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HomeMy WebLinkAboutCIVIC PLUS, INC. (2)INSURANCE ON FILE WORK MAY PROi 71) MAYOR UNTIL INSURA;-TIRE'- VicenteEMto MAYOR PRORO TEM p N W _ )aZ� David Penaloza CLERK OF COI'. COUNCILMEMBERS DATE: Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza Thai Viet Phan CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza . P.O. Box 1988 V19 VA � I J� . _l �/ I� ,r' Santa Ana. California r92702 g Q P Jrl " VGi,(k `Y wwwsanta-ana.ora September 15, 2021 N CivicPlus, Inc. c 302 South 4th Street, Suite 500 cm Manhattan, Kansas 66502 o Attention: Mr. Tim Grant, Director of Sales A-2017-076-02 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez L5 O Re: Second and Final Extension of Agreement No. A-2017-076 to Provide Activity Registration and Site Reservation Software. Dear Mr. Grant: Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by CivicPlus, Inc. and the City of Santa Ana, dated April 19, 2017, the term of the Agreement is hereby extended for a one-year period, from December 1, 2021 through November 30, 2022. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, remain unchanged and in full force and effect. Please sign below and return this extension to the City at your earliest convenience. S�c Lisa Rudloff Executive Director, Parks, Recreation & Community Services Agency CTTY OF SANTA ANA: �N)\-_ �✓ Kristine Ridge City Manager APPROVED AS TO FORM: X.,A.R Laura A. Rossini Chief Assistant City Attorney Vicente Batmlento Davit Penaloza Thal Viet Phan Mayor Mayor Pm Tom, Ward 2 We'd1 ysenrilerecAserita doenaloatiAsanta-ana om Wharetteantaana om ATTEST: t Daisy Gomez Clerk of the Council CV PLU , INC. l 7w' �1�jR.lrEf-ZP By:Amy Vikander Title:Vice President of Client Services SANTA ANA CITY COUNCIL Jessie Lcpez Phil Bacerm Johnathan Ryan Hernandez Nelida Mendoza Ward Ward Want Wahl ssielooeal5isant,-ana om obacana0sanlaana.om irvanhemandesixteamaananno neesdosa5santa one om Tori Piersona m'®=_ Page 1 of 2 CERTIFICATE OF LIABILITY INSURANCE D06/10ATE I/2021Y) 06/10/2021 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 endorsements). PRODUCER Willis Towers Watson Northeast, Inc. c/a 2fi Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 FAX 1-BBB-967-2378 AIC No: ADD LESS. certificatesilwillis.com INSURERS AFFORDINGCOVERAGE NAIL# Nashville, IN 372305191 USA INSURERA: Great Northern Insurance Company 20303 INSURED CivicPlus, LLC 302 S 4th Street, Suite 500 INSURERS: Federal Insurance Company 20281 INSURERC: Westchester Surplus Lines Insurance Compan 10172 INSURERD: Manhattan, KS 66502 NSURER E: NSURERF: COVERAGES CERTIFICATE NUMBER: w21237828 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 SUER Jm POUCYNUMBER POLICY EFF I POLICY EXP MMIOnM LIMITS X COMMERCIALGENERALLABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,0 00,000 PREMISES( aoneum PREMISES Ea oceurreime $ 2,000,000 MED EXP(Any one arson) $ 30,000 A pERSONALa ADV INJURY $ 1,000,000 y 3602-53-12 05/17/2021 05/17/2022 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L %( POLICY jRa LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILELIABILITY COMBINED SINGLE LIMIT Es accident $ 1,000,000 BODILY INJURY (Per Pinson) $ X ANY AUTO H OWNED SCHEDULED AUTOS ONLY AUTOS 7358-87-92 05/17/2021 05/17/2022 BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accdent $ $ B UMBRELLALRB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE 7989-49-14 05/17/2021 05/17/2022 DED X RETENTION 0 $ H WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNEWEXECUiNE YIN OFFICERIMEMBER EXCLUDED? N/A (22 ) ]779-92-99 OS/17/2021 05/17/2022 X STATUTE ERH E.L. 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 $ 1,000,000 C Technology errors and Omissions F15611984 002 04/30/2021 04/30/2022 Aggregate/ ded $5,000,000/$25,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) This Voids and Replaces Previously Issued Certificate Dated 05/18/2021 WITH ID: W20947704. The City of Santa Ana, Risk Management, it's Officers, employees, agents, representatives, and volunteers are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be City of Santa Ana Risk Management Division 20 Civic Center Place, 4th Floor 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. ITHORD:EDREPRESENTATNE y RNIMpngeranl Oh4lan - N t REMEY/ED6/1rPRP'FD BY: 81 1 ^ 7ou i7u7Jdr U 1UBB-2016 ACORD C( ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a5 To: 21197135 BATCH: 2125567 C H U B Bm Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Data Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization MAY 17, 2021 TO MAY 17, 2022 MAY 17, 2021 3602-53.12 TPA CMCPLUS,LLC GREAT NORTHERN INSURANCE COMPANY NNE 4, 2021 Under Who Is An Insured, the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligatedpursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: if and then only to the extent the person or organization is described in the Schedule; to the extent such contract or agreement requires the person or organization to be afforded status as an insured; for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). with respect to any assumption of liability (of another person or organization) by them in a contract or agreement This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement Liability Insurance Addidonalineured- Scheduled Person OrOrganizatlon Fonn 80-02.2367(Rev. 5-07) Endorsement Wh Mo.gmwtniWi ` rRHElgID6�fMPRbJ®arr: Ru1,M1MwgermrtClmUlAitle C H U B B• Policy Conditions Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: COMMON POLICY CONDITIONS Conditions MAY 17, 2021 TO MAY 17, 2022 MAY 17, 2021 3602-53-12 TPA CIVICPLUS,LLC GREAT NORTHERN INSURANCE COMPANY JUNE 4, 2021 The following changes are made as respects exposures in the state of Kansas. Under Conditions, Cancellation and When We Do Not Renew are deleted and replaced by the following: Cancellatlon We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation, stating the reasons for cancellation, at least: • 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or • 30 days before the effective date of cancellation if we cancel for any other reason. If this policy has been in effect for 90 days or more, or if it is a renewal of a policy we issued, we may cancel this policy only for one or more of the following reasons: • nonpayment of premium; • this policy was issued because of a material misrepresentation; • you or any other insured violated any of the material terns and conditions of this policy; • unfavorable underwriting factors, specific to the insured, existed that were not present at the inception of this policy; RWi M"Pa dmw `.. atom& A� Br Policy Caretion8 KaneBB Mandatory �c u Form 80-02-9737(Ed. 3-96) Erxioraement .xm.,r,.,ye�nCl,iwade Cyber Crime Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Chubb Cyber Enterprise Risk Management Policy Chubb DigiTech® Enterprise Risk Management Policy It is agreed that solely with respect to the coverage provided by this endorsement, the Policy is amended as follows: i. Item 4. of the Declarations is amended to include the following: Each Loss Aggregate Limit of Each Loss Cyber Crime Insuring Agreements I i t of Insurance Retention Insurance ® Funds Transfer Fraud limit of $250,000 $250,000 $25,000 Insurance ® Computer Fraud Limit of $250,000 $250,000 $25,000 Insurance ® Social Engineering Fraud Limit $250,000 $250,000 $25,000 of Insurance 2. Section I, INSURING AGREEMENTS, is amended by adding the following: CYBER CRIME INSURING AGREEMENTS Funds Transfer Fraud The Insurer will pay for loss of Money or Securities sustained by an Insured resulting directly from Funds Transfer Fraud committed by a third parry which is Discovered during the Policy Period. Computer Fraud The Insurer will pay the Insured for loss of Money, Securities or Property sustained by an Insured resulting directly from Computer Fraud committed by a third parry which is Discovered during the Policy Period. Social Engineering Fraud The Insurer shall pay the Insured for loss of Money or Securities sustained by an Insured resulting directly from Social Engineering Fraud committed by a person purporting to be a Vendor, Client or an Employee who was authorized by the Insured to instruct other Employees to transfer Money or Securities which is Discovered during the Policy Period. Hereinafter, the above Insuring Agreements shall be collectively referred to as the "Cyber Crime Insuring Agreements". 3. Section II, DEFINITIONS, is amended to include the following: Client means a customer of an Organization to whom such Organization provides goods or services under written contract or for a fee. Computer Fraud means the unlawful taldng of Money, Securities or Props RwW .V..dDW� Computer Violation. `: 6^P°� Or. 70u 7�rcraon PF-48257 (09/18) xexrts.�wye�eronm�iaae 5. Section III, EXCLUSIONS, is deleted and replaced with the following: A. No coverage will be available for: t. loss due to kidnap, ransom or any other extortion payment surrendered to any person as a result of a threat to do bodily harm to any person or a threat to do damage to any property; 2. loss involving: a. the disclosure of an Insured's or another entity or person's confidential or personal information while in the care, custody or control of an Insured, including but not limited to patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any similar type of non-public information; b. loss involving the use of another entity or person's confidential or personal information while in the care, custody or control of an Insured, including but not limited to patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any similar type of non-public information; or c. fees, costs, fines, penalties or any other expenses incurred by an Insured which result, directly or indirectly, from the access to or disclosure of another entity or person's confidential or personal information, including but not limited to patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any similar type of nonpublic information, provided that this Exclusion 2. a. and b. shall not apply to loss that is otherwise covered under any Cyber Crime Insuring Agreement; 3. loss or damage due to declared or undeclared war, civil war, insurrection, rebellion, revolution, military, naval or usurped power, governmental intervention, expropriation or nationalization, or any act or condition incident to any of the foregoing; 4. loss or damage due to nuclear reaction, nuclear radiation or radioactive contamination, or any act or condition incident to any of the foregoing; 5. loss of income not realized as the result of a covered loss; 6. indirect or consequential loss of any Idnd; 7. fees, costs or expenses incurred or paid in defending or prosecuting any legal proceeding or claim; 8. loss sustained by one Insured to the advantage of any other Insured; 9. loss or damage due to Computer Fraud or Funds Transfer Fraud or other fraudulent, dishonest or criminal act committed by any authorized representative of an Insured, whether acting alone or in collusion with others. B. With respect to the Funds Transfer Fraud and Computer Fraud Insuring Agreements, no coverage will be available for loss resulting from any transfer, payment or delivery of Money, Securities or Property approved by an Employee, or arising out of any misrepresentation received by any Employee, agent, independent contractor or other representative of the Insured, whether such transfer, payment or delivery was made in good faith or as a result of trick, artifice, fraud or false pretenses. C. With respect to the Social Engineering Fraud Insuring Agreement, the Insurer shall not be liable for: 1. loss or damage to Money or Securities as a result of Computer Fraud or Funds Transfer Fraud; 2. loss due to any investment in Securities, or ownership in any corporation, partnership, real property, or similar instrument, whether or not such investment is genuine; 71 w�tto� 3. loss due to the failure of any party to perform, in whole or in part, under any coi PF-48257(o9/18)rsw,m.,,ay�n<,rcum�iaee -: by one natural person or entity, or in which the same group of natural persons or entities acting together are implicated, regardless of whether such act, casualty or event or series of acts, casualties or events was committed or occurred before or during the Policy Period. 3. Applicable to the Social Engineering Fraud Insuring Agreement: for all loss or losses resulting from any act, casualty or event, any series of related acts, casualties or events, or any act or series of acts committed by one natural person or entity, or in which the same group of natural persons or entities acting together are implicated, regardless of whether such act, casualty or event or series of acts, casualties or events was committed or occurred before or during the Policy Period. If a loss is covered under more than one Cyber Crime Insuring Agreement, the maximum amount payable under this Policy shall not exceed the largest applicable limit of insurance of any such Cyber Crime Insuring Agreement. The Insurer's total cumulative liability for all loss Discovered during the Policy Period shall not exceed the applicable Cyber Crime Aggregate Limit of Insurance asset forth in Item 4. of the Declarations. Such amount shall be part of and not in addition to the Maximum Policy Aggregate Limit of Insurance as stated in Item 3. of the Declarations. Each payment made under the terms of this endorsement shall reduce the unpaid portion of the applicable Cyber Crime Aggregate Limit of Insurance and the Maximum Policy Aggregate Limit of Insurance until they are exhausted. On exhausting the applicable Cyber Crime Aggregate Limit of Insurance by such payments the Insurer shall have no further liability for loss or losses regardless of when Discovered and whether or not previously reported to the Insurer; and the unpaid portion of the applicable Cyber Crime Aggregate Limit of Insurance and Maximum Policy Aggregate Limit of Insurance shall not be increased or reinstated by any recovery made and applied in accordance with Section XVIII. Recoveries (as amended in paragraph t7 of this endorsement). In the event that a loss of Securities is settled by indemnity in lieu of payment, then such loss shall not reduce the unpaid portion of the applicable Cyber Crime Aggregate Limit of Insurance or Maximum Policy Aggregate Limit of Insurance. 8. Section VII, RETENTION, is deleted and replaced with the following: A. The Insurer's liability under this Policy shall apply only to that part of each loss which is in excess of the applicable Retention set forth in item 4 of the Declarations for this Policy. B. If an Insured receives payment under another policy or bond, after applying a deductible or retention, for loss also covered hereunder, then the applicable Retention set forth in Item 4 of the declarations as amended by this endorsement shall be reduced by the deductible or retention previously applied to such loss. Notwithstanding the foregoing, if an Insured receives payment under another policy or bond, including but not limited to the Other Crime Policy, as set forth in paragraph 13., amended Section XIL, Other Insurance, of this endorsement, after applying a deductible or retention, for loss also covered hereunder, then the Retention set forth in Item 4 of the Declarations shall be reduced, up to the amount of such Retention, by the sum of: 1. the deductible or retention amount previously applied to such loss, and 2. any amount paid with respect to such loss under such other policy or bond. 9. Section VIII, NOTICE, is deleted and replaced with the following: Section VIII. NOTICE AND PROOF OF LOSS A. Knowledge possessed by any Insured or Discovery shall be deemed knowledge possessed by or Discovery by all Insureds. B. It is a condition precedent to coverage hereunder that, upon Discovery, the Name"ivna� t. give written notice to the Insurer as soon as practicable but in no event lat such Discovery; %656D&w66 R6klrLnu —'Om.Mde then coverage under this Policy will continue in full force and effect until termination of this Policy, but only with respect to loss resulting directly from Computer Fraud, Funds Transfer Fraud or Social Engineering Fraud sustained before such event. Coverage under this Policy will cease as of the effective date of such event with respect to loss resulting directly from Computer Fraud, Funds Transfer Fraud or Social Engineering Fraud sustained after such event. This Policy may be cancelled by the Named Insured on or after the effective time of the event, and the Insurer shall refund the unearned premium computed pro rata, calculated as of the date on which the Insurer receives a communication from the Insured requesting cancellation of this Policy. The Insurer will be under no obligation to accept requests to retroactively cancel this Policy. C. Termination of a Subsidiary If before or during the Policy Period an organization ceases to be a Subsidiary, coverage with respect to the Subsidiary shall continue until termination of this Policy. Such coverage continuation shall apply only with respect to loss resulting directly from Computer Fraud, Funds Transfer Fraud or Social Engineering Fraud sustained prior to the date such organization ceased to be a Subsidiary. 15. Section XIV, REPRESENTATIONS, is deleted and replaced with the following: Section XIV. CONCEALMENT, MISREPRESENTATION ORFRAUD This Policy is void in any case of fraud by the Insured as it relates to this Policy at any time. It is also void if any Insured, at any time, intentionally conceals or misrepresents a material fact concerning: i. this Policy; 2. the property covered under this Policy; 3. the Insured's interest in the property covered under this Policy; or 4. a claim under this Policy. 16. Section XVI, TERRITORY AND VALUATION, is deleted and replaced with the following: The Insurer shall pay: 1. the actual market value of lost, damaged or destroyed Securities at the closing price of such Securities on the business day immediately preceding the day on which a loss is Discovered; or the cost of replacing Securities, whichever is less, plus the cost to post a Lost Instrument Bond; 2. the cost of blank books, pages or tapes or other blank materials to replace lost or damaged books of account or other records; 3. the least of: 1. the actual cash value of the Property; or 2. the cost to repair or replace Properly, other than precious metals, with that of similar quality and value, at the time the Insured complies with Section VIII, Notice and Proof of Loss, regarding the furnishing of proof of loss; 4. the United States of America dollar value of foreign currency based on the rate of exchange published in The Wall Street Journal on the day loss involving foreign currency is Discovered; or 5. the United States of America dollar value of any precious metals based on the rate of exchange published in The Wall Street Journal Cash Prices, Precious Metals, on the day loss involving foreign currency is Discovered. 17. Section XVIII, SUBROGATION, is deleted and replaced with the following: Section XVIII. RECOVERIES Recoveries for any loss under this coverage, whether effected by the Insurer or by an Insured, less the cost of recovery, shall be distributed as follows: 11 PF-48257(09/18) Ra�M�iona� RVIE & A� BY: ?ate >DiCxJOx RbkhUm9cnvrt Gm�al/4tle 00 A _ : — Diaitally si edbv AC6RhP CERTIFICATE OF LIABILITNrINA WRICE Angie cW9022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO NOT F OR ATIVELY ICIES BELOW. THIS CERTIFICATE CERT FIICATEOES OFATIVELY INSURANCE DOES NOT CONSTITUTE TUTEXA CONTRACT BETWEEN TF;F ISSUING�I L S �al1TI'I0R ZEID j 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 Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 F' 1-888-467-2378 A/C No Ext : A/C, No : E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURERA: Great Northern Insurance Company 20303 INSURED CivicPlus, LLC and its direct and indirect subsidiaries 212 West Main St Suite 500 INSURER B: Federal Insurance Company 20281 INSURERC: Endurance American Specialty Insurance Com 41718 INSURER D Durham, NC 27701 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: W25464256 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 10,000 A Y 36025312 05/17/2022 05/17/2023 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY PRO- JECT LOC x PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT Ea accident $ 1,000,000 x BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 7358-87-92 05/17/2022 05/17/2023 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 x AGGREGATE $ 5,000,000 EXCESS LAB CLAIMS -MADE 7989-49-14 05/17/2022 05/17/2023 DED x RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICE R/M EMBER EXCLUDED? (Mandatory in NH) N/A (23) 7174-92-49 05/17/2022 05/17/2023 x PER OTH- STATUTE ER 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 1,000,000 $ C Technology Errors and Omissions PR030018745600 04/30/2022 04/30/2023 Aggregate/ ded $5,000,000/$25,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 05/23/2022 WITH ID: W24809984. The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Risk Management Division 20 Civic Center Plaza, 4th Floor � Santa Ana, CA 92702sN REviEwED & APPROVED BY: © 1988-2016 ACORD °( e Aeevaa ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD — Risk Management specialist SR ID: 22865989 BATCH: 2605326 AGENCY CUSTOMER ID: LOC #: ACCOR" ® ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. CivicPlus, LLC and its direct and indirect subsidiaries 212 West Main St Suite 500 POLICY NUMBER Durham, NC 27701 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS C H U B B° Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date issued This Endorsement applies to the following forms: MAY 17, 2022 TO MAY 17, 2023 MAY 17, 2022 3602-53-12 TPA CIVICPLUS, LLC VIGILANT INSURANCE COMPANY JULY 1, 2022 GENERAL LIABILITY Under Who Is An Insured, the following provision is added Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional insured - Scheduied Person Or Organization Form 80-02 2367 (Rev. 5-07) Endorsement Risk Muaigmad DlMsian E REVIEWED & APPROVED BY: e Aeevaa '�--'Rfsk Management Specialist CHUBB" Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO A CONTRACT OR AGRFM4ENT, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional insured - Scheduied Person Or Organization Form 80-02 2367 (Rev. 5-07) Endorsement Risk DlMsian E o N,`P' REVIEWED & APPROVED BY: '�--'Rfsk Management Specialist