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8239 - Contract Executed Docusign City Council Transmittal Coversheet File Name Purchasing Contact City Council Target Date Piggy Back Option Contract Expiration Ordinance DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 RFP No 8239 Christa Christian Life & Disability SEPTEMBER 19, 2023 DECEMBER 31, 2028 23-1703 Symetra Group Benefits DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Renewal Amendment City of Denton - Contract # 8239Denton, TX on behalf of McGriff, Seibels, & Williams August 4, 2023 Prepared for: Symetra Group Benefits DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Amendment ……………………..…...…......….……………………..……………..…...…......……….. Section 1 Exhibit B ……………………..…...…......….……………………..……………..…...…......….……….. Section 2 Exhibit C ……………………..…...…......….……………………..……………..…...…......….……….. Section 3 Table of Contents DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 1Amendment DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 1 Renewal Amendment Number 1 to Contract (Contract 8239) This Renewal Amendment Number 1 to Contract (Contract 8239) (this Amendment) is entered into between City of Denton, Texas (Subscriber) and Symetra Life Insurance Company (Symetra). Background Subscriber and Symetra have previously entered into Contract (6808) dated July 19, 2018 which was renewed and replaced by Subscriber’s RFP 8239 – Life and Disability (Contract 8239), which is on file at the purchasing office and made a part hereof as Exhibit A (the Agreement). Initially capitalized terms used but not otherwise defined in this Amendment will have the meanings set forth in the Agreement. The parties desire to amend the Agreement as follows: 1 Effective Date The terms of this Amendment are effective as of __January 1, 2024__________________. 2 Extension The contract term will be three (3) years, effective from date of award. The City and the Supplier shall have the option to renew this contract for an additional two (2) one-year periods. The Contract shall commence upon the Effective Date and shall automatically renew each year, in accordance with the procedures set forth in the Agreement. At the mutual agreement of both parties, the Contract may be further extended as needed, not to exceed a total of six (6) months. 3 Scope of Work Symetra shall perform all those services as necessary and as described in the Subscriber’s Contract 8239 as if written word for word herein. 4 Contract Amount The contract total for the continued services shall not exceed approximately $5,570,000.00. In the event scope of services provided to the City of Denton by Symetra exceeds $5,750,000.00 an amendment to this contract as well as the Fee Schedule will be required. 5 Insurance Insurance requirements per Exhibit C Insurance Requirements are attached. 6 Contractor’s Proposal Contractor agrees to do all services listed in Contract 8239 at the rates set forth in Contractor’s Proposal per Exhibit B attached. DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 2 7 Updated Notices Addresses. The agreement is amended to reflect the following updated notice address for City of Denton: City of Denton, Attn: Purchasing Manager – File 8239, 901B Texas Street, Denton, TX 76201, with an additional copy to: City of Denton Attn: Legal Counsel 215 E. McKinney St., Denton, TX 76201, with additional copy emailed to city of Denton at: purchasing@cityofdenton.com Symetra Life Insurance Company Attn: _Lisa Marecki__ 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004-5135, with additional copy emailed to _lisa.marecki@symetra.com_. 8 Updated contract number This Amendment constitutes a new agreement beginning on the Effective Date between the parties incorporating, except as amended herein, all the terms and conditions in the Agreement for all intents and purposes Such Agreement will have contract number 8239 . Confirmation of Agreement This Amendment (together with all exhibits attached hereto) constitutes the entire agreement between the parties regarding the matters of this Amendment and supersedes all prior and contemporaneous agreements and understandings regarding the matters of this Amendment. In the event of a conflict between this Amendment and the Agreement as it relates to the matters of this Amendment, the terms of this Amendment will control. Otherwise, all terms and conditions of the Agreement will remain in full force and effect and likewise apply to this Amendment. DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 3 Authorized Signatures City of Denton, Texas Symetra Life Insurance Company By: By: Name: Name: Lisa Marecki Title: Title: SVP Worksite Benefits Date: Date: August 4, 2023 ATTEST: JESUS SALAZAR, CITY SECRETARY BY: _______________________________ APPROVED AS TO LEGAL FORM: MACK REINWAND, CITY ATTORNEY BY: _______________________________ THIS AGREEMENT HAS BEEN BOTH REVIEWED AND APPROVED as to financial and operational obligations and business terms. _______________ ______________ SIGNATURE PRINTED NAME _______________ _______________ TITLE DEPARTMENT DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 2023- In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that the City may not enter into this contract unless the Contractor submits a disclosure of interested parties (Form 1295) to the City at the time the Contractor submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Commission. Contractor will be required to furnish a Certificate of Interest Parties before the contract is awarded, in accordance with Government Code 2252.908. The contractor shall: 1. Log onto the State Ethics Commission Website at : https://www.ethics.state.tx.us/filinginfo/1295/ 2. Register utilizing the tutorial provided by the State 3. Print a copy of the completed Form 1295 4. Enter the Certificate Number on page 2 of this contract. 5. Complete and sign the Form 1295 6. Email the form to purchasing@cityofdenton.com with the contract number in the subject line. (EX: Contract 1234 – Form 1295) The City must acknowledge the receipt of the filed Form 1295 not later than the 30th day after Council award. Once a Form 1295 is acknowledged, it will be posted to the Texas Ethics Commission’s website within seven business days. TEXAS ETHICS COMMISSION 1295 CERTIFICATE NUMBER 2018-428212 Deputy HR Director Human Resources Megan Gilbreath 9/20/2023 City Manager Sara Hensley 2Exhibit B DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Policyholder: City of Denton Policy Number: 01-017863-00 Account Manager: Rachel Stetzer Renewal Date: 1/1/2024 Basic Employee Life Lives Volume Rate per $1,000 Monthly Premium Annual Premium Basic Employee Life 1,591 $126,327,000 $0.025 $3,158.18 $37,898.16 Basic Employee AD&D Lives Volume Rate per $1,000 Monthly Premium Annual Premium Basic Employee AD&D 1,591 $126,327,000 $0.010 $1,263.27 $15,159.24 Supp EE Life Plan Change - Class 1 & 2 $10k increment to $500,000, $250k GI Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 34 $2,220,000 $0.063 $139.86 $1,678.32 25 - 29 83 $8,310,000 $0.054 $448.74 $5,384.88 30 - 34 140 $16,420,000 $0.063 $1,034.46 $12,413.52 35 - 39 147 $17,800,000 $0.090 $1,602.00 $19,224.00 40 - 44 172 $22,120,000 $0.153 $3,384.36 $40,612.32 45 - 49 140 $16,640,000 $0.243 $4,043.52 $48,522.24 50 - 54 135 $15,380,000 $0.432 $6,644.16 $79,729.92 55 - 59 78 $8,400,000 $0.702 $5,896.80 $70,761.60 60 - 64 46 $3,780,000 $0.936 $3,538.08 $42,456.96 65 - 69 14 $950,000 $1.476 $1,402.20 $16,826.40 70 - 74 4 $190,000 $2.592 $492.48 $5,909.76 75 +0 $0 $4.320 $0.00 $0.00 Total 993 $112,210,000 $28,626.66 $343,519.92 *Lives, volume, and premium TBD. Above reflects current enrollees and elections - There are no Basic Employee AD&D commissions. Underwriting Renewal Worksheet - Requested Plan Changes - There are no Basic Employee Life commissions. - Basic Employee Life Rates are guaranteed for 3 years - Basic Employee AD&D Rates are guaranteed for 3 years - There are no Supplemental Employee Life commissions. - Supplemental Employee Life Rates are guaranteed for 3 years _________________________________________________________________________________________________________________________________________________ Prepared by 2 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Supplemental Employee Life Plan Change - Class 3 Retirees Flat $10,000 Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 $0.080 25 - 29 $0.070 30 - 34 $0.080 35 - 39 $0.110 40 - 44 $0.190 45 - 49 $0.310 50 - 54 $0.550 55 - 59 $0.890 60 - 64 $1.190 65 - 69 $1.870 70 - 74 $3.280 75 +$5.470 Estimated Total 34 $339,000 *TBD *TDB *Minimum 15% particpation for the Supp Life Retirees (226 retirees with max volume of $2,260,000) - There are no Supplemental Employee Life commissions. - Supplemental Employee Life Rates are guaranteed for 3 years _________________________________________________________________________________________________________________________________________________ Prepared by 3 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Supplemental AD&D - To match plan changes to EE, Spouse, and Child Lives Volume Rate per $1,000 Monthly Premium Annual Premium Supplemental Employee AD&D 993 $112,210,000 $0.020 $2,244.20 $26,930.40 Supplemental Spouse 475 $21,666,000 $0.020 $433.32 $5,199.84 Supplemental Child 524 $5,240,000 $0.020 $104.80 $1,257.60 *Lives, volume, and premium TBD. Above reflects current enrollees and elections Supp Spouse Life Plan Change - Class 1,2 - $5k increment to $250,000, $50k GI Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 3 $15,000 $0.063 $0.95 $11.34 25 - 29 18 $740,000 $0.054 $39.96 $479.52 30 - 34 53 $2,820,000 $0.063 $177.66 $2,131.92 35 - 39 76 $3,215,000 $0.090 $289.35 $3,472.20 40 - 44 99 $5,135,000 $0.153 $785.66 $9,427.86 45 - 49 78 $3,975,000 $0.243 $965.93 $11,591.10 50 - 54 72 $3,335,000 $0.432 $1,440.72 $17,288.64 55 - 59 46 $1,535,000 $0.702 $1,077.57 $12,930.84 60 - 64 20 $630,000 $0.936 $589.68 $7,076.16 65 - 69 7 $195,000 $1.476 $287.82 $3,453.84 70 - 74 3 $71,000 $2.592 $184.03 $2,208.38 75 +0 $0 $4.320 $0.00 $0.00 Spouse Total 475 $21,666,000 $5,839.32 $70,071.80 *Lives, volume, and premium TBD. Above reflects current enrollees and elections Supp Child Life Plan Change - Class 1,2 - Flat $25,000) Child 524 $5,420,000 $0.070 $379.40 $4,552.80 Long Term Disability - Plan change to SSNRA Lives Volume Rate per $100 Monthly Premium Annual Premium Long Term Disability 1,550 $9,568,574 $0.145 $13,874.43 $166,493.19 - Long Term Disability Rates based on $100 of monthly covered payroll - There are no Supplemental AD&D commissions. - Supplemental AD&D Rates are guaranteed for 3 years - There are no Supplemental Spouse & Child Life commissions. - Supplemental Spouse & Child Life Rates are guaranteed for 3 years - There are no Long Term Disability commissions. - Long Term Disability Rates are guaranteed for 3 years _________________________________________________________________________________________________________________________________________________ Prepared by 4 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Short Term Disability - Plan change to 7/7/12 Age Band Lives Volume Rate Per $10 Monthly Premium Annual Premium < 25 20 $12,324 $0.370 $456.00 $5,472.05 25 - 29 61 $42,015 $0.390 $1,638.57 $19,662.88 30 - 34 99 $88,853 $0.350 $3,109.86 $37,318.32 35 - 39 130 $111,651 $0.340 $3,796.14 $45,553.72 40 - 44 126 $116,192 $0.380 $4,415.28 $52,983.41 45 - 49 98 $92,257 $0.390 $3,598.02 $43,176.20 50 - 54 95 $90,836 $0.470 $4,269.28 $51,231.42 55 - 59 56 $49,288 $0.590 $2,907.98 $34,895.77 60 - 64 47 $37,289 $0.720 $2,684.81 $32,217.69 65 - 69 11 $8,009 $0.810 $648.69 $7,784.28 70 - 74 3 $2,926 $0.810 $236.97 $2,843.66 75 +0 $0 $0.810 $0.00 $0.00 Total 746 $651,639 $27,761.62 $333,139.40 *Quoted rates reflect 47% participation currently in-force - Short Term Disability Rates based on $10 of weekly covered benefit Technology Credit - effective 1/1/24 Schedule Ongoing - There are no Short Term Disability commissions. - Short Term Disability Rates are guaranteed for 3 years Stucture Maximum 2% of the annualized premium up to $20,000 per year _________________________________________________________________________________________________________________________________________________ Prepared by 5 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 3Exhibit C DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Basic and Supp Life – AD&D and Disability - 8239 INSURANCE REQUIREMENTS Respondent’s attention is directed to the insurance requirements below. It is highly recommended that respondents confer with their respective insurance carriers or brokers to determine in advance of Proposal/Bid submission the availability of insurance certificates and endorsements as prescribed and provided herein. If an apparent low respondent fails to comply strictly with the insurance requirements, that respondent may be disqualified from award of the contract. Upon contract award, all insurance requirements shall become contractual obligations, which the successful contractor shall have a duty to maintain throughout the course of this contract. STANDARD PROVISIONS: Without limiting any of the other obligations or liabilities of the Contractor, the Contractor shall provide and maintain until the contracted work has been completed and accepted by the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter. As soon as practicable after notification of contract award, Contractor shall file with the Purchasing Department satisfactory certificates of insurance including any applicable addendum or endorsements, containing the contract number and title of the project. Contractor may, upon written request to the Purchasing Department, ask for clarification of any insurance requirements at any time; however, Contractors are strongly advised to make such requests prior to proposal/bid opening, since the insurance requirements may not be modified or waived after proposal/bid opening unless a written exception has been submitted with the proposal/bid. Contractor shall not commence any work or deliver any material until he or she receives notification that the contract has been accepted, approved, and signed by the City of Denton. All insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance with these general specifications throughout the duration of the Contract, or longer, if so noted: • Each policy shall be issued by a company authorized to do business in the State of Texas with an A.M. Best Company rating of at least A+ or better. • Any deductibles or self-insured retentions shall be declared in the proposal. If requested by the City, the insurer shall reduce or eliminate such deductibles or self-insured retentions with respect to the City, its officials, agents, employees and volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. • Liability policies shall be endorsed to provide the following: o Name as Additional Insured the City of Denton, its Officials, Agents, DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Basic and Supp Life – AD&D and Disability - 8239 Employees and volunteers. o That such insurance is primary to any other insurance available to the Additional Insured with respect to claims covered under the policy and that this insurance applies separately to each insured against whom claim is made or suit is brought. The inclusion of more than one insured shall not operate to increase the insurer's limit of liability. o Provide a Waiver of Subrogation in favor of the City of Denton, its officials, agents, employees, and volunteers. • Cancellation: City requires 30 day written notice should any of the policies described on the certificate be cancelled or materially changed before the expiration date. • Should any of the required insurance be provided under a claims made form, Contractor shall maintain such coverage continuously throughout the term of this contract and, without lapse, for a period of three years beyond the contract expiration, such that occurrences arising during the contract term which give rise to claims made after expiration of the contract shall be covered. • Should any of the required insurance be provided under a form of coverage that includes a general annual aggregate limit providing for claims investigation or legal defense costs to be included in the general annual aggregate limit, the Contractor shall either double the occurrence limits or obtain Owners and Contractors Protective Liability Insurance. • Should any required insurance lapse during the contract term, requests for payments originating after such lapse shall not be processed until the City receives satisfactory evidence of reinstated coverage as required by this contract, effective as of the lapse date. If insurance is not reinstated, City may, at its sole option, terminate this agreement effective on the date of the lapse. SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS: All insurance policies proposed or obtained in satisfaction of this Contract shall additionally comply with the following specifications, and shall be maintained in compliance with these additional specifications throughout the duration of the Contract, or longer, if so noted: A. COMMERCIAL GENERAL LIABILITY INSURANCE Commercial General Liability Insurance including, but not limited to, Premises/Operations, Personal & Advertising Injury, Products/Completed Operations, Independent Contractors, and Contractual Liability with minimum combined bodily injury (including death) and property damage limits of DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Basic and Supp Life – AD&D and Disability - 8239 $1,000,000.00 per occurrence and $2,000,000.00 general aggregate. DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 1 of 16 (NK000) City of Denton 901B Texas Street Denton, TX 76201 Parker, Smith & Feek Insurance, LLC. 2233 112th Avenue NE Bellevue, WA 98004 ~~~DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 2 of 16 (NK000) THIS PAGE INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 3 of 16 (NK000) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 THISCERTIFICATE 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 07/19/2023 Parker, Smith & Feek Insurance, LLC. 2233 112th Avenue NE Bellevue, WA 98004 425-709-3600 425-709-7460 Hartford Fire Insurance Co. Symetra Financial Corporation Attn: Corporate Insurance - 15th Flr, 777 108th Ave NE, Suite 1200 Bellevue, WA 98004-5135 A X 1,000,000 8 X 8 8 52UUNCE1902 01/21/2023 01/21/2024 1,000,000 10,000 1,000,000 2,000,000 2,000,000 Total Aggregate Limit 20,000,000 Basic and Supp Life - AD&D and Disability - 8239. City of Denton and its Officials, Agents, employees and volunteers are additional insureds on the general liability policy per the attached endorsement/form... (See Attached Description) City of Denton 901B Texas Street Denton, TX 76201 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 4 of 16 (NK000) THIS PAGE INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 5 of 16 (NK000) DESCRIPTIONS (Continued from Page ) 1 . Waiver of subrogation applies on the general liability policy per the attached endorsement/form. Notice of cancellation for the general liability policy per the attached form. DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 6 of 16 (NK000) THIS PAGE INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 7 of 16 (NK000) Page 12 of 21 HG 00 01 09 16 with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. e. Unnamed Subsidiary Any subsidiary, and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of the Coverage Part. The insurance afforded herein for any subsidiary not named in this Coverage Part as a named insured does not apply to injury or damage with respect to which such insured is also a named insured under another policy or would be a named insured under such policy but for its termination or the exhaustion of its limits of insurance. 3. Newly Acquired Or Formed Organization Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain financial interest of more than 50% of the voting stock, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a.Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b.Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c.Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. 4. Nonowned Watercraft With respect to watercraft you do not own that is less than 51 feet long and is not being used to carry persons for a charge, any person is an insured while operating such watercraft with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a."Bodily injury" to a co-"employee" of the person operating the watercraft; or b."Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 5. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The following person(s) or organization(s) are an additional insured when you have agreed,in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement. A person or organization is an additional insured under this provision only for that period of time required by the contract or agreement. However, no such person or organization is an insured under this provision if such person or organization is included as an insured by an endorsement issued by us and made a part of this Coverage Part. a.Vendors Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard". (1)The insurance afforded the vendor is subject to the following additional exclusions: This insurance does not apply to: (a)"Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b)Any express warranty unauthorized by you; (c)Any physical or chemical change in the product made intentionally by the vendor; (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 such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 8 of 16 (NK000) HG 00 01 09 16 Page 13 of 21 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 the vendor's premises in connection with the sale of the product; (g)Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h)"Bodily injury" or "property damage" arising out of the sole negligence of the vendor 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: (i)The exceptions contained in Sub- paragraphs (d)or (f); or (ii)Such inspections, adjustments, tests or servicing as the vendor 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. (2)This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b. Lessors Of Equipment (1)Any person(s) or organization(s) from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). (2)With respect to the insurance afforded to these additional insureds this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. c. Lessors Of Land Or Premises Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. With respect to the insurance afforded these additional insureds the following additional exclusions apply: This insurance does not apply to: 1.Any "occurrence" which takes place after you cease to lease that land; or 2.Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. d. Architects, Engineers Or Surveyors Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1)In connection with your premises; or (2)In the performance of your ongoing operations performed by you or on your behalf. With respect to the insurance afforded these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: 1.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. e. Permits Issued By State Or Political Subdivisions Any state or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. With respect to the insurance afforded these additional insureds, this insurance does not apply to: (1)"Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 9 of 16 (NK000) Page 14 of 21 HG 00 01 09 16 (2)"Bodily injury" or "property damage" included within the "products-completed operations hazard". f. Any Other Party Any other person or organization who is not an additional insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1)In the performance of your ongoing operations; (2)In connection with your premises owned by or rented to you; or (3)In connection with "your work" and included within the "products-completed operations hazard", but only if (a)The written contract or agreement requires you to provide such coverage to such additional insured; and (b)This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard". However: (1)The insurance afforded to such additional insured only applies to the extent permitted by law; and (2)If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, this insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1)The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2)Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. The limits of insurance that apply to additional insureds is described in Section III – Limits Of Insurance. How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV – Commercial General Liability Conditions. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III – LIMITS OF INSURANCE 1. The Most We Will Pay The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 2. General Aggregate Limit The General Aggregate Limit is the most we will pay for the sum of: a.Medical expenses under Coverage C; b.Damages under Coverage A,except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard"; and c.Damages under Coverage B. 3. Products-Completed Operations Aggregate Limit The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products- completed operations hazard". 4. Personal And Advertising Injury Limit Subject to 2.above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Each Occurrence Limit Subject to 2.or 3.above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a.Damages under Coverage A;and DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 10 of 16 (NK000) THIS PAGE INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 11 of 16 (NK000) Page 18 of 21 HG 00 01 09 16 impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V – DEFINITIONS 1. "Advertisement"means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: a. (1)Radio; (2)Television; (3)Billboard; (4)Magazine; (5)Newspaper; or b.Any other publication that is given widespread public distribution. However, "advertisement" does not include: a.The design, printed material, information or images contained in, on or upon the packaging or labeling of any goods or products; or b.An interactive conversation between or among persons through a computer network. 2."Advertising idea"means any idea for an "advertisement". 3. "Asbestos hazard"means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto"means: a.A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 5. "Bodily injury"means physical: a.Injury; b.Sickness; or c.Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. 6. "Coverage territory"means: a.The United States of America (including its territories and possessions), Puerto Rico and Canada; b.International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a.above; or c.All other parts of the world if the injury or damage arises out of: (1)Goods or products made or sold by you in the territory described in a.above; (2)Theactivitiesofapersonwhosehomeis in the territory described in a.above, but is away for a short time on your business; or (3)"Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication provided the insured's responsibility to pay damages is determined in the United States of America (including its territories and possessions), Puerto Rico or Canada, in a "suit" on the merits according to the substantive law in such territory or in a settlement we agree to. 7. "Employee"includes a "leased worker". "Employee" does not include a "temporary worker". 8. "Employment-Related Practices"means: a.Refusal to employ that person; b.Termination of that person's employment; or c.Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination or malicious prosecution directed at that person. 9. "Executive officer"means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document. 10."Hostile fire"means one which becomes uncontrollable or breaks out from where it was intended to be. Waiver Of Rights Of Recovery (Waiver Ofg Subrogation) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 12 of 16 (NK000) THIS PAGE INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 13 of 16 (NK000) IL 01 46 08 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. 3.The conditions in this endorsement replace any We may cancel the Commercial Property similar conditions in the policy that are less favorable Coverage Part and the Capital Assets Program to the insured.(Output Policy) Coverage Part, if made a part of this policy, by mailing or delivering to the firstA. Cancellation Named Insured and the first Named Insured's1.The first Named Insured shown in the agent or broker written notice of cancellation at Declarations may cancel this policy by notifying least five days before the effective date of us or the insurance producer in one of the cancellation for any structure where two or following ways:more of the following conditions exist: a.Written notice by mail, fax or e-mail;a.Without reasonable explanation, the b.Surrender of the policy or binder; or structure is unoccupied for more than 60 consecutive days, or at least 65% of the c.Verbal notice.rental units are unoccupied for more than Upon receipt of such notice, we will cancel this 120 consecutive days, unless the structure policy or any binder issued as evidence of is maintained for seasonal occupancy or is coverage, effective on the later of the following:under construction or repair;a.The date on which notice is received or the b.Without reasonable explanation, progress policy or binder is surrendered; or toward completion of permanent repairs to b.The date of cancellation requested by the the structure has not occurred within 60 first Named Insured.days after receipt of funds following satisfactory adjustment or adjudication of2.We may cancel this policy by mailing or loss resulting from a fire;delivering to the first Named Insured and the first Named Insured's agent or broker written c.Because of its physical condition, the notice of cancellation, including the actual structure is in danger of collapse; reason for the cancellation, to the last mailing d.Because of its physical condition, a address known to us, at least: vacation or demolition order has been a.10 days before the effective date of issued for the structure, or it has been cancellation if we cancel for nonpayment of declared unsafe in accordance with premium; or applicable law; b.45 days before the effective date of e.Fixed and salvageable items have been cancellation if we cancel for any other removed from the structure, indicating an reason; intent to vacate the structure; except as provided in Paragraphs 3.and 4.f.Without reasonable explanation, heat, below. water, sewer and electricity are not furnished for the structure for 60 consecutive days; or g.The structure is not maintained in substantial compliance with fire, safety and building codes. IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 1 of 4 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 14 of 16 (NK000) 4.If:7.If this policy is cancelled, we will send the first Named Insured any premium refund due. If we a.You are an individual; cancel, the refund will be pro rata. If the first b.A covered auto you own is of the "private Named Insured cancels, the refund will be at passenger type"; and least 90% of the pro rata refund unless the c.The policy does not cover garage, following applies: automobile sales agency, repair shop, a.For Division Two – Equipment Breakdown, service station or public parking place if the first Named Insured cancels, the operations hazards; refund will be at least 75% of the pro rata we may cancel the Commercial Automobile refund. Coverage Part by mailing or delivering to the b.If:first Named Insured and the first Named (1)You are an individual; Insured's agent or broker written notice of (2)A covered auto you own is of thecancellation, including the actual reason for cancellation, to the last mailing address known "private passenger type"; to us: (3)The policy does not cover garage, a.At least 10 days before the effective date of automobile sales agency, repair shop, cancellation if we cancel for nonpayment of service station or public parking place premium; or operations hazards; and b.(4)At least 10 days before the effective date of The first Named Insured cancels; cancellation for any other reason if the the refund will be not less than 90% of any policy is in effect less than 30 days; or unearned portion not exceeding $100, plus c.At least 20 days before the effective date of 95% of any unearned portion over $100 but cancellation for other than nonpayment if not exceeding $500, and not less than 97% the policy is in effect 30 days or more; or of any unearned portion in excess of $500. d.At least 20 days before the effective date of The cancellation will be effective even if we cancellation if the policy is in effect for 60 have not made or offered a refund. days or more or is a renewal or continuation 8.If notice is mailed, proof of mailing will be policy, and the reason for cancellation is sufficient proof of notice.that your driver's license or that of any B. Changes driver who customarily uses a covered The policy contains all the agreements between "auto" has been suspended or revoked you and us concerning the insurance afforded. during policy period. The first Named Insured shown in the Declarations 5.We will also mail or deliver to any mortgage is authorized to make changes in the terms of thisholder, pledgee or other person shown in this policy with our consent. This policy's terms can bepolicy to have an interest in any loss which amended or waived only by endorsement issued may occur under this policy, at their last by us and made a part of this policy.mailing address known to us, written notice of C. Examination Of Your Books And Records cancellation, prior to the effective date of cancellation. If cancellation is for reasons other We may examine and audit your books andA.3.than those contained in Paragraph above, records as they relate to this policy at any timethis notice will be the same as that mailed or during the policy period and up to three years delivered to the first Named Insured. If afterward.cancellation is for a reason contained in D. Inspection And Surveys Paragraph A.3.above, we will mail or deliver 1.We have the right to:this notice at least 20 days prior to the effective date of cancellation.a.Make inspections and surveys at any time; 6.Notice of cancellation will state the effective b.Give you reports on the conditions we find; date of cancellation. The policy period will end andon that date. c.Recommend changes. Page 2 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 15 of 16 (NK000) 2.We are not obligated to make any inspections, G. Nonrenewal surveys, reports or recommendations, and any 1.We may elect not to renew this policy by such actions we do undertake relate only to mailing or delivering written notice of insurability and the premiums to be charged. nonrenewal, stating the reasons forWe do not make safety inspections. We do not nonrenewal, to the first Named Insured and the undertake to perform the duty of any person or first Named Insured's agent or broker, at their organization to provide for the health or safety last mailing addresses known to us. We will of workers or the public. And we do not warrant also mail to any mortgage holder, pledgee orthat conditions:other person shown in this policy to have an a.Are safe or healthful; or interest in any loss which may occur under this policy, at their last mailing address known to b.Comply with laws, regulations, codes or us, written notice of nonrenewal. We will mailstandards.or deliver these notices at least 45 days before 3.Paragraphs 1. and 2. of this condition apply not the:only to us, but also to any rating, advisory, rate a.Expiration of the policy; or service or similar organization which makes b.insurance inspections, surveys, reports or Anniversary date of this policy if this policy recommendations.has been written for a term of more than one year. 4. 2.Paragraph of this condition does not apply to any inspections, surveys, reports or Otherwise, we will renew this policy unless: recommendations we may make relative to a.The first Named Insured fails to pay the certification, under state or municipal statutes, renewal premium after we have expressed ordinances or regulations, of boilers, pressure our willingness to renew, including a vessels or elevators.statement of the renewal premium, to the E. Premiums first Named Insured and the first Named Insured's insurance agent or broker, at least The first Named Insured shown in the 20 days before the expiration date;Declarations: b.Other coverage acceptable to the insured 1.Is responsible for the payment of all premiums;has been procured prior to the expiration and date of the policy; or2.Will be the payee for any return premiums we c.The policy clearly states that it is not pay. renewable and is for a specific line, F. Transfer Of Your Rights And Duties Under This subclassification, or type of coverage that is Policy not offered on a renewable basis. Your rights and duties under this policy may not be 2.If:transferred without our written consent except in a.You are an individual; the case of death of an individual Named Insured. b.A covered auto you own is of the "private If you die, your rights and duties will be transferred passenger type"; and to your legal representative but only while acting c.within the scope of duties as your legal The policy does not cover garage, representative. Until your legal representative is automobile sales agency, repair shop, appointed, anyone having proper temporary service station or public parking place custody of your property will have your rights and operations hazards; duties but only with respect to that property. Page 3 of 4© Insurance Services Office, Inc., 2010IL 01 46 08 10 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 16 of 16 (NK000) b.We will not refuse to renew Liability the following applies to nonrenewal of the Commercial Automobile Coverage Part in Coverage or Collision Coverage solely G.1.:place of because an "insured" has submitted claims under Comprehensive Coverage or Towing a.We may elect not to renew or continue this And Labor Coverage.policy by mailing or delivering to you and c.your agent or broker written notice at least If we fail to mail or deliver proper notice of 20 days before the end of the policy period,nonrenewal and you obtain other insurance, including the actual reason for nonrenewal. this policy will end on the effective date of If the policy period is more than one year, that insurance. we will have the right not to renew or continue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer. Our President and Secretary have signed this policy. Where required by law, the Declarations page has been countersigned by our duly authorized representative. ABCDABCD Page 4 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a) and by City of Denton Ethics Code, Ordinance 18-757. By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information in this section is being disclosed. Name of Officer Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relations hip with the local government officer. This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship as defined by Section 176.00 1(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor? Yes No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? Yes No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of one percent or more? Yes No D. Describe each employment or business and family relationship with the local government officer named in this section. 4 I have no Conflict of Interest to disclose. 5 Signature of vendor doing business with the governmental entity Date DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Symetra Life Insurance Company EXHIBIT - FORM CIQ CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code § 176.003(a)(2)(A) and (B): (A) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. City of Denton Ethics Code Ordinance Number 18-757 Definitions: Relative: a family member related to a City Official within the third 3rd degree of affinity (marriage) or consanguinity (blood or adoption) City Official: for purpose of this article, the term consists of the Council Members, Department Heads, or member of the Board of Ethics, Planning and zoning Commission Members, Board of Adjustment, Historic Landmark Commission, or Public Utilities Board Vendor: a person who provides or seeks to provide goods, services, and/or real property to the City in exchange for compensation. This definition does not include those property owners from whom the City acquires public right-of-way or other real property interests for public use. Per the City of Denton Ethics Code, Section 2-273. – Prohibitions (3) It shall be a violation of this Article for a Vendor to offer or give a Gift to City Official exceeding fifty dollars ($50.00) per gift, or multiple gifts cumulatively valued at more than two hundred dollars ($200.00) per a single fiscal year. Per the City of Denton Ethics Code, Section 2-282. – Disposition (b), (5) Ineligibility If the Board of Ethics finds that a Vendor has violated this Article, the Board may recommend to the City Manager that the Vendor be deemed ineligible to enter into a City contract or other arrangement for goods, services, or real property, for a period of one (1) year. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BA1F-327297E0D100 Certificate Of Completion Envelope Id: 4C862EC495A94E9DBA1F327297E0D100 Status: Completed Subject: Please DocuSign: City Council Contract 8239 Life & Disability Source Envelope: Document Pages: 36 Signatures: 4 Envelope Originator: Certificate Pages: 6 Initials: 1 Christa Christian AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 901B Texas Street Denton, TX 76209 Christa.Christian@cityofdenton.com IP Address: 198.49.140.104 Record Tracking Status: Original 8/28/2023 8:28:17 AM Holder: Christa Christian Christa.Christian@cityofdenton.com Location: DocuSign Signer Events Signature Timestamp Christa Christian christa.christian@cityofdenton.com Purchasing Supervisor City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 198.49.140.104 Sent: 8/28/2023 8:36:49 AM Viewed: 8/28/2023 8:37:00 AM Signed: 8/28/2023 8:37:27 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Lori Hewell lori.hewell@cityofdenton.com Purchasing Manager City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 8/28/2023 8:37:31 AM Viewed: 8/28/2023 8:57:04 AM Signed: 8/28/2023 9:05:24 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Marcella Lunn marcella.lunn@cityofdenton.com Mack Reinwand City Attorney City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 8/28/2023 9:05:26 AM Viewed: 8/28/2023 2:46:42 PM Signed: 8/28/2023 2:47:58 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Rachel Stetzer Rachel.Stetzer@symetra.com Security Level: Email, Account Authentication (None) Completed Using IP Address: 23.236.87.60 Sent: 8/28/2023 2:48:01 PM Viewed: 8/29/2023 3:33:14 PM Signed: 8/30/2023 8:12:22 AM Electronic Record and Signature Disclosure: Accepted: 8/29/2023 3:33:14 PM ID: 4ed2b66d-428e-4189-b21c-415e6b004671 Signer Events Signature Timestamp Megan Gilbreath megan.gilbreath@cityofdenton.com Deputy HR Director City of Denton - Human Resources Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 8/30/2023 8:12:26 AM Viewed: 8/30/2023 9:16:53 AM Signed: 8/30/2023 9:17:12 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Cheyenne Defee cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 198.49.140.10 Sent: 8/30/2023 9:17:16 AM Viewed: 9/20/2023 10:50:24 AM Signed: 9/20/2023 10:50:50 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Sara Hensley sara.hensley@cityofdenton.com City Manager City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 9/20/2023 10:50:52 AM Viewed: 9/20/2023 11:31:06 AM Signed: 9/20/2023 11:31:16 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Jesus Salazar jesus.salazar@cityofdenton.com Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 9/20/2023 11:31:18 AM Viewed: 9/20/2023 12:27:29 PM Signed: 9/20/2023 12:28:49 PM Electronic Record and Signature Disclosure: Accepted: 9/20/2023 12:27:29 PM ID: a8f221ef-420a-4497-9b6f-a2854e69fe80 In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Cheyenne Defee cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Sent: 8/28/2023 8:37:30 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Gretna Jones gretna.jones@cityofdenton.com Legal Secretary City of Denton Security Level: Email, Account Authentication (None) Sent: 8/30/2023 9:17:15 AM Viewed: 8/30/2023 9:17:48 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign City Secretary Office citysecretary@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 9/20/2023 12:28:52 PM Viewed: 9/20/2023 1:56:29 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign LINDA KILE LINDA.KILE@CITYOFDENTON.COM Benefits Supervisor Risk Management - HR Security Level: Email, Account Authentication (None) Sent: 9/20/2023 12:28:53 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/28/2023 8:36:49 AM Certified Delivered Security Checked 9/20/2023 12:27:29 PM Signing Complete Security Checked 9/20/2023 12:28:49 PM Completed Security Checked 9/20/2023 12:28:53 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Denton (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through your DocuSign, Inc. (DocuSign) Express user account. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of this document. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. For such copies, as long as you are an authorized user of the DocuSign system you will have the ability to download and print any documents we send to you through your DocuSign user account for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. To indicate to us that you are changing your mind, you must withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your DocuSign account. This will indicate to us that you have withdrawn your consent to receive required notices and disclosures electronically from us and you will no longer be able to use your DocuSign Express user account to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through your DocuSign user account all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM Parties agreed to: Rachel Stetzer, Jesus Salazar How to contact City of Denton: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: purchasing@cityofdenton.com To advise City of Denton of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at melissa.kraft@cityofdenton.com and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address.. In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in DocuSign. To request paper copies from City of Denton To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an e-mail to purchasing@cityofdenton.com and in the body of such request you must state your e-mail address, full name, US Postal address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with City of Denton To inform us that you no longer want to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your DocuSign account, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may; ii. send us an e-mail to purchasing@cityofdenton.com and in the body of such request you must state your e-mail, full name, IS Postal Address, telephone number, and account number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process.. Required hardware and software Operating Systems: Windows2000? or WindowsXP? Browsers (for SENDERS): Internet Explorer 6.0? or above Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0, NetScape 7.2 (or above) Email: Access to a valid email account Screen Resolution: 800 x 600 minimum Enabled Security Settings: •Allow per session cookies •Users accessing the internet behind a Proxy Server must enable HTTP 1.1 settings via proxy connection ** These minimum requirements are subject to change. If these requirements change, we will provide you with an email message at the email address we have on file for you at that time providing you with the revised hardware and software requirements, at which time you will have the right to withdraw your consent. Acknowledging your access and consent to receive materials electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this disclosure and consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format on the terms and conditions described above, please let us know by clicking the 'I agree' button below. By checking the 'I Agree' box, I confirm that: • I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and • I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and • Until or unless I notify City of Denton as described above, I consent to receive from exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to me by City of Denton during the course of my relationship with you.