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HomeMy WebLinkAboutKEENAN & ASSOCIATES (4)y INSURANCE ON FILE WORT( MAY PROCEED INSURANCE EXPIRES UNTIL N CLERK Of COUNCIL DATE: A-2021-082 Exhibit I AMENDMENT No. 2 This Amendmenf hereby amends the Consulting Agreement ("Agreement") dated June 21, 2016 by and between Keenan & Associates and City of Santa Ana (hereinafter referred to collectively as the "Parties") as follows: WHEREAS the Parties wish to add KeenanWell services to this agreement; and WHEREAS, the Parties desire to continue their relationship subject to the terms and conditions outlined in the agreement; NOW, THEREFORE, the Parties agree as follows: 1. Additionallv, Statement of Work No. 1 - KeenanWell ("SOW No. 1") is hereby added as pursuant to the attached terms and conditions. 2. all the remaining terms and conditions of the Agreement shall remain unchanged and in full force and effect, and shall govern the conduct of the Parties during the Renewal Term. 3. The effective date of this Amendment is June 1, 2021. 1. Each person signing this Amendment to the Agreement on behalf of a Party represents and warrants that he or she has the necessary authority to bind such Patty and that this Amendment is binding on and enforceable against such Party. .\mcnJmcn[ Vo. 3 6ecnan & \,,o6, es—L.iunse #1451171 ( Confidential lntn[mahun—Por Clem Csc Onle (Rc,. 12/2020) Page 1 d4 STATEMENT OF WORK No. 1— KeenanWell Health Management Consulting Services ("SOW No. 1") This SOW No. 1 shall commence on June 1, 2021 and shall be effective until June 30, 2021. a. Section 1 Scope of Services is amended to add: ",Additionally, Consultant shall perform the services (Program Tasks) as set forth in this SOW No. 1." b. Section 2 Compensation is hereby amended as follows to add 2C KeenanWell compensation: "c. Notwithstanding the foregoing, City agrees to pay Consultant a sum of twenty-five thousand dollars ($25,000.00), ten thousand dollars ($10,000.00) shall be for the KeenanWell Services and fifteen thousand dollars ($15,000.00) shall be for the Third - Party Vendor products and/or services described in this SOW No. 1. The payment for Keenan's is a separate and distinct amount from any amounts for third - party vendor products and/or services. In no instance shall the amount for Keenan's Services offset the amount for third -party vendor products and/or services, nor shall the amount for third -party vendor products and/or services offset the amount for Keenan's Services. This amount shall be due in full on June 1, 2021, and shall be considered fully earned as of June 30, 2021 and non -cancellable. Additionally, Client shall be invoiced for any additional fees, including but not limited to thud -party vendor services or products, relating to the KeenanWell Services. Further, if an increase in services is requested, KeenanWell will provide an updated proposal of such applicable increase in compensation." c. The Term of this SOW No. 1 shall be limited to June 1, 2021 and shall be effective until June 30, 2021, and shall be subject to the Parties executing a separate written renewal amendment confirming that this SOW No. 1 will renew. d. Keenan shall provide the following KeenanWell services to assist Client in developing and implementing its health management program from June 1, 2021 to June 30, 2021 are as follows: Continuer) on page 3. .-Amendment No. 2 Keenan & dssocia[es— Lwc .,e #0451271 { Confidential Information— for Client Use Only !e� (Rev. 12/2020) Page 2 of 4 !S- KeenanWell Consulting Services 1. Leveraging the Wellness Committee • Determine purpose, structure, and function e Identify committee responsibilities • assist with meeting agendas and facilitating meetings 2. Crafting a Program Strategic Plan • Develop a best -practice program design based on the organization's needs, interests, and program goals/objectives « Design an incentive plan • Assist with rewards fulfillment and tracking • Develop strategies to establish a wellness culture 3. Identifying and Recommending Program Resources • Review existing health carrier resources and help the organization leverage available resources + Gather information from third -party wellness vendors and assist with vendor/sub-contractor. Procurement as needed • Identify program gaps and recommend appropriate additional resources via health carriers and third -party vendors • Serve as the liaison between the organization and health carriers and vendors/sub- contractors for wellness resources and programming 4. Communications and Promotion • Develop multimedia communication strategies including promotional language, flyers, email templates, and rewards winner announcements • Create communications materials to promote wellness program offerings • Provide guidance on health promotion best practices and utilization of communication pieces • Create communication timeline for applicable wellness programs and campaigns *This $10,000 amount is paid for Keenan's Services only. It is a separate and distinct amount of $15,000 from Item No. 5 below, which is strictly for third -party vendor products and/or services. In no instance shall the amount in Item No. 5 below offset this amount for Keenan's Services in Item Nos 1-4, nor shall the amount in Item Nos 1-4 offset the amount in Item 5. Cost 5. Secure and Pay the Cost of Third -Party Vendor Products and/or Services for Wellness Programming • Online wellness challenges $15,000 • Biometric screenings • Health assessment • Corporate fitness class pass discount program :Amendment No. 2 Keenan & .Associates — License 90451271 ConEdential Information— For Client Use Only ([ice. 12/2020) Page 3 of 4 • Cooling demonstration • Rewards (gift cards, prizes) Subject to availability, COVID-19 regulations, and cost of each service. *A new, separate Consulting Agreement dated July 1, 2021 will carry-over any remainder of the $10,000 for Keenan's services not completed during this Agreement, and any of the $15,000 for third -party vendor products and/or services not utilized during this Agreement. That new Consulting Agreement executed will include an additional amount of $2,000 for Keenan's Services, for a total of $27,000 for the period of June 1, 2021 - June 30, 2021 and July 1, 2021- June 30, 2022. Total Cost Citv of Santa Ana Keenan & Associates Signature, lL Signature:zf.-- By- Kristine A. Ride B Laurie Lofranco Title: City Manager Title: Municipalities Practice Leader Address: Address: 2355 Crenshaw Blvd., Ste. 200 Torrance, CA 90501 Tele_ hone: Tele hone: 310 212-0363 Attention: Attention: Tierne Allen E-mail: E-mail: llof anco@keenan.com A T S oe Si afore: B . Daisy Gomez Title: Clerk of the Council APPRO D AS TO FORM Si ature: for BY-- Sonia R. Carvalho Title. City Attorney RECOMMENBEDFOR APPROVAL Si afore B son Motsick Title: Executive Director of Human Resources ml� Amendment No. 2 Keenan & Assoeiazns — License #0431271 Confi�cntial [nfo�muion — Fbr f tkm Use 0.1, (Rea. 12/2030) Ng. 4oF4 (� t` Digitally signed by Fransme R. Francine R. Villareal Villareal Dace:20n o6.oi 1413.31 dTCO' ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `i 1 05/28/2021 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(les) 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 Jeanne Vezina NAME: AssuredPartners Northeast, LLC. PHONE (914) 761-9000 FAX pNo Ext: Arc, No: (914) 761-3749 123 Main Street aoDREss: leanne.vezina@assured partners.com 14th Floor INSURER(S) AFFORDING COVERAGE NAIC p White Plains NY 10601 INSURERA: Charter Oak Fire Insurance Co 25615 INSURED INSURER B. The Travelers Indemnity Co. 25658 Keenan &Associates INSURER C : Travelers Property Casualty Company of Amedca 25674 c/o The Assured Partners Group, LP INSURER°: Federal Insurance Co. 20281 200 Colonial Center Parkway INSURER E: Ace Amedcan Ins. Co. 37540 Lake Mary FL 32746 INSURER F: COVERAGES CERTIFICATE NUMBER: CL20111362381 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 Um TYPE OF INSURANCE AUDL INSR gUKK Me POLICY NUMBER POLICYEFF MMIDOIYYYY POLICY E P MMIODIYYYY LIMITS X COMMERCIALGENERALLIABILITY CLAIMS -MADE rx� OCCUR EACH OCCURRENCE $ 1.000,000 PREMISES Ea occurrence $ 1.000,000 MED EXP(Anyone pursing) $ 10,000 PERSONAL a ADV INJURY $ 1.000,000 A Y Y 6301 C226998 10/01/2020 10/01/2021 GENIAGGREGATE LIMITAPPLIES PER: X POLICY JE� LOC GENERALAGGREGATE $ 10,000,000 PRODUCTS-COMP/OPAGG $ 2.000,000 $ OTHER: AUTOMOBILE X LIABILITY ANYAUTO COMBINED SINGLE LIMIT Ea accident) $ 1,000,900 BODILY INJURY (Per person) g B OWNED SCHEDULED AUTOS ONLY AUTOS BA6N912905 10/01/2020 10/01/2021 BODILY INJURY Peraccident) S HIRED NO..WNEO AUTOS ONLY AUTOS ONLY q PROPERTY DAMAGE Per accident)$ _S_ — — X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 25,000,000 C Excess LlAe CLAIMS -MADE CUP9J434350 10/01/2020 10/01/2021 AGGREGATE $ 25.000,000 OEO RETENTION $ s$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A Ue-9P291231-20-14-E 10101/2020 10/01/2021 PER _ X STATUTE ERH L. E.EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYEE $ 1-000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 11000,000 EMPLOYEE THEFT D 8225-9951 10/01/2020 10/01/2021 $10,000,000 LIMIT $200,000 DED. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is mourned) Insurer E: Cyber Liability, Policy #D94933262, 11/6/20-11/6/21. $10,000,000 Limit, $250,000 Deductible. Re: City of Santa Ana Employee Benefits Consulting Services Agreement 7/112021-7/30/2022. The City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if required by written contract with respects to General Liability. A waiver of subrogation applies with respects to General Liability. 30 Day Notice of Cancellation applies. City of Santa Ana, Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACOR ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD RiskManegernmL Division rR'EMEWED &AP1P'R.O'VVED BY: >`Aa%-Ult-,tip f AFWiN.I Z. vjt-VAt Risk Management Analyst Policy Number: Y6301C226998 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The 'bodily injury" or 'property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as anadditional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reset REAeweo&APPRCVED BY.' Risk Management MabfA -' COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 6301C226998 ISSUE DATE: 10/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED BY A WRITTEN CONTRACT. Section II — Who Is An Insured is amended to Include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property, damage", "personal injury" or "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; or B. In connection with your premises owned by or rented to you. CG D4 11 04 OR ® 2008 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Oflke, Inc. with Its permission. �.s. Ride Mnnagement Dh isl en a cREVIE+!/ED 6 APPROVED Sr. 6CLL116 7�1 Risk Management Analyst POLICY NUMBER: Y-630-iC226998-COF-18 COMMERCIAL GENERAL LIABILITY GENERAL PURPOSE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SERVICE INDUSTRIES - ASSURED PARTNERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured — Management Con- trol B. Blanket Additional Insured — Broad Form Vendors C. Damage To Premises Rented To You • Perils of fire, explosion, lightning, smoke, water • Limit increased to $300,000 D. Blanket Waiver Of Subrogation E. Blanket Additional Insured —Owners. Mana_oers Or Lessors Of Premises F. Blanket Additional Insured — Lessors Of Leased Equipment G. Incidental Medical Malpractice H. Personal Injury— Assumed By Contract PROVISIONS I. Amended Bodily Injury Definition J. Bodily Injury To Co -Employees And Co -Volunteer Workers K. Aircraft Chartered With Crew L. Non -Owned Watercraft— Increased From 25 Feet To 50 Feet M. Increased Supplementary Payments Cost of bail bonds increased to $2,500 Loss of earnings increased to $500 per day N. Knowledge And Notice Of Occurrence Or Offense O. Unintentional Omission P. Reasonable Force — Bodily Injury Or Property Damage A. BROADENED NAMED INSURED —"MANAGEMENT CONTROL" 1. The following is added to SECTION II- WHO IS AN INSURED: Any "organization" over which you maintain ownership interest or "management control" on the effec- tive date of the policy qualifies as a Named Insured if there is no other insurance which provides simi- lar coverage to that "organization". However, coverage for any such "organization" will cease as of the date during the policy period that you no longer maintain ownership interest or "management con- trol" in such "organization". 2. The following replaces Paragraph 4. of SECTION II- WHO IS AN INSURED: 4. CG T8 00 O 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permit Any "organization" you newly acquire or form and over which you maintain ownership interest or "management control' will qualify as a Named Insured if there is no other insurance which provides similar coverage to that "organization". However: a. Coverage afforded under this provision only applies to the operations of such "organization"; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred beforeyou acquired or formed the "organization'; c. Coverage B does not apply to "personal injury" or "advertising injury" fense committed before you acquired or formed the "organization"; a Rmkroon >r RenEwm & APPRO Br. sll�.®a-r�:L" ��.crr...r� �'V:.((s✓uk ® Risk Manageme.nt Malys[ Of COMMERCIAL GENERAL LIABILITY d. Coverage for any such "organization" will cease as of the date during the policy period that you no longer maintain ownership interest or "management control" in such "organization". 3. The following is added to the DEFINITIONS Section: "Organization" means any of the following: a. Partnership or joint venture; b. Limited liability company; c. Corporation; or d. Trade name. "Management control" means the authorization by written contract executed prior to loss, to do one or more of the following: a. Direct or manage the "organization"; b. Hire or fire "employees" of the "organization"; or c. Enter into contracts binding on the "organization", including contracts to purchase or sell assets on behalf of the "organization", including the right and authority to delegate any of the above activities to others. B. BLANKET ADDITIONAL INSURED —BROAD FORM VENDORS The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. is caused by an "occurrence" that takes place after you have signed and executed that contract or agreement; and b. Arises out of "your products" which are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the limits which you agreed to provide in the writ- ten contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such vendor does not apply to: (f) "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; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor, (4) Repackaging, unless 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; (5) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products'; (6) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your products'; or (7) "Your 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 such vendor. Coverage under this provision does not apply to: 10. PdskManegenentDrvislon REVIEWED 6 APPROVED BY: F4A W . R. VXA Zd Page 2 of 8 ® 2017 The Travelers Indemnity Company. All right reserved. = ''• Risk Management Analyst Includes copyrighted material of Insurance Services Office, Inc., with its permissi CG T8 00 C 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance Services Office, Inc., with its pemii: COMMERCIAL GENERAL LIABILITY a. Any person or organization from whom you have acquired "your products", or any ingredient, part or con- tainer entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional Insured specifically is scheduled by endorsement. C. DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Exclusions c. through In. do not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Paragraph 6. of Section III — Limits Of Insurance. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6. of SECTION III —LIMITS OF INSURANCE; Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Cover- age A for damages because of "property damage" to any one premises while rented to you, or temporari- ly occupied by you with permission of the owner, caused by fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; ex- plosion; lightning; smoke resulting from such fire, explosion, or lightning; water, or any combination of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations of this Coverage Part for Damage To Premises Rented To You Limit. 3. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINITIONS Section: a. A contract for a lease of premises. however, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, explosion, or lightning; or (5) Water. is not an "insured contract"; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV— COMMERCIAL CONDITIONS: Risk Management Division REvt x & APPRMM BY: s3lli1 _lllt.L' F�"-,z Z V.i/Awed Risk Management Analyst COMMERCIAL GENERAL LIABILITY (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SEC- TION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED —OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION 11— WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed; after you have signed and executed that con- tractor agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following provisions: a. The limits of insurance provided to such premises owner, manager or lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collecti- ble other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. BLANKET ADDITIONAL INSURED —LESSORS OF LEASED EQUIPMENT The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to li- ability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury' caused by an offense that is committed, after you have signed and executed that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, which- ever are less. Page 4 of 8 ® 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance Services Office, Inc., with its pennissio t�,044L" Rialtmarvgement Division rR�ene&so 6 APPRovm ar. Rnk Management Analyst COMMERCIAL GENERAL LIABILITY b. The insurance provided to such equipment lessor does not apply to any "bodily injury' or "property dam- age" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to ap- ply on a primary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "occurrence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services" to a person. 2. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies orappliances; c. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emergency medical services for which no compensation is de- manded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION II —WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury` arising out of any providing or failing to provide "incidental medical services" by any of your "employees", other than an employed doctor. Any such "employees" providing or failing to provide "incidental medical services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COW ERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury' or "property damage" arising out of the willful violation of a penal statute or ordinance relat- ing to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in the providing or failing to provide "incidental medical services" to any one person will be considered one "occurrence". 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contin- gent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Par- agraph 2.a.(1) of SECTION II — WHO IS AN INSURED. H. PERSONAL INJURY —ASSUMED BY CONTRACT The following replaces Exclusion a., Contractual Liability, in Paragraph 2. of SECTION I — COVERAG- ES —COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: e. Contractual Liability CG T8 00 m 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance services Office, Inc., with its peuni tz:sk hlwvgm,enE oiP� �n rtE ���� �� WOWED APPROVED Br. "!,6a11"gimm Fv rr a R. V:CLanut Rnk Managem tMalys[ COMMERCIAL GENERAL LIABILITY "Personal injury" or "advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for damages because of "personal injury" assumed in a contract or agreement that is an "insured contract", provided that the "personal injury" is caused by an offense committed subse- quent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or al- ternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAYMENTS — COV- ERAGES A AND B: Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily injury And Prop- erty Damage Liability or Paragraph 2.e. of Section 1 — Coverage B — Personal and Advertising Injury Lia- bility, such payments will.not be deemed to be damages because of "bodily injury", "property damage" or "personal injury", and will not reduce the limits of insurance. 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS — COVERAGES A AND B: d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interests of the indem- nitee; 4. The following replaces the first subparagraph of Paragraph f, of the definition of "Insured contract" in the DEFINITIONS Section: L That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury," "property damage" or "personal injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. I. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. J. BODILY INJURY TO CO -EMPLOYEES AND CO-VOLUNTEERWORKERS The following is added to Paragraph 2.a.(1) of SECTION 11— WHO IS AN INSURED: Paragraph (1)(a) above does not apply to "bodily injury' to a co -"employee" in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily in- jury" to your other "volunteer workers" while performing duties related to the conduct of your business. K. AIRCRAFT CHARTERED WITH CREW The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or property for a charge. Page 6 of 8 © 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance Services Office, Inc., with its pennissi � R/akMmagenentl)rvtalan Renexm & APPROV® By: ® R¢k Managem ntA aipt CG T8 00 ® 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permit COMMERCIAL GENERAL LIABILITY L NON -OWNED WATERCRAFT 1. The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) Fifty feet long or less; and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTION II —WHO IS AN INSURED: Any person or organization that, with your express or implied consent, either uses or is responsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS —COVERAGES A AND B of SECTION I — COVERAGES: b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS —COVERAGES A AND B of SECTION 1— COVERAGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or de- fense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. N. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the insurance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section 11 — Who Is An In- sured: (1) Notice to us of such "occurrence" or offense must be given as soon as practicable only after the "oc- currence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership orjoint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occur- rence" or offense. (2) If you are a partnership, joint venture, limited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, notice to us of such "occurrence" or of- fense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who is: (1) A partner or member of any partnership or joint venture; (ii) A manager of any limited liability company; (iii) A trustee of any trust; or (iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited liability company, trust or other organization to give notice of an "occurrence" or offense. . rs e�wsntavm BY. F11W4.1 P MAnrRl � Ruk Management Malys[ COMMERCIAL GENERAL LIABILITY (3) Notice to us of such "occurrence" or offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons described in Paragraphs e.(1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorsement that provides limited coverage for "bodily injury" or "prop- erty damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which con- tains a requirement that the discharge, release or escape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. O. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Representations, of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. P. REASONABLE FORCE —BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclu- sion does not apply to "bodily injury' or "property damage" resulting from the use of reasonable force to protect any person or property. Page 8 of 8 © 2017 The Travelers Indemnity Company. All right reserved. Includes copyrighted material of Insurance services Office, Inc., with its permissic RideMmJ&rV neitlxvieIm k aw ef`� REAEwm&APPROVE] BYE: q F4446N.0 R. VSAA Risk Management Analyst POLICY NUMBER 6301026998 ISSUE DATE 10-01-2020 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. DESIGNATED ENTITY- NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies Insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR ORGANIZATION: City of Santa Ana, Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ADDRESS: PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 0 2011 The Travelers Indemnity Campany. AN rights reserved. la-044y,. RlakMmagemm1DM5lmt RMAFwED & APPROVED BY. V Risk Management Analyst 01 ACC)Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/03/2020 .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 endorsament(s). PRODUCER CONTACT Heather Verdul NAME: Mike Smith, New Jersey Lic.P&C !Surplus#99401fi5 pN�NNO (201)847-9175 a?c (201)847-9174 Ezt; Ne: E-MAIL hverdui@jaxislns.com ADDRESS: Axis Insurance Services, LLC 795 Franklin Avenue, Suite 210 INSURER(SI AFFORDING COVERAGE NAIC k INSIIRERA: Allied World Insurance Cc 22730 Franklin Lakes NJ 07417 INSURED INSURER B: INSURER C : Keenan & Associates INSURER D: 2355 Crenshaw Blvd, Suite 200 INSURER E Torrance CA 90501 INSURER F: COVERAGES CERTIFICATE NUMBER: I0760 EO20121 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSR WVD POLICY NUMBER POLICY F MMIDDIYYYY) POLICY EXP (MMIDDrYNNY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 15,000,000 CLAIMS -MADE DOCCUR DAMAGE TO RENTED PREMISES Es occurrence S MED EXP(Any oneperson) $ Limits are Per Claim Errors & Omissions PERSONAL &AOV INJURY $ A 0307-7977 10/01/2020 10101/2021 GEN'L AGGREGATE LI MIT APPLIES PER: GENERALAGGREGATE $ 15,000,000 POLICY ❑ PRO- JECTLOG PRODUCTS-COMPIOPAGG $ OTHER: Retro 3/31/2017 Retention Per Claim $ 250,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO I OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY q PROPERTY DAMAGE Per ddent $ 8 1 UMBRELLALIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION I PER OH - AND EMPLOYERS' LIABILITY YIN STATUTE 11 1 ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be atfached if more space is required) Professional Services include Insurance AgenUBroker, Claims Administration, HR Consultant, Benefits Administrator, Enrollment Services and Third Party Administrator. The defnilion of an Insured in this policy includes bath the company and individuals in their roles as Principals, employees, sub -agents, sub -brokers .and independent contractors of the Insured. These individuals are automatically insured for covered Professional Services when they are performed on behalf of and at the direction of the Insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (M-24) Santa Ana CA 92702 .� ,yx-w �stp ! RkIrM¢nagannriLDivIslan zry t M•?: REVIEWED, &APPROVED aY: ©1966-2015 ACOR " '' rMGW�-K R. V:.U4M1td� ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst Additional Named Insureds Other Named Insureds The Assured Partners Group CP, LLC; The Ass uredPartners Group, LP A.ssuredPartners, Inc. Keenan E Associates vj PAk MMagnnmtDivislon RenEWED&APPRw Br. OFAPPINF (02/2007) COPY Risk Management Anmyet F ACC)RbF CERTIFICATE OF LIABILITY INSURANCE DATE (MMII[ IYYYY) 05/28/2021 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 Jeanne Vezina NAME: Assured Partners Northeast, L-C. N0NNo (974)761-9000 FA(AicX. (914)781-3749 (. Not 445 Hamilton Avenue E-MAIL Ieanne.vez@ p m ina assured artners.co ADDRESS: 1 UIh Floor INSURER(S) AFFORDING COVERAGE NAIC W White Plains NY 10601 INSURERA: ACE American Insurance Company 10030 INSURED INSURERS: Keenan & Associates INSURER C : c/o The AssuredPartners Group, LP INSURER D : 200 Colonial Center Parkway INSURER E: Lake Mary FL 32746 INSURER F: :ERTIFICATE NUMBER: CL2 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR in TYPE OF INSURANCE ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS COMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE g 77KWAffff`FTTMTrED- PREMISES Ea occurrence S MEO EXP (An one person) S PERSONAL&ADV INJURY S N/A GENL AGGREGATE LIMITAPPUES PER: POLICY 0 PROECT - ❑ LOC GENERALAGGREGATE S PRODUCTS - COMPIOPAGG $ $ OTHER: AUTDMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ BODILY INJURY (Per person) g ANYAUTO OWNED SCHEBULED AUTOS ONLY AUTOS N/A BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY' DAMAGE Pereccidenl $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE N/A BED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' UABILHY YIN STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NHl If yes, describe under EL.DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below CYBER LIABILITY A SECURITY& PRIVACY COVERAGE D94933262 11/06/2020 11/06/2021 $10,000,000 LIMIT $250,000 DED. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FOR EVIDENCE PURPOSES ONLY City of Santa Ana, Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 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 WAI ©1988-2015 ACORC ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ,,�", =x,t�e W&k1.lvwgelnenEDivislpn fj rREVIEWED &APPROVED Br. Risk Namgement Analyst Ejhjubmmz!tjhofe! DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE Bohjf! 04/18/2022 cz!Bohjf!Bdfwfep! 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 Ebuf;!3133/15/32! BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. Bdfwfep 27;42;15!.18(11( 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). CONTACT PRODUCER Jeanne Vezina NAME: FAX PHONE AssuredPartners Northeast, LLC.(914) 761-9000(914) 761-3749 (A/C, No): (A/C, No, Ext): E-MAIL 445 Hamilton Avenuejeanne.vezina@assuredpartners.com ADDRESS: 10th Floor INSURER(S) AFFORDING COVERAGENAIC # White PlainsNY10601Charter Oak Fire Insurance Co25615 INSURER A : INSURED The Travelers Indemnity Co.25658 INSURER B : Keenan & AssociatesKeenan & AssociatesTravelers Property Casualty Company of America25674 INSURER C : c/o The AssuredPartners Group, LPFederal Insurance Co.20281 INSURER D : 200 Colonial Center ParkwayACE American Insurance Company22667 INSURER E : Lake MaryFL32746 INSURER F : CL2111881212 COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITYCOMMERCIAL GENERAL LIABILITY 1,000,0001,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 1,000,000 CLAIMS-MADEOCCUROCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ AYY6301C22699810/01/202110/01/202210/01/20221,000,000 PERSONAL & ADV INJURY$ 10,000,00010,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITYAUTOMOBILE LIABILITY 1,000,0001,000,000 $ (Ea accident) ANY AUTOANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BBA6N91290510/01/202110/01/202210/01/2022 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIABUMBRELLA LIAB 25,000,00025,000,000 OCCUREACH OCCURRENCE$ C EXCESS LIAB CUP9J43435010/01/202110/01/202210/01/202225,000,000 CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATIONWORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITYAND EMPLOYERS' LIABILITY Y / N 1,000,0001,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ CN N / A UB-9P291231-21-14-E10/01/202110/01/202210/01/2022 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Limit of Insurance:$10,000,000 EMPLOYEE THEFT D8225-995110/01/202110/01/2022Retention:$250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Insurer E: Cyber Liability, Policy #D96553468, 11/6/21-11/6/22. $10,000,000 Limit; $1,000,000 Deductible.Insurer E: Cyber Liability, Policy #D96553468, 11/6/21-11/6/22. $10,000,000 Limit; $1,000,000 Deductible. Re: City of Santa Ana Employee Benefits Consulting Services Agreement 7/1/2021-7/30/2022. The City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if requiredThe City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if requiredThe City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if required by written contract with respects to General Liability and waiver of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30by written contract with respects to General Liability and waiver of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30by written contract with respects to General Liability and waiver of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30 days' written notice of cancellation except 10 days for non-payment of premium plus mailing time will be granted.days' written notice of cancellation except 10 days for non-payment of premium plus mailing time will be granted. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana, Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa AnaCA92702 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD 2101203132 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/21/2022 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). CONTACT PRODUCER Heather Verdui NAME: FAX PHONE Mike Smith, New Jersey Lic. P&C /Surplus # 9940165(201) 847-9175(201) 847-9174 (A/C, No): (A/C, No, Ext): E-MAIL Axis Insurance Services, LLChverdui@axisins.com ADDRESS: 795 Franklin Avenue, Suite 210 INSURER(S) AFFORDING COVERAGENAIC # Franklin LakesNJ07417Allied World Insurance Company22730 INSURER A : INSURED INSURER B : INSURER C : Keenan & AssociatesKeenan & Associates INSURER D : 2355 Crenshaw Blvd, Suite 2002355 Crenshaw Blvd, Suite 200 INSURER E : TorranceCA90501 INSURER F : J 001 EO21-22 COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 15,000,00015,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) Limits are Per Claim MED EXP (Any one person)$ AErrors & Omissions (monoline)Errors & Omissions (monoline)0307-797710/01/202110/01/202210/01/2022 PERSONAL & ADV INJURY$ 15,000,00015,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Retro 3/31/2017Retention Per Claim250,000 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB OCCUREACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Services: include Insurance Agent/Broker, Claims Administration, HR Consultant, Benefits Administrator, Enrollment Services and Third Party Administrator. ... The definition of insured in this policy includes both the company and individuals in their roles as Principals, employees, solicitor, sub-agent, sub-broker and independent contractors of the Insured. Individuals in these roles are covered for the listed Professional Services when performed on behalf of the named insured, The AssuredPartners Group GP, LLC; The AssuredPartners Group, LP or their subsidiaries. (see pg. 2) CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management DivisionCity of Santa Ana Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza (M-24) Santa AnaCA92702 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds The AssuredPartners Group GP, LLC; The AssuredPartners Group, LP AssuredPartners, Inc. Keenan & Associates OFAPPINF (02/2007)COPYRIGHT 2007, AMS SERVICES INC