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HomeMy WebLinkAbout26-1733ORDINANCE NO. 26-1733 AN ORDINANCE OF THE CITY OF DENTON, A TEXAS HOME -RULE MUNICIPAL CORPORATION, AUTHORIZING THE CITY MANAGER TO EXECUTE A CONTRACT WITH SYMETRA LIFE INSURANCE COMPANY, FOR BASIC/SUPPLEMENTAL LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT AND VOLUNTARY SHORT-TERM AND GROUP LONG-TERM DISABILITY (COLLECTIVELY "LIFE AND DISABILITY") COVERAGE FOR CITY EMPLOYEES FOR THE HUMAN RESOURCES DEPARTMENT; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (RFP 9073 —AWARDED TO SYMETRA LIFE INSURANCE COMPANY, FOR THREE (3) YEARS, WITH THE OPTION FOR TWO (2) ADDITIONAL ONE (1) YEAR EXTENSIONS, IN THE TOTAL FIVE (5) NOT -TO -EXCEED AMOUNT OF $5,900,000.00). WHEREAS, the City has solicited, received, and evaluated competitive proposals for basic/supplemental life and accidental death and dismemberment and voluntary short-term and group long-term disability (collectively "Life and Disability") coverage for City employees for the Human Resources Department; and WHEREAS, the City Manager, or a designated employee, has received, reviewed, and recommended that the herein described proposals are the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals; and WHEREAS, this procurement was undertaken as part of the City's governmental function; and WHEREAS, the City Council has provided in the City Budget for the appropriation of funds to be used for the purchase of the materials, equipment, supplies, or services approved and accepted herein; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. The items in the following numbered request for proposal for materials, equipment, supplies, or services shown in the "Request Proposals" on file in the office of the Purchasing Agent, are hereby accepted and approved as being the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals. RFP NUMBER CONTRACTOR AMOUNT 9073 Symetra Life Insurance Company $5,900,000.00 SECTION 2. That by the acceptance and approval of the above numbered items of the submitted proposals, the City accepts the offer of the persons submitting the proposals for such items and agrees to purchase the materials, equipment, supplies, or services in accordance with the terms, specifications, standards, quantities, and for the specified sums contained in the Proposal Invitations, Proposals, and related documents. SECTION 3. That should the City and person submitting approved and accepted items wish to enter into a formal written agreement as a result of the acceptance, approval, and awarding of the proposals, the City Manager, or their designated representative, is hereby authorized to execute the written contract which shall be attached hereto; provided that the written contract is in accordance with the terms, conditions, specifications, standards, quantities, and specified sums contained in the Proposal and related documents herein approved and accepted. SECTION 4. The City Council of the City of Denton hereby expressly delegates the authority to take any actions that may be required or permitted to be performed by the City of Denton under this ordinance to the City Manager of the City of Denton, or their designee. SECTION 5. By the acceptance and approval of the above enumerated bids, the City Council hereby authorizes the expenditure of funds therefor in the amount and in accordance with the approved bids. SECTION 6. This ordinance shall become effective immediately upon its passage and approval. The motion to approve this ordinance was made by Jill Jester and seconded by George Ferrie . The ordinance was passed and approved by the following vote [ - 0 1: Aye Nay Abstain Absent Mayor Chris Watts: Jordan Villarreal, District 1: Nick Stevens, District 2: y Suzi Rumohr, District 3: V_ Joe Holland, District 4: y George Ferric, At Large Place 5: y Jill Jester, At Large Place 6: y_ PASSED AND APPROVED this the 27th day of October , 2026. CHRIS WATTS, MAYOR ATTEST: KRISTI GILBERT, CITY SECRETARY APPROVED AS TO LEGAL FORM: MACK REINWAND, CITY ATTORNEY BY: l3ua� Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 I CITY OF DENTON Docusign City Council Transmittal Coversheet RFP 9073 File Name 9073 - LTD, STD, and AD&D Purchasing Contact Christina Dormady City Council Target Date Piggy Back Option "o Contract Expiration Ordinance Initial Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 RENEWAL AMENDMENT TO CONTRACT BETWEEN CITY OF DENTON, TEXAS AND SYMETRA LIFE INSURANCE COMPANY (Contract #9073) This Renewal Amendment to Contract (Contract 9073) (this Amendment) is entered into between the City of Denton, Texas (City) and SYMETRA LIFE INSURANCE COMPANY(Supplier). Background The City and Supplier have previously entered into Contract (8239), as amended (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, 2027. 2 Contract Term Section 2 of Renewal Amendment Number 1 to Contract will be deleted and replaced in its entirety with the following: 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 Amendment shall commence upon the issuance of a Notice of Award by the City of Denton and shall automatically renew each year, from the date of award by City Council. The Supplier's request to not renew the contract must be submitted in writing to the Purchasing Manager at least 60 days prior to the contract renewal date for each year. At the sole option of the City of Denton, the Contract may be further extended as needed, not to exceed a total of six (6) months. 3 Fee Schedule/Contractor's Proposal Attachment 1 to this Amendment includes the Underwriting Renewal Worksheet. This Attachment 1 shall supersede Exhibit B of the Agreement. 4 Total Contract Amount The contract total for the continued services shall not exceed $5,900,000. 5 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 9073. 6 Insurance Requirements Attachment 2 to this Amendment includes the Insurance Requirements. This Attachment 2 shall supersede Exhibit C of the Agreement. 7 RFP 9073 Documents City of Denton's RFP 9073 will be on file at the office of the Purchasing Agent and will replace RFP 8239 documents. 8 Attachment 3 Conflict of Interest Questionnaire. 9 Attachment 4 Certificate of Interested Parties, Form 1295. 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 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 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. IN WITNESS WHEREOF, the City and the Contractor, have each executed this Amendment, by and through their respective duly authorized representatives and officers on this date BY: CONTRACTOR Symetra Life Insurance Company DocuSigned by: Authorized Signa e-& 0ai/�t. 1134595A0991449... Printed Name: Keith Daigle Title: VP, Workforce Benefits Underwriting and Claims Email Adress: keith.daigle@symetra.com keith.daigle@symetra.com TEXAS ETHICS COMMISSION CERTIFICATE NUMBER BY: CITY OF DENTON, TEXAS Cassey Ogden, Interim City Manager ATTEST: KRISTI GILBERT, CITY SECRETARY :• APPROVED AS TO LEGAL FORM: MACK REINWAND, CITY ATTORNEY Signed by: 0/i�A, 17U..4A. 3A6254145BDA469... THIS AGREEMENT HAS BEEN BOTH REVIEWED AND APPROVED as to financial and operational obligations and business terms. Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Signed by: SAra, 66S OASj W V r. Deputy Director of Human Resources TITLE Human Resources DEPARTMENT Docusiqn Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Attachment 1 Final BAFO Pricing (Renewal) Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 =-L- SYMETRA RETIREMENT I BENEFITS I LIFE Symetra Group Life and Disability Insurance Proposal June 29, 2026 Presented to City of Denton Denton, TX Presented on behalf of McGriff, Seibels & Williams Proposed Contract Effective Date 1 /1 /2027 Any policy sold and issued in the State of New York is insured and underwritten by First Symetra National Life Insurance Company of New York, a New York -licensed insurer. Any policy sold and issued in any state other than the State of New York is insured and underwritten by Symetra Life Insurance Company, an Iowa -domiciled insurer that is licensed in all states except New York. Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Proposed Rates Lives Volume Rate per $1,000 Monthly Premium Annual Premium Basic Employee Life 1,714 $156,340,000 $0.020 $3,126.80 $37,521.60 - There are no Basic Employee Life commissions. - Basic Employee Life Rates are guaranteed for 3 years 7Employee Lives Volume Rate per $1,000 Monthly Premium Annual Premium AD&DD 1,714 $156,340,000 $0.010 $1,563.40 $18,760.80 - There are no Basic Employee AD&D commissions. - Basic Employee AD&D Rates are guaranteed for 3 years Active Employees Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 31 $2,940,000 $0.060 $175.96 $2,111.51 25 - 29 107 $10,530,000 $0.051 $540.19 $6,482.27 30-34 156 $20,290,000 $0.060 $1,214.36 $14,572.28 35-39 166 $21,390,000 $0.086 $1,828.85 $21,946.14 40 -44 166 $21,800,000 $0.145 $3,168.63 $38,023.56 45-49 171 $22,360,000 $0.231 $5,161.81 $61,941.67 50 - 54 126 $14,380,000 $0.410 $5,901.55 $70,818.62 55 - 59 93 $11,230,000 $0.667 $7,489.29 $89,871.44 60-64 53 $4,980,000 $0.889 $4,428.22 $53,138.59 65-69 11 $840,000 $1.402 $1,177.85 $14,134.18 70 - 74 4 $159,000 $2.462 $391.52 $4,698.26 75 + 0 $0 $4.104 $0.00 $0.00 Total 1,084 $130,899,000 $31,478.21 $377,738.52 Prepared by S Y M E T R A Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Proposed Rates Retirees Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 0 $0 $0.080 $0.00 $0.00 25 - 29 0 $0 $0.070 $0.00 $0.00 30 - 34 0 $0 $0.080 $0.00 $0.00 35 - 39 0 $0 $0.110 $0.00 $0.00 40 - 44 0 $0 $0.190 $0.00 $0.00 45 - 49 1 $10,000 $0.310 $3.10 $37.20 50 - 54 3 $30,000 $0.550 $16.50 $198.00 55 - 59 5 $50,000 $0.890 $44.50 $534.00 60-64 11 $110,000 $1.190 $130.90 $1,570.80 65 - 69 10 $100,000 $1.870 $187.00 $2,244.00 70 - 74 12 $120,000 $3.280 $393.60 $4,723.20 75+ 18 $180,000 $5.470 $984.60 $11,815.20 Total 60 $600,000 $1,760.20 $21,122.40 - There are no Supplemental Employee Life commissions. - Supplemental Employee Life Rates are guaranteed for 3 years .. 7 Lives Volume Rate per $1,000 Monthly Premium Annual Premium Employee 1,084 $130,898,485 $0.020 $2,617.97 $31,415.64 Spouse 477 $24,743,312 $0.020 $494.87 $5,938.39 Child 568 $5,680,000 $0.020 $113.60 $1,363.20 - There are no Supplemental AD&D commissions. - Supplemental AD&D Rates are guaranteed for 3 years Prepared by S Y M E T R A Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Proposed Rates Age Band Lives Volume Rate per $1,000 Monthly Premium Annual Premium < 25 2 $105,000 $0.060 $6.28 $75.41 25 - 29 19 $850,000 $0.051 $43.61 $523.26 30 - 34 53 $3,235,000 $0.060 $193.61 $2,323.38 35 - 39 67 $3,490,000 $0.086 $298.40 $3,580.74 40 - 44 87 $4,450,000 $0.145 $646.81 $7,761.69 45-49 94 $5,840,000 $0.231 $1,348.16 $16,177.97 50 - 54 61 $2,785,000 $0.410 $1,142.96 $13,715.57 55 - 59 53 $2,475,000 $0.667 $1,650.58 $19,806.93 60 - 64 32 $1,220,000 $0.889 $1,084.82 $13,017.89 65 - 69 5 $230,000 $1.402 $322.51 $3,870.07 70 - 74 4 $64,000 $2.462 $157.59 $1,891.12 75 + 0 $0 $4.104 $0.00 $0.00 Spouse Total 477 $24,744,000 $6,895.34 $82,744.03 Child 568 $5,680,000 $0.070 $397.60 $4,771.20 - There are no Supplemental Spouse & Child Life commissions. - Supplemental Spouse & Child Life Rates are guaranteed for 3 years . . Lives Volume Rate per $100 Monthly Premium Annual Premium Long Term Disability 1,673 $11,364,624 $0.090 $10,228.16 $122,737.94 - There are no Long Term Disability commissions. - Long Term Disability Rates based on $100 of monthly covered payroll - Long Term Disability Rates are guaranteed for 3 years Prepared by S Y M E T R A Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Proposed Rates Short Term Disability Age Band Lives Volume Rate Per $10 Monthly Premium Annual Premium < 25 18 $13,873 $0.261 $362.08 $4,344.96 25 - 29 73 $59,517 $0.279 $1,660.53 $19,926.39 30 - 34 95 $86,990 $0.252 $2,192.15 $26,305.78 35 - 39 114 $110,649 $0.243 $2,688.77 $32,265.27 40 - 44 110 $106,833 $0.270 $2,884.49 $34,613.90 45 - 49 122 $120,643 $0.279 $3, 365.94 $40, 391.26 50-54 93 $95,021 $0.333 $3,164.20 $37,970.42 55 - 59 69 $66,960 $0.423 $2,832.43 $33,989.12 60 - 64 43 $39,012 $0.513 $2,001.32 $24,015.83 65 - 69 14 $12,685 $0.576 $730.67 $8,768.02 70 - 74 6 1 $4,948 1 $0.576 1 $284.99 $3,419.86 75 + 0 $0 $0.576 $0.00 $0.00 Total 757 $717,132 $22,167.57 $266,010.80 - There are no Short Term Disability commissions. - Short Term Disability Rates based on $10 of weekly covered benefit - Short Term Disability Rates are guaranteed for 3 years Prepared by � S Y M E T R A 5 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Basic Employee Life and AD&D Insurance All full-time and part-time active employees meeting the minimum work Eligibility: hour requirement who are citizens or legal residents of the United States, excluding temporary, leased or seasonal employees Classes: Class 1: All Active Full Time Directors and Above Class 2: All Other Active Full -Time and Part -Time Employees Waiting Period (months): 0 Benefit Schedule: Class 1: 2.00 X Annual Earnings Class 2: 1.00 X Annual Earnings Benefit Maximum: Class 1: $500,000 Class 2: $300,000 Benefit Minimum: $15,000 Guaranteed Issue Amount: Class 1: $500,000 Class 2: $300,000 Disability Provision: Premium Waiver If Disabled Prior To Age 60 Premium Waiver Elimination Period: 9 Months Disability Duration: To SSNRA Accelerated Death Benefit %: 80% Combined Accelerated Death Benefit Maximum: Class 1: $500,000 Class 2: $400,000 Terminal Illness Period: 12 Months Or Less Definition of Earnings: Salary Rounding Method: Next Higher $1,000 Continuity of Coverage: Included Portability: Not Included Minimum Hour Requirement: 20 Employee Contribution: 0% Employer Contribution: 100% Current Participation Level: 100% Age Reduction: Original volume reduced to 65% @ age 70, 45% @ age 75, 30% @ age 80 Conversion: Included Prepared by S Y M E T R A 6 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 EmployeeBasic Classes: Class 1: All Active Full Time Directors and Above Class 2: All Other Active Full -Time and Part -Time Employees Benefit Schedule: Class 1: 2.00 X Annual Earnings Class 2: 1.00 X Annual Earnings Benefit Maximum: Class 1: $500,000 Class 2: $300,000 Benefit Minimum: $15,000 Guaranteed Issue Amount: Class 1: Match Maximum Benefit Amount Class 2: Match Maximum Benefit Amount Coverage Type: 24-hour coverage Common Carrier Benefit: Not Included Definition of Earnings: Salary Rounding Method: Next Higher $1,000 Continuity of Coverage: Included Minimum Hour Requirement: 20 Employee Contribution: 0% Employer Contribution: 100% Current Participation Level: 100% Age Reduction: Original volume reduced to 65% @ age 70, 45% @ age 75, 30% @ age 80 Conversion: Not Included Portability: Not Included Prepared by � S Y M E T R A Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 All full-time and part-time active employees meeting the minimum work Eligibility: hour requirement who are citizens or legal residents of the United States, excluding temporary, leased or seasonal employees Supplemental. . Classes: Class 1: All Active Full Time Directors and Above Class 2: All Other Active Full -Time and Part -Time Employees Class 3: Retirees Waiting Period (months): 0 Benefit Schedule: Class 1,2: Increments of $10,000 Class 3: Flat $10,000 Benefit Maximum: Class 1,2: The Lesser of 5 X Annual Earnings Or $200,000 Class 3: $10,000 Benefit Minimum: $0 Guaranteed Issue Amount: Class 1,2: $200,000 Class 3: $10,000 Disability Provision: Class 1,2: Premium Waiver If Disabled Prior To Age 60 Class 3: Death Benefit Only Premium Waiver Elimination Period: Class 1,2: 9 Months Class 3: Not Applicable Disability Duration: Class 1,2: To SSNRA Class 3: Does Not Apply Accelerated Death Benefit %: Class 1,2: 80% Class 3: 0% Combined Accelerated Death Benefit Maximum: Class 1,2: $500,000 Class 3: $3,000 Terminal Illness Period: Class 1,2: 12 Months Or Less Class 3: None Definition of Earnings: Salary Rounding Method: Next Higher $1,000 Continuity of Coverage: Included Portability: Class 1,2: Included Class 3: Not Included Combined Portability Maximum: Class 1,2: $200,000 Employee Contribution: 100% Employer Contribution: 0% Current Participation Level: 63% Age Reduction: Class 1,2: Original volume reduced to 65% @ age 70, 45% @ age 75, 30 % @ age 80 Class 3: None Suicide Exclusion: 24 Months Conversion: Included Prepared by /Z S Y M E T R A 8 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Supplemental.. D:D Insurance Classes: Class 1: All Active Full Time Directors and Above Class 2: All Other Active Full -Time and Part -Time Employees Benefit Schedule: Class 1,2: Increments of $10,000 Benefit Maximum: Class 1,2: The Lesser of 5 X Annual Earnings Or $200,000 Benefit Minimum: Class 1,2: $0.00 Guaranteed Issue Amount: Class 1,2: Match Maximum Benefit Amount Coverage Type: Class 1,2: 24-Hour Coverage Common Carrier Benefit: Not Included Definition of Earnings: Class 1,2: Salary Rounding Method: Class 1,2: Next Higher $1,000 Continuity of Coverage: Class 1,2: Included Employee Contribution: Class 1,2: 100% Employer Contribution: 0% Age Reduction: Class 1,2: Original volume reduced to 65% @ age 70, 45% @ age 75, 30 % @ age 80 Conversion: Not Included Portability: Not Included Prepared by � S Y M E T R A Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 All full-time and part-time active employees meeting the minimum work Eligibility: hour requirement who are citizens or legal residents of the United States, excluding temporary, leased or seasonal employees Classes: IClass 1: All Active Full Time Directors and Above Class 2: All Other Active Full -Time and Part -Time Employees Spouse Benefit Schedule: Increments of $5,000 Spouse Benefit Maximum: Lesser of 50% of the employee's life benefit or $100,000 Spouse Guarantee Issue: $50,000 Terminal Illness Period: 12 Months Or Less Rounding Method: Next Higher $1,000 Spouse Age Reduction: Original volume reduced to 65% @ age 70, 45% @ age 75, 30% @ age 80 Continuity of Coverage: Included Spouse Portability: Included Spouse Portability Maximum: $100,000 Conversion: Included Child Benefit Schedule: Flat Benefit Amount Child Benefit Maximum: $10,000 Child Guarantee Issue: Match The Benefit Max Quoted Benefit Start Age: Live Birth Benefit End Age: 26 Child Portability: Included Child Portability Maximum: $10,000 Conversion: Included Supplemental..AD&D Spouse Benefit Amount: Insurance Increments of $5,000 Spouse Benefit Maximum Amount: $100,000 Spouse Benefit Minimum Amount: $0 Spouse Age Reduction: Original volume reduced to 65% @ age 70, 45% @ age 75, 30% @ age 80 Child Benefit Amount: Equal to Supplemental Child Life Benefit Schedule Child Benefit Maximum Amount: $10,000 Child Benefit Minimum Amount: $0 Coverage Type: 24-Hour Coverage Common Carrier Benefit: Not Included Definition of Earnings: Salary Rounding Method: Next Higher $1,000 Continuity of Coverage: Included Employee Contribution: 100% Employer Contribution: 0% Conversion: Not Included Portability: Not Included Prepared by ;= S Y M E T R A 10 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Continuity of Coverage If included on the schedule page for takeover coverage, Symetra's "enhanced" Continuity of Coverage provision covers individuals who are not actively at work on the policy effective date but who are otherwise eligible under our policy, in accordance with the following guidelines: • Their coverage was in force under the prior plan on the day before the Symetra policy effective date; and -[Required premium was paid under the prior plan on the day before the Symetra policy effective date; and •❑gwaiver of premium disability claim was not previously approved by the prior carrier. Individuals who have previously been approved for waiver of premium will retain life insurance protection under the prior carrier's policy. The group life insurance provided under the Continuity of Coverage provision is equal to the lesser of the coverage amount under the prior plan or the coverage amount under the Symetra plan for the applicable class and coverage type, as shown on the schedule page, reduced by any coverage amount that is in force, paid or payable under the prior policy or that would have been so payable under the prior policy had timely election been made. Such amount of insurance under this provision is subject to any reductions included within the Symetra policy and will not increase. Suicide Exclusion If a suicide exclusion is included on the schedule page, we will not pay any amount of life insurance for the deceased person which was elected or became effective within the time period, as noted on the schedule page, immediately prior to the date of death. This applies to initial coverage and increases in coverage for employees and dependents, but does not apply to benefit increases that resulted solely due to an increase in earnings. For takeover cases, this exclusionary time period includes the time group life insurance coverage was in force under the prior policy. Age Reductions The age reduction schedule, if applicable, will be listed on the schedule page. Note that compliance with the Age Discrimination in Employment Act of 1967 (ADEA), as amended, is the responsibility of the employer. Please consult your legal counsel to determine if this reduction schedule complies with ADEA guidelines and other applicable laws. Evidence of Insurability We require satisfactory Evidence of Insurability for initial coverage, if the insured individual: • Enrolls as a late entrant (which is usually defined as enrolling more than 31 days after the date they are first eligible to enroll), including electing initial coverage after a Change in Family Status; • Enrolls for an amount of Life Insurance greater than the Guaranteed Issue Amount, if applicable and as noted on the schedule page, regardless of when they enroll for coverage; or • [Was eligible for any coverage under the prior policy, but did not enroll and later chooses to enroll for that coverage under Symetra's policy. Evidence of Insurability is also required for an increase in coverage, except that increases in coverage for a times - earnings plan due solely to an increase in earnings does not require evidence of insurability if the amount of life coverage is less than the Guaranteed Issue Amount. Once evidence of insurability has been approved for amounts at or above the Guaranteed Issue Amount, we will require Evidence of Insurability again due solely to increases in the insured's earnings only: • It the amount of life insurance is greater than the Guaranteed Issue Amount; and • Mould increase solely because the individual's earnings increased more than $25,000 during the last 12 consecutive month period or since their Evidence of Insurability was last approved, whichever occurred most recently. Prepared by ;:W S Y M E T R A 11 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Accelerated Death Benefit We will pay an Accelerated Benefit amount in the event that an insured individual (or Dependent, as applicable) is diagnosed as Terminally III and requests in writing that a portion of the Terminally III person's amount of Life Insurance be paid as an Accelerated Benefit. The Accelerated Benefit is only payable if the Terminally III person is covered under the policy for an amount of Life Insurance of at least $10,000 and is under age 60. The minimum amount of Accelerated Benefit that may be requested is usually $3,000, while the maximum amount and maximum percentage is included on the schedule page. The amount of Life Insurance payable upon the Terminally III person's death will be reduced by any Accelerated Benefit Amount paid under this benefit. Dependent Coverage If Dependent Life coverage is included on the schedule page, this is a reminder that an insured individual may not elect coverage for their dependent if such dependent is already covered as an insured individual under the policy. No person can be insured as a dependent of more than one individual under the policy. Dependent Non -Confinement Requirement Initial coverage, new coverage, or increases in coverage for dependents is subject to our non -confinement requirement; coverage will be deferred until they are no longer confined and they have the ability to engage in all the normal and customary activities of a person of like age and gender, in good health, for at least 15 consecutive days. This does not apply to disabled children who qualify under the definition of Dependent Children. Continuity of Coverage will apply on the policy effective date for initial coverage for Dependents, without a deferred effective date, if they were covered as a dependent under the prior policy on the day before the Symetra policy effective date and required premium was paid under the prior plan on the day before the Symetra policy effective date. Prepared by ;:ML S Y M E T R A 12 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 If the insured sustains an injury which results in any of the following losses within 365 days of the date of accident, we will pay the injured person's amount of Principal Sum or a portion of such Principal Sum, as shown opposite the loss after we receive Proof of Loss in accordance with the Proof of Loss provision. No more than the Principal Sum will be paid to any one person, for all losses due to the same accident. Accidental Loss Of: Life Both hands or both feet or sight of both eyes One hand and one foot Speech and hearing in both ears Either hand or foot and sight of one eye Movement of both upper and lower limbs (Quadriplegia) Movement of both lower limbs (Paraplegia) Movement of three limbs (Triplegia) Movement of the upper and lower limbs of one side of the body (Hemiplegia) Either hand or foot Sight of one eye Speech or hearing in both ears Movement of one limb (Uniplegia) Thumb and index finger of either hand Additional Benefits: Seatbelt Airbag Repatriation Exposure and Disappearance Benefit Amount of Principal Sum Payable: 100% 100% 100% 100% 100% 100% 75% 75% 50% 50% 50% 50% 25% 25% Percent Maximum 10.0% $10,000 5.0% $5,000 5.0% $5,000 Included Prepared by � S Y M E T R A 13 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 The Policy does not cover any Loss caused or contributed by: 1) Intentionally self-inflicted Injury; 2) Suicide or attempted suicide, whether sane or insane; 3) War or act of war, whether declared or not; 4) Injury sustained while on full-time active duty as a member of the armed forces (land, water, air) of any country or international authority; 5) Injury sustained while on any aircraft except a Civil or Public Aircraft, or Military Transport Aircraft; 6) Injury sustained while on any aircraft: a) as a pilot, crewmember or student pilot; b) as a flight instructor or examiner; c) if it is owned, operated or leased by or on behalf of the Policyholder,or any Employer or organization whose eligible persons are covered under The Policy; d) being used for tests, experimental purposes, stunt flying, racing or endurance tests; 7) Injury sustained while taking drugs, including but not limited to sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless as prescribed by or administered by a Physician; 8) Injury sustained while riding or driving in a scheduled race or testing any Motor Vehicle on tracks, speedways or proving grounds; 9) Injury sustained while committing or attempting to commit a felony; 10) Injury sustained while Intoxicated; or 11) Injury sustained while driving while Intoxicated. Intoxicated means: 1) the blood alcohol content; 2) the results of other means of testing blood alcohol level; or 3) the results of other means of testing other substances; that meet or exceed the legal presumption of intoxication, or under the influence, under the law of the state where the accident occurred. Prepared by � S Y M E T R A 14 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 All full-time active employees working minimum of 20 hours per week Eligibility: Employee means a person who is a citizen or permanent resident of the United States, excluding all temporary and seasonal employees Classes: JAII Active Full -Time and Part -Time Employees Waiting Period (months): 0 months Benefit Type: Variable Benefit Percent: 60% Maximum Weekly Benefit: $1,200 Minimum Weekly Benefit: $25 Accident Elimination Period (Days): 14 Sickness Elimination Period (Days): 14 Maximum Payment Duration (Weeks): 11 Definition of Disability: Regular Occ Partial Coverage Basis: Non Occ Coverage First Day Hospital: No: Inpatient Contributory: Contributory Employer Contribution Percent: 0% Employee Contribution Percent: 100% Premium Contributions: Post Tax Current Participation Level: 44% Pre -Existing Condition Exclusion: None inforce - a 3/12 pre -ex exclusion will apply to the 1/1/27 open enrollment Pay Employer FICA: No Pre -Disability Earnings: Base Salary Return to Work Incentive: Included Reasonable Employment Option: Included Integration Method: IDirect Prepared by � S Y M E T R A 15 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Actively at Work: If an individual is not in active employment, their coverage will be effective on the date they return to active employment. This applies to initial coverage, as well as any increases or additions to coverage occurring after initial coverage is effective. Active employment means an individual is working for you at your work site for earnings you pay on a regular basis and performing the material and substantial duties of their regular occupation. Active employment includes normal non -work days such as vacation, weekends and holidays. Continuity of Coverage: Actively at Work on the Policy Effective Date: For takeover coverage, Symetra standardly includes Continuity of Coverage for the active employment provision which covers employees who are not in active employment but who are otherwise eligible under our policy on the policy effective date, in accordance with the following guidelines: • Their coverage was in force and required premium was paid under the prior plan on the day before the Symetra policy effective date; and • The disability begins while they are insured under our policy, subject to all the terms and provisions of our policy. The group disability insurance provided under the Continuity of Coverage rules for the Symetra policy is limited to the weekly amount that the prior plan would have paid if the prior plan had stayed in effect, reduced by the amount the prior plan is responsible for paying. Elimination Period: The STD benefit is payable after the satisfaction of the elimination period listed on the schedule page. The elimination period is a period of continuous days of disability (trial work days may be available). The elimination period begins on the first day of disability. Disabled/Disability: The definition of disability is listed on the schedule page; options include Total, Partial, or Residual Disability, as follows: Total Disability means our determination that the insured's sickness or injury: • Prevents them from performing with reasonable continuity the material and substantial duties of their regular occupation; and • as a result, they are not working at all, or they are working and the income they are able to earn is less than or equal to 20% of their pre -disability earnings. Partial Disability means our determination that the insured's sickness or injury: • During the elimination period, prevents them from performing with reasonable continuity the material and substantial duties of their regular occupation; and as a result, they are not working at all, or they are working but the income they are able to earn is less than or equal to 20% of their pre -disability earnings. • After the elimination period, prevents them from performing with reasonable continuity the material and substantial duties of their regular occupation; and as a result, the income they are able to earn is less than or equal to 80% of pre -disability earnings. Residual Disability means our determination that the insured's sickness or injury: • Prevents them from performing with reasonable continuity the material and substantial duties of their regular occupation; and • as a result, the income they are able to earn is less than or equal to 80% of their pre -disability earnings. Please note that a Reasonable Employment Option offered to the insured by the employer may be included within the definition of disability to expand rehabilitation possibilities, and Own Job may be used in place of Regular Occupation for an additional cost. Please refer to the schedule page for details of the applicable definition of disability. Prepared by � S Y M E T R A 16 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Return to Work Incentive: Partial and Residual definitions of disability include an unlimited return to work incentive in the STD benefit calculation to encourage disabled individuals to return to work. This means that if the insured is working while disabled, no offset will be taken for other income amounts (which includes income from employment), until the sum of the gross weekly benefit and other income amounts exceeds 100% of pre -disability earnings. Exclusions and Limitations: We will not cover a disability if it is due to: • War, declared or not, or any act of war; • Intentionally self-inflicted injuries or illness, while sane or insane; • Active participation in a riot; • Attempt to commit or commission of a felony under federal or state law, or being engaged in an illegal occupation; • Service in the armed forces, military reserves or National Guard of any country or International authority, or in a civilian unit serving with such forces; • Cosmetic or reconstructive surgery, except for complications arising from any such surgery or for surgery necessary to correct a deformity caused by accidental injury or sickness; • An accident resulting from or caused by operation of a motor vehicle while intoxicated according to the laws of the jurisdiction where the accident occurred; • A pre-existing condition, but only if a pre-existing condition exclusion is included on the schedule page; or • An accident resulting from or caused by being under the influence of drugs or any controlled substance, unless taken as prescribed by the insured's doctor. And, if the Coverage Basis on the schedule page is "Non Occ Coverage," the following two exclusions also apply: • An injury arising out of, or in the course of, any work for wage or profit; or • A sickness for which the insured is entitled to benefits under any Workers' Compensation Act, Occupational disease law, Compulsory Benefit Act or law or similar law, unless the insured is a partner or sole proprietor not covered by any of these acts or laws; No benefits are payable for any period of disability during which the insured is incarcerated in a penal or correctional facility for a period of 30 or more consecutive days or for which the insured is not under the regular care of a doctor. Pre -Existing Condition Exclusion If a Pre -Existing Condition Exclusion is included on the schedule page, a Pre -Existing Condition is defined as a sickness or injury for which the insured received treatment within the "look -back" period prior to the insured's effective date of coverage. Disabilities due to a pre-existing condition will be excluded for the "exclusionary" period. For example, if a "3/12" Pre -Existing Condition Exclusion is included on the schedule page, the "Y would mean a 3 month "look -back" period and the "12" would mean a 12 month "exclusionary" period. Please note that "Prudent person" wording may be included within the definition of pre-existing condition and if so, would be noted on the schedule page. Pre-existing condition exclusions and limitations, like all benefits and provisions, are subject to state - required variations and restrictions. Prepared by ;= S Y M E T R A 17 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Continuity of Coverage for Pre-existing Conditions: For takeover coverage, Continuity of Coverage will be included for pre-existing conditions to give credit to eligible individuals on our policy effective date for any period of time the individuals were continuously covered under the prior plan if: • Their coverage was in force under the prior plan on the day before the Symetra policy effective date; and • Required premium was paid under the prior plan on the day before the Symetra policy effective date; and • The individual is in active employment and insured under our plan continuously from the Symetra policy effective date. We will consider the total amount of time the individual was continuously covered under both plans in order to determine if the pre-existing condition provision of the prior plan or our plan is satisfied. If Continuity of Coverage applies and one of the pre-existing condition provisions has been satisfied, we will cover a person for a disability in accordance with the following guidelines: • Disability, which is caused or contributed by a pre-existing condition, begins while they are insured under our policy; and • Coverage is subject to all the terms and provisions of our policy, but the amount of insurance will not be more than the STD maximum benefit under the prior plan and it will end on the earlier of the date benefits would have ended under the prior plan, had that plan stayed in effect, or the end of the maximum benefit duration of our plan. Integration Method: One of the following integration methods will be applicable, as indicated on the schedule page: • Direct integration: Offsets for other income amounts are subtracted from the gross weekly benefit. • Not Integrated: The gross weekly benefit will not be reduced by other income amounts. Offsets for Other Income Amounts, including offset for Social Security: The insured's gross weekly benefit will be reduced by any other income amounts the insured receives or is eligible to receive, including any disability or retirement benefits from Social Security. If a "Family" Social Security Offsets are noted on the schedule page, other income amounts also include amounts that the insured's spouse and dependent children receive or are eligible to receive as a result of the insured's disability. Other income amounts also standardly include, but are not limited to, benefits the insured receives or is eligible to receive from any disability income benefits under any compulsory benefit act or law; any group insurance plan with the employer or with an association; any benefits received from the employer's sick leave or formal salary continuation plan; unemployment benefits; workers compensation benefits; and any income the insured earns or receives from any form of employment, including any income the insured could have earned while disabled by working to maximum capacity, even if the insured does not do so. Refer to the Policy or contact Symetra for more details on the offsets taken for other income amounts. State Variations: Please note that all benefits and provisions may be subject to state -required variations and restrictions. The wording included within the STD Terms pages is generic and is included for informational purposes. Filed and approved state wording will be included in any issued policy according to the sold plan design and policy issue state. Prepared by � S Y M E T R A 18 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Long Term Disability Insurance All full-time active employees working at least 30 hours per week Eligibility: Employee means a person who is a citizen or permanent resident of the United States, excluding all temporary and seasonal employees Classes: Class 1: All Active Full -Time Police, Non -Civil Fire, and Regular Employees Class 2: All Active Full -Time Civil Service Fire Employees Waiting Period: 0 Months Benefit Percent: 60% Maximum Monthly Benefit: $5,200.00 Minimum Monthly Benefit: The Greater of $100 or 10% of Gross Monthly Benefit Elimination Period (Days): 90 Days Maximum Payment Duration: 5 Years / RBD Definition of Disability: 24 month Own Occ Partial / Residual: Residual Own Occ / Any Occ Earnings Test: 80/60% Return to Work Incentive: 12 Months Integration Method: Class 1: Direct Class 2: Indirect Social Security Offset: Class 1: Family Class 2: 70% All Sources Pre -Existing Condition Exclusion: 3/12 Lump Sum Survivor Benefit: 100% Gross 3 Months Mental Illness Limitation 24 Months Substance Abuse Limitation: 24 Months Special Conditions Limitation: Unlimited Lifetime / Per Occurrence: Per Lifetime Indexation: Class 1: Yes Class 2: No Dependent Care Benefit (total for all Family Members): 350 / 12 months Personal Care Benefit: Not Included Extended Care Benefit: Not Included Education Benefit: Not Included Rehabilitation Program Benefit: Not Included Pension Supplement Percent: Not Included Pension Supplement Max: Not Included COLA: Not Included Additional Catastrophic: Not Included Workplace Modification: Not Included Contribution Method: Non Contributory Employee Contribution Percent: 0% Employer Contribution Percent: 100% Current Participation Level: 100% Recurrent Disability: 6 Months Waiver of Premium: Included Conversion Privilege: Not Included Prepared by S Y M E T R A 19 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Pre -Disability Earnings: Base Salary Partial Disability Formula (Post Incentive Period): Proportionate Loss Vocational Rehabilitation Participation: Voluntary Reasonable Employment Option: Included Prepared by � S Y M E T R A 20 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Actively at Work: If an individual is not in active employment, their coverage will be effective on the date they return to active employment. This applies to initial coverage, as well as any increases or additions to coverage occurring after initial coverage is effective. Active employment means an individual is working for you at your work site for earnings you pay on a regular basis and performing the material and substantial duties of their regular occupation. Active employment includes normal non -work days such as vacation, weekends and holidays. Continuity of Coverage: Actively at Work on the Policy Effective Date: For takeover coverage, Symetra standardly includes Continuity of Coverage for the active employment provision which covers employees who are not in active employment but who are otherwise eligible under our policy on the policy effective date, in accordance with the following guidelines: • Their coverage was in force and required premium was paid under the prior plan on the day before the Symetra policy effective date; and • The disability begins while they are insured under our policy, subject to all the terms and provisions of our policy. The group disability insurance provided under the Continuity of Coverage rules for the Symetra policy is limited to the monthly amount that the prior plan would have paid if the prior plan had stayed in effect, reduced by the amount the prior plan is responsible for paying. Elimination Period: The LTD benefit is payable after the satisfaction of the elimination period listed on the schedule page. The elimination period is a period of continuous days of disability (trial work days are available to encourage the individual to try to return to work). The elimination period begins on the first day of disability. Disabled/Disability: The definition of disability is listed on the schedule page. Options include: • Extended Own Occ: The definition of disability looks at the insured's inability to perform with reasonable continuity the material and substantial duties of their regular occupation (which is often referred to as "Own Occ") during the entire maximum benefit duration; or • Limited Own Occ: The definition of disability looks at the insured's ability to perform with reasonable continuity the material and substantial duties of their regular occupation (which is often referred to as "Own Occ") during the elimination period and for the number of months indicated on the schedule page, and then for the remainder of the maximum benefit duration, looks at the insured's ability to perform any gainful occupation (which is often referred to as "Any Occ") for which the insured's past training, education, or experience would allow them to perform or for which they can be trained. Partial or Residual Disability: The schedule page will also indicate if the definition of disability includes Partial or Residual Disability: • Partial Disability: During the elimination period, the insured must be "totally disabled" and not working at all, or working but unable to earn more than 20% of pre -disability earnings. Thereafter, the insured can earn up to the earnings test percentage(s) and still be considered disabled. • Residual Disability: The insured can earn up to the earnings test percentage(s) and still be considered disabled, during both the elimination period and maximum benefit duration. Earnings Test: The schedule page includes the Own Occ and, if applicable, Any Occ earnings tests. The earnings test is the maximum percentage of earnings that an individual can earn while disabled and still be considered to be disabled. Please note that a Reasonable Employment Option offered to the insured by the employer may be included within the Own Occ portion of the definition of disability to expand rehabilitation possibilities, and other optional definitions of disability may be available. Please refer to the schedule page for details of the applicable definition. Prepared by � S Y M E T R A 21 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Return to Work Incentive: All definitions of disability include a return to work incentive period (for the number of months noted on the schedule page, if applicable) in the LTD benefit calculation to encourage disabled individuals to return to work. This means that if an insured is working while disabled during the incentive period, no offset will be taken for other income amounts (which includes income from employment), until the sum of the gross monthly benefit and other income amounts exceeds 100% of pre -disability earnings. Exclusions and Limitations: We will not cover a disability if it is due to: • War, declared or not, or any act of war; • Intentionally self-inflicted injuries or illness, while sane or insane; • Active participation in a riot; • Attempt to commit or commission of a felony under federal or state law, or being engaged in an illegal occupation; • Service in the armed forces, military reserves or National Guard of any country or International authority, or in a civilian unit serving with such forces; • Cosmetic or reconstructive surgery, except for complications arising from any such surgery or for surgery necessary to correct a deformity caused by accidental injury or sickness; • An accident resulting from or caused by operation of a motor vehicle while intoxicated according to the laws of the jurisdiction where the accident occurred; • A pre-existing condition, as noted on the schedule page; or • An accident resulting from or caused by being under the influence of drugs or any controlled substance, unless taken as prescribed by the insured's doctor. No benefits are payable for any period of disability during which the insured is incarcerated in a penal or correctional facility for a period of 30 or more consecutive days or for which the insured is not under the regular care of a doctor. Pre -Existing Condition Exclusion: A Pre -Existing Condition is defined as a sickness or injury for which the insured received treatment within the "look - back" period prior to the insured's effective date of coverage. Disabilities due to a pre-existing condition will be excluded for the "exclusionary" period. For example, if a "3/12" Pre -Existing Condition Exclusion is included on the schedule page, the "Y would mean a 3 month "look -back" period and the "12" would mean a 12 month "exclusionary" period. If the schedule page includes a Pre -Existing Condition Exclusion with three numbers, such as a "3/6/12," the "6" would mean a 6 month "treatment - free" period, which means we'd cover the disability if caused or contributed to by a pre-existing condition if the insured has gone at least 6 months after the effective date of coverage under our policy without receiving treatment for the condition. Please note that "prudent person" wording may be included within the definition of Pre -Existing Condition if allowed in the state of policy issue and if so, would be noted on the schedule page. Prepared by � S Y M E T R A 22 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Mental Illness, Substance Abuse and Special Conditions Limitations: Any limitations on the duration of benefits for disabilities caused or contributed to by certain conditions, such as Mental Illness, Substance Abuse, or Special Conditions, will be noted on the schedule page. If a limitation is applicable, the number of months for the maximum duration of benefits for that condition will be specified. If no limitation is applicable, it will be noted as "Unlimited" on the schedule page. The limitation will apply on a Per Lifetime or Per Occurrence basis, as indicated on the schedule page. For Per Lifetime limitations, the limitation period will be applied on a combined basis for all limited conditions. Continuity of Coverage for Pre-existing Conditions: For takeover coverage, Continuity of Coverage will be included for pre-existing conditions to give credit to eligible individuals on our policy effective date for any period of time the individuals were continuously covered under the prior plan if: • Their coverage was in force under the prior plan on the day before the Symetra policy effective date; and • Required premium was paid under the prior plan on the day before the Symetra policy effective date; and • The individual is in active employment and insured under our plan continuously from the Symetra policy effective date. We will consider the total amount of time the individual was continuously covered under both plans in order to determine if the pre-existing condition provision of the prior plan or our plan is satisfied. If Continuity of Coverage applies and one of the pre-existing condition provisions has been satisfied, we will cover an insured individual in accordance with the following guidelines: • Disability, which is caused or contributed by a pre-existing condition, begins while they are insured under our policy; and • Coverage is subject to all the terms and provisions of our policy, but the amount of insurance will not be more than the LTD maximum benefit under the prior plan and it will end on the earlier of the date benefits would have ended under the prior plan, had that plan stayed in effect, or the end of the maximum benefit duration of our plan. Integration Method: One of the following integration methods will be applicable, as indicated on the schedule page: • Direct: Offsets for other income amounts are subtracted from the gross monthly benefit. • All Sources: The benefit is the lesser of the monthly benefit calculated using the Benefit Percent shown on the schedule page, with no offsets, or the monthly benefit calculated using the All Sources percentage shown on the schedule page minus all other income amounts, including any income from employment. • Not Integrated: The gross monthly benefit will not be reduced by other income amounts. Offsets for Other Income Amounts, including offset for Social Security: The insured's gross monthly benefit will be reduced by any other income amounts the insured receives or is eligible to receive, including any disability or retirement benefits from Social Security. If "Family" Social Security Offsets are noted on the schedule page under the Social Security Offset, this means that other income amounts include amounts that the insured's spouse and dependent children receive or are eligible to receive as a result of the insured's disability. If "Primary" Social Security Offsets are noted on the schedule page under the Social Security Offset, other income amounts will include only amounts that the insured receives or is eligible to receive. Other income amounts also standardly include, but are not limited to, benefits the insured receives or is eligible to receive from any disability income benefits under any compulsory benefit act or law; any group insurance plan with the employer or with an association; any benefits received from the employer's sick leave or formal salary continuation plan; unemployment benefits; workers compensation benefits; and any income the insured earns or receives from any form of employment, including any income the insured could have earned while disabled by working to maximum capacity, even if the insured does not do so. Refer to the Policy or contact Symetra for more details on the offsets taken for other income amounts. Prepared by � S Y M E T R A 23 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 Partial Disability Formula (Post Incentive Period): For claimants who are partially or residually disabled, the benefit calculation that is applied after the Return to Work Incentive period will be identified on the schedule page. Options include the following: • Proportionate Loss, which means that the calculation used is "(A divided by B) x C" where A equals the insured's indexed pre -disability earnings minus any income from employment (as described in the other income amounts section), B equals the insured's indexed pre -disability earnings, and C equals the net monthly benefit the insured would have been eligible for if totally disabled and not working at all; or • 50% Work Earnings Offset, which means that only 50% of any income from employment (as described in the other income amounts section) is included as an offset. Workplace Modification Benefit: If included, this benefit reimburses the employer for up to 100% of reasonable costs the employer incurs, not to exceed the maximum amount noted on the schedule page, through modifications to the workplace to accommodate the return to work for a disabled insured who is receiving an LTD benefit from us. Vocational Rehabilitation: Provides vocational rehabilitation assistance to disabled insureds who are receiving an LTD benefit from us. These services may include vocational testing and training, job modifications, job placement, or other services we find reasonably needed to assist the individual in returning to active employment. We will determine the extent to which these services may be provided and will pay for these services with the service provider(s), unless we agree to other arrangements. The schedule page will clarify if the program is Mandatory or Voluntary: • Mandatory Vocational Rehabilitation Participation: If the insured's doctor approves the rehabilitation program we have designed but the insured does not complete their responsibilities under the program, then we may discontinue our payments, unless there is good cause for the non -participation. • Voluntary Vocational Rehabilitation Participation: The insured can choose to participate in the program or not, with no effect on payment of disability benefits. Social Security Assistance: Provides advice and assistance to a disabled insured regarding their disability claim and assist them with their application for Social Security disability benefits or an appeal. State Variations: Please note that all benefits and provisions may be subject to state -required variations and restrictions. The wording included within the LTD Terms pages is generic and is included for informational purposes. Filed and approved state wording will be included in any issued policy according to the sold plan design and policy issue state. Prepared by � S Y M E T R A 24 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 • Symetra's proposal is subject to the qualifications and deviations identified below. Our proposal assumes that all of the preceding information is accurate and correct, to the best of the prospective client's knowledge and belief. If any information is inaccurate or incorrect, we reserve the right to adjust pricing accordingly, withdraw this proposal from consideration or rescind coverage. • This quote assumes a situs state of TX and an SIC code of 9111. • By delivering this proposal for coverage, the producer represents and warrants to Symetra that each of the producer and any other person and entity acting with or on behalf of the producer in the sale or solicitation of such coverage maintains such insurance producer licenses and appointments as are required by each state in which the coverage has been or will be solicited, and in all states in which the policy(ies) will be issued (including any states in which a statutory disability policy may be issued). This proposal is authorized for delivery only if the foregoing representation and warranty is true and correct. • As compensation for the promotion, sale or renewal of the products and services offered in this proposal, Symetra may pay the selling broker or agency commissions, administrative service fees or bonuses that may be based on factors such as total premium volume written with Symetra, persistency levels, and the overall profitability of the business placed with Symetra. The cost of this compensation may be directly or indirectly reflected in the premium or service fees Symetra collects, and will be included in ERISA Form 5500, Schedule A information provided by Symetra, if applicable. For further details, please contact the agent or broker that represents you. • Life Insurance standard Value -Added Services include the following Symetra Support services: - Beneficiary Assistance provides compassionate support to help with paperwork, notifications and other time- consuming details in the event of the loss of a loved one. - Identity Theft Assistance provides guidance and services in the event that identity theft occurs. - Travel Assistance provides pre -trip planning information and assistance, medical assistance and transport services, and emergency travel services and other assistance due to medical issues and emergencies that may occur when the covered person is on a trip 100 miles or more from home lasting 90 days or less. - Estate Planning Services - a simple, secure and affordable online tool that allows insureds to decide what documents they need, from a last will & testament, living will and healthcare power of attorney forms, financial power of attorney form, and/or final arrangements, for, at most, a minor additional fee. - Empathy (Effective 3/1/2026) - provides enhanced bereavement care and dedicated grief support including legacy planning, probate and estate settlement, tax guidance, funeral planning and grief support. - Value -Added Services are not available in all states and may be presented as optional, subject to a fee that is separate from the insured rates. • STD and LTD Insurance standard Value -Added Services include the following services: - Employee Assistance Program (EAP) finds the resources employees and their family members need to help with a variety of issues, such as finding child or elder care, managing a serious illness or dealing with work/life issues, and provides access to confidential counseling, financial information and resources, and legal support. - Well -Being Coaching empowers clients to discover and reflect on aspects of their well-being that are most important to them. Services offer holistic one-on-one support for a variety of issues. - Computerized Cognitive Behavioral Therapy (CCBT) provides a digital program available by mobile app, tablet or desktop offering guided programs to help reduce personal roadblocks, whenever and wherever needed. - Value -Added Services are not available in all states and may be presented as optional, subject to a fee that is separate from the insured rates. • Value -Added Services may not standardly be included in all states. • The Value -Added Services are provided by third party vendors in a non-discriminatory manner and the cost is reasonable in comparison to the overall premium paid by the policyholder. The policyholder will be provided with contact information to assist employees with questions regarding these services. • Any policy sold and issued in the State of New York is insured and underwritten by First Symetra National Life Insurance Company of New York, a New York -licensed insurer. Any policy sold and issued in any state other than the State of New York is insured and underwritten by Symetra Life Insurance Company, an Iowa -domiciled insurer that is licensed in all states except New York. Prepared by � S Y M E T R A 25 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 • All rates assume a non -participating financial arrangement. • Unless otherwise stated, this quote assumes all eligible employees are citizens or legal residents in the United States, and on the U.S. payroll. • The following conditions will apply if Symetra agrees to provide coverage to employees residing outside of the United States after receiving and reviewing the total exposure and risk. a. Symetra will conduct all business and administrative communications in U.S. English. b. All benefits must be calculated, reported and specified in U.S. dollars, and Symetra will make all benefits payable in U.S. dollars. c. Symetra will make all benefits payable to the covered person and/or his or her designated beneficiary. Symetra will not make payments of supplemental health benefits to a provider located outside of the U.S. Unless otherwise indicated to the covered person and/or his or her designated beneficiary in writing, Symetra will not withhold the amount of any taxes from the benefit amount, will not perform any regulatory tax reporting and will not remit any amounts to taxing authorities. d. Symetra may require, in its sole discretion, any evidence submitted in respect of a claim submitted by a covered person working outside the United States for an extended period of time to be translated by the U.S. Embassy and contain the U.S. Embassy seal. Symetra shall bear no expenses incurred in respect of such translation. Failure to comply could result in declination of the claim. e. For short term disability and long term disability quotes, Symetra may require, in its sole discretion, any person receiving disability income benefits while outside the United States for an extended period of time to return to the United States at a frequency that Symetra deems necessary to substantiate the claim. Symetra shall bear no expenses incurred in respect of such travel. Failure to comply could result in declination of the claim. • This quote assumes that the employer's benefit plan is governed by ERISA. • The grace period for premium payment is 31 days unless otherwise required by state law. • Policies and certificates of insurance will be delivered electronically as PDF attachments. A fee may apply for printing and delivery of paper certificates if requested. The policyholder may not modify the electronic certificates in any way, and is responsible for making certificates available or providing current versions of certificates, including amendments, to insureds. • Quote assumes premium billing will be on a self-administered basis for groups with 500 or more insureds. • It is Symetra's intent to provide the requested plan design and benefit levels. However, Symetra's standard policy provisions and language will apply, due to state requirements that policy forms be filed and approved in the state where the policy will be issued. • This proposal is not intended as a contract. Policy provisions, exclusions and limitations will be subject to Symetra standard provisions. If there is any conflict between this proposal and a subsequently issued group policy, the policy will prevail. The limitations and exclusions of any policy issued will comply with state insurance laws and regulations as applicable and/or as amended. The agent/broker does not have authority to bind or modify the terms of this offer without prior written approval from Symetra. • Our quote is based on the census provided to us when this proposal was requested. If the proposal is accepted, we will require an updated census that reflects the makeup of the group we will be insuring on the policy effective date. Actual cost will be based on the updated census. Should there be any changes in the original data the quote was based on - number of lives, class occupations, salaries, or other pertinent facts - the case will be subject to new underwriting to determine acceptability of the group, and the policy provisions and rate may be changed. • Symetra reserves the right to revise the quote if the lives and/or total insured risk changes by +/-10% after initial enrollment or if the policyholder adds or removes a division, subsidiary, or affiliated company. • A copy of the prior policy, a current billing statement to verify covered lives and volumes and a final sold case census are required at time of sale. Census must include lives, classes, and volume by coverage line, and work or home address. • This proposal is valid for 90 days or until the proposed policy effective date, whichever comes first. • The rates shown in this proposal will be increased to reflect any additional fees or commissions payable by Symetra other than those noted in this proposal. • Requests for experience, billing and/or loss units that are outside Symetra's standards for account structure may be subject to additional charges. • Where "days" are referenced in this proposal, it means calendar days. Prepared by � S Y M E T R A 26 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 • The rate structure quoted in this proposal may result in the premiums for voluntary coverages (i.e., employee/member-paid coverages) partially covering the cost of basic coverage (i.e., policyholder -paid coverages). This proposal and the rate structure contained herein is expressly conditioned on the policyholder's determination that the rate structure (i) is part of a single employee benefit plan sponsored by the policyholder, (ii) is consistent with information provided to employees or members, and (iii) is consistent with sponsor's obligations under applicable law and regulation (including ERISA, as applicable). A rate structure in which premiums paid for employee -paid coverages do not cover any of the cost of employer -paid coverages is available upon request. • Proposed rates are contingent on writing all lines including Basic Life, Basic AD&D, and Supplemental Life and AD&D coverages as a package. • If applicable, tobacco usage means any use of tobacco product (including but not limited to cigarettes, cigars, pipes, chewing tobacco, snuff, vaping, or a nicotine delivery device such as a patch or gum) in the last 12 months prior to their application. • This quote is conditional on satisfying Symetra's concentration of risk requirements. Please provide a list of locations with 500 or more lives, outlining the address and number of lives at the location. Terms of quote are subject to change based on Symetra's evaluation of concentration of risk information received. • If the group is comprised of at least 25%, subject to a minimum of 25, MN residents, those MN residents will receive a Life Certificate that has been filed in MN with MN state requirements, including the MN Life Continuation of Coverage provision. • Symetra requires a list of all employees eligible for life insurance but not actively at work. Symetra must review and approve this list before binding coverage. • This proposal assumes that the group of covered persons on the policy effective date does not include any employees whose coverage levels do not conform to the plan design(s) included in this proposal. For any employees whose coverage levels exceed those shown in this proposal, coverage will be decreased to an amount that most closely matches a coverage amount included in this proposal. The following Enrollment Rules apply: • One -Time True Open Enrollment - An allotted timeframe, which occurs once at policy takeover or a different agreed upon period, for eligible employees to elect coverage who did not enroll during their respective initial enrollment period or for employees with current coverage to elect to increase their coverage. Eligible employees may elect or increase coverage amounts up to the Guarantee Issue amount without submission and approval of evidence of insurability. Open enrollment is available on schedules based upon fixed amount levels or upon salary multiples. Individuals previously declined for coverage or who failed to submit the required evidence of insurability may reapply during an open enrollment but must provide evidence of insurability for any amount of new or increased coverage. • Annual Modified Open Enrollment - An allotted timeframe, which occurs yearly, for employees with current coverage to elect to increase their coverage. Eligible employees may increase coverage amounts, by 1 level, up to the Guarantee Issue amount without submission and approval of evidence of insurability. Open enrollment is available on schedules based upon fixed amount levels or upon salary multiples. Individuals previously declined for coverage or who failed to submit the required evidence of insurability may reapply during an open enrollment but must provide evidence of insurability for any amount of new or increased coverage. • There is no open enrollment outside of the rules defined above unless agreed to in writing in advance by Symetra Underwriting. Prepared by ;= S Y M E T R A 27 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 City of Denton Effective 11112027 • Rates assume participation in Social Security and Workers' Compensation Insurance plan and integration with any salary continuation program. • The quoted STD rate(s) are based on the expected timeline and structure of the STAT/PFML program(s). STD rates may be adjusted if there are changes to STAT/PFML start date(s), benefit design, or how it impacts STD coverage. • The quoted STD rate(s) assume mandatory participation in the STAT/PFML program(s) and that you are not classified as an exempt group, or you are considered exempt but have chosen to opt into the STAT/PFML program. STD rates may be adjusted if this assumption does not align with how the prospective Policyholder expects their policy to be administered. • Evidence of insurability/proof of good health is required for applicants who apply for contributory/voluntary coverage more than 31 days after first becoming eligible. • Employees must be actively at work to become eligible. This policy does not replace or affect requirements for coverage by Workers' Compensation Insurance or State Disability Insurance. • Coverage will continue while employees are on FMLA. • Integration with salary continuation and accumulated sick leave are included. The following Enrollment Rules apply: • One-time Open Enrollment: One-time Open Enrollments assume coverage can be elected without submitting Evidence of Insurability (EOI) during a scheduled open enrollment period. Employees that were previously denied coverage are not eligible. A 3/12 pre-existing condition exclusion will apply to this one-time enrollment • There is no open enrollment outside of the rules defined above unless agreed to in writing in advance by Symetra Underwriting. • Rates assume participation and integration with Social Security, Workers' Compensation Insurance, Statutory Disability Plans and any salary continuation programs, if applicable. • Evidence of insurability/proof of good health is required for applicants who apply for contributory/voluntary coverage more than 31 days after first becoming eligible. • Employees must be actively at work to become eligible. This policy does not replace or affect requirements for coverage by Workers' Compensation Insurance or State Disability Insurance. • Coverage will continue while employees are on FMLA. • LTD benefits will be reduced by other income amounts, including integration with Family Social Security benefits The following Enrollment Rules apply: • Traditional Evidence of Insurability (EOI) Enrollment: EOI enrollments assume scheduled annual enrollment periods and standard EOI requirements will apply meaning EOI is required for all late entrants and increases in coverage. • There is no open enrollment outside of the rules defined above unless agreed to in writing in advance by Symetra Underwriting. Prepared by � S Y M E T R A 28 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Attachment 2 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. Life Insurance, Short -Term Disability, and Long -Term Disability — 9073 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 • Liability policies shall be endorsed to provide the following: o Name as Additional Insured the City of Denton, its Officials, Agents, 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 Life Insurance, Short -Term Disability, and Long -Term Disability — 9073 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Operations, Independent Contractors, and Contractual Liability with minimum combined bodily injury (including death) and property damage limits of $1,000,000.00 per occurrence and $2,000,000.00 general aggregate. B. ERRORS & OMISSIONS INSURANCE Errors & Omissions Insurance to provide coverage against claims for any loss on accounts assigned to the CONTRACTOR due to negligent act, error or omission on the part of the CONTRACTOR or its employees with minimum limits of $1,000,000 per claim, $2,000,000 annual aggregate. Such insurance shall include coverage for Cyber Liability and Network Risk. SUBCONTRACTING LIABILITY (1) Without limiting any of the other obligations or liabilities of the CONTRACTOR, the CONTRACTOR shall require each Subcontractor performing work under the contract, at the Subcontractor's own expense, to maintain during the engagement with the CITY, types and limits of insurance that are appropriate for the services/work being performed, comply with all applicable laws and are consistent with industry standards. The Subcontractor's liability insurance shall name CONTRACTOR as an additional insured. (2) CONTRACTOR shall obtain and monitor the certificates of insurance from each Subcontractor. CONTRACTOR must retain the certificates of insurance for the duration of the contract and shall have the responsibility of enforcing insurance requirements among its subcontractors. The CITY shall be entitled, upon request and without expense, to receive copies of these certificates. Life Insurance, Short -Term Disability, and Long -Term Disability — 9073 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Httacnment 3 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received 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). By law this questionnaire must be filed with the records administrator of the local governmental 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. .1J Name of vendor who has a business relationship with local governmental entity. Symetra Life Insurance Company 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 is being disclosed. N/A Name of Officer 4 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 relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. N/A A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F---] 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 or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes F---] No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. N/A 6 ❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Keith Daigle, VP Workforce Benefits Underwriting June 29, 2026 Name of signatory Signature Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/14/2024 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.leg is.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) Avendor 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. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/14/2024 Docusign Envelope ID: 5AB287E9-2362-83D6-818F-69B825129237 Attachment 4 Certificate of Interested Parties Electronic Filing 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/filin2info/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. a docusign. Certificate Of Completion Envelope Id: 5AB287E9-2362-83D6-818F-69B825129237 Subject: Please DocuSign: City Council Contract 9073 - Life Insurance, LTD, STD, and AD&D Source Envelope: Document Pages: 39 Signatures: 3 Certificate Pages: 6 Initials: 1 AutoNav: Enabled Envelopeld Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) Record Tracking Status: Original 9/17/2026 9:31:28 AM Signer Events Christina Dormady christina.dormady@cityofdenton.com Buyer City of Denton Security Level: Email, Account Authentication (None) 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) Electronic Record and Signature Disclosure: Not Offered via Docusign Leah Bush leah.bush@cityofdenton.com Assistant City Attorney Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Keith Daigle keith.daigle@symetra.com VP, Workforce Benefits Underwriting and Claims Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/22/2026 11:48:18 AM ID:82490c05-5b56-4891-86aa-13dd28bd4a6e Holder: Christina Dormady christina.dormady@cityofdenton.com Signature Completed Using IP Address: 198.49.140.104 �al Signature Adoption: Pre -selected Style Using IP Address: 198.49.140.10 ESi,nby: ed 6456D. Signature Adoption: Pre -selected Style Using IP Address: 198.49.140.104 by: ED�11"Sillld �vat 1134595A09914 Signature Adoption: Pre -selected Style Using IP Address: 128.77.42.48 Status: Sent Envelope Originator: Christina Dormady 901 B Texas Street Denton, TX 76209 christina.dormady@cityofdenton.com IP Address: 198.49.140.104 Location: DocuSign Timestamp Sent: 9/17/2026 9:48:24 AM Viewed: 9/17/2026 9:48:36 AM Signed: 9/17/2026 9:49:34 AM Sent: 9/17/2026 9:49:36 AM Viewed: 9/17/2026 3:31:36 PM Signed: 9/17/2026 3:32:13 PM Sent: 9/17/2026 3:32:15 PM Viewed: 9/22/2026 9:56:55 AM Signed: 9/22/2026 11:46:58 AM Sent: 9/22/2026 11:47:00 AM Viewed: 9/22/2026 11:48:18 AM Signed: 9/22/2026 12:11:33 PM Signer Events Signature Timestamp Sara Kjos by: Sent: 9/22/2026 12:11:35 PM Sara.kjos@cityofdenton.com [Sig",d aV'a Ys Resent: 9/28/2026 8:45:33 AM Deputy Director of Human Resources OAI152EC6652437 Viewed: 9/28/2026 7:19:33 PM Security Level: Email, Account Authentication Signed: 9/28/2026 7:20:12 PM (None) Signature Adoption: Pre -selected Style Using IP Address: 2600:1702:56e3: a9f0:35dd:5dd8: a6d9:9726 Electronic Record and Signature Disclosure: Not Offered via Docusign Cheyenne Defee Sent: 9/28/2026 7:20:15 PM cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Cassey Ogden Cassey.Ogden@cityofdenton.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Kristi Gilbert Kristi.Gilbert@cityofdenton.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign 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 COPIED Sent: 9/17/2026 9:49:36 AM cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Gretna Jones COPIED Sent: 9/28/2026 7:20:14 PM gretna.jones@cityofdenton.com Viewed: 9/29/2026 2:01:56 PM Legal Secretary City of Denton Security Level: Email, Account Authentication (None) Carbon Copy Events Status Timestamp Electronic Record and Signature Disclosure: Not Offered via Docusign City Secretary Office citysecretary@cityofdenton.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Matt Grebliunas Matt.Grebliunas@cityofdenton.com Security Level: Email, Account Authentication (None) 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 9/17/2026 9:48:24 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM Parties agreed to: Keith Daigle 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. 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