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MY CODING CLASSES (PARAMOUNT EDUCATION LLC)
INSURANCE ON FILE W{}W SVY PROCEED LII�iiL I 1F; ,NCt FXM','KS N-2026-013 ?1J $ o ERK oe5tineQ Sorianot°Z)RECREATION SERVICES AGREEMENT WITH PARAMOUNT EDUCATION LLC FOR COMPUTER CODING CLASSES THIS AGREEMENT is made and entered into on this 9th day of January, 2026 by and between Paramount Education LLC dba My Coding Classes, a California limited liability company ("Provider"), 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'"). City and Provider may be collectively referred to as the "Parties" or individually as a"Party." RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide computer coding classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. 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 a. Provider shall perform those services as set forth in Exhibit A to this Agreement. b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC-), California Department of Public Health ("CDPH"). the Orange County Health Care Agency("OCHCA")and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s)associated with COVID-19 including but not limited to,fever above 100.4, chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. Pagel of8 d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self-isolate due to symptoins of COVID-19 or a positive test result for COVID-19. e. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. f. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation class policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Fifteen Thousand Dollars and Zero cents ($15,000). b. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%)of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on February 1, 2026 and end on January 31, 2027 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor 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 manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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 Page 2 of 8 applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Insurance requirements attached hereto as Exhibit B. 6. INDEMNIFICATION Provider agrees to and shall indemnify, defend and hold harmless the City, its officers, agents, employees,consultants,special counsel,and representatives from liability: (1)for personal injury,damages,just compensation,restitution,judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section I of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages,just compensation, restitution,judicial or equitable relief is caused by the negligence of the Provider. 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. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages,just compensation, restitution,judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, 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. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e) is independently developed by the Provider without reference to information disclosed by the City. Page 3 of 8 8. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19,some people have become seriously ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVM-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees,volunteers,and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST a. Provider covenants that it presently has no interests and shall not have interests, direct or indirect,which would conflict in any manner with performance of services specified under this Agreement. b. No immediate family members of either the Mayor, City Council Member, or any appointed City Official, including appointed board and commission members, as defined under the City's Municipal Code, whose position with the City shall award or influence the award of this Agreement, or any competing contract or amendment thereof, shall be employed in any capacity by the Provider or have any other direct or indirect financial benefit or interest in this Agreement. c. The section also prohibits the awarding of any agreement, contract, grant, or any amendment to those awards, to any former full-time employee for one-year from date of employee separation except for any CaIPERS retiree as authorized by City Council resolution d. Provider must comply with all conflict of interest laws, ordinances, and regulations now in effect or hereafter to be enacted during the term of this Agreement.The Provider warrants that it is not now aware of any facts which conflict with the prohibitions defined above. If Provider hereafter becomes aware of any facts that might reasonably Page 4 of 8 be expected to create a conflict of interest, it must immediately make full written disclosure of such facts to the City. Full written disclosure must include, but is not limited to, identification of all persons implicated and a complete description of all relevant circumstances. Failure to comply with the provisions of this paragraph will be a material breach of this Agreement, e. Provider covenants that none of its directors, officers, employees, or agents shall participate in selecting or administrating any subcontract supported(in whole or in part) by City funds stemming from the Agreement where the awarding of the subcontract has any direct or indirect financial benefit or interest to any individual, as defined in subsections (b)and (c) above. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee,agent, subcontractor,volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c). Disqualifying convictions include but are not limited to,violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, 207-209.5, 211,212, 212.5, 213, 214, 215, 218-219, 220, 236.t(b) or 236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d,285, 286, 288, 288a, 288.2,288.3,288.4,288.5,288.7,289,290,311.1, 311.2,311.3, 311.4,311.10, 31.1.11,314, 347(a),368,417(b),451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. 11. 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 snail, 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 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services Page 5 of 8 City of Santa Ana 20 Civic Center Plaza(M-23) P.O. Box 1988 Santa Ana, California 92702 Fax(714) 571-4211 To Provider: Paramount Education LLC dba My Coding Classes Attn: Jack Daswani, Partnership Lead 4661 Rimini Court Dublin, CA 94568 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, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, 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 Provider. 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 Provider 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. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. 14. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. Page 6 of 8 b. Termination or cancellation of classes by the Provider must be given to the City, in writing, at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk. 15. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. t6. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic 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. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 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. LICENSES Provider 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, 19. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unertforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the Parties hereunder. Page 7 of 8 i 20. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if frilly set forth in the body of this Agreement. 21. AUTHORITY The person(s) executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by so executing this Agreement, the Parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. ATTEST: i'>,, CITY OF S TA AN ate• _ ennifer L al Alvaro Nuftez City Cler City Manager APPROVED AS TO FORM: SONIA R. CARVALHO PROVIDER: City Attorney iacVDaswani(Jan 15,2026 09:36:38 PST) Jonathan T. Marrtnez Jack Daswam Assistant City Attorney Partnership Lead RECOM DED FO PPROVAL: Scott ve D' �Commtinityy Recreation an Services Agency Pane 8 of 8 Exhibit A SCOPE OF SERVICES Program Overview: This Scope of Services outlines the responsibilities and expectations for engagement of Provider to provide youth coding classes for ages 5 - 17 years at City recreation facilities and parks, as defined below. The aim is to promote health and wellness in the community by offering affordable recreation opportunities that encourage creative activity and teamwork. A. Program and Class Offerings: i. Seasonal programs and class offerings may include, but are not limited to the following class options: i. Music with Sonic Pi ii. Canva iii. Web Builder iv. Minecraft v. Scratch vi. Roblox ii. Instructor shall teach such or similar classes at available City facilities to be designated by the City on a schedule agreed upon by the parties, in writing, for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Provider and City agree that class locations and/or scheduling are subject to change due to unforeseen events or needs beneficial to the class participants. The Parties agree that changes to scheduling or location of classes shall be agreed upon, in writing, prior to the allowance of said change(s). iii. Class Size i. At the City's discretion and upon mutual agreement, the minimum and maximum number of participants required for each class will be determined to ensure the quality and safety of the class participants. ii. Class ratio of participants to instructor(s)will be set far each class to ensure effective instruction and safety based on statewide standards. iii. If the minimum registration has not been reached by the second class, it is up to the discretion of the City upon mutual agreement with Instructor, that the class shall be cancelled. Instructor will be under no obligation to l provide services for the cancelled classes, and the City will have no further obligations to pay Instructor compensation for the remaining classes that were cancelled in that session. iv. Class Fees i. Class pricing is dependent on session length per season and subject to City staff approval. Class pricing is limited to no more than a 5% increase annually. ii. Each participant shall pay class registration fees as established by City. Instructor may not waive class participation/registration fees. Only registered participants paid in full may participate in class. iii. Any refunds to participants will be made in accordance with City policy. B. Instructor Responsibilities: i. Planning and delivering engaging and age-appropriate coding classes as defined by class curriculum and description to be approved by City staff. ii. Ensuring the safety and well-being of all participants during class sessions. ■ instructor will immediately report to City staff, by phone or email, any injuries as a result of class participation, damages to the facility that could cause potential injury to a class participant and/ or require facility repairs. • Instructor will notify parent/guardian of minors under the age of 18 and city staff regarding any injuries experienced during class. iii. Submitting seasonal program proposals to City staff for seasonal approval of class descriptions, details, and schedules. Proposals must be submitted in writing by way of the provided City form(s) to City staff for review and approval at least 60 days prior to the start of the new season, unless otherwise specified by City staff. City staff will review and approve written proposals based on community needs, facility availability, and alignment with City goals. iv. Adhering to all City policies and procedures related to the use of facilities and interaction with participants. v. Adhering to all City deadlines for required documentation. vi. The instructor's organization is responsible for fingerprinting, monitoring, and managing all staff that will be instructing. 2 vii. Promotion of class(es) with City approved marketing materials outside of City managed platforms. Publicizing on additional channels and networks outside of City platforms is the sole responsibility of the instructor. viii. Instructor shall provide all materials, supplies, equipment, records and personnel. Instructor shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Instructor shall ensure clean-up of the facilities and materials to ensure the safety and effectiveness of instruction. The City will not responsible for any damage, repairs, misplaced, or stolen supplies or equipment, and will not be responsible for storing supplies or equipment. C. City Responsibilities: i. City shall manage participant registration and class information through registration software. Instructor shall be granted access to the class roster on the City registration system and is responsible for tracking attendance. ii. City shall collect all enrollment fees through the registration software. Instructor shall not accept enrollment fees directly from a participant, and shall only collect materials fees that are pre-approved by City and published in advance as a part of the program marketing. Such material fees shall be collected by Instructor at the first scheduled class meeting. No additional fees shall be collected for materials, uniforms, awards, etc. without written approval and advanced advertising. iii. City shall provide publicity for class(es) seasonally in the City's recreation magazine (published seasonally). City shall have the sole discretion to decide what information will be included in the recreation magazine about the class and Instructor. Publicity may also include flyers created by City. Instructor created flyers are encouraged, but must be finalized by City to include use of City logos before distribution. iv. City shall provide a location for the class(es). Instructor will request dates and times for the class(es) seasonally, in writing. The City will confirm the class(es) schedule seasonally. Location selection is based on need, size of class, type of activity and availability, and is reserved at the discretion of the City. V. City shall provide refunds to participants when: ■ The participant formally requests to drop the class before the second schedule class meeting. ■ The class is canceled by City or Instructor. 3 Insurance Requirements--Exhibit B Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied. Total cost of such insurance shall be borne by Provider. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01covering 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. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. Automobile Liability (AL): .Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Provider does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance, provided that such policy is endorsed for business use and provides coverage with a minimum limit of $1,000,000.Required policy limits can be met with primary and umbrella/excess insurance policies. 3. Workers' Compensation (WC); 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, policy or employee, for bodily injury or disease. Coverage is not required if Provider has no employees and signs request to waive such insurance. 4. Sexual Abuse or Molestation Liability (SAML): If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Provider shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than $1,000,000 per occurrence or claim. If Provider maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: 1. City of Santa Ana, its City Council, its officers,officials,employees,agents,and volunteers are to be covered as additional insureds on Provider's CGL, AL, and SAML policies with respect to liability arising out of work or operations performed by or on behalf of the Insurance Requirements—Exhibit B Provider including materials,parts,equipment,and personnel furnished in connection with such work or operations. 2. Provider's Insurance company(ies) 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 Provider's CGL,AL,and WC policies which arise from work performed by Provider under this Agreement. 3. For any claims related to this contract, Provider's 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. A severability of interest provision must apply for all the additional insureds, ensuring that Provider's 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. Insurance policy(ies) 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: Parks, Recreation, and Community Services Agency, 20 Civic Center Plaza, M-23, Santa Ana, CA 42701. The name and location of project must be included in the Description of Operations section of each certificate. 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. Verification of Coverage Provider 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 before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider's 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. Special Events Coverage Special events coverage is available and can be purchased by Provider. Use this link to learn more: https:H2sparta.com/selipa application.php. 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. 16-�® CERTIFICATE OF LIABILITY INSURANCE DATE( YY) �� 1211612025 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 end°rsement(s). PRODUCER CONTACT NAME: Next First Insurance Agency,Inc. nlcN'o Ext:{85S)222-5919 iA No): PO Box 60787 Palo Alto,CA 94306 E-MAIL ADDRESS: supp ont@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: State National Insurance Company,Inc. 12831 INSURED INSURER B: National Specialty Insurance Company 22608 Paramount Education LLC DBA MyCodingClasses 4661 Rimini Cr INSURERC: Dublin,CA 94568 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:629234563 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. IPOLICY FEE POLICY EXP N R TYPE OF INSURANCE INSD WVQSUBR POLICYNUMBER MM0DIYYYY MM DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1,000,000.0o CLAIMS-MADE FX I RE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1 00,000.00 MED EXP(Any one person) S 15,000.00 A X X NXTPCH7HXR-G0-GL 02/28/2025 02/28/2026 PERSONAL BADVINJURY 51,000,000.00 GEN•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000.00 POLECY JECT PRO LOC PRDDUCTS-COMPIOPAGO $2,000,000.00 X PRI- OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident) S UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S 5 WORKERS COMPENSATION X I PEA EMPLOYERS'LIABILITY YIN STATUTE ER B ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBER EXCLUDED? Q NIA X NXT7CLDW3F-GO-WC 03/14/2025 03/14/2026 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000.00 Each Occurrence: $1,000,000.00 A Professional Liability NXTPCH7HXR-00-GL 02/28/2025 02/28/2026 Aggregate: $2,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The Certificate Holder is City of Santa Ana.A Workers Compensation Waiver of Subrogation applies In favor of City ci Santa Ana,its City Council,officers,officials,employees, agents,and volunteers.A General Liability Waiver of Subrogation applies in favor of City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers.The City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers is an Additional Insured on the General Liability policy With respect to ongoing operations.All Additional Insured privileges apply only if required by written agreement between the City of Santa Ana,its City Council,officers,officials,employees,agents, and volunteers and the insured,and are subject to policy terms and conditions. niga,11,,gg dby Tu Tran Tu Tran Nguyen Nguyen 115,03.43208'00'e APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:03 prta,Jan 20,2026 City of Santa Ana LIVE CERTIFICATE Parks,Recreation,and Community Services Agency ?.f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center M-23 v❑ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. •r' • {•' ti AUTHORIZED REPRESENTATIVE M}•LSD^ �r- Click or scan to view ©1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 16 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE NXTPCH7HXR-00-GL 12/16/2025 State National Insurance Company, Inc. NAMED INSURED AUTHORIZED REPRESENTATIVE Jack Daswani Paramount Education LLC DBA MyCodingClasses 4661 Rimini Ct Dublin,CA 94568 Ann Ryan COVERAGE PARTS AFFECTED Commercial General liability Coverage Part CHANGES SEE ATTACHED SCHEDULE Return Total $0.00 Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 2 Copyright, ISO Commercial Risk Services, Inc., 1983 SCHEDULE OF POLICY CHANGES It is understood and agreed that; The following forms are added; CG 20 10 04 13-Additional Insured-Owners, Lessees or Contractors-Scheduled Person or Organization All other terms and conditions remain unchanged. IL 12 01 11 85 Copyright, insurance Services Office, Inc., 1983 Page 2 of 2 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 POLICY NUMBER: NXTPCH7HXR-00-GL COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations City of Santa Ana, its City Council, officers,officials, CA employees,agents,and volurteers 20 Civfc Center Piz#E M-23 Santa Ana,CA 92701 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" property damage occurring after; pp y y in 1 ry caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above, completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 2010 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section ]III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended to include the following as insureds: 1. Lessor of Leased Equipment Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured 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. No such person or organization is an insured under this section: a. Upon expiration or termination of their contract or agreement with you for such leased equipment ends; b, For any"bodily injury"or"property damage"caused by an"occurrence"which takes place after expiration or termination of their contract or agreement with you; or c. For any "personal and advertising injury" caused by an "offense" which takes place after expiration or termination of their contract or agreement with you. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability arising out of your ownership, maintenance or use of that part of the premises leased to you. No such person or organization is an insured under this section for any: a. For"bodily injury"or"property damage"caused by an"occurrence"which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of such person ororganization. 3. Grantor of Franchise Any person or organization (referred to below as grantor of a franchise)with whom you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to"bodily injury" or"property damage" arising out of" liability as grantor of a franchise to you B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III LIMITS OF INSURANCE: 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. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc.used with its Page 1 of 2 permission COMMERCIAL GENERAL LIABILITY C. With respect to the provisions of this endorsement, the following Is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. All other terms and conditions of the policy remain unchanged. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc.used with its Page 2 of 2 permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B (Ed. 7-01) POLICY INFORMATION PAGE ENDORSEMENT The following item(s) F, Insured's Name (WC 89 06 01) r Item 3,13, Limits (WC 89 06 12) Policy Number(WC 89 06 02) r Item 3.C.States (WC 89 06 13) Effective Date(WC 89 06 03) )t Item 3.D.Endorsement Numbers(WC 89 0614) j Expiration Date(WC 89 06 04) ❑ Item 4.*Class, Rate,Other(WC 89 04 15) ❑ Insured's Mailing Address(WC 89 06 05) ❑ Interim Adjustment of Premium(WC 89 04 18) ❑ Experience Modification (WC 89 04 06) ❑ Carrier Servicing Office (WC 89 06 17) ❑ Producer's Name(WC 89 06 07) ❑ Interstate/intrastate Risk ID Number(WC 89 0618) ❑ Change in Workplace of Insured(WC 89 06 08) ❑ Carrier Number(WC 89 06 19) ❑ Insured's Legal Status(WC 89 06 10) ❑ Issuing AgencylProducer Office Address(WC 89 06 25) ❑ Item 3.A.States (WC 89 06 11) is changed to read: It is understood and agreed that: The following forms are added: WC 00 03 13-Waiver Of Our Right To Recover From Others Endorsement All other terms and conditions remain unchanged. *Item 3.D. Change to Form Number Form Title WC 89 06 00 3(07-01) Policy Information Page Endorsement WC 04.03 06 Waiver of Our Right to Recover from Others Endorsement--California WC 89 06 OOB (Ed.7-01) m 2001 National Council on Compensation Insurance,Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B (Ed. 7-01) POLICY INFORMATION PAGE ENDORSEMENT (CONTINUED) *Item 4. Change To: Premium Basis Rate Per$100 Classifications Code Total Estimated of Estimated No. Annual Remuneration Annual Premium Remuneration WC 89 06 OOB (Ed. 7-01) 0 2001 National Council on Compensation Insurance,Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B (Ed. 7-01) POLICY INFORMATION PAGE ENDORSEMENT ELI Increased Limits Charge Safety'Factor Drug-Free Workplace Factor Experience Rating Premium Waiver of Subrogation $250.00 Premium Deductible Premium Total State Surcharges $53.00 Total Estimated Annual Premium$ 1,103.00 Total Amount Due 1,103.00 Minimum Premium$ 750.00 Deposit Premium$ 0,00 All other terms and conditions of this policy remain unchanged. 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 Effective03/14/2025 Policy No.NXT7CL1DW3F-00-WC Endorsement No. 02 Insured Paramount Education LLC DBA MyCodingClasses Premium$ 1,103.00 Insurance Company National Specialty Insurance '` Company Countersigned by WC 89 06 OOB (Ed. 7-01) ®1987 National Council on Compensation Insurance,Inc. 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. 2 The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC 04 03 06 (Ed. 04-84) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 07 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE NXTPCH7HXR-00-GL 02/28/2025 State National Insurance Company, Inc. NAMED INSURED AUTHORIZED REPRESENTATIVE Jack Daswani Paramount Education LLC DBA MyCodingClasses 4661 Rimini Ct Dublin,CA 94568 Ann Ryan COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES SEE ATTACHED SCHEDULE Additional Total $20.00 62, Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 2 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 SCHEDULE OF POLICY CHANGES It is understood and agreed that: The following forms are added: CG 24 C4 05 09-Waiver Of Transfer Of Rights Of Recovery Against Others To Us All other terms and conditions remain unchanged. IL 12 01 11 85 Copyright, insurance Services Office, Inc., 1983 Page 2 of 2 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 POLICY NUMBER: NXTPCH7HXR-00-GL COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: 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. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 13 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABUSE AND MOLESTATION COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Abuse or Molestation Limit of Insurance-Each Person:$100,000.00 Abuse or Molestation Limit of Insurance-Aggregate: $1 oo,000.00 The following changes apply only to the coverage provided by this endorsement. A. The following exclusion is added to Paragraph 2. Exclusions under SECTION I—COVERAGES, COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B— PERSONAL AND ADVERTISING INJURY LIABILITY: This insurance does not apply to: Abuse Or Molestation "Bodily injury", "property damage"or"personal and advertising injury" arising out of the actual or threatened abuse, molestation or exploitation by anyone.This exclusion applies even if the claim against the insured alleges negligence or other wrongdoing in the employment, investigation, supervision, reporting to the proper authorities or failure to so report, training or retention. B. The following is added to SECTION I—COVERAGES: ABUSE OR MOLESTATION COVERAGE 1. Insuring Agreement a. We will pay those sums the insured becomes legally obligated to pay as damages because of"bodily injury"arising out of abuse, molestation or exploitation to which this insurance applies.We will have the right and duty to defend the insured against any"suit"seeking such damages. However, we will have no duty to defend the insured against any"suit" seeking damages to which this insurance does not apply. Nor do we have a duty to defend any insured who is alleged to have taken part in the abuse, molestation or exploitation. We may,at our discretion, investigate and settle any claim or"suit"that may result. But: (1) The amount we will pay for damages is limited as described in Paragraph C. Limits Of Insurance below; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Abuse Or Molestation Coverage. b. This insurance applies to "bodily injury" arising out of abuse, molestation or exploitation only if the abuse, molestation or exploitation: (1) Takes place in the"coverage territory'; (2) Results from the insured's negligence in employment, investigation, supervision, reporting to the proper authorities or failure to so report, training or retention;and (3) First occurs during the policy period. NXT-011 4 13M GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 3 permission I I I COMMERCIAL GENERAL LIABILITY c. Abuse, molestation or exploitation which first occurs during the policy period includes any continuation, change or resumption of that abuse, molestation or exploitation after the end of the policyperiod. d. Multiple acts of abuse, molestation or exploitation of any one person by one or more perpetrators will be deemed to have first occurred at the time of the first act of such abuse, molestation or exploitation and shall be subject to the coverage and limits in effect at the time of the first act of abuse, molestation orexploitation. 2. Exclusions This insurance does not apply to: a. Fines And Penalties Any fines, penalties, punitive damages, exemplary damages or aggravated damages. b. Participating Insured Any insured who takes part in the abuse, molestation or exploitation. c. Passive Insured Any insured who remains passive upon gaining knowledge of any actual, alleged or threatened abuse, molestation or exploitation. C. SECTION III—LIMITS OF INSURANCE is replaced by the following: SECTION III—LIMITS OF INSURANCE 1. The Limits of Insurance shown in the SCHEDULE above and the rules below fix the most we will pay under Abuse Or Molestation Coverage regardless of the numberof: a. Insureds; b. Claims made or"suits" brought;or c. Persons or organizations making claims or bringing"suits". 2. The Aggregate limit shown in the Schedule of this endorsement is the most we will pay under Abuse Or Molestation Coverage for the sum of all damages. 3. Subject to Paragraph 2.above, the Each Person limit shown in the Schedule of this endorsement is the most we will pay under Abuse Or Molestation Coverage for damages because of"bodily injury"arising out of abuse, molestation or exploitation committed upon any one person, regardless of the number of acts of abuse, molestation or exploitation committed, the period of time over which such acts occur,or the number of perpetrators taking part in the abuse, molestation or exploitation. 4. The coverage provided by this endorsement does not provide any duplication or overlap of any other coverage provided elsewhere in this policy. No coverage is provided for abuse, molestation or exploitation under this policy except as provided in this endorsement. 5. The Limits of Insurance provided by this endorsement are in addition to, not part of,the Limits of Insurance provided by the Commercial General Liability Coverage Form. The Limits of Insurance shown in the Schedule of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations of the Commercial General Liability Coverage Form, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. NXT-0114 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc.used with its Page 2 of 3 permission COMMERCIAL GENERAL LIABILITY D. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The heading and Paragraph a. of Condition 2. is replaced by the following: 2. Duties In The Event Of Abuse, Molestation, Exploitation, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an act or allegation of abuse, molestation or exploitation which may result in a claim.To the extent possible, notice should include: (1) How, when and where the abuse, molestation or exploitation took place; (2) The names and addresses of any injured persons and witnesses;and (3) The nature and location of any injury or damage arising out of the abuse, molestation or exploitation. 2. The following is added to Paragraph b. Excess Insurance of Condition 4.Otherinsurance: The insurance provided by this endorsement is excess over any other insurance provided to any insured, whether such other insurance is provided on a primary, excess, contingent or any other basis, unless such other insurance is written to be specifically excess of this insurance. 3. The following Condition is added: Multiple Coverage Forms Or Policies Issued By Us When two or more Coverage Forms or policies issued by us apply to the same claim, "suit" or loss, the maximum limit of our liability under all such Coverage Forms or policies combined shall not exceed the highest applicable limit of liability under any one Coverage Form or policy among them. E. Definition 3."bodily injury" under SECTION V—DEFINITIONS is amended as follows: "Bodily injury"means bodily injury, sickness, disease, mental anguish or emotional distress sustained by a person, including death resulting from any of these at any time. All other terms and conditions of the policy remain unchanged. NXT-0114 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 3 of 3 permission CITY of SAN'TA area Risk Management a division of Human Resources ig Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE I Jack Daswani (`Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of Paramount Education LLC ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide coding courses ("Services"): (Services to be provided under agreementicontract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rented/leased/borrowed vehicles to perform Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 1-15-2026 Signature Date Jack Daswani Print Name Managing Partner Title 925.895.9131 Contact Irrtbrmation,i.e.,Telephone Number and/or Email Address Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 7OT3/14/2026 E(MM/DDIYYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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 NAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 FAX PO Box 60787 AIC No Ext: (A/C,No Palo Alto,CA 94306 E-MAIL pp ADDRESS: support@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Next Insurance US Company 1628S INSURED INSURER B: National Specialty Insurance Company 22608 Paramount Education LLC DBA MyCodingClasses 4661 Rimini Ct INSURERC: Dublin,CA 94S68 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:893286600 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LTR MM/DDIYYYYI iMMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE 1XI OCCUR DAMAGE TO RENTED 1 PREMISES Ea occurrence $ 00,000.00 IVIED EXP(Any one person) $15,000.00 A X X NXTPCH7HXR-01-GL 02/28/2026 02/28/2027 PERSONAL&ADV INJURY $1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 POLICY❑ PRO ❑ $2,000,000.00 LOC PRODUCTS-COMP/OPAGG X JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBER EXCLUDED? FIN ] NIA X NXT7CLDW3F-01-WC 03/14/2026 03/14/2027 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 Each Occurrence: $1,000,000.00 A Professional Liability NXTPCH7HXR-01-GL 02/28/2026 02/28/2027 Aggregate: $2,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is City of Santa Ana.A Workers Compensation Waiver of Subrogation applies in favor of City of Santa Ana,its City Council,officers,officials,employees, agents,and volunteers.A General Liability Waiver of Subrogation applies in favor of City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers.The City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers is an Additional Insured on the General Liability policy with respect to ongoing operations.All Additional Insured privileges apply only if required by written agreement between the City of Santa Ana,its City Council,officers,officials,employees,agents, and volunteers and the insured,and are subject to policy terms and conditions. APPROVED By Tu Tran Nguyen at 11:16 am,Mar 19,2026 CERTIFICATE HOLDER CANCELLATION City of Santa Ana LIVE CERTIFICATE Parks,Recreation,and Community Services Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Piz#M-23 r� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 92701 ' ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ❑. 62,�. Click or scan to view @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NXTPCH7HXR-00-GL COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: 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. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ POLICY NUMBER: NXTPCH7HXR-00-GL COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations City of Santa Ana, its City Council,officers,officials, CA employees,agents,and volunteers 20 Civic Center Piz#M-23 Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodilyinjury" or damage" or "personal and advertising injury" property damage occurring after: pp y caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III— Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended to include the following as insureds: 1. Lessor of Leased Equipment Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured 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. No such person or organization is an insured under this section: a. Upon expiration or termination of their contract or agreement with you for such leased equipment ends; b. For any"bodily injury'or"property damage"caused by an 'occurrence"which takes place after expiration or termination of their contractor agreement with you; or c. For any "personal and advertising injury" caused by an 'offense" which takes place after expiration or termination of their contract or agreement with you. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability arising out of your ownership, maintenance or use of that part of the premises leased to you. No such person or organization is an insured under this section for any: a. For"bodily injury'or"property damage"caused by an 'occurrence"which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Grantor of Franchise Any person or organization (referred to below as grantor of a franchise)with whom you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to"bodily injury' or"property damage" arising out of" liability as grantor of a franchise to you B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III LIMITS OF INSURANCE: 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. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 2 permission COMMERCIAL GENERAL LIABILITY C. With respect to the provisions of this endorsement, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. All other terms and conditions of the policy remain unchanged. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 2 of 2 permission COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABUSE AND MOLESTATION COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Abuse or Molestation Limit of Insurance-Each Person:$100,000.00 Abuse or Molestation Limit of Insurance-Aggregate: $1 oo,000.00 The following changes apply only to the coverage provided by this endorsement. A. The following exclusion is added to Paragraph 2. Exclusions under SECTION I—COVERAGES, COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B— PERSONAL AND ADVERTISING INJURY LIABILITY: This insurance does not apply to: Abuse Or Molestation "Bodily injury", "property damage" or"personal and advertising injury" arising out of the actual or threatened abuse, molestation or exploitation by anyone. This exclusion applies even if the claim against the insured alleges negligence or other wrongdoing in the employment, investigation, supervision, reporting to the proper authorities or failure to so report, training or retention. B. The following is added to SECTION I—COVERAGES: ABUSE OR MOLESTATION COVERAGE 1. Insuring Agreement a. We will pay those sums the insured becomes legally obligated to pay as damages because of"bodily injury" arising out of abuse, molestation or exploitation to which this insurance applies.We will have the right and duty to defend the insured against any"suit" seeking such damages. However, we will have no duty to defend the insured against any"suit" seeking damages to which this insurance does not apply. Nor do we have a duty to defend any insured who is alleged to have taken part in the abuse, molestation or exploitation. We may, at our discretion, investigate and settle any claim or"suit"that may result. But: (1) The amount we will pay for damages is limited as described in Paragraph C. Limits Of Insurance below; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Abuse Or Molestation Coverage. b. This insurance applies to "bodily injury" arising out of abuse, molestation or exploitation only if the abuse, molestation or exploitation: (1) Takes place in the "coverage territory"; (2) Results from the insured's negligence in employment, investigation, supervision, reporting to the proper authorities or failure to so report, training or retention;and (3) First occurs during the policy period. NXT-0114 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 3 permission COMMERCIAL GENERAL LIABILITY c. Abuse, molestation or exploitation which first occurs during the policy period includes any continuation, change or resumption of that abuse, molestation or exploitation after the end of the policyperiod. d. Multiple acts of abuse, molestation or exploitation of any one person by one or more perpetrators will be deemed to have first occurred at the time of the first act of such abuse, molestation or exploitation and shall be subject to the coverage and limits in effect at the time of the first act of abuse, molestation orexploitation. 2. Exclusions This insurance does not apply to: a. Fines And Penalties Any fines, penalties, punitive damages, exemplary damages or aggravated damages. b. Participating Insured Any insured who takes part in the abuse, molestation or exploitation. c. Passive Insured Any insured who remains passive upon gaining knowledge of any actual, alleged or threatened abuse, molestation or exploitation. C. SECTION III—LIMITS OF INSURANCE is replaced by the following: SECTION III—LIMITS OF INSURANCE 1. The Limits of Insurance shown in the SCHEDULE above and the rules below fix the most we will pay under Abuse Or Molestation Coverage regardless of the number of: a. Insureds; b. Claims made or"suits" brought;or c. Persons or organizations making claims or bringing"suits". 2. The Aggregate limit shown in the Schedule of this endorsement is the most we will pay under Abuse Or Molestation Coverage for the sum of all damages. 3. Subject to Paragraph 2. above, the Each Person limit shown in the Schedule of this endorsement is the most we will pay under Abuse Or Molestation Coverage for damages because of"bodily injury" arising out of abuse, molestation or exploitation committed upon any one person, regardless of the number of acts of abuse, molestation or exploitation committed, the period of time over which such acts occur, or the number of perpetrators taking part in the abuse, molestation or exploitation. 4. The coverage provided by this endorsement does not provide any duplication or overlap of any other coverage provided elsewhere in this policy. No coverage is provided for abuse, molestation or exploitation under this policy except as provided in this endorsement. 5. The Limits of Insurance provided by this endorsement are in addition to, not part of, the Limits of Insurance provided by the Commercial General Liability Coverage Form. The Limits of Insurance shown in the Schedule of this endorsement apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations of the Commercial General Liability Coverage Form, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. NXT-0114 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 2 of 3 permission COMMERCIAL GENERAL LIABILITY D. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The heading and Paragraph a. of Condition 2. is replaced by the following: 2. Duties In The Event Of Abuse, Molestation, Exploitation, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an act or allegation of abuse, molestation or exploitation which may result in a claim. To the extent possible, notice should include: (1) How, when and where the abuse, molestation or exploitation took place; (2) The names and addresses of any injured persons and witnesses;and (3) The nature and location of any injury or damage arising out of the abuse, molestation or exploitation. 2. The following is added to Paragraph b. Excess Insurance of Condition 4. Otherinsurance: The insurance provided by this endorsement is excess over any other insurance provided to any insured, whether such other insurance is provided on a primary, excess, contingent or any other basis, unless such other insurance is written to be specifically excess of this insurance. 3. The following Condition is added: Multiple Coverage Forms Or Policies Issued By Us When two or more Coverage Forms or policies issued by us apply to the same claim, "suit" or loss, the maximum limit of our liability under all such Coverage Forms or policies combined shall not exceed the highest applicable limit of liability under any one Coverage Form or policy among them. E. Definition 3. "bodily injury" under SECTION V—DEFINITIONS is amended as follows: "Bodily injury" means bodily injury, sickness, disease, mental anguish or emotional distress sustained by a person, including death resulting from any of these at any time. All other terms and conditions of the policy remain unchanged. NXT-0114 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 3 of 3 permission mahvnx|Specialty Insurance Company Nexr w stock insurance company) POLICY DOCUMENTS HELL4D,I, Enclosed you will find the policy documents that make up your insurance contract. Please read through all uf these documents. |f you have any questions mr need to update any of your information, please contact us. A few key insurance terms to help navigate these documents Need 1Ofile a c}8joz? ' Declarations:States that your business is the named insured and specifies limits. we are here to assist and protect your ' Policy:The formal contract issued bv the insurance company. interests.Please report a claim ao soon aoan - Endorsements: Included modifications in the policy. incident occurs,even if you're not otfault. ' Exclusions: What ia not covered in the policy. Login m the customer portal o,contact support and share your details about the claim. SIGNATURE PAGE In Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. (signature) (signature) Secretary President NXT-0001 IL 10 17 Page 1 of 1 Important Information for Workers'Compensation Policyholders There are safety program services to assist you in preventing workplace accidents. Implementing a safety program can reduce risk, have a positive effect on your premium,and keep your business running smoothly. The cost of safety program services may or may not be included in your insurance premium.This depends on the extent of services that you request,your policy documents, and applicable regulations.Contact Next Insurance, Inc. at 855-222-5919 to request more information. Available Safety Program Services . Reference Materials: Providing you with useful information on a variety of workplace safety topics. . Telephone Consultation: Helping assess your current safety program, identifying areas for improvement, and providing helpful suggestions during a teleconference. . On-Site Consultation: For larger operations with more hazards,visiting your location to help assess and address your safety program needs on-site. See pages 2 and 3 of this document for important notices required by some states. IMPORTANT NOTICES Notice to Arkansas Policyholders: National Specialty Insurance Company is required by law to provide accident prevention services to policyholders at no additional cost as required by Ark. Code Ann. § 11-9-409(d)and AWCC Rule 32. If you would like more information,call Next Insurance, Inc. at 855-222-5919. If you have any questions about this requirement,call the Health and Safety Division,Arkansas Workers'Compensation Commission at 1-800-622-4472. Notice to California Policyholders: National Specialty Insurance Company is required by Cal. Labor Code§6354.5 to provide loss control consultation services to policyholders at no additional charge. For Targeted Employers as defined in 8 CCR§339.3,these services include evaluation of operations, identification of factors most related to losses experienced,formulation of recommended loss control measures,a consultation report,and ongoing evaluations to determine the impact of the consultation on loss control experience. For Non-Targeted Employers, these services include workplace surveys, reviews of injury records, and plans to improve employer health and safety loss control experience. For more information about these services, please call Next Insurance, Inc.at 855-222-5919. Workers' compensation insurance policyholders may register comments about the insurer's loss control consultation services by writing to:State of California, Department of Industrial Relations, Division of Occupational Safety and Health, P.O. Box 420603,San Francisco,CA 94142. Notice to Maine Policyholders: National Specialty Insurance Company is required by 24-A M.R.S.A. §2385-C to make workplace health and safety consultation services available to policyholders.These services advise and assist with the identification, evaluation,and control of existing and potential accident and occupational health problems. For more information about these services, please contact Next Insurance, Inc. at 975 California Ave, Palo Alto,CA 94304 or call 855-222-5919. Notice to Montana Policyholders: National Specialty Insurance Company is required by MCA 39-71-1506 to notify its policyholders about the availability of safety consultation services. For more information about these services, please contact Next Insurance, Inc. at 975 California Ave, Pala Alto,CA 94304 or call 855-222-5919 Notice to Minnesota Policyholders: National Specialty Insurance Company is required by M.S.A. §79.085 to make safety and occupational health loss consultation services available to policyholders.These services include conducting workplace surveys to identify health and safety problems, reviewing employer injury records,and developing plans to improve employer occupational health and safety loss records. For more information about these services, please contact Next Insurance, Inc. at 975 California Ave, Palo Alto,CA 94304 or call 855-222-5919. Notice to Mississippi Policyholders: National Specialty Insurance Company is required by Miss.Code Ann. § 71-3-121 to make a safety program available to policyholders. For more information about the safety program, please contact Next Insurance, Inc. at 855-222-5919. Notice to Missouri Policyholders: National Specialty Insurance Company is required by MO ST 287.123 to make safety engineering and management services available to policyholders. For more information about safety engineering and management services, please contact Next Insurance, Inc. at 855-222-591. Notice to Oregon Policyholders: National Specialty Insurance Company is required to notify its policyholders of the availability of loss prevention services.These services include on-site evaluation of your loss prevention needs,workplace surveys to identify health and safety problems, review of injury records,development of improvement plans for health and safety loss records,availability of safety resources and safety training materials, and training in hazard recognition and loss control. For more information about these services, please call Next Insurance, Inc. at 855-222-5919. Per the Oregon Safe Employment Act, employers are required to provide a safe and healthful workplace. Review ORS 654.001 to 654.295 and 654.991 for more information. If Next Insurance, Inc.fails to respond to your request for loss prevention services or otherwise fails to provide services as offered or required,you may file a complaint with Oregon OSHA. This notice should be distributed to each of your fixed places of employment in Oregon. Notice to Pennsylvania Policyholders: National Specialty Insurance Company maintains accident and illness prevention services for policyholders as required by 77 P.S. § 1038.1.Additionally,there may be a 5%premium discount available to employers who form a certified workplace safety committee. For more information about these services, please contact Next Insurance, Inc. at 975 California Ave, Palo Alto,CA 94304 or call 855-222-5919. Notice to Texas Policyholders: Pursuant to Texas Labor Code§411.066, National Specialty Insurance Company is required to notify its policyholders that accident prevention services are available from National Specialty Insurance Company at no additional charge.These services may include surveys, recommendations,training programs,consultations,analyses of accident causes,and industrial hygiene and industrial health services. National Specialty Insurance Company is also required to provide return-to-work coordination services as required by Texas Labor Code§413.021 and to notify you of the availability of the return-to-work reimbursement program for employers under Texas Labor Code§413.022. If you would like more information,contact Next Insurance, Inc. at 855-222-5919 and support@next-insurance.com for accident prevention services or for return-to-work coordination services. For information about these requirements, call the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC)at 1-800-687-7080 or for information about the return-to-work reimbursement program for employers,call the TDI-DWC at(512)-804-5000. If Next Insurance, Inc.fails to respond to your request for accident prevention services or return-to-work coordination services,you may file a complaint with the TDI-DWC in writing at http://www.tdi.texas.gov or by mail to Texas Department of Insurance, P.O. Box 12050, Division of Workers'Compensation, HS-WS,Austin,Texas 78711-2050. Summary: Transaction Fees A transaction fee of 1.84% is applied to credit card payments. This rate is less than NEXT's credit card processing costs. You can avoid this fee by paying with a debit card or bank account. $26.31 is the total transaction fee amount that you will pay if the total annual premium and service fee for this policy is paid by credit card. (Please see your policy declarations page for details of your total annual premium for this policy.) NXT-IL-8007.2-0825 Includes copyrighted material of Insurance Services Office, Inc with its permission. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 01 B (Ed. 10-14) INFORMATION PAGE National Specialty Insurance Company Policy No. NXT7CLDW3F-01-WC Insurer ID No(s). 16447 Prior Policy No. 1. Named Insured: Paramount Education LLC DBA ❑ Individual © LLC Mailing Address: Paramount Education LLC DBA ❑ Corporation ❑ LLP MyCodingClasses ❑ Partnership ❑ Other: 4661 Rimini Ct Dublin, CA 94568 Email Address: Jack@mycodingclasses.com FEIN: XX-XXX1604 Intra/Interstate Risk ID No. Other workplaces not shown above: 2. The policy period is from 03/14/2026 to 03/14/2027 12:01 A.M. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: CA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $1,000,000.00 each accident Bodily Injury by Disease $1,000,000.00 policy limit Bodily Injury by Disease $1,000,000.00 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All States Except Ohio, North Dakota,Washington,Wyoming, Michigan, Pennsylvania, Delaware,Wisconsin, Minnesota, Massachusetts and Washington D.C. D. This policy includes these endorsements and schedules: 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans.All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated Code Estimated Annual $100 of Annual No. Classifications Remuneration Remuneration Premium Refer to Form WC 04 00 05-Classifications for more information. Experience Modification n/a Total Estimated Annual Premium $$1,430.00 Minimum Premium$ $500.00 Deposit Premium $$238.34 Premium Adjustment Period: Annually Countersigned By Producer Information: Servicing/Issuing Office Palo Alto Date 12/18/2025 WC040001 B (Ed. 10-14) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NXT-WC-2.1 EXTENSION OF INFORMATION PAGE Policy Number: NXT7CLDW3F-01-WC Other Locations Not Shown on the Information Page: Location Number Physical Address 1 4661 Rimini Ct, Dublin, CA 94568 NXT-WC-2.1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NXT-WC-3.1 Policy Number NXT7CLDW3F-01-WC EXTENSION OF INFORMATION PAGE Loc number Class code Class Decription Estimated Exposure Rate Premium 1 8742 Salespersons or Collectors-Outside 63700 O.S3 $336.00 8868 School-Professional Employees 27600 1.12 $310.00 8871 Clerical Telecommuter Employees 63700 0.17 $108.00 Territory Rating Factor 0.81 Location Premium $611.00 Total Manual Premium $611.00 NXT-WC-3.1 (Ed. 0624) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NXT-WC-3.1 Total Manual Premium $611.00 Waiver of Subrogation Premium $250.00 Employers Liability Increased Limits Factor 2.8% $150.00 Employers Liability Increased Limits Charge or Balance to Minimum Premium $133.00 Total Subject Premium Experience Modification Factor 1.0 Experience Modification charge $0.00 Total Modified Premium Schedule Rating Factor 12 5% Schedule Rating Amount $126.38 Total Standard Premium $1,137.00 Premium Discount 0.0 ($0) Expense Constant $200.00 Terrorism 0 5% Catastrophe $8.00 1% $16.00 Estimated Annual Premium Workers Comp Administrative Revolving Fund Assessment 0.01237 $17.00 Subsequent Injuries Benefits Trust Fund Assessment Surcharge 0.030148 $41.00 Uninsured Employers Benefits Trust Fund Assessment 8.18E-4 $1.00 Surcharge OSHA Fund Assessment Surcharge 3.0 $3.00 Labor Enforcement Compliance Fund Assessment Surcharge 0.001058 $1.00 Fraud Account Assessment Surcharge Insurance Guarantee Association Assessment Surcharge 0.004096 $ 0.0 $0.00 .00 Total Amount Due $1,430.00 Minimum Premium $500.00 NXT-WC-3.1 (Ed. 0624) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 02 (Ed. 07-98) EXTENSION OF INFORMATION PAGE Schedule of Named Insured Item 1 NXT7CLDW3F-01-WC Policy No. Named Insured FEIN Paramount Education LLC DBA MyCodingClasses XX-XXX1604 WC 04 00 02 (Ed. 07-98) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 04 (Ed.07-98) EXTENSION OF INFORMATION PAGE Schedule of Forms Item 3D NXT7CLDW3F-01-WC Policy No. Form Numbers Applicable States NXT-0003.7 WC 1121 NXT-0001 IL 10 17 CA Policy APS Notice WC 04 00 01 B 0323 NXT-WC-2.1-CA NXT-WC-3.1-0624_CA WC 04 00 02 WC040004 WC000000C WC 00 04 03 WC000419 WC000421 F WC000422C WC040301 D WC 04 03 06 WC040310 WC 04 03 60 B WC040601 B WC040604A O FAC-N-CA-W TOESCAE1 WC040410A WC040421 PN 04 99 01 1 PN 04 99 02 B PN 04 99 04 MPN Notices WC 04 00 04 (Ed. 07-98) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to PART ONE all terms of this policy, we agree with you as follows: WORKERS COMPENSATION INSURANCE A. How This Insurance Applies GENERAL SECTION This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. A. The Policy Bodily injury includes resulting death. This policy includes at its effective date the Infor- 1. Bodily injury by accident must occur during the mation Page and all endorsements and schedules policy period. listed there. It is a contract of insurance between 2. Bodily injury by disease must be caused or ag- you (the employer named in Item 1 of the Infor- gravated by the conditions of your employment. mation Page) and us (the insurer named on the In- The employee's last day of last exposure to the formation Page). The only agreements relating to conditions causing or aggravating such bodily in- this insurance are stated in this policy. The terms of jury by disease must occur during the policy this policy may not be changed or waived except period. by endorsement issued by us to be part of this policy. B. We Will Pay B. Who is Insured We will pay promptly when due the benefits required You are insured if you are an employer named in of you by the workers compensation law. Item 1 of the Information Page. If that employer is a C. We Will Defend partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- We have the right and duty to defend at our expense ployer of the partnership's employees. any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to in- vestigate and settle these claims, proceedings or C. Workers Compensation Law suits. Workers Compensation Law means the workers or We have no duty to defend a claim, proceeding or workmen's compensation law and occupational suit that is not covered by this insurance. disease law of each state or territory named in Item 3.A. of the Information Page. It includes any D. We Will Also Pay amendments to that law which are in effect during the policy period. It does not include any federal We will also pay these costs, in addition to other workers or workmen's compensation law, any fed- amounts payable under this insurance, as part of eral occupational disease law or the provisions of any claim, proceeding or suit we defend: any law that provide nonoccupational disability 1. reasonable expenses incurred at our request, benefits. but not loss of earnings; 2. premiums for bonds to release attachments and D. State for appeal bonds in bond amounts up to the State means any state of the United States of amount payable under this insurance; America, and the District of Columbia. 3. litigation costs taxed against you; 4. interest on a judgment as required by law until E. Locations we offer the amount due under this insurance; This policy covers all of your workplaces listed in and Items 1 or 4 of the Information Page; and it covers 5. expenses we incur. all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such E. Other Insurance workplaces. We will not pay more than our share of benefits and costs covered by this insurance and other Page 1 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) insurance or self-insurance. Subject to any limits of workers compensation law that apply to: liability that may apply, all shares will be equal until a. benefits payable by this insurance; the loss is paid. If any insurance or self-insurance b. special taxes, payments into security or oth- is exhausted, the shares of all remaining insurance er special funds, and assessments payable will be equal until the loss is paid. by us under that law. 6. Terms of this insurance that conflict with the F. Payments You Must Make workers compensation law are changed by this You are responsible for any payments in excess of statement to conform to that law. the benefits regularly provided by the workers Nothing in these paragraphs relieves you of your du- compensation law including those required ties under this policy. because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation PART TWO of law; EMPLOYERS LIABILITY INSURANCE 3. you fail to comply with a health or safety law or regulation; or A. How This Insurance Applies 4. you discharge, coerce or otherwise discriminate This employers liability insurance applies to bodily against any employee in violation of the workers injury by accident or bodily injury by disease. Bodily compensation law. injury includes resulting death. If we make any payments in excess of the benefits 1. The bodily injury must arise out of and in the regularly provided by the workers compensation course of the injured employee's employment by law on your behalf, you will reimburse us promptly. you. 2. The employment must be necessary or inci- G. Recovery From Others dental to your work in a state or territory listed in Item 3.A. of the Information Page. We have your rights, and the rights of persons enti- 3. Bodily injury by accident must occur during the tled to the benefits of this insurance, to recover our policy period. payments from anyone liable for the injury.You will do everything necessary to protect those rights for 4. Bodily injury by disease must be caused or ag- us and to help us enforce them. gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- H. Statutory Provisions jury by disease must occur during the policy These statements apply where they are required by period. law. 5. If you are sued, the original suit and any related 1. As between an injured worker and us, we have legal actions for damages for bodily injury by ac- notice of the injury when you have notice. cident or by disease must be brought in the 2. Your default or the bankruptcy or insolvency of United States of America, its territories or pos- you or your estate will not relieve us of our du- sessions, or Canada. ties under this insurance after an injury occurs. 3. We are directly and primarily liable to any per- B. We Will Pay son entitled to the benefits payable by this in- We will pay all sums that you legally must pay as surance. Those persons may enforce our duties; damages because of bodily injury to your employ- so may an agency authorized by law. Enforce- ees, provided the bodily injury is covered by this ment may be against us or against you and us. Employers Liability Insurance. 4. Jurisdiction over you is jurisdiction over us for The damages we will pay, where recovery is permit- purposes of the workers compensation law. We ted by law, include damages: are bound by decisions against you under that 1. For which you are liable to a third party by rea- law, subject to the provisions of this policy that son of a claim or suit against you by that third are not in conflict with that law. party to recover the damages claimed against 5. This insurance conforms to the parts of the Page 2 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) such third party as a result of injury to your 9. Bodily injury to any person in work subject to the employee; Federal Employers' Liability Act(45 U.S.C. Sec- t. For care and loss of services;and tions 51 et seq.), any other federal laws obligat- ing an employer to pay damages to an employee 3. For consequential bodily injury to a spouse,child, due to bodily injury arising out of or in the course parent, brother or sister of the injured employee; of employment, or any amendments to those provided that these damages are the direct conse- laws; quence of bodily injury that arises out of and in the course of the injured employee's employment by 10.Bodily injury to a master or member of the crew you; and of any vessel, and does not cover punitive dam- ages related to your duty or obligation to provide 4. Because of bodily injury to your employee that arises transportation, wages, maintenance, and cure out of and in the course of employment,claimed under any applicable maritime law; against you in a capacity other than as employer. 11.Fines or penalties imposed for violation of federal C. Exclusions or state law; and 12.Damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act(29 1. Liability assumed under a contract. This exclu- U.S.C. Sections 1801 et seq.) and under any sion does not apply to a warranty that your work other federal law awarding damages for violation will be done in a workmanlike manner; of those laws or regulations issued thereunder, 2. Punitive or exemplary damages because of bodi- and any amendments to those laws. ly injury to an employee employed in violation of law; D. We Will Defend 3. Bodily injury to an employee while employed in We have the right and duty to defend, at our ex- violation of law with your actual knowledge or the pense, any claim, proceeding or suit against you for actual knowledge of any of your executive damages payable by this insurance. We have the officers; right to investigate and settle these claims, proceed- 4. Any obligation imposed by a workers compensa- ings and suits. tion, occupational disease, unemployment com- We have no duty to defend a claim, proceeding or pensation, or disability benefits law, or any simi- suit that is not covered by this insurance. We have lar law; no duty to defend or continue defending after we 5. Bodily injury intentionally caused or aggravated have paid our applicable limit of liability under this by you; insurance. 6. Bodily injury occurring outside the United States of America, its territories or possessions, and E. We Will Also Pay Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States We will also pay these costs, in addition to other of America or Canada who is temporarily outside amounts payable under this insurance, as part of these countries; any claim, proceeding, or suit we defend: 7. Damages arising out of coercion, criticism, de- 1. Reasonable expenses incurred at our request, motion, evaluation, reassignment, discipline, but not loss of earnings; defamation, harassment, humiliation, discrimina- 2. Premiums for bonds to release attachments and tion against or termination of any employee, or for appeal bonds in bond amounts up to the limit any personnel practices, policies, acts or of our liability under this insurance; omissions; 3. Litigation costs taxed against you; 8. Bodily injury to any person in work subject to the 4. Interest on a judgment as required by law until Longshore and Harbor Workers' Compensation we offer the amount due under this insurance; Act(33 U.S.C. Sections 901 et seq.), the Nonap- and propriated Fund Instrumentalities Act (5 U.S.C. 5. Expenses we incur. Sections 8171 et seq.), the Outer Continental Shelf Lands Act(43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act(30 U.S.C. Sections 801 et seq. and 901- 944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; Page 3 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) F. Other Insurance We will not pay more than our share of damages 2. The amount you owe has been determined with and costs covered by this insurance and other in- our consent or by actual trial and final judgment. surance or self-insurance. Subject to any limits of li- This insurance does not give anyone the right to add ability that apply, all shares will be equal until the us as a defendant in an action against you to deter- loss is paid. If any insurance or self-insurance is ex- mine your liability. The bankruptcy or insolvency of hausted, the shares of all remaining insurance and you or your estate will not relieve us of our obliga- self-insurance will be equal until the loss is paid. tions under this Part. G. Limits of Liability PART THREE Our liability to pay for damages is limited. Our limits OTHER STATES INSURANCE of liability are shown in Item 3.B. of the Information Page. They apply as explained below. A. How This Insurance Applies 1. Bodily Injury by Accident. The limit shown for 1. This other states insurance applies only if one or "bodily injury by accident—each accident" is the more states are shown in Item 3.C. of the Infor- most we will pay for all damages covered by this mation Page. insurance because of bodily injury to one or 2. If you begin work in any one of those states after more employees in any one accident. the effective date of this policy and are not in- A disease is not bodily injury by accident unless sured or are not self-insured for such work, all it results directly from bodily injury by accident. provisions of the policy will apply as though that 2. Bodily Injury by Disease. The limit shown for state were listed in Item 3.A. of the Information "bodily injury by disease—policy limit" is the Page. most we will pay for all damages covered by this 3. We will reimburse you for the benefits required insurance and arising out of bodily injury by dis- by the workers compensation law of that state if ease, regardless of the number of employees we are not permitted to pay the benefits directly who sustain bodily injury by disease. The limit to persons entitled to them. shown for"bodily injury by disease—each em- 4. If you have work on the effective date of this pol- ployee" is the most we will pay for all damages icy in any state not listed in Item 3.A. of the In- because of bodily injury by disease to any one formation Page, coverage will not be afforded for employee. that state unless we are notified within thirty Bodily injury by disease does not include dis- days. ease that results directly from a bodily injury by accident. B. Notice 3. We will not pay any claims for damages after we Tell us at once if you begin work in any state listed in have paid the applicable limit of our liability un- Item 3.C. of the Information Page. der this insurance. PART FOUR H. Recovery From Others YOUR DUTIES IF INJURY OCCURS We have your rights to recover our payment from anyone liable for an injury covered by this insurance. Tell us at once if injury occurs that may be covered You will do everything necessary to protect those by this policy. Your other duties are listed here. rights for us and to help us enforce them. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. I. Actions Against Us 2. Give us or our agent the names and addresses There will be no right of action against us under this of the injured persons and of witnesses, and insurance unless: other information we may need. 1. You have complied with all the terms of this poli- 3. Promptly give us all notices, demands and legal cy; and Page 4 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) papers related to the injury, claim, proceeding D. Premium Payments or suit. You will pay all premium when due. You will pay the 4. Cooperate with us and assist us, as we may re- premium even if part or all of a workers compensa- quest, in the investigation, settlement or defense tion law is not valid. of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would in- E. Final Premium terfere with our right to recover from others. The premium shown on the Information Page, 6. Do not voluntarily make payments, assume obli- schedules, and endorsements is an estimate. The gations or incur expenses, except at your own final premium will be determined after this policy cost. ends by using the actual, not the estimated, premi- um basis and the proper classifications and rates PART FIVE—PREMIUM that lawfully apply to the business and work covered by this policy. If the final premium is more than the A. Our Manuals premium you paid to us, you must pay us the bal- All premium for this policy will be determined by our ance. If it is less, we will refund the balance to you. manuals of rules, rates, rating plans and classifica- The final premium will not be less than the highest tions. We may change our manuals and apply the minimum premium for the classifications covered by changes to this policy if authorized by law or a gov- this policy. ernmental agency regulating this insurance. If this policy is canceled, final premium will be de- termined in the following way unless our manuals B. Classifications provide otherwise: Item 4 of the Information Page shows the rate and 1. If we cancel, final premium will be calculated pro premium basis for certain business or work classifi- rata based on the time this policy was in force. cations. These classifications were assigned based Final premium will not be less than the pro rata on an estimate of the exposures you would have share of the minimum premium. during the policy period. If your actual exposures are 2. If you cancel, final premium will be more than not properly described by those classifications, we pro rata; it will be based on the time this policy will assign proper classifications, rates and premium was in force, and increased by our short-rate basis by endorsement to this policy. cancelation table and procedure. Final premium will not be less than the minimum premium. C. Remuneration Premium for each work classification is determined F. Records by multiplying a rate times a premium basis. Remu- You will keep records of information needed to com- neration is the most common premium basis. This pute premium. You will provide us with copies of premium basis includes payroll and all other remu- those records when we ask for them. neration paid or payable during the policy period for the services of: G. Audit 1. all your officers and employees engaged in work You will let us examine and audit all your records covered by this policy; and that relate to this policy. These records include ledg- 2. all other persons engaged in work that could ers, journals, registers, vouchers, contracts, tax re- make us liable under Part One (Workers Com- ports, payroll and disbursement records, and pro- pensation Insurance) of this policy. If you do not grams for storing and retrieving data. We may con- have payroll records for these persons, the con- duct the audits during regular business hours during tract price for their services and materials may the policy period and within three years after the pol- be used as the premium basis. This paragraph 2 icy period ends. Information developed by audit will will not apply if you give us proof that the em- be used to determine final premium. Insurance rate ployers of these persons lawfully secured their service organizations have the same rights we have workers compensation obligations. under this provision. Page 5 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) If you die and we receive notice within thirty days af- PART SIX—CONDITIONS ter your death, we will cover your legal representa- A. Inspection tive as insured. We have the right, but are not obliged to inspect D. Cancellation your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurabil- 1. You may cancel this policy. You must mail or de- ity of the workplaces and the premiums to be liver advance written notice to us stating when charged. We may give you reports on the conditions the cancelation is to take effect. we find. We may also recommend changes. While 2. We may cancel this policy. We must mail or de- they may help reduce losses, we do not undertake liver to you not less than ten days advance writ- to perform the duty of any person to provide for the ten notice stating when the cancelation is to take health or safety of your employees or the public. We effect. Mailing that notice to you at your mailing do not warrant that your workplaces are safe or address shown in Item 1 of the Information Page healthful or that they comply with laws, regulations, will be sufficient to prove notice. codes or standards. Insurance rate service organiza- 3. The policy period will end on the day and hour tions have the same rights we have under this stated in the cancelation notice. provision. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in B. Long Term Policy this policy is changed by this statement to com- If the policy period is longer than one year and six- ply with the law. teen days, all provisions of this policy will apply as though a new policy were issued on each annual E. Sole Representative anniversary that this policy is in force. The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this C. Transfer of Your Rights and Duties policy, receive return premium, and give or receive Your rights or duties under this policy may not be notice of cancelation. transferred without our written consent. Page 6 of 6 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 03 (Ed. 4-84) EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT The premium for the policy will be adjusted by an experience rating modification factor. The factor was not available when the policy was issued. The factor, if any, shown on the Information Page is an estimate. We will issue an endorsement to show the proper factor, if different from the factor shown, when it is calculated. 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 Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned by WC 00 04 03 (Ed.4-84) ©1983,1994 National Council on Compensation Insurance,Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 (Ed. 1-01) PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. 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 Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned by WC 00 04 19 (Ed. 1-01) ©2000 National Council on Compensation Insurance,Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 21 F (Ed.08-2022 Countrywide, Ed.07-2022 in Texas) CATASTROPHE(OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement is notification that we are charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism)as that term is defined below.Your policy provides coverage for workers compensation losses caused by a Catastrophe(Other Than Certified Acts of Terrorism).Coverage for such losses is subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement attached to this policy. For purposes of this endorsement, Catastrophe(Other Than Certified Acts of Terrorism) is defined as: A single event or peril resulting in a group of claims with aggregate workers compensation losses in excess of$50 million.This$50 million threshold applies per occurrence, across all states for which claims arise from a single event or peril. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe(Other Than Certified Acts of Terrorism)is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium CA $0.01 $16.00 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 Policy No. Endorsement No. Insured Premium: Insurance Company Countersigned by WC000421 F (Ed.08-2022 Countrywide, Ed.07-2022 in Texas) 1 of 1 ©Copyright 2021 National Council on Compensation Insurance, Inc.All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 C (Ed. 01-2021) Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002,which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States, as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property, or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation)that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. 1 of 2 ©Copyright 2020 National Council on Compensation Insurance,Inc.All Rights Reserved. WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-2021) Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds$100,000,000,000; and for aggregate Insured Losses up to$100,000,000,000,we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000,the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium CA $0.01 $8.00 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by WC 00 04 22 C (Ed. 01-2021) 2 of 2 ©Copyright 2020 National Council on Compensation Insurance,Inc.All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 01 D (Ed. 02-18) POLICY AMENDATORY ENDORSEMENT—CALIFORNIA It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1. Minors Illegally Employed—Not Insured.This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2. Punitive or Exemplary Damages—Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefore is prohibited by law or contrary to public policy. 3. Increase in Indemnity Payment—Reimbursement.You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d)of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse,to appeal the decision of the insurer to the Department of Insurance. 4. Application of Policy. Part One, "Workers Compensation Insurance",A, "How This Insurance Applies", is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment.Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. 6. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period. 7. Statutory Provision.Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. 8. Part Five, "Premium", E, "Final Premium", is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us,you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled,final premium will be determined in the following way unless our manuals provide otherwise: a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b. If you cancel,final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short-rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. 1 of 2 WC040301 D (Ed. 02-18) WC 04 03 01 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 02-18) It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By 2 of 2 WC040301 D (Ed. 02-18) 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. 2 The additional premium for this endorsement shall be %of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC 04 03 06 (Ed. 04-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 10 (Ed. 01-95) DUTY TO DEFEND—CALIFORNIA The insurance afforded by Part One, Section C, "We Will Defend", is hereby deleted and replaced with the following: WE WILL DEFEND We have the right and duty to defend at our expense any claim or proceeding against you before the California Workers' Compensation Appeals Board or its equivalent in any other state (and any appeal of a decision therefrom)for the benefits payable by this workers' compensation insurance.We have the right to investigate and settle these claims or proceedings. We have no duty to defend a claim, proceeding, or suit that is not covered by this insurance. Nothing contained in this Section shall amend, modify, restrict, or otherwise alter any obligations or conditions under Part Two— Employer's Liability Insurance of the policy. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC040310 (Ed. 01-95) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 60 B (Ed. 01-15) EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT—CALIFORNIA The insurance afforded by Part Two(Employers' Liability Insurance) by reason of designation of California in item 3 of the information page is subject to the following provisions: A. "How This Insurance Applies," is amended to read as follows: A. How This Insurance Applies This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in California. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment.The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C. The"Exclusions"section is modified as follows(all other exclusions in the"Exclusions"section remain as is): 1. Exclusion 1 is amended to read as follows: 1. liability assumed under a contract. 2. Exclusion 2 is deleted. 3. Exclusion 7 is amended to read as follows: 7. damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employment, or any personnel practices, policies, acts or omissions. 4. The following exclusions are added: 1. bodily injury to any member of the flying crew of any aircraft. 2. bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers' compensation law(s) applicable to you or otherwise fail to comply with that law. 3. liability arising from California Labor Code Section 2810.3 which relates to labor contracting. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC 04 03 60 B (Ed. 01-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B (Ed.01-22) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A.of the Information Page. The cancelation condition in Part Six(Conditions)of the policy is replaced by these conditions: Cancellation: 1. You may cancel this policy.You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives; h. The occurrence of a material change in the ownership of your business; i. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; j. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; k. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a)through (f),we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items(g)through (k),we will give you 30 days advance written notice; however,we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. If we mail the notice to you,the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. 5. The policy period will end on the day and hour stated in the cancelation notice. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC 04 06 01 B (Ed. 01-22) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 04 A (Ed. 01-23) COVID-19 REPORTING REQUIREMENT ENDORSEMENT—CALIFORNIA In addition to the requirements under Part 4, "Your Duties if Injury Occurs" of your policy, if you have five or more employees and an employee that is not described in California Labor Code section 3212.87 tests positive for COVID-19, you are required to report the following information as provided below. Pursuant to California Labor Code Section 3212.88(i), when you know, or reasonably should know, that an employee has tested positive for COVID-19 between September 17, 2020 and January 1, 2024,you must report to your claims administrator in writing via electronic mail or facsimile within 3 business days all of the following: (1) An employee has tested positive. For purposes of this reporting, do not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a claim form pursuant to California Labor Code Section 5401. (2) The date that the employee tests positive, which is the date the specimen was collected for testing. (3) The specific address or addresses of the employee's specific place of employment during the 14-day period preceding the date of the employee's positive test. (4) The highest number of employees who reported to work at the employee's specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment. Labor Code Section 3212.88(j)states that the intentional submission of false or misleading information or the failure to report the above information as required may subject you to a civil penalty in the amount of up to$10,000 to be assessed by the Labor Commissioner. For the purposes of these reporting requirements, California Labor Code Section 3212.88(m) provides the following: (1) "COVID-19" means the 2019 novel coronavirus disease. (2) "Test"or"testing" means a PCR(Polymerase Chain Reaction)test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA. "Test"or"testing"does not include serologic testing, also known as antibody testing."Test"or"testing" may include any other viral culture test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA which has the same or higher sensitivity and specificity as the PCR test. (3) "A specific place of employment" means the building, store,facility, or agricultural field where an employee performs work at the employer's direction. "A specific place of employment"does not include the employee's home or residence, unless the employee provides home health care services to another individual at the employee's home or residence. Note: This endorsement is only applicable until January 1,2024,unless the repeal date of California Labor Code Section 3212.88 is extended. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC040604A (Ed. 01-23) NATIONAL SPECIALTY INSURANCE COMPANY U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of"national emergency". OFAC has identified and listed numerous: • Foreign agents; • Front organizations; • Terrorists; • Terrorist organizations; and • Narcotics traffickers; as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web site—http//www.treas.gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC.When an insurance policy is considered to be such a blocked or frozen contract,no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. OFAC-N-CA-W NATIONAL SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS The following is added to this policy: Trade Or Economic Sanctions This insurance does not provide any coverage, and we(the Company)shall not make payment of any claim or provide any benefit hereunder,to the extent that the provision of such coverage, payment of such claim or provision of such benefit would expose us (the Company) to a violation of any applicable trade or economic sanctions, laws or regulations, including but not limited, to those administered and enforced by the United States Treasury Department's Office of Foreign Assets Control (OFAC). All other terms and conditions remain unchanged. This endorsement is subject to the provisions of the policy or policies and endorsements listed in the Declarations Page,except where amended by this endorsement. NXT7CLDW3F-01-WC Policy Number is subject to all the terms and conditions of this policy not inconsistent hereto. Issued to Paramount Education LLC DBA MyCodingClasses Endorsement Number Effective date of this Endorsement 03/14/2026 Date Authorized Representative TOESCAEI WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 10 A (Ed.01-18) ESTIMATED ANNUAL PREMIUM ENDORSEMENT—CALIFORNIA The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. Your experience modification, when issued, will be effective on 03/14/2026 , your rating effective date determined by the Workers' Compensation Insurance Rating Bureau of California(WCIRB) in accordance with California law. Pending the issuance of your experience modification by the WCIRB, the estimated annual premium shown below is based on an estimated experience modification. The estimated annual premium will be revised when the WCIRB issues your applicable experience modification. ESTIMATED ANNUAL PREMIUM $ $1,430.00 NOTE: THE ESTIMATED ANNUAL PREMIUM MAYBE INCREASED WHEN THE WCIRB ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC040410A (Ed. 01-18) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 21 (Ed.01-08) OPTIONAL PREMIUM INCREASE ENDORSEMENT—CALIFORNIA You must provide us, or our authorized representative, access to records necessary to perform a payroll verification audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure. We will contact you to schedule appointments during normal business hours. We will notify you of your failure to provide access by mailing a certified, return-receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s)to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By WC040421 (Ed. 01-08) PN 04 99 01 1 (Ed.02-22) POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I. Information Available to You A. Information Available from Us—National Specialty Insurance Company (1) General questions regarding your policy should be directed to: National Specialty Insurance Company Call: Next First Insurance Agency, Inc. Toll-free: 1-855-222-5919 Email: support@nextinsurance.com Mail: P.O. Box 60787 Palo Alto, CA 94306 Fax: (650)644-0332 Website: nextinsurance.com (2) Dividend Calculation. If this is a participating policy(a policy on which a dividend may be paid), upon payment or non- payment of a dividend,we shall provide a written explanation to you that sets forth the basis of the dividend calculation.The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code,you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy,we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers'Compensation Insurance Rating Bureau of California(WCIRB)no later than twenty months after the policy becomes effective.The cost of any settled claims will also be reported at that time.At twelve-month intervals thereafter,we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim.The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent.As such,the WCIRB is responsible for administering the California Workers'Compensation Uniform Statistical Reporting Plan- 1995(USRP)and the California Workers'Compensation Experience Rating Plan-1995(ERP).WCIRB contact information is: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612,Attn: Customer Service; 888.229.2472(phone);415.778.7272 (fax); and customerservice(a)wcirb.com (email).The regulations contained in the USRP and ERP are available for public viewing through the WCIRB's website at wcirb.com. (2) Policyholder Information. Pursuant to California Insurance Code(CIC)Section 11752.6, upon written request,you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules,or other information impacting your premium that is maintained in the records of the WCIRB.Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612,Attn: Custodian of Records.The Custodian of Records can be reached at 415.777.0777(phone)and 415.778.7272(fax). (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB's website at wcirb.com/ratesheet.The Experience Rating Form/Worksheet will include a Loss-Free Rating,which is the experience modification that would have been calculated if$0 (zero)actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process. If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us,you may send us a written Complaint and Request for Action as outlined below. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you.Written Complaints and Requests for Action should be forwarded to: P N 04 99 01 1 1 of 2 (Ed.02-22) P N 04 99 01 1 (Ed.02-22) National Specialty Insurance Company Call: Next First Insurance Agency,Inc. Toll-free: 1-855-222-5919 Fax: (650)644-0332 Mail:P.O.Box 60787 Palo Alto,CA 94306 After you send your Complaint and Request for Action,we have 30 days to send you a written notice indicating whether your written request will be reviewed. If we agree to review your request,we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review,you may appeal to the Insurance Commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing,that the WCIRB reconsider its decision, action, or omission to act.You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues,your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification,your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule,the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry.Written Inquiries should be sent to:WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612,Attn: Customer Service.Customer Service can be reached at 888.229.2472(phone),415.778.7272(fax)and customerservice(dwcirb.com (email). If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry,you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review,you may appeal to the Insurance Commissioner as described in paragraph II.C., below.Written Complaints and Requests for Action should be forwarded to:WCIRB, 1901 Harrison Street, 17th Floor, Oakland,CA 94612,Attn: Complaints and Reconsideration.The WCIRB's contact information is 888.229.2472(phone), 415.371.5204(fax)and customerservice(dwcirb.com (email). C. California Department of Insurance—Appeals to the Insurance Commissioner.After you follow the appropriate dispute resolution process described above, if(1)we or the WCIRB decline to review your request, (2)you are dissatisfied with the decision upon review,or(3)we or the WCIRB fail to grant or reject your request or issue a decision upon review,you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq.You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent,your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Administrative Hearing Bureau California Department of Insurance 1901 Harrison Street, 3rd Floor Mailroom Oakland, CA 94612 415.538.4243 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. III. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A.and I.B., above.The ombudsman may advise you on any dispute with us,the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code.The address of the policyholder ombudsman is WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612,Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159(phone),415.371.5288(fax)and ombudsman(o),wcirb.com (email). B. California Department of Insurance—Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP(4357)or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. PN0499011 2of2 (Ed.02-22) P N 04 99 02 B (Ed. 05-02) POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 1. We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. 2. The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers'compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. 3. Rating organizations may develop pure premium rates that are subject to the insurance commissioner's approval.A pure premium rate reflects the anticipated cost and expenses of claims per$100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. 4. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history.A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. 5. A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. 6. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process requires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the insurance commissioner. California Workers' Compensation Insurance Notice of Nonrenewal Section 11664 of the California Insurance Code requires us, in most instances,to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. PN 04 99 02 B 1 of 2 (Ed. 05-02) PN 04 99 02 B (Ed. 05-02) We are not required to provide you with a notice of nonrenewal in any of the following situations: 1. Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2. The policy was extended for 90 days or less and the required notice was given prior to the extension. 3. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6. We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations established in accordance with California Insurance Code Section 11750.3(c). (B) For purposes of this Notice, "premium rate"means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. This notice does not change the policy to which it is attached. PN 04 99 02 B 2 of 2 (Ed. 05-02) PN 04 99 04 (Ed.12-01) POLICYHOLDER NOTICE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION(CIGA)SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California Insurance Guarantee Association.If a company becomes insolvent,the California Insurance Guarantee Association settles unpaid claims and assesses each insurance company for its fair share. California law requires all companies to surcharge policies to recover these assessments. If your policy is surcharged,"CA Surcharge"or"CA Surcharge(CIGA Surcharge)"with an amount will be displayed on your premium notice. This notice does not change the policy to which it is attached. Workers' Compensation Claim Form(DWC 1)&Notice of Potential Eligibility Formulario de Reclamo de Compensacion de Trahajadores(DWC 1)y Notificacion de Posihle Elegihilidad If you are injured or become ill,either physically or mentally,because of your job, Si Ud. se lesiona o se enferma, ya sea fisicamente o mentalmente, debido a su including injuries resulting from a workplace crime, you may be entitled to trabajo, incluyendo lesiones que resulten de un crimen en el lugar de trabajo, es workers' compensation benefits. Use the attached form to file a workers' posible que Ud. tenga derecho a beneficios de compensaci6n de trabajadores. compensation claim with your employer.You should read all of the information Utilice el formulario adjunto Para presentar un reclamo de compensaci6n de below.Keep this sheet and all other papers for your records.You may be eligible trabajadores con su empleador. Ud. debe leer toda la informacion a for some or all of the benefits listed depending on the nature of your claim.If you continuaci6n.Guarde esta hoja y todos los demas documentos Para sus archivos. file a claim,the claims administrator,who is responsible for handling your claim, Es posible que usted reuna los requisitos Para todos los beneficios, o parte de must notify you within 14 days whether your claim is accepted or whether estos,que se enumeran dependiendo de la indole de su reclamo.Si usted presenta additional investigation is needed. un reclamo,1 administrador de reclamos,quien es responsable por el manejo de su To file a claim,complete the"Employee"section of the form,keep one copy and reclamo,debe notificarle dentro de 14 dias si se acepta su reclamo o si se necesita give the rest to your employer. Do this right away to avoid problems with your investigacion adicional. claim.In some cases,benefits will not start until you inform your employer about Para presentar un reclamo, Ilene la secci6n del formulario designada Para el your injury by filing a claim form.Describe your injury completely.Include every "EmPleado," guarde una copia, y dele el resto a su empleador. Haga esto de part of your body affected by the injury. If you mail the form to your employer, inmediato Para evitar problemas con su reclamo. En algunos casos,los beneficios use first-class or certified mail. If you buy a return receipt, you will be able to no se iniciaran hasta que usted le informe a su empleador acerca de su lesion prove that the claim form was mailed and when it was delivered. Within one mediante la presentaci6n de un formulario de reclamo. Describa su lesion por working day after you file the claim form, your employer must complete the completo.Incluya cada parte de su cuerpo afectada por la lesion.Si usted le envia "Employer" section, give you a dated copy,keep one copy, and send one to the por correo el formulario a su empleador,utilice primera clase o correo certificado. claims administrator. Si usted compra un acuse de recibo,usted podrA demostrar que el formulario de reclamo fire enviado por correo y cuando fire entregado.Dentro de un dia laboral Medical Care: Your claims administrator will pay for all reasonable and despues de presenter el formulario de reclamo, su empleador debe completer la necessary medical care for your work injury or illness. Medical benefits are secci6n designada pare el"Empleador,"le darA a Ud.una copia fechada,guardarA subject to approval and may include treatment by a doctor, hospital services, una copia,y enviarA una al administrador de reclamos. physical therapy, lab tests, x-rays, medicines, equipment and travel costs. Your claims administrator will pay the costs of approved medical services directly so Atenci6n MMica: Su administrador de reclamos pagarA por toda la atenci6n you should never see a bill.There are limits on chiropractic,physical therapy,and medica razonable y necesaria Para su lesion o enfermedad relacionada con el other occupational therapy visits. trabajo. Los beneficios medicos estan sujetos a la aprobaci6n y pueden incluir tratamiento por parte de un medico,los servicios de hospital,la terapia fisica,los The Primary Treatina Physician (PTP) is the doctor with the overall anAlisis de laboratorio,las medicinal,equipos y gastos de viaje. Su administrador responsibility for treatment of your injury or illness. de reclamos pagarA directamente los costos de los servicios medicos aprobados de • If you previously designated your personal physician or a medical group, manera que usted nunca verA una factura. Hay limites en terapia quiropractica, you may see your personal physician or the medical group after you are injured. fisica y otras visitas de terapia ocupacional. • If your employer is using a medical provider network(MPN)or Health Care El Medico Primario que le Atiende(Primary Treating,Physician-PTP) es el Organization(HCO),in most cases,you will be treated in the MPN or HCO medico con la responsabilidad total Para tratar su lesion o enfermedad. unless you predesignated your personal physician or a medical group. An Si usted design previamente a su medico personal o a un grupo medico, MPN is a group of health care providers who provide treatment to workers usted podrA ver a su medico personal o grupo medico despues de lesionarse. injured on the job. You should receive information from your employer if . Si su empleador estd utilizando una red de proveedores medicos (Medical you are covered by an HCO or a MPN. Contact your employer for more provider Network-MPN) o una Organizacion de Cuidado Medico (Health information. Care Organization-HCO),en la mayoria de los casos,usted sera tratado en • If your employer is not using an MPN or HCO, in most cases,the claims la MPN o HCO a menos que usted hizo una designaci6n previa de su medico administrator can choose the doctor who first treats you unless you predesignated your personal physician or a medical group. personal o grupo medico. Una MPN es un grupo de proveedores de • If your employer has not put up a poster describing your rights to workers' asistencia medica quien da tratamiento a los trabajadores lesionados en el compensation, you may be able to be treated by your personal physician trabajo. Usted debe recibir informaci6n de su empleador si su tratamiento es right after you are injured. cubierto por una HCO o una MPN. Hable con su empleador Para mas Within one working day after you file a claim form,your employer or the claims informacion. administrator must authorize up to$10,000 in treatment for your injury,consistent Si su empleador no estd utilizando una MPN o HCO, en la mayoria de los with the applicable treating guidelines until the claim is accepted or rejected. If casos, el administrador de reclamos puede elegir el medico que to atiende the employer or claims administrator does not authorize treatment right away,talk primero a menos de que usted hizo una designaci6n previa de su medico to your supervisor,someone else in management,or the claims administrator.Ask personal o grupo medico. • Si su empleador no ha colocado un cartel describiendo sus derechos Para la for treatment to be authorized right now, while waiting for a decision on your compensaci6n de trabajadores,Ud.puede ser tratado por su medico personal claim. If the employer or claims administrator will not authorize treatment, use c m compensaci6n despues de es,Ulesio arse. your own health insurance to get medical care. Your health insurer will seek reimbursement from the claims administrator.If you do not have health insurance, Dentro de un dia laboral despues de que Ud.Presente un formulario de reclamo, there are doctors, clinics or hospitals that will treat you without immediate su empleador o el administrador de reclamos debe autorizar hasta $10000 en payment.They will seek reimbursement from the claims administrator. tratamiento Para su lesion, de acuerdo con las pautas de tratamiento aplicables, hasta que el reclamo sea aceptado o rechazado. Si el empleador o administrador Switching to a Different Doctor as Your PTP: de reclamos no autoriza el tratamiento de inmediato, liable con su supervisor, • If you are being treated in a Medical Provider Network(MPN), you may alguien mas en la gerencia, o con el administrador de reclamos. Pida que el switch to other doctors within the MPN after the first visit. tratamiento sea autorizado ya mismo, mientras espera una decision sobre su • If you are being treated in a Health Care Organization (HCO), you may switch at least one time to another doctor within the HCO.You may switch reclamo. Si el empleador o administrador de reclamos no autoriza el tratamiento, to a doctor outside the HCO 90 or 180 days after your injury is reported to utilice su propio seguro medico Para recibir atenci6n medica. Su compaiiia de your employer (depending on whether you are covered by employer- seguro medico buscarA reembolso del administrador de reclamos. Si usted no provided health insurance). tiene seguro medico, hay medicos, clinicas u hospitales que to trataran sin Pago • If you are not being treated in an MPN or HCO and did not predesignate, inmediato. Ellos buscaran reembolso del administrador de reclamos. you may switch to a new doctor one time during the first 30 days after your injury is reported to your employer. Contact the claims administrator to Cambiando a otro Medico tratamiento en una Red de Proveedores Medicos ario o PTP: Si usted estd recibiendo switch doctors.After 30 days,you may switch to a doctor of your choice if tr Rev.1/l/2016 Page 1 of your employer or the claims administrator has not created or selected an (Medical Provider Network- MPN), usted puede cambiar a otros medicos MPN. dentro de la MPN despues de la primera visita. Disclosure of Medical Records: After you make a claim for workers' Si usted esta recibiendo tratamiento en un Organizacion de Cuidado Medico compensation benefits, your medical records will not have the same level of (Healthcare Organization-HCO),es posible cambiar al menos una vez a otro privacy that you usually expect.If you don't agree to voluntarily release medical medico dentro de la HCO. Usted puede cambiar a un medico fuera de la records,a workers'compensation judge may decide what records will be released. HCO 90 o 180 dias despues de que su lesion es reportada a su empleador If you request privacy, the judge may "seal" (keep private) certain medical (dependiendo de si usted esta cubierto por un seguro medico proporcionado records. por su empleador). Problems with Medical Care and Medical Reports:At some point during your Si usted no esta recibiendo tratamiento en una MPN o HCO y no hizo una claim, you might disagree with your PTP about what treatment is necessary. If designacion previa,usted puede cambiar a un nuevo medico una vez durante this happens,you can switch to other doctors as described above. If you cannot los primeros 30 dias despues de que su lesion es reportada a su empleador. reach agreement with another doctor,the steps to take depend on whether you are Pongase en contacto con el administrador de reclamos Para cambiar de receiving care in an MPN, HCO, or neither. For more information, see "Learn medico.Despues de 30 dias,puede cambiar a un medico de su eleccion si su More About Workers'Compensation,"below. empleador o el administrador de reclamos no ha creado o seleccionado una If the claims administrator denies treatment recommended by your PTP,you may MPN. request independent medical review(IMR)using the request form included with Divulaaci6n de Expedientes Medicos: Despues de que Ud.presente un reclamo the claims administrator's written decision to deny treatment.The IMR process is Para beneficios de compensacion de trabajadores, sus expedientes medicos no similar to the group health IMR process, and takes approximately 40(or fewer) tendran el mismo nivel de privacidad que usted normalmente espera. Si Ud. no days to arrive at a determination so that appropriate treatment can be given.Your esta de acuerdo en divulgar voluntariamente los expedientes medicos,un juez de attorney or your physician may assist you in the IMR process. IMR is not compensacion de trabajadores posiblemente decida que expedientes seran available to resolve disputes over matters other than the medical necessity of a revelados. Si usted solicita privacidad, es posible que el juez"selle" (mantenga particular treatment requested by your physician. privados)ciertos expedientes medicos. If you disagree with your PTP on matters other than treatment, such as the cause Problemas con la Atenci6n Medica y los Informes Medicos: En algun of your injury or how severe the injury is, you can switch to other doctors as momento durante su reclamo, podria estar en desacuerdo con su PTP sobre que described above. If you cannot reach agreement with another doctor, notify the tratamiento es necesario. Si esto sucede, usted puede cambiar a otros medicos claims administrator in writing as soon as possible.In some cases,you risk losing como se describe anteriormente. Si no puede llegar a un acuerdo con otro medico, the right to challenge your PTP's opinion unless you do this promptly.If you do los pagos a seguir dependen de si usted esta recibiendo atencion en una WN, not have an attorney,the claims administrator must send you instructions on how HCO o ninguna de las dos.Para mas informacion, consulte la seccion"Aprenda to be seen by a doctor called a qualified medical evaluator(QME)to help resolve Mas Sobre la Compensacion de Trabajadores,"a continuacion. the dispute. If you have an attorney, the claims administrator may try to reach Si el administrador de reclamos niega el tratamiento recomendado por su PTP, agreement with your attorney on a doctor called an agreed medical evaluator puede solicitar una revision medica independiente (Independent Medical Review- (AME).If the claims administrator disagrees with your PTP on matters other than IMR), utilizando el formulario de solicited que se incluye con la decision por treatment,the claims administrator can require you to be seen by a QME or AME. escrito del administrador de reclamos negando el tratamiento. El proceso de la Payment for Temporary Disability(Lost Waues): If you can't work while you IMR es parecido al proceso de la IMR de un seguro medico colectivo, y tarda are recovering from a job injury or illness,you may receive temporary disability aproximadamente 40 (o menos)dias Para llegar a una determinacion de manera payments for a limited period. These payments may change or stop when your que se pueda dar un tratamiento apropiado. Su abogado o su medico le pueden doctor says you are able to return to work.These benefits are tax-free.Temporary ayudar en el proceso de laIMR. LaIMR no esta disponible Para resolver disputas disability payments are two-thirds of your average weekly pay,within minimums sobre cuestiones aparte de la necesidad medica de un tratamiento particular and maximums set by state law. Payments are not made for the first three days solicitado por su medico. you are off the job unless you are hospitalized overnight or cannot work for more Si no esta de acuerdo con su PTP en cuestiones aparte del tratamiento, como la than 14 days. causa de su lesion o la gravedad de la lesion,usted puede cambiar a otros medicos Stay at Work or Return to Work: Being injured does not mean you must stop como se describe anteriormente. Si no puede llegar a un acuerdo con otro medico, working. If you can continue working, you should. If not, it is important to go notifique al administrador de reclamos por escrito tan pronto como sea posible. back to work with your current employer as soon as you are medically able. En algunos casos,usted arriesg perder el derecho a objetar a la opinion de su PTP Studies show that the longer you are off work,the harder it is to get back to your a menos que hace esto de inmediato. Si usted no tiene un abogado, el original job and wages. While you are recovering, your PTP, your employer administrador de reclamos debe enviarle instrucciones Para ser evaluado por un (supervisors or others in management), the claims administrator, and your medico llamado un evaluador medico calificado (Qualified Medical Evaluator- attorney(if you have one)will work with you to decide how you will stay at work QME) Para ayudar a resolver la disputa. Si usted tiene un abogado, el or return to work and what work you will do. Actively communicate with your administrador de reclamos puede tratar de llegar a un acuerdo con su abogado PTP,your employer,and the claims administrator about the work you did before sobre un medico llamado un evaluador medico acordado (Agreed Medical you were injured,your medical condition and the kinds of work you can do now, Evaluator-AME).Si el administrador de reclamos no esta de acuerdo con su PTP and the kinds of work that your employer could make available to you. sobre asuntos aparte del tratamiento,el administrador de reclamos puede exigirle Payment for Permanent Disability: If a doctor says you have not recovered que sea atendido por un QME o AME. completely from your injury and you will always be limited in the work you can Pauo por Incapacidad Temporal(Sueldos Perdidos): Si Ud.no puede trabajar, do,you may receive additional payments.The amount will depend on the type of mientras se esta recuperando de una lesion o enfermedad relacionada con el injury,extent of impairment,your age,occupation,date of injury,and your wages trabajo, Ud. puede recibir pagos por incapacidad temporal por un periodo before you were injured. limitado.Estos pagos pueden cambiar o parar cuando su medico diga que Ud.esta en condiciones de regresar a trabajar. Estos beneficios son libres de impuestos. Supplemental Job Displacement Benefit (SJDB): If you were injured on or Los pagos por incapacidad temporal son dos tercios de su pago semanal promedio, after 1/l/04, and your injury results in a permanent disability and your employer con cantidades minimas y maximas establecidas por las leyes estales. Los pagos does not offer regular, modified, or alternative work, you may qualify fora no se hacen durante los primeros tres dias en que Ud.no trabaje,a menos que Ud. nontransferable voucher payable for retraining and/or skill enhancement. If you sea hospitalizado una noche o no puede trabajar durante mas de 14 dias. qualify,the claims administrator will pay the costs up to the maximum set by state law. Permanezca en el Trabaio o Reareso al Trabaio: Estar lesionado no significa que usted debe dejar de trabajar. Si usted puede seguir trabajando, usted debe Death Benefits: If the injury or illness causes death,payments may be made to a hacerlo. Si no es asi,es importante regresar a trabajar con su empleador actual tan Rev.1/l/2016 Page 2 of 3 spouse and other relatives or household members who were financially dependent pronto como usted pueda medicamente hacerlo. Los estudios demuestran que on the deceased worker. entre mas tiempo este fuera del trabajo,mas dificil es regresar a su trabajo original It is Meeal for your employer to punish or fire you for having a job injury or y a sus salarios. Mientras se esta recuperando, su PIP, su empleador illness,for filing a claim,or testifying in another person's workers'compensation (supervisores u otras personas en la gerencia),el administrador de reclamos,y su case(Labor Code 132a).If proven,you may receive lost wages,job reinstatement, abogado(si tiene uno)trabajaran con usted Para decidir c6mo va a permanecer en increased benefits,and costs and expenses up to limits set by the state. el trabajo o regresar at trabajo y qu6 trabajo hard. Comuniquese de manera activa con su PIP, su empleador y el administrador de reclamos sobre el trabajo que Resolving Problems or Disputes: You have the right to disagree with decisions hizo antes de lesionarse, su condici6n medica y los tipos de trabajo que usted affecting your claim.If you have a disagreement,contact your employer or claims puede hacer ahora y los tipos de trabajo que su empleador podria poner a su administrator first to see if you can resolve it. If you are not receiving benefits, disposici6n. you may be able to get State Disability Insurance (SDI) or unemployment insurance(UI)benefits. Call the state Employment Development Department at Paso por Incapacidad Permanente: Si un medico dice que no se ha recuperado (800)480-3287 or(866)333-4606,or go to their website at www.edd.ca.gov. completamente de su lesi6n y siempre sera limitado en el trabajo que puede hacer, es posible que Ud.reciba pagos adicionales.La cantidad dependera de la clase de You Can Contact an Information & Assistance (I&A) Officer: State I&A lesion, grado de deterioro, su edad, ocupaci6n, fecha de la lesion y sus salarios officers answer questions,help injured workers,provide forms,and help resolve antes de lesionarse. problems. Some I&A officers hold workshops for injured workers. To obtain Beneficio Suplementario por Desplazamiento de Trabaio(Supplemental Job important information about the workers' compensation claims process and your Displacement Benefit-SJDB): Si Ud. se lesion6 en o despues del 1/l/04, y su rights and obligations, go to www.dwc.ca.gov or contact an I&A officer of the lesion resulta en una incapacidad permanente y su empleador no ofrece un trabajo state Division of Workers'Compensation.You can also hear recorded information regular,modificado,o alternativo,usted podria cumplir los requisitos Para recibir and a list of local I&A offices by calling(800)736-7401. un vale no-transferible pagadero a una escuela Para recibir un nuevo un curso de You can consult with an attorney.Most attorneys offer one free consultation.If reentrenamiento y/o mejorar su habilidad. Si Ud. cumple los requisios, el you decide to hire an attorney, his or her fee will be taken out of some of your administrador de reclamos pagara los gastos hasta un maximo establecido por las benefits. For names of workers' compensation attorneys, call the State Bar of leyes estatales. California at (415) 538-2120 or go to their website at www. Beneficios por Muerte:Si la lesion o enfermedad causa la muerte,es posible que californiaspecialist.org. los pagos se hagan a un c6nyuge y otros parientes o a las personas que viven en el Learn More About Workers' Compensation: For more information about the hogar que dependian econ6micamente del trabajador difunto. workers' compensation claims process, go to www.dwc.ca.gov. At the website, Es ileeal que su empleador le castigue o despida por sufrir una lesion o you can access a useful booklet, "Workers' Compensation in California: A enfermedad laboral, por presentar un reclamo o por testificar en el caso de Guidebook for Injured Workers." You can also contact an Information & compensacion de trabajadores de otra persona. (C6digo Laboral, secci6n 132a.) Assistance Officer (above), or hear recorded information by calling 1-800-736- De ser probado,usted puede recibir pagos por perdida de sueldos,reposici6n del 7401. trabajo, aumento de beneficios y gastos hasta los limites establecidos por el estado. Resolviendo problemas o disputas:Ud.tiene derecho a no estar de acuerdo con las decisiones que afecten su reclamo. Si Ud. tiene un desacuerdo, primero comuniquese con su empleador o administrador de reclamos Para ver si usted puede resolverlo.Si usted no esta recibiendo beneficios,es posible que Ud.pueda obtener beneficios del Seguro Estatalde Incapacidad (State Disability Insurance- SDI) o beneficios del desempleo (Unemployment Insurance- UI). Llame al Departamento del Desarrollo del Empleo estatal al(800)480-3287 o(866)333- 4606,o visite su pagina Web en www.edd.ca.gov. Puede Contactar a un Oficial de Informaci6n v Asistencia (Information & Assistance- I&A): Los Oficiales de Informaci6n y Asistencia (I&A) estatal contestan preguntas, ayudan a los trabajadores lesionados, proporcionan formularios y ayudan a resolver problemas. Algunos oficiales de I&A tienen talleres Para trabajadores lesionados. Para obtener informacion importante sobre el proceso de la compensacion de trabajadores y sus derechos y obligaciones,vaya a www.dwc.ca.gov o comuniquese con un oficial de informacion y asistencia de la Division Estatal de Compensaci6n de Trabajadores. Tambien puede escuchar informacion grabada y una lista de las oficinas de I&A locales llamando al(800) 736-7401. Ud.puede consultar con un abogado. La mayoria de los abogados ofrecen una consulta gratis. Si Ud. decide contratar a un abogado, los honorarios seran tornados de algunos de sus beneficios. Para obtener nombres de abogados de compensacion de trabajadores, flame a la Asociaci6n Estatal de Abogados de California (State Bar) al (415) 538-2120, o consulte su pagina Web en www.califomiaspecialist.org. Aprenda Mas Sobre la Compensaci6n de Trabaiadores: Para obtener mas informacion sobre el proceso de reclamos del programa de compensacion de trabajadores, vaya a www.dwc.ca.gov. En la pagina Web, podra acceder a un folleto util, "Compensaci6n del Trabajador de California: Una Guia Para Trabajadores Lesionados." Tambien puede contactar a un oficial de Informaci6n y Asistencia(arriba), o escuchar informacion grabada llamando al 1-800-736- 7401. Rev.1/l/2016 Page 3 of 3 Nguyen, Tu Tran From: Uribe,Juan Sent: Thursday, March 19, 2026 11:03 AM To: RM D Cc: Soriano, Destinee Subject: RE: Renewal COI Review: Paramount Education LLC dba My Coding Classes Good morning, Yes, I can confirm the contractor will still not be driving to City premises. Sincerely, ®�- Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services 20 Civic Center Plaza, Santa Ana, CA 92701 (714) 571-4276 iuribe(a�santa-ana.org "City Hall is closed every other Friday. Click here for dates" From: RMD Sent:Thursday, March 19, 2026 10:46 AM To: Uribe,Juan <juribe@santa-ana.org> Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Renewal COI Review: Paramount Education LLC dba My Coding Classes Hi Juan, For the Automobile Liability, I see that they signed an Affidavit previously. Please confirm that the contractor will not be driving to City premises. i Managing.Ftisk through AwaFene5s and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE 1. Ja&Das"i i'*Rgx,csentatiW).anesl(hat]am an authariz (14 aaJ luk A+'rmiw kepra mamP rgmv- „tativv d Paramount Education LL (V ,.ny-)..awe ld'mmkl capWaiy N ) pow"�k authority to kWily bind CaTnI aay. In my capacity as Represenlaiive of Company,1 relm sent and coniinn the Following-as relates to the agrccment betwemCornpany and,City-of Santa Aro,aUc,:mcnt numbeF ("r xC.+ t�l }to lxoa,idc coding oourses a.`K++.m so fs pR+mkd�4 Ws�ayl4 During the course and a.+opeofCon"ny's&$ret teem with nct Ciry of Santa Are, Company employees,conatllancs.represelttatives,and aXnu will not use md,br drivr any Companyownc&rentcdlca toiray.,advchidcstopCfrbFrnSalvices to,far,ocern bdisirof city of Santa Ant. If at any titnc ii is found tbatCompalty is cot adheriegto any an&xall onhe strtmef"in(iris doeunrm turd does not maintain the mtmmutinaulaauabile liability insuaauce u aa'ctsge as regoimd in the hgaacmm.it will be om*rod a bunch of 1gPeComi mwde ng the Agroen%ffl troll and void and Company will be fully Iablc for any and all damages: ti,v,ru,r .. . ....�:.. ,hack Daswani N-W Managing Partner Kind regards, Tu Tran Nguyen Risk Management Technician City of Santa Ana - Human Resources Department n 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-5141 Email: TNguyen20(aD-santa-ana.org I santa-ana.org/human-resources Linkedln I nstagram 2