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ADMINSURE, INC. (8)
INSURANCE NOT ON FILE A-2025-202 i WORD MAY NOT PROCEED CITY CLERK DATE DEC 1 ?0?5 PROFESSIONAL SERVICES AGREEMENT FOR THIRD PARTY WORKERS' COMPENSATION CLAIMS ADMINISTRATION { BETWEEN THE CITY OF SANTA ANA AND ADNIINSURE,INC. This "Professional Services Agreement Between the City of Santa Ana and Adminsure, hie. ("Agreement") is made and entered into this 2nd, day of December, 2025, by and between the City of Santa Ana, California, a California Municipal Corporation (the "City") and Adminsure, a California corporation("Consultant). The City and Consultant are sometimes hereinafter referred to individually as a"Party"or collectively as the"Parties". The Parties enter into this Agreement with reference to the following: Recitals A. City needs a qualified third party to whom to delegate the responsibilities and duties of administering the City's self-insured workers' compensation claims program; B. City desires to engage Consultant to provide Workers' Compensation Claims Administration services; C. Consultant recently participated in a Request for Proposal("RFP")for the same services with the City of Newport Beach and was selected through this RFP process; D. The City's purchasing procedures allow the City to piggyback off a successful RFP process through another government entity for the same services; and R. Consultant possesses the necessary skills, experiences,training, and certifications to provide the professional services set forth in this Agreement. NOW,THEREFORE,in consideration of the performance by the Parties of the covenants and conditions herein contained,the City and Consultant hereby agree as follows: i i Terms and Conditions I 1. Consultant Services. Consultant agrees to perform any and all work necessary to supervise and administer the workers'compensation claims program for the City,represent the City in all matters related to the investigation, adjustment,processing, supervision and resolution of workers' compensation claims Fled against the City, and provide to the City during the term of this Agreement all the services described in the Scope of Services attached hereto as Exhibit A and incorporated herein by reference(collectively, the "Services"). 2. Consultant Compensation and Schedule of Payment. a. Consultant will accept as payment and City agrees to pay for all services rendered pursuant to this Agreement,the monthly fees set forth below: f Page 1 of 9 e I I Dates Covered Mon*W Char es 9/l/2025--6/30/2025 $57 866.00 7/l/2026---6/30/2027 $60,760.00 7/112027—6/30/2028 $63 798.00 7/1/2028—6/30/2029 $66,988.00 b. The total amount to be expended during the term of this Agreement shall not exceed two million eight hundred seventy-seven thousand two hundred and twelve dollars and zero cents ($2,877,212.00). C. The Parties agree and acknowledge that services rendered since September 1,2025 are intended to be paid through this Agreement. d. Payment Schedule. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant agrees to execute the City's standard ACH Vendor Payment .Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. e. Inspection of Books and Records. Upon request by City, Consultant shall provide time records and back up data and records verifying project costs and expenses, including out of pocket third party expenses. 3, Term. The term of this Agreement is for a period of three and a half (3 /2) years, commencing on December 2,2025 and terminating on J''une 30,2029. 4. Termination. a. The City may terminate this Agreement at any time,without cause,with ninety days'written notice. b. The City may terminate this Agreement for cause upon providing the Consultant thirty(30)days written notice if: (i) if the Consultant breaches any provision of this Agreement and does not cure such breach within ten(10) days after written notice of the breach is given by the City; (ii) in the event the Consultant's services, in the judgment of City, are unsatisfactory; (iii) in the event of the Consultant's failure to prosecute the work with diligence or within the time limits specified in the contract documents and Consultant fails to cure this breach within ten(10) days of being advised of the breach; (iv) failure to procure or maintain insurance as required by this Agreement; or Page 2 of 9 I i f (v) in the event of bankruptcy,whether voluntary or involuntary,of Consultant. C. The Consultant may terminate this Agreement in the event that the City is delinquent in paying any invoices for a period in excess of sixty(60)days.Termination shall be effective thirty (30) days after notice is received by mail at the City's office unless the City has remedied said failure(s)to the satisfaction of the Consultant. d. If this Agreement is terminated without cause, Consultant shall be paid for the reasonable value of the Services provided up to the time of such termination or suspension. From and after Consultant's receipt of notice of termination, Consultant shall use all reasonable efforts tominimize project costs and expenses, except to the extent the City's notice requested that certain services are continued. 5. Confidentiality, If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary,Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and fiuther 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. 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 Consultant disclosed in a publicly available source, (c)is in rightful possession of the Consultant without an obligation of confidentiality; (d)is required to be disclosed by operation,of law; or(e)is independently developed by the Consultant without reference to information disclosed by the City. 6. Owncrshiv of Records and Work Product. a. All claim data is owned by the City.All claim electronic files,loss reports,payroll information,and other documents and materials,aad all transactional level electronic data in the requested format, shall be delivered to the City upon termination of this Agreement. b. All products of undertaking and completing the Services and Consultant's duties hereunder including, but not limited to, the study results, reports, drawings, photographs, photo simulations,maps,plans,renderings,specifications,analyses,surveys,data,computer printouts,programs and software, and all supporting documentation of such programs prepared in the performance of the Services shall be the property of City, and shall be delivered to City before final payment and the completion of performance or any earlier termination under this Agreement. 7. Indemnification. a. The Consultant agrees to indemnify,defend and hold harmless the City,and/or their respective officers,members,agents,and employees from.any and all loss,liability,claim, demand,cause � Page 3 of 9 i i of action or suit,of any and every kind and description, arising or resulting from, or in any way connected with, Consultant's performance and/or non-performance of the Services required by this Agreement including,but not limited to,liability for inaccurate data,loss or dissemination of data,whether intentional or inadvertent. The Consultant shall, upon demand by the City, as applicable, and at its sole cost and expense, defend and provide attorneys acceptable to the City, as applicable, to defend the City, and/or their respective officers, officials,employees and agents from and against any and all loss,liability,claim,, demand, cause of action or suit,of any and every kind and description,arising or resulting from,or in any way connected with, Consultant's performanw and/or non-performance of the Services required by this Agreement. If the City provides its own defense against any such action or suit, the Consultant shall reimburse the City for all reasonable attorney fees and other costs incurred by the City. b. The Consultant agrees to indemnify,defend and hold harmless the City,and/or their respective officers,members,agents,and employees from any and all loss,liability, claim,demand,cause of action or suit,of any and every kind and description,arising or resulting from,or in any way contracted with, any f~raes, fees, penalties or Medicare reimbursements required to be paid as a result of the Consultant's failure to timely report any Medicare-eligible judgments, awards, or settlements, or for failure to adequately protect Medicare's conditional or future medical payments. C. City agrees to defend any demand, claim, or legal action commenced against the Consultant regarding a matter or incident allegedly caused by or resulting from wrongful or negligent acts of their respective officers, employees, agents, or others engaged by the City, and to indemnify the Consultant against any liability,loss,cost,or damage,including attorney's fees,resulting there from. 8. Intellectual Property Indemnification Consultant shall defend and indemnify the City,its officers,agents,representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent,trademark,or copyright infringement, including costs,contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. Insurance. Consultant agrees to obtain and maintain through the term of this Agreement insurance coverages as set forth in the attached Exhibit ll and incorporated herein by reference. 10, Non-liability of City Officials. No City representative shall be personally liable to the Consultant,or any successor in interest of Consultant,in the event of any default or breach by the City,or for any amount which may become due to the Consultant or any successor,or on any obligation under the terms of this Agreement. 11, Independent Consultant. Consultant shall,during the entire term of this Agreement,be construed to be an independent Consultant and not an employee of the City, This Agreement is not intended nor shall it be construed to create an employer-employee relationship,a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement;however,the services to be provided by Consultant shall be Page 4 of 9 I j provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes,unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withbolding taxes.The Consultant shall agree to indemnify,defend and hold harmless the City for any action or proceeding related to Consultant's employees or agents' independent Consultant status. 12. Employment practices. Consultant 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.Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal,state and local laws and regulations. 13. Conflicts of Interest. a. Consultant covenants that it presently has no interests and shalt not Dave 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 Consultant or have any other dint 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 Ca1PERS retiree as authorized by City Council resolution d. The Consultant 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 Consultant warrants that it is not now aware of any facts which conflict with the prohibitions do-fined above.If the Consultant hereafter becomes aware of any facts that might reasonably 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. Consultant 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. Page 5 of 9 E E i i ! 14. Force Majoure. f a. "Force Majeure" means any cause beyond the reasonable control of a party, € including but not limited to act of Cod,civil or military disruption,fire,strike, flood,riot,war,or inability due to the aforementioned causes to obtain necessary labor,materials, or facilities. b. If any Party hereto is delayed or prevented from fulfilling its obligations under this Agreement by Force Maj cure,said Party will not be liable under this Agreement for such delay or failure, nor for damages or injuries resulting directly from the inability to perform scheduled work due to Force Majeure. c. Consultant shall be granted an automatic extension of time cornmensuratc with any delay in performing scheduled work arising from Force Majeurc. Consultant agrees to resume such work within three(3)days after the Force Maj aura has subsided enough to do so. 15. AssiMent. Neither Party shall assign or transfer its interest in this Agreement or any part thereof without the written consent of the other Party. 16. Exclusivity and_Amendment, This Agreement represents the complete and exclusive statement between the City and Consultant, 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 Consultant. The parties agree that any terms or conditions of any purchase order or other instnuxrent that are inconsistent with,or in addition to,the terms and conditions hereof, shall not bind or obligate Consultant 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. 17. Waiver of Breach. No waiver of breach,failure of any condition,or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach,failure, right or remedy.No waiver of any breach,failure or right,or remedy shall be deemed a waiver of any other breach,failure,right or remedy,whether or not similar,nor shall any waiver constitute a continuing waiver unless the writing so spe6fles. 18. Notice. Whenever it shall be necessary for either Party to serve notice on the other respecting this Agreement,such notice shall be served by personal delivery or by certified mail addressed at the following address, unless and until different addresses may be furnished in writing by either Party to the other and such notice shall be deemed to have been served within seventy-two (72)hours after the same has been deposited in a United States Post Office by certified snail or has been delivered personally, and shall be valid and sufficient sei vice of notice for all purposes: Page 6 of 9 i i i i i , i i If to City: City Clerk i City of Santa Ana 20 Civic Center Plaza(M-30) P,O,Box 1988 Santa Ana,CA 92702-1988 Fax 714-647-6956 With courtesy copies to: Execrative Director—Human Resources Agency City of Santa Aria 20 Civic Center Plaza(M-24) P.O, Box 1988 Santa Ana,California 92702 Fax 714- 647-6930 and City Attorney City of Santa.Ana 20 Civic Center Plaza(M-29) P.O.Box 1988 Santa Ana, California 92702 Fax 714-647-6515 If to Consultant: Adminsure Attention, Alithia Vargas-Flores 3380 Shelby Street Ontario,CA 91764 19, Ooverning Law and Venue, This Agreement shall be construed and enforced pursuant to 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. 20, professional L ocuses. Consultant 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. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits,licenses, approvals, waivers,and exemptions. S aid inability shall be cause for termination of this Agreement. 21. Attorne sue. Each Party shall also bear its own attorneys' fees and all casts related to the preparation of this Agreement. In the event any Party to this Agreement brings suit to enforce any provision of this Agreement,or is required to defend an action relating to any provision of this Agreement, Page 7 of 9 I the non-prevailing Party agrees to pay the prevailing Party such court costs and attorneys'fees as the court deems just. 22. Advice of Counsel. Each of the Parties acknowledges that it has received or has had the opportunity to receive independent legal advice from an attorney with respect to the advisability of making this Agreement and with respect to the advisability of executing this Agreement. 23. No Reliance on Outside Parties. Each of the Parties acknowledges that it has not relied upon any statement or representation by any other Party or any representative of any other Party,in making or executing this Agreement, except as expressly stated herein. 24. Authority. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully,including reasonable costs and attorney's fees,for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 25. Counteiparts. This Agreement may be signed in counterparts and compiled into one agreement to make an original. 26. Amendment. This Agreement cannot be amended or modified except by an instrument in writing signed by both Parties. 27. Interpretation. Should it be necessary for a court to interpret this Agreement, the Parties agree that it has been prepared by a joint effort of all Parties. Accordingly, only the fair meaning of the words shall be used in any interpretation hereof. 28. Severability. The provisions of this Agreement are severable and if one or more provisions or subcomponents should be determined to be unconstitutional, illegal or judicially unenforceable, in whole or in part, then, unless such unenforceability would make it impossible to effectuate the original intent of the Parties, the remaining provisions or subcomponents hereof shall remain binding and enforceable. 29. Expression of Entire Agreement. This Agreement constitutes a single, integrated written contract, and as such, expresses the entire Agreement of the Parties with respect to the matters contained herein and supersedes all prior negotiations, discussions, correspondence and other cornmunications regarding the terms and conditions hereof. IN WITNESS WHEREOF,the City, and Consultant hereto have executed this Agreement on the date Crst above written. CONSULTANT Adminsure, Inc. [Signatures continue on the next page] By: Alithia Varg Flores Its: President Page 8 of 9 ATTEST: CITY OF SANTA AN II ' Giles 1 R� ennifer al Alvaro Nunez City Cl City Manager APPROVED AS TO FORM: SONIA R. CARVALHO RECOMMENDED FOR APPROVAL: City Attorney By:a autA. X. m Laura A. Rossini Lori Sehnaider Chief Assistant City Attorney Executive Director of Human Resources Page 9 of 9 I I Exhibit A Scope of Sakes l r l� 1 I Scoue of Services Third Party Administration of � Workers' Compensation Claims Program CLAIMS,ADMINISTRATION The Consultant shall comply with all performance standards of the City's liability pool and any excess insurers. The Consultant shall also have the authority and responsibility to provide claims administration services,which include: - A. Establishing an electronic claim file and computer database record upon receipt of an injury report. B. Setting and updating reserves. C. Initiating and maintaining contact with injured workers or their attorneys. D. Arranging for investigation;. E. Determining cornpensability. F. Preparing and issuing benefit notices,if applicable. G. Arranging for medical treatment and medical services from clinics, facilities, phannacies,hospitals, specialists, and other vendors as necessary. H. Performing all utilization review services through Medkeview, communicating decisions to approve,modify,delay or deny medical treatment in accordance with State law. I. Monitoring disability status by reviewing medical reports and contacting doctors for updates. J. Auditing and reviewing all medical bills through MedReview and paying all properly adjusted medical bills in a thnely and accurate manner. K. Paying mileage or medical reimbursements to injured workers. L, Paying temporary disability compensation when appropriate to do so or advising the City of the need to adjust payroll records when salary continuation is applicable, M. Arranging medical exams in conformance with State law to determine whether an injured worker's medical condition is permanent and stationary (reached Maximum Medical ImprovementlMMI) and what,if any,permanent disability exists. N. Paying the permanent disability compensation in accordance with the law. Q. Arranging for attorney representation of the City whenever the need arises subject to final approval of the City. P. Monitoring attorneys and assisting them in preparing cases. Q. Auditing and paying legal expenses subject to authorization of payment by the City. R. Arranging for vocational rehabilitation services when appropriate, monitoring vocational rehabilitation consultants and assisting them as necessary. S. Auditing and paying vocational rehabilitation expenses. T. Attending all hearings that are required by law or where requested by the City. U. Preparing and issuing Vocational Rehabilitation/Supplemental Job Displacement Benefits(SJD]3)notices. i V. Preparing and issuing the permanent disability compensation.notices, 3 1 i 1 W. Comply with all legal requirements including but not limited to,the California Labor Code. X. Pursuing subrogation when there is a viable third party subject to authorization by the s City. Y. Notifying the City, the City's liability pool when required by the Memorandum of Coverage and excess insurers when applicable of all claims which exceed or may exceed the self-insurance retention;maintaining a liaison among the City,the liability pool, and their excess insurers on matters affecting the handling of such claims and arranging for reimbursement to the City of losses in excess of its self-insurance retention. Z. Obtaining settlement authority from the City and negotiating settlement on appropriate claims. AA, Closing claim files when appropriate to do so. BB. Participating when necessary in the interactive process or other medical legal assessments which may affect open claims. CC. Participating fully in any audit performed by the City or by a third party of the City. DD. Providing Medicare required reporting. EE. Providing requested information to the City within twenty-four(24)hours and on the same day when involving critical issues. OBLIGATIONS OF THE CITY The City shall: A. Submit all reports of work injury to the Consultant in a timely manner not to exceed two business days of the City's knowledge of the injury. B. Respond to the Consultant's requests for information and authority within five days of such requests. C. Provide information that is accurate and is in a form specified by the Consultant. D. Grant settlement authority, where the City deems it appropriate to do so, to the Consultant in advance of WCAB,Rehabilitation,and legal hearings,or be available by phone or in person during same. C»IECHING ACCOUN The City and the Consultant agree that: A. The City shall establish and maintain a checking account from which all Workers' Compensation benefits and expenses are to be paid. B. The Consultant shall prepare checks and issue those cheeks directly to payees without delay. C. The Consultant shall sign checks with a facsimile signature or manually. D. The Consultant shall secure checks:in a looked area accessible to a limited number of personnel. R The Consultant shall keep an accurate statement of all payments made from the account and will provide information on payments inad-c from the account when requested by the City. F. The City shall maintain an adequate balance in their checking account to meet all Workers'Compensation obligations without delay. i i i r G. The checking account may be used to pay penalties in which case the Consultant shall reimburse the City within fifteen (15) working days for any amount of the penalty which the Consultant caused, ELECTRONIC DATA PROCESSING A, The Consultant shall provide the City with electronic data processing services that will allow for the production of loss experience and transaction reports within ten (10) days following the close of each calondar month, B. Notify the City immediately of any unauthorized breach of City's information contained in Consultant's electronic data system and/or computer system REGULATORY REPORTING The Consultant shall prepare all reports required by State and Federal regulatory agencies(if any) in connection with the Program, including the Self-Insurer's Annual Report required by the Department of Self-Insurance Plans. RECORDS The Consultant shall establish and maintain electronic claim files, claim logs, transaction documents and all other records associated with the Program, These records shall be the property of the City. Unless this Agreement is cancelled, closed hard files, if any, shall be stored by the Consultant for five (5) years and shall thereafter become the responsibility of the City. Upon cancellation of this Agreement,the City shall be responsible for maintaining and storing all data, records, et cotera. The Consultant shall not dispose of or destroy hard files without the prior, written authorization of the City. The City shall allow the Consultant to perform all Bill Review Services through Medlteview. )gill review fees are at,$9.00 per bill. Preferred Provider Organization fees shall not exceed 25% of savings when applicable. The City shall allow the Consultant to perform all Utilization Review Services through MedReview. Utilization review fees are incorporated into medical bill review invoices at the rate of 7% of billed charges. The naaximzun utilization review fee charged per medical bill is capped at $750,00.Utilization review by a physician is billed separately in 10-minute increments, at the rate of$200.00 per hour. ALLOCATED EXPENSES The City shall pay for field investigation, defense attorneys, legal casts, remote photocopy, engineering experts, accident reconstruction experts, process servers, messenger service, court reporters, vocational rehabilitation consultants, structured settlement consultants,translators, and any other vendor necessary to administer claim files. Payment of expenses in excess of$150,000 require prior approval of the City before those expenses are paid, PENALTIES The Consultant shall be responsible for paying or appealing penalties that are caused by the Consultant. The Consultant shall not be responsible for penalties that are caused by the City or E 3 E any third parties. The Consultant will advise City in writing immediately of any penalties that are levied against the City for any reason and prior to paying such penalties. i i i i Exhibit E Insurance Requirements i i i Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require any subcontractors to obtain and maintain insurance as described below f'or 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 to City.Total cost of such insurance shall be borne by Consultant. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability(CCL): Insurance Services Office Form CO 00 01 covering COL on an"occurrence"basis, including products and completed operations, property damage,bodily injury and personal&advertising injury with limits no less than $2,000,000 per occurrence and$4,000,000 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 combined single limits. In the event Consultant 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 Consultant has no employees and signs request to waive such insurance. 4. Professional Liability(PL)/E+rrors and Omissions(E&O):with limits no less than $2,000,000 per occurrence or claim,and$4,000,000 aggregate. S. Cyber Liability(CL): Insurance,with limits not less than.$2,000,000 per occurrence or claim and$2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Consultant in this agreement and shall include, but not be limited to,claims involving security breach,system failure, data recovery, business interruption,cyber extortion,social engineering,infringement of intellectual property,including but not limited to infringement of copyright,trademark,trade dress, invasion of privacy violations,information theft, and release of private information.The policy shall provide coverage for breach response costs,regulatory fines and penalties as well as credit monitoring expenses. G. Technology Professional Liability-Errors and Omissions Insurance(E&O): appropriate to the Consultant's profession and work hereunder,with limits not less than $2,000,000 per occurrence and$2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by the Consultant in this agreement and shall include,but not be limited to, claims involving business interruption, i i I i I I 1 i i i damage to or destruction of electronic information, and alteration of electronic information.The policy shall provide coverage for Consultant's failure to provide professional services and/or products tinder this Agreement. The Policy shall include, or be endorsed to include,damage to, alteration of,loss of, or destruction of electronic data and/or information"properly"of Customer in the care, custody, or control of Consultant. If Consultant 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 Consultant.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,its City Council,its officers,officials,employees, agents, and volunteers are to be covered as additional insureds,under Consultant's COL and AL policies,with respect to any liability arising out of world or operations performed by or on behalf of the Consultant including materials,parrs,equipment, and personnel furnished i:n connection with such work or operations. 2. Consultant'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 Consultant's CGL,AL,and WC policies which arise from world performed by Consultant under this Agreement. 3. For any claims related to this contract,Consultant'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 Consultant'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. S. Insurance policies required hercin 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 wztitten notice shall be provided to City for policy cancellation or non-renewal duo to non-payment of premium. G. Certificate bolder on each Evidence of Insurance certificate shall be; City of Santa.Ana, Attention: (Luisa Mendoza,Acting Risk Manager), City of Santa Ana,Human Resources Agency, 20 Civic Center Plaza,P.O.Box 1988,M-24, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Self-insured Retentions Self-insured retentions must be declared to and approved by the City.The City may require the Consultant to purchase coverage with a lower retention or provide proof of ability to pay lasses and related investigations, claim administration,and defense expenses within the retention, 1 i i I i i 1 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 IT,unless otherwise acceptable to City. Verification of Coverage Consultant 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 CGf,policy listing all policy endorsements before work begins.However, failure to obtain the required documents prior to the work beginning shall not waive Consultant'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 Risks or CircurnstAnces 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, i Ilii I I I I I 712/18/2025 E(MM/DD/YYYY) ACOR" 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: Digital Insurance LLC-Clayton, MO PHONE FAX 8235 Forsyth Blvd#1200 A/C No Ext: 314-746-4700 A/C,No:314-889-3700 Clayton MO 63105 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# License#:8012081 INSURERA: National Fire Ins Co Of Hartford 20478 INSURED ADMIINC-01 INSURERB: Continental Insurance Company 35289 AdminSure, Inc. 3380 Shelby St INsuRERc: Hartford Fire Ins Co 19682 Ontario CA 91764 INSURERD: Evanston Ins Co 35378 INSURERE: QBE Specialty 11515 INSURER F: COVERAGES CERTIFICATE NUMBER:1092020042 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y 7036373730 1/1/2026 1/1/2027 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $100,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY� PRO- � LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 7036373744 1/1/2026 1/1/2027 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED FIR ERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB X OCCUR 7036373761 1/1/2026 1/1/2027 EACH OCCURRENCE $6,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $6,000,000 DED X RETENTION$1 n nnn $ C WORKERS COMPENSATION Y 84WEBC3WUM 1/1/2026 1/1/2027 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTEI ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Professional Liability MKLV7PE0004322 1/1/2026 1/1/2027 Each Claim/Agg 5,000,000 E Cyber Liability CELP001940274826300 1/1/2026 1/1/2027 Each Claim/Agg 4,000,000 Digitally signed DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Nguyen Crime Liability Insurer: Atlantic Specialty Insurance Company Nguyen Date:2025.12.24 Policy No: MML0092160126 08:44:40-08'00' Effective Dates: 1/1/2026-1/1/2027 Per Occurrence Limit: $2,000,000 City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are named additional insured as respects General Liability and Automobile Liability.Waiver of Subrogation is applicable as respects General Liability,Auto Liability,and Workers Compensation. APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 8:43 am,Dec 24,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Human Resources Dept 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CNA Business Auto Policy Policy Endorsement COVERAGEI EXTENDED FOR HIRED AND NON-OWNEDAUTOS It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. TABLE OF CONTENTS I. AMENDMENTS TO LIABILITY COVERAGE A. Who Is An Insured 1. Majority Owned Corporations 2. Newly Acquired Organizations 3. Additional Insureds Required By Written Contracts 4. Employee-Hired Autos B. Increased Loss of Earnings Allowance C. Fellow Employee Coverage II. AMENDMENTS TO PHYSICAL DAMAGE COVERAGE A. Increased Loss of Use Expense B. Broadened Electronic Equipment Coverage III. AMENDMENTS TO BUSINESS AUTO CONDITIONS A. Knowledge of Accident or Loss B. Knowledge of Documents C. Waiver of Subrogation D. Unintentional Failure To Disclose Hazards E. Primary and Non-Contributory When Required By Contract IV. AMENDMENTS TO DEFINITIONS A. Broadened Bodily Injury I. AMENDMENTS TO LIABILITY COVERAGE A. Amendments to Who Is An Insured Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Who Is An Insured is amended to add the following: 1. Majority Owned Corporations Any incorporated entity in which you own a majority of the voting stock on the inception date of this Coverage Form is an insured, but only if such entity is not an insured under any other liability "policy" that provides auto coverage. 2. Newly Acquired Organizations Form No: CNA83700XX (10-2015) Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 11; Page: 1 of 4 Policy Page: 50 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright CNA All Rights Reserved. CNA Business Auto Policy Policy Endorsement Any organization you newly acquire or form during the policy period, other than a limited liability company, partnership or joint venture, and in which you maintain majority ownership interest is an insured, but only if such organization is not an insured under any other liability "policy" that provides auto coverage. The insurance afforded by this provision: a. Is effective on the date of acquisition or formation of the organization, and applies until: (1) The end of the policy period of this Coverage Form; or (2) The next anniversary of this Coverage Form's inception date, whichever is earlier; and b. Does not apply to bodily injury or property damage caused by an accident that occurred before you acquired or formed the organization. 3. Additional Insureds Required By Written Contract Any person or organization that you are required by written contract to make an additional insured under this insurance is an insured, but only with respect to that person or organization's legal liability for acts or omissions of a person who qualifies as an insured for Liability Coverage under SECTION II - WHO IS AN INSURED of this Coverage Form. 4. Employee-Hired Autos Any employee of yours is an insured while operating with your permission an auto hired or rented under a contract in that employee's name, while performing duties related to the conduct of your business. With respect to provisions A.1. and A.2. above, "policy" includes those policies that were in force on the inception date of this Coverage Form, but: i. Which are no longer in force; or ii. Whose limits have been exhausted. B. Increased Loss of Earnings Allowance Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Coverage Extensions is amended under Supplementary Payment subparagraph (4) to delete the $250. a day limit for loss of earnings and replace it with a $500. a day limit. C. Fellow Employee Coverage Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Exclusions is amended to delete the exclusion entitled Fellow Employee. II. AMENDMENTS TO PHYSICAL DAMAGE COVERAGE A. Increased Loss of Use Expense Under SECTION III — PHYSICAL DAMAGE COVERAGE, the paragraph entitled Coverage Extensions is amended under Loss of Use Expenses to delete the maximum of $600., and replace it with a maximum of $800. B. Broadened Electronic Equipment Coverage Under SECTION III — PHYSICAL DAMAGE COVERAGE, the paragraph entitled Exclusions is amended to delete paragraphs 5.a through 5.d. in their entirety, and replace them with the following: 5. Exclusions 4.c. and 4.d. above do not apply to loss to any electronic equipment that at the time of loss is: Form No: CNA83700XX (10-2015) Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 11; Page: 2 of 4 Policy Page: 51 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright CNA All Rights Reserved. CNA Business Auto Policy Policy Endorsement a. Permanently installed in or upon a covered auto, nor to such equipment's antennas or other accessories used with such equipment. A $100 deductible applies to this provision, and supersedes any otherwise applicable deductible; or b. Designed to be operated solely by use of the power from the auto's electrical system and is: (1) Removable from a housing unit which is permanently installed in or upon the covered auto; (2) An integral part of the same unit housing any electronic equipment described in paragraphs a. or b.(1) above; or (3) Necessary for the normal operation of the covered auto or the monitoring of the covered auto's operating system. III. AMENDMENTS TO BUSINESS AUTO CONDITIONS A. Knowledge of Accident or Loss Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Duties In the Event of Accident, Claims, Suit, or Loss is amended to add the following subparagraph a.(4): (4) If your employees know of an accident or loss, this will not mean that you have such knowledge until such accident or loss is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the above to be your insurance manager. B. Knowledge of Documents Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Duties In the Event of Accident, Claims, Suit, or Loss is amended to add the following subparagraph b.(6): (6) If your employees know of documents concerning a claim or suit, this will not mean that you have such knowledge until such documents are known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the above to be your insurance manager. C. Waiver of Subrogation Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an accident or loss. D. Unintentional Failure To Disclose Hazards Under BUSINESS AUTO CONDITIONS, the General Condition entitled Concealment, Misrepresentation or Fraud is amended to add the following: Your failure to disclose all hazards existing on the inception date of this Coverage Form shall not prejudice you with respect to the coverage provided by this insurance, provided such failure or omission is not intentional. E. Primary and Non-Contributory When Required By Contract Under BUSINESS AUTO CONDITIONS, the General Condition entitled Other Insurance is amended to add the following: Form No: CNA83700XX (10-2015) Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 11; Page: 3 of 4 Policy Page: 52 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright CNA All Rights Reserved. CNA Business Auto Policy Policy Endorsement Notwithstanding provisions 5.a. through 5.d. above, the coverage provided by this Coverage Form shall be on a primary and non-contributory basis when required to be so by a written contract entered into prior to accident or loss. IV. AMENDMENTS TO DEFINITIONS A. Broadened Bodily Injury Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, mental anguish or mental injury sustained by that person which results as a consequence of the physical injury, sickness or disease. 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. Form No: CNA83700XX (10-2015) Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 11; Page: 4 of 4 Policy Page: 53 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright CNA All Rights Reserved. CNA Business Auto Policy Policy Endorsement LESSOR - ADDITIONAL INSURED AND LOSS PAYEE 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: ADMINSURE, INC. Endorsement Effective Date: 01/01/2026 SCHEDULE Insurance Company: National Fire Insurance Company of Hartford Policy Number: 7036373744 Effective Date: 01/01/2026 Expiration Date: 01/01/2027 Named Insured: ADMINSURE, INC. Address: 3380 SHELBY ST ONTARIO, CA 91764-5566 Additional Insured (Lessor): Address: Designation Or Description Of "Leased Autos": Coverages Limit Of Insurance Or Deductible Liability $1,000,000 Each"Accident" Comprehensive Deductible For Each Covered "Leased Auto" Collision Deductible For Each Covered "Leased Auto" Specified Causes Of Loss Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Form No: CA 20 01 11 20 Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 3; Page: 1 of 2 Policy Page: 40 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright Insurance Services Office, Inc., 2019 CMA Business Auto Policy Policy Endorsement A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the Policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the Policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. Form No: CA 20 01 11 20 Policy No: BUA 7036373744 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 01/01/2026 Endorsement No: 3; Page: 2 of 2 Policy Page: 41 of 62 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 ©Copyright Insurance Services Office, Inc., 2019 CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through K. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part; and (2) was executed prior to: (a) the bodily injury or property damage; or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A.through K. below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability for bodily injury, property damage or personal and advertising injury as co-owner of such premises. C. Grantor of Franchise Any person or organization that has granted a franchise to a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury as grantor of a franchise to the Named Insured. D. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. CNA75102XX(1-15) Policy No: 7036373730 Page 2 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement E. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. F. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. G. Mortgagee,Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership, maintenance, or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. H. State or Governmental Agency or Subdivision or Political Subdivisions—Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which N N this insurance applies: 0 a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk 0 vaults, street banners, or decorations and similar exposures; or N b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. Bodily injury or property damage included within the products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. CNA75102XX(1-15) Policy No: 7036373730 Page 3 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement I. Trade Show Event Lessor 1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury caused by: a. the Named Insured's acts or omissions; or b. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. J. Vendor Any person or organization but only with respect to such person or organization's liability for bodily injury or property damage arising out of your products which are distributed or sold in the regular course of such person or organization's business, provided that: 1. The coverage granted by this paragraph does not apply to: a. bodily injury or property damage for which such person or organization is obligated to pay damages by reason of the assumption of liability in a contract or agreement unless such liability exists in the absence of the contract or agreement; b. any express warranty unauthorized by the Named Insured; c. any physical or chemical change in any product made intentionally by such person or organization; d. repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. any failure to make any inspections, adjustments, tests or servicing that such person or organization has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. demonstration, installation, servicing or repair operations, except such operations performed at such person or organization's premises in connection with the sale of a product; g. products which, after distribution or sale by the Named Insured, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for such person or organization; or h. bodily injury or property damage arising out of the sole negligence of such person or organization for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) the exceptions contained in Subparagraphs d.or f.above; or (2) such inspections, adjustments, tests or servicing as such person or organization has agreed with the Named Insured to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. CNA75102XX(1-15) Policy No: 7036373730 Page 4 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement 2. This Paragraph J. does not apply to any insured person or organization, from whom the Named Insured has acquired such products, nor to any ingredient, part or container, entering into, accompanying or containing such products. 3. This Paragraph J.also does not apply: a. to any vendor specifically scheduled as an additional insured by endorsement to this Coverage Part; b. to any of your products for which coverage is excluded by endorsement to this Coverage Part; nor c. if bodily injury or property damage included within the products-completed operations hazard is excluded by endorsement to this Coverage Part. K. Other Person Or Organization Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such additional insured is an Insured solely for bodily injury, property damage or personal and advertising injury for which such additional insured is liable because of the Named Insured's acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: 1. for bodily injury, property damage, or personal and advertising injury arising out of the rendering or failure to render any professional service; 2. for bodily injury or property damage included within the products-completed operations hazard; nor 3. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part. 2. ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own insurance means insurance on which the additional insured is a named insured. N W B. With respect to persons or organizations that qualify as additional insureds pursuant to paragraph 1.K. of this endorsement, the following sentence is added to the paragraph above: Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to N such person or organization is excess of any other insurance available to such person or organization. 0 0 T 3. BODILY INJURY—EXPANDED DEFINITION Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a CNA75102XX(1-15) Policy No: 7036373730 Page 5 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement C. Solely for the purpose of the coverage provided by this paragraph, the following changes are made to the Section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee; 2. The first unnumbered paragraph beneath Paragraph 21(2)(b)is deleted and replaced by the following: So long as the above conditions are met, attorneys fees incurred by the Insurer in the defense of that indemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the Insurer's request will be paid as defense costs. Notwithstanding the provisions of Paragraph e.(2)of the Contractual Liability exclusion (as amended by this Endorsement), such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance. D. This PERSONAL AND ADVERTISING INJURY-LIMITED CONTRACTUAL LIABILITY Provision does not apply if Coverage B—Personal and Advertising Injury Liability is excluded by another endorsement attached to this Coverage Part. 17. PROPERTY DAMAGE—ELEVATORS A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators. B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the Other Insurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators. 18. SUPPLEMENTARY PAYMENTS N The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: 0 A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000. 0 limit; and N B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit. 19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. 20. WAIVER OF SUBROGATION-BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products-completed operations hazard. CNA75102XX(1-15) Policy No: 7036373730 Page 13 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 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. CNA75102XX(1-15) Policy No: 7036373730 Page 14 of 14 Endorsement No: 6 Nat 'l Fire Ins Co of Hartford Effective Date: 01/01/2026 Insured Name:ADMINSURE, INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 84 WE BC3WUM Endorsement Number: Effective Date: 01/01/26 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: ADMINSURE, INC. 3380 SHELBY ST ONTARIO CA 91764 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 shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization for whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date: 10/16/25 Policy Expiration Date: 01/01/27 . sss THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 84 WE BC3WUM Endorsement Number: Effective Date: 01/01/26 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: ADMINSURE, INC. 3380 SHELBY ST ONTARIO CA 91764 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 %of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us ��►YIC � Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 10/16/25 Policy Expiration Date: 01/01/27 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 84 WE BC3WUM Endorsement Number: Effective Date: 01/01/26 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: ADMINSURE, INC. 3380 SHELBY ST ONTARIO CA 91764 This endorsement applies only to the insurance provided respect to bodily injury arising out of the operations by the policy because Texas is shown in Item 3.A. of the described in the Schedule where you are required by a Information Page. written contract to obtain this waiver from us. We have the right to recover our payments from anyone This endorsement shall not operate directly or indirectly liable for an injury covered by this policy. We will not to benefit anyone not named in the Schedule. enforce our right against the person or organization The premium for this endorsement is shown in the named in the Schedule, but this waiver applies only with Schedule. Schedule 1. ( ) Special 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: Form WC 42 03 04 B Printed in U.S.A. Process Date: 10/16/25 Policy Expiration Date: 01/01/27