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Home My WebLink AboutNATIONAL CENTER FOR SAFETY INITIATIVES, LLC INSURANCE ON'FILE WORK MAY PROCEED N-2025-120 UNTIL INSURANCE EXPIRO �7--� CITY CLERK DATE: AGREEMENT FOR BACKGROUND SCREENING REPORTS MAY 2 2 202� BETWEEN THE CITY OF SANTA ANA AND NATIONAL CENTER FOR SAFETY INITIATIVES, LLC THIS AGREEMENT is made and entered into on this 30th day of April, 2025 by and between National Center for Safety Initiatives, LLC, a Delaware limited liability company, ("NCSI"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California("City"). RECITALS A. The City desires to retain NCSI to complete background screening reports. B. NCSI represents that NCSI is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, NCSI represents that it is knowledgeable in its field and that any services performed by NCSI under this Agreement will be performed in compliance with such standards as may reasonably be expected from a consumer reporting agency in the field. NOW THEREFORE, in consideration of the mutual and respective promises,and subject to the terms and conditions hereinafter set forth,the parties agree as follows: 1. SCOPE OF SERVICES NCSI shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services-Exhibit A,attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and NCSI agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit A. The total amount to be expended during the term of this Agreement shall not exceed $20,000. Any charges or costs, including but not limited to surcharges and other fees levied by federal, state, county, other governmental agencies, educational institutions, employer verification lines and licensing agencies, incurred by NCSI in servicing City, may be passed on to City in accordance with the City's pricing program with the Company. b. This Agreement shall include payment for services incurred since March 15, 2025. c. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work, which fails to meet the standards of performance set forth in the Recitals, which may reasonably be expected by City. Page I of 11 #2040577vl 3. TERM This Agreement shall commence on the date first written above for a three (3) year term, with two, one year options for extension exercisable by the City with the approval of NCSI unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR NCSI shall, during the entire term of this Agreement, be construed to be an independent NCSI and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which NCSI performs the services which are the subject matter of this Agreement; however, the services to be provided by NCSI shall be provided in a manner consistent with all applicable standards and regulations governing such services. NCSI shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes,which are prepared or caused to be prepared by NCSI under this Agreement ("Documents & Data"). NCSI makes no such representation and warranty about Documents &Data,which were provided to NCSI by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk, G. INSURANCE a. NCSI shall maintain limits of insurance coverage in the following minimum amounts and shall be at least as broad as: 1) Commercial General Liability(CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations,property damage, bodily injury and personal& advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. 2) Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with combined single limits of$1,000,000. In the event NCSI Page 2 of 11 #2040577vl does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance with existing limits,which can be lower than $1,000,000. 3) Workers' Compensation (W/C): as required by the State of California, with statutory limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident,per employee,per policy for bodily injury or disease.This requirement can be waived if NCSI has no employees. b. If NCSI maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by NCSI.Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. c. Other Insurance Provisions- the insurance policies are to contain, or be endorsed to contain,the following provisions: 1) CGI_, and AL policies: City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of NCIS including materials,parts,equipment, and personnel furnished in connection with such work or operations. 2) All required insurance policies: Insurance company(ics) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by NCIS for City. 3) All required insurance policies: For any claims related to this contract, NCIS' insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers,officials,employees, agents, or volunteers shall not contribute with it. 4) All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that NCIS' insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5) Each insurance policy required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non-renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non-renewal due to non-payment. 6) Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Human Resources Agency, 20 Civic Center Plaza, P.O. Box 1988, M-34, Santa Ana, CA 92701. The name and location of event, if applicable, should be included in the Description of Operations section of each certificate. Page 3 of 11 #2040577vl i d. Self-Insured Retentions-Self-insured retentions must be declared to and approved by the City. City may require NCIS to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. e. Acceptability of Insurers- Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A:VII,unless otherwise acceptable to City. f. Verification of Coverage- Permittee shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to Entity before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive NCIS' obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. g. Claims Made Policies - If any of the required policies provide coverage on a claims- made basis: 1) The retroactive date must be shown and must be before the date of the contract or the beginning of work. 2) Insurance must be maintained and evidence of insurance must be provided for at least three(3) years after completion of work. 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, NCIS must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. h. Subcontractors- NCIS shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and NCIS shall ensure that City is an additional insured on insurance required from sub-contractors. i. Special Risks or Circumstances-City reserves the right to modify these requirements, including limits, based on the nature of the risk,prior experience, insurer, coverage, or other special circumstances. 7. INDEMNIFICATION & WARRANTIES NCSI agrees to defend, and shall indemnify and hold harmless the City, its officers, agents,employees,contractors, special counsel, and representatives from liability: (1)for personal injury,damages,just compensation,restitution,judicial or equitable relief arising out of third party claims for personal injury, including death,and claims for property damage, which may arise from the negligent operations of NCSI, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any third party claim that personal injury, damages, just compensation, restitution, judicial or Page 4 of 11 42040577v1 equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution,judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. Notwithstanding the foregoing,to the extentNCSI's services are subject to Civil Code Section 2782.8,the above indemnity shall be limited,to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. NCS1 does not guarantee City's compliance with all applicable laws in its use of reported information,and does not provide legal or other compliance related services upon which City may rely in connection with its furnishing of reports. City understands that any documents, information, conversations or communication with NCSFs representatives regarding searches, verifications or other services offered by NCSI are not to be considered a legal opinion regarding such use. City agrees that(1) it will consult with its own legal or other counsel regarding the use of background screening information, including but not limited to,the legality of using or relying on reported information and to review any forms as well as the content of prescribed notices, adverse or pre-adverse action letters and any attachments to this Agreement for compliance with all applicable laws and regulations and (2)the provision of such notices, pre-adverse or adverse action letters and the contents thereof is the sole responsibility of City not NCS1. 8. INTELLECTUAL PROPERTY INDEMNIFICATION NCSI shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent,trademark,or copyright infringement,including costs,contained in the work product or documents provided by NCSI to the City pursuant to this Agreement. 9. RECORDS NCSI shall keep records and invoices in connection with the work to be performed under this Agreement. NCS1 shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to NCSI under this Agreement. All such records and invoices shall be clearly identifiable. NCSI shall allow a representative of the City to examine,audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours upon reasonable notice and limited to once per year without cause. 10. CONFIDENTIALITY Neither party shall reveal,publish or otherwise disclose any Confidential Information to any third party without the prior written consent of the other party and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. The Parties agree to keep this information confidential at all times during the term of this Agreement,and continuing for five years after receipt of any Confidential Information. "Confidential Information" shall include all nonpublic information. Confidential Page 5 of 11 #2040577vl information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion,termination or other employment related activities or any services provided under this Agreement. NCSI affirms that it is an equal opportunity employer and. shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and NCSI, and supersedes any and all other agreements, oral or written, between the parties, In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of NCSI. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to,the terms and conditions hereof, shall not bind or obligate NCSI or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of NCSI,NCSI may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment,transfer,delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services, which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, NCSI shall be entitled to receive and the City shall pay NCSI compensation for all services performed by NCSI prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require NCSI to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and NCSI consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVED No waiver of breach, failure of any condition, or any right or remedy contained in or Page 7 of 11 #2040577vl granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach,failure, right or remedy.No waiver of any breach,failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION- VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES NCSI shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals,waivers,and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. NCSI shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. .NOTICE Any notice,tender,demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section,to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza(M-30) P.O. Box t988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Executive Director, Human Resources Agency City of Santa Ana 20 Civic Center Plaza(M-34) P.O. Box 1988 Santa Ana, California 92702 Page 8 of 11 #2040577v1 To Contractor: Kate Quattlebaum, Director National Center for Safety Initiatives, LLC 807 Broadway Street NE, Suite 300 Minneapolis, MN 55413 Fax: (866)996-1292 Email: kate.quattlebaum@nbcuni.com A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, fcderal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact,held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF,the parties hereto have executed this Agreement the date and year first above written. ATTEST: a, CITY OF SA TA ANA 71144� .J ennifer L a Alvaro Nunez Cit City Manager [Signatures continue on the next page] Page 9 of 11 #2040577vl EXHIBIT A SCOPE OF SERVICES 1. Description of Service. NCSI shall conduct a background check on each individual identified by the Client who registers with NCSI. When registering, the individual shall authorize NCSI to conduct a background search, authorize NCSI to disclose the results of the background search to the Client and shall consent to such other terms and conditions as required by NCSI. In conducting the background search, and in providing any services to any and all Client-affiliated leagues and clubs, NCSI shall abide by the following: a. Advanced 2 Year Screening Package $21: NCSI shall conduct the following searches on each individual as part of its Client Screening Package: i. Social Security Number validation; ii. Name and address history records; iii. Two independent Multi-Jurisdictional Criminal Database searches covering 50 states plus DC, Guaira, and Puerto Rico; iv. County Criminal Records for the county (or counties) where the individual currently lives or has lived during the past five years, going back the length of time records are available and reportable for each county searched based on the name and address the Individual provides and the developed address history records; v. Two Sex Offender Registry database searches of all available states, plus DC, Guam, and Puerto Rico; vi. Multiple National Watch Lists; b. All searches conducted above shall cover(i)the last(7)seven years of history, (ii)the longest period available if information is not available for seven (7) years or (iii) the longest period allowed by applicable law, if less than seven (7) years. Page 11 of 11 Consultant Agreement-NCSI 2025(2040577.3) Final Audit Report 2025-05-08 Created: 2025-05-06 By: James Murray(JMurray@santa-ana,org) Status: Signed Transaction ID: CBJCHBCAASAArxPfo5fBylmC9p4XP7MYBIJddfF39mbs 'Consultant Agreement-NCSI 2025(2040577.3)" History Document created by James Murray (JMurray@santa-ana.org) 2025-05-06-10:15:46 PM GMT C`. Document emailed to Kate Quattlebaum (kate.quattlebaum@nbcuni.com)for signature 2025-05-06-10:15:51 PM GMT C'► Document emailed to Lori Schnaider(LSchnaider@santa-ana.org)for signature 2025-05-06-10:15:51 PM GMT Email viewed by Lori Schnaider(LSchnaider@santa-ana.org) 2025-05-06-10:21:01 PM GMT Email viewed by Kate Quattlebaum (kate.quattlebaum@nbcuni.com) 2025-05-07-9:52:18 AM GMT Document e-signed by Kate Quattlebaum (kate.quattlebaum@nbcuni,com) Signature Date:2025-05-07-9:52:42 AM GMT-Time Source:server Document e-signed by Lori Schnaider(LSchnaider@santa-ana.org) Signature Date:2025-05-08-0:13:55 AM GMT-Time Source:server Agreement completed. 2025-05-08-0:13:55 AM GMT Q Adobe Acrobat Sign Ac®� CERTIFICATE OF LIABILITY INSURANCE DATElYYIY) 05114120254f2025 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(ios)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 Marsh USA LLC NAME: 30 South 17th Street PHONE FAX AM o t• " No Philadelphia,PA 19103 aDnRl�ss: Attn:NBCU.Certrequest@marsh.com Fax 212-948-5143 INSURERS AFFORDING COVERAGE NAIC# CN101608515-N8CU-GAWUW-24- INSURER A: ACE American Insurance Company 22667 INSURED NBCUniversal Media,LLC INSURER B: Indemnity Ins Co Of North America 43575 a fully owned subsidiary of Conrl Corporation INSURER C: ACE Property n _Qa5ualty Ins Co 20699 30 Rockefeller Plaza INSURER D: ACE Fire Underwri s.Co. 24702 NewYork,NY 10112 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CLE-007329709-04 REVISION NUMBER: 13 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 I ADDLSUBR. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD1YYYY MMIDDrn YY LIMITS A X COMMERCIAL GENERAL LIABILITY XSL G4893044A 12101/2024 12l0112025 EACH OCCURRENCE $ 19,900,000 CLAIMS-MADE X❑OCCUR DAMAGES( ED PREMISES Eaa o occcurrence) $ 19,90Q000 X SIR:$100,000 MEO EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 19,900,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 60,000,000 X POLICY JECTPRO- [:] LOC PRODUCTS-COMPlOP AGG $ 15,440,044 OTHER: $ A AUTDMOBILELIABILITY I5AH11352637 1210112024 12101/2025 COMBiNEDSINGLELIMIT $ Ea accident 20,000,000 X ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS B ( ) $ HIRED NON OWNEDPROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ C X UMBRELLA LAB X OCCUR XEU G27924840 010 1210112024 12/01/2425 EACH OCCURRENCE $ 10,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 10,000,000 QED RETENTION S $ B WORKERS AND EMPLOYERS'LIABILITY ABILITY WLR C72613363(ADS) 12/01/2024 12/01/2025 X STA UTE ER A Y t N WLR C72613405 CA,MA 12/0112024 1210112425 OFFICE IMEMB RIPARTNEREXECUTIVE { ) E.L.EACH ACCIDENT $ 2,000,400 D OFFICERlMEMBEREXCLUDED? � NIA (Mandatory in NHI SCF C7261348A(WI) 12/01/2024 12141I2025 E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under D $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 2,000,000 A Excess Workers Compensation WCU C72613442(WA) 12/01/2024 12101/2025 Ea AodDis EmployeelDis Pdic t 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) RE:City of Santa Ana conducts background screening with NCSI City of Santa Ana is included as additional insured(except workers'compensation)where required by written contract with the Named Insured. This insurance is Primary&Non-Contributory with any other insurance available to the Certificate Holder. NBCUniversal Media,LLC subsidiaries include,but are not limited to:SportsEngine Inc.dba National Cente€for Safety Initlatives LLC Waiver of subrogation is applicable where required by written contract. Digitally signed by TuTran Nguyen pat,2QZSOs15 APPROVED 09:31:39-07'00' By Tu Tran Nguyen at_9:3'!_aM,_1Nay 15,2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Lauren Hirano, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza,M-24, ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA LLC @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED -- DESIGNATED PERSONS OR ORGANIZATIONS Named Insumd Endorsement Numbor Comcast Corporation Policy Symbol Policy Number Policy.Porldd Effective Rate of Endorsement ISA I H11352637 12101/2024 to 12101/2025 12/01/2024 Issued By(Noma of insurence Company) ACE American Insurance Company Insert the polcy number;The remalndor:of the information Is to be completed only when this endorsem ent is3ssued subsequent:to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT DAREFULLY This endorsement modifies insurance provided under the`following- BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional insured.(s): City of Santa Ana,its City Council, officers, officials, emp(oyeas, agents,.and volunteers" A. For covered"auto,''Who I:s Insured Is amen.ded.to Include as an "Insured,"the persons.olrorganizslWns named in this.endorsement, However.,these persons or organizations are an'Insured"only for"bodily ]njury"or"property damage"resulting from acts or omissions of: 1. You, 2. Any of your"employees"or agents, 3. Arty person operating-a covered "auto"with permission from you,.any of your"employees"or agents. B. The persons or organizations named in this endorsement are not liable for payment of your promium, AufharEwJ Repl•wnta" nA-9U74c.(03116) Page t of i NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured EndorsernentNumber comcast Corporation Policy Symbol Policy Number policy Period Effnotive Date of Eli dcrssmenI X4. G4893044A 12/01/2024 to 12/01/2025 12/01/2024. Issuod sy{Nan1�tf Insurance Company} ACE Ametican Insurance company Insert.lho policy nurnbet.The remainder of the information is to be complated only when this andorsemeht is issued subsaquonl to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAM IT CAREFULLY. This.endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or organization: City of Santa Ana, its City Council, officers,olfiaWs, employees, agents,and volunteers" We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make For injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. Authorized Representative XSwM34(09195)Ptd.In U.S. Mass Coda 2-14057 NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Endorsement Number Cornoast Corporation Policy Symbol Policy Number Policy Porlod FtfectiVo Idle of lindorsement. ISA H11352637 121112024 to 12/11202.5 12/01/2024 Issued By(Name of Insurance Company) ACE Amorioan InsurAnCO Cpmpalny Insert the policy number.Tho mmoindsr of:the.information is tG be completed only when thls sndatsement.Is issued,subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies Insurance provided under this following. BUSINESS,AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM ,AUTO DEALERS COVERAGE FORM We waive any tight of recovery we may have against the. parson or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE City of Santa Ana, Its City Council, officers, officials, employees, agonts, and volunteers Authorized Representative DA-1.3415a(06/14) Page. 1 .of 1 Class Code:2-14057 NOTICE; THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS, ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION Named Inaurnd Indorsement Number comcw;t Corporation Pofloy Symbol Policy Number Policy Period Effoctive Date of Endorsement XSL G4893044A 12/01/2024 to 12/01/2025 12/01/20.24 Issued By.tNamo or Insurance Company ACE American insurance Company Insert the policy nunihor,The remainder of the informallan is to be completed only when this endwoment is inc ad subsequent to the preperstlon of the policy, THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Namo of Person or organization., City of Santa Ana, Its City Council, officers,officials, employees, agents, and volunteers A. Section 11—Who Is An Insured is amended to Include as an additional insured the person(s) or organizations)shown to the Schedule, but only with respect to Ilabillty 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: 1, In the performance of your ongoing operatioris; or 2. In connection with your:premises owned by or rented to you. However: 1. The Insurance afforded to such additional Insured only applies to the extent:permitted by law; and 2. if coverage.provided to the additional insured is required by a contract or agreement, the Insurance afforded.to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. X5-6W25b(04113) Includes copyrighted material of Insurance Services Office, Inc„with its permission. Pagel of 2 Class code:2-14057 B. With respect to the insurance afforded to these additional insureds, the following Is added to Section III— Limits Of Insurance And Retainer! Limit: If coverage provided to the additional insured Is required by a contract or agreement,.the most we will pay on behalf of the additional insured is the amount of insurance: 9. Required by the contractor agreement;or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown In the Declarations. Authorized Representative X8-6W25b(0411 3) Includes copyrighted material of Insurance Services Office Inc„with its permission. Page 2 of 2 Class Code:2-14457 i Workers"Compensation and Employers'L.lability Policy Named Insured Endorsement Number COMCAST CORPORATION 1701 JOHN F. KENNEDY BOULEVARD Policy Number A&TOA6-AO R S mbol,WLR Number; C72613363 1M1-2424 TO 12-01-2425 Effective Date of Endorsement 12/01/2024 Issued By(Name of Insurance Company);Indemnity Insurance Co.of North Amerlca neert the policy number,The remainder of the Wormation Is to be competed only when this endorsement Is issued subsequent to the preparation of the pallGy, WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 reamed 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, This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule City of Santa Ana,Its City Council, Officers,Officials, employees, agents,and Volunteers For the states of CA,UT,TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH,and NJ. Authorized Agent wo 00 03 13(11105) Copyright 1982-83,National Council on Compensation i A�® CERTIFICATE OF LIABILITY INSURANCE 70T, E2/2026IYYYY) /02/2026 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 Marsh USA LLC NAME: HONE FAX 30 South 17th Street AIC_ Ext: A/C,No Philadelphia,PA 19103 E-MAIL Attn:NBCU.Certrequest@marsh.com Fax 212-948-5143 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN 101 608515-NBCU-GAWUW-25- wsURERA: ACE American Insurance Company 22667 INSURED INSURER B: Indemnity Ins Cc Of North America 43575 NBCUniversal Media,LLC a fully owned subsidiary of Comcast Corporation INSURER C: ACE Property And Casualty Ins Cc 20699 30 Rockefeller Plaza INSURER D: ACE Fire Underwriters Ins.Co. 20702 New York,NY 10112 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: CLE-006533573-24 REVISION NUMBER: 31 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LTR MM/DDIYYYYI iMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY y y XSLG49368793 12/01/2025 12/01/2026 EACH OCCURRENCE $ 19,900,000 RENTEDDAMAGE TO CLAIMS-MADE X� OCCUR FIR SES(Ea occurre... $ 19,900,000 X SIR:$100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 19,900,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 60,000,000 POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 15,000,N 000 OTHER: $ A AUTOMOBILE LIABILITY ISA H11361262 12/01/2025 12/01/2026 COMBINED SINGLE LIMIT $ 20,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ C X UMBRELLALIAB X OCCUR XEU G27924840 011 12/01/2025 12/01/2026 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION y WLR C7280143A(AOS) 12/01/2025 12/01/2026 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D YIN SCF C72801441(W) 12/01/2025 12/01/2026 2,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers Compensation WCU C72801453(WA) 12/01/2025 12/01/2026 Ea Acc/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 Dlgitallysigned DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Nguyen RE:Service Contract between SportsEngine Inc.-NCSI and City of Santa Ana,CA Nguyen Date:2026.01.06 09:19:24-08'00' NBCUniversal Media,LLC subsidiaries include,but are not limited to:SportsEngine Inc.dba National Center for Safety Initiatives LLC City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as additional insured(except workers'compensation)where required by written contract with the Named Insured. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Waiver of subrogation is applicable where required by written contract. Please see attached for Notice of Cancellation endorsements. APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 9:18 am,Jan 06,2 226 City of Santa Ana, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention:Human Resources Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA LLC @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED — DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Endorsement Number Comcast Corporation Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA H 11361262 12101/2025 TO 12/01/2026 12101/2025 Issued By(Name of Insurance Company) ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional I ns u red(s): Any person or organization wham 9) a named insured other than NBCUniversal Media, LLC andlor its subsidiaries has agreed to include as an additional insured under written contract or written agreement, provided such contract or agreement was executed prior to the date of loss;and 2)NBCUniversal Media, LLC andlor its subsidiaries has agreed to include as an additional insured under contract or agreement,provided such contract or agreement was executed prior to the date of loss A. For a covered"auto,"Who Is Insured is amended to include as an "insured,"the persons or organizations named in this endorsement. However, these persons or organizations are an"insured"only for"bodily injury"or"property damage" resulting from acts or omissions of: 1. You. 2. Any of your"employees"or agents. 3. Any person operating a covered "auto"with permission from you,any of your"employees"or agents. B. The persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative ❑A-91-174c(03i16) Page 1 of 1 NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Endorsement Number Comcast Corporation Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA H11361262 12/01/2025 TO 12/01/2026 12/01/2025 Issued By{Name of Insurance Company} ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE Any person or organization whom 9) a named insured other than NBCUniversal Media, LLC and/orits subsidiaries has agreed to include as an additional insured under written contractor written agreement, provided such contract or agreement was executed prior to the elate of loss; and 2)NBCUniversalMedia, LLC andlorits subsidiaries has agreed to include as an additional insured under contract or agreement, provided such contract or agreement was executed prior to the date of loss Authorized Representative DA-131 15a(06/14) Page 1 of 1 Class Code:2-14057 NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Named Insured Endorsement Number Comcast Corporation Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G49368793 12/01/2025 TO 12/01/2026 12/01/2025 Issued By{Name of Insurance Company} ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization whom tJ a named insured other than NBCUniversal Media,L L C and/or its subsidiaries has agreed to include as an additional insured under written contract or writ fen agreement,provided such contract or agreement was executed prior to the date of loss;and 2)NBCUniversal Media, LLC andfor its subsidiaries has agreed to include as an additional insured under contract or agreement,provided such contract or agreement was executed prior to the date of loss A. Section II—Who Is An Insured is amended to include as an additional insured the persons)or organizations)shown in the Schedule, 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: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will notbe broaderthan thatwhich you are required bythe contract oragreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance And Retained Limit: If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Authorized Representative XS-6W25b(04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Class Code:2-14057 NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Endorsement Number Comcast Corporation Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G49368793 12/01/2025 TO 12/01/2026 12/0112025 Issued By{Name of Insurance Company} ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization whom 9) a named insured other than NBCUniversal Media, LLC and/or its subsidiaries has agreed to include as an additional insured under written contract or written agreement, provided such contract or agreement was executed prior to the date of loss; and 2)NBCUniversal Media, LLC andlor its subsidiaries has agreed to include as an additional insured under contract or agreement, provided such contract or agreement was executed prior to the date of loss We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the"products-completed operations hazard".This waiver applies only to the person or organization shown in the Schedule above. Authorized Representative XS-6W34(09195)Ptd.in U.S. Page 1 of 1 Class Code 2-14057 Workers' Compensation and Employers' Liability Policy Named Ensured Endorsement Number Comcast Corporation 1701 John F. Kennedy Boulevard Policy Number 49th Floor Symbol: WLR Policy: C7280143A Philadelphia, PA 19103 Policy Period Effective Date of Endorsement 12/01/2025 TO 12/01/2026 12/01/2025 Issued By{Name of Insurance Company} Indemnity Insurance Co.of North America Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE Any person or organization whom 9) a named insured other than NBCUniversal Media, LLC andlor its subsidiaries has agreed to include as an additional insured under written contract or written agreement; provided such contract or agreement was executed prior to the date of loss; and 2) NBC Universal Media, LLC and/or its subsidiaries has agreed to include as an additional insured under contract or agreement provided such contract or agreement was executed prior to the date of loss For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. Authorized Representative WC 00 03 13(11105) Copyright 1982-83,National Council on Compensation Page 1 of 1