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HomeMy WebLinkAboutAON RISK INSURANCE SERVICES WEST, INCSON o: ov- 0 gre-o"A LTIIl' Nkr-) INSURANCE ON TILE WORN MAY PROCEED UNTIL 3-;5U:f,V4cE EXPIRES CITY OATLc P 2 4 2024 City of Santa Ana Aon Risk Insurance Services West, Inc. Proposal for Actuarial Services Issue Date - September 5, 2024 W2Q24-322 SON Table of Contents Introduction.........................................................................................................................................................1 Scopeof Work............................................................................................................................. ProjectApproach ................................................................................................................................................... --.... ...... 2 Deliverables.....................................................................................................................................................................3 Timeline........................................................................... ................................................................................................ 4 References..............•...-----------------•------............................................................................................................................5 ProjectTeam and Roles....................................................................................................................................6 ProfessionalFees.. ........................ .................................................................................................................... 7 Duration.............................................................................................................................................................................7 Payment............................................................................................................... ...•- -.... ............................7 ProjectRisks.......................................................................................................................................................8 Representations and Warranties.. ............................... .......... ............................ ........ .......... ................. 8 Relationship.............................................................................................................................. Confidentiality....................................................................................................... ........................9 Client Responsibility..........................................................................•--------...................10 --------------------------------. Limitationof Liability----•...................................................................................................................................11 NoSolicitation ... ..............................................................................................................................................11 Termination...................................................................................................................................................... 12 ForceMajeure.................................................................................................................................................. 12 Ownership........................................................ ......... ....................................................................................... Miscellaneous.................................................................................................................................................. 13 EntireProposal................................................................................................................................................. 14 ProposalAcceptance....................................................................... ........................ ---.........................15 Aon Proprietary and Confidential Prepared for: The City of Santa Ana LION Introduction Aon Risk Insurance Services West, Inc. (AON) is pleased to submit this proposal to provide services to the City of Santa Ana (Client) for actuarial services for its self -insured workers compensation and liability programs. The broad scope of work is to develop estimated outstanding liabilities and funding amounts for future fiscal years. This will provide important data for financial audit statements (including Governmental Accounting Standards Board [GASB] Statement No. 10 compliance) and strategic long-range planning. The conclusions of our work will be provided in a written report. The report will have an executive summary designed to be easily understood by non -actuaries. It will contain a technical section with sufficient information to support all conclusions and to facilitate future analysis. Scope of Work The following is our understanding of the ultimate goals of the project and will serve as a Scope of Work: 1. Estimate Outstanding Losses. Estimate outstanding losses (including allocated loss adjustment expenses [ALAE] and unallocated loss adjustment expenses [ULAE]) as of June 30, 2023. The estimated outstanding losses are the cost of unpaid claims. The estimated outstanding losses include case reserves, the development of known claims and incurred but not reported (IBNR) claims. ALAE are the direct settlement expenses for specific claims, primarily legal expenses. ULAE are general claims administration expenses. The estimated outstanding losses will be provided in both discounted and undiscounted basis, based on the discount rate provided by the Client. 2. Project Ultimate Limited Losses_ Project ultimate limited losses (including ALAE) for 2024/25 through 2025/26 The projected ultimate limited losses are the accrual value of losses with accident dates in 2024/25 through 2025/26, regardless of report or payment date. The amounts are limited to the indicated self - insured retentions. Projected ultimate losses will be provided in both discounted and undiscounted basis, based on the discount rate provided by the Client. 3. Project Losses Paid. Project losses paid during each fiscal year from 2024/25 through 2025/26. Aon Proprietary and Confidential Prepared for: The City of Santa Ana AON The projected losses paid are the claim disbursements during each fiscal year from 2024/25 through 2025/26, regardless of accident or report date. The amounts are limited to the self -insured retention. 4. Allocate Premium. Calculate premium contribution by City Department for 2024/25. 5. Affirm GASB Statement No. 10. Provide a statement affirming the conclusions of this report are consistent with Governmental Accounting Standards Board (GASB) Statement No. 10. These actuarial services will result in the production of the following deliverables: The conclusions of our work will be in a written report for Client. The report will be designed to be easily understood by non - actuaries. [twill contain a technical section with sufficient information to support all conclusions and facilitate future analysis. Project Approach Submit a written data request to Client. 2. Gather and compile data provided by Client. We will review the data for reasonableness. Anomalies(if any) will be identified. If requested, we can obtain data dfrectly from the claims administration firm(s). 3. Discuss large Individual cialms with Client. Large claims can have a disproportionate impact upon the actuarial analysis. We want to be certain we fully understand the large claims. 4. Develop estimates of claim costs for 2024/25 and 2025/26. The estimates will be based on Client's own data to the extent it is a good predictor of future activity.To the extent Client's loss data is not a good predictor, our projections will reflect other similar programs with which we are familiar. Based on our experience, we have found that insurance industry statistics are often not applicable to public entities. This is because insurance industry statistics reflect a wide range of diverse risks (public entities are much more homogeneous). Public entities tend to manage claims very carefully. Therefore, reporting and payout patterns differ from insurance industry statistics. For the above reasons, we will apply insurance industry statistics judiciously. Our estimates will be developed based on generally accepted actuarial practices and will beconsistent with GASB Statement No. 10. We will consider at least the following actuarial methodologies: ■ Paid loss development Reported incurred loss development ■ Case reserve analysis ■ Reported claims development ■ Frequency and severity analysis ■ Loss rate analysis Aon Proprietary and Confidential Prepared for: The City of Santa Ana AON ■ Born huetter-Ferguson analysis ■ Increased limits analysis 5. Based on projected losses and expected claims disbursement patterns, project investment income. 6. Prepare a draft report of our conclusions and recommendations. The conclusions and recommendations will be clear, concise, and easily understood by non -actuaries. The report will 'Include charts, graphs, and other documentation sufficient to support all conclusions and recommendations. Further discussion of the report appears in the "Deliverables," Section of this proposal. 7. Discuss the draft report with Client by telephone. Based on new facts ascertained in our discussions,we will revise the draft report and issue a final report. Deliverables Client will receive a thorough, yet easy -to -understand report. The technical section will include the following information to support all conclusions and facilitate future analysis. ■ Background. Relevant details concerning the history, administration, claims handling, retention levels and excess coverage will be provided. ■ Data Sources. Descriptions of the loss and exposure data provided by Client and its administrators will be provided. Individual claims requiring special treatment in the analysis will be cited, including an explanation of how we treated the claims in the analysis. If industry data is used to supplement our analysis, a description of the data source will be provided; we will explain how we Incorporated the industry data into the analysis. ■ Methods Used. Descriptions of the various actuarial methods used in the analysis will be provided. We will also explain the considerations associated with selecting the methods as well as the underlying assumptions. Exhibits. The exhibits will show the details of our analysis and support all conclusions stated in the Executive Summary. ■ Our reports are practical, useful documents, frequently referred to by our clients over months until they are updated by ensuing Ado Proprietary and Confidential 3 Prepared for: The City of Santa Ana Timeline Major Activity (1) (A) Project kickoff (B} Submit written data request (C) Aon submits draft report (D) Final report Timing (2) Within two (2) days of notification to proceed Within two (2) days of project kickoff Within four to six (4-6) weeks of receipt of data, Within two days of Client's approval of the draft Aon Proprietary and Confidential Prepared for: The City of Santa Ana References Entity (1) City of Pasadena City of Minneapolis City of San Buenaventura City of Tampa City of Mountain View City of Houston County of Los Angeles County of San Mateo County of Brevard Harris County Tarrant County Texas El Paso County, Colorado State of Nevada State of Hawaii Contact Name (2) Ms. Arlene Gallardo Risk and Insurance Administrator Ms. Lori Johnson Deputy Chief Finance Officer Ms. Lisa Oland Risk Manager Mr. Greg Mazer Safety and Loss Prevention Supervisor Ms. Claudia Koob, ARM Risk Manager Ms. Carla Coleman, CPM, IPMA-SCP Chief Finance Officer Ms. Rhonda Aven-Haggenmiller Chief Program Specialist Mr. Scott Johnson Risk Manager Ms. Julie Jones Risk Manager Ms. Bridgett Sweeny Harris County Human Resources & Risk Management Mr. Travis Yarbrough Risk Manager Mr, Rick Bransford Human Resources & Risk Management Ms. Nancy Katafias Manager Ms. Ladea M. Nash Accounting System Manager Phone Number (3) (626) 744-6772 agaliardo@cityofpasadena.net (612) 673-2918 lori.johnson@minneapolismn.gov (805) 654-7760 loland@cityofventura.ca.gov (813) 274-5747 Greg.Mazer@tampagov.net (650) 903-6060 Claudia.koob@mountainview.gov (832) 393-6141 carla.coleman@houstontx.gov (213) 738-2214 RAven- Haggenmiller@ceo.lacounty.gov or snyblom@ceo.lacounty.gov sjohnson@smcgov.org (321) 617-7247 julie.jones@brevardfl.gov (713) 274-1153 bridgett.sweeny@bmd.hctx. net thyarbrough@tarrantcounty.com (817) 884-2645 (719) 520-7488 rickybransford@elpasoco.com (775) 684-1252 nkatafias@ag.nv.gov (808) 586-0606 iadea.m.nash@hawaii.gov Aon Proprietary and Confidential Prepared for. The City of Santa Ana 5 SIL Project Team and Roles Colleagues expected to work on this project include: Benjamin Chen, ACAS, MAAA. Mr. Chen, a Consultant & Actuary at Aon, will lead the actuarial analysis. He has been with the company for six years and has experience estimating outstanding losses and providing peer review for commercial lines. Tracy Fleck, ACAS, MAAA. Ms. Fleck, a senior actuarial consultant, will also lead the project. She is an Associate of the Casualty Actuarial Society and Member of the American Academy of Actuaries. Ms. Fleck has experience providing reserve and funding analysis for self -insured programs, concentrating on public entity workers compensation, general liability, automobile liability, and property. Ms. Fleck's expertise extends to forecasting analyses, cost allocation as well as financial benchmarking for self - insured public entities. She leads and peer reviews over 100 public sector projects annually. Rugaya Alloo. Ms. Alloo, an actuarial analyst, will assist with the actuarial analysis. Ms. Alloo has experience in loss reserving and funding studies for self -insured workers compensation, automobi€e liability, general liability, and property programs. Aon Proprietary and Confidential Prepared for: The City of Santa Ana LION Professional Fees AON's fee for the actuarial service will be a Flat Fee of $12,000 for the actuarial study and $5,500 for the cost allocation. The proposed fees include telephone, postage, and photocopying expenses. Duration AON's services for this proposal begin on September 5, 2024 and end on June 30, 2025. The contract may be extended beyond the duration noted with formal written approval amending this contract. Services may not begin nor payment authorized prior to execution of this proposal by an authorized signatory of the Client. Payment AON will invoice the Client at project completion. The invoice shall be due and payable to AON within thirty (30) days following the Client's receipt of invoice. Aon Proprietary and Confidential Prepared for', The City of Santa Ana LION The Services will be performed in strict accordance with the requirements of this proposal, applicable professional standards and laws. AON is not debarred, proposed for debarment, suspended or otherwise ineligible for participation in any federal procurement or non -procurement transaction. Relationship Consultant's employees assigned to perform Services hereunder shall be and remain employees of Consultant whether Services are performed at Consultant's facilities or Client's facilities and shall not for any purpose be considered Client's employees. Consultant shall be solely responsible for the payment of salaries and all matters relating thereto, including the withholding and/or payment of all payroll taxes, workmen's compensation, unemployment compensation, public liability, insurance -related benefits, vacation pay, holiday pay and all such additional legal requirements applicable to Consultant's employees. Consultant's relationship to Client hereunder is one of independent contractor and nothing contained in this proposal or any Schedule shall be construed to imply that Consultant or any of Consultant's officers, employees or agents is an employee or agent of Client for any purpose. Consultant shall have no right, power or authority to create any obligation, expressed or implied, or to make any representation on behalf of Client, except as may be expressly authorized from time to time by Client in writing and then only to the extent of such authorization. Nothing herein is to imply an agency, joint venture or partner relationship between the parties. Confidentiality "Confidential Information" shall mean various trade secrets and confidential information of Client and/or a third party who has provided such information to Client, including, but not limited to any process, system, formula, pattern, model, device, compilation, or other information, information concerning manufacturing methods, operational methods, business and technology plans, distribution strategies, sales, costs, pricing, marketing, customers, the terms and conditions of this proposal, and research and development of Client or any information that Client deems to be confidential to its business unless same: (i) was already in AON's possession prior to its receipt from Client without restriction on its use or disclosure; (ii) is or becomes available to the general public through no act or fault of AON; or (iii) is rightfully disclosed to AON by a third party, and to the best of AON's knowledge, without restriction on its use or disclosure; or (iv) is demanded by any state or federal government agency or by court order provided that Client receives prior written notice of such disclosure. Ann Proprietary and Confldentiai Prepared for: The City of Santa Ana AON AON will honor confidentiality regarding any data Client provides to AON during this engagement as well as any analysis conducted or conclusions derived from such data. Except as required by the Scope of Work, no Client -identifiable data shall be shared with parties other than AON or Client unless Client provides consent, which consent needs to be provided on a case -by -case basis, or compliance with any validly issued subpoena or court order is required. In turn, the techniques utilized and results produced by AON will not be shared by Client with any other party that could utilize the information to gain a competitive advantage against AON. AON will be responsible for any breach of these obligations by its employees or agents. AON agrees to take all necessary steps to protect any Confidential Information with the same degree of care that AON uses to protect its own confidential and proprietary information of like kind, but in no event less than a reasonable degree of care. Upon any expiration or termination of this proposal and upon Client's written request, AON will promptly return to Client or destroy the originals and all copies of all Confidential Information (which destruction shall include, without limitation, the process of expunging, to the extent reasonably practicable, all such Confidential Information from any computer, hard drive, word processor, server, backup tape, or other electronic device containing such Confidential Information), as well as any equipment or other items, furnished by Client to AON. Notwithstanding the foregoing, AON may retain one archival copy of the Confidential Information in its confidential files for the purpose of complying with applicable laws or established company procedure regarding the preservation of business records. AON gathers data containing information about our customers. This information may be shared among AON affiliated businesses. In addition to being used to provide services to AON customers, the information may be used for business administration, business reporting, statistical analysis, marketing of AON products or services and providing consulting or other services to companies for which AON or its affiliates may receive remuneration. AON takes appropriate measures to protect the privacy and confidentiality of our AON customers as well as to comply with applicable laws and regulations. AON may use or disclose information about our customers if we are required to do so by law, AON policy, pursuant to legal process or in response to a request from law enforcement authorities or other government officials. Due to the global nature of services provided by AON, the information/data you provide may be transmitted, used, stored and otherwise processed outside of the country where you submitted that information. If you have questions about AON data processing, please contact your AON consultant. The requirements of this Confidentiality provision shall survive the termination of this proposal. Client Responsibility AON and Client acknowledge that the reliability of our services depends upon the accuracy and completeness of the data supplied to AON. Client accepts sole responsibility for errors or delays in services solely resulting from inaccurate or incomplete data supplied to AON, and acknowledges and agrees that any additional services thereby necessitated will result in additional fees payable by Client to AON. AON must receive promptly the information to deliver the Services as well as the Client's prompt updates to any information where there has been a material change which may affect the scope Aon Proprietary and Confidential 10 Prepared for: The City of Santa Ana AON or delivery of the Services, such as a change in the nature of the Client's products or equipment, systems, and/or processes that are the focus of AON's service(s). Client agrees to provide its project data in the form agreed upon. Client understands and agrees that if data is submitted in a form other than agreed upon, Client shall pay AON, in addition to the fees set forth in the proposal the reasonable expenses incurred to merge/convert the data to the agreed upon form so long as AON has informed Client of such additional expenses and Client has consented in writing to those additional expenses prior to AON incurring such. Limitation of Liability Both parties further agree that AON and its personnel shall be released to the fullest extent permitted by applicable law from any and all claims, liabilities, costs and expenses attributable to any knowing misrepresentation by Client, its directors, its officers and/or its employees except for claims attributable solely to the negligence of AON. In no event shall AON be liable to the Client, whether in tort (including negligence), contract or otherwise for any amount, in the aggregate, in excess of six times the total fees paid by the Client under this proposal, except to the extent fully and finally determined by a court of competent jurisdiction to have resulted from the willful misconduct or fraudulent behavior of AON, and neither AON nor Client shall be liable to the other for any consequential, indirect, lost profit, lost opportunity or similar damages relating to AON's services provided under this proposal. As AON and Client intend the aforementioned limitation of liability clause to be enforceable, they agree that any over breadth in the clause shall not itself render the clause void, but rather, the clause shall be interpreted and enforceable to the fullest extent permitted by the law of the applicable state_ This Liability Limitation shall apply to the Client and extend to the Client's parent(s), affiliates, subsidiaries, and their respective directors, officers, employees and agents (hereinafter, each a "Client Group Member" and together, "Client Group") wherever located that seek to assert claims against AON, and its parent(s), affiliates, subsidiaries and their respective directors, officers, employees and agents (each an "Aon Group Member" and together, "Aon Group"). Nothing in this Liability Limitation section implies that any Aon Group Member owes or accepts any duty or responsibility to any Client Group Member. No Solicitation The parties agree that during the term of each Schedule issued pursuant to this proposal and for a period of one (1) year after the termination of each such Schedule, neither party shall directly or indirectly solicit for employment, without the permission of the other party, any person employed then or Aon Proprietary and Confidential Prepared for The City of Santa Ana SON within the preceding one (1) year if such person performed the Services under such Schedule; provided that, (a) general solicitations of employment for employees published in a journal, newspaper or other publication of general circulation and not directed specifically toward one or more employees of the other party and any resulting offer to hire shall not be deemed to be in violation of this Section, and (b) this Section shall not prevent a party from offering to employ or employing any employees of the other party who contacts the hiring party on his or her own initiative with no direct or indirect encouragement by the hiring party. Termination At any time, the parties may terminate the Services under this proposal or under any Schedule by giving the other thirty (30) days written notice, in which event Consultant shall be reimbursed for Services performed prior to the effective date of such termination. Either party may terminate this proposal by written notice to the other party if the other party (i) breaches or is in default of any material obligation under this proposal which default is incapable of cure or which, being capable of cure, has not been cured with ten (10) days after receipt of notice of such default or (ii) becomes insolvent, makes a general assignment for the benefit of creditors, files a voluntary petition for protection under bankruptcy or insolvency law, or has wound up or liquidated its business. Provisions of this proposal which by their express terms extend beyond expiration or termination or which by their nature so extend to give effect to their meaning will survive and continue in full force and effect after any expiration or termination of this proposal. Force Majeure The performance by either party or their approved subcontractors hereunder shall be subject to delays caused by an Act of God, war, riot, fire, explosion, accident, flood, sabotage, inability to obtain fuel or power, but not due to any act of the party claiming the force majeure event, new governmental laws, Aon Proprietary and Confidential 12 Prepared for: The City of Santa Ana SON regulation or orders, acts or inaction of the other party, or any other cause beyond the reasonable control of a party. In the event of any such delay, the times for performance will be extended accordingly for additional period(s) of delay. In the event, however that any such delay lasts for a period of forty-five (45) days, then either party may terminate this proposal immediately. In the event of such non-performance, the party which was delayed in its performance shall make reasonable efforts to promptly resume its performance hereunder. Ownership All data supplied by Client shall be and remain at all times the sole and exclusive property of Client. AON will provide the Client with a report and/or certain other tangible items specified as deliverables ("Deliverables"), set forth in the "Scope of Services" section of the attached Proposal. The Deliverables, upon full and final payment to AON, shall become the property of the Client, except that AON owns or has rights to all products, processes, concepts, know-how, techniques, software, and methodology used, and records created or maintained, (collectively "Prior Works") for the production of the Deliverables, and Client shall gain no rights in or to them. To the extent that any Prior Works are contained in the Deliverables, AON hereby grants the Client, upon full and final payment to AON, a royalty -free, fully paid -up, worldwide, non-exclusive license to use such Prior Works in connection with the Deliverables. Services and Deliverables are for the exclusive use of Client and are not to be relied upon by third parties. Client acknowledges and agrees that AON is in the business of providing consulting services to clients utilizing AON's Prior Works, and nothing contained herein shall prohibit AON from using any of AON's general knowledge or knowledge acquired under this proposal to perform similar services for others. Miscellaneous Should any provisions of this proposal be held unenforceable or in conflict with the law of any jurisdiction, the validity of the remaining provisions shall not be affected by such holding. Consultant shall not assign, delegate, convey, encumber or otherwise dispose of this proposal or any rights or obligations hereunder without the prior express written consent of Client. This proposal is fully Aon Proprietary and Confidential 13 Prepared for: The City of Santa Ana LION assignable by Client and shall inure to the benefit of any assignee or other legal successor in interest of Client herein. This proposal shall be binding upon the successors, and/or legal representatives of the parties. Entire Proposal This proposal contains the entire understanding and agreement between the parties with respect to the subject matter described herein and supersedes and replaces all prior and contemporaneous agreements, whether written or oral, as to such subject matter. This proposal may be modified only by a written agreement signed by both parties. This proposal shall be governed by and construed in accordance with the laws of the State without regard for its conflicts of law rules. Aon Proprietary and Confidential 14 Prepared for: The City of Santa Ana AON Proposal Acceptance By executing this proposal, the Client has read all of the terms and conditions stated herein and fully understands their contents. The execution of this proposal confirms the Client's understanding and acceptance of those terms. The signing of this proposal by an authorized signatory of the Client indicates that the Client hereby authorizes AON to proceed with the services as described herein. This document should be returned to Ruqaya Alloo. This proposal is valid until September 30, 2024. Client Signature: Printed Name: Title: Date: 01w, I � _ Mo. a► --Z�p 9 APPROVED AS TO FORiII SONIA R. CARVALHO City Attomey By onathau T. Martinez U Assistant City Attorney AON William Deeb Director of Public Entities Aon Risk Insurance Services West, Inc. 9/5/2024 CITY OF SANTA ,// 7 Alvaro Niuiez City Manager RECONMEENDED FOR kPPROVAL: Lori Sclivaider Executive Director Hiinun Resotirces Ann Proprietary and Confidential Prepared for: The City of Santa Ana 15 0ATEIMM0D,`(YYY) I -4 a CERTIFICATE OF LIABILITY INSURANCE I 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 ACn Risk Servi Ce5 Central, Inc. Chicago IL Office CONTACT NAME: _ (A PHONE EKt): (865) 283-7122 (C No)- (800) 363AX -0105 E-MAIL ADDRESS: 200 Fast Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Transportation Insurance Co. 20494 Acn Corporation and its Subsidiaries (see subsidiary Information Below) 200 E. Randolph Chicago IL 60601 USA INSURERB: American Casualty Co. of Reading PA 20427 INSURERC: Continental casualty Company 20443 INSURER D: INSURER F; INSURER F: GUVEHAI t;tH l III r NUMtStH: 5/Ul Ubl,541oGb HtV15IUN NUMtStH: 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD POLICY EFF POLICY EXP SUBRI WVD POLICY NUMBER MMlDDIYYYY MMrDDIYYYY LIMITS C X COMMERCIAL GENERAL LIABILITY 4 0 14 10 T8—T5— EACH OCCURRENCE 11,000,000 CLAIMS -MADE ❑OCGUR DAMAGE TO RENTED $1,D00,000 PREMISES (Ea occurrence MEU EXP (Any one person) S10,000 N PER50NAIT& ADVINJURY 11,000 1 m GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,D00,000 POLICY ❑ JECT ❑X LOC m PRODUCTS - CCMPiCPAGG 12,000,000 OTHER: n C AUTOMOBILE LIABILITY 4014103656 06/01/2074 06/01/2025 COMBINEDSINGLELIMIT Ea accidenu $1, 000,000 L4 BODILY INJURY (Per person} X ANY AUTO O Z BODILY INJURY (Per accidenq OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY Q� O PROPE RTYDAMAGE Per accidenll 07 UMBRELLA LIARH OCCUR EACH OCCURRENCE V AGGREGATE EXCESS LIAR CLAIMS -MADE DEO RETENTION A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YI ANY PROPRIETOR? PARTNER: EXECUTIVE N OFFECERIMEMBEREXCLUDED' (Mandatory in NH) NIA 4014100157 AZWI , 4014100059 All Other States 06/01/2024 06/01/2024 06/01/2025 06/01/2 02 5 X PER STATUTE OTH ER E,L, EACH ACCIDENT 31, 000, 000 E, L. DISEASEEAEMPLOYEE .$1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below ---- E.L. DISEASE -POLICY LIMIT S1,000.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES {ACORO 101, Additional Remarks Schedule, may be attached 11 more space Is required) RE; Aor Risk Insurance Services West, Inc., PO Box 849932. certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. A waiver Of Subrogation is granted in favor of certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. The above terms are as required by written contract. CERTIFICATE HOLDER city of Santa Ana Attn: Aarti Kaushal 20 Civic Center Plaza Santa Ana CA 92701 USA e,sk lU.zi,nexme�,e I]ivfsir. —_ .y nevimrd and Apra'nvne hY. t F4sk Mm,eScr CANCELLATION SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 001988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10224227 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Ann Risk Services Central, Inc. NAMED INSURED Aon Corporation and its subsidiaries POLICYNUMBER See Certificate Number: 570108134626 CARRIER See certificate Number: 570108134626 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Insurance INSURER(S) AFFORDING COVERAGE I NAIL # II ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR VTR TYPE OF INSURANCE ADDL INSU SUBR wVD POLICYNUMUER POLICY !EFFECTIVE UATE (MM/DUfYYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION R N/A 4014100014 CA 06/01/2024 06/01/2025 ACORD 101 (2008/01) m 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DAT 1097 21D2024�Y� 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 AOn Risk Service5 Central, Inc. Chicago IL Office Chicago CONTACT NAME: (ACNNo.Exq: (666) 283-7122 FAX $00-3b3-0165 EMAIL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: XL Specialty Insurance CO 37895 AOn Corporation (see Subsidiary Information Below) 200 E. Randolph Chicago IL 60601 USA INSURER B: INSURER C: INSURER D: INSURER E! INSURER F: COVERAGES CERTIFICATE NUMBEH: b/01013134632 HEVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIFS 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 CCNTRACT 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. Limits shown are as requested INSR LTR TYPF OFINSVRANCE INSD WVD POLICY NUMBER MMIDDlYYYY MMlODfYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑ OCCUR DA TO P REAd35ES Ea occurrence G ENt AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO JECT F7 LOC OTHER: AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY H AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY AGED EXP (Any one person) PERSONAL& ADV INJURY GENERAL AGGREGATE PRODUCTS-COMPiOPAGG COMBINED SINGLE LIMIT EEa acddentI BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE UMBRELLA LIAB I EACH OCCURRENCE AGGREGATE EXCESS L€AB HOCCUR CLAIMS -MADE DED I RETENTION WORKERS COMPENSATION AND PEH STATUTE I JOTI EMPLOYERS' LIABILITY YIN ER E.L. EACH ACCIDENT ANY PROPRIETOR! PARTNER! EXECUT IVE C)FFICERIVEMBER EXCLUDED' ❑ N r A EL. DISEASE -EA EMPLOYEE (Mandatory In NH) f yes, describe under DESCRIPTION OF CPERATIONS below E.L. DISEASE -POLICY LIMIT A E&O - Professional Liability US0008736SE024A 03/01/2024 03/01/2028 Each Claim - Primary Errors & Omissions Aggregate SIR applies per policy terms & condi ions DESCRIPTION Or OPERATIONS f LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: ADD Risk insurance services West, Inc., PO Box 849832. CERTIFICATE HOLDER City of Santa Ana Attn: Aarti Kaushal 20 Civic Center Plaza Santa Ana CA 92701 USA �, RfsEC Munugsmsn[pi��sion R,sk [.i,�nnFci �4,000, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORzFD(REEPPPRRESENTAAT�IVE [3C[G�d eJ1�G �Gtiz4�,D ��ll���eJ7�Gt ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD N Cl) va c1 0 0 r AGENCY CUSTOMER ID: 10224227 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMEDINSURED Aon corporation POLICYNUMBER see certificate Number: 570108134632 CARRIER See Certificate Number: 570108134632 NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, Carrier Participation schedule insurer: XL specialty Insurance company Policy #: us00087368E024A I Participation: 6.67% 1 Policy Term: 3/1/2024-3/1/2028 insurer:Illinois National Insurance Co. Policy #: 025827769 1 Participation: 16.67% 1 Policy Term: 3/1/2024-3/1/2028 Insurer:Starr surplus Lines insurance Company I Policy #: 1000624723241 1 Participation: 6.67% 1 Policy Term: 3/1/2024-3/l/2028 InSUrer:HOuston Casualty Company I Policy #: 14MG24AI6363 Participation: 3.33% 1 Policy Term: 3/1/2024-3/1/2028 Insurer:National Fire & Marine xnsurance Company I Policy #: 42EPP33358701 I Participation: 6.67% 1 Policy Term: 3/1/2024-3/1/2028 XL specialty Insurance Company I Policy #: US00137987Eo24A I Participation: 60% 1 Policy Term: 3/1/2024-3/1/2028 innnn i of ronnRmf I The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/02/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Chicago IL Office CONTACT NAME: PHONE FAX (A/C.No. Ezt): (866) 283-7122 (A/C.No.): (800) 363-0105 E-MAIL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: American Casualty Co. of Reading PA 20427 Aon Corporation and its Subsidiaries (See Subsidiary Information Below) 200 E. Randolph INSURERB: Transportation Insurance Co. 20494 INSURER C: Continental Casualty Company 20443 Chicago IL 60601 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570112954286 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD1YYYY) POLICY EXP (MM/DDNYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY 4014103835 06 01 2025 06 01 2026 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10 , 000 PERSONAL &ADV INJURY $1,000,000 LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 P'LAGGREGATE POLICY ❑ PRO JECT �LOC PRODUCTS - COMP/OPAGG $2,000,000 OTHER: C AUTOMOBILE LIABILITY 4014103656 06/01/2025 06/01/2026 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY( Per person) )( ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED (Per accident) ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED I RETENTION B WORKERS COMPENSATION AND 4014100157 06/01/2025 06/01/2026 X PER STATUTE ORTH- A EMPLOYERS' LIABILITYJE v/N A oEEiCERMENIBPROPRIETOR/ PARTNER/ EXECUTIVE cERrMEMaERExcwoeD? N N/A AZ, WI 4014100059 06/01/2025 06/01/2026 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) All Other States UID SCes, Under RIPTION OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Aon Risk Insurance Services West = Inc., PO Box 849832. City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. A Waiver of Subrogation is granted in favor of City of Santa Ana, its City Council, officers, officials) employees, agents and volunteers in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. The above terms are as required by written contract. CERTIFICATE HOLDER I APPROVED CANCELLATION (By Tu Tran Nguyen at 2:52 pm, Jun 02, 2025 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION l DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa And by Tu T,.n ned AUTHORIZED REPRESENTATIVE Attn: Risk Manager Tu Tran N9�y nran 20 Civic Center Plaza, M-24 Nguyen Date: 2025.06.0 Santa Ana CA 92701 USA rass:ra-moo' `w O Z R U N U N NI 0i x_ y 91 ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10224227 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk services Central, Inc. NAMED INSURED Aon corporation and its subsidiaries POLICY NUMBER See Certificate Number: 570112954286 CARRIER See Certificate Number: 570112954286 I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. FFSR LTR TYPE OF LNSURANCE ADDL LNSD SUBR VVVD POLICY NUMBER POLICY EFFECTIVE DATE b M/DD/YYYY POLICY EXPIRATION DATE (MbI/DD/YYYY) LBIFIS WORKERS COMPENSATION A N/A 4014100014 CA 06/01/2025 06/01/2026 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT 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 Personi Or Organization(s) ANY PERSON OR ORGANIzATION WHOM YOu ARE REQuEsTEDBY CONTRACTTO ADD As AN ADDITIONAL INsuRED IN THEPERFORMANCBDR YOUR ONGOING OPERATIONs AND THATCONTRACT ExPREssLY REQuIREs THE usE OF IsO ENDORsEMENTCG2010 04/13 OR ITs EQUIVALENT. CG 2 0 1012 19 Page 1 of 2 CONTINENTAL CAsuALTY COMPANY Insured Name: AON CORPORATION Policy No: 4014103835 Endorsement No: Effective Date: 06/01/2025 Copyright Insurance Services Office, Inc., 2018 I CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement 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 TO WHOM YOU ARE OBLIGATED BY VIRTUE OF CONTRACT OF AGREEMENT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The Insurer is amended by the addition of the following: Solely with respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work done under a contract with that person or organization and included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (1-15) Policy No: 4014103835 Page 1 of 1 Endorsement No: CONTINENTAL CASUALTY COMPANY Effective Date: 06/01/2025 Insured Name: AON CORPORATION Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. �1111!�Av/_1 Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: AON CORPORATION Endorsement Effective Date: 06/01 /2024 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT TO NAME AS AN ADDITIONAL INSURED AS AN "INSURED" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A. 1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph 0.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. Form No: CA 20 48 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: ; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 4014103656 Policy Effective Date: 06/01 /2025 Policy Page: of ° Copyright Insurance Services Office, Inc., 2011 CNA Business Auto Policy Policy Endorsement WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: AON CORPORATION Endorsement Effective Date: 06/01 /2024 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM YOU ARE OBLIGATED BY VIRTUE OF CONTRACT OF AGREEMENT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: ; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 4014103656 Policy Effective Date: 06/01 /2025 Policy Page: of © Copyright Insurance Services Office, Inc., 2011 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: WC 00 03 13 (04-1984) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: ; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Policy No: WC 4 14100059 Policy Effective Date: 06/01 /2025 Policy Page: of Copyright 1983 National Council on Compensation Insurance. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ❑ Specific Waiver Name of person or organization X❑ Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: All Texas Operations 3. Premium: The premium charge for this endorsement shall be 2% percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: Refer to Schedule of Operations All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: WC 42 03 04 B (06-2014) Policy No: WC 4 14100059 Policy Endorsement Effective Date: Endorsement Expiration Date: Effective Date: 06/01/2025 Policy Endorsement No: ; Page: 1 of 1 Page: of Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 ° Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G-19160-B (11-1997) Policy No: WC 4 14100014Policy Endorsement Effective Date: Endorsement Expiration Date: Effective Date: 06/01 /2025 Endorsement No: Page: 1 of 1 Policy Page: of Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 ° Copyright CNA All Rights Reserved