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23-1703ORDINANCE NO. 23-1703 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 8239 – 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) YEAR NOT-TO-EXCEED AMOUNT OF $5,750,000.00). 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 ORDArNS: 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 8239 Symetra Life Insurance Company $5,750,000.00 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. Th, m,ti,„ t, ,pp„,, thi, ,rdinan„ wa, made by R, \ h,I h,/ and seconded by Grt As q)c.A . This ordinance was passed and approved by the following vote a - A: Aye V 7 t/ Nay Abstain Absent Mayor Gerard Hudspeth: Vicki Byrd, District 1 : Brian Beck, District 2: Paul Meltzer, District 3 :,Z t/ J Joe Holland, District 4: Brandon Chase McGee, At Large Place 5 : Chris Watts, At Large Place 6:7 _, 2023.PASSED AND APPROVED this the f 11 t \day of } 4cw\be/ N ATTEST: JESUS SALAZAR, CITY SECRETARY L\\\1 tIlt III APPROVED AS TO LEGAL FORM: MACK REINWAND, CITY ATTORNEY Digitally signed by MaKella Lunn DN: cn=Marcella Lunn. o. LW on.com. c=US Date: 2023.08.31 11 :22:17 -05'00' _nI l=fity nf rlenrnn + email=marcella.lunn@cityofdent\IBY: -\XfHaUJ\ DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 DENTON Docusign City Council Transmittal Coversheet 8239 Life & Dlsabi11ty RFP File Name Purchasing Contact chrlsta Christlan CIty C,,n,II T„g,t D,t, SEPTE"-E- 19’ 2023 Piggy Back Option Contract Expiration Ordinance NO DECEMBER 31, 2028 23-1703 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EODI OO SVmetra Life Insurance Company First SYmetra National Life Insurance Company of New York RETIREMENT I BENEFITS i LIFE Symetra Group Benefits o ;862EC4-95A94E9D-BAIF-327297EODI 00 Symetra Group Benefits qI TIRE h'. tNT gENE i ITS LIFE Renewal Amendment Prepared for: City of Denton - Contract # 8239 Denton, TX on behalf of McGriff, Seibels, & Williams August 4, 2023 DocuSign Envelope ID: 4C862EC4-95A94E9D-BAIF-327297EOD100 Table of Contents Exhibit B Exhibit C Section 2 Section 3 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 Amendment 1 DocuSign Envelope ID: 4C862ECJ-95A94E9D-BAI F-327297EOD100 Renewal Amendment Number 1 to Contract (Contract 8239) This Renewal Amendment Number 1 to Contract (Contract 8239) (this Amendment) is entered into between City of Denton, Texas (Subscriber) and Symetra Life Insurance Company (Symetra). Background Subscriber and Symetra have previously entered into Contract (6808) dated July 19, 2018 which was renewed and replaced by Subscriber’s RFP 8239 – Life and Disability (Contract 8239), which is on file at the purchasing office and made a part hereof as Exhibit A (the Agreement). Initially capitalized terms used but not otherwise defined in this Amendment will have the meanings set forth in the Agreement. The parties desire to amend the Agreement as follows: 1 Effective Date The terms of this Amendment are effective as of January 1, 2024 Extension2 The contract term will be three (3) years, effective from date of award. The City and the Supplier shall have the option to renew this contract for an additional two (2) one-year periods. The Contract shall commence upon the Effective Date and shall automatically renew each year, in accordance with the procedures set forth in the Agreement. At the mutual agreement of both parties, the Contract may be further extended as needed, not to exceed a total of six (6) months. 3 Scope of Work Symetra shall perform all those services as necessary and as described in the Subscriber’s Contract 8239 as if written word for word herein. 4 Contract Amount The contract total for the continued services shall not exceed approximately 55,570,000.00. In the event scope of services provided to the City of Denton by Symetra exceeds 85,750,000.00 an amendment to this contract as well as the Fee Schedule will be required. 5 Insurance Insurance requirements per Exhibit C Insurance Requirements are attached. 6 Contractor’s Proposal Contractor agrees to do all services listed in Contract 8239 at the rates set forth in Contractor’s Proposal per Exhibit B attached. DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 7 Updated Notices Addresses. The agreement is amended to reflect the following updated notice address for City of Denton: City of Denton, Ann: Purchasing Manager – File 8239, 901B Texas Street, Denton, TX 76201, with an additional copy to: City of Denton Attn: Legal Counsel 2 15 E. McKinney St., Denton, TX 76201, with additional copy emailed to city of Denton at: purchasing(a}cityofdenton.com Symetra Life Insurance Company Attn: Lisa Marecki 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004-5 135, with additional copy emailed to _lisa.marecki@symetra.com . 8 Updated contract number This Amendment constitutes a new agreement beginning on the Effective Date between the parties incorporating, except as amended herein, all the terms and conditions in the Agreement for all intents and purposes Such Agreement will have contract number 8239 . Confirmation of Agreement This Amendment (together with all exhibits attached hereto) constitutes the entire agreement between the parties regarding the matters of this Amendment and supersedes all prior and contemporaneous agreements and understandings regarding the matters of this Amendment. In the event of a conflict between this Amendment and the Agreement as it relates to the matters of this Amendment, the terms of this Amendment will control. Otherwise, all terms and conditions of the Agreement will remain in full force and effect and likewise apply tothis Amendment . DocuSign Envelope ID: 4C862EC4-95A94E9D-BAI F-327297EOD100 Authorized Signatures City of Denton, Texas Symetra Life Insurance Company DocuSlgned bF SMA HtM££9By:mJ Name. Sara Hensley Name: Lisa Marecki Title. C1 ty Manager Title: SVP Worksite Benefits Date: 9/20/2023 Date: August 4, 2023 2023- 2018-428212 TEXAS ETHICS COMMISSION 1295 CERTIFICATE NUMBER In 2015 , the Texas Legislature adopted House Bi11 1295 . which added section 2252.908 of the Government Code. The law states that the City maynot enter into th1 s contract unless the contractor submits a disclosure of interested parties (Form 1295) to the clty at the tlme the contractor submIts the slgned contract. The Texas Ethics commisslon has adopted rules requ1 ring the business entity to file Form 1295 electronlca1 1y with the Comm1 ssi on . ATTEST: JESUS SALAZAR, CITY SECRETARY BNNt r : ( &S KS S aL&4) 1Etr APPROVED AS TO LEGAL FORM: MACK REnqWAND, CITY ATTORNEY contractor wi11 be requ1 red to furnIsh acertificate of Interest Parties before the contract is awarded, in accordance withGovernment Code 2252.908 . The contractor sha11 : 1. Log onto the state Ethlcs commission webslte https : //www . ethics . state . tx . us/H 1 1 nglnfo/1295/ 2 . Register utilizi ng the tutoria1 provlded bythe State 3 . PrInt a copy of the completed Form 12954. Enter the certificate Number on page 2 of this contract . 5 . Complete and slgn the Form 12956. Emai1 the form to purchas1 ng@cityofdenton . com wi th the contract number in the subject 11 ne. (EX: Contract 1234 Form 1295) at THIS BOTH HZ AGREEMENT nAS BEEN REVIEWED AND APPROVED to financial and operational obligations terms. Megan Gilbreath PRINTED NAME Deputy HR DIrector Human Resources TITLE DEPARTMENT The city must acknowledge the receipt of thefiled Form 1295 not later than the 30th day after Counc11 award. Once a Form 1295 is acknowledged , it wi11 be posted to the Texas Ethics Commission’s webslte within seven business days . 3 DocuSign Envelope ID: 4C8621 .E9D-BAI F-327297EODI OO Exhibit B 2 DocuSign Envelope ID: 4C862EC4-95A9JtE9D-BAI F-327297EOD100 Underwriting Renewal Worksheet - Requested Plan Changes Policyholder: City of Denton Policy Number: 01-017863-00 Account Manager: Rachel Stetzer Renewal Date: 1/1/2024 LifeBasic Volume Rate per $1,000Lives $0.025$126,327,000 Monthly Premium $3,158.18Basic Employee Life $37,898.16 - There are no Basic Employee Life commissions. - Basic Employee Life Rates are guaranteed for 3 years loyee AD&D Basic Employee AD&D $126,327,000 $0.010 $1 ,263.27 $15, 159.24 - There are no Basic Employee AD&D commissions. - Basic Employee AD&D Rates are guaranteed for 3 years hI Lil +lOI hE LITe FF+ III bn nIno in W bEn bT; I f+1 / ni II TII, lllelIHllIHlll• Io $500.000 $250k Gl Monthly Premium Annual Premium $1 ,678.32 $5,384.88 $12,413.52 $19,224.00 $40,612.32 $48,522.24 $79,729.92 $70,761.60 $42,456.96 $16,826.40 $5,909.76 $0.00 $343,519.92 Age Band Lives Volume Rate per $ 1, 000 $0.063< 25 25 - 29 34 83 $2,220,000 $8,310,000 $16,420,000 $17,800,000 $22, 120,000 $16,640,000 $15,380,000 $8,400,000 $3,780,000 $139.86 $448.74$0.054 30 - 34 140 147 $0.063 $0.090 $1 ,034.46 $1 ,602.00 $3,384.36 $4,043.52 $6,644.16 $5,896.80 $3,538.08 $1 ,402.20 $492.48 35 - 39 40 - 44 172 $0.153 45 - 49 140 $0.243 50 - 54 135 78 M $0.702 $0.936 55 - 59 60 - 64 46 65 - 69 14 $950,000 $1.476M $4.320 70 - 74 4 $190,000 $075 +0 $0.00 993 1 2 *Lives, volume, and premium TBD. Above reflects current enrollees and elections - There are no Supplemental Employee Life commissions. - Supplemental Employee Life Rates are guaranteed for 3 years Prepared by aSYM ETR A DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 SunnlementaIHlmDlovee Life Plan CHnanae - CIETs 3 Retirees Flat $10.000 Monthly Premium Annual PremiumAge Band Lives Volume Rate per $1,000 $0.080< 25 25 - 29 $0.070 30 - 34 $0.080 35 - 39 40 - 44 $0.110 $0. 190 $0.31045 - 49 50 - 54 55 - 59 $0.550 $0.890 60 - 64 65 - 69 $1.190 $1.870 $3.28070 - 74 75 +$5.470 Estimated Total 34 for the Supp $339,000 *TBD *TDB *Minimum 15% particpation Life Retirees (226 retirees with max volume of $2,260,000) - There are no Supplemental Employee Life commissions. - Supplemental Employee Life Rates are guaranteed for 3 years Prepared by aS Y MET RA DocuSign Envelope ID: 4C862EC4-95A94E9D-BAIF-327297EOD100 L o match plan changes to EE, Spouse, and Child Monthly Premium $2,244.20 $433.32 $104.80 Annual Premium $26,930.40 Supplemental Child $112,210,000 $21 ,666,000 $5,240,000 $0.020 $0.020 $0.020 *Lives, volume, and premium TBD. Above reflects current enrollees and elections - There are no Supplemental AD&D commissions. - Supplemental AD&D Rates are guaranteed for 3 years all IIe IIB 1+1111 elIIS P 1 llln lara n lanF+IHlfOllP = in 1 mIns 1 / w =linK IIe in 1 d aiR IBnl if a h / no $250.000 $50k Gl Age Band < 25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 . 54 55 - 59 60 - 64 65 - 69 70 - 74 75 + Spouse Total *Lives, volume, and Lives Volume Rate per $ 1,000 $0.063 Monthly Premium $0.95 $39.96 Annual Premium $1 1 .34 $479.52 $2,131.92 $3,472.20 $9,427.86 $11 ,591.10 $17,288.64 $12,930.84 $7,076.16 $3,453.84 $2,208.38 $0.00 $70,071 .80 3 18 $15,000 $740,000 $2,820,000 $3,215,000 $5, 135,000 $3,975,000 $3,335,000 $1 ,535,000 $0.054 $0.063 $0.090 53 $177.66 $289.35 $785.66 $965.93 $1 ,440.72 $1 ,077.57 $589.68 76 99 $0.153 $0.24378 72 $0.432 $0.70246 20 $630,000 $0.936 $1.476$195,000 $287.82 $71 ,000 $0 $2.592 $4.320 $ 184.03 0 $0.00n4 2 5 premium TBD. Above reflects current enrollees and elections Supp Child Life Plan Change - Class 1,2 - Flat $25,000 Child $0.070$5,420,000524 mEn $4,5@] - There are no Supplemental Spouse & Child Life commissions. - Supplemental Spouse & Child Life Rates are guaranteed for 3 years Long Term Disability - Plan change to SSNRA Long Term Disabili'$9,568,574 $0.145 $13.874.43 $166,493.19 - 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 aSYM ETR A DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 Short Term Disabilitv - Plan chanae to 7/7/12 Age Band Lives 20 61 99 IEiiI 126 98 95 56 47 11 3 0 746 participation Volume $12,324 Rate Per $10 $0.370 Monthly Premium $456.00 $1 ,638.57 $3,109.86 $3,796.14 $4,415.28 $3,598.02 $4,269.28 $2,907.98 $2,684.81 $648.69 $236.97 $0.00 2 Annual Premium $5,472.05 $19,662.88 $37,318.32 $45,553.72 $52,983.41 $43, 176.20 $51 ,231.42 $34,895.77 $32,217.69 $7,784.28 $2,843.66 $0.00 $333,139.40 < 25 25 - 29 $42,015 $0.390 30 - 34 35 - 39 $88,853 $111 ,651 $0.350 $0.340 40 - 44 $116,192 $0.380 45 - 49 $92,257 $0.390 50 - 54 $90,836 $49,288 $0.470 55 - 59 $0.590 60 - 64 $37,289 $0.720 65 - 69 $8,009 $0.810 70 - 74 $2,926 $0.810 75 +$0 $0.810 Total *Quoted rates reflect 47% $651 ,639 currently in-force - 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 Technology Credit - effective 1/1/24 Schedule Ongoing Stuctu re Maximum up to $20,000 per year2% of the annualized premium Prepared by PhSYM ETR A DocuSign Envelope ID: 4 .E9D-BAIF-327297EODI OO Exhibit C 3 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 INSURANCE REQUIREMENTS Respondent’s attention is directed to the insurance requirements below. It is highly recommended that respondents confer with their respective insurance carriers or brokers to determine in advance of Proposal/Bid submission the availability of insurance certificates and endorsements as prescribed and provided herein. If an apparent low respondent fails to comply strictly with the insurance requirements, that respondent may be disqualified from award of the contract. Upon contract award, all insurance requirements shall become contractual obligations, which the successful contractor shall have a duty to maintain throughout the course of this contract. STANDARD PROVISIONS: Without limiting any of the other obligations or liabilities of the Contractor, the Contractor shall provide and maintain until the contracted work has been completed and accepted by the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter. As soon as practicable after notification of contract award, Contractor shall file with the Purchasing Department satisfactory certificates of insurance including any applicable addendum or endorsements, containing the contract number and title of the project. Contractor may, upon written request to the Purchasing Department, ask for clarification of any insurance requirements at any time; however, Contractors are strongly advised to make such requests prior to proposal/bid opening, since the insurance requirements may not be modified or waived after proposal/bid opening unless a written exception has been submitted with the proposal/bid. Contractor shall not commence any work or deliver any material until he or she receives notification that the contract has been accepted, approved, and signed by the City of Denton. All insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance with these general specifications throughout the duration of the Contract, or longer, if so noted: • Each policy shall be issued by a company authorized to do business in the State of Texas with an A.M. Best Company rating of at least A+ or better. •Any deductibles or self-insured retentions shall be declared in the proposal. If requested by the City, the insurer shall reduce or eliminate such deductibles or self-insured retentions with respect to the City, its officials, agents, employees and volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. •Liability policies shall be endorsed to provide the following: 0 Name as Additional Insured the City of Denton, its Officials, Agents, Basic and Supp Life – AD&D and Disability - 8239 DocuSign Envelope ID: 4C862EC4-95A94E9D-BAIF-327297EOD100 Employees and volunteers. 0 That such insurance is primary to any other insurance available to the Additional Insured with respect to claims covered under the policy and that this insurance applies separately to each insured against whom claim is made or suit is brought. The inclusion of more than one insured shall not operate to increase the insurer's limit of liability. o Provide a Waiver of Subrogation in favor of the City of Denton, its officials, agents, employees, and volunteers. • Cancellation: City requires 30 day written notice should any of the policies described on the certificate be cancelled or materially changed before the expiration date. •Should any of the required insurance be provided under a claims made form, Contractor shall maintain such coverage continuously throughout the term of this contract and, without lapse, for a period of three years beyond the contract expiration, such that occurrences arising during the contract term which give rise to claims made after expiration of the contract shall be covered. •Should any of the required insurance be provided under a form of coverage that includes a general annual aggregate limit providing for claims investigation or legal defense costs to be included in the general annual aggregate limit, the Contractor shall either double the occurrence limits or obtain Owners and Contractors Protective Liability Insurance. •Should any required insurance lapse during the contract term, requests for payments originating after such lapse shall not be processed until the City receives satisfactory evidence of reinstated coverage as required by this contract, effective as of the lapse date. If insurance is not reinstated, City may, at its sole option, terminate this agreement effective on the date of the lapse. SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS: All insurance policies proposed or obtained in satisfaction of this Contract shall additionally comply with the following specifications, and shall be maintained in compliance with these additional specifications throughout the duration of the Contract, or longer, if so noted: A.COMMERCIAL GENERAL LIABILITY INSURANCE Commercial General Liability Insurance including, but not limited to, Premises/Operations, Personal & Advertising Injury, Products/Completed Operations, Independent Contractors, and Contractual Liability with minimum combined bodily injury (including death) and property damage limits of Basic and Supp Life – AD&D and Disability - 8239 DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 $1,000,000.00 per occurrence and $2,000,000.00 general aggregate. Basic and Supp Life – AD&D and Disability - 8239 DocuSign Envelope ID: 4C862ECH-95A94E9D-BAI F-327297EOD100 Parker, Smith & Feek Insurance, LLC. 2233 112th Avenue NE Bellevue, WA 98004 City of Denton 901B Texas Street Denton, TX 76201 1 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 THIS PAGE INTENTIONALLY LEFT BLANK 2 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A94E9D-BAIF-327297EOD100 AC/oh CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/WW) 07/1 9/2023 A mM9© R. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXrEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 0 NAME: PHONEParker. Smith & Feek Insurance, LLC2233 1 12th Avenue NE Bellevue, WA 98004 1. 425-709-3600 425-709-7460 INSURER(S) AFFORDING COVERAGE INsuRER A, Hanford Fire Insurance Co. NAIC # INSURED Symetra Financial Corporation AHn: Corporate Insurance - 15th FIr, 777 108th Ave NE1200 Bellevue, WA 98004-5135 Suite INSURER B : INSURER C : INSURER D : INSURER E INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: A GENERAL LIABILITY 52UUNCEI 902 LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE [xI OCCUR 01 /21 /2023 01 /21 /2024 EACH OCCURRENCE A PREMISES (Ea occurrence' 1 ,000,000 1 ,000,000X MED EXP (Any one person)$ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 AUTOMOBILE LIABILITY Total Aggregate Limit[My]mm :Ea accident: PRODUCTS - COMP/OP AGG $ 2,000,000 $ 20,000,000 ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOSNON-OWNED AUTOS e E R:Per accident) I ' $ BODILY INJURY (Per person) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE $ $ DED 1 1 RETENTION $ B AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE r––i OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) LJ If yes, describe underDESCRIPTION OF OPERATIONS below WC STATU. 1 1 01 $ OTFI- N/A E.L. EACH ACCIDENT 1 s E.L. DISEASE .EA EMPLOYEd $ E.L. DISEASE . POLICY LIMIT 1 s Basic and Supp Life - AD&D and Disability - 8239. City of Denton and its Officials, Agents, employees and volunteers are additional insureds on the general liability policy per the attached endorsement/form... (See Attached Description) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Denton901 B Texas Street Denton, TX 76201 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 THIS PAGE INTENTIONALLY LEFT BLANK 4 of 16 (NKOOO) DocuSign Envelope ID: 4C862ECH-95A94E9D-BAIF-327297EOD100 DESCRIPTIONS (Continued from Page 1 ) Waiver of subrogation applies on the general liability policy per the attached endorsement/form Notice of cancellation for the general liability policy per the attached form. 5 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 THIS PAGE INTENTIONALLY LEFT BLANK 6 of 16 {NKOOO) DocuSign Envelope ID: 4C862EC4-95A94+E9D-BAI F-327297EODI OO with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. Unnamed Subsidiary Any subsidiary, and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of the Coverage Part. The insurance afforded herein for any subsidiary not named in this Coverage Part as a named insured does not apply to injury or damage with respect to which such insured is also a named insured under another policy or would be a named insured under such policy but for its termination or the exhaustion of its limits of insurance. 5. Additional Insureds When Required Written Contract, Written AgreementPermit By Or e.The following person(s) or organization(s) are an additional insured when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement. A person or organization is an additional insured under this provision only for that period of time required by the contract or agreement. However, no such person or organization is an insured under this provision if such person or organization is included as an insured by an endorsement issued by us and made a part of this Coverage Part. a. Vendors 3.Newly Acquired Or Formed Organization Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain financial interest of more than 50% of the voting stock, will qualify as a Named Insured if there isno other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. Nonowned Watercraft Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard" . (1) The insurance afforded the vendor is subject to the following additionalexclusions: This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the 4. With respect to watercraft you do not own that is less than 51 feet long and is not being used to carry persons for a charge, any person is an insured while operating such watercraft with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co-"employee" of the person operating the watercraft; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration , testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally Page 12 of 21 7 of 16 HG 00 01 09 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 undertakes to make in the usual course of business. in connection with the distribution or sale of the products; This insurance does not apply to: Any "occurrence" which takes place after you cease to lease that land; or Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 2. d. Architects, Engineers Or Surveyors (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", 'property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (h) "Bodily injury" or "property damage" arising out of the sole negligence of thevendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) in connection with your premises; or (2) in the performance of your operations performed behalf, orlgolrlg by you or on your (i) The exceptions contained in Sub- paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the With respect to the insurance afforded these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you . Permits Issued By State Or Political Subdivisions products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b.Lessors Of Equipment (1)Any person(s) or organization(s) from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). With respect to the insurance afforded to these additional insureds this (2) insurance does not apply to any "occurrence" which takes place after the equipment lease e. Any state or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. With respect to the insurance afforded these additional insureds, this insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or expIres. c. Lessors Of Land Or Premises Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. With respect to the insurance afforded these additional insureds the following additional exclusions apply: HG 00 01 09 16 Page 13 of 21 8 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A94E9D-BAI F-327297EOD100 (2)"Bodily injury" or included within the operations hazard". "property damage" "products-completed by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. The limits of insurance that apply to additional insureds is described in Section III – Limits Of Insurance. f. Any Other Party Any other person or organization who is not an additional insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV – Commercial General Liability Conditions. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. (1) in the performance operations; of your orlgolrlg (2) in connection with your premises owned by or rented to you; or (3)connection with "your work" andIn included within the "products-completed operations hazard", but only if SECTION III - LIMITS OF INSURANCE 1. The Most We Will Pay (a) The written contract or agreement requires you to provide such coverage to such additional insured; and The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: (b) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard". a.Insureds; Claims made or "suits" brought; or makingPersons or organizations bringing "suits". claims or However: (1) (2) The insurance afforded to such additional insured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. General Aggregate Limit2 The General Aggregate Limit is the most we will pay for the sum of: a b. Medical expenses under Coverage C; Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard"; and C.Damages under Coverage B. With respect to the insurance afforded to these additional insureds, this insurance does 3. Products-CompletedLimit Operations Aggregate not apply to:The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products- completed operations hazard". Personal And Advertising Injury Limit Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. Each Occurrence Limit "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or suIveying services, including: 4. (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, engineering activities. architectural or 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of:This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others a. Damages under Coverage A; and Page 14 of 21 HG 00 01 09 16 9 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EODI OO THIS PAGE INTENTIONALLY LEFT BLANK 10 of 16 (NKOOO} DocuSign Envelope ID: 4C862EC4-95A9zIE9D-BAI F-327297EOD100 impair them. At our request, the insured will bring "suif' or transfer those rights to us and help us enforce them. other motor vehicle insurance law where it is licensed or principally garaged. However,"auto"does not include "mobile b.Waiver Of Rights Of Recovery (Waiver Of Subrogation) equipment". If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or 5."Bodily injury" means physical: Injury; Sickness; or Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. organization in a contract, agreement or permit that was executed prior to the injury or 6."Coverage territory" means: The United territories Canada; States and of America (including its possessions), Puerto Rico anddamage. 9.When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V – DEFINITIONS b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a. above; or c. All other parts of the world damage arises out of: if the Injury or (1)Goods or products made or sold by you in the territory described in a. above; 1."Advertisement" means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: (2)The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; or (3)"Personal and advertising injury" offenses that take place through the Internet orsimilar electronic means of communicationa. (1) (2) (3) (4) (5) Radio; Television; Billboard ; provided the insured's responsibility to pay damages is determined in the United States of America (including its territories and possessions), Puerto Rico or Canada, in a "suit" on the merits according to the substantive law in such territory or in a settlement we agree to. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". Magazine; Newspaper; or Any other publication that is given widespread public distribution. However, "advertisement" does not include: 7. a.The design, printed contained in labeling material. information or on or upon the packaging or products; or An interactive conversation between or among persons through a computer network. Images of any goods or 8. "Employment-Related Practices" means: a. Refusal to employ that person; b.Termination of that person's employment; or C.Employment-related or omissions, such practices, policies, as coercIon, reassignment, harassment, malicious acts demotion, discipline, humiliation, prosecution 2."Advertising idea" "advertisement". rrlearls any idea for an evaluation. defamation, discrimination or directed at that person. 3."Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form . "Auto" means: 9."Executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar4. governing document.a. b. A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or Any other land vehicle that is subject to a compulsory or financial responsibility law or 10."Hostile fire" means one uncontrollable or breaks out from intended to be which becomes where it was Page 18 of 21 HG 00 01 09 16 11 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAI F-327297EOD100 THIS PAGE INTENTIONALLY LEFT BLANK 12 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A94E9D-BAI F-327297EOD100 IL 01 46 08 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. The conditions in this endorsement replace any similar conditions in the policy that are less favorable to the insured. 3.We may cancel the Commercial Property Coverage Part and the Capital Assets Program (Output Policy) Cowrage Part, if made a part of this policy, by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation at least five days before the effective date of cancellation for any structure where two or more of the following conditions exist: A. Cancellation 1.The first Named Insured shown in the Declarations may cancel this policy by notifying us or the insurance producer in one of the following ways: a. Written notice by mail, fax or e-mail; b. Surrender of the policy or bindeR or c. Verbal notice a. WIthout reasonable explanation, the structure is unoccupied for more than 60 consecutive days, or at least 65% of the rental units are unoccupied for more than 120 consecutive days, unless the structure is maintained for seasonal occupancy or is under construction or repair; Upon receipt of such notice, we will cancel this policy or any binder issued as evidence of coverage, effective on the later of the following: a. The date on which notice is received or the policy or binder is surrendered; or b. The date of cancellation requested by the first Named Insured. b. Without reasonable explanation, progress toward completion of permanent repairs to the structure has not occurred within 60 days after receipt of funds following satisfactory adjustment or adjudication of loss resulting from a fire; 2.We may cancel this policy by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation, including the actual reason for the cancellation, to the last mailing address known to us, at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of prernlurrl; or b. 45 days before the effective date of cancellation if we cancel for any other reason ; except as provided in Paragraphs 3. and 4. below. c. Because of its physical condition, structure is in danger of collapse; the d. Because of its physical condition, vacation or demolition order has Men issued for the structure. or it has declared unsafe in accordance applicable law; been with e. Fixed and salvageable items have removed from the structure, intent to vacate the structure; explanation, and electricity are the structure for been indicating an f. Without reasonable water, sewer furnished for consecutive days; or heat, not 60 g. The structure is not maintained in substantial compliance wtth fire, safety and building codes. IL O1 46 08 IO © Insurance Services Office, Inc., 2010 Page 1 of 4 13 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EODI OO 4. If:7.If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund will be at least 90% of the pro rata refund unless the following applies: a. For Division Two - Equipment Breakdown, if the first Named Insured cancels, the refund will be at least 75% of the pro rata refund. a. You are an individual; b. A covered auto you own is of the "private passenger type"; and c. The policy does not cover garage, automobile sales agency, repair shop, service station or public parking place operations hazards; we may cancel the Commercial Automobile Coverage Part by mailing or delivering to the first Named Insured and the first Named Insured's agent or broker written notice of cancellation, including the actual reason for cancellation, to the last mailing address knownto us: b. If: (1) You are an individual; (2) A 11 covered auto you own private passenger type"; IS of the a. At least 10 days before the effective date of cancellation if we cancel for nonpayment of prernlurrl; or b. At least 10 days before the effective date of cancellation for any other reason if the policy is in effect less than 30 days; or c. At least 20 days before the effective date of cancellation for other than nonpayment if the policy is in effect 30 days or more; or d. At least 20 days before the effective date of cancellation if the policy is in effect for 60 days or more or is a renewal or continuation policy, and the reason for cancellation is that your driver's license or that of any driver who customarily uses a covered "auto" has been suspended or revoked during policy period. (3) The policy does not cover garage, automobile sales agency, repair shop, service station or public parking place operations hazards; and (4) The first Named Insured cancels; the refund will be not less than 90% of any unearned portion not exceeding $100, plus 95% of any unearned portion over $100 but not exceeding $500, and not less than 97% of any unearned portion in excess of $500. The cancellation will be effective even if we have not made or offered a refund 8. If notice is mailed, proof of mailing will be sufficient proof of notice. Changes The policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. Examination Of Your Books And Records B. 5.We will also mail or deliver to any mortgage holder, pledgee or other person shown in this policy to have an interest in any loss which may occur under this policy, at their last mailing address known to us, written notice of cancellation, prior to the effective date of cancellation. If cancellation is for reasons other than those contained in Paragraph A.3. above, this notice will be the same as that mailed or delivered to the first Named Insured. If cancellation is for a reason contained in Paragraph A.3. above, we will mail or deliver this notice at least 20 days prior to the effective date of cancellation. C. We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspection And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and 6. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. c. Recommend changes. Page 2 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 14 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A94E9D-BAI F-327297EOD100 2.We are not obligated to make any inspections, surwys, reports or recommendations, and any such actions we do undertake relate only to insurabiltty and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: G. Nonrenewal 1.We may elect not to renew this policy by mailing or delivering written notice of nonrenewal, stating the reasons for nonrenewal. to the first Named Insured and the first Named Insured's agent or broker, at their last mailing addresses known to us. We will also mail to any mortgage holder, pledgee or other person shown in this policy to have an interest in any loss which may occur under this policy, at their last mailing address known to us, written notice of nonrenewal. We will mail or deliver these notices at least 45 days before the a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3.Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, suIveys, reports or recommendations. Expiration of the policy; or b.Anniversary date of this policy if this policy has been written for a term of more than 4.Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. one year. Otherwise, we will renew this policy unless: a. The first Named Insured fails to pay the renewal premium after we have expressed our willingness to renew, including a statement of the renewal premium, to the first Named Insured and the first Named Insured's insurance agent or broker, at least 20 days before the expiration date; E. Premiums The first Named Insured shown in the Declarations: 1. Is responsible for the payment of aN premiums; and H•Other coverage acceptable to the insured has been procured prior to the expiration date of the policy; or2. Will be the payee for any return premiums we pay. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our wr#ten consent except in the case of death of an individual Named Insured. The policy clearly states that it is not renewable and is for a specific line, subclassification, or type of coverage that is not offered on a renewable basis. F. 2. If: a. b. Ca You are an individual; A covered auto you own is of the "private passenger type"; and The policy does not cover garage, automobile sales agency, repair shop, service station or public parking place operations hazards; If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custaly of your property will have your rights and duties but only with respect to that property. IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 3 of 4 15 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD100 the following applies to Commercial Automobile place of G.1.: nonrenewal of the Coverage Part in b. We will not refuse to renew Liability Coverage or Collision Coverage solelybecause an "insured" has submitted claims under Comprehensive Coverage or Towing And Labor Coverage.a. We may elect not to renew or continue this policy by mailing or delivering to you and your agent or broker written notice at least 20 days before the end of the policy period, including the actual reason for nonrenewal. If the policy period is more than one year, we will have the right not to renew or continue it only at an anniversary of its original effective date. If we offer to renew or continue and you do not accept, this policy will terminate at the end of the current policy penal. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer. c. If we fail to mail or deliver proper notice of nonrenewal and you obtain other insurance, this policy will end on the effective date of that insurance. Our President and Secretary have signed this policy. Where required by law, the Declarations page has been countersigned by our duly authorized representative. &'; d. hr TurIn ShIelds, SBWbry NIck+ A Hapol, neddnt Page 4 of 4 © Insurance Services Office, Inc., 2010 IL 01 46 08 10 16 of 16 (NKOOO) DocuSign Envelope ID: 4C862EC4-95A9JtE9D-BAI F-327297EOD100 About Symet ra Symetra is a financially strong, well-capitalized company on the rise, as symbolized by our brand icon–the swift. Swifts are quick, hardworking and nimble–everything we aspire to be when serving our customers. We’ve been in business for more than half a century with a commitment to creating employee benefit products that people need and understand. We appreciate your business and look forward to the opportunity to continue serving you with professional, informative and responsive service. IA :In ’ TS II #.a Our success as a business is guided by the prIncIples of Value, Transparency and SustaInability, or VTS. • Value: We provide products and solutions people need at a competitive price–backed by dedication to excellent customer service. Transparency: We communicate clearly and openly so people can understand what they are buying. • SustaInability: Our products stand the test of time. We’re financially disciplined, so we’ll be there when customers need us. RETIREMENT [ BENEFITS LIFE www.$ymotr8.com www.$VmeUamn/ny Syrleva+ and VTS' are roast+red servIce #uks of SWneUa LIfe hsunnce Cl>rrp&tv DocuSign Envelope ID: 4C862EC4-95A9-4E9D-BAIF-327297EOD10Q- ' EXH I BIT FORM CIQ CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entit' This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. FORM CIQ This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a) and by City of Denton Ethics Code, Ordinance 18-757 By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after thI 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. misdemeanor. a W An offense under this section is a Symetra L1 fe Insurance Company 2 1 1 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information in this section is being disclosed. Name of Officer Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relations hip with the local government officer. This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship as defined by Section 176.00 1(1-a), Local Government Code Attach additional pages to this Form CIQ as necessary, A.Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?= Yes = No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity?a Yes E No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of one percent or more? = Yes E No D.Describe each employment or business and family relationship with the local government officer named in this section. 4 5 LJ I have no Conflict of Interest to disclose. Signature of vendor doing business with the governmental entity Date DocuSign Envelope ID: 4C862EC4-95A94E9D-BAI F-327297EOD100 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Govemment Code may be found at http://www. statutes.legis.state.tx.us/ Docs/LG/htm/LCI 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 ofa 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) acontract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vaxk)c (B) has given to the local government officer or a family member ofthe officer one or more gifts that have an aggregate value ofmore than $ 100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code $ 176.006(a) and {a-1 ) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: ( 1) has an employment or other business relationship with a local government officer of that local govemmental entity, or a family member ofthe 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) gubmits 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 govemment 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 omcer. City of Denton Ethics Code Ordinance Number 18-757 Definitions Relative: a family member related to a City Official within the third 3d degree of affinity (marriage) or consanguinity (blood or adoption) City Official: for purpose of this article, the term consists of the Council Members, Department Heads, or member of the Board of Ethics, Planning and zoning Commission Members, Board of Adjustment, Historic Landmark Commission, or Public Utilities Board Vendor: a person who provides or seeks to provide goods, services, and/or real property to the City in exchange for compensation. This definition does not include those property owners from whom the City acquires public rightof-way or other real property interests for public use. Per the City of Denton Ethics Code, Section 2-273. – Prohibitions (3) it shall be a violation of this Article for a Vendor to offer or give a Gift to City Official exceeding fifty dollars (850.00) per gift, or multiple gift cumulatively valued at more than two hundred dollars (8200.00) per a single fiscal year. Per the City of Denton Ethics Code, Section 2-282. – Disposition (b), (5) Ineligibility If the Board of Ethics finds that a Vendor has violated this Article, the Board may recommend to the City Manager that the Vendor be deemed ineligible to enter into a City contract or other arrangement for goods, services, or real property, for a period of one (1) year. 'orm provided by Texas Ethics Commission www. ethics .state . tx . us Revised 11/30/2015 [k>cuSign Certificate Of Completion Envelope Id: 4C862EC495A94E9DBAI F327297EOD 100 Subject: Please DocuSign: City Council Contract 8239 Life & Disability Source Envelope Status: Completed Document Pages: 36 Certificate Pages: 6 AutoNav: Enabled Signatures: 4 Initials: 1 Envelope Originator: Christa Christian 901 B Texas Street Envelopeld Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) Denton, TX 76209 Christa.Christian@cityofdenton.com IP Address: 198.49.140.104 Record Tracking Status: Original 8/28/2023 8:28:17 AM Holder: Christa Christian Christa.Christian@cityofdenton.com Location: DocuSign Signer Events Christa Christian christa.christian@cityofdenton.com Purchasing Supervisor City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Signature Timestamp Sent: 8/28/2023 8:36:49 AM Viewed: 8/28/2023 8:37:00 AM Signed: 8/28/2023 8:37:27 AM Completed Using IP Address: 198.49.140.104 Lori Hewell lori.hewell@cityofdenton.com Purchasing Manager City of Denton SecurIty Level: Email, Account Authentication (None) Sent: 8/28/2023 8:37:31 AM Viewed : 8/28/2023 8:57:04 AM Signed: 8/28/2023 9:05:24 AM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Electronic Record and Signature Disclosure: Not Offered via DocuSign Marcella Lunn marcella.lunn@cityofdenton.com Mack Reinwand City Attorney City of Denton Security Level: Email, Account Authentication (None) Sent: 8/28/2023 9:05:26 AM Viewed: 8/28/2023 2:46:42 PM Signed: 8/28/2023 2:47:58 PM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Electronic Record and Signature Disclosure: Not Offered via DocuSign Rachel Stetzer Rachel.Stetzer@symetra.com Security Level: Email, Account Authentication (None) Completed Sent: 8/28/2023 2:48:01 PM Viewed: 8/29/2023 3:33:14 PM Signed: 8/30/2023 8:12:22 AM Using IP Address: 23.236.87.60 Electronic Record and Signature Disclosure: Accepted: 8/29/2023 3:33:14 PM ID: 4ed2b66d-428e4 189-b2 1 c2115e6b004671 Signer Events Megan Gilbreath megan.gilbreath@cityofdenton.com Deputy HR Director City of Denton - Human Resources Security Level: Email, Account Authentication (None) Signature Timestamp Sent: 8/30/2023 8:12:26 AM Viewed: 8/30/2023 9:16:53 AM Signed: 8/30/2023 9:17:12 AM 'DoaISW bF blUE_6bml Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Electronic Record and Signature Disclosure: Not Offered via DocuSign Cheyenne Defee cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Completed Sent: 8/30/2023 9:17:16 AM Viewed: 9/20/2023 10:50:24 AM Signed: 9/20/2023 10:50:50 AM Using IP Address: 198.49.140.10 Sara Hensley sara.hensley@cityofdenton.com City Manager City of Denton Security Level: Email, Account Authentication (None) Sent: 9/20/2023 10:50:52 AM Viewed: 9/20/2023 1 1 :31 :06 AM Signed: 9/20/2023 11 :31 :16 AM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Electronic Record and Signature Disclosure: Not Offered via DocuSign Jesus Salazar jesus.salazar@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 9/20/2023 1 1 :31:18 AM Viewed: 9/20/2023 12:27:29 PM Signed: 9/20/2023 12:28:49 PM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Electronic Record and Signature Disclosure: Accepted: 9/20/2023 12:27:29 PM ID: a8f221ef420a4497-9b6f-a2854e69fe80 In Person Signer Events Signature Status Timestamp Editor Delivery Events Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Status Timestamp Certified Delivery Events Timestamp Carbon Copy Events Status Timestamp Sent: 8/28/2023 8:37:30 AMCheyenne Defee 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 Carbon Copy Events Gretna Jones gretna.jones@cityofdenton.com Legal Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Status Timestamp Sent: 8/30/2023 9:17:15 AM Viewed: 8/30/2023 9:17:48 AM City Secretary Office citysecretary@cityofdenton.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 9/20/2023 12:28:52 PM Viewed: 9/20/2023 1 :56:29 PM LINDA KILE LINDA.KILE@CITYOFDENTON.COM Benefits Supervisor Risk Management - HR Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 9/20/2023 12:28:53 PM Witness Events Signature Signature Timestamp Notary Events Timestamp Envelope Summary Events Envelope Sent Certified Delivered Signing Complete Completed Status Timestamps 8/28/2023 8:36:49 AM 9/20/2023 12:27:29 PM 9/20/2023 12:28:49 PM 9/20/2023 12:28:53 PM Hashed/Encrypted Security Checked Security Checked Security Checked 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: Rachel Stetzer, Jesus Salazar 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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Required hardware and software Operata-gI= Browsers (for SENDERS ) Browsers (for SIGNERS) r Internet Explorer 6.0? or above B1 t=;;TExplorer 6.0?, N NetSca1 7.2 (or above) ®ccess to a valid email accountmEmail Screen Resolution Enabled Security Settings •Allow per session cookies •Users accessing the internet behind a Proxy Server must enable HTTP 1.1 settings via roxy connectron ## These minimum requirements are subject to change. If these requirements change, we will provide you with an email message at the email address we have on file for you at that time providing you with the revised hardware and software requirements, at which time you will have the right to withdraw your consent. 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