FIRST AMENDMENT TO AGREEMENT
This First Amendment to Agreement ("First Amendment") is made by the County of Alameda ("County") and Design Action Cooperative, Inc., ("Contractor") with respect to that certain agreement entered by them on July l, 2016 referred to herein as the
"Contract") pursuant to which Contractor provides services of a Marketing Consultant for Center of Healthy Schools and Communities services to County.
For valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, County and Contractor agree to amend the Agreement in the following respects:
1. The term of the Agreement is currently scheduled to expire on June 30, 2017. As of the Effective Date, the term of the Agreement is extended through June 30, 2018.
2. Except as otherwise stated in this First Amendment, the terms and provisions of this Amendment will be effective as of the date this First Amendment is executed by the County ("Effective Date").
3. DEBARMENT AND SUSPENSION CERTIFICATION:
a. By signing this First Amendment and Exhibit (D), Debarment and Suspension Certification, Contractor/Grantee agrees to comply with
applicable federal suspension and debarment regulations, including but not limited to 7 Code of Federal Regulations (CFR) 3016.35, 28 CFR 66.35, 29 CFR 97.35, 34 CFR 80.35, 45 CFR 92.35 and Executive Order 12549.
b. By signing this agreement, Contractor certifies to the best of its knowledge and belief, that it and its principals:
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(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntary excluded by any federal department or agency;
(2) Shall not knowingly enter into any covered transaction with a person who is proposed for debarment under federal regulations, debarred, suspended, declared ineligible, or voluntarily excluded from
participation in such transaction.
4. Except as expressly modified by this First Amendment, all of the terms and conditions of the Contract are and remain in full force and effect.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first above written.
COUNTY OF ALAMEDA
By: 2Y'~ /Z--
Signature
Name:
(Printed)
Wilma Chan
Title: President, Board of Supervisor Date: _ _
----'\e'-+-\ ...._ZP---1\1-'-\J __.___ _ _ _
Approved as to Form, Donna R. Ziegler, County Counsel for the County of Alameda:
By: t
K. Scott Dickey, Deputy County Co
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DESIGN ACTION COOPERATIVE INC.
By: , ~ f_w!br;
Sigfiature
Name: Nadia Khastagir (Printed)
Title: Marketing Consultant Date: 5J! -;? j 1 t
By signing above, signatory warrants
and represents that he/she executed this
First Amendment in his/her authorized
capacity and that by his/her signature
on this First Amendment, he/she or the
entity upon behalf of which he/she
acted, executed this First Amendment
EXHIBIT C
COUNTY OF ALAMEDA MINIMUM INSURANCE REQUIREMENTS
Without limiting any other obligation or liability under this Agreement the Conlractor. at its sole cost and expense, shall sea.ire and keep in force ::luring the entire term of the Agreement or longer, as may be specified below. the fo!IO\\ling mnimum ilsuraoo:i coverage, limts and
!lndorsements·
I
TYPE OF INSURANCE COVERAGESA Commercial General Liability
Premises liability: Products and Completed Operations: Contractual Liabilitv; Personal lniurv and Advertisina liabilitv
B Commercial or Business Automobile Liability
All owned vehides. hired or leased vehides. non-owned. borrowed and permissive uses. Personal Automobile Liability is acceptable for individual contractors with no transportation or haulina related activities C Workers' Compensation (WC) and Employers Liability (EL)
Reauired for au contractors with emolovees D Endorsements and Conditions·
MINIMUM LIMITS
$1.000,000 per occurrence (CSL) Bodily Injury and Property Damage
$1.000,000 per occurrence (CSL) Any Auto
Bodily Injury and Property Damage
WC: Statutory limits
EL: $1 000 000 oer accident for bodilv iniurv or disease
1. ADDITIONAL INSURED: All insurance required above with the exception of Commercial or Business Automobile liability, Workers' Compensation and Employers Liability. shall be endorsed to name as additional insured: County of Alameda, its Board of Supervisors. the individual members thereof. and all County officers. agents. employees. volunteers. and representatives.
The Additional Insured endorsement shall be at least as broad as ISO Form Number CG 20 38 04 13.
2. DURATION OF COVERAGE: All required insurance shall be maintained during the entire term of the Agreement In addition.
Insurance poflcies and coverage(s) written on a daims-made basis shall be maintained during the entire tenn of the Agreement and until 3 years following the later of termination of the Agreement and acceptance of all work provided under the Agreement.
with the retroactive date of said insurance (as may be applicable) concurrent with the commencement of activities pursuant to this Agreement.
3. REDUCTIO.N OR LIMIT OF OBLIGATION: All insurance policies, including excess and l.lllbrella insurance policies. shall indude an endorsement and be primary and non-conlributory and will nol seek contribution from any other insurance (or self- insurance) available to the County. The primary and non-<:0ntributory endorsement shall be at least as broad as ISO Form 20 01 0413. Pursuant to the provisions of this Agreement insurance effected or procured by the Contractor shall not reduce or limit Contractor's contractual obligation to indemnify and defend the lndermified Parties.
4. INSURER FINANCIAL RA TING: Insurance shall be maintained through an insurer with a A.M. Best Rating of no less than A:Vll or equivalent. shall be admitted to the State of California unless otherwise waived by Risk Management. and with deductible amounts acceptable to the County. Acceptance of Contractor's insurance by County shall not relieve or decrease the liability of Contractor hereunder. Any deductible or self-insll'ed retention amount or other similar obligation under the policies shall be the sole responsibility of the Contractor.
5. SUBCONTRACTORS: Contractor shall include au subcontractors as an insured (covered party) under its policies or shall verify that the subcontractor. under its own policies and endorsements. has complied with the insurance requirements in this Agreement. including this Exhibit The additional Insured endorsement shall be at least as broad as ISO Form Number CG 20 380413.
6. JOINT VENTURES: If Contractor is an association. partnership or other joint business venture. required insurance shall be provided by one of the following methods:
- Separate insurance policies issued for each individual entity, with each entity included as a "Named Insured" (covered party), or at minimum named as an· Additional Insured" on the other's policies. Coverage shall be at least as broad as in the ISO Forms named above.
- Joint insurance program with the association. partnership or other joint business venture included as a "Named Insured". 7. CANCELLATION OF INSURANCE: All insurance shall be reqlired to provide thirty (30) days advance written notice to the
County of cancellation.
8. CERTIFICATE OF INSURANCE: Before commencing operations under this Agreement, Contractor shall provide Certificate(s) of Insurance and applicable insurance endorsements. in form and satisfactory to County. evidencing that all required insurance coverage is in effect. The County reserves the rights to require the Contractor lo provide complete. certified copies of all required insurance policies. The required cerlificate(s) and endorsements must be sent as set forth in the Notices provision.
:Arificate C-1 Page 1of1 Form2001-1(Rev.02126114)
ACORD® CERTIFICATE OF LIABILITY INSURANCE I
DATE (MM/DD/YYYY)~ 05/16/2017
THIS CERTIFICATE IS ISSUED AS A MATIER 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 BElWEEN 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 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 Doug Auzat Insurance Agency, Inc. ~2~~cT DOUG AUZAT
~~'j!'n ~-·•· 818-84'.'!-124R
I
FAXDoug Auzat, Agent, Lie. # 0065243 iAJC Nol: 818-84'.'!-4'.'!71
E.YAIL
.. ... ..
· 2607 West Olive Ave ADDRESS:
.. •4••
....
Burbank, CA 91505 INSURER(S) AFFORDING COVERAGE NAICf
.. INSURER A: State Farm General Insurance ComDanv 25151
INSURED
Design Action Cooperative Inc. INSURERB:
1730 Franklin St, Ste 103 INSURERC:
Oakland, CA 94612 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
INSR
TYPE OF INSURANCE ~!>!-!':,'!.~ POUCYEFF POLICY EXP
LIMITS
LTR POLICY NUMBER IM IMMID"~
A GENERAL LIABILITY
~!~
EACH OCCURRENCE $ 1,000,000X
COMMERCIAL GENERAL LIABILITY'
92-LT-6233-BG 10/25/2016 10/25/2017 PREMIB'EJ?~~~encel $- D
CLAIMS-MADE[Kl
OCCUR MED EXP (My one person) $ 5,000PERSONAL & ADV INJURY $ 1,000,000
-
GENERALAGGREGAlE $ 2,000,000-
;GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000
1
POLICYn
~tR-rn
LOC $AUTOMOBILE UABILllY ~OMBINEO SINGLt:. L.IMIT
Ea aoctdef\t\ $
-
ANY AUTO BODILY INJURY (Per person) $- ALL OWNED - SCHEDULED
AUTOS AUTOS BODILY INJURY (Per eccident) $
- HIRED AUTOS
-
NON-OWNED AUTOS fp~~~~t?AMAGE $-
-
$ UMBRELLA LIAB
HOCCUR EACH OCCURRENCE $
- EXCESSUAB CLAIMS-MADE AGGREGATE $
OED I I RETENTION$ $
WORKERS COMPENSATION IT~~Ift..'W;,,I IOJ~-
AND EMPLOYERS' LIABILITY YIN
/U'jy PROPRIETOR/PARTNER/EXECUTIVE
D
~ E.L. EACH ACCIDENT $OFFICEIMEMBER EXCLUDED? NIA
(M1ndotory In NH) ~ E.L. DISEASE -EA EMPLOYEE $
If yes, describe under
~·-
..
E.L. DISEASE-POLICY LIMIT $,,,~n•
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Add~lonal Remarlcs Schedule, if more 5P'1Ce Is required)
Additional Insured:
County of Alameda. its Board of Supervisors, the individual members thereof, and all County Officers, agents, employees, volunteers, and representatives.
CERTIFICATE HOLDER
Alameda County Health Care Service Agency 1000 San Leandro Blvd, Suite 300
San Leandro, CA 94577
CANCELLATION
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 (2010/05) The ACORD name and logo are registered 1001486 132849.B 01-23-2013
FE-6494 PAGE 1OF1
SECTION II ADDITIONAL INSURED ENDORSEMENT
Policy No.: 92-LT-6233-8 G Name Insured:
Design Action Cooperative Inc.
1730 Franklin St., Ste 103 Oakland, CA 94612-3489
Additional Insured (include address):
County of Alameda, its Board of Supervisors, the individual members thereof, and all County Officers, agents, employees, volunteers, and representatives.
221 Oak Street, Oakland, CA 94612
Any person or organization where required by written contract
PERMITTEE HEREIN INDEMNIFIES, DEFENDS AND HOLDS HARMLESS THE CITY, IT'S OFFICERS, AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL LIABILITY, DAMAGES, COSTS, LOSSES, CLAIMS AND EXPENSES, INCLUDING ATTORNEY'S FEES AND COSTS, CAUSED OR SUFFERED BY ANY PERSON RESULTING DIRECTLY OR INDIRECTLY FROM OR CONNECTED WITH THE PRIVILEGE OF TEMPORARILY ENCROACHING UPON THE PUBLJC RIGHT-OF-WAY. SAID INDEMNIFICATION AND DEFENSE SHALL INCLUDE ALL AREAS UNDER THE CONTROL OF THE PERMITTEE UNDER THIS AGREEMENT.
WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or suit brought for damages for which you are provided coverage.
The Primary Insurance coverage below applies only when there is an "X" in the box.
~ Primary Insurance. The insurance provided to the Additional Insured shown above shall be Any insurance carried by the Additional Insured shall be noncontributory with respect to Coverage provided to you.
All other provisions of the policy apply.
FE-6494
Attn.: Contract Review:
County of Alameda
Request
for ln&uranceW11iver orChange
(To be comp/mcf by the Contracting Deparlmtnt}Fax or QIC
to:
Rl$k Managemert Unit Fax 272-6815 or 2-6815 I QIC 28505- - - · - - -- (Sr.
Risk & lnsuranoo Analyst)-
Phooe:Fax
Backto:
Name:Phone:
Date of Request: - - -·
~~ount
ofCon~: lb ~ ~ .
Tennof Cciitract: _7 fr I
'htC&> -b I oo/ J-tJt ~
NameofContractor:
WS lt'~
__L\?;...!bCY\ -~· fi(..,.t
1v<e, ~.
1. What do you
want to
waive or change (W=walve a C"'Change)?2 .
a) C<iverage (s): General Liability _ _ Auto Liability
Q
Professl9nal Liability__ Workers'Comp 'VJ
otf1er Required
Coverages:
b) Changeinlimits: GeneralLiatAlity: From$1,000,000toL _ __ . __ ,peroccurrence Auto Uablllty: From $1 ,000,000 to $ _ __ per occurrence ProfeSsional LiabiUty: From $1,000,000 to$______ _per claim
Other
CowrageUmits: - - - -- -.,--- •c) Reason:
No e.mrta p ,,Q_;:J N, 'l)'Y\ ~~ ·. u >, ~ri, :
.....)~~dYl-~~
Request for Time Waiver: Cove.(s) · List# of d requested __ ~ _
. (This alk>ws Contractor time to bind the insurance !>afore the Contract teim begins)
3
. F~rWorken' Compenaation Waiver,
pfuse
haveContractor sign this
de~laration:Declaration:
With respect to the abo\'e-mcntioned business, I hereby warrant that the business has no employees other than the owners, officers, dircctars, partners or other principals who have elected to be eiu:ropt from Worker's Coxnpcnsatioo. coverage in accordance with California Jaw.
1
further warrant
that I understand the requirements of Section 3 700 etseq.
of the Calif~ Labor Code with respect to providing Worker's Compensation coverage for any cmpl<>ycc6 of the above mentioned business. l agree to comply with the code requirements and all other applicable laws and regulations rc:g11tdlng\vorkers compensation,
payroll taxes, FICA and tax withholdingand
similar eroplO)'mCll.t issues. I further agree to holdthe
County of Alameda harmless from Joss or liability whichmay
arise fromthe
failure of the above-mentioned business to coinply with any such laws or regulations. I therefcre request that the County of Alameda waive its requirement fur evidence of Workers' Compc11sation insurance in connection with the above-re&r ced work.~~~~ 61.a:-111-
Nod.(~_?±rujlc ~--- ·- UJ~-
1 ~llfl)peNanie Title
4. Please attach a COJ1f
of
the Scope of Strvlces.&idliSd::Uil:•:tchs&sauUwhilh>• ",.,..,. ... ,..;
''*
·~... ,.., ...
..,.,'T>, .... , ... -•• .,..4•-••-••••.,•• ... ••~•·-••-i••'"**""••--u-·•,..•••'"u"*u•..,••,..:tt'***""'u..,01Hu"*uw'*'•..,••,..,,...,. .... ,.,._. .. ,.. .. ...,ut...,ui....o..-.uThis Section to be completed by Risk Managemert
ldtntffy Riek to County:
w.~~-- G";t~A·
Denied_. - Charlge: Granted _ _ Denied_I
C()fl~•: Av~ lnsunmce Pr, m hes been developedfor
canttJctors who do not heve ()(cannot sJford tht requitedt
lnslftl!CO. PleBse <Mar;t the Risk Management for lnfonnation. - - -·- - - 'Authorized Slgnatuni: _
Date:h/,Jj
,~1
Rev: OtmlOll
\
State Farm
A . CALIFORNIA INSURANCE CARD
State Farm Mutual Automobile Insurance Company 900 Old River Road Bakersfield, CA 93311
INSURED WHITEHEAD, JAMES JR AND MUTL
KHASTAGIR, NADIA VOL
POLICY NUMBER256 7882-D06-75A EFFECTIVE YR 2000 MAKE VOLKSWAGEN APR 06 2017 TO OCT 06 2017 MODEL PASSAT VIN WVWMA23BOYP345314
AGENT DOUG W AUZAT 3662-A18
PHONE 1818)843-1150 NAIC 25178
COVERAGE! PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW.
COVERAGES A 0500 G500 H R1 U U1
SEE REVERSE SIDE FDR AN EXPUNATIDN .
. ... .
EXHIBITD
COUNTY OF ALAMEDA
DEBARMENT AND SUSPENSION CERTIFICATION
The contractor, under penalty of perjury, certifies that, except as noted below, contractor, its principals, and any named or unnamed subcontractor:
• Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency;
• Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past three years;
• Does not have a proposed debarment pending; and
• Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessary result in denial of award, but will be considered in
determining contractor responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action.
Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Standard Services Agreement.
Signing this Standard Services Agreement on the signature portion thereof shall also constitute signature of this Certification.
CONTRACTOR: Design Action Cooperative
PRINCIPAL: Nadia Khastagir TITLE: Marketing Consultant
SIGNATIJRE: c;dt,A,).;t, ~ DATE: ilt -:r /q /
ExhibitD Page 1of1
