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HomeMy WebLinkAboutNATIONAL CENTER FOR SAFETY INITIATIVES, LLC.Dowq nvelope ID: 304580EC-4319-4C34-8C29-AEC86722752C N-2020-140 LJLAnANLL ON FILE ;v6RK MAY PROCEED :INPI, INSURANCE EXPIRES )a a0 AGREEMENT FOR BACKGROUND SCREENING REPORTS CLERK OF COUNCIL BETWEEN THE CITY OF SANTA ANA AND i7F NATIONAL CENTER FOR SAFETY INITIATIVES, LLC �' 1 f�(t���hleiy,H AGREEMENT is �(1 1c�ts m � made and entered into on this 16th day of March, 2020 by and between National Center for Safety Initiatives, LLC, a Delaware limited liability company, ("NCSINCSI"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain NCS1 to complete background screening reports. B. NCSI represents that NCSI is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, NCSI represents that it is knowledgeable in its field and that any services performed by NCSI under this Agreement will be performed in compliance with such standards as may reasonably be expected from a consumer reporting agency in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES NCSI shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Exhibit A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and NCSI agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit A. The total amount to be expended during the term of this Agreement shall not exceed S 5;000. Any charges or costs, including but not limited to surcharges and other fees levied by federal, state, county, other governmental agencies, educational institutions, employer verification lines and licensing agencies, incurred by NCSI in servicing City, may be passed on to City in accordance with the City's pricing program with the Company. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work, which fails to meet the standards of performance set forth in the Recitals, which may reasonably be expected by City. Page 1 of 8 #31029v2 DocuSign Envelope ID: 304580EC-43194C34-8C29-AEC86722752C 3. TERM This Agreement shall commence on the date first written above for a five (5) year term, ending -March 15, 2025 unless tenninated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR NCSI shall, during the entire tenn of this Agreement, be construed to be an independent NCSI and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which NCSI performs the services which are the subject matter of this Agreement; however, the services to be provided by NCSI shall be provided in a manner consistent with all applicable standards and regulations governing such services. NCSI shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by NCSI under this Agreement ("Documents & Data"). NCSI makes no such representation and warranty about Documents & Data, which were provided to NCSI by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Prior to undertaking performance of work under this Agreement, NCSI shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Corr nereialGeneral Liability Insurance. NCSI shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of NCSI's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) include the City, its officers, employees, agents, and Page 2 of S #31029v2 DocuSigm Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. W6 er's Compelft'Vftn Insurance. In accordance with the provisions of Section 3700 of the Labor Code, Contractor, if NCSI has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, NCSI agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. C. The following requirements apply to the insurance to be provided by NCSI pursuant to this section: i. NCSI shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ii. Certificates of insurance shall be fumished to the City upon execution of this Agreement and shall be approved by the City. iii. Certificates and policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. iv. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. V. NCSI shall supply City with a fully executed additional insured endorsement. d. if NCSI fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith tenninate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. NCSI waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 7. INDEMNIFICATION & WARRANTIES NCSI agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of third party claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of NCSI, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any third party claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This Page 3 of 8 #31029v2 DocuSlgn Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. Notwithstanding the foregoing, to the extent NCSI's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. NCSI does not guarantee City's compliance with all applicable laws in its use of reported information, and does not provide legal or other compliance related services upon which City may rely in connection with its fiirnishing of reports. City understands that any documents, information, conversations or communication with NCSI's representatives regarding searches, verifications or other services offered by NCSI are not to be considered a legal opinion regarding such use. City agrees that (1) it will consult with its own legal or other counsel regarding the use of background screening information, including but not limited to, the legality of using or relying on reported information and to review any forms as well as the content of prescribed notices, adverse or pre -adverse action letters and any attachments to this Agreement for compliance with all applicable laws and regulations and (2) the provision of such notices, pre -adverse or adverse action letters and the contents thereof is the sole responsibility of City not NCSI. 8. INTELLECTUAL PROPERTY INDEMNIFICATION NCSI shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by NCSI to the City pursuant to this Agreement. 9. RECORDS NCSI shall keep records and invoices in connection with the work to be performed under this Agreement. NCSI shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to NCSI under this Agreement. All such records and invoices shall be clearly identifiable. NCSI shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours upon reasonable notice and limited to once per year without cause. 10. CONFIDENTIALITY Neither party shall reveal, publish or otherwise disclose any Confidential Information to any third party without the prior written consent of the other party and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. The Parties agree to keep this information confidential at all times during the term of this Agreement, and continuing for five years after receipt of any Confidential Information. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, Page 4 of 8 #31029v2 DocuSlgn,Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of NCSI disclosed in a publicly available source; (c) is in rightful possession of NCSI without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the NCSI without reference to information disclosed by the City. It. CONFLICT OF INTEREST CLAUSE NCSI covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION NCSI shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. NCSI affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and NCSI, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of NCS I. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate NCSI or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein, 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of NCSI, NCSI may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services, which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. Page 5 of 8 #31029v2 DocuSign Envelope ID: 304580EC-4319-4C34-8C29-AEC88722752C 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, NCSI shall be entitled to receive and the City shall pay NCSI compensation for all services performed by NCSI prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require NCSI to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and NCSI consents to the City's use thereof for such purposes as the City deerns appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES NCSI shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. NCSI shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: Page 6 of 8 #31029v2 DocuSign•Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Executive Director, Human Resources Agency City of Santa Ana 20 Civic Center Plaza (M-34) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 647-6930 To Contractor: Ryan Hurley, Director of Safety National Center for Safety Initiatives, LLC 807 Broadway Street NE, Suite 300 Minneapolis, MN 55413 Fax: (866) 996-1292 Email: ryan.hurley@sportsengine.coin A party may change its address by giving notice in writing to the other party,. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terns of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. Page 7 of 8 #31029v2 DocuSign Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C N-2020-140 b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Daisy Gomez Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: �w,,,6t, A • � Vl Laura A. Rossini Senior Assistant City Attorney FOR Steven V. $ll#m Executive Vector Human Resources Agency #31029v2 AL: CITY OF SANTA ANA " Kristine Ridge City Manager NCSI: JZYA . 0"y Ryan Hurley Director of Safety Page 8 of 8 DocuSign. Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C EXHIBIT A SCOPE OF SERVICES SCHEDULE A -SCREENING PROGRAM DESCRIPTION AND PRICING A. Screening Services. For each Individual (as defined in this Agreement), NCSI shall conduct the following searches 1. The NCSI national screening program includes: • One independent, screened and selected Multi -Jurisdictional Database searches available state sex offender registries • Social security number validation conducted through one database o For registrants who require further identity validation, Company will initiate the verification process and reach out directly to the registrant via email to verify data. o All searches will be placed on hold until the required information is provided by the registrant. The Company will make reasonable attempt(s) to reach the registrant. If the required information is not received within 30 days of the original submission date, the screening request will be cancelled, and cannot be reopened or refunded • Address history records conducted through one database o Identity validation based on SSN/Address Trace report • NCSI will use a commercial data provider to conduct a local criminal record search of all jurisdictions in which the Individual has resided in the last five (5) years based on the address the Individual provides and the developed address history records 0 For registrants who are residents of New York State OCA counties, only a multi- jurisdictional database screen will be conducted initially. If the screen results for such registrant return any criminal records, then Company will attempt to verify the records with the NY OCA. End -User (client) may request for the Company to add the NY OCA fees to their program, in which case the End User will be responsible for the pass -through fee in addition to the base price. • The scope of the searches will be based on the information from public record data sources that the commercial data providers have available at the time of the multi -jurisdictional search is conducted. The available public record data sources may be accessed by the End- User on NCSI's website. Available public record data sources may change at any time without notice and it is the sole responsibility of the Company to confirm that the then available public record data sources include those jurisdictions that the Company wants to be searched. DocuSign Envelope ID: 304580EC-4319-4C34-8C29-AEC86722752C Any possible criminal record returned by a database provider (with a disposition date in the last seven 7 years) will be verified at the source of information. ii. All searches conducted above shall cover seven years (or longest period legally available if information is not available for a minimum seven years). iii. Pricing: $18.50 per screening for the Gold Standard Program. NCSI reserves the right to change pricing upon thirty (30) days' notice to the End -User, in order to adapt to any material fees levied by local or federal institutions. B. Additional offerings upon request and additional fees: L Federal District Court Search (es) ii. International Criminal Records Search(es) iii. Motor Vehicle Records iv. Education and - $7.50 (may include additional fees) v. Employment Verification - $7.50 (may include additional fees) vi. Professional Credential verification - S 10.00 C. Change in standard services in the Gold Standard offering NCSI reserves the right to update the standard services as provided through the Gold Standard product offering in order to adapt to local and federal regulations and continue to provide the quality of search as described in this Schedule. The specifics of the offering, can always be viewed at ncsisafe.com Dgiully,igned r, F Ira, Francine R. Villareal vii—el pare: mm.aen IM nwurar ` cc> o CERTIFICATE OF LIABILITY INSURANCE DAT71202DDn rvvl gam7n9zo 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 USA Inc. 1717 Arch Street Philadelphia, PA 19103-2797 Alin: NBCU.Ceorequest@marsh.com Fax 212-948-5143 CONTACT NAME; PHONE FAK Exit N. A/C No: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICS CN701608515-NBCU-GAWUW-19- INSURER A: ACE American Insurance Company 22667 INSURED NBCUnivemal Media, LLC INSURER B: Indemnity Ins Co Of North America 43S75 INSURER C: ACE Property And Casualty Ins Cc 20699 a fully owned subsidiary of Comcast Corporation 30 Rockefeller Plaza New York, NY 10112 INSURER D: ACE Fire Underwriters Ins. Co, 20702 INSURER E: INSURER F: C_GVERAbCJ IaK I ]FICA I NDMFPR' CIF-nnR53.m J,Lm DOLnclnsd anlnnecca. c 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 LTR TYPE OF INSURANCE ND —DI = POLICYNUMBER MM/U�IYEYYV POLICYXP LIMITS A X COMMERCIAL GENERAL LIABILITY M OCCUR SIR: $100,000 XSLG7144756A 12101/2019 12JW(2620: EACH OCCURRENCE $ 9,900,000 —RENTED -UAMCLAIMS-MADE PREMISES PREMISES Ea occurrence Ea occurrence) $ 9,900,000 X MED EXP(Any one person) $ 10,000 PERSONAL 3 ADV INJURY $ 9,900,000 AGGREGATE LIMIT APPLIES PER POLICY ❑ JEST LOG GENERALAGGREGATE $ 40,000,000 GENT X PRODUCTS - COMP/OP AGG $ 10,000,000 $ OTHER: A AUTOMOBILE LIABILITY ANY AUTO ISAH25285438 1210t12019 12/01I2020 COMBINED SINGLE LIMIT Ea accident $ 10,000,000 X BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED ONLY AUTOSONLY (Per actldent) $HIRED Y DAMAGEAUTOS ent $X UMBRELLA LIAB X OCCUR XOO G27924840005 1210112019 VJ0112020 CURRENCE s 10,000,000EXCESS W(PerJURY $ 10,000,000BEO LIAB CLAIM'-MADEATE RETENTION$ $WORKERS COMPENSATION ANDEMPLOYERS'LIABILRY YIN in NH) If yes, describe under NIA WLRC66040677(ADS) WLRC66040719(CA, MA) SCFC66040793(WI) 121112019 1MI12019 1210112019 12/01/2020 1210112020OFFICERIMEMBEREXCLUDED1 12/01/2020 OTH- TUTE ERAANYPROPRIETORIPARTNERIEXECUT1VE ACCIDENT $ 2,000,000(Mandatory ASE-EA EMPLOYE $ 2,000,000 E.L. DISEASE -POLICY LIMIT Lie $ 2,000,000 DESCRIPTION OF OPERATIONS below A Excess Workers Compensation WCUC6604W56 (WA) 1210112019 12101/2020 Ea Accf[As Employee/Dis 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Addltlanal Remarks Schedule, maybe attached if more space is required) RE: Service Contract between SpodsEngine Inc. -NCSI and City of Santa Ana, CA NBCUniversal Media, LLC subsidence include, but are not limited to: Spore Engine Inc. dba National Center for Safely Initiatives LLC The Certificate Holder is included as additional insured (except workers' compensation) where required by written contract with the Named Insured. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Please see attached for Notice of Cancellation endorsements. City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 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 of Marsh USA Inc. Manashi Mukherjee �a-lylyl 988.2016 ACORD CI ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rtakfilanage 1entDiviabin 9x. REVIEWED S APPROVED BY I� Risk Management Analyst01 y NOTICE TO OTHERS. ENDORSEMENT -SPECIFIC PARTIES THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. A_, If we can_obl the Policy prior to Its expiration date by notice to You or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice Of cancellation, via'such electronic or otkier form of notiflcatioij as we determine to the persons or organizations listed In -the schedule set out below (the "5chodule"). You or your representative must provide us with both, the physical and e-mail address of such persons or organizations; and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B, We will endeavor to send or deliver such notice to the e-mail, address or physical address corresponding to each person. or organization indicated in the :Schedule at least 30 .days prior to the canceftat€on date appiicabfo to._the Policy; C:- The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) ,named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person,(s) or organization(s): Our Failure to provide advance notification of cancellation to the porsoh(s) or organization(s) shown, In the Schedule.shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Poticy. D, We are hot responsible for verffying any information provided to us in any Schedule, nor are we responsible for any incorrect information -'that you or your representative provide to ;us. If you of your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you noryour representative provides us with e-mail and physical addeess'Information with respect to a particular person or organization, then we ,half have no responsibility for taking action with regard to such parsonor entity under this endorsement: E. We may arrange with your representative to send such notice in the event of any such cancellation. Ft You will cooporate with us in providing; or In causing your representative to provide, the e-mail address and physical address of the persons or organizations listed In the Schedule. G. This endorsement does not apply in the event that you cancel the Policy. SCHEDULE Name of Certificate Holder E-Mail Address Physical Address City -oafSanta Ana Risk Management Division) 8 2.0 CivicCenter plaza, 4th floor, - - -- .Santa Ana, CA 427U1 ALL-32688 (01111) RiekMenVMer&;Dmewn RWEWED&APPR�/W�p�EDUYp RskManagementAnalyst Name of Certificate Holder E-Mail Address Physical Address. All other terms and conditions of the Policy remain unchanged. ALL,-32688 (01 / 11) -- F -- -�" Authorized Representative s.y Riek MmiegementDEviefun x IZEVIEWED&APPR(NED Y: t�l Ffias,rvna �.. V«Efdnrd�" Kisk ManagerncntAlil t NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES Namedlnsursd - Endorsormt. Number- Comoest Corporation P611cy SymWl G7144750A - Policy PonoU 'Ermoth,eeatrs e.of Endoement XS4 .,.. 1211119-to 12/112d .., Issued By tNmeofansdrence Gam puny) . ACE American Insurance Cornpany msert me policy pummel. in a remmnonr of meMrorma non is tobo complied only When this engprsommt hi kowud subseg4ient to the prepe elipn. of the pollcy, .. THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY, Ay If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for'any .reason other than nonpayment of prenliu r, We will endeavor, as set out below, to send written notice of cancellation, Via such electronic- or other form of notification as we determine, to the persons yr organizations listed In the schedule set out below (the "Schedule"), You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mall address or physical address that you or your representative provided to us on such S. We will endeavor to send or deliver :such notice to the a -mail address or physical address corresponding to each person `or organization indicated in the Schedule at -least 30 days prior to the Cancellation date applicab[a to the Policy. C. The notice refere%nced In this endorsement is intended only to be a courtesy notification to the person(s) or organizabon(s) named In the Schedule in the event of a pending cancellation of coverage. We have he legal obligation of any kind to any such person(s) or orgaiization(s)c Our failure to provide advance notification of cancellation to the persons) or organization(s) shown in the. Schodul.e shall impose no obligation or liability of any kind uporr us, our agents or representatives, will not extend. any Policy cancellation date and will not negate any cancellation of the Policy_ D. We are not responsible for, verifying any information provided to us in any ,Schedule, nor are we .responsible for any incorrect information that you or your representative provide to Ids. if you be youe representative does not provide us with the information necessary to complete the Schedule, wefiave no responsibility .for taking any action under this endorsement. In addition, if neither you nor your reprosentative provides- us with e-mall and physical address information with respect to a particular person or organizatfon, then we shall have no responsibility for taking action with regard to such E, We may arrange with your representative to send such notice in. the event; of any such cancellations.: F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail. address and physical address of the persons or organizations listed to the Schedule. G. This endorsement does not apply In the event that you cancel the Policy, SCHEDULE Name of Certificate Holder E-Mali Address Physical Address City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th ftoor Santa Ana, CA 9M,11 ALL-32688 (01/11 ) P.AMunag0nmtD1vbbn 1l Xw p`f //R�EVIEWED&ryAP'PARIoevpmgy):: F Mi Wir.Mt ICW.nPr'M':aC Risk ManagementAnalyet All other teems and conditions of the Policy remain anchat ged> ALL-32688 (01/ 11) Authrst'ized Repres'etttetive allys Br WekM &APPRovEoewn :� f � ((R'�EVIEWER6gqAP`PR,O##V��Eq BW)) ll 'S ('�ekl•6u5�C R.V4kyMph'Ct t Risk Manage.ment Analyst WORKERS' COMPENSATION AND EMPLOYERS LIABILITY POLICY Na4fed.ln5ured; Comcast Corporation Endorsement Numbor" Po116y Numudr Symbol WLR NnmbocC66040719. Pofidy Pariod, - - Effective Dale of Endom.ment(- 1211 19 TO,12?1120 lasuod BY (Nnirq of nsursnce company): Indomnity Insdrance Co of North America tr)aerit¢@ goliay nnmbdc The remafnd er: or the utrormggon is to $e een7plpted only wlteli this endoasem"ontis�ssuodsubserytleni to Ihu, yreparation tiflhu pd€(ay: NOTICE TO OTHERS ENDORSEMENT-;SPEGIF C PARTIES; A. If we cancel this Policy prior to: its expiration date by notice to you or the first Named.. insured for any reason other than nonpayment of premium, we will endeavor, as set out below,10 send written notice of cancellation, via such electronic or other"form of notification as we determine, to the persons or organizations listed in the schedule set out below (tlo "Schedule"). You or your representative must provido us with both the physical ;and e-mail_ address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule, 13. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding;_ to each person or organization Indicated in the Schedule at least 30 days prior to the cancellation date= applicable to the Policy. C. The notice referenced in this endorsement is Intended only to he a courtesy notification to the persons) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organizatlon(s,). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind) upon us, our agents or representatives, will not extend any Policy, cancellation date and will not negate any cancellation of the, Policy, 1). We are not responsible for verifying any information provided to LIS in any Schedule, nor are we responsiole;fnr any Incnnact information that you or your representative provide to us_ If you or your representative does riot provide us with the Information necessary to complete the Schedule, we have he responsibility for taking any action under this andorsoment, In addition, If neither you nor your representative provides us with e-mall and physical ;address informarboh with respect to a pa'cular person or organization, then we shall have no responsibility for taking action with regard to such person or entity Linder this endorsement. E. We may arrange with your representative to send such notice in the event ofanysuch cancellation: F. You will cooperate with us in providing, or In causing' your representative to provide; the e-mail address and physical address of, the persons or organizations listed in the Schedule. G. This endorsement does not apply in the event that you cancel the Policy. SCHEDULE Name of Certificate Holder E-Mail Address Physical Address City o€Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 qc S; 03 t i (vii i i ) Page 1 of,2 Ja sv, , yK°� '� I Wok Managzmam6Divieton -R2gEwEc&APPR0/maY: �o' Risk Managenien(Analyst C All other terms and conditions of this Policy remain unchanged.. Authorized Representative WC ys 03 7r (OVII ) Pa9e.2 of 2 �pZ,&"Ix ��FnMwdat h., �+,G{�kAA4i Risk Management Analyst Anderson Camba, Ashleigh From: RMD Sent: Wednesday, August 12, 2020 11:15 AM To: Anderson Camba, Ashleigh Subject: RE: Request COI Review: NBCUNIVERSAL Media, LLC (NCSI is our Contractor) Attachments: NBCUniversal Media, LLC COI_ RMD08122020.pdf Hi Ashleigh, The attached Col documents have been reviewed and approved by Risk Management. Thank you, Francine R. Villareal I Risk Management Analyst City of Santa Ana I Risk Management a division of Human Resources Department Phone: (714)647-5470 1 RMD Email: RMD@Santa-Ana.org Modmizing-Rish idrrough Posl&e Changed City Hall is closed every other Friday. Click here fora list of observed holidays and Friday closure dates. }„ This e-mail (and attachments, if any) may be subject to the California Public Records Act, and as such, may, therefore, be j m 2 0 `Z 0 subject to public disclosure unless otherwise exempt under the Act. e, n Ir s, _ sANTA ANACOUNTS From: Anderson Camba, Ashleigh <AAndersonCamba@santa-ana.org> Sent: Monday, August 10, 2020 7:05 AM To: RMD <rmd@santa-ana.org> Subject: RE: Request COI Review: NBCUNIVERSAL Media, LLC (NCSI is our Contractor) Hi Francine, Here is the updated COI. Thank you, Ashleigh Anderson Camba I Human Resources Techniclan Human Resources Department 1 20 Civic Center Plaza I Santa Ana, CA 92701 714-647-5349 1 aanderencanbp a santa-ana,oEg I Litt www.santa-ana.or This e-mail (and attachments, if any) maybe subject to the California Public Records Act and as such, may, therefore, be subject to public disclosure unless otherwise exempt under the Act. City Hall is closed every other Friday. Click here for dates From: RMD Sent: Friday, July 31, 2020 3:29 PM 1 Francine R. oi�yvow�mr�.�a Villareal o.aanai ® CERTIFICATE OF LIABILITY INSURANCE D^;E92020DYYYY) 1t.i 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 CONTACT NAME: Marsh USAlnc. FAX NNa 1717 Arch Strad AHC Ent,(A/C, No): E-MAIL ADDRESS: Philadelphia, PA 19103-2797 Atb: NBCU.Certrequest@mamh.com Fax 212-948-5143 INSURER(S) AFFORDING COVERAGE NAICN INSURER A : ACE American Insurance Company 22667 CN10160851 SNBCU-GAWUW-20- INSURED NBCUniversal Media, LLC INSURER B : Indemnity Ins Co Of North America 43575 INSURERC: ACE Property And C asualty Ins Co 20699 a fully owned subsidiary of Comcast Corporabon 30 Rockefeller Plaza INSURER D : ACE Fire Underwriters Ins. Co. 20702 NewYork,NY 10112 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: CLE-006533573-04 REVISION NUMBER: 8 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 R OF INSURANCE ADDTYPE INSD WVDSIUBR POLICYNUMBER POLICY MMIDY DVYV POLICY Y MMDDVYV LIMITS A X COMMERCIAL GENERAL LIABILITY XSLG71447510 12/01/2020 12/012021 EACH OCCURRENCE $ 14,900,000 CLAIMS -MADE IX I OCCUR PREMISES Ea occurrence $ 14,900,000 X MED EXP (Any one person) $ 10,000 SIR: $100,000 PERSONAL B ADV INJURY $ 14,900,000 GEML AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 60,000,000 POLICY PRO ❑ EDT LOG X PRODUCTS - COMPIOPAGG $ 15,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISA H25305590 12/01/2020 12/012021 COMBINED SINGLE LIMIT Ea accident' $ 15,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR XEU G27924840006 12/01/2020 12/012021 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN RIIMEMBER EXCLUDED' N (Mandatory in NH) NIA WLR C67458928(ADS) WLR C67458965 (CA, MA) SCF C67459040(INI) 12Po1/2020 12/01/2020 12/012021 12/012021 12/012021 OT X PER H- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000OFFIC E.L. DISEASE - EA EMPLOYEE $ 2,000,000 f yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT 2,000,000 $ A Excess Workers Compensation WCU C67459003(INA) 12/01/2020 12/012021 Ea Acc/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEH IC LES (AC 0RD 181, Additional Remarks Schedule, may be attached if more space is required) RE'. Service Contract between SportsEngine Inc. - NCS I and City of Santa Ana, CA NBCUniversal Media, LLC subsidiaries include, but are not limited to Sports Engine Inc. dips National Center for Safety Initiatives LLC The Certificate Holder is included as additional insured (except workers' compensation) where required by written contract with the Named Insured. This insurance is primary and non contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Please see attached for Notice of Cancellation endorsements. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza, 4th floor ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. MariMukherjee _Sz[n,! WskMRnagemerdDivildot REVIEWED & APPROVEDBY: © 1988.2016 ACORD C Z. (1,Q ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '�' Risk Management Analyst NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES Named Insured Endorsement Number Comcast Corporation Policy Symbol H25285438 Policy Period Effective Date of Endorsement ISA 1211119 to 12/1120 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed oNy, when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the "Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule- B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy- D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. E. We may arrange with your representative to send such notice in the event of any such Cancellation- F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical address of the persons or organizations listed in. the Schedule- G. This endorsement does not apply in the event that you cancel the Policy SCHEDULE Name of Certificate Holder E-Mail Address Physical Address City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 ALL-32688 (01/11) Risk hl enagonentDhisian REV EWED & APPRovm By., '� Risk Management Analyst Name of Certificate Holder I E-Mail Address I Physical Address All other terms and conditions of the Policy remain unchanged. ALL-32688 (01111 Authorized Representative Rime Management DMsian REVIEWED&APPROVED By: '� Risk Management Analyst NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES Named Insured Endorsement Number Comcast Corporation Policy Symbol G7144756A Policy Period Effective Date of Endorsement XSL 1211119 to 12/1120 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the "Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule- B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy- D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. E. We may arrange with your representative to send such notice in the event of any such Cancellation- F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical address of the persons or organizations listed in. the Schedule- G. This endorsement does not apply in the event that you cancel the Policy SCHEDULE Name of Certificate Holder E-Mail Address Physical Address City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 ALL-32688 (01/11) Ride Mrenagment Dhisian REV EWED & APPRovm By., '� Risk Management Analyst AB other terms and conditions of the Policy remain unchanged. ALL-32688 (01111 Authorized Representative Rime Mattagmient DMsinn REVIEWED&APPRDVEDBY: '� Risk Management Analyst WORKERS' COMPENSATION AND EMPLOYERS LIABILITY POLICY Named Insured. Endorsement Numbe, COmcast Corporation Policy Number Symbor. WLR Number. C66040719 Policy Period; EffecSve Date of Endorsement. 12/1119 TO 1211f20 Issued By (Name M Insurance company). Indemnity Insurance Co. of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the "Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy- C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with the information necessary to complete the Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. E. We may arrange with your representative to send such notice in the event of any such cancellation- F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical address of the persons or organizations listed in the Schedule. G. This endorsement does not apply in the event that you cancel the Policy. SCHEDULE Name of Certificate Holder E-Mail Address Physical Address City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 WG 99 03 71 (01111) Pane 1 of 2 Risk Mrrnagement Division REVIEWED&APPROVED By., '� Risk Management Analyst All other terms and conditions of this Policy remain unchanged. Authorized Representative WC 99 03 71 (01111) Page 2of2 Rime Management DMsinn REVIEWED&APPROVED By: '� Risk Management Analyst NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor National Center for Safety Initiatives, LLC Name: Project N-2020-140 Number: Agreement For Background Screening Reports Between The Project City Of Santa Ana And National Center For Safety Initiatives, Name: LLC The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: POLICY EXPIRATION COI TYPE OF INSURANCE FILE NAME NUMBER DATE DATE cert_CLE_City of GENERAL LIABILITY XSLG47308859 12/01/2023 11/30/2022 Santa Ana_6533573_11.pdf WORKERS COMPENSATION SportsEngine's COI - AND EMPLOYERS' SCFC70307881WI 12/01/2023 11/28/2022 2023.pdf LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 12/15/2022 6:44 PM