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HomeMy WebLinkAboutIGOE ADMINISTRATIVE SERVICES (3)DocuSign Envelope ID: 10DC72A2-A9C6-40FB-A2DC-2AB28AF423E9 A-2020-200,4-03 N INSURANCE NOT ON FILE n, WORK MAY NQT PROCEED CLERK OF COUNCIITHIRD AMEctz NDMENT TO SPENDING ACCOUNT DATE: ADMINISTRATIVE SERVICES AGREEMENT WITH IGOE ADMINISTRATIVE SERVICES �- yirttlola) THIS THIRD AMENDMENT TO AGREEMENT is entered into this 2-3 day of February 2021, by and between IGOE & Company Incorporated, dba IGOE Administrative Services ("IGOE"), and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City"). City and IGOE are also referred to collectively as "the Parties." RECITALS A. On October 20, 2020, City entered into Agreement A-2020-200A-01, a Spending Account Administrative Services Agreement ("Agreement") with IGOE. B. City and IGOE entered into a First Amendment to the Agreement on November 3, 2020 (#A-2020-200A-01) to correct insurance requirements that were inadvertently omitted from the Agreement. C. Thereafter, City and IGOE entered into a Second Amendment to the Agreement (#A-2020- 200A-02) to amend IGOE's standard ACH payment provision to allow Client to compensate IGOE by physical check or wire transfer for services rendered after receipt of a proper invoice D. In accordance with the terms and conditions of the Agreement, the parties desire to amend the agreement to include additional services to be provided by IGOE regarding the Plan Design Change -Consolidated Appropriations Act, 2021, and an increase in compensation to cover the service fee for said services. THE PARTIES THEREFORE AGREE: Exhibit A to the Agreement regarding Spending Account Services, shall be amended to include Exhibit A-1 to this Third Amendment detailing the additional services including Plan Amendments, Summary Plan Descriptions, System Updates, and customized participant communication options as outlined by IGOE to implement as directed by the City. 2. Compensation shall be amended per the terms in Exhibit A-1 to allow for payment of services in the amount of $100. Except as hereinabove modified, the terms and conditions of said Agreement, as amended, remain unchanged and in full force and effect. [Signatures on the following page] Page 1 of 2 DocuSign Envelope ID: 10DC72A2-A9C6-40FB-A2DC-2AB28AF423E9 A-2020-200A-03 IN WITNESS WHEREOF, the parties hereto have executed this Third Amendment to the Agreement the date and year first above written. ATTEST: DAISY GOMEZ�`+�� Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho, City Attorney �'i By: JOSE MONTOYA Deputy City Attorney Vxecutive Director, Human Resources Department CITY OF SANTA ANA ld�KTINE RIDG City Manager CONSULTANT Uccu9lgn.d by: � auras M'6A ,• rtaAkKiollay, C O Page 2 of 2 DocuSign Envelope ID: 10DC72A2-A9C6-40FB-A2DC-2AB28AF423E9 EXHIBIT A-1 to Third Amendment Plan Design Change -Consolidated Appropriations Act, 2021 The purpose of this form is to collect all information necessary to update your Plan design in response to COVID-19. Overview The Consolidated Appropriations Act, 2021 allows clients to electively adopt any combination of the following changes: • Allow unlimited carryover of funds from plan year ending in 2020 and in 2021 for the following account types: o Health FSA o Dependent Care Assistance Plans (DCA) • Extend a Grace Period that ended in 2020 or will end in 2021 to a full 12-month period following the original plan year end date for the following account types: o Health FSA o DCA • Extend previously adopted relaxed change in status rules so that they apply for the plan year ending in 2021 or adopt them for the first time for the plan year ending in 2021. For new adopters, changes are prospective. • Allow employees who terminated in 2020 or 2021 to spend down balances in their Health FSA. • Allow reimbursement for daycare expenses for children up to the age of 14 if the dependent aged out (turned 14 during the previous plan year, provided that enrollment in the DCA took place on or prior to January 1, 2020. To make these changes, a Plan Amendment is required but does not need to be completed until December 31, 2021. As a result, employers have time to consider what changes they wish to apply to their plan even when those changes are retroactive to plan years ending in 2020. Employer may wish to review their final run out activity reporting before making any retroactive plan design changes. Please note that Igoe will automatically update claim management to allow qualified account holders to claim dependent care reimbursement for children up to the age of 14. No action is needed on your part. To ease the review and adoption process, Igoe has put together a preferred plan design option for your review within this Statement of Work. Instructions 1. Please complete the following form in its entirety. Basic Client Information Company Name (Client):City of Santa Ana Plan Design Change CAA 2021 COVID-19—SOW: Page 1 iC UE © Igoe Administrative Services DocuSign Envelope ID: tODC72A2-A9C6-40FS-A2DC-2AB28AF423E9 EXHIBIT A-1 to Third Amendment Igoe Recommendations: Fee: $100: Services include Plan Amendments, Summary Plan Descriptions, System Updates, customized participant communication options. This fee is billed one time. To qualify for this discounted package, you must select an option listed in each of the below 6 sections. If you are not able to select options for each of the 6 sections below, please proceed to the Additional Relief Section of this Statement of Work. Add and/or Increase Carryover for All Eligible Plans Carryover amounts can now be unlimited for plan years that end in 2020 and 2021. Additionally, carryover is now available for both Health FSAs and/or Dependent Care Assistance Plans (DCA). The carryover option is highly recommended for the following reasons: ➢ Preserves the employee's ability to use contributed plan funds which can in turn increase adoption of this benefit and promote good will toward your benefit package as a whole ➢ Allows employers and employees to have flexibility with future plan designs as carryover funds, when designed correctly, do not prohibit HSA contributions (unlike the grace period feature) ➢ Simplifies the accountholder's user experience by keeping all spendable funds in a single plan year view ➢ Allows finance to close out administration for old plan years after a standard run out period has ended ➢ Contains costs for per participant/per account -based fee structures 1. ® Change/Add Carryover to my Health FSA/s for the full value allowed in the plan year ending in 2021. Include the plan year that ended in 2020: ® Yes ❑ No Client agrees to automatically recalibrate the carryover amount to the maximum allowed each applicable plan year, if the maximum value is adjusted ($50 annual charge applies if future adjustments are made as a result of newly indexed amounts). Additionally, please set up the Carryover with the following provisions (chose one): ❑ Add minimum carryover value of $20 OR © Add minimum carryover value of $0.00 for 2020 & $0.00 for 2021 (Input $0 if you do not want to have a minimum carryover value.) 2. 0 Allow carryover funds to be waived or moved into a Limited Purpose FSA (LPFSA) if an employee wishes to accept and/or begin making HSA contributions in the future. I understand that I will need to inform Igoe as part of open enrollment if any accountholder choses to waive carryover or move funds into an LPFSA. If you do not have an LPFSA and wish to add one, check here: ❑ ® Add Carryover to my DCA forthe full value allowed for the plan years that end in the calendar year indicated below. If you do not have the grace period and do not wish to add it, indicate that below.. By checking this box, Igoe is authorized to amend out any Grace Period (if applicable). NOTE: minimum carryover values will match selections made in the Health FSA Carryover section above. Plan Design Change CAA 2021 COVID-19 — SOW: Page 2 �IGVL' © Igoe Administrative Services DocuSign Envelope ID: 10DC72A2-A9C6-40FB-A2DC-2AB28AF423E9 EXHIBIT A-1 to Third Amendment ® 2020 N 2021 ❑ Client does not have the Grace period Provision and is opting not to add the carryover or extended grace period feature at this time. 4. Client agrees to wait for guidance and before adding spend down to the Health FSA. No Additional amendment fees will apply if this change is adopted in response to guidance prior to December 31, 2021. ❑ Please put client on the interest list and reach out once guidance is available. N Client is not interested I this option S. N Add Spend Down to my DCAs (please check this box if you are not sure if your plan includes this provision and want to make sure it has been added). Please also select whether you wish to make this change retroactive to the plan year that ended in 2020: ❑ No 6. Optional: Add/or Extend Mid -Year Election Changes Without Requiring a Qualifying Event as listed below. These provisions are prospective for new adopters or will be extended to the end of the plan year ending in 2021 for employers that adopted this provision under the CARES Act. ➢ Health FSA: revoke an election ➢ Health FSA: make anew election ➢ Health FSA: increase/decrease an election NOTE: If an employee makes a new Health FSA election, they will not be able to contribute to an HSA (if applicable) ➢ DCA: revoke an election ➢ DCA: make a new election ➢ DCA: increase/decrease an election N Add prospectively ❑ Extend ❑ Client did not adopt this provision and wishes not to at this time. Plan Design Change CAA 2021 COVID-19 —SOW: Page 3 C/LUF' © Igoe Administrative Services 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 . "A ,AFF. III1RINT I'Ill I I111 ^i 1111,10E ,CLR I" CLLEE CI I I'Ill1 , GREE OIEL I" 'O 111IE CLERIC OL 1.7111E COLLCI➢L 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: N Ma W I[s] 0IMIN:4.1lere 01 PROFESSIONAL LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 9/6/2022 10:48 AM POLICY EXPIRATION COI DATE FILE NAME NUMBER DATE MPL429896821 11/05/2022 08/15/2022 Cert of Ins - City of Santa Ana.pdf 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 NOTICE OF COMPLIANCE n,',II"try sIrA1:II:'::: n°'O 5 II�AGIEh AP1 JIIl) IIII`VIR:,II II II I)III![ MpIi ni Iro If II°'OII."": n II II:ii oii: If II is R:oi VV`VIR":,IIIL. 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) area TYPE OF INSURANCE POLICY EXPIRATION COI DATE FILE NAME NUMBER DATE Cert of Ins - PROFESSIONAL LIABILITY TER5325644 11/05/2024 11/02/2023 City of Santa Ana.PDF CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01 /09/2024 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 (066)467-8730 FAX (A/C, No, Ext): (A/C, No): The Hartford Business Servic enter I �J I LC31 S[gn, 3600 VU Antonio, T Blvd I E-MAIL San Antonio, TX 78251 ADDRESS: INSLJFER(S) AFFOWING COVERAGE A NAIC# INSURED INSURER A: o 'tin J%en C T y Igoe & Company, Incorporated DBA Igoe AdmirA e Services, INSURER B: Incorporated INSURER C 10905 TECHNOLOGY PL ST SAN DIEGO CA 92127-1811 IR c e INSURE 0 L 4 U 4 &tV U -i :%j np..R 1 nR -n]7,n COVERAGES CERTIFICATE NUMBER: R WSI N NW WR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE' )W' AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED.NOTVATHSTANDING ANY REQUIREMENT, TERM OR CO ID'-.JN 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence X MED EXP (Any one person) $10,000 General Liability A X 72 SBA BF9102 02/07/2024 02/07/2025 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ❑ PRO- LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY (Per person) ANY AUTO A ALL OWNED SCHEDULED AUTOS AUTOS 72 SBA BF9102 02/07/2024 02/07/2025 BODILY INJURY (Per accident) X HIRED NON -OWNED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 A EXCESS LIAB CLAIMS- MADE 72 SBA BF9102 02/07/2024 02/07/2025 AGGREGATE $2,000,000 DED X RETENTION $ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT ANY YIN PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA 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 BF9102 02/07/2024 02/07/2025 Each Claim Limit Aggregate Limit $2,000,000 $4,000,000 DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. 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 as provided by the Business Liability form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Division 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 RisieManagemaltDiviaian REVIEWED & APPROVED BY: © 1988-2015 ACORD COf �,­91�9Aawdo — J Risk Management Specialist ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/28/2024 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 CONTACT Stephanie Tran NAME:PHONE g18 233-0825 FAX No : 818 561-7117 A/C No Ext: ( ) ( ) ADDRIESS: info@whins.com Westlake Village, CA 91362 INSURER(S) AFFORDING COVERAGE NAIC # License #: OG66655 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: 00003536-639998 REVISION NUMBER: 67 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 $ CLAIMS-MADE1:1 OCCUR DAM AGETORENTED PREMISES Ea occurrence $ MED FRCP (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 YERS' LIABILITY AND EMPLOYERS' LIABILITY AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A WC PI 891143-000 03/01/2024 03/01/2025 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 12000,000 B Errors & Omissions TER 5325644 11/05/2023 11/05/2024 Each Claim 3,000,000 C Cyber Liability AB-6664879-01 12/09/2023 12/09/2024 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. SHOULD ANY OF THE ABOVE DESCRI City of Santa Ana THE EXPIRATION DATE THEREOF, NO Risk DMsIan Risk Management Division ACCORDANCE WITH THE POLICY PRC si"�`€,aF REM�D�OVED BY: 20 Civic Center Plaza ;z AaN44 Santa Ana CA 92702 AUTHORIZED RESENTATIVE � — J Risk Management Specialist 988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are regi ered marks of ACORD Printed by SKT on 02/28/2024 at 10:44AM THE HARTFORD BUSINESS SERVICE CENTER THE `"`''' ' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of Santa Ana Human Resources Department 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 Account Information: Igoe & Company, Incorporated Policy Holder Details : DBA Igoe Administrative Services, Incorporated January 14, 2025 Ll Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 ;►► CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/14/2025 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 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: PHONE (866)467-8730 (A/C, No, Ext): FAX (A/C, No): 72186575 The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Underwriters Insurance Company 30104 Igoe & Company, Incorporated DBA Igoe Administrative Services, INSURERB: Incorporated 10905 TECHNOLOGY PL STE A INSURERC: INSURER D SAN DIEGO CA 92127-1811 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED $1 000 000 PREMISES Ea occurrence X MED EXP (Any one person) $10,000 General Liability A X 72 SBA BH9RMS 02/07/2025 02/07/2026 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ❑ PRO- X JECT ❑ LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000 Ea accident BODILY INJURY (Per person) ANY AUTO A ALL OWNED SCHEDULED AUTOS AUTOS 72 SBA BH9RMS 02/07/2025 02/07/2026 BODILY INJURY (Per accident) X HIRED NON -OWNED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) X UMBRELLA LABX OCCUR EACH OCCURRENCE $2,000,000 A EXCESS LAB CLAIMS- MADE 72 SBA BH9RMS 02/07/2025 02/07/2026 AGGREGATE $2,000,000 DED RETENTION $ 10,000 WORKERS COMPENSATION PER OTH- AN D EMPLOYERS' LIABILITY YSTATUTE ER E.L. EACH ACCIDENT ANY Y/N PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A 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 02/07/2025 02/07/2026 Each Claim Limit Aggregate Limit $2,000,000 $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. 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. 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 APPROVED- ----------------------------------------------------------------------------- © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Digitally signed byTu Tu Tran Tran Nguyen Date:2025.02.04 Nguyen 14:31:11-08'00' ACCORD® CERTIFICATE OF LIABILITY INSURANCE �.....�1 DATE(MMIDD/YYYY) 1/31/2025 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 CONTACT Stephanie Tran PHONE FAX A/c No Ext: (818)233-0825 A/C No: (818)561-7117 ADDRESS: info@whins.com Westlake Village, CA 91362 INSURER(S) AFFORDING COVERAGE NAIC# License #: OG66655 INSURERA: The Pie Insurance Company 21857 INSURED Igoe & Company, Incorporated DBA: Igoe Administrative Services INSURER B : Great American E & S Insurance Company 37532 INSURER : 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: 71 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 CONTRACTOR 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-MADE1:1 OCCUR PREMI DAMAGE TO PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY D PRO- JECT LOC 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 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N WC PI 891143-000 3/1/2024 3/1/2025 PER 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 $ 12000,000 B Errors & Omissions TER 5827942 11/5/2024 11/5/2025 Each Claim 3,000,000 C Cyber Liability AB-6664879-02 12/9/2024 12/9/2025 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. 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 SK @ 1981fW04015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by SKT on 01/31/2025 at 04:17PM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE 11' HARTFORD BLANKET ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision that such person or organization be added as an additional insured on your Coverage Part, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. However, no such person or organization is an additional insured under this provision if such person or organization is included as an additional insured by any other endorsement issued by us and made a part of this Coverage Part. The insurance afforded to such additional insured will not be broader than that which you are required by the contract, agreement, or permit to provide for such additional insured. The insurance afforded to such additional insured only applies to the extent permitted by law. The limits of insurance that apply to additional insureds are described in Section D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS. a. Vendors Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (1) The insurance afforded to the vendor is subject to the following additional exclusions: This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Form SL 30 32 06 21 Page 1 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE 11' HARTFORD (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b. Lessors Of Equipment (1) Any person or organization from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after you cease to lease that equipment. c. Lessors Of Land Or Premises (1) Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) Any 'occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. d. Architects, Engineers Or Surveyors (1) Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" 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: (a) In connection with your premises; (b) In the performance of your ongoing operations performed by you or on your behalf; or (c) In connection with "your work" and included within the "products -completed operations hazard", but only if: (i) The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: (1) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (ii) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the "bodily injury", "property Form SL 30 32 06 21 Page 2 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE 11' HARTFORD damage", or "personal and advertising injury" arises out of the rendering of or the failure to render any professional service. e. State Or Governmental Agency Or Subdivision Or Political Subdivision Issuing Permit (1) Any state or governmental agency or subdivision or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (b) "Bodily injury" or "property damage" included within the "products -completed operations hazard". f. Any Other Party (1) Any other person or organization who is not in one of the categories or classes listed above in Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" 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: (a) In the performance of your ongoing operations performed by you or on your behalf; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products -completed operations hazard", but only if: (i) The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the "bodily injury", "property damage", or "personal and advertising injury" arises out of the rendering of or the failure to render any professional service described in Paragraphs f.(2)(a) or f.(2)(b) above. Form SL 30 32 06 21 Page 3 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) 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) 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