The URL can be used to link to this page

19-088 York Risk Services Group, Inc., Workers' Compensation Services CITY OF isPROFESSIONAL/CONSULTING SERVICES AGREEMENT CUPERTINO 1. PARTIES This Agreement is made and entered into as of June 30, 2017 ("Effective Date")by and between the City of Cupertino, a municipal corporation("City"), and York Risk Services Group, Inc. ("Contractor"), a Corporation for workers' compensation services 2. SERVICES Contractor agrees to provide the services and perform the tasks ("Services") set forth in detail in Scope of Services, attached here and incorporated as Exhibit A. 3. TIME OF PERFORMANCE 3.1 This Agreement begins on the Effective Date and ends on June 30, 2020 ("Contract Time"), unless tenninated earlier as provided herein. Contractor's Services shall begin on June 30, 2017 and shall be completed by June 30, 2020 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here Exhibit B. I 3.3 Time is of the essence for the performance of all the Services. Contractor must have sufficient time, resources, and qualified staff to deliver the Services on time. 1 I 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will based on actual costs but that will be capped so as not to exceed $79,494.00 ("Contract Price"), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C, Compensation attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount. No extra work or payment is pennitted without prior written approval of City. 4.2 Invoices and Payments. Monthly invoices must state a description of the deliverable completed and the amount due for the preceding month. Within thirty (30) days of completion of Services,Contractor must submit a requisition for final and complete payment of costs and pending claims for City approval. Failure to timely submit a complete and accurate payment requisition relieves City of any further payment or other obligations under the Agreement. C/18275 Page 1 of 41 Professional/Consulting Contracts/Version:May 22,2018 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. Contractor is not entitled to health benefits,worker's compensation or other benefits from the City. 5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Services in a competent and professional manner and according to the highest standards and best practices in the industry. 53 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Services as required by law and have procured a City Business License. i 54 Subcontractors. Only Contractor's employees are authorized to work under this j Agreement. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Agreement will apply to any approved subcontractor. 55 Tools, Materials and Equipment. Contractor will supply all tools, materials and equipment required to perform the Services under this Agreement. M Payment of Taxes. Contractor must pay income taxes on the money earned under this j Agreement. Upon City's request, Contractor will provide proof of payment and will indemnify City for violations pursuant to the indemnification provision of this Agreement. 6. PROPRIETARY/CONFIDENTIAL INFORMATION In performing this Agreement, Contractor may have access to private or confidential information owned or controlled by the City, which may contain proprietary or confidential details the disclosure of which to third parties may be damaging to City. Contractor shall hold in confidence all City information provided by City to Contractor and use it only to perform this Agreement. Contractor shall exercise the same standard of care to protect City information as a reasonably prudent contractor would use to protect its own proprietary data. 7. OWNERSHIP OF MATERIALS 7.1 Property Rights. Any interest (including copyright interests) of Contractor in any product, memoranda, study, report, map, plan, drawing, specification, data, record, document or other information or work,in any medium(collectively, "Work Product"),prepared by Contractor in connection with this Agreement will be the exclusive property of the City and shall not be shown to any third-party without prior written approval of City. 7.2 Copyright. To the extent permitted by Title 17 of U.S. Code, all Work Product arising out of this Agreement is considered "works for hire" and all copyrights to the Work Product will be the property of City. Alternatively, Contractor assigns to City all Work Product copyrights. Contractor may use copies of the Work Product for promotion only with City's written approval. C/18275 Page 2 of 41 Professional/Consulting Contracts/Version:May 22,2018 73 Patents and Licenses. Contractor must pay royalties or license fees required for authorized use of any third party intellectual property, including but not limited to patented, trademarked,or copyrighted intellectual property if incorporated into the Services or Work Product of this Agreement. 7.4 Re-Use of Work Product.Unless prohibited by law and without waiving any rights, City may use or modify the Work Product of Contractor or its sub-contractors prepared or created under this Agreement, to execute or implement any of the following: (a) The original Services for which Contractor was hired; (b) Completion of the original Services by others; (e) Subsequent additions to the original Services; and/or (d) Other City projects. i i 75 Deliverables and Format. Contractor must provide electronic and hard copies of the Work Product, on recycled paper and copied on both sides, except for one single-sided original. 8. RECORDS Contractor must maintain complete and accurate accounting records relating to its performance in accordance with generally accepted accounting principles. The records must include detailed information of Contractor's performance, benchmarks and deliverables, which must be available to City for review and audit. The records and supporting documents must be kept separate from other records and must be maintained for four years from the date of City's final payment. 9. ASSIGNMENT Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Agreement and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. 10. PUBLICITY/SIGNS Any publicity generated by Contractor for the project under this Agreement, during the tern of this Agreement and for one year thereafter, will reference the City's contributions in making the project possible. The words "City of Cupertino" will be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted, exhibited or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. i 11. INDEMNIFICATION 11.1 To the fiillest extent allowed by law, and except for losses caused by the sole and active negligence or willfiil misconduct of City personnel, Contractor shall indemnify, defend and hold i C/18275 Page 3 of 41 Professional/Consulting Contracts/Version:May 22,2018 harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and consultants ("Indemnitees"), through legal counsel reasonably acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings) of every nature, arising directly or indirectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Negligent acts or omissions or willful misconduct committed during performance of the Services; (c) Personal injury,property damage,or economic loss resulting from the negligent acts or omissions in the performance of Contractor or its subcontractors or sub-subcontractors; (d) Unauthorized use or disclosure of City's confidential and proprietary Information; (e) Claim of infringement or violation of a U.S. patent or copyright, trade secret, trademark, or service mark or other proprietary or intellectual property rights of any third party. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim, in accordance with California Public Contract Code Section 9201. At City's request, Contractor will assist City in the defense of a claim, dispute or lawsuit arising out of this Agreement. 11.3 Contractor's duties under this section are not limited to the Contract Price, workers' compensation payments, or the insurance or bond amounts required in the Agreement. Nothing in the Agreement shall be construed to give rise to an implied right of indemnity in favor of Contractor against City or any Indemnitee. 11.4. Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Agreement, a purchase order, or other transaction. tl 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D, and must maintain the insurance for the duration of the Agreement, or longer as required by City. City will not execute the Agreement until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor's compensation or terminating the Agreement. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state and federal laws and regulations applicable to this Agreement. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor's ability to perform. Contractor is responsible for verifying the employment authorization of employees performing the Services, as required by the Immigration Reform and Control Act. C/18275 Page 4 of 41 Professional/Consulting Contracts/Version:May 22,2018 13.2 Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a"public works"component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws. 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777 and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee,or any other person,by Contractor or its employees or sub-contractors will not be tolerated. 13.4 Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable to this Agreement and must avoid any conflict of interest. Contractor warrants that no public official, employee, or member of a City board or commission who might have been involved in the making of this Agreement, has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. Contractor may be required to file a conflict of interest form if Contractor makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of the California Code of Regulations. Contractor agrees to abide by the City's riles governing gifts to public officials and employees. 13.5 Remedies.Any violation of Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements or terminating this Agreement. City reserves all other rights and remedies available under the law and this Agreement, including the right to seek indemnification under Section 11 of this Agreement. 14. PROJECT COORDINATION City Project Manager. The City assigns Kristina Alfaro, Director of Administrative Services as the City's representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Tony Zuniga, Sr. Account Exec., York Risk Services as its single Representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. Contractor's Project manager is responsible for coordinating and scheduling the Services in accordance with the Scope of Services and the Schedule of Performance. Contractor must regularly update the City's Project Manager about the progress with the work or any delays, as required under the Scope of Services. City written approval is required prior to substituting a new Representative. 15. ABANDONMENT OF PROJECT City may abandon or postpone the Project or parts therefor at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment, and will be C/18275 Page 5 of 41 Professional/Consulting Contracts Nersion:May 22,2018 given reasonable time to assemble the work and close out the Services. With City's pre-approval in writing, the time spent in closing out the Services will be compensated up to a maximum of ten percent (10%) of the total time expended to date in the performance of the Services. 16. TERMINATION City may terminate this Agreement for cause or without cause at any time. Contractor will be paid for satisfactory Services rendered through the date of termination, but final payment will not be made until Contractor closes out the Services and delivers the Work Product. 17. GOVERNING LAW,VENUE AND DISPUTE RESOLUTION This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in court. If a dispute arises, Contractor must continue to provide the Services pending resolution of the dispute. If the Parties elect arbitration,the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 18. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. 19. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Agreement. 20. WAIVER Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract provision. City's waiver of a breach shall not constitute waiver of another provision or breach. 21. ENTIRE AGREEMENT This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement(s) and understanding(s), either oral or written, between the Parties. Any modification of this Agreement will be effective only if in writing and signed by each Party's authorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsistency between the main Agreement and the attachments or exhibits thereto, the text of the main Agreement shall prevail. C/18275 Page 6 of 41 Professional/Consulting Contracts/Version:May 22,2018 22. INSERTED PROVISIONS Each provision and clause required by law for this Agreement is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 23. HEADINGS The headings in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the terms or provisions of this Agreement. i 24. SEVERABILITY/PARTIAL INVALIDITY If any term or provision of this Agreement, or their application to a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling. All other terms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. The Parties agree to work in good faith to amend this Agreement to carry out its intent. 25. SURVIVAL All provisions which by their nature must continue after the Agreement expires or is terminated, mnification, Ownership of Materials/Work Product, Records, Governing Law including the Inde and Attorney Fees, shall survive the Agreement and remain in full force and effect. 26. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail,postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: To Contractor: York Risk Services Group, Inc. 10300 Torre Avenue 1101 Creekside Ridge Drive, Suite 100 Cupertino, CA 95014 Roseville, CA 95678 Attention: Kristina Alfaro Attention: Kristen Brooks Email: Kristinaa@cupertino.org Email: kristen.brooks@yorkrisk.com With a copy to: Michael Krawitz, General Counsel 101 Hudson Street, Suite 3500 Jersey City, NJ 07302 C/18275 Page 7 of 41 Professional/Consulting Contracts/I"ersion:May 22,2018 27. VALIDITY OF CONTRACT This Agreement is valid and enforceable only if(a) it complies with the purchasing and contract provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, as amended from time to time, (b) is signed by the City Manager or an authorized designee, and (c) is approved for form by the City Attorney's Office. 28. EXECUTION The person executing this Agreement on behalf of Contractor represents and warrants that Contractor has full right,power, and authority to enter into and carry out all actions contemplated by this Agreement and that he or she is authorized to execute this Agreement, which constitutes a legally binding obligation of Contractor. This Agreement may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. IN WITNESS WIIEREOF, the parties have caused the Agreement to be executed. CONTRACTOR CITY OF CUPERTINO j York Risk Services Group,Inc. A Municipal Corporation 6 t i By O Iri By Name Jody Moses Name Kristina Alfaro Title Executive vice President Title Director of Administrative Services I Date l jo /7 &H Date Tax I.D.No.: 13-1963636 APPROVED AS TO FORM: q HEATHER M. MINNER Cupertino City Attorney ATTEST: (5v, GRACE SCH T S"_ 36 City Clerk C/18275 Page 8 of 41 Professional/Consulting Contracts/version:May 22,2018 Exhibit A SCOPE OF THE WORK TO BE PERFORMED AND STANDARDS TO BE FOLLOWED A. Claims Administration Promptly create a claims file within twenty-four(24)hours after receipt of the Employer's First Report of Injury from the City. Investigate Workers' Compensation claims and incidents, which may be the subject of such claim against the City. Recommend acceptance/rejection of submitted claims. 1. Determine liability for claimed injuries and illnesses on a timely basis and in accordance with the California Labor Code. 2. Determine eligibility for and authorize payment of medical and indernnity benefits on a timely basis. 3. Review, compute, and, seek approval by the City to pay all informal ratings, findings and awards, and settlements. 4. Arrange for informal disability ratings whenever possible to avoid unnecessary litigation. 5. Pay any and all penalties due in accordance with the California Labor Code. Such penalties shall be paid by the claims achninistrator with liability for theaction determined by the record unless such penalties were incurred as a result of the City's action or inaction. 6. Establish files containing medical and factual information on each reported claim, together with complete accounting records and maintain in accordance with statutory time requirements. 7. Prepare, file, and maintain all information and reports as required by the State of California, Department of Self-Insurance. I 8. Provide the City with information and recommendations for implementation strategies for changes or proposed changes in statutes, rules and regulations affecting the City under the a California Labor Code for workers' compensation. 9. Review the program's progress, including identification of problem areas and possible solutions. 10. Arrange for and supervise all necessary investigations to determine eligibility for compensation benefits and liability of negligent third parties. 11. Establish procedures to support the payment of all benefits and allocated expenses together with appropriate documentation necessary to reconcile a trust fund checking account provided by the City. 12. Sponsor and pay for a membership in the nationwide Index System on the City's behalf, submit all claims to the Index System as regular practice; 13. Provide (at no cost to the City) informational pamphlets in appropriate languages to employees as required by the State of California relative to their workers' compensation benefits. 14. Attend, where indicated, trials, hearings, arbitrations,rehabilitation hearings and any and all legal proceedings. 15. Produce computer generated reports as specified by the City. 16. Coordinate Medicare and Medicaid set aside agreements in compliance with Section 111 of the MMSEA including required reporting. C/18275 Page 9 of 41 Professional/Consulting Contracts lVersion:May 22,2018 Bill Review 1. Review all bills in a timely manner for compliance with applicable fee schedules and reduce accordingly, including those that fall outside of a fee schedule or PPO network. 2. Identify and reduce all duplicate billings. 3. Deny charges for all items not required for injury described. 4. Identify all unauthorized charges to insure billing does not exceed parameters of injured workers' treatment plan. 5. Maintain contracts with effective PPO organizations (including phannacies),that include providers in the City. 6. Provide reports on a monthly and annual basis outlining bill review activity, savings and costs. Provide ad hoc reports as requested. 7. Provide a computer system that interfaces with both the City's workers' compensation TPA and utilization review provider. 8. Handle all provider inquiries regarding bill reductions. Utilization Review 1. Approve or disallow service requests within the applicable time standards and provide medical advice as warranted. 2. Provide timely reports to the City outlining utilization review requests, approvals, denials and costs/savings. 3. Recommend panels of medical professionals, specialists, and treatment facilities to which injured employees should be referred for long-tern or specialized treatment. 4. Provide medical management of all cases to assure cost-effective and appropriate treatment, including assurance that treatment is related to the cornpensable injury or illness. 5. Arrange for medical/legal opinions in disputed cases, conferring with medical examiners, professional personnel, the City and legal counsel where indicated. 6. Provide a computer system that interfaces with the selected TPA and bill review service provider. Nurse Case Management 1. Provide telephonic and field case management nurses. 2. Maintain close liaison with selected doctors and ensure maximum efficiency in the management of claims by practicing proactive case management and aggressive return-to-duty when clinically feasible. C118275 Page 10 of 41 Professional/Consulting Contracts/[version:May 22,2018 Exhibit B Schedule of Performance. Consultant shall provide products and perform all services required pursuant to this Agreement in accordance with generally accepted professional practices and principles and in a manner consistent with the level of care and skill ordinarily exercised under similar conditions by a member of Consultant's profession currently practicing in California. Consultant is responsible for making an independent evaluation and judgment of all conditions affecting performance of the work, including without limitation applicable federal, state, and local laws and regulations, and all other contingencies or considerations. Consultant's responsibilities under this section shall not be delegated. Consultant shall be responsible to City for acts, errors, or omissions of Consultant's subcontractors. i Consultant is responsible for malting an independent evaluation and judgment of all conditions affecting performance of the work and shall prepare plans,reports, and/or other work products in such a way that additional costs will not be incurred beyond a project budget approved or amended by the City Manager or his or her designee. Whenever the scope of work requires or permits review, approval, conditional approval or disapproval by City, it is understood that such review, approval, conditional approval or disapproval is solely for the purposes of administering this Agreement and determining whether the Consultant is entitled to payment for such work, and not be construed as a waiver of any breach or j acceptance by the City of any responsibility, professional or otherwise, for the work, and shall not relieve the Consultant of responsibility for complying with the standard of performance or laws, regulations, industry standards, or from liability for damages caused by negligent acts, errors, omissions,noncompliance with industry standards, or the willful misconduct of Consultant. i I l I i C/18275 Page 11 of 41 Professional/Consulting Contracts/Version:May 22,2018 Exhibit C YORK'S FEE PROPOSAL For City of Cupertino May 25, 2017 July 1, 2017 to June 30,2020 York appreciates the partnership we have shared with the City of Cupertino since 1998!. Our goal is always to deliver service with focus on reducing your overall cost of risk. York is pleased to present a three year proposal to continue Workers' Compensation administrative services. We are j proposing no increase with the claims administrative fees and modest increases with some managed care fees. I Claims Services York will provide claims handling at the following rates: ANNUAL FEE LINE OF BUSINESS ANNUALFEE Workers' Compensation Fiscal Year 2017-2018 $26,498 � Fiscal Year 2018-2019 $26,498 Fiscal Year 2019-2020 $26,498 Definitions: Annual Fee: York's Annual Fee quotation is a guaranteed flat annual fee and applies to claims a administration services provided during the 12 month contract term. Any additional administration beyond the initial 12 month contract term will be subject to an additional negotiated flat annual fee or other mutually agreed upon rate structure. If there is a significant increase in claims volume, York may propose additional charges. If client agrees to such additional charges, the fees will be adjusted accordingly. If client does not agree to such charges, York will have the right to terminate services on 60 days' notice. C/18275 Page 12 of 41 Professional/Consulting Contracts/Version:May 22,2018 Services of the Account Manager, along with telephonic claim reviews, are provided at no additional charge. General Fees, Services, Terms and Conditions Outside Activity/Field Investigations will be billed at time and expense. MMSEA Reporting: $8.75 per claim `r Billing: York will issue an electronic invoice monthly, via e-mail. Payments shall be due and payable no later than thirty days from the invoice date. Pricing has been developed based on provided loss data. In the event that the loss data is erroneous or otherwise incorrect both parties agree to discuss an equitable adjustment of service fees. The City of Cupertino may request that the services York performs be rendered in a particular or different way or additional services be provided, and York will make all reasonable efforts to comply. If such request increases York's cost of providing the services, York shall be entitled to an equitable adjustment in its compensation. Subrogation: York's pricing includes placing parties that it deems responsible on notice and taking reasonable action to recover. Should referral to a specialist be required beyond this point if performed outside of the dedicated unit can be performed at 20% of recovery,plus costs, such as locate searches, skip traces, collection counsel fees and expenses, etc. No referrals will be made without the City of Cupertino approval. York's proposed fees will remain in effect for 90 days from the date of this proposal. > This proposal contemplates that York will be entering into a direct contract the City of Cupertino Should York be required to contract with any other party, different terms may apply. Allocated Loss Adjustment Expenses York will arrange for various services and other costs as agent for our client. These costs are referred to as Allocated Loss Adjustment Expenses (ALAE). A list of these expenses follows. Payment of ALAE is the responsibility of the city of Cupertino. York's fees do not cover ALAE, and York is under no obligation to pay ALAE with its own funds. Fees of outside counsel for claims in suit, coverage opinions and litigation and for representation at hearings or pretrial conferences Fees of court reporters `r All court costs, court fees and court expenses Fees for service of process > Costs of undercover operatives and detectives > Costs for employing experts for the preparation of maps, professional photographs, accounting, chemical or physical analysis, diagrams C/18275 Page 13 of 41 Professional/Consulting Contracts/Version:May 22,2018 ➢ Costs for employing experts for the advice, opinions or testimony concerning claims under investigation or in litigation or for which a declaratory judgment is sought > Costs for independent medical examination or evaluation for rehabilitation Costs of legal transcripts of testimony taken at coroner's inquests, criminal or civil proceeding Costs for copies of any public records or medical records Costs of depositions and court reported or recorded statements ➢ Costs and expenses of subrogation > Costs of engineers, handwriting experts or any other type of expert used in the preparation of litigation or used on a one-time basis to resolve disputes ➢ Witness fees and travel expenses ➢ Costs of photographers and photocopy services > Costs of appraisal fees and expenses (not included in flat fee or performed by others) > Costs of indexing claimants > Services performed outside York's normal geographical regions > Costs of outside investigation, signed or recorded statements > Out of the ordinary expenses incurred in connection with an individual claim or requiring meeting with Customer > Any other extraordinary services performed by York at Customer's request > Investigation of possible fraud including SILT services and related expenses Any other similar cost, fee or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a claim or loss or to the protection or perfection of the subrogation rights of Customer. y York may, but need not, elect to utilize its own staff or affiliated entities to perform any of these services. Associated fees and costs will be charged as ALAS. C/18275 Page 14 of 41 Professional/Consulting Contracts/Version:May 22,2018 Managed Care Fees: DETAIL FEE MEDICAL : WORKERS Fee Per $10.50 per Bill Enhanced Audit Savings Fiscal Year 2017-2018 26% of Savings Fiscal Year 2018-2019 27% of Savings Fiscal Year 2019-2020 28% of Savings PPO Network& Out of Network Savings Fiscal Year 2017-2018 26% of Savings Fiscal Year 2018-2019 27% of Savings Fiscal Year 2019-2020 28% of Savings CASE MANAGEMENT Telephonic Case Management $99.00 per Hour Field Case Management $99.00 per Hour, Plus Mileage (IRS Reimbursement Rate&Expenses) Life Care Plan $150.00 per Hour WellComp Nurse Hotline(24/7 Nurse Triage) $98.00 per Incident UTILIZATION REVIEW/CERTIFICATION Procedure Rate $69 per Review Level 1 $149.00 per Review Levels 2 &3 Physician Review (additional fee when applicable) $225.00 per Review Appeal Reviews $400.00 per Review PEER REVIEW Peer Review $195.00 - $400.00 per Hour Depending on Specialty Physician Intervention Review(Pharmacy Review $275.00 per Hour w/P2P) C/18275 Page 15 of41 Professional/Consulting Contracts Version:May 22,2018 MEDICARE SECONDARY PAYER SERVICES(MSA) Mandatory CMS MMSEA Reporting $8.75 per claim Standard MSA $2,950.00 per Referral Complex/Catastrophic MSA $3,500.00 per Referral Rush MSA Additional $500.00 per Referral MSA CMS Submission $500.00 per Referral Medical Cost Projections $1,750.00 per Referral Conditional Payment Request $150.00 per Inquiry Conditional Payment Dispute Resolution $125.00 per Hour Final Settlement Document Submission $125.00 per Referral Medicare/Medicaid Investigation $50.00 per Inquiry Medical Cost Projection to MSA Conversion $1,200.00 per Referral j York's medical management services include a complete suite of all ancillary medical services, using multiple networks that address our clients' needs — including, but not limited to, pharmacy benefit management, 1 diagnostics, durable medical equipment, transportation and translation, home health, physical therapy, and independent medical exams. These services are subject to the bill review rates as quoted above, plus the applicable percentage of network savings achieved below the fee schedule or usual & customary charges. I s u I I I C/18275 Page 16 of 41 Professional/Consulting Contracts lVersion:May 22,2018 EXHIBIT D Insurance Requirements Design Professionals & Consultants Contracts Consultant shall procure prior to cominencement of Services and maintain for the duration of the contract, at its own cost and expense, the following insurance policies and coverage with companies doing business in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED 1. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location(ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i)the minimum coverage/limits specified in this agreement; or(ii)the broader coverage and maximum limits of coverage of any insurance policy,whichever is greater. b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO CA 00 01 covering any auto (including owned,hired, and non-owned autos)with limits no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers'Compensation: As required by the State of California,with Statutory Limits and Employer's Liability Insurance of no less than$1,000,000 per occurrence for bodily injury or disease. O Not required. Consultant has provided written verification of no employees. 4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant's f profession, with limits no less than $2,000,000 per occurrence or $2,000,000 aggregate. If written on a claims made form: a. The Retroactive Date must be shown and must be before the Effective Date of the Contract. b. Insurance must be maintained for at least five(5)years after completion of the Services. c. If coverage is canceled or non-renewed,and not replaced with another claims-made policy form with a Retroactive Date prior to the Contract Effective Date,the Consultant must purchase"extended reporting"coverage for a minimum of five (5)years after completion of the Services. OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Exh.D-Insurance Requirements for Design Professionals&Consultants Contracts Form Updated Feb. 2018 1 Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers ("Additional Insureds") are to be covered as additional insureds on Consultant's CGL policy. General Liability coverage can be provided in the form of an endorsement to Consultant's insurance (at least as broad as ISO Forn CG 20 10(11/85)or both CG 20 10 and CG 20 37 forms, if later editions are used). Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment ofpremiurns. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, the Workers' Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City's option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide,that the self-insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M.Best Rating of A-VII, orbetter. I Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements(or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to comrnencernent of the Contract. City retains the right to demand verification of compliance at any time duringthe Contract tern. I Subconsultants i Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant's insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above,City shall be entitled to coverage for the higher insurance limits maintained byConsultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk,prior experience,insurer or other special circumstances, with not less than ninety(90) days prior written notice. Exh.D-Insurance Requirements for Design Professionals&Consultants Contracts Form Updated Feb. 2018 2 , 61.R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2019 Y) `� 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cheryl Trawick York Alternative Risk Solutions,LLC PHONE 205- FAX 333 City Blvd.West,Ste.1500 AIc No Ext: FAX AIC No 614-717-6371 Orange,CA 92868 E-MAIL I rawc orkrs ADDRESS:Che ryT ik• @Y g•com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arch Insurance Company 11150 INSURED INSURER B Onex York Holdings Corp. and its Subsidiaries INSURER C: 1 Upper Pond Road INSURER D Building F,4th Floor Parsippany,NJ 07054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:PZ73AHEA REVISION NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DD LIMITS A X COMMERCIAL ENERAL LIABILITY ZAGL81820002 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 G DAMAGET RENTED CLAIMS-MADE I X I OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,000 X X PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- OTHER: LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY ZACAT1811402 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO ZACAT1812102-State of MA only BODILY INJURY(Per person) $ OWNED SCHEDULED X X BODILY INJURY Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION ZAWC11804402 07/01/2018 07/01/2019 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N NIA X E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Cupertino is included as Additional Insured with Respect to General and Automobile Liability Where Required by Written Contract. Waiver of Subrogation is Applicable Where Required by Written Contract with Respects to General Liability,Auto Liability and/or Workers Compensation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Cupertino AUTHORIZED REPRESENTATIVE 10300 Torre Avenue Cupertino, & Cupertino,CA 95014 Page 1 of 20 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 'I"ms ENDORSEMENT CHANGES THE POLICY. PLEASIE BEAD IT CARETl)I...LY, AQ.QI`t'IONAL INSURED - BLANKET This endorsement modifies.insurance provided under-the following: ... ........... ...... ......... ... . .......... ... AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Under Covered Autos Liability Coverage, the Who is An Insured provision is amended to include as an "insured" the person or organization who is required under a written contract to be included as an "insured"under this policy, but only with respect to their legal liability for your acts or omissions or the act or omissions of a person for whom Covered Autos Liability Coverage is afforded under this policy, All other terms and conditions of this policy remain unchanged. Endorsement Number: PoilcyNumber: ZACAT1811402 Named Insured:ONEX YORK HOLDINGS, CORP. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 07-01-18 00 CAO115 00 10 13 Page 1 of 1 Page 2 of 20 PZ73AHEA POLICY NUMBER; ZACAT1811402 COMMERCIAL AUTO CA04441013 THm ENDORSEMENT C;IzIANGES TI°]E POLICY. PLEASE READ ET CAREFULLY. WAIVER OF TRANSFER OF RIGHT OF RECOVERY AGAINST QTHER� T® U� (VV�4IVER ®F SU�R0GATI®N} 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 dale is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE 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. CA 04 44 10 13 ©Insurance Services Office, Inc.,2011 Page 1 of 1 Page 3 of 20 PZ73AHEA POLICY NUMBER:R: ZAGLB1820002 COMMERCIAL GENERAL LIABILITY G,.O 20.26 Gi9.1.3 THIS ENWA§F i�INIT CHAi°I ES THE P01;I✓Y: Pf:OAst 4... . IT t;AREhULf=Y, . ADDITIONAL,INSURED � TED : SIGNA.. RRSN 0R ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s); ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT. Information required to complete this Schedule, If not shown above,will be shown in the Declarations, 1 A. Seotfon II — Who is An Insured Is amended to B. With respect to the Insurance afforded to these include as an additional Insured the person(s) or additional Insureds, the following Is added to organizations) shown in the Schedule, but only Section III—Urnits Of Insurance: with respect to liability for'bodily Injury", "property damage" or "personal and advertising Injury" If coverage provided to the additional Insured is caused, In whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting willpay on behalf of the additional insured Is the on your behalf: amount of Insurance; 1 Required by the contractor agreement;or 1. In the performance of your ongoing operations;or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; I rented to you, whichever is less. However: This endorsement shall not Increase the 1. The Insurance afforded to such additional applicable Limits of Insurance shown In the Insured only applies to the extent permitted by Declarations. law;and 2. If coverage provided to the additional insured Is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. CC 20 26 04 19 ©Insurance Serv ices Office-Inc; 2012 Page 1 of 1 I Page 4 of 20 PZ73AHEA I i POLICY NUMBER: ZACAT1811402 COMMERCIAL AU-r0 CA20010306 T HIS.ENDORSENJENT CIIANQ�S THE POLICY. PLEA5E. RE-AD IT C. -FULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYE . . ..... ............... ............ . ........... ... This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date Is indicated below. Named Insured: Endorsement Effective Date: Countersignature Of Authorized Representative Name: Title: Signature: Date: CA 20 0103 06 ©ISO Properties, Inc., 2005 Page 1 of 3 ❑ Page 5 of 20 PZ73AHEA | THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ N'CAREFULLY. � / NOTICE QFCANCELLATION-CERTIFICATE HOLDERS � (SPECIFIED DAYS) � ' - ---.--. Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that wosent to you. If possible,such copies of the notice except for cancellation for non-payment of premium which will bo mailed 1O days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. Schedule Pomon(a)o,CkAonbation(u) including mailing address: All certificate holders whom written notice of the cancellation of this policy Is required by written contract, permit or agreementwd(h the Named Insured and whose names and addresses will be provided Uy the broker or agent listed in the Do:|mmd|ono Page of this policy for the purposes of complying with such request. This notification of cancellation of the policy|o Intended as courtesy only. Our failure to provide such � noU800t|un to the person(s) or orgonlzod|un(a) shown in the Schedule will not extend any policy � cancellation date nor |m Impact negate ihopoUo� This nn�ondde ! � � the person(s) or orOonbuUnn(o) listed or described in the Schedule above to any benefit, rights or i protection under this policy. ! Any provision of this endorsement that is In conflict with a statute or rule Is hereby amended to conform � hu that statute orrule. / Uonoof\h�poUnyromm� unchanged, i e��e��t -nrIdig- ! 8 Po|�yNumbnnZAcAzI 11402 | Named Insured:O0QX YORD HOLDINGS, CORP. � This endorsement is effective on the Inception date of this Policy unless otherwise stated heroin: Endorsement Effective Date: 07-01-I8 00MLV0870011 10 Page 1o/ 1 Page omoo PzraAnsx i THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBOTI 1G INS-URANCE ENDORSEMENT - DESIGNATED CONTRACT(S) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM SCHEDULE Designated Contract(s): ALL PARTIES WHERE REQUIRED IN A WRITTEN CONTRACT. With respect to the contract(s) designated in the Schedule above, it is agreed that the following subparagraph e, is added to SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph S. 5. and SECTION V--GARAGE CONDITIONS, Paragraph B.5, 5. Other Insurance e. Wth respect to SECTION 11 - LIABILITY COVERAGE, where you are specifically required by a written contract designated in the Schedule above to provide insurance that is primary and non-contributory, and the written contract designated in the Schedule above so requiring is executed by you before any"accident', this insurance Will be primary and the other insurance will not contribute with this insurance, but only to the extent required by that written contract. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement Is effective on the Inception date of this policy unless otherwise stated herein, (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: ZACAT1811402 Named Insured: ONEX YORK HOLDINGS, CORP, Endorsement Effective Date: 0 7-01-18 00 CA0116 00 04 10 Page 1 of 1 Page 7 of 20 PZ73AHEA POLICY NUMBER; ZACAT1811402 COMMERCIAL AUTO CA 04 44 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER .OF TRANSFER OF RIGHTSOF RECOVERY AGAINST ''T'I� RS `T® US (VVAI�l R ®F SU R®GATI®N} 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: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE 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. CA 04 44 10 13 ©Insurance Services Olfice, Inc., 2011 Page 1 of 1 Page 8 of 20 PZ73AHEA i COMMERCIAL AUTO CA99441293 THIS* Ef\lDORSIEI11AENT CHANGES TFI' POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE QLAQ,SE. . This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. A. We will pay, as Interest may appear, you and the Cancellation ends this agreement as to the loss loss payee named In the policy for 'loss"to a cov- payee's Interest. If we cancel the policy we will mail ered"auto". you and the loss payee the same advance notice. B, The insurance covers the interest of the loss payee D, If we make any payments to the loss payee, we will unless the 'loss" results from conversion, secre- obtain his or her rights against any other party. tion or embezzlement on your part. C. We may cancel the policy as allowed by the CAN- CELLATION Common Policy Condition. CA 99 4412 93 Copyright, Insurance Services Office, Inc., 1993 Page 1 of 1 Page 9 of 20 PZ73AHEA POLICY NUMf3SR, ZAGLB1820002 COMMERCIAL LIA131LITY C0 20 11 04 13 TF-(R ENDORSIEN N I--CHANG S THE POLICY. PLEASES=READ IT{ ARIEr- I Y. ITIN�� IJIRK� NAB. S.O ... .. ... ....... .. .. .. ....... LESSO OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises(Part Leased To You): ANY PREMISES WHERE REQUIRED BY WRITTEN CONTRACT. Name Of Person(s)Or Organizatlon(s)(Additional Insured): ANY PERSON OR ORGANIZATION WHERE REQUIRED BY WRITTEN CONTRACT. Additional Premium: INCL. Information required to complete this Schedule,If not shown above,will be shown In the Declarations. A. Section iI --Who Is An insured is amended to 2. If coverage provided to the additional insured Include as an additional Insured the person(s) or Is required by a contract or agreement, the organization(s) shown In the Schedule, but only insurance afforded to such additional Insured with respect to liability arising out of the will not be broader than that which you are ownership,maintenance or use of that part of the required by the contract or agreement to premises leased to you and shown In the provide for such additional Insured. Schedule and subject to the following additional B. With respect to the Insurance afforded to these exclusions: additional Insureds, the following Is added to This Insurance does not apply to: Section IiI—Limits Of Insurance: 1. Any 'occurrence"which takes place after you If coverage provided to the additional Insured is cease to be a tenant In that premises, required by a contract or agreement,the most we 2. Structural alterations, new construction or will pay on behalf of the additional Insured Is the demolition operations performed by or on amount of Insurance: behalf of the person(s) or organization(s) 1. Required by the contract or agreement;or shown In the Schedule. 2, Available under the applicable Limits of However: Insurance shown In the Declarations; 1. The insurance afforded to such additional whichever is less. Insured only applies to the extent permitted This endorsement shall not Increase the by law,and applicable Limits of Insurance shown In the Declarations. CG 20 11 04,13 ©Insurance Servlces OffCco, Inc,,2012 Page 1 o.I1 Page 10 of 20 PZ73AHEA i POLICY NUMBER: ZAGLB1820002 COMMERCIAL GENERAL LIABILITY 00 0,2404.1.3 1 Fi9.' N C9 t t EN' T MANdIE&I HE K)LICY. Kt A I R'FA'D IT CAREFULLY. IIVt t'tt "'hd iiVRd "AS BEEN L Eb This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises Name Of Persons Or Or anlzatlon s Part Leased To You ALL PARTIES WHERE REQUIRED 13Y A WRITTEN CONTRACT, Information required to complete this Schedule If not shown above will be shown In the Declarations, A, Section 11 — Who Is An Insured Is amended to 2. Structural alterations, new construction or Include as an additional Insured the person(s) or demolition operations performed by or on organization(s) shown in the Schedule, but only behalf of the person(s) or organization(s) with respect to liability arising out of the shown in the Schedule. ownership, maintenance or use of that part of the C. With respect to the Insurance afforded to these land leased to you and shown In the Schedule, additional insureds, the following is added to However: Section III—Limits Of Insurance: 1. The insurance afforded to such additional If coverage provided to the additional insured is Insured only applies to the extent permitted by required by a contract or agreement, the most we law;and will pay on behalf of the additional Insured Is the 2, If coverage provided to the additional Insured amount of Insurance: Is required by a contract or agreement, the 1. Required by the contract or agreement;or insurance afforded to such additional Insured 2, Available under the applicable Limits of will not be broader than that which you are Insurance shown in the Declarations; required by the contract or agreement to provide for such additional Insured, whichever is less. B. With respect to the insurance afforded to these This endorsement shall not Increase the additional Insureds, the following additional applicable Limits of Insurance shown in the exclusions apply: Declarations, This Insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; GG 20 24 04 13 ©Insurance Services Office, inc,,2012 {gage 1 of 1 Page 11 of 20 PZ73AHEA i POLICY NUMBER:-ZAGLB 18 2 0 0 0 2 C OMMFRCIAi..GEiJERAL LIABILITY 06.2g 12,041.3.. hfa f��Rf d HAf ,t°f�fn 00_(,l0.Y. 0L-lEA E READfl'GARfaNLLY. ADDITIONAL IiVSURE® ® STATE OWGOVERNM I ISIO1 O POLIT'I�At� SUBDIVISION ® PERMIT'S OR AUTHORiZATIONS This endorsement modifles Insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivlslon Or Political Subdlvislon: ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT. Information required to complete this Schedule If not shown above will be shown In the Declarations. A. Section Il — Who Is An Insured is amended to 2. This Insurance does not apply to: Include as an additional Insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury"arising out subdivision shown In the Schedule, subject to the of operations performed for the federal following provisions: government,state or municipality;or 1. This insurance applies only with respect to b. "Bodily Injury" or "property damage" operations performed by you or on your behalf included within the "products-completed for which the state or governmental agency or operations hazard", subdivision or political subdivision has Issued S. With respect to the Insurance afforded to these a permit or authorization. additional Insureds, the following is added to However: Section III—Limits Of Insurance: a, The insurance afforded to such additional If coverage provided to the additional insured Is Insured only applies to the extent required by a contract or agreement the most we permitted will pay on behalf of the additional Insured Is the by law;and amount of Insurance: b. If coverage provided to the additional 1. Required by the contract or agreement;or Insured is required by a contract or 2, Available under the applicable Limits of agreement, the Insurance afforded to such Insurance shown In the Declarations; additional insured will not be broader than whichever is less. that which you are required by the contract or agreement to provide for such additional This endorsement shall not increase the { Insured. applicable Limits of Insurance shown in the Declarations. CG 2012 0413 ©Irisurarice Sorvlcos Office, lhc.,2012 Page 1 of 1 Page 12 of 20 PZ73AHEA POLICY NUMBER; ZAGLB1820002 COMMERCIAL GENERAL LIABILITY GG 20 10 04 13 f if END0R$L-MlEIN T H.ANtJt; 'THi 1:QOLIdY fdS"E P.E AD IT CAA REP@9 ILL Y. gg �e �p�j . .t CONTRACTORS ��4��J LED PER�� OR p((��11 �° qq�� . . This endorsement modifies Insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT, Information required to complete this Schedule If not shown above,will be shown In the Declarations, CG 20 10 0413 ©Insurance Sewlces Olflce, Inc.,2012 Page 1 of 8 I I Page 13 of 20 PZ73AHEA i | !THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ DCAREFULLY. NOTICE OF CANCELLATION-CERTIFICATE HOLDERS (SPECIFIED DAYS) The in the Schedule mcekmwhKwn noUoeofm�nonU��nwhn !his � oonoe�dbyd�� VVe<�U ��|b�d�k��h�lh�-------' ` | Person(s) or Organization(s) listed or described 'in the Schedule m copy of the written notice of cancellation that we sent Vuyou, |f possible,such copies nf the notice will bo mailed aileast 68 except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. � Schedule Femon(s)orOrganbadon(s) Including mailing address; | | � � / � � � All certificate holders where written notice of the cancellation of this policy is required by written contract, permit or agreement with the.Named Insured and whose names and addresses will be | provided by the broker or agent listed in the Declarations Page of this policy for the purposes | of complying with such request, This notification of cancellation of the policy Is Intended as courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown In the Schedule will not extend any policy cancellation date nor Impact or negate any cancellation o( the policy. This endorsement does not entitle | ' the person(s) or o,gonbaUon(e) listed or d000dbad in the Schedule above to any benefit, rights or � protection under this policy, | Any provision o(this endorsement that is |noon8lct*whhaxtatu0uo,rule|ohovabyomondodk/ oon/orm to that statute orrule. ` All other terms d conditionsnt this policy remain unchanged. Endorsement Number: pn|lcy Numbec ZAGLB1820002 ' Named |nuUred:ONEX YOR8 B0LDZMGG CODF This endorsement Is effective on the Inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 07-0I-I8 ~ ` 00ML0O87O .1110/ Page of � ` | Puuo 14orom pz73AHsx | � COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS f.NDORS-EMENT CHANGES T°H*E' PC)LIC ICY'. P ,E:ASNw AD IT CAnE PIJILLY. ................:....:....... . ............ . . ...... . .... . .........:......... .......... . . . OTHER INSURANCI CONDITION N This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART i The following is added to the Other Insurance (2) You have agreed In writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other Insurance available to the i This Insurance is primary to and will not seek additional insured, contribution from any other Insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and h i i i CG 20 0104 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 Page 15 of 20 PZ73AHEA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAIREFUI...I.N. AD..D)"HONAL INSURED - BLANKET This endorsement modifies.insurance provided under..the following: _.. ........... .......... . ... ........... .......... ... AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Under Covered Autos Liability Coverage, the Who is An Insured provision is amended to include as an "insured" the person or organization who is required under a written contract to be included as an "insured" under this policy, but only with respect to their legal liability for your acts or omissions or the act or omissions of a person for whom Covered Autos Liability Coverage Is afforded under this policy, All other terms and conditions of this policy remain unchanged. Endorsement Number Policy Number: ZACAT1811402 Named Insured:ONEX YORK HOLDINGS, CORP. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 0 7-01-18 00 CA0115 00 10 13 Page 1 of 1 Page 16 of 20 PZ73AHEA i I ZAGLB1820002 POLICY NUM[iEFi:' COMMERCIAL GENERAL LIABILITY 0020124413 r rr >,v�c t �n i r c r ✓i r t ,rr . t�ILWE-EA.D-ir CARIEF.ULL.Y. . .... ADDITIONAL Ia�SURED STATE ®R::QQV�RIV FENTAL �R POL�7I AL:.. . . . .... SUBDIVISION ® PERMIT'S OR AUTHORIZATIONS This endorsement modifles Insurances provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHIrDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: ALL PARTIES WHERE REQUIRED BY A WRITTEN CONTRACT, Information required to complete this Schedule if not shown above will be shown In the Declarations. A include asection 11 ~an additional Is An I cured isaa state oo 2' This Insurance does not apply to: a. Bodily injury", property damage or governmental agency or subdivision or political "personal and advertising in Jury"arising out subdivision shown In the Schedule, subject to the of operations performed or the federal following provisions: government,state or municipality;or 1. This insurance applies only with respect to b. "Bodilyy Injury" or "property damage" operations performed by you or on your behalf operations hazard", within inthe "products-completed for which the state or governmental agency or pe subdivision or political subdivision has Issued S. With respect to the Insurance afforded to these a permit or authorization. additional Insureds, the following Is added to However: Section III—Limits Of Insurance: a, The insurance afforded to such additional If coverage provided to the additional Insured Is Insured only applies to the extent permitted re ulred by a contract or agreement the most we will pay on behalf of the additional Insured Is the by law;and amount of Insurance: b. If coverage provided to the additional 1. Required by the contract or agreement;or Insured Is required by a contract or 2, Available under the applicable Limits of agreement, the Insurance afforded to such Insurance shown In the Declarations; additional insured will not be broader than whichever is less. that which you are required by the contract or agreement to provide for such additional This endorsement shall not increase the Insured. applicable Limits of Insurance shown in the Declarations, CG X 12 0413 ©Insurance Sorvlces Office, Inc.', 2012 Pape 1 of 1 I I Page 17 of 20 PZ73AHEA POLICY NUMBER: ZAGLB 18 2 0 0 0 2 COMMERCIAL GENERAL LIABILITY C G 24 04 05 09 WAIVER OF TRANSFER O.F .GINS OF RECOVERY Ad AI NS -OTHERS TO U This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE LOSS, Information required to complete this Schedule if not shown above will be shown In the Declarations, The following Is added to Paragraph 8. Transfer Of Fights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'Your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown In the Schedule above, CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 13 Page 18 of 20 PZ73AHEA WORKERS COMPENSATION AND EMPLOYERS LIABILI T Y INSURANCE POLICY WC 00 0313 (Ed. 4-84) POLICYNUMBER: ZAWCI1804402 WA1V-Ut OF Ol9tD,t=tIGFI17.f'0 I"ii-COV�.o'S Fi;'O In O'fHEP.S ENE Ord SEMEN I We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the`person'or organization named in the Schedule,(This agreement applies only to the extent that-you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO DATE OF LOSS. i This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07-01-18 Policy No. ZAWCII804402 Endorsement No. Insured ONEX YORK HOLDING CORP. Premium $ INCL. Insurance Company ARCH INSURANCE COMPANY Countersigned By DATEOF ISSUE: 07-01-18 WC 00 0313 (Ed. 4-84) ©1983 National council on Compensation Insurance. i Page 19 of 20 PZ73AHEA AGENCY CUSTOMER ID: LOC#: ACo ADDITIONAL REMARKS SCHEDULE Page 20 of20 PRODUCER INSURED York Alternative Risk Solutions,LLC Onex York Holdings Corp. and its Subsidiaries POLICY NUMBER CARRIER NAIC CODE ISSUE DATE: 03/05/2019 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: NAMED INSUREDS: ALAMED HOLDINGS, INC, ATLANTIC GATEWAY INTERNATIONAL (SAC) LTD ATTENTA SERVICES, LLC AXIS (EASTERN CARIBBEAN) LIMITED AXIS (JAMAICA) LIMITED AXIS INTERNATIONAL SERVICES LTD BICKMORE BROWN REHABILITATION MANAGEMENT, INC. CAREWORKS OF OHIO LTD, LLC CAREWORKS TECHNOLOGIES LTD, LLC CAREWORKS USA LTD, LLC CAREWORKS, LTD CAREWORKS MANAGED CARE SERVICES,INC. f.k.a WELLCOMP MANAGED CARE SERVICES, INC. CCI INVESTMENTS, LLC CMI, A YORK RISK SERVICES COMPANY, INC. COMPEVAL DD EXAMS, LLC COMPPARTNERS, INC DONALD K SAMS & ASSOCIATES, INC. FARA GENERAL AGENCY, INC. FAST360 LLC / fka MANAGED CARE NETWORK SERVICES, LLC FOX HILL HOLDINGS, INC. FRANK GATES (BERMUDA) LTD. INTEGRATED RISK MANAGEMENT, INC. JI SPECIAL RISKS INSURANCE AGENCY, INC. JI SPECIALTY SERVICES, INC. JOSEPH IVY FINANCIAL GROUP, INC. LITIGATION SOLUTIONS, LLC MCMC INDEPENDENT EXAMS, LLC MCMC, LLC. NORTHEAST ASSOCIATION MANAGEMENT, INC. (NEAMI) ONEX YORK MID CORP PERSI, LLC PUBLIC ENTITY RISK SERVICES OF ILLINOIS, LLC PUBLIC ENTITY RISK SERVICES OF OHIO, INC. QUICK CAT, LLC RISK CONTROL 360, LLC ROCKPORT COMMUNITY NETWORK, INC SAMS & ASSOCIATES, INC. SAMS INVESTIGATIONS UNLIMITED THE FRANK GATES COMPANIES, INC. THE FRANK GATES SERVICE COMPANY THE RISK MANAGEMENT PLANNING GROUP, INC VOCWORKS LTD, LLC York Alternative Risk Solutions LLC fka FRANK GATES ALTERNATIVE RISK, LLC YORK INSURANCE HOLDINGS, INC. YORK INTERNATIONAL ARGENTINA S.A. YORK RISK CONTROL SERVICES, LLC YORK RISK POOLING SERVICES, INC YORK RISK SERVICES GROUP, INC. YORK RISK SERVICES GROUP INTERNATIONAL HOLDINGS, LTD YORK RISK SERVICES HOLDING CORP. YORK RISK SERVICES ORGANIZATION, INC. YORK RSG (INTL) COLOMBIA SAS YORK RSG (INTL) LTD YORK RSG (INTL) MEXICO YORKPRO, INC ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE NUMBER:PZ73AHEA A��O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/15/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Beecher Carlson Insurance Services CONTACT NAME: Judith BOICII 1500 Broadway, 21 st Floor PHONE FAX New York, NY 10036 1A c e A/C No): 770-870-3031 E-MAIL ADDRESS: bOICh beechercarlson.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Aspen Specialty Insurance Company 10717 INSURED INSURER B: n York Holdings Corp. a it and its subsidiaries INSURERC: Navigators Insurance Company 42307 a 1 U�pper Pond Road INSURER D: BUlldIng F, 4th Floor INSURERE: Parsippany NJ 07054 INSURER F: COVERAGES CERTIFICATE NUMBER: 48686695 REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICYNUMBER MMIDD MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGETO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ H L $ C �/ UMBRELLALIAB ,/ OCCUR NYI8UMR9307971V 3/17/2018 7/1/2019 EACH OCCURRENCE $5000000 EXCESS LAB CLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION$ $ WORKERS COMPENSATION T PER OTH- AND EMPLOYERS'LIABILITY YIN SATUTE I I ER ANYPROPRIEfOR/PARTN ER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ A Professional Liability LRO03TG18 9/15/2018 9/15/2019 Each Claim/Agg. $10,000,000 Deductible $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance See Attached Named Insured List CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityy of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10300 Torre Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Cupertino, CA 95014 p nq AUTHORIZED REPRESENTATIVE [�eeC2___ bon grwttrtatwe sc viCQO,,C..ee Beecher Carlson Insurance Services,LLC ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 48686695 I Umbrella. PL and Cyber 3/2019 renewal I Judith Boich 1 5/15/2019 2:51:55 PM (EDT) I Page 1 of 3 NAMED INSUREDS: ALAMED HOLDINGS, INC, ATLANTIC GATEWAY INTERNATIONAL(SAC) LTD ATTENTA SERVICES, LLC AXIS (EASTERN CARIBBEAN) LIMITED AXIS (JAMAICA) LIMITED AXIS INTERNATIONAL SERVICES LTD BICKMORE BROWN REHABILITATION MANAGEMENT, INC. CAREWORKS MANAGED CARE SERVICES, INC„ F/K/A WELLCOMP MANAGED CARE SERVICES, INC. CAREWORKS OF OHIO LTD, LLC CAREWORKS TECHNOLOGIES LTD, LLC CAREWORKS USA LTD, LLC CAREWORKS, LTD CC] INVESTMENTS, LLC CMI, A YORK RISK SERVICES COMPANY, INC. COMPEVAL DID EXAMS, LLC COMPPARTNERS, INC DONALD K SAMS &ASSOCIATES, INC. FARA GENERAL AGENCY, INC. FAST360 LLC/fka MANAGED CARE NETWORK SERVICES, LLC FOX HILL HOLDINGS, INC. FRANK GATES (BERMUDA) LTD. INTEGRATED RISK MANAGEMENT, INC. JI SPECIAL RISKS INSURANCE AGENCY, INC. JI SPECIALTY SERVICES, INC. JOSEPH IVY FINANCIAL GROUP, INC. LITIGATION SOLUTIONS, LLC MCMC INDEPENDENT EXAMS, LLC MCMC, LLC NORTHEAST ASSOCIATION MANAGEMENT, INC. ONEX YORK HOLDING CORP. ONEX YORK MID CORP. PERSI, LLC PUBLIC ENTITY RISK SERVICES OF ILLINOIS, LLC PUBLIC ENTITY RISK SERVICES OF OHIO, INC. QUICK CAT, LLC RISK CONTROL 360, LLC ROCKPORT COMMUNITY NETWORK, INC SAMS &ASSOCIATES, INC. SAMS INVESTIGATIONS UNLIMITED THE FRANK GATES COMPANIES, INC. THE FRANK GATES SERVICE COMPANY THE RISK MANAGEMENT PLANNING GROUP, INC VOCWORKS LTD, LLC YORK ALTERNATIVE RISK SOLUTIONS LLC FKA FRANK GATES ALTERNATIVE RISK, LLC 48686695 1 Gmb—lla. PL and Cyber 3/201° rene,-! I Judith Boich 1 5/-5/20 L° °:51:55 PM (EDT) I Pa3e 2 sf 3 YORK INSURANCE HOLDINGS, INC. YORK INTERNATIONAL ARGENTINA S.A YORK PRO, INC YORK RISK CONTROL SERVICES, LLC YORK RISK POOLING SERVICES, INC. YORK RISK SERVICES GROUP INTERNATIONAL HOLDINGS, LTD YORK RISK SERVICES GROUP, INC. YORK RISK SERVICES HOLDING CORP. YORK RISK SERVICES ORGANIZATION, INC. YORK RSG (INTL) COLOMBIA SAS YORK RSG (INTL) LTD YORK RSG (INTL) MEXICO 48686695 Umbrella. PL and Cyber 3/2019 renewal I Judith Boich 1 5/15/2019 2:51:55 PM (EDT) Page 3 of 3