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HomeMy WebLinkAboutIGOE ADIMISNTRATIVE SERVICESAILI, ,mK MAY PROCEED UNTIL INSURANCE EXPIRES _ S- I •�JLi CLERK OF COUNCIL PATE A-2020-20OA-01 FIRST AMENDMENT TO SPENDING ACCOUNT ADMINISTRATIVE SERVICES r� (I ( ma y, p AGREEMENT WITH IGOE ADMINISTRATIVE SERVICES �S��rlGb�ot� S9- THIS FIRST AMENDMENT TO AGREEMENT is entered into on this 3`d day of November 2020, by and between IGOE & Company Incorporated dba IGOE Administrative Services ("IGOE"), and the City of Santa Ana, a charter city and municipal corporation duty organized and existing under the Constitution and laws of the State of California ("City"). IGOE and City are also referred to collectively as "the Parties." RECITALS A. The Parties entered into Agreement #A-2020-2AA approved October 20, 2020 ("Agreement") by which IGOE agreed to provide City with employee spending account administrative services. The Agreement is current and in effect. B. Certain insurance requirements were inadvertently omitted from the Agreement. IGOE acknowledge the City's minimum insurance requirements and the Parties hereby amend the Agreement to include those provisions herein. Now, therefore, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except as herein modified, the Parties agree as follows: THE PARTIES THEREFORE AGREE: 1. Section 5-1, INSURANCE, is added to the Agreement to read as follows: A. Prior to undertaking performance of work under this Agreement, IGOE shall maintain and shall require its subcontractors, if any, to obtain and maintain Professional Liability (Errors and Omissions) Insurance appropriate to IGOE's provision of administrative services, access to and handling of monetary funds, and processing of claims and benefits with limits no less than $2,000,000 per occurrence or claim, and $2,000,000 aggregate. If IGOE maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by IGOE. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. B. The following requirements apply to the insurance to be provided by IGOE pursuant to this section: 1) IGOE shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. 2) IGOE shall firmish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause). 3) Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 4) The certificate and policies shall state that the policies are primary and not contributory and shall not be canceled, reduced in coverage, or changed in any other material aspect without thirty (30) days' prior written notice to the City. 5) Where the amounts or coverage provided by the certificate of insurance provides coverage greater than that listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. #63945v1 DocuSign Envelope ID: 668CC5FA-86004A1C-8251-1259999D7E72 A-2020-20OA-01 6) If IGOE 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 terminate this Agreement. Such termination shall not affect IGOE'S right to be paid for its time and materials expended prior to notification of termination. IGOE waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. Except as hereinabove modified by this First Amendment, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement the date and year fast above written. ATTEST: DAISY MMEZI Clerk of the CouAcil APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Laura A. Rossini Acting Chief Assistant City Attorney Executive Director of Human Resources Agency CITY OF SANTA ANA %94�� KRISTINE RIDGE City Manager IGOE Do.Slg.ed by: �a.wa i'�7c Kisu�, 9pF@1<F�fiel�ay President/ CEO (Name) (Title) #63945vl Francine R. Villareal CERTIFICATE OF LIABILITY INSURANCE Digitally signed by Francine R. Villareal Date: 2022.02.1 1 DATE (MM/DD/YYYY) 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 WHINS Insurance Agency PHONE .... Stephanie Tran 7610 BeverlyBlvd #48249 PHONE Ext) (818)233 0825 FAX No) (818)561-7117 E-MAIL ........ ....... ................ Los Angeles, CA 90048 ADDRESS Stephanie@whlns.com License #: OG66655 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA AmG.UARD Insurance Comnanv �42390 INSURED Igoe & Company, Incorporated INSURER,B Lloyd's of London ---- DBA Igoe Administrative Services INSURER c Palomar Exce..ss and Surplus Insurance Compony----- 16754 ........ 10905 Technology PI Ste A INSURERD Hiscox Insurance Company --Inc 10200 .......... San Diego, CA 92127 INSURER.E INSURER F : COVERAGES CERTIFICATE NUMBER: 00003536-319686 REVISION NUMBER: 41 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY Y IGBP256625 09/03/2021 09/03/2022 EACH OCCURRENCE $ 1, 00,000 CLAIMS -MADE I X OCCUR DAMAGE TO RENTED PREMISES(Eaoccurrence) $. 50�000 ......... ......... ......... ......... MED EXP (Any one person) $ 5 000 ... ........ ......... ......... PERSONAL & ADV INJURY ... ... $ 1,000,000 ................. GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X- PRO - POLICY ECT l LOC PRODUCTS COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE --------- LIABILITY IGBP256625 09/03/2021 09/03/2022 COMBINED SINGLE LIMIT ....-(Eaaccident) ..................................................... $ .....-1_,000,...0.0........... ANY AUTO BODILY INJURY (Per person) $ ........ OWNED SCHEDULED .... ......... ......... ......... BODILY INJURY (Per accident) ......... ................. $ --------- AUTOS ONLY .................. AUTOS X HIRED NON -OWNED X PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY _(Per accident) ... ........... ................................................... A X UMBRELLA X OCCUR --------- IGUM235783 09/03/2021 09/03/2022 .... EACH OCCURRENCE $ 2,000,000 ...... ......... ................. EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000,000 DED RETENTION $ $ A WORKERS COMPENSATION IGWC301479 03/01/2022 03/01/2023 X ATUTE OERH ST AND EMPLOYERS' LIABILITY Y / N - ---- ---- .--- - --. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH,ACCIDENT $ 1 ,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A .E ----........................................... E.L. DISEASE - EA EMPLOYE $ 1 ,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ 1 ,000,000 B Errors & Omissions MPL4298968.21 11/05/2021 11/05/2022 Each Claim 3,000,000 C Cyber Liability QCB-250-OQK5PILM 12/09/2021 12/09/2022 Aggregate 3,000,000 D Crime UC24068163.22 02/09/2022 02/09/2023 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to Insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are additionally insured on this policy per endorsement BP 04 48 01 06. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory per CG 20 01 04 13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHOR�SENTATIVE Ii:AManagmentDMsian Santa Ana, CA 92702 k4e 1°x REVIEWED &APPROVED BY.- 1 988-2015 ACORD C 1,- MER Risk Pjanagement Analyst ACORD 25 (2016/03) The ACORD name and logo are regi ered marks of ACORD Prin , POLICY NUMBER: IGBP256625 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: 111 91041*8141TA041:1zwelely/:l SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Santa Ana officers, agents, employees, and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An In- sured in Section II — Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. BP 04 48 01 06 © ISO Properties, Inc., 2004 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESSOWNERS BP 14 88 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph H. Other 2. You have agreed in writing in a contract or Insurance of Section III — Common Policy agreement that this insurance would be Conditions and supersedes any provision to the primary and would not seek contribution from contrary: any other insurance available to the additional Primary And Noncontributory Insurance insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and BP 14 88 07 13 © Insurance Services Office, Inc., 2012 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst NOTICE OF COMPLIANCE CITY t„„ . "A ,AM I1111RINT I'III I IPi I1111 AGL ,CLL INCLUDE Ck I 111 1AGREEMENTTOT111IL CLERK CAL MIL COUNCIL IL Contractor Igoe & Company, Incorporated Name: Project A-2020-20OA-03 Number: Project Third Amendment To Spending Account Administrative Name: Services Agreement With Igoe Administrative Services 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: TYPE OF INSURANCE PROFESSIONAL LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 11/14/2022 12:49 PM POLICY EXPIRATION NUMBER DATE MPL429896822 11/05/2023 COI DATE FILE NAME Cert of Ins - 11/04/2022 City of Santa Ana.pdf ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/05/2025 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 WHINS Insurance Agency 5760 Lindero Canyon Rd. #1045 Westlake Village, CA 91362 CONTACTNAMEStephanie Tran PHONE g18 233-0825 FAX 818 561-7117 Ext : ( ) A/C No : ( ) /C, a L° ADDRESS: info@whins.com License #: OG66655 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: The Pie Insurance Company 21857 INSURED Igoe &Company, Incorporated DBA: Igoe Administrative Services INSURER B : Great American E & S Insurance Company 37532 INSURERC: At -Bay Specialty Insurance Company 19607 10905 Technology PI Ste A INSURER D7 San Diego, CA 92127 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00003536-0 REVISION NUMBER: 74 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 1:1OCCUR DAMAGE TO RENTED PREMISESccurrrence)$ (E. occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A AND EMPS YERS' LSA IONILIT AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN Y WC PI 891143-001 03/01/2025 03/01/2026 X STATUTE EEPERTR E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 B Errors & Omissions TER 5827942 11/05/2024 11/05/2025 Each Claim 3,000,000 C Cyber Liability AB-6664879-02 12/09/2024 12/09/2025 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to Insured's operations. Waiver of subrogation applies per endorsement WC 04 03 16, subject to policy terms. Tu Tran byT�Tr- °ed APPROVED Nguyen Nguyen Dzte:2025.03.06 By Tu Tran Nguyen at 8:41 am, Mar 06, 2025 08:41:40-08'00' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE i Santa Ana, CA 92702 1_1�— _ - (SKT) ACORD 25 (2016/03) @ 19�84015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by SKT on 03/05/2025 at 02:47PM WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA (Ed. 04-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.05 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person Or Organization Job Description City of Milpitas Administration of requestor's FSA and Cobra employee benefits. CITY OF SANTA ANA Benefits Administration ( customer service/data entry) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/05/2025 Policy No. WC PI 891143-001 Endorsement No. 003 Insured Igoe & Company Incorporated Insurance Company The Pie Insurance Company Countersigned By yAc WC 04 03 06 (Ed. 04-84) ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/05/2025 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 WHINS Insurance Agency 5760 Lindero Canyon Rd. #1045 Westlake Village, CA 91362 CONTACTNAMEStephanie Tran PHONE g18 233-0825 FAX 818 561-7117 EXt : ( ) A/C No): ( ) a"/ Lo ADDRESS: info@whins.com License #: OG66655 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: The Pie Insurance Company 21857 INSURED Igoe &Company, Incorporated DBA: Igoe Administrative Services INSURER B : Great American E & S Insurance Company 37532 INSURERC: At -Bay Specialty Insurance Company 19607 10905 Technology PI Ste A INSURER D : San Diego, CA 92127 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00003536-0 REVISION NUMBER: 74 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MWDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR PREMISES TO RENTED DAMACLAIMS-MADE1:1 PREMISES Ea occurrence $ IVIED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICYEl PRO LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A IONILIT AND EMPLOYERS' LIABILITY AND EMPLOYERS' YERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N Y WC PI 891143-001 03/01/2025 03/01/2026 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Errors 8r Omissions TER 5827942 11/05/2024 11/05/2025 Each Claim 3,000,000 C Cyber Liability AB-6664879-02 12/09/2024 12/09/2025 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Those usual to Insured's operations. Waiver of subrogation applies per endorsement WC 04 03 16, subject to policy terms. Tu an APPROVED Tu Tran Dgitaltysigned b Tr Nguyen Nguyen Date: 2025.03.06 By Tu Tran Nguyen at 8:41 am, Mar 06, 2025 08:41:40-08'00' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 (SKT) ACORD 25 (2016/03) © 19g84015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by SKT on 03/05/2025 at 02:47PM WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 04-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.05 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person Or Organization Job Description City of Milpitas Administration of requestor's FSA and Cobra employee benefits. CITY OF SANTA ANA Benefits Administration ( customer service/data entry) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/05/2025 Policy No. WC PI 891143-001 Endorsement No. 003 Insured Igoe & Company Incorporated Insurance Company The Pie Insurance Company Countersigned By WC 04 03 06 (Ed. 04-84) 7TE,(MMIDDfYYYY) ACORO° CERTIFICATE OF LIABILITY INSURANCE05/2025 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 CONTACTAME� Stephanie Tran WHINS Insurance Agency / APHONE 5760 Lindero Canyon Rd. #1045 aL° Ex : (g18 233-0825 No): (818)561-7117C, Westlake Village, CA 91362 ADDRESS: info@whins.com License #: OG66655 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: American Casualty Company 20427 INSURED Igoe &Company, Incorporated INSURER B: Great American E&S Insurance Company 37532 DBA: Igoe Administrative Services INSURERC: Certain Underwriters at Lloyd's AA112200 10905 Technology PI Ste A INSURER D7 San Diego, CA 92127 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00003536-0 REVISION NUMBER: 76 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A AND EMPS YERS'LSA IONILIT 7039343574 07/01/2025 07/01/2026 X STATUTE EEPERTR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Errors & Omissions TER5780121 11/05/2025 11/05/2026 Each Claim 3,000,000 C Cyber Liability ES00040562973 12/09/2025 12/09/2026 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to Insured's operations. APPROVED By Tu Tran Nguyen at 10:34 am,Nov 20,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE I I %_ (SKT) @ 1988-2 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SKT on 11/05/2025 at 10:34AM ATE CERTIFICATE OF LIABILITY INSURANCE D 01/29/20 6 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 be endorsed. If SUBROGATIONIS 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 WHINS INSURANCE AGENCY LLC/PHS NAME: 72186575 PHONE (866)467-8730 FAX (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 VUseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Underwriters Insurance Company 30104 Igoe&Company, Incorporated DBA Igoe Administrative Services, INSURER B: Incorporated 10905 TECHNOLOGY PL STE A INSURERC: SAN DIEGO CA 92127-1811 INSURER D 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $1 000 000 PREMISES Ea occurrence X General Liability MED EXP(Any one person) $10,000 A X X 72 SBA BH9RMS 02/07/2026 02/07/2027 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X JECT ❑LOC PRODUCTS-COMP/OPAGG $4,000,000 POLICY ❑PRO- OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) A ALL OWNED SCHEDULED 72 SBA BH9RMS 02/07/2026 02/07/2027 BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) X UMBRELLA LABX OCCUR EACH OCCURRENCE $2,000,000 EXCESS LAB CLAIMS- AGGREGATE $2,000,000 A MADE 72 SBA BH9RMS 02/07/2026 02/07/2027 DED RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AN D EMPLOYERS'LIABILITY YSTATUTE ER ANY YIN E.L.EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below A Employee Benefits Liability 72 SBA BH9RMS 02/07/2026 02/07/2027 Each Claim Limit $2,000,000 Aggregate Limit $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is require APPROVED Those usual to the Insured's Operations. By Charlene R.Mum at 3:28 pm,Feb 06,2026 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Human Resources Department BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-4058 AUTHORIZED REPRESENTATIVE �i,4eotil 6f ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: Y'� ne• - ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED WHINS INSURANCE AGENCY LLC/PHS IGOE &COMPANY, INCORPORATED DBA IGOE POLICY NUMBER ADMINISTRATIVE SERVICES, INCORPORATED SEE ACORD 25 10905 TECHNOLOGY PL STE A CARRIER NAIC CODE SAN DI EGO CA 921 27-1 81 1 SEE ACORD 25 EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Santa Ana, its officers, agents, employees, and volunteers, but only as required by a valid written contract, agreement, or permit is an additional insured per the Business Liability Coverage Part includes a Blanket Additional Insured By Contract Endorsement, Form SL 30 32, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00 00, attached to this policy. ACORD 101 (2014/01) ©2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD