shall issue all insurance policies required above;
The company must be rated 110 less than "A-" as to management, and no less
than "Class V" as to Financial Strength, by the latest edition of Best's Insurance
Guide, published by A.M. Best Company, Oldvviek, New Jersey, or its
equivalent Al! policies and /or certificates of insurance are subject to review and
verification by Risk Management prior to insurance approval.
ACCPRE) CERTIFICATE OF LIABILITY INSURANCE
k.-----
DATEIM/DIVYYTY)
(N
6/29/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require art endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Artex Risk &Albans, Inc, (CB)
2850 Gotf Road, Sth Floor
Rolling Meadows IL 60008-4050
CONTACT
NAME: Christian orotners rerv: ees
Nome 1 FAx
aktc,A„,,t). 800-807-0300 i orcorol 630-378-2508
E.MAIL
:ADDRESS:.
INSURER(SIAFFORDING COVERAGE
NAIC #
INSURER A : Pennsylvania Manufacturers Assoc Ins Co
12262
INSURED Pi imanci-14
Brothers of the Christian Schools & Affiliates
Loc #1176001 CAMILLUS HOUSE INC
1205 VVindham Parkway
Romeoville IL 60446,1679
INSURER B : Old Republic Insurance Company
24147
INSURER C:
INSURER D ;
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 429307486
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.
NOR
LTR
TYPE OF INSURANCE
ADDLSURR
INS()
WV()
.,
POLICY NUMBER
POLICY EFF
(MM/DD/YYTY)
POLICY EXP
(MM/DD/YYTY)
ITS
A
X i COMMERCIAL GENERALLIABILITY
Y
N
R1800 0998922
0/15/2016
e#15/201a,'
/
i
BADH OCCURRENCE
62.000000
DAMAGE T s, RENTED
PREMIS 8 ' a accurst:cu.)
$ Included
CLAIMS -MADE
X
oc6uri
Men P (Any one person)
1 16,000
e. L & ADV INJURY
PE1 S4
$ 1,000,000.
4E -RAL. AGGREGATE
t3,000,00a
GENT.
'4,
n
AGGREGATE LIMN' APPLIES PER:
--
. PRO- I
POLICY JEor i 1 LOC
OTHER:
P1 obLIcra -ebNIF/OP AGO
$1,000,000
$
8
AUTOMOBILE
X
11
X
LIABILITY
ANY AUTO
OVVNED
AUTOS ONLY
1A111.11E0°.6 ON LY
y
—„. ..
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
V
II
MWTH 21548
, ',
/15/2018
ic
. '
-
-•':
6/1 0 •
COMBINE SINGLE LIMIT
Ea ac ' : •
$ 1,009,000
BO* Y INJURY (Per erson)
P
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Par acciderri)
$
UIVIBRELLA LIM
EXCESS MB
oecuR
I
; CLAIMS -MADE
I,'
EACH OCCURRENCE
GGREGATE
$
ED ! RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y i N
ANYPROPRIETOR/PARTNER1EXECLITIVE
OFFICER/MEMBER EXCLUDED?
(mandatory In NH)
If yes, describe under.
DESCRIPTION OF OPERATIONS bolas
N/14
PER f 1 OTH-
STATlEE I LEI%
E.L.EACI1 ACCIDENT
EL. DISEASE - EA EMPLOYEE
0
. . . .
E.L. DISEASE - POLICY LIMIT
A
Ltd. Prot Healthcare-
14
N
821800 099892.2
6/16/201p
6/182019
01000000 OccUrr.
'81,000,900 Aggreg.
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, :nay be attached if inaro.spaco id required)
Only the General Liability coverage will apply on a Primary and Non -Contributory basis (per attached endorsement) if required by fully executed written contract.
Certificate Hatder is added as an Additional Insured (per the attached endorsement) for General Liability and Automobile coverages solely, strictly, and
specifically with regards to:
City of Miami Contracts. City of Miami is added' as Additional Insured where required by "contract
CERTIFICATE HOLDER
CANCELLATION
The Qity of 11/tiami
444 SW 2nd Avenue
Miami FL 33130
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2016/03)
01988-2015 ACORD CORPORATION. An rights reserved.
The ACORD name and loge are registered marks of ACORD
PENNSYLVANIA MANUFACTURERS'
ASSOCIATION INSURANCE COMPANY
Attaching to and forming part of Policy No, 821800 0998922
Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE
CHRISTIAN SCHOOLS AND AFFILIATES
Effective date of this endorsement is June 15, 2018
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under SECTION 11 INSURING AGREEMENT C, GENERAL LIABILITY
COVERAGEdefined within the Coverage Agreement
SECTION 1 Schedule
Name of Additional Insured Persons(s) or
Organization(s):
Designated Location(s) Of Covered Operations:
ANY PERSON OR ORGANIZATION WHEN YOU HAVE
AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR
ORGANIZATION TO BE ADDED AS AN ADDITIONAL
INSURED ON YOUR POLICY,
If no entry appears above., information required to complete this endorsement will be shown In the Certificate of Coverage
as applicable to this endorsement,
Section It Insuring Agreement C -Name of Insured Amended
A. Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured
the person(s) or organization(sj shown in the Schedule above, but only with respect to liability in the performance of
the Named Insureds ongoing operations for the Additional Insured(s) at the Location(s) designated in the Schedule
above for "bodily nfury" or "property damage", caused in whole or n part, by the Named Insured's acts or omissions
which takes place after the execution of a written agreement with the Additional insured(s).
B. For the coverage provided by this endorsement: the following paragraph is added to Section IV —General
Conditions, Section 11, Insuring Agreement C-General Liebility
This insurance is primary insurance as respects to this coverage to the additional insured person or organization,
where the written contract or written agreement requires that this insurance be primary and noncontribUtory. In that
event, we will not seek contribution from any other insurance policy available to the additional insured on which the
additional insured person or organization is a Named Insured,
C. Who Is An Insured is also amended to include as an additional insured the person(s) or organization(s) shown to
the Schedule, with respect to liability for "bodily Injury" or "property damage" caused, in whole or in part by the
"Named Insured's work" at the location designated and described irt the schedule of this endorsement performed for
that additional insured and included in the "products -completed operations hazard".
The most we will pay is the amount of insurance required by the written contract or the amount of applicable limits of
insurance under this policy; whichever is less.
This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or
indirectly, from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation,
sexual abuse or any claim sexual in nature, physical or mental, of any person,
Except as amended in this endorsement, this insurance is subject to all coverage terms, clauses and conditions in the
policy 10 which this endorsement is attached and only applies to the extent permitted by law,
THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (10-13)
IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
SCHEDULE
Name of Person(s) or Organization(s):
All persons or organizations as required by contract or agreernent
With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the
addition of the following:
Each person or organization shown in the Schedule for whom you are doing work is an Insured". But
only for "bodily injury" or "property damage that results from the ownership, maintenance or use of a
covered "auto" by:
You;
2. an "employee" of yours; or
3. anyone who drives a covered "auto" with your permission orwith the permission of one of your
"employees".
However, the insurance afforded to the person or organization shown in the Schedule shall not exceed
the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event
shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the
contract or agreement.
PCA 001 'to 13
MWTD 2/543 Religious and Charitable Risk Pooling Trust 06/15/2018 06/15/2019
A Raf CERTIFICATE OF LIABILITY INSURANCE
DATE(MMI DIT )
018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,: EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder' in lieu of such endorsement(s).
PRODUCER
Marsh & McLennan Agency LLC
1000 Corporate Drive
Suite 400
Fort Lauderdale FL_33334
CONTACT
NAME:
PHONE FAX Ext)` 9$4-938-8788 to X No):
iAlC
ADDRESS:
INSURER(S)AFFORDING COVERAGE
NAIC lr
INSURER .A: Employers lnsurance_Company of Wausau
21458
INSURED CAMILHOUSE1
Camillus House Inc.
1603 NW 7th. Avenue
Building C.
Miami FL 33136
INSURER' S
INSURER 0
INSURER 0
INSURER E::
INSURERF
COVERAGES
CERTIFICATE NUMBER: 1384760537
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH. THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
..ITR
L
TYPE OF INSURANCE
ADM
„1NS0.,
SUER
WVD
POLICY NUMBER
POLICYEFF.
(MM/DD/YYYY)
POLICY EXP
IMM/DDIYYYYI
LIMITS
COMMERCIAL GENERAL LIABILITY
,�
E4CHOCCI)I�rtENCE
CLAIMS -MADE
OCCUR
NTED
DAMAGE 7C• EaEaoccurrence)
PREMISr bueurrance)
MEDEXP (Any dne person):
P ii NAL&ADVIN RY
$
GEN'L
AGGREGATE
LIMIT APPLIES PER,
PRO.
JECT 1 LOC
E ERAL AGGR A ,.
P ODUCTS- OMP/OPAGG
'$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED-
—
SCHEDULED,
AUTOS
NON -OWNED
AUTOS ONLY
-
r" �,,••.•
}
,
j
°MEIN DSINGLELimn-
Ea aacccidentl
BODILY INJURY (Par person)
$'
BODILY INJURY (Per accident)
PROPERTY DAMAGE
,,,(Per accident)
$
UMBRELLA LIAR
EXCESS LAB
—
OCCURS'-
C1AIMS•MADE
t
EACH OCCURRENCE
AGGREGATE
$-
DED I RETENTION$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORJPARTNER/EXEGU71VE Y/N
OFFICERJMEMBEREXCLUDED? -.
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N IA.
WCCZ91448009028
1/1/2018
-
1/1/2019
X PER OTH--
STATUTE: ER
EL. -EACH ACCIDENT
.$1,000,000.
EL. DISEASE- EA EMPLOYEE
$1,000,000
EL: DISEASE - POLICY LIMIT
. $1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mare. space Is required)
re: Day Center Agreement and PoftingerShelter Program ,
Proof of Insurance only:
CERTIFICATE HOLDER
CANCELLATION
City of Miami
3500 Pan .American Drive
Miami FL:33133
AGORA 25 (2()16/03)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION [LATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C? 1988-2015 ACORD CORPORATION. All rights
The ACORD name and logo are registered marks of ACORD
served.