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Home My Public Portal AboutC-17-039 - Principal Life Amendment No. 1, Self Insured Dental PlanV AMENDMENT NO. I TO AGREEMENT FOR ADMINISTRATIVE SERVICES THIS AMENDMENT TO THE AGREEMENT FOR ADMINISTRATIVE SERVICES ("Amendment") by and between the CITY OF CARSON, a California municipal l corporation ("City") and Principal Life Insurance Company, an Iowa Corporation ("Principal"), whose principal place of business is 711 High Street, Des Moines, Iowa 50392, is effective as of the 151 day of November, 2018. RECITALS A. City and Principal entered into that certain Agreement for Administrative Services dated November 1, 2017 ("Agreement"), whereby Principal agreed to provide certain non - discretionary claims and administrative functions and services on behalf of City as Plan Administrator for City's employee welfare benefit plan, subject to the federal Employee Retirement Income Security Act of 1974. B. The Agreement provided for an initial term of November 1, 2017 to November 1, 2018. and for renewal thereafter at City's sole option for up to three successive one-year terms. C. City and Principal now desire to amend the Agreement to extend the term of the Agreement until November 1, 2020, and to ratify and affirm through this Amendment the continuous and uninterrupted term of the Agreement commencing on November 1, 2017 and continuing until November I, 2020. TERMS I. Contract Changes. The Agreement is amended as provided herein (additions shown in bold italics, deletions shown in st-riket h). a. Subsection (a) of Section 17 (Term and Termination) of the Agreement is amended to read in its entirety as follows: "The initial term of this Agreement will begin on the Effective Date and continue until November 1, 2020 3-04. Thereafter, unless earlier terminated by either Party, this Agreement may be renewed at Employer's sole option for up to three successive one-year terms." 2. Continuing Effect of Agreement. Except as amended by this Amendment, all provisions of the Agreement shall remain unchanged and in frill force and effect. From and after the date of this Amendment, whenever the term "Agreement" appears in the Agreement, it shall mean the Agreement, as amended by this Amendment to the Agreement. 3. Affirmation of Agreement; Warranty Re Absence of Defaults. City and Principal each ratify and reaffirm each and every one of the respective rights and obligations arising under the Agreement. Each party represents and warrants to the other that there have been fl l no7. 00071558488, no written or oral modifications to the Agreement other than as provided herein. Each party represents and warrants to the other that the Agreement is currently an effective, valid, and binding obligation. Principal represents and warrants to City that. as of the date of this Amendment, City is not in default of any material term of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both. would constitute a material default under the Agreement. City represents and warrants to Principal that, as of the date of this Amendment, Principal is not in default of any material tarn of the Agreement and that there have been no events that, with the passing of time or the giving of notice, or both, would constitute a material default under the Agreement. 4. Adequate Consideration. The parties hereto irrevocably stipulate and agree that they have each received adequate and independent consideration for the performance of the obligations they have undertaken pursuant to this Amendment, 5. Authority. The persons executing this Amendment on behalf of the parties hereto -t warrant that (i) such party is duly organized and existing, (ii) they are duly authorized to execute and deliver this Amendment on behalf of said party, (iii) by so executing this Amendment, such party is formally bound to the provisions of this Amendment, and (iv) the entering into this Agreement does not violate any provision of any other agreement to which said party is bound. [SIGNATURES ON FOLLOWING PAGFIJ 01007 0004l5584 88 1 IN WITNESS dates set forth below, I, 2018. WHEREOF, the parties hereto have executed this Amendment on the with express intent that this Amendment shall be effective as of November -*Yp UNLTN(�%,- ATTE" Donesia Gause-Aldana, City Cler APP1b3*v=- AS TO FORM: WYNDER, LLP CITY: CITY OF _ ARSON,.acorporation Alyrt Robles, Mayor � Date: ci 1-7,2019 G L TORI LYNN ROHDE Oommltlnlnil Number 774679 Ni GOMMIWon Expires tit+nb., 05, 2021 PRINCIPAL: PRINCIPAL LIFE INSURANCE COMPANY, an Iowa Corporation By: Iw Name: KA1'p kohv c1tiSt;lti �+t'S Title: Vice. P,SiC44t— "Ct1't Date: 1:2, '2019 By:Q ave Name: 0,Q&A66LA Title: VP^Ult) v-- t- �ccnu- Date: 5942* k) --L"`" f 2019 Two corporate officer signatures required for Principal as a corporation, with one signature required from each of the following groups: 1) Chairman of the Board, President or any Vice Presiden(; and 2) Secretary, any Assistant Secretary, Chief Financial Officer or any Assistant 'Treasurer. PRINCIPAL'S SIGNA*rURES SHALL BE DULY NO'T'ARIZED, AND APPROPRIATE ATTESTATIONS SHALL BE INCLUDED AS MAY BE REQUIRED BY THE BYLAWS, .3. 01007.0004/558488.1 ARTICLES OF INCORPORATION, OR OTHER RULES OR REGULATIONS APPLICABLE TO PRINCIPAL AS A CORPORATION, 01007 00041558488 1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy or validity of that document. STATE OF CALIFORNIA COUNTY OF LOS ANGELES O�, 2019 before tne, d'�ofsonally appcarc Ir � rproved to me on the ba is of satisfactory evidence to be the •rson(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is trite and correct. WITNESS my hand and official seal. TORI LYNN ROHDE amrnissk.n►Dumber T/4679 Ow iaY Cc trnission Expires Signature: _^ Sep. Iber05,2021 OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. 01007.00041558488.1 CAPACITY CLAINIED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER TITLE(S) TITLE OR TYPE OF DOCUMENT ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) NUMBER OF PAGES ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING: DATE OF DOCUMENT (NAME OF PERSON(S) OR ENTITY(IES)) SIGNER(S) OTHER THAN NAMED ABOVE 01007.00041558488.1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the indivkNal who signed the document to which this certificate is attached, and not the truthfulness. accuracy or validity of that document. STATE OF CALIFORNIA COUNTY OF LOS ANGELES Otu{ 4�� 2019 before n ► �xt , giersonaily appeaA!� �p e tb me on the ba sof satisfactory evidence to be the person(s) whose names(s) Wabed to clic Av tin instrument and acknowledged to me that he+sher'they executed the same in his4teritheir authorized capacity(ies), and that by his?her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PE=NALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNES my hand and offic.al seal_ TORI LYNN ROHDE signature, g r Commission Number 774679g _ .. .` My Commission Expires uw► September 05, 2021 OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL. ❑ ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER SIGNER IS REPRESENTING. (NAME OF PERSON(S) OR ENTITY(IES)) 01007-0004-558488.1 DESCRIPTION OF ATTACHED DOCUa1IENT TITLE OR TYPE OF DOCUMENT NUMBER OF PAGES DATE OF DOCUMENT S) OTHER THAN NAMED A