Agenda - 08-01-2022; 2 - Ratification of County Manager's Execution of an Insurance Coverage Agreement with Travelers Insurance and Approval of a Letter of Credit Agreement

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DocuSign Envelope ID: FCD9FE56-CF01-4E96-B983-B8E8DFE6811C 23 LOSS FUND EXHIBIT In connection with your Workers Compensation & Employers Liability program,we will make Plan Losses,Allocated Loss Adjustment Expenses and Claims Handling Charges(together referred to as"Loss Transaction"or"Loss Transactions")on your behalf under your insurance or self-insured program using checks drawn against one of our bank accounts. You acknowledge that these Loss Transactions are Obligations as defined in your Insurance Program Agreement. In exchange for our agreement to pay Loss Transactions on your behalf,you agree to the following: • You will designate a bank and account("Source Account")against which monthly Automated Clearing House("ACH")debits will be drawn by us as payment of your Loss Transactions. • You will provide us with the documentation authorizing Bank of America to make monthly charges and reimbursements at our direction including a signed authorization letter to direct Bank of America to draw ACH debits against your Source Account,along with the Source Account codes and Source Account's bank ABA Code. • We will determine the amount due to us by combining the monthly Loss Transaction payments,along with any corrections caused by edits on each Loss payment.This amount will be sent electronically to Bank of America with instructions to draw an ACH debit on your Source Account. In addition to deposit amount agreed to in the Loss Fund Requirements section of the applicable Program Exhibit,we will periodically perform an analysis of Loss Transactions based upon data from our billing systems to determine the adequacy of the deposit amount. If we, in the exercise of our good faith discretion, determine additional deposits to the Loss Fund Requirements are necessary, this amount will be sent electronically to Bank of America with instructions to draw an ACH debit on your Source Account. Upon request, we will provide you with documentation of the Loss Transactions payment analysis. Reports identifying Loss(es) and Allocated Loss Adjustment Expense payments must be accessed electronically by you via e-TRACER reporting.These reports identify the Loss Transactions and a premium tax,if applicable for your program with us. We may automatically continue these payment and billing arrangements if your Insurance program is renewed. If your Insurance program is cancelled or not renewed, we reserve the right to continue or discontinue these payment and billing. If TRACER is discontinued by either of us,your program will change to a monthly billed program,and each month after TRACER is discontinued,we will send you an invoice for the total amount of Loss Transactions due. Upon receipt,you will pay the amount due on or before the date set forth on the invoice. Version 08.19.19 Loss Fund Exhibit Orange County Page 21 ©(2019)The Travelers Indemnity Company.All rights reserved.