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IGOE ADMINISTRATIVE SERVICES (4)
INSURANCE ON FILE A-2020-20OA-04 WORK MAY PROCEED UNTOLTN u�Rrx, EXPIRES - CITY CLERK DATE: FOURTH AMENDMENT TO SPENDING ACCOUNT ADMINISTRATIVE SERVICES AGREEMENT WITH �� 1✓ IGOE ADMINISTRATIVE SERVICES THIS FOURTH AMENDMENT TO AGREEMENT is entered into this _ 0 day of August 2023, by and between IGOE & Company Incorporated, dba IGOE Administrative Services C-2 ("IGOE"), and the City of Santa Ana, a charter city and municipal corporation duly organized and c. 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-2020-20OA-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-2020-20OA-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. On February 23, 2021, the Parties entered into a Third Amendment to the Agreement (#A- 2020-200A-03) 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, E. Pursuant to the terms of the original Agreement, the original rate was guaranteed for three years until December 31, 2023. The Parties now intend to amend the Agreement to add a new rate guarantee beginning January 1, 2024 through December 31, 2026. The City also intends to amend the statement of work to add a provision that requires re -enrollment in the new plan year to receive carryover funds. The Parties therefore agree as follows; 1, The Parties agree to replace the previous Exhibit A (fees and charges) with the attached Exhibit A, effective January 1, 2024 through December 31, 2026. A-2020-200A-04 2. The Parties agree that the City will require re -enrollment in the new plan year effective immediately for Plan Year 2023 in order to receive carryover funds as outlined in the attached Exhibit B. 3. Except as modified by this Fourth Amendment, all terms and conditions of the Agreement, as previously amended, shall remain in full force and effect. IN WITNESS WHEREOF, the Parties hereto have executed this Fourth Aniendment to the Agreement on the date and year first written above. ATTEST: CITY OF SANTA ANA ENNIFER L +KRISTINE RIDG C� y erk rx City Manager APPROVED AS TO FORM: Sonia R. Carvalho, City Attorney . 2, ' � By: Laura A. Rossini Chief Assistant City Attorney RECOMMENDED FOR APPROVAL: J N MOTSICK xecutive Director, Human Resources Agency CONSULTANT By'—Alrr M Services & Fees Overview for City of Santa Ana Exhibit A: Fee Exhibit All of Igoe's services have the following features and fee assessments. In all cases, clients receive Igoe's Personalized Service Support via the following resources: Dedicated Client Relations Executive Dedicated Client Support Team Access to Executive -level, Decision -maker Support Participant/Member Call Center Support V1 Domestically Based ri Multi-lingual Client, Broker and Participant Web Portal Access (real-time) Eligibility Feed Development and Support (when added during implementation for inbound files) Please take a look at the Service Expectations section of this pricing sheet to see how we "quantify" Igoe's level of service. Available Services: • COBRA Administration • Premium Billing (Direct Billing) • Spending Account Services (tax-exempt) NOTE: This service includes all of the following account types, if contracted: • FSA (Full and/or Limited Health FSA and Dependent Care FSA) • HSA • H RA • Commuter (Parking and Transit) • Spending Account Services (taxable) • LSA (Lifestyle Spending Accounts) CA O�_UDE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only: PEPM17 Page 1 Services & Fees Overview for City of Santa Ana Spending Account Services Fee Guarantee Period: Begins on January 1, 2024, and ends December 31, 2026 Annual Anniversary Date': January 15t Minimum Monthly Feel: $100 FSA Administration (Section 125 Services} 3 Includes Limited and Full Purpose Health FSA and Dependent Care Assistance Plans. Bundled rate. FSA Monthly Participation Rate: $3.85 per participant per month Commuter Benefit Administration Includes Qualified Transportation and Parking Plans. Bundled Rate. Commuter Monthly Participation Rate: $3.85 per participant per month (rate bundled with FSA Monthly Participation Rate for those enrolled in multiple plans) Commuter Program Design Requirements: Below is a list of administrative requirements that must be in place in order to maintain the Fee Guarantee outlined herein. Custom Plan Designs are available and upon written request. Fees for custom services will be made available at the time of the request. • Connection to approved WireclCommute vendors • Automatic update to current federal monthly limits • Fund rollover with annual re -enrollment • Manual claim remittance (participant will receive a check mailed home or can opt in to direct deposit) • 180-day claim submission period (the termination run out will be invoked for employment termination) • First of the month funding • Eligibility changes must be submitted prior to the 20th of the month and will be effective the 1st of the following month 'Once the Fee Guarantee Period expires, fees will renew as is on an annual basis unless new fee offerings are presented In writing 60 days prior to the Annual Anniversary Date. 2 Minimum monthly billing for a single contracted Spending Account Service is $75. It additional Spending Account Services are contracted, the total minimum monthly billing for all combined services is $100. 'Participation fees are assessed by Plan Year and will remain billable until the Plan year has closed administration. Section 125 Services include standard and limited Health Flexible Spending Accounts as well as Dependent Care Reimbursement Account administration. A participant is billable as long as they are enrolled In at least one of the aforementioned account types. Igoe reserves the right to increase the monthly participation rate at any time due to increases in Federal Postage rates, changes to Federal legislation governing the provision of these services, or as a result of CPI adjustments (not to exceed 3% annually). 'Participation fees are assessed by Plan year and will remain billable until the Plan year has closed administration. Section 125 Services include standard and limited Health Flexible Spending Accounts as well as Dependent Care Reimbursement Account administration. A participant is billable as long as they are enrolled in at least one of the aforementioned account types. Igoe reserves the right to increase the monthly participation rate at any time due to increases in Federal Postage rates, changes to Federal legislation governing the provision of these services, or as a result of CPI adjustments (not to exceed 3% annually). �--- %GOE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only: PEPM17 Page 2 Services & Fees Overview for City of Santa Ana Included Services List: These services are part of all Spending Accounts unless expressly indicated below. ✓ Implementation • Plan Configuration Support • Initial EDI Testing ✓ Client Relations Manager (CRM) ✓ Benefit Card Administration' (card stacked for multiple plans) ✓ Claim Review ✓ Client & Participant Portals ✓ Daily Reimbursement Remittance ✓ Direct Deposit Reimbursement ✓ Electronic Eligibility Updates ✓ Employer Reporting— scheduled and on demand ✓ Enrollment Processing and Eligibility Updates' ✓ FDIC Insured ✓ Fund Rollover (FSA Carryover, HRA and Commuter) ✓ Investment Options (HSA only) ✓ Participant Call Center Support - Domestically Based ✓ Participant Communications & Alerts (Real Time) • Communications are in electronic format • Account Statements are emailed monthly • Year-end tax statements (HSA only) ✓ Participant Mobile App ✓ Plan Document and Summary Plan Descriptions (fees apply if such documentation is not required for Plan compliance) Included Annual Services List: ✓ Non-discrimination Testing (NDT) (provided such testing is required for compliance of spending accounts administered by Igoe) ✓ Open Enrollment Processing' 'For files received prior to the administrative effective date 'Includes 2 benefit cards per account (both initial cards and cards renewed due to standard card expiration) 'Enrollment and Account Updates that require manual entry by an Igoe Associate are subject to a processing fee — please refer to the Billable Services List. 'Manual Enrollment Processing fees will apply if election data is provided in a manual format and/or afterthe data submission detail outlined in the Annual Open Enrollment Guide. Changes made to system configuration to accommodate amended benefit offerings are subject to System Re -configuration fees. � C41111 lCWA' Document Generated on June S, 2023 for City of Santa Ana Internal Use Only: PEPM17 Page 3 Services & Fees Overview for City of Santa Ana Billable Services List — Not Included This list outlines services that are not included in the Monthly Participation Rate. Fees based on time and ability will be presented to the Client by means of a written proposal (statement of work) and must be agreed to before such services are provided, Postage expenses are calculated using the official Federal USPS postal rate as of the time of the mailing. ✓ Benefit Fair and/or Open Enrollment Meeting Attendance $300 peF day + +..ayel This fee is waived as the client is located within 100 miles of Igoe's San Diego based corporate facility. Igoe's attendance is subject to associate availability. ✓ Banking Fees • ACH Rejection -Client: $50.00 per each rejected client ACH • Direct Deposit Rejection -Participant: $15.00 per each returned participant ACH • Reimbursement Reissuance: $10.00 per each reissued reimbursement (ACH or manual check) • Stop Payment: $15.00 per stop payment (fee only applies to manually issued checks) ✓ EDI Development • $300 per vendor connection This fee includes consultation and file testing for fifes that are initiated and/or altered after initial plan administration has begun. ✓ Manual Enrollment Processing • $5.00 per manually entered enrollment ✓ System Corrections/Re-Configuration 0 $30 per 1/4 hour ($120 minimum) Page 4 CGOE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only: PEPM17 Services & Fees Overview for City of Santa Ana Service Expectations At Igoe, our commitment is that we will deliver and deliver reliably. If we fail to do so, you not only receive our dedicated assistance to make it right, you don't pay for the services that were not rendered. Period. Below we have listed the value standards you can expect as a partner. However, our drive to maintain our reputation for excellence will continually push us to over -perform. In cases where volume spikes well beyond average or technology is disrupted beyond our control, we have business continuity plans that will go immediately into effect so that benefit delivery is not notably interrupted. In the rare event that these circumstances force us to delay any of the below deliverables, we will notify you and will do all we can to return to these standards within a matter of days. • Client Relations Manager — Igoe provides a dedicated point of contact that oversees the client relationship. This contact is a highly trained individual who has consistently demonstrated aptitude in their field as well as maintaining adequate internal training certifications. The Client Relations Manager is responsible to be as accessible as possible to a client. That means, they are required to provide a response to any partner inquiries no later than 1 business day after the inquiry is received. Client Relations Managers are supported by an internally dedicated team that is there to ensure assistance is available when the Client Relations Manager is out of the office for any extended period of time. • Executive Sponsors —All partners are also provided with executive level support with the decision makers of our company. Contact information for the executive support members is listed on our client contact sheets. Our expectation is that the executive member be available to assist with complicated issues and to oversee resolution should an issue arise that compromises our client's faith in our partnership. Executive members adhere to the same response timeline as Client Relations Managers. • Participant Support — Our Participant Services team is located in our corporate office allowing our team members to work directly with Client Relations Managers and Executive Sponsors if the team notices a trend in a specific participant support need or is working with an individual experiencing a sensitive issue. o Ernail — emails are generally responded to within the day received as long as we get them prior to 3pm PT. However, our commitment is that no inquiry will go more than 2 business days without response. o Phone — calls are answered in the order in which they are received. Our commitment is that our live call handling rate cannot dip below 90% as an average. If a caller leaves a message, our �/GOE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only: PEPM17 Page 5 Services & Fees Overview for City of Santa Ana commitment is that they will never go more than 2 business days without a response. Callers have access to a 24/7 IVR for the purpose of checking on spending account claim status, spending account balances, spending account card status, and to report Benefits Cards lost or stolen. o Spending Account Communications — Igoe provides a variety of real time communications, many of which can be customized by our partners. The following communications are guaranteed to be included in our service package in electronic format via email. Many of these communications can also be accessed via Igoe Mobile or SMS text messaging should a participant sign up for those additional tools. ■ Enrollment Confirmation Statements (email) ■ Monthly Spending Account Balance Statements (email) ■ Acknowledgement of Claim Submission/receipt (email, website and mobile alert, SMS text) ■ Acknowledgement of Claim Remittance (email, website and mobile alert, SMS text) ■ Detailed Claim Denial Communications (email, website and mobile alert, SMS text) ■ Benefit Card Transaction Confirmation (email, website and mobile alert, SMS text) ■ Benefit Card Substantiation Requests (email, website and mobile alert, SMS text) ■ Red Flag Notifications, such as confirmation of change in participant demographic details (email, website and mobile alert, SMS text) as required by law. o COBRA Communications— Federal COBRA communications are mailed to applicable COBRA Qualified Beneficiaries the business day following entry or upload of qualifying event information. Additional non -Federal communications are mailed the following business day as events occur within our system. These communications are accessible in electronic format via the employer and member real-time portals and can be printed as .pdf documents. Members can choose to have non -Federal notices posted to their secure account and bypass physical mailing. Webslte Tools o Employer — Igoe's website allows employers to see all plan data necessary to monitor our performance and to oversee their benefits as the Plan Sponsor/Plan Administrator. Employers are able to self -serve within our systems as it relates to eligibility updates, demographic changes, Benefits Card management reporting, and retrieval of COBRA communications. o Spending Account Participant — Igoe's website allows our participants to securely submit claims and attach proper documentation, review and update claim remittance preference (check or direct deposit), update demographic information, manage communication preferences, view CAGOE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only: PEPM17 Page 6 Services & Fees Overview for City of Santa Ana account balances, manage their Benefits Card, access additional forms and resources designed to simplify the experience and support consumer proficiency, and make HSA investment choices. o COBRA Members — COBRA members are able to view their COBRA account, make initial elections, make electronic payments, view and retrieve all mailed correspondence, sign up to receive email notifications for notifications that are not required to be sent via mail, sign up for recurring payments, view and respond to open enrollment options when applicable. • Igoe Mobile — Igoe provides a free spending account participant mobile App for Apple and Android devices searchable as "Igoe Mobile". Igoe Mobile allows participants to view balances, submit claims and include photograph copies of receipts, and submit additional claim substantiation as requested. Igoe Mobile is the most progressively updated aspect of our technology solution and will only offer more tools as time goes on. • Claim Review Process and Timing — Claims can be submitted to Igoe online, via Igoe Mobile, via email, mail and fax. Once a claim is received, the claim undergoes a maximum review period of 4 business days. After that timeframe, the claim is either approved for remittance based on the participant's remittance choice (check or direct deposit) or a denial communication is provided to the participant outlining why the claim was not approved and what corrective action they can take to resubmit claims. Igoe does not adjudicate claims. That means we are not verifying that the receipt and expense actually occurred. Rather, Igoe is looking at the information supplied and attested to by the participant and ensuring such information meets IRS requirements. • Benefits Card Experience — Igoe strives to maintain an average auto -approval rate of 90%. However, that rate cannot be guaranteed as employers' plan design and benefit card parameters are unique and customizable. As a result, our commitment is to provide transparency in connection with the client's auto approval rate and to work with the client to improve that rate if it drops below standard. o Card Delivery - Cards are ordered when initial enrollment data is input into our system. Card delivery generally takes no more than 10 business days. • Eligibility Management — Clients have the ability to make eligibility updates directly through their secure self-service portal via written . with the Client Relations Manager or electronic data transfer through a third -party vendor of their choice. When establishing a new electronic connection, Igoe's commitment is to provide the required specifications and guides in a timely manner to the client's CGOE Document Generated on June S, 7023 for City of Santa Ana Internal Use Only: PEPMI7 Page 7 Services & Fees Overview for City of Santa Ana third -party partner and to respond to file testing needs. We define timely as not exceeding a 3-business day gap between any incoming request for specification information, plan mapping details, or testing needs. Once a file is approved, Igoe processes files within 1 business day of receipt and posts any applicable error report to our client's secure sites for their review and action. o Carrier Updates (COBRA) —Carriers are notified every business day of any changes to COBRA eligibility that were processed the previous business day. Notice of termination for non-payment is held from carriers until after the payment grace period has expired. • Reporting — Igoe provides monthly reporting necessary for clients to oversee their benefit plans and meet their obligations as the Plan Sponsor/Plan Administrator. Such reporting includes: o Remittance Reporting (monthly) — COBRA o Member Status Reporting — COBRA o Subsidy Reporting — COBRA o Monthly Account Balances — Spending Accounts a Ineligible Benefits Card Transactions — Spending Accounts a Claim Remittance Reporting —Spending Accounts o Bank Transaction Reporting — Spending Accounts o Comprehensive Suites of On -Demand Self -Service Reporting (All services) CGDE Document Generated on June 5, 2023 for City of Santa Ana Internal Use Only; PEPM17 Page 9 Exhibit B Statement of Work: Plan Design Change -Carryover The purpose of this form is to collect all information necessary to update your Plan design to either remove or add the carryover feature. Instructions 1. Please complete the following form in its entirety. 2. Send the completed form to your Client Relations Executive If you are not sure how to answer any of the below questions, please contact your Client Relations Executive. They will coordinate a conference call with the appropriate parties. Basic Client Information and Demographics Please complete what you are able to. If you are uncertain of the below, you may leave the below items blank. This simply allows us to check your existing plan documents for accuracy in these areas. 1. Company Name:City of Santa Ana 2. Tax ID:- 3. Company Phone Number: (714) 647-5299 4. Company Fax Number: 5. Address:20 Civic Center Plaza #M-34, Santa Ana, CA 92701 6. Entity Type: ❑C Corp ❑S Corp ❑ LLC ❑ LLP ©Other, Please explain: Government Agency SOW: Carryover: Page 1 C �� ljt-r��UE 0 Igoe Administrative Services 2021 Change Carryover - Effective Immediately for the 2023 Plan Year 1. Choose the account options to which current carryover rules will be adjusted. Note: carryover cannot be added to a plan that has the 2.5 month grace period. By checking any of the below options, you are agreeing to remove the 2.5 month grace period if that feature is part of the current plan design. Changes will apply to future plan years and will not impact any current plan year functionality. ❑X Health FSA ❑ Limited Purpose Health FSA 2. Designate carryover amount. x❑ Maximum available at this time. If selected, consider automatically updating the maximum value each year. A fee of $50 will apply annually when adjustments are needed. This fee will not be charged if you have already elected to have the FSA maximum contribution amount automatically update. The fee covers plan amendments, system updates and new custom enrollment flyers. ❑x Yes ❑ No (',current set up) ❑ Othervalue: 3. Add or change minimum carryover value (optional). Designate minimum value (if left blank, no minimum value will be enforced): 4. require re-ennAlment in the new plan year in order to receive carryover funds. 0 Yes (add) ❑ No (remove) SOW: Carryover: Page 2 (•� 1VjE © Igoe Administrative Services 2021 Fees System reconfiguration fees will apply. Please see your Fee Exhibit for details, Signature I attest that I am authorized to make decisions and indebt City of Santa Ana as listed above. I further attest that the information in this document is truthful, accurate and can be used to begin system re -configuration (if applicable) and updates to any existing Plan Document (if applicable). Charges for these services will apply as listed in Exhibit A of the Administrative Services Agreement. Print Name: Lori Schnaider Signature: Title: HR Operations Manager Date: July 31, 2023 SOW: Carryover: Page 3 C � levwE c0 Igoe Administrative Services 2021 Close Prim To : steI3hanie@avhins,com CC: Subject: Internal Notice of Compliance ANCE 'rY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREE.,J&'1,T TO THE CLERK OF THE COUNCIL Contractor Name: Igoe & Company, Incorporated -2020-20DA-03 Project Number: Project Third Amendment To Spending .Account Administrative Services Agreement With Name: 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., ;pity of Santa Ana Risk Management Division F partnership with Trax Plus Services Tearn 1111.' 12022 12:49 PPN1 POLICY EXPIRATION CCI[ DATE NUMBER DATE M P L429896822 11 /05/2023 11 /0412022 Close Prir7. FILE NAME Cert of Ins -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): ( ) a"/ Lo ADDRESS: info@whins.com License #: OG66655 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: The Pie Insurance Company 21857 INSURED Igoe &Company, Incorporated DBA: Igoe Administrative Services INSURER B : Great American E & S Insurance Company 37532 INSURERC: At -Bay Specialty Insurance Company 19607 10905 Technology PI Ste A INSURER D : San Diego, CA 92127 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00003536-0 REVISION NUMBER: 74 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MWDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR PREMISES TO RENTED DAMACLAIMS-MADE1:1 PREMISES Ea occurrence $ IVIED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICYEl PRO LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A IONILIT AND EMPLOYERS' LIABILITY AND EMPLOYERS' YERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N Y WC PI 891143-001 03/01/2025 03/01/2026 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Errors 8r Omissions TER 5827942 11/05/2024 11/05/2025 Each Claim 3,000,000 C Cyber Liability AB-6664879-02 12/09/2024 12/09/2025 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Those usual to Insured's operations. Waiver of subrogation applies per endorsement WC 04 03 16, subject to policy terms. Tu an APPROVED Tu Tran Dgitaltysigned b Tr Nguyen Nguyen Date: 2025.03.06 By Tu Tran Nguyen at 8:41 am, Mar 06, 2025 08:41:40-08'00' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 (SKT) ACORD 25 (2016/03) © 19g84015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by SKT on 03/05/2025 at 02:47PM WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 04-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.05 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person Or Organization Job Description City of Milpitas Administration of requestor's FSA and Cobra employee benefits. CITY OF SANTA ANA Benefits Administration ( customer service/data entry) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/05/2025 Policy No. WC PI 891143-001 Endorsement No. 003 Insured Igoe & Company Incorporated Insurance Company The Pie Insurance Company Countersigned By WC 04 03 06 (Ed. 04-84)