Agenda packet — Placentia City Council, January 10, 2023 (part 4 of 4)

CNA
c. We will pay up to $500 for loss to Personal
Property which is:
(1) Owned by an "insured"; and
(2) In or on the covered "auto."
This coverage applies only in the event of a
total theft of your covered "auto."
This insurance is excess over any other
collectible insurance and no deductible applies.

F. Rental Reimbursement
The following is added to Section III, Paragraph
A.4.:
d. We will pay for rental reimbursement expenses
incurred by you for the rental of an "auto"
because of "loss" to a covered "auto." Payment
applies in addition to the otherwise applicable
amount of each coverage you have on a
covered "auto." No deductibles apply to this
coverage.

1. We will pay only for those expenses
incurred during the policy period beginning
24 hours after the "loss" and ending,
regardless of the policy's expiration, with
the lesser of the following number of days:
(a) The number of days reasonably
required to repair or replace the
covered "auto"; or,
(b) 15 days.

2. Our payment is limited to the lesser of the
following amounts:
(a) Necessary and actual expenses
incurred; or,
(b) $25 per day subject to a maximum of
$375.

3. This coverage does not apply while there
are spare or reserve "autos" available to
you for your operations.

4. If "loss" results from the total theft of a
covered "auto" of the private passenger
type, we will pay under this coverage only
that amount of your rental reimbursement
expenses which is not already provided for
under the Physical Damage Coverage
Extension.

G. Hired "Autos"
The following is added to Section III. Paragraph
A..

5. Hired "Autos"
If Physical Damage coverage is provided under
this policy, and such coverage does not extend
SCA 23 500D
(Ed. 10/11)
H.

SCA 23 500D
(Ed. 10/11)
to Hired Autos, then Physical Damage
coverage is extended to:
a. Any covered "auto" you lease, hire, rent or
borrow without a driver; and
b. Any covered "auto" hired or rented by your
"employee" without a driver, under a
contract in that individual "employee's"
name, with your permission, while
performing duties related to the conduct of
your business.
c. The most we will pay for any one "accident"
or "loss" is the actual cash value, cost of
repair, cost of replacement or $75,000
whichever is less minus a $500 deductible
for each covered auto. No deductible
applies to "loss" caused by fire or lightning.
d. The physical damage coverage as is
provided by this provision will be limited to
the types of physical damage coverage(s)
provided on your owned "autos."
e. Such physical damage coverage for hired
"autos" will:
(1) Include loss of use, provided it is the
consequence of an "accident" for which
the Named Insured is legally liable, and
as a result of which a monetary loss is
sustained by the leasing or rental
concern.
(2) Such coverage as is provided by this
provision G.e.(1) will be subject to a
limit of $750 per "accident."
Airbag Coverage
The following is added to Section III, Paragraph
B.3.

The accidental discharge of an airbag shall not be
considered mechanical breakdown.

Electronic Equipment
Section III, Paragraphs B.4.c and B.4.d. are
deleted and replaced by the following:
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories
d. A $100 per occurrence deductible applies
to the coverage provided by this provision.

Diminution In Value
The following is added to Section III, Paragraph
B.6.

Includes copyrighted material of the Insurance Services Office used with its permission.

Page 2 of 3 ends

CNA
Subject to the following, the "diminution in value"
exclusion does not apply to:
a. Any covered "auto" of the private
passenger type you lease, hire, rent or
borrow, without a driver for a period of 30
days or less, while performing duties
related to the conduct of your business; and
b. Any covered "auto" of the private
passenger type hired or rented by your
"employee" without a driver for a period of
30 days or less, under a contract in that
individual "employee's" name, with your
permission, while performing duties related
to the conduct of your business.
c. Such coverage as is provided by this
provision is limited to a "diminution in value"
loss arising directly out of accidental
damage and not as a result of the failure to
make repairs; faulty or incomplete
maintenance or repairs; or the installation of
substandard parts.
d. The most we will pay for "loss" to a covered
"auto" in any one accident is the lesser of:
(1) $5,000; or
(2) 20% of the "auto's" actual cash value
(ACV)
III. Drive Other Car Coverage — Executive Officers
The following is added to Sections II and III:

1. Any "auto" you don't own, hire or borrow is a
covered "auto" for Liability Coverage while
being used by, and for Physical Damage
Coverage while in the care, custody or control
of, any of your "executive officers," except:
a. An "auto" owned by that "executive officer"
or a member of that person's household; or
b. An "auto" used by that "executive officer"
while working in a business of selling,
servicing, repairing or parking "autos."
Such Liability and/or Physical Damage
Coverage as is afforded by this provision will
be:
(1) Equal to the greatest of those
coverages afforded any covered "auto";
and
(2) Excess over any other collectible
insurance.

2. For purposes of this provision, "executive
officer" means a person holding any of the
SCA 23 500D
(Ed. 10/11)
SCA 23 500D
(Ed. 10/11)
officer positions created by your charter,
constitution, by-laws or any other similar
governing document, and, while a resident of
the same household, includes that person's
spouse.

Such "executive officers" are "insureds" while
using a covered "auto" described in this
provision.

IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claim, Suit Or
Loss
The following is added to Section IV, Paragraph
A.2.a.
(4) Your "employees" may know of an
"accident" or "loss." This will not mean that
you have such knowledge, unless such
"accident" or "loss" is known to you or if you
are not an individual, to any of your
executive officers or partners or your
insurance manager.

The following is added to Section IV, Paragraph
A.2.b.
(6) Your "employees" may know of documents
received concerning a claim or "suit." This
will not mean that you have such
knowledge, unless receipt of such
documents is known to you or if you are not
an individual, to any of your executive
officers or partners or your insurance
manager.

B. Concealment, Misrepresentation or Fraud
The following is added to Section IV, Paragraph
B.2.

Your failure to disclose all hazards existing on the
date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded
provided such failure or omission is not intentional.

C. Policy Period, Coverage Territory
Section IV, Paragraph B.7.b.(5) is revised to
provide:
a. 45 days of coverage in lieu of 30 days
V. DEFINITIONS
Section V. Paragraph C. is deleted and replaced
by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish, mental injury or death resulting from any of
these
Copyright, CNA Corporation, 2000.

Includes copyrighted material of the Insurance Services Office used with its permission.

Page 3 of 3 ends

C'NA
1 Product Name
LFOrm I ypej

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: Geocon Inc.

Endorsement Effective Date:01 /O1 /2022

SCHEDULE
Name(s) Of Person(s) Or Organization(s):

ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

Form No: CA 04 44 10 13
Endorsement Effective Date: 01/01/2022
© Copyright Insurance Services Office, Inc., 2011
Policy No: 6079910088
Policy Effective Date:
01/01/2022

20020009160799100913291
CNA

CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:

I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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:

A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if:

1. the written contract requires you to provide the additional insured such coverage; and

2. this coverage part provides such coverage.

11. But if the written contract requires:

A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or
B. additional insured coverage with "arising out of" language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following:

WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract.
111. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with:

A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract.

IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of:

A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including:

1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and

2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part.

V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part:

CNA75079XX (10-16) Policy No: 6079910091

Page 1 of 2 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

CNA

CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed
Operations Coverage Endorsement
Primary and Noncontributory Insurance
With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be:

1. primary and non-contributing with other insurance available to the additional insured; or

2. primary and to not seek contribution from any other insurance available to the additional insured.

But except as specified above, this insurance will be excess of all other insurance available to the additional insured.

VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:

The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following:

Any additional insured pursuant to this endorsement will as soon as practicable:

1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;

2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and

3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured.

The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured.

VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition:

Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement:

A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to:

1. the bodily injury or property damage; or

2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage.

Any coverage granted by this endorsement shall apply solely to the extent permissible by law.

All other terms and conditions of the Policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.

CNA75079XX (10-16)

Page 2 of 2 ends

Nat'l Fire Ins Co of Hartford
Insured Name: THE GEOCON GROUP, INC.

Policy No: 6079910091
Endorsement No: 36
Effective Date: 01/01/2022

20020009160799100913292
CNA

CNA PARAMOUNT
Pollution Exclusion Amendatory Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed that under COVERAGES, Coverage A, Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete paragraph (2) of exclusion f. Pollution, in its entirety, and replace it with the following:

This insurance does not apply to:
(2) Any loss, cost or expense arising out of any:
(a) request, demand, order or statutory or regulatory requirement that any Insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of, pollutants; or (b) Claim by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of, pollutants.

However, if liability for damages because of property damage is not excluded by paragraph (1) of this exclusion, then neither will paragraph (2)(a) above serve to exclude such damages.

All other terms and conditions of the Policy remain unchanged.

CNA74843XX (1-15) Policy No: 6079910091

Page 1 of 1 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

20020009160799100913293
CNA

CNA PARAMOUNT
Amendment of Insuring Agreement - Known or
Continuing Injury or Damage Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART (OCCURRENCE VERSION) It is understood and agreed that:

I. under Coverages, Coverage A — Bodily Injury And Property Damage Liability, the paragraph entitled Insuring Agreement, subparagraphs 1.b.(3), c. and d. are deleted and replaced with the following:
b. This insurance applies to bodily injury and property damage only if:
(3)
with respect to bodily injury or property damage that continues, changes or resumes so as to occur during more than one policy period, both of the following conditions are met:
(i) prior to the policy period, no authorized insured knew that the bodily injury or property damage had occurred, in whole or in part; and
(ii) during the policy period, an authorized insured first knew that the bodily injury or property damage had occurred, in whole or in part.

For purposes of this paragraph 1.b.(3) only, if (a) bodily injury or property damage that occurs during this policy period does not continue, change or resume after the termination of this policy period; and (b) no authorized insured first knows of this bodily injury or property damage until after the termination of this policy period then such first knowledge will be deemed to be during this policy period. c. bodily injury or property damage which occurs during the policy period and was not, prior to the policy period, known to have occurred by any authorized insured includes any continuation, change or resumption of that bodily injury or property damage after the end of the policy period. d. Bodily injury or property damage will be deemed to have been known to have occurred at the earliest time when any authorized insured:
(1) reports all, or any part, of the bodily injury or property damage to the insurer or any other insurer; (2) receives a written or verbal demand, claim for damages because of the bodily injury or property damage; or
(3) becomes aware by any other means that bodily injury or property damage has occurred or has begun to occur.

11. the section entitled DEFINITIONS is amended to add the following definition:

Authorized insured means any Insured listed under paragraph 1. of the section entitled Who Is An Insured, or any employee authorized by such an Insured to give or receive notice of an occurrence or claim.

All other terms and conditions of the Policy remain unchanged.

CNA74859XX (1-15) Policy No: 6079910091

Page 1 of 1 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

20020009160799100913294
CNA

CNA PARAMOUNT
Primary and Noncontributory - Other Insurance
Condition Endorsement
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
It is understood and agreed that the condition entitled Other Insurance is amended to add the following:

Primary And Noncontributory Insurance
Notwithstanding anything to the contrary, this insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that:
a. the additional insured is a named insured under such other insurance; and b. the Named Insured has agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

All other terms and conditions of the Policy remain unchanged.

CNA74987XX (1-15) Policy No: 6079910091

Page 1 of 1 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

CNA

CNA PARAMOUNT
Architects, Engineers and Surveyors General Liability
Extension Endorsement
by the indemnitee at the Insurer's request will be paid as defense costs. Such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance.

C. This PERSONAL AND ADVERTISING INJURY - LIMITED CONTRACTUAL LIABILITY Provision does not apply if Coverage B —Personal and Advertising Injury Liability is excluded by another endorsement attached to this Coverage Part.

This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.

22. PROPERTY DAMAGE — ELEVATORS
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.

B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the Other Insurance conditions is amended to add the following paragraph:

This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators.

23. RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES
WHO IS INSURED is amended to include as Insureds natural persons who are retired partners, members, directors or employees, but only for bodily injury, property damage or personal and advertising injury that results from services performed for the Named Insured under the Named Insured's direct supervision. All limitations that apply to employees and volunteer workers also apply to anyone qualifying as an Insured under this Provision.

24. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:

A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000. limit; and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit.

25. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure.

26. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following:

The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of:

1. the Named Insured's ongoing operations; or

2. your work included in the products -completed operations hazard.

However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement:

CNA74858XX (1-15) Policy No: 6079910091

Page 16 of 18 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

20020009160799100913261
CNA

CNA PARAMOUNT
Architects, Engineers and Surveyors General Liability
Extension Endorsement

1. is in effect or becomes effective during the term of this Coverage Part; and

2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim.

27. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation.

If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached, then the following changes apply:

A. The following wording is added to the above -referenced endorsement:

With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of:

1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor

2. Bodily injury or property damage included within the products -completed operations hazard that arises out of those portions of the project that are not residential structures.

B. Condition 4. Other Insurance is amended to add the following subparagraph 4.b.(1)(c):

This insurance is excess over:
(c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up) insurance program.

C. DEFINITIONS is amended to add the following definitions:

Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.I.P.).

Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency, including but not limited to:

1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments; and

2. the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs, detached garages, guest houses or any similar structures).

However, when there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels or motels. Residential structure also does not include hospitals or prisons.

CNA74858XX (1-15) Policy No: 6079910091

Page 17 of 18 ends

Nat'l Fire Ins Co of Hartford Effective Date: 01/01/2022 Insured Name: THE GEOCON GROUP, INC.

CNA
1 NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS
It is understood and agreed that:

If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective.

If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice.

Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.

Form No: CC68021A (02-2013)
Endorsement Effective Date: 01/01/2022
Named Insured: Geocon Inc.
©CNA All Rights Reserved.

Policy No: 6079910091
6079910088
WC6079910107

CNA
Workers Compensation And Employers Liability Insurance
Policy Endorsement

BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.

It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following:

We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 3%.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.

Form No: G -19160-B (11-1997)
Endorsement Effective Date: Endorsement Expiration Date:

Endorsement No: 2; Page: 1 of 1
Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 © Copyright CNA All Rights Reserved.

Policy No: WC679910107
Policy Effective Date: 01-01-2022
Policy Page: 33 of 50

TO:

VIA:

FROM:

DATE:

Placentia Cit Council

AGENDA REPORT

CITY COUNCIL

CITY ADMINISTRATOR

DEPUTY CITY ADMINISTRATOR / SUPPORT AND EMERGENCY SERVICES JANUARY 10, 2023
SUBJECT: ANNUAL CITY COUNCIL APPOINTMENTS TO VARIOUS INTERGOVERNMENTAL

AGENCIES, ASSOCIATIONS, AND CITY SUBCOMMITTEES
FISCAL
IMPACT: NONE
SUMMARY:

City Council Members represent the City on various intergovernmental agencies, associations, and City subcommittees which consider and/or recommend policy and legislation that directly affects the City. These appointments are reviewed and modified annually following the reorganization of the City Council and/or swearing in of new Council Members. This item is being presented to give the City Council the opportunity to make annual appointments for 2023.

As a related item, former Council Member Craig S. Green served on various intergovernmental agencies, associations, and City subcommittees, including the Orange County Vector Control District (OCVCD) Board of Trustees and as a member of the City's Senior/Community Center Blue -Ribbon Committee. The OCVCD has requested, and it is Mr. Green's desire, that he continue to serve on the OCVCD Board of Trustees. Additionally, Mr. Green would like to continue serving on the Senior/Community Center Blue -Ribbon Committee. Final discretion on these appointments rest with the City Council.

Tonight's action allows the City Council to make appointments to various intergovernmental agencies, associations, and subcommittees. Additionally, this action will consider the policy question of having Mr. Green continue serving on the OCVCD Board of Trustees for calendar year 2023 as well as the City's Senior/Community Center Blue -Ribbon Committee for its duration.

RECOMMENDATION:

It is recommended that the City Council take the following actions:

1. Review the attached list of current appointments to the various intergovernmental agencies, associations, and City subcommittees and make appointments as desired; and

2. Consider having Mr. Craig S. Green serve on the Orange County Vector Control District Board of Trustees for the 2023 calendar year; and

3. Consider having Mr. Craig S. Green serve on the City's Senior/Community Center Blue - Ribbon Committee for the duration of the Committee; and

3.b.

Jan 10, 2023

City Council Agenda
January 10, 2023

Page 2 of 3 ends

4. Direct Staff to notify the various intergovernmental agencies, associations, and City subcommittees of the City Council appointments.

DISCUSSION:

Each year after City Council reorganization and/or swearing in of new Council Members, the Mayor and City Council must consider appointments to numerous intergovernmental agencies, associations, and City subcommittees. These agencies, associations, and subcommittees include, but are not limited to the following:
• League of California Cities Orange County Division
• Association of California Cities Orange County
• Orange County Sanitation District
• Santa Ana Flood Control Protection Agency
• Southern California Association of Governments
City Council had previously approved former Council Member Craig S. Green to serve on a two- year term for the OCVCD Board of Trustees, which expires on January 11, 2023. The Board of Trustees is comprised of 35 members, one from each Orange County's 34 cities and one representing the County at Targe. The stipend for serving on the OCVCD Board of Trustees is $100 per month. It is Mr. Green's desire to continue to serve on the OCVCD Board of Trustees for calendar year 2023. In addition, OCVCD submitted an official correspondence (Attachment 1) on November 30, 2022 to request that Mr. Green remain on the Board of Trustees for the 2023 term. As stated in the letter, California Health and Safety Code that governs the duties and responsibilities of vector control agencies in California, permits and encourages a member of the City Council, or a member of the public that resides within the appointing agency's jurisdiction.

The City also has the distinction of determining the length of the term, either for two or four years.

Additionally, Mr. Green had previously served as a member of the City's Senior/Community Center Blue Ribbon Committee ("Blue Ribbon Committee") along with Mayor Ward Smith. On July 20, 2021 the City Council authorized the formation of the Blue Ribbon Committee to assist the City in identifying the community needs and design components for a proposed Senior/Community Center at Tri -City Park. The Blue Ribbon Committee is comprised of nine (9) members: one (1) appointed from each of the five (5) City Council districts; one (1) from the Parks, Arts and Recreation Commission; one (1) from the Senior Advisory Committee; and two (2) City Council Members. At the September 7, 2021 City Council meeting, the City Council formally appointed former Council Member Craig Green to serve on the Blue Ribbon Committee. It is Mr.

Green's desire to continue to serve on the Blue Ribbon Committee for the remainder of its duration.

The Fair Political Practices Commission (FPPC) has modified its rules governing the appointment process, to account for the fact that councilmembers may be voting on an appointment that will give them additional compensation for serving on outside boards. Councilmembers may participate in the vote to appoint themselves so long as, prior to the meeting, the City has posted an updated copy of FPPC Form 806, which details current appointments and compensation. The City is in compliance with this requirement. Attached is a list of the current appointments to various agencies, associations, and subcommittees along with the stipend, if any.

City Council Agenda
January 10, 2023

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Prepared by:

Po .J
Carole M. Wayman lJ
Deputy City Clerk
Reviewed and approved:

Christian Bettenhausen
City Attorney
Reviewed and approved:

Ro nna Ramirez
Deputy City Administrate
Reviewed and ap
Damien R. Arrula
City Administrator
Attachments:

1. Correspondence from Orange County Vector Control District

2. Appointments to Various Agencies, Associations, and City Subcommittees 2022

BOARD OFFICERS FOR 2022

PRESIDENT

JAMES GOMEZ

VICE-PRESIDENT

PEGGY HUANG

SECRETARY

CRAIG GREEN

DISTRICT MANAGER

RICHARD HOWARD

CLERK OF THE BOARD
TAWNIA E. PETT
BOARD OF TRUSTEES - 2022

ALISO VIEJO

RICHARD HURT

ANAHEIM

LUCILLE KRING
BREA

CECILIA HUPP

BUENA PARK

SUSAN SONNE

COSTA MESA

WILLIAM TURPIT

CYPRESS

SCOTT MINIKUS

DANA POINT

RICHARD VICZOREK

FOUNTAIN VALLEY

KIM CONSTANTINE

FULLERTON

FRED JUNG

GARDEN GROVE

STEPHANIE KLOPFENSTEIN

HUNTINGTON BEACH

MIKE POSEY
IRVINE

TAMMY KIM

LA HABRA

JAMES GOMEZ

LA PALMA
DEBBIE S. BAKER

LAGUNA BEACH

SUE KEMPF

LAGUNA HILLS

ERICA PEZOLD

LAGUNA NIGUEL

RISCHI PAUL SHARMA

LAGUNA WOODS
SHARI L. HORNE

LAKE FOREST

VLADIMIR ANDERSON

LOS ALAMITOS

TANYA DOBY

MISSION VIEJO

ROBERT RUESCH

NEWPORT BEACH

JOY BRENNER
ORANGE

JONATHAN DUMITRU

PLACENTIA

CRAIG GREEN

RANCHO SANTA MARGARITA

APRIL JOSEPHSON

SAN CLEMENTE

STEVE KNOBLOCK

SAN JUAN CAPISTRANO

JOHN TAYLOR

SANTA ANA

NELIDA MENDOZA

SEAL BEACH

SANDRA MASSA-LAVITT

STANTON

GARY TAYLOR
TUSTIN

REBECCA GOMEZ

VILLA PARK

CRYSTAL MILES

WESTMINSTER

CHI CHARLIE NGUEYN

YORBA LINDA

PEGGY HUANG

COUNTY OF ORANGE

ELIZABETH

GUILLEN-MERCHANT
November 30, 2022
Honorable Mayor Rhonda Shader
City of Placentia
401 E. Chapman Avenue
Placentia, CA 92870
Dear Mayor Shader:
13001 GARDEN GROVE BOULEVARD
GARDEN GROVE, CA 92843-2102
PHONES: (714) 971-2421
(949) 654-2421
FAX: (714) 971-3940
ocvcd (a) ocvecto r. o ra
ocvector.org
facebook.com/ocvectorcontrol
twitter.com/ocvector
I am writing to you today as the President of the Board of Trustees of the Orange County Mosquito and Vector Control District. The District Board of Trustees is comprised of thirty-five members, one from each of Orange County's 34 cities and one representing the county at Targe.

Councilman Craig Green currently serves as the Secretary of the Board of Trustees and is in-line to be the District's next Vice President in 2023. In my opinion, Craig has been an outstanding member of the District's Board of Trustees since he was first appointed to serve in 2017. He has served in a number of leadership capacities, including Chair of the Budget and Finance Committee, as well as the Joint Committee that is exploring potential relocation efforts for our District facilities.

While Craig may be transitioning off of his role as a member of the Placentia City Council, his service to the public can continue as a member of the District's Board of Trustees. The California Health and Safety Code that governs the duties and responsibilities of vector control agencies in California permits and encourages members -at -large to sit on a Board of Trustees. Cities have the discretion of appointing a member of the city council, or a member of the public that resides within the appointing agency's jurisdiction. The city also has the distinction of determining the length of the term, either for two or four years.

Currently, the District's Board of Trustees is comprised of twenty-nine sitting council members and six at -large members.

I'd like to ask you to support Craig Green's reappointment to the Orange County Mosquito and Vector Control District Board of Trustees for the next two -or four-year period. In my opinion, Craig's past work and institutional knowledge will be a loss to the District if not reappointed.

Regardless of who the city selects to serve on the Board of Trustees, I look forward to working collaboratively on the many issues currently before the Orange County Vector Control District Board of Trustees.

Regards,
James Gomez, President
Orange County Vector Control District Board of Trustees Cc: Craig Green
"An Independent Special District Serving Orange County Since 1947" The mission of the Orange County Mosquito and Vector Control District is to educate and protect Orange County from vectors and prevent vector-borne diseases in an environmentally responsible manner.

Organization
City of Placentia
Appointments to Various Agencies, Associations, and City Subcommittees 2022
Meeting Schedule
Meeting Location
Delegate/Alternate
City Liaison
Association of California Cities -
OC
wwwLaccocLbrq
714-953-1300
c/o City of Dana Point
Schedule and
locations to be
announced
❑arious locations in Orange County
Shader/Wan❑e
FacilitatorEMaria Perez
Administration
Citywide Fiber Optic and Smart
City Ad -Hoc (Est. 10/19/2021)
TBD
TBD
lamaguchi/Shader
Luis Estevez
Public Works
Finance and Investment Committee Meetings are held
quarterly
Placentia City Hall
Shader/Wanl 'e/Larson
(Mayor/Mayor Pro Term/ City
Treasurer)
Jennifer Lampman
Finance Department
Financial Audit Oversight
Subcommittee
Internal Committee Placentia City Hall
Green/Smith
Jennifer Lampman
Finance Department
Heritage Committee
2nd Wednesday of
each month at 700
p.m.
(except December)
Placentia City Hall
❑amaguchi/Smith
Veronica Ortiz
Community Services
Historic Preservation Ad -Hoc
(Est. 10/19/2021)
TBD
TBD
Green/Smith
Joe Lambert
Development Services
Housing, Community, and
Economic Development
Ad Hoc Committee General Plan
Advisory Subcommittee
Internal Committee Placentia City Hall
Meets as needed
Wan e/Shader
Joe Lambert
Development Services

Organization
League of California Cities
Orange County Division
wwwlstalcities ora
714-944-4023
Meeting Schedule
Statewide League
Events-
Annual Conference
Meeting Location
General Membership Meetings
❑ uarterly at ❑arious locations in
Orange County
Delegate/Alternate
❑amaguchi/Wan ❑e
City Liaison/Dept)
Facilitator -Maria Perez
Administration
County of Orange City Selection
Committee
https 7/cob.ocgov.com/boards-
commissions-committees/city-
selection-committee
714-834-2206
May and November ❑arious locations in Orange County
Shader/Wan❑e
Facilitator❑Maria Perez
Administration
Old Town ParCing Ad -Hoc
(Est. 4/20/2021)
Meetings called as
needed
Shader/Green
Joe Lambert
Development Services
Orange County Council of
Governments
wwwlcccoglctom
949-698-2856
Monthly
Orange County Council of Governments
(OCCOG)
3972 Barranca Pkwy.

Irvine, CA 92606
Smith
Chosen as Alternate by
Brea's Marty Simonoff
Facilitator Maria Perez
Administration
Orange County Sanitation District
wwwL csdicom
714-593-7130
113tipend❑$212.50 per mtg,
Maximum of 6 meetings per month
4t" Wednesday of each OCSD Administrative Offices
month at 61)0 p.m. 10844 Ellis Ave.

Fountain ❑alley, 92708
Wan ie/Smith
FacilitatorAllaria Perez
Administration
Orange County Vector Control
District - Board of Trustees
wwwlocvcd org
714-971-2421
rStipend11$100 per month in lieu of travel
(no meeting, no pay)
3rd Thursday of each
month at 3[00 p.m.

OCCCD Office
13001 Garden Grove Blvd.

Garden Grove, 92843
Green
(2 -yr term expires
01/11/2023)
FacilitatorAllaria Perez
Administration
Placentia Community Foundation Meetings called as
needed
Placentia City Hall
Shader/Green/Larson
(Mayor/Councilmember/City
Treasurer)
Veronica Ortiz
Community Services

Organization
Meeting Schedule
Meeting Location Delegate/Alternate City Liaison/Dept)
Placentia Disaster Council
Meets as needed
Placentia City Hall
Shader/Smith
Patric❑ Powers
Emergency & Health
Services Manager
Public Safety Facility Ad -Hoc
(Est. 10/20/2020)
Meetings called as
needed
Green/Smith
Luis Estevez
Public Works
Recreational Vehicle Paring Ad -
Hoc (Est. 7/6/2021)
Meetings called as
needed
❑amaguchi/Smith
Joe Lambert
Development Services
Santa Ana River Flood Protection
Agency
wwwl ocflood I eom/saro/sarfoa
714-647-3938
4th Thursday of odd -
numbered months
4300 p.m.

Orange County Water District
18700 Ward Street
Fountain ❑alley, 92708
lamaguchi/Shader
FacilitatorEMaria Perez
Administration
Senior/Community Center Blue
Ribbon Committee
3rd Wednesday of
each month
6[30 p.m.

Front Community Meeting Room
Green/Smith
Karen Crooner
Community Services
Sewer Utility, Recycling and
Refuse Committee
Meetings called as Placentia City Hall
needed
❑amaguchi/Smith
Elsa Robinson
Public Works.

Southern California Association of
Governments
wwwlscaolcalOov
213-236-1800
LStipendL$120 per mtg & mileage
reimbursement
1St Thursday of each
month
8330 a.m. — 230 p.m.
(depending on the
particular committee)
818 W. 7th Street, 12th Floor
Los Angeles,90017
Smith/Shader
Facilitator❑Maria Perez
Administration
Southern California Association of
Governments — Annual General
Assembly Voting Delegates
wwwlscacticcalOov
213-236-1800
May 5, 2022
Palm Desert, CA
LW Marriott Desert Springs Resort & Spa
74-885 Country Club Drive
Smith
1St Alt. Shader
2nd Alt. ❑amaguchi
FacilitatorLlMaria Perez
Administration

Organization Meeting Schedule Meeting Location Delegate/Alternate City Liaison/Dept iorba Linda Water District/Golden
State Water Joint Water Services
Committee
wwwr Iwdtom
wwwrgswater cLom
714-701-3000 714-528-1462
Called meeting
Alternates with Placentia City Hall,
HLWD
1717 E. Miraloma Ave., Placentia 92870
and
Golden State Water
500 Cameron St., Placentia 92870
uamaguchi/Wanue
and City Admin. Arrula
Luis Estevez
Public Works

Placentia City CouncilJanuary 10, 2023

Placentia City Council
January 10, 2023