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HomeMy Public PortalAboutC-17-039 - Principal Life Insurance Company, Inc. Amendment No. 2, Employee DentalAMENDMENTNO.2TOAGREEMENTFORADMIMSTRATIVESERWCETifiSAMENDMENTNO.2TOTHEAGREEMENTFORADIVIINISTRATWESERVICES(“Amendment”)byandbetweentheCITYOFCARSON,aC4liforniamunicipalcorporation(“City”)andPrincipalLifeInsuranceCompany,anIowaCorpo4tion(“Principal”),whoseprincipalplaceofbusinessis711HighStreet,DesMoines,Iowa5039f,iseffectiveasoftheoidayofNovember,2020.RECITALSA.CityandPrincipalenteredintothatcertainAgreementforAdministrativeServicesdatedNovember1,2017(“Agreement”),wherebyPrincipalagreedtoprvidecertainnon-discretionaryclaimsandadministrativefunctionsandservicesonbehal.ofCityasPlanAdministratorforCity’semployeewelfarebenefitplan,subjecttothefederalEmployeeRetirementIncomeSecurityActof1974.B.TheAgreementprovidedforaninitialtermofNovember1,20:17toNovember1,201$,andforrenewalthereafteratCity’ssoleoptionforuptothreesuccessivone-yearterms.C.EffectiveNovember1,201$,CityandPrincipalenteredintoMnendmentNo.1totheAgreementtoextendthetermoftheAgreementuntilNovember1,2020,whileretainingtheCity’sthreeone-yearoptionstoextendthetermbeyondsaiddate.D.BythisAmendment,andpursuanttoPrincipal’soffertotheityofa“ratepass”forservicesfortheperiodofNovember1,2020toNovember1,2021,Citydesirestoexercisethefirstofitsthreeone-yearoptions,therebyextendingthetermofthAgreementuntilNovember1,2021,withtwoone-yearoptionsremainingthereafter.Accordingly,CityandPrincipalacknowledgeandagreethattheexisting/originalfeeratespursuanttotheAgreementwillremainineffectuntiltheconclusionofthefirstoptionperiod(Novmber1,2021),atearliest.TERMS1.Recitals.Theforegoingrecitalsaretrueandcorrect,andare:ncorporatedhereinbyreference.2.ContractChanges.TheAgreementisamendedasprovidei1herein(additionsshowninbolditalics,deletionsshoWninstrikcthrough).a.Subsection(a)ofSection17(TermandTermination)otheAgreementisamendedtorçadinitsentiretyasfollows:“TheinitialtermofthisAgreementwillbeginontheEffetiveDateandcontinueuntilNovember1,20212O2.Thereafter,utilessearlierterminatedbyeitherParty,thisAgreementmayberenwed—1—O1007.0004165098&4 atEmployer’ssoleoptionforuptotwothieesuccessiveone-tearterms.”3.ContinuingEffectofAgreement.ExceptasamendedbythkAmendment,allprovisionsoftheAgreementshallremainunchangedandinfullforceandeff4ct.fromandafterthedateofthisAmendment,whenevertheterm“Agreement”appearsinthe4igreement,itshallmeantheAgreement,asamendedbythisAmendmenttotheAgreement.I4.AffirmationofAgreement;WarrantyReAbsenceofIefaults.CityandPrincipaleachratifyandreaffirmeachandeveryoneoftherespectiverigttsandobligationsarisingundertheAgreement.EachpartyrepresentsandwarrantstotheothertlattherehavebeennowrittenororalmodificationstotheAgreementotherthanasprovidedtierein.EachpartyrepresentsandwarrantstotheotherthattheAgreementiscurrentlyanef’ective,valid,andbindingobligation.PrincipalrepresentsandwarrantstoCitythat,asofthedateofthisAnendment,CityisnotindefaultofanymaterialtermoftheAgreementandthattherehavebennoeventsthat,withthepassingoftimeorthegivingofnotice,orboth,wouLdconstituteamaterialdefaultundertheAgreement.CityrepresentsandwarrantstoPrincipalthat,asofthedateofthisAmFndment,PrincipalisnotindefaultofanymaterialtermoftheAgreementandthattherehavebennoeventsthat,withthepassingoftimeorthegivingofnotice,orboth,wouldconstitute‘amaterialdefaultundertheAgreement.5.AdequateConsideration.ThepartiesheretoirrevocablystiplateandagreethattheyhaveeachreceivedadequateandindependentconsiderationfortheprformanceoftheobligationstheyhaveundertakenpursuanttothisAmendment.6.Authority.ThepersonsexecutingthisAmendmentonbehalfJfthepartiesheretowarrantthat(1)suchpartyisdulyorganizedandexisting,(ii)theyaredutyau$horizcdtoexecuteanddeliverthisAmendmentonbehalfofsaidparty,(iii)bysoexecutingthisjAmendment,suchpartyisformallyboundtotheprovisionsofthisAmendment,and(iv)thenteringintothisAgreementdoesnotviolateanyprovisionofanyotheragreementtowhichsaiipartyisbound.[SIGNATURESONFOLLOWINGPAGE]-2-01007.0004/650988.4 INWITNESSWHEREOF,thepartiesheretohaveexecutedthismendrnentonthedatefirstsetforthhereinabove.CITY:Cff2,7ujrporationAlRles,Maor—/-Y7SunnyK.SoltanI,CityAttorney[BRJIPRINCIPAL:PRINCIPALLIFEINSURANCCOMPANY,anIowaCorporationBy:____Name.KaraHoogensenTitle:SVPSpedaltyBenefitsBy:i716q—APPROVEDASTOFORM:ALESHIRE&WYNDER,,LLPName:GinaNoaTitle:AVP-GroupUnderw7iblTwocorporateofficersignaturesrequiredforPrincipalasacorporation,withonesignaturerefollowinggroups:I)ChairmanoftheBoard,PresidentoranyVicePresidentand2)Secretary,ChiefFinancialOfficeroranyAssistantTreasurer.PRINCIPAL’SSIGNATURESSHALLB]ANDAPPROPRIATEAI[ESTATIONSSHALLBEINCLUDEDASMAYBEREQUIREARTICLESOFINCORPOR411ON,OROTHERRULESORREGULATIONSAPPLICABLECORPORATION.niredfromeachofthenyAssistantSecretary,DULYNOTARIZED,BYTHEBYLAWS,TOPRINCIPALASA01007.0004/650918.43- CALIFORNIAALL-PURPOSEACKNOWLEDGMENI’Anotarypublicorotherofficercompletingthiscertificateverifiesonlytheidentityoftheifdividualwhosignedthedocumenttowhichthiscertiftcateisattached,andnotthetruthfulness,accuracyorvalidityofthatdocument.STATEOFbIfORNh40r,COUNTYOF+OSkN6EbES‘,\‘4,Onpc4,2020beforeme,Tcv.Y\.1J4,s,personallyappearedprovedtomeonthebasofsatisfactoryevidencetobetheperson(s)whosenames(s)is/aresubscribedtothevithininstrumentandacknowledgedtomethathe/she/theyexecutedthesameinhis/her/theirauthorizedcapaity(ies),andthatbyhis/her/theirsignature(s)ontheinstrumenttheperson(s),ortheentityuponbehalfofwhichtheperson(s)acted,executedtheinstrument.IcertiIyunderPENALTYOFPERJURYunderthelawsoftheStateofa1ifoiiethattheregoingparagraphistrueandcorrect.WITNESSmyhandandofficialseal.Signature:-.r----lThOPTIONALIJEANM.KSSfIV.CommissionNumbr1605961.MyCommissionxpiresI[°Mayl6,2021CAPACITYCLAIMEDBYSIGNERDINDIVIDUALEiCORPORATEOFFICERTITLE(S)0PARTNER(S)0c0ATTORNEY-IN-FACTflTRUSTEE(S)OGUARDIAN/CONSERVATORQOTHER________________SIGNERISREPRESENTING:(NAMEOFPERSON(S)ORENTITY(IES))Thoughthedatabelowisnotrequiredbylaw,itmayprovevaluabletopersonsrelyingonthpreventfraudulentreattachmentofthisform.documentandcouldDESCRIPTIONOFATTACHEDDOCUMENTLIMITEDGENERALTITLEORTYPEOfD)CUMENTNUMBEROFPAGESDATEOFDOCUIENTSIGNER(SOTHERTHANAMEDABOVE01007.00041650988.4 CALIFORNIAALL-PURPOSEACKNOWLEDGMENTAnotarypublicorotherofficercompletingthiscertificateverifiesonlytheidentityoftheindividualwhosignedthedocumenttowhichthiscertificateisattached,andnotthetruthfulness,accuracyorvatiditofthatdocument.STATEOfe*bWGRNFACOUNTYOFt-e&On2020beforepersonallyappeared,provedtomeonthebasisofsatisfactoryevidencetobetheperson(s)whosenames(s)is/aresubscribedtothj%vithininstrumentandacknowledgedtomethathe/she/theyexecutedthesameinhis/her/theirauthorizedcapabity(ies),andthatbyhis/her/theirsignature(s)ontheinstrumentthepersonfs)ortheentityuponbehalfofwhicitheperson(s)acted,executedtheinstrument.IcertiI’underPENALTYOFPERJURYunderthelawsoftheStateof€aN1rn1athattheloregoingparagraphistrueandcorrect.WITNESSmyhandandofficialseal.Signature:.‘i1.3xc7.9.Co059OPTIONALThoughthedatabelowisnotrequiredbylaw,itmayprovevaluabletopersonsrelyingonthpdocumentandcouldpreventfraudulentreattachmentofthisform.CAPACITYCLAIMEDBYSIGNERDESCRIPTIONOFATTACIkEDDOCUMENTQINDIVIDUALQCORPORATEOFFICERTITLE(S)TITLEORTYPEOFDOCUMENTPARTNER(S)flLTMIThDIQGENERALQATTORNEY-IN-FACTflTRUSTEE(S)NUMBEROfPAGESQGUARDIAN/CONSERVATOROTHER_____________________SIGNERISREPRESENTING:DATEOfDOCUIc1ENT(NAMEOFPERSON(S)ORENTITY(IES))SIGNER(S)OTHERTHANI11AIMEDABOVE01007.0004/650988,4 ACRDCERTIFICATEOFLIABILITYINSURANCETHISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferriohtstothecertificateholderinlieuofsuchendorsement(s).PRODUCERLocktonCompanies—CONTACT-3280PeachtreeRoadNE,Suite#250NOE(NC,No):AtlantaGA3030E-MAIL(404)460-3600ADDRESS:INSURER(S)AFFORDINGCOVERAGENAIC#INSURERA:AIGSpecialInsuranceCompany26883INSURED1407923Principal[‘inancialGrocip,Inc.INSURERB.711HighStreetINSURERC:DesMoinesIA50392E1SURERD:-——-—_________INSURERE:INSURERF:COVERAGESCERTIFICATENUMBER:16283244REVISIONNUMBER:XXXXXXXTHISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENT(MTHRESPECTTOWHICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS.--COMMERCIALGENERALLIABILITYNOTAPPLICABLEEACHOCCURRENCE$_XXXXXXX1DAMAGETORENTEDCLAIMSMADEOCCURPREMaSSCccL$XXXXXXXMEDEXP(Anyoneperson)$XXXXXXXPERSONAL&ADVINJURY$XXXXXXXGEN’LAGGREGATELIMITAPPLIESPER.GENERALAGGREGATE$XXXXXXXPOLICYLOCPRODUCTS-COMP/OPAGGsXXXXXXXOTHER$AUTOMOBILELIABILITY——NOTAPPLICABLELIMITANYAUTOBODILYINJURY(Perperson)$AUTOSONLYSCHEDULEDBODILYINJURY(Peraccidenl)$HIREDNON-OWNEDPROPERTYDAMAGE$AUTOSONLYAUTOSONLYCPeracbdent)sXXXXXXXUMBRELLALIABL_JOCCURNOt’APPLICABLEEACHOCCURRENCE$XXXXXXXEXCESSLIABL_iCLAIMS-MADEAGGREGATE$XXXXXXXDEDflRETENTIONs$XXXXXXXANDOIRSLIABILITYYIN——NOTAPPLICABLEJ-uI-.ANYPROPRIETOR/PARTNER/EXECUTIVEEL.EACHACCIDENT$XXXXXXXOFFICER/MEMBEREXCLUDED’?N/A-(MandatoryinNH)E.LDISEASE-BAEMPLOYEE$XXXXXXXIfyes,describeunder————-.---.-—--.—————-—.-..———DESCRIPTIONOFOPERATIONSbelow——EL.DISEASE-POLICYLIMIT$XXXXXXXANetworkSecLlrity/Cyber.1NN03-984-50-801/20/20201/20/2021Limit.$10,000,000PolicyRetention$1,000,000DESCRIPTIONOFOPERATIONS/LOCATIONSIVEHICLESIACORD101,AdditionalRemarksSchedule,maybeattachedifmorespaceisrequIred)TiltsCERTIFICATESUPERSEDESALLPREVIOUSLYISSUEDCI/RTIFIC’AitSFORmISHOLDER,APPLICABLETOTHECARRIERSLISTEDANDTHEPOLICYtERM(S)REFERENCEDSeeAttachedforExcessLayers.CERTIFICATEHOLDERCANCELLATIONSeeAttachment16283244CitofCarsonSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE‘THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN701E.CarsonStreetACCORDANCEWITHTHEPOLICYPROVISIONS.CarsonCA90745IAUTHORIZEDDATE(MMIDDIYYYY)1/20/20219/15/2020INSRLTRTYPEOFINSURANCEADDLISUBRJPOLICYNUMBERPOLICYEFFIRRAMflflIVwy1POLICYEXPIMMIDD/YYYYILIMITS©1988201ACORDCORPOIATION.Allrightsreserved.ACORD25(2016/03)TheACORDnameandlogoareregisteredmarksofACORD MiscellaneousAttachment:M5164$7MasterID:1407923,CertificateID:162832441stExcessNetworkSecurity/CyberPolicy;LloydsSyndicateBrit2987&298$;Policy#BO713MEDTE20014SO;PolicyPeriod:01/20/2020-01/20/2021;Limit:$10Mexcessof$1OM;2ndExcessNetworkSecurity/CyberPolicy;GreenwichInsuranceCompany(XL);Policy#MTE903204305;PolicyPeriod:01/20/2020-01/20/2021;Limit:$OMexcessof$20M;3rdExcessNetworkSecurity!CyberPolicy;LloydsSyndicate1955(Barbican);Policy#B0713MEDTE2001627;Policyperiod01/20/2020-01/20/2021;Limit$OMexcessof$30M;4thExcessNetworkSecurity!CyberPolicy;AxisInsuranceCompany;Policy#P-001-000069548-02;Policyperiod01/20/2020-01/20/2021;Limit$OMexcessof$40M;5thExcessNetworkSecurity,’CyberPolicy;TokioMarineKilnSyndicatesLimited(Barbican);Policy#BO713MEDTE2001684;PolicyPeriod01/20/2020-01/20/2021;Limit:$35Mexcessof$50M;6thExcessNetworkSecurity/CyberPolicy;TravelersExcessandSurplusLinesCompany;Policy#107034205;PolicyPeriod01/20/2020-01/20/2021;Limit$5Mexcessof$$5M;7thExcessNetworkSecurity!Cyber;PolicyContinentalCasualtyCompany;Policy#596658657;PolicyPeriod:01/20/2020-01/20/2021;Limit$1OMexcessof$90M. __—__I’,®AC3RDCERTIFICATEOFPROPERTYINSURANCETHISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER..CONTACTPRODUCERLocktonCompaniesNAME:3280PeachtreeRoadNE,Suite#250rgo,Ext):(NC,No):AtlantaGA30305iss.(404)460-3600PRODUCERCUSTOMER_ID:INSURER(S)AFFORDINGCOVERAGENAIC#INSUREDPrincipalFinancialGroup,Inc.INSURERA:NationalUnionFireInsCoPitts.PA19445104814711HighStreetINSURERB:DesMoinesIA50392-0001INSURERC:INSURER0:INSURERE:INSURERF:COVERAGESCERTIFICATENUMBER:REVISIONNUMBER:LOCATIONOFPREMISESIDESCRIPTIONOFPROPERTY(AttachACORD101,AdditionalRemarksSchedule,ifmorespaceIsrequired)THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED,NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS.INSRPOLICYEFFECTIVEPOLICYEXPIRATIONTYPEOFINSURANCEPOLICYNUMBERLTRDATE(MMIDDIYYYY)DATE(MM/OOIYYYY)COVEREDPROPERTYLIMITSjPROPERTY—BUILDING$XXXXXXXCAUSESOFLOSSDEDUCTIBLESPERSONALPROPERTY$xxxxxxxBASICBUILDINGBUSINESSINCOME$XXXXXXXBROADEXTRAEXPENSE$xXxXXXXSPECIAL-NOTAPPI,ICAE3LE--RENTALVALUEsXXXXXXXEARTHQUAKEBLANKETBUILDING$xxxxxxxIPv1ND.BLANKETPERSPROPsXXXXXXXFLOOD.-BLANKETBLDG&PP$xxxxxxx$xxxxxxxsXXXXXXX•INLANDMARINETYPEOFPOLICY-$XXXXXXXCAUSESOFLOSSNOtAPPlICABLE$xxxxxxxNAMEDPERILSPOLICYNUMBER-—$XXXXXXX—sXXXXXXXAXCRIME01-317-35-40511/20205/1/2021XEmployeeDishone15,000,000TYPEOFPOLICYXOnPremises$15,000,000FtBondXInTransitL$15.000,000BOILER&MACHINERY!—$xxxxXXXEQUIPMENTBREAKDOWNNOTAPPLICABLE$xxxxxxxACornputerCrime..]01-317-52-485/1/20205/1/2021Xs15,000,000BSeeRemarks5/1/20205/1/2021X$30,000,000SPECIALCONDITIONS!OTHERCOVERAGES(ACORD101,AdditionalRemarksSchedule,maybeattachedifmorespaceIsrequired)*SeeAttachedDATE(MMIDDCA’YY)5/1/20219/15/2020209286CityofCarson701ECarsonStreetCarsonCA90745SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDINACCORDANCEWITHTHEPOLICYPROVISIONS.AUThORIZEDjNTATIVEACORD24(2016/03)TheACORDnameandlogoareregisteredmarksofACORD StandardAttachment024MasterID:104814,CertIficateID:209286FlBondExcessPolicy1stExcessFlBondCarrier:ACEAmericanInsuranceCompanyPolicy#:DOXG25542812005Effective:5/1/2020—5/1/2021SingleLossLimit:$15,000,000excessof$30,000,000plusdeductibleAggregateLimit:$30,000,0002ndExcessFlBondCarrier:BerkleyRegionalInsuranceCompanyPolicy#:BFIC-45000342-26Effective:5/1/2020—5/1/2021SingleLossLimit:$20,000,000excessof$30,000,000plusdeductibleAggregateLimit:$40,000,000ComputerCrimeExcessPolicies1StExcessComputerCrimeCarrier:ACEAmericanInsuranceCompanyPolicy#:DOXG25543233005Effective:5/1/2020—5/1/2021SingleLossLimit:$15,000,000/SingleLossDed:$1,000,0002ndExcessComputerCrimeCattier:BerkleyRegionalInsuranceCompanyPolicy#BFCC-45000341-26Effective:5/1/2020—5/1/2021SingleLossLimit:$20,000,000excessof$30,000,000plusdeductibleAggregateLimit:$40,000,000 ACcRLCERTIFICATEOFLIABILITYINSURANCETHISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferriqhtstothecertificateholderinlieuofsuchendorsement(s).CONTACTPRODUCERNAME:LindsayGentryLMCInsurance&RiskManagement,Inc.PHONEFAX4200UniversityAve.,Suite200INC.No.Eat):515-237-0150INC.No):515-244-9535E-MAILWestDesMoinesIA50266-5945ADDRESS:Iindsay.gentryImcins.comINSURERIS)AFFORDINGCOVERAGEINAIC#INSURERA:SentryInsuranceaMutualCompany24988INSUREDPRINFIN-OlIINSURERB:IPrincipalFinancialGroup,Inc.711HighStreetINSURERC:DesMoinesIA50309INSURERD:INSURERE:INSURERF:COVERAGESCERTIFICATENUMBER:1649023760REVISIONNUMBER:INSRADDLSUERPOLICYEFFPOLICYEXPLTRTYPEOFINSURANCEiisaWVDPOLICYNUMBERIMMIDDIYYYY)(MM!DDPfl’YY)LIMITSCOMMERCIALGENERALLIABILITYEACHOCCURRENCE$DAMAGETORENTEDCLAIMS-MADEOCCURPREMISES(Baoccurrence)SMEDEXP(Anyoneperson)$.PERSDNAL&ADVINJURY$GEN’LAGGREGATELIMITAPPLIESPER:GENERALAGGREGATE$POLICYT.LOCPRODUCTS-COMPIOPAGGOTHER:——$AUTOMOBILELIABILITYCOMBINEDSINGLELIMIT$ANYAUTOBODILYINJURY(Perperson)$AUTOSONLYDSCHEDULEDBODILYINJURY(Peraccident)$HIREDNON-OWNED.PROPERTYDAMAGE$AUTOSONLY,AUTOSONLY(Peraccident)_JUMBRELLAL)ABOCCUR——EACHOCCURRENCESEXCESSLIABCLAIMS-MADEAGGREGATE$DEDRETENTION$$AWORKERSCOMPENSATION——90-02771-025/1/20205/1/2021XSTATUTEERANDEMPLOYERSLIABILITYYINANYPROPRIETOR/PARTNER/EXECUTIVEELEACHACCIDENT$1.000,000OFFICERIMEMBEREXCLUDED?NIA(MandatoryInNH)ELDISEASE-EAEMPLOYEE!$1.000.000Ifyes.describeunderDESCRIPTIONOFOPERATIONSbelow—EL.DISEASE-POLICYLIMIT$1000,000DESCRIPTIONOFOPERATIONS!LOCATIONSIVEHICLES(ACORD101,AdditIonalRemarksSchedule,maybeattachedIfmorespaceIsrequired)CERTIFICATEHOLDERCANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDINACCORDANCEWITHTHEPOLICYPROVISIONS.CityofCarson701ECarsonStreetAUTHRIZEDREPRESENTATIVECarsonCA90745DATE(MMIDDrIYYY)911412020THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWiTHRESPECTTOWHICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS.EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS©1988-2015ACORDCORPORATION.Allrightsreserved.TheACORDnameandlogoareregisteredmarksofACORDACORD25(2016I03) ARDCERTIFICATEOFLIABILITYINSURANCETHISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTiFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothecertificateholderinlieuofsuchendorsement(s).PRODUCERCONTACTI...4RealEstatecertsajg.comNAME:ArthurJ.Gallagher&Co.PHONEFAXInsuranceBrokersofCA.License#0726293)AIC.No,Ext):818-5391415(A/C,No):818539l804E-MAIL505N.BrandBoulevard,Suite600ADDRESS:LARealEstateCerts@ajg.comGlendaleCA91203INSURER(S)AFFORDINGCOVERAGENAIC#INSURERA:ACEProperty&CasualtyInsuranceCo20699INSUREDPRINFIN-04IINSURERB:EnduranceAssuranceCorporation11551PrincipalFinancialGroup,Inc.711HighStreetINSURERC:SompoAmericaInsuranceCompany11126DesMoines,IA50392INSURERD:INSURERE:INSURERF:ICOVERAGESCERTIFICATENUMBER:238246367REVISIONNUMBER:ADDLSUBNPOLICYEFFPOLICYEXPLjq—TYPEOFINSURANCEjppPOLICYNuMBER(MMIDDIYYYY)IMM/DDIYYYYILIMITSBXCOMMERCIALGENERALLIABILITYGGR100145485015/1/20205/1/2021EACHOCCURRENCES1,000000DAMAGETORENTEDCLAIMS-MADEAOCCURPREMISEStEaOccurrence)$1.000.000I..EXP(Anyoneperson)S1.000[_ONAL&ADVINJURY$1,000,000J’LAGGREGATELIMITAPPLIESPERIGENERALAGGREGATES2,000,000!POLICYLLOCPRODUCTS-COMPIOPAGG$1,000,000OTHERDeduclible$NILCAUTOMOBILELIABILITY7——ACVS1168005/1/20205/1/20211INELIMIT$7ANYAUTOBODILYINJURY(Perperson)$AUTOSONLYDSCHEDULEDBODILYINJURY(Peraccidenl)$xHIREDxNON-OWNEDPROPERTYDAMAGE$.._.....AUTOSONLY.... ,AUTOSONLY,(Peraccidenl)I.SAUMBRELLALIABXIOCCUR‘‘I—XEUG466351150045/1/2020r5/1/2021EACHOCCURRENCE$25,000,000EXCESSLIABCLAIMS-MADE,AGGREGATES25,000,000DEDXRETENTIONS——$WORKERSCOMPENSATIONPER0TH-ANDEMPLOYERS’LIABILITYY/NSTATUTEERANYPROPRIETOR/PARTNER/EXECUTIVEEL,EACHACCIDENT$OFFICER/MEMBEREXCLUDED?NIAIMandatoryInNH)ELDISEASE-EAEMPLOYEE$Ityes,describeunderDESCRIPTIONOFOPERATIONSbelow——ELDISEASE-POLICYLIMIT$DESCRIPTIONOFOPERATIONSILOCATIONSIVEHICLES(ACORD101,AdditionalRemarksSchedule,maybeaBachedIfmorespaceIsrequired)Terrorismcoverageisincluded.Evidenceonly.CERTIFICATEHOLDERCANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDINCityofCarsonACCORDANCEWITHTHEPOLICYPROVISIONS.Attn:FayeMoseley701ECarsonStreetAUTHORIZEDREPRESENTATIVECarsonCA90745©1988-2015ACORDCORPORATION.Allrightsreserved.TheACORDnameandlogoareregisteredmarksofACORDDATE(MMIDDIYYYY)5/11/2020THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOmEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED.NO1WTHSTANDINGANYREOUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTVITHRESPECTTOWHICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYAIDCLAIMSACORD25(2016/03)