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2019-20 Family Hospice Care (Volunteer) - Bereavement Groupta (2�W GENI ,fhe OESERT — MEMORANDUM TO: Monika Radeva, City Clerk FROM: Caroline Doran, Community Resources Specialist DATE: August 14, 2019 RE: Family Hospice Care Bereavement Group and Health & Wellness Day on Thursday, October 24, 2019. Attached for your signature is an agreement with Family Hospice Care to provide bereavement services on Fridays and to offer information in the annual Health & Wellness Day on Thursday, October 24, 2019. N/A R� egges ing department shall check and attach the items below as appropriate: Contract payments will be charged to account number: N/A Amount of Agreement, Amendment, Change Order, etc.: $ N/A A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is attached with no reportable interests in LQ or reportable interests N/A A Conflict of Interest Form 700 Statement of Economic Interests is not required because this Consultant does not meet the definition in FPPC regulation 18701(2). Authority to execute this agreement is based upon: N/A Approved by the City Council on N/A City Manager's signature authority provided under Resolution No. 2019-021 for budgeted expenditures of $50,000 or less. This expenditure is $ and authorized by Director N/A Initial to certify that 3 written informal bids or proposals were received and considered In selection The following required documents are attached to the agreement: X Iy tns�r��g�ertificates as required by the agreement (approved by Risk Manager on ,�,, da te) N/A Performance bonds as required by the agreement (originals) N/A City of La Quinta Business License number N/A A requisition for a Purchase Order has been prepared (amounts over $5,000) i N/A A coov of this Cover Memo has been emailed to Finance VOLUNTEER ORGANIZATION SERVICE AGREEMENT Our organization, FAWO ROSPICE- CA/Z� will provide volunteers to perform only the services as outlined in the attached scope of work for the City of La Quinta ("City"). We understand that we will not be compensated for our work and we will complete our organization volunteer duties in a responsible manner. If we decide to discontinue our organization volunteer services, our contact person - AIS,911 CoHC-nl will notify Caroline Doran, City designee. We understand and agree that: ■ No one in the group is to appear for volunteer service under the influence of any drugs or alcohol. • Our organization will provide the City with a roster of individual participants including the names and hours worked. • Our organization will report any injuries sustained by participants during their volunteer activities to Caroline Doran, City designee immediately upon occurrence. • Our organization is responsible for directly supervising the activities of all the individuals in our group who will be doing volunteer work, and therefore, in consideration of our organization and members being permitted to perform services on City property, our organization agrees to defend, indemnify, and hold harmless the City and its officials, employees, and agents from any damage claim or lawsuit for injury, illness, damage or other loss of any kind to anyone including members of our organization that might arise out of our activities or the actions of any individuals of our group, except for injuries or damages caused by the sole negligence of the City. ■ Our organization has commercial general liability insurance of at least one million dollars to cover our activities. A copy of the certificate of insurance and the additional insured endorsement, naming the City as an "additional insured," is attached or will be submitted to the City prior to the start of any activity. ■ The City may terminate this agreement at any time without cause, and we agree that we are volunteering our services at will and may be asked to discontinue such without prior notice or reason. This agreement will be in effect for the duration of our volunteer services or one year, whichever is less, beginning on this date. Dated this _- lqw,).. day of t _, 20 19 Paqe 1 of 2 CITY OF LA QUINTA, a California Municipal Corporation CAROLINE DORAN, City Designee City of La Quinta, California Dated: li ATTEST: MONIKA RAD VA, Ci Clerk La Quinta, California APPROVED AS TO FORM: WILLIAM IHRKE, City Attorney City of La Quinta, California I a ca qr(v ^--- CALIFORNIA ---- f HRISTINA CALDERON, Community Resources Manager City of La Quinta, California 'FA MlL`-( R"1,5fICz� Gp— Name of Or anization 1 Authorized ure on behalf of Organization Coin r-� e0 - Printed Name / om l s`-Flag l�-- Title 2, 55 N .'CLL C10Ly 21D, SO LTC-,- i30eDl Address PRE S RA--4 S CP� c� �zso2— �b�, Email Address --!oo U'4-4- 3 -34--4— Phone Number Paqe 2 of 2 Attachment Scope of Work Family Hospice Care is providing a free Bereavement Support Group to persons who are experiencing bereavement. Bereavement Support Group will include: • First time group attendees register with Family Hospice Care. ■ Grief group is a non -religious, safe and caring environment. • Materials and support are provided. vRo� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 8/14/2019 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 WE;_ Arthur J. Gallagher & Co Insurance Brokers of CA. PHONE 7777 Center Avenue #400 WQ, Nc E-MAILHuntington Beach CA 92647 ADDRE INSURED Family Hospice Care LLC Prime Healthcare Inc. 8510 Balboa Avenue #285 Northridge CA 91325 714-799-5500 INSURER A: Travelers P FAMIHOS-02j INSURER B : INSURER C : INSURER D : INSURER E: COVERAGE COVERAGES CERTIFICATE NUMBER:946669345 REVISION NUMBER: 25674 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. INSR TYPE OF INSURANCE IADEFUSUBR POLICY E POLICY EXP 71 POLICY NUMBER DD/YYYY YY LIMITS A X COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE IX:lJ OCCUR 6301 F993178TILl8 12/8/2018 12/8/2019 .EACH OCCURRENCE $ 1,000,000 �1TE6 PREMI ES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000 000 GEN'LAGGREGATE LIMIT APPLIES PER : X POLICY JECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED TINGLIzLIMIT jEaaeadeny $ BODILY INJURY (Per person) $ ANY AUTO r OWNED ONLYAUTOS SCHEDULEDPROPERTYD BODILY INJURY (Per accident) $atAUTOS NON -OWNED AUTOS ONLYAUTOS ONLY q MHIRED Per accident $ UMBRELLA LIAR IOCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB _ CLAIMS -MADE $ $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER _1 E.L, EACH ACCIDENT $ ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E. L. DISEASE - EA EMPLOYEI; (Mandatory in NH) $ If yes, describe under OF OPERATIONS below E L, DISEASE - POLICY LIMIT $ fDESCRIPTION I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of La Quinta, its elected and appointed officials, officers, employees, and volunteers (for purposes of this policy, individual and collectively, the "City Insureds") are included as additional insureds as respects to the General Liability Coverage for the event dates June 2019 to December 2019. All coverage is per the policy terms and conditions. Policy exclusions, limitations and endorsements may apply to the stated coverage. CERTIFICATE HOLDER CANCELLATION The City of La Quinta Wellness Center 78-495 Calle Tampico La Quinta CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 630IF993178TIL18 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 08_ 14_2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): The City of La Quinta, its elected and appointed officials, officers, employees and volunteers (for the purposes of this policy, individual and collectively, the "City Insureds") PROJECT/LOCATION OF COVERED OPERATIONS: 78-495 Calle Tampico La Quinta, CA 92253 1. WHO IS AN INSURED — (Section II) is amended b) The insurance provided to the additional in- to include the person or organization shown in the sured does not apply to "bodily injury", "prop - Schedule above, but: erty damage" or "personal injury" arising out a) Only with respect to liability for "bodily injury", of the rendering of, or failure to render, any "property damage" or "personal injury"; and professionalarchitectural, engineering or sur- y g g: b) If, and only to the extent that, the injury or i. The preparing, approving, or failing to damage is caused by acts or omissions of you or your subcontractor in the performance prepare or approve, maps, shop draw - of "your work" on or for the project, or at the ings, opinions, reports, surveys, field or - location, shown in the Schedule. The person ders or change orders, or the preparing, or organization does not qualify as an addi- approving, or failing to prepare or ap- tional insured with respect to the independent prove, drawings and specifications; and acts or omissions of such person or organiza- ii. Supervisory, inspection, architectural or tion. engineering activities. 2. The insurance provided to the additional insured c) The insurance provided to the additional in - by this endorsement is limited as follows: sured does not apply to "bodily injury" or a) In the event that the Limits of Insurance of "property damage" caused by "your work" this Coverage Part shown in the Declarations and included in the "products -completed op - "written exceed the limits of liability required by a erations hazard" unless a contract "written contract requiring insurance" for that requiring insurance" specifically requires you additional insured, the insurance provided to to provide such coverage for that additional the additional insured shall be limited to the insured, and then the insurance provided to limits of liability required by that "written con- the additional insured applies only to such tract requiring insurance". This endorsement "bodily injury" or "property damage" that oc- shall not increase the limits of insurance de- curs before the end of the period of time for scribed in Section III — Limits Of Insurance. which the "written contract requiring insur- ance" requires you to provide such coverage CG D2 47 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "written contract requiring insurance" for that ad- ditional insured specifically requires that this in- surance apply on a primary basis or a primary and non-contributory basis, this insurance is pri- mary to 'other insurance" available to the addi- tional insured which covers that person or organi- zation as a named insured for such loss, and we will not share with that 'other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other insurance", whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional in- sured under such 'other insurance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: i. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of 'other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 47 08 05 Caroline Doran From: Abby Cohen <Abby.Cohen@FamilyHospiceCare.com> Sent: Wednesday, September 11, 2019 8:33 AM To: Caroline Doran Cc: T R Barto LCSW Subject: [noencrypt] Scope of Service EXTERNAL: This message originated outside of the City of La Quinta. Please use proper judgement and caution when opening attachments, clicking links or responding to requests for information. This message was sent securely using Zix, Good morning Caroline So sorry, we have some changes to our Scope of Work information. Please scroll down. Scope of Work Family Hospice Care is afe providing a free Bereavement Support Group to persons who are experiencing bereavement. have experieneed the death ef semeene el Bereavement Support Group will include: • First time group attendees register with Family Hospice Care. • Grief group is a non -religious, safe and caring environment. • Materials and support are provided. NEW: Family Hospice Care is providing a free Bereavement Support Group to persons who are experiencing bereavement. Bereavement Support Group will include: • First time group attendees register with Family Hospice Care. + Grief Group is a non -religious, safe and caring environment. • Materials and support are provided. Abby Cohen Community Relations Liaison Email: Abby.Cohen@FamilyHospiceCare.com 255 N. El Cielo Road Suite C300 Tel: 760-674-3344 Ext 1038 Palm Springs I CA 192262 Fax: 760-674-3372 www.FamilyHospiceCare.com J 1