22-124 Amendment #1 dated 3-1-23 for OmnidataFIRST AMENDMENT TO AGREEMENT 22-124
BETWEEN THE CITY OF CUPERTINO AND
OMNIDATA INC., FOR DATA WAREHOUSE
This First Amendment to Agreement 22-124 between the City of Cupertino and
OMNIDATA, INC., is by and between the CITY OF C{JPERTINO, a municipal corporation
(hereinafter "City") and OMNIDATA, INC., a Coiporation ("Contractor") whose address is 2158
Brookfield Dr., Thousand Oaks, CA 91362, and is made with reference to the following:
RECIT ALS:
A. On 8/25/22 Agreement 22-124 ("Agreement") was entered into by and between City
and Contractor for Data Warehouse.
B. City and Contractor desire to modify the Agreement on the terms and conditions set
forth herein.
NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as
follows:
SERVICES
1. Paragraph 2. Services is modified to read as follows: Contractor agrees to provide the services
and perfoim the tasks ("Services") set forth in detail in Scope of Services, attached here and
incorporated as Exhibit Al. Contractor further agrees to carry out its work in compliance with
any applicable local, State, or Federal order regarding COVID- 19.
TIME OF PERFORMANCE
2. Paragraph 3.1 Time of Performance is modified to read as follows: Tis Agreement begins on
the Effective Date and ends on August 31, 2024 ("Contract Time"), unless terminated earlier as
provided herein. Contractor's Services shall begin on the effective date and shall be completed
by August 31, 2024. The City's appropriate department head or the City Manager may extend
the Contract Time through a written amendment to this Agreement, provided such extension
does not include additional contract funds. Extensions requiring additional contract funds are
subject to the City's purchasing policy.
3. 2 Schedule of Performance. Contractor must deliver the Services in accordance with the
Schedule of Performance, attached and incorporated here Exhibit Bl.
3. 3 Time is of the essence for the performance of all the Services. Contractor must have
sufficient titne, resources, and qualified staff to deliver the Services on time.
COMPENSATION
3. Paragraph 4.1 Compensation is modified to read as follows: 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 $96,995.00 ("Contract Price"), based
upon the scope of services in Exhibit Al and the budget included in Exhibit Cl, 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 permitted without prior written approval of City.
1
4. Except as expressly modified herein, all other terms and covenants set foith in the
Agreement shall remain the same and shall be in full force and effect.
IN WITNESS WHEREOF, the paities hereto have caused tbis modification of Agreement
to be executed.
CITY OF CUPERTINO
Title CTo
Date Mar 1, 2023
OMNIDAT A, INC.
BY 76;b=
Title cEo
Date Mar 1, 2023
APPROVED AS TO FORM
CkijtlAerD ,:bt,rew
City Attoiney
ATTEST:
City Clerk
Date Mar l 2023
F,XPENDITURE DISTRIBUTION
2
EXHIBIT Al
Statement of Work
for
Cupertino Enterprise Data Warehouse - Build and
Deploy - Phase 2
Presented to: City of Cupertino
CITY OF
CUPERTINO
OMNIDATA
1/25/2023
Dan Erasmus
3120139th Avenue SE
Bellevue, WA
(425) 375 5956
derasmus@omnidata.com
Teri Gerhardt
(408) 777 -3311
TeriG@cu rtino.org
This Statement of Work ("SOW") is entered into and is effective as of signature (the "SOW Effective
Date"), by and between OmniData Insights ("OmniData") and City of Cupertino, ("Customer").
This Statement of Work is entered into based on the Master Services Agreement between OmniData
and Customer (the "Agreement"). Capitalized terms not defined in this Statement of Work are as
defined in the Agreement.
1. Statement of Need
The City of Cupertino and OmniData created a successful partnership during the first phase of the
EDW project. This phase, focused on discovery and design of the EDW, was characterized by a series
of productive working sessions involving Subject Matter Experts (SME's) from both teams, data
analysis, and ultimately the creation of comprehensive set of source-to-target mappings as well as a
series of logical data models aligned to each source system analyzed.
In parallel to this, an Architecture TaskJorce consisting of team members from both OmniData and
the city was established to discuss, review and decide on the best modern data warehouse
architecture for the EDW.
The working sessions with SME's helped to identify key data requirements, while the data analysis
helped to identify data structures and formats while corfirming business and system logic. The
source-to-target mappings and logical data models created during this phase provided a clear
understanding of how data would be used and how it would flow through the entire EDW process,
which helped to ensure that the project met the city's needs.
These elements were critical in ensuring the project's success while laying the foundation for a robust
Enterprise Data Warehouse.
The City of Cupertino would like to continue the successful partnership with OmniData through the
build and deploy phase of the EDW, for the ZenDesk and Accela systems.
2. Solution Approach
Overview:
The delivery of the project will be conducted in close cooperation with the technical team from the
City of Cupertino with the initial delivery/deployment of the technical infrastructure followed by the
build of data for ZenDesk and Accela. The team from the City will then use these models to build a
series of Power Bl reporting models and reports.
Following the technical build process, a series of deep dive training sessions will be conducted to
upskill the City of Cupertino. The focus of the sessions will be on upskilling the team to be able to
j -i 'i
o
OMNIDATA
aN Microsoftis
provide support for the system while imparting crucial technical skills and knowledge that will enable
the team to expand and enhance the solution.
Solcition Approach Specifics and Architecture:
During Phase 1, the Architecture Taskforce reviewed and discussed several architecture options. A
robust data architecture, known as the Azure Data Lakehouse, was selected based on the technology
direction, maturity and scalability. In addition, this architecture is flexible enough to cater for the
addition of any source system in the future.
AZlile Synapse Anaiyt:iS SpalR POO)
Eoiid-ied
I
I @-6
i ..A.. ..,,,:,,,. ,,,.,.,,,
Figure 7. Azure Data Lakehouse Archrtecture
The delivery of the project will focus on the deployment of the above architecture and infrastructure
in a new Azure Subscription. Once completed, the already developed logical data models and
source-to-target mappings will be used to ingest data from Accela and ZenDesk, create a physical
data model and perForm data validation and testing.
From there, the City of Cupertino team will build a series of enterprise Power Bl models and reports
(under the technical guidance of an OmniData Power Platform Specialist) to accurately represent the
data in the data warehouse.
The above architecture places no restrictions on the number of additional data sources that can be
added to the overall solution. This will allow for the addition of data from all of the initially identified
data sources in future internally conducted phases or in cooperation with the OmniData team.
OmniData Page 3 of 15
o ffl'l !:'ju'llroonisPoa!'lnri
OMNIDATA
Solution Approach Detail:
The solution approach is designed in 3 workstreams:
1. Infrastructure Deployment (Dev, Test, Prod):
2. Solution Build & Deploy: Accela & Zendesk
o Data Ingestion
o Physical Data Model Design and Build
o Data Validation
o Technical User Acceptance Testing
3. Power BI Solution Architecture
4. Technical Training and Upskilling:
1. Infrastrcictui-e Deployment (Dev, Test, Prod):
n this workstream in the project, a Solution Architect from OmniData to work with the City of
Cupertino team to gain a complete understanding of:
* the current Azure infrastructure deployed.
* the desired data center for analytics and reporting
This will ensure that once deployment of architecture starts, the current configuration and deployed
services are understood, new services and the interaction between these and existing services as
planned and catered for.
Following the environment analysis, the OmniData team will work with the City of Cupertino team to
deploy the needed services in Azure in a Development, Testing and Production environment.
The services will include but are not limited to:
* Azure Synapse Analytics
* Azure Storage Account
* Azure DevOps
This needs to be done for all environments (Development, UAT and Production) that will be 7sed
throughout the lifecycle of the solution.
Outcomes:
* The outcomes, post this workstream, is a complete understanding of the as-is environment
and a logical design ofthe current-state architecture.
* A full understanding of the currently deployed Azure services and all required services that
need to be deployed to support the solution architecture.
* The needed Azure services, deployed to fill the gap identified above.
* A fully deployed and configured Development, UAT and Production environment with
DevOps configured to manage Continues Deployment and Continues Integration (Cl/CD)
between the environments.
OmniData Page 4 of15
II "SolLcmsllo'arjnei
Dati8i Al
Aniie
2. Solcition Bciild & Deploy: Accela & ZenDesk
o Data Ingestion
During the data ingestion process, connections to the identified source systems (Accela
and Zendesk) will be established. Data, as identified in the analysis and logical data
modelling process conducted in Phase1, will then be extracted, and loaded into the Raw
layer in the Azure Data Lake.
a ZenDesk
For ZenDesk, the newly released to preview Synapse ZenDesk connector will be
utilized to connect to and source data from ZenDesk.
Acce a
For Accela, data will be sources from a SQL server environment and may require
the installation of the Microsoft Inteqration Runtime
Outcomes:
* Upon the completion of this workstream, the data ingestion from source to Raw
ayer for both Accela and ZenDesk will be configured. This will allow data to flow
seamlessly from the source system to the Azure Data Lake on a regular basis.
* All the relevant technical components including the Synapse ZenDesk connector,
and the Integration Runtime are deployed and the technical infrastructure is
configured.
o Physical Data Model Design and Build
During this process, the logical data model is reviewed and compared with the physically
anded data. This is done to ensure that data structure and data modelling decisions
made during the Discover and Design phase hold true in comparison to the actual
datasets made available during the ingestion process.
Adjustments to the logical data model design is done after which the physical data
models are built and populated through a data transformation process. The data
transformation process will read data from the Raw layer, apply data transformations to
shape and restructure the data and write the data to the enriched and ultimately the
curated later of the process.
This process will be repeated for both ZenDesk and Accela.
Outcomes:
* Any potential updates to the data model are understood and designed based on
the actual data v the logical data model.
* The data transformations for both the data models are created and data is moved
through the Raw, Enriched and Curated layers to populate the physical data
model.
OmniData Page 5 of15
o
OMNIDATA
H!:;aonssopa'bi"iii
o Data Validation
With the physical data models built and populated with data, the team will start a detailed
data validation process. Data validation will take into consideration record counts, field
values and data types.
Outcomes:
* Data in the physical data models are validated and balanced across fact and
dimension tables to the source system.
@ Any adjustments to the process are identified and implemented to ensure data
validity across the data warehouse.
o Technical User Acceptance Testing
n this step, the OmniData team works with the technical team from City of Cupertino to
establish a set of test cases and to conduct the testing of the new data model. This wi
ensure balancing of data and ultimately build trust in the data and the end-to-end
process.
The Findings from the first UAT are reviewed and updates to the models are made in
preparation for a final UAT of the models.
Outcomes:
* Technical users are exposed to the data models.
* Detailed testing of the data models are conducted to validate the data
* The data models are updated with findings from the UAT process.
* The data models are signed off and ready for promotion to production.
3. Power BI Solution Architecture
In this workstream, a Power BI Solution Architect from OmniData will walk the technical team from the
City of Cupertino through using Power Bl in the context of the new architecture and provide guidance
in building the reporting models based on the ingested data from ZenDesk and Accela.
As the City of Cupertino will take responsibility for the building the Power Bl models and reports
based on the data models created, it is critical the broad Power Bl stills already in the team are
updated to align with the enterprise architecture.
Outcome:
At the end of this workstream the Power Bl team from the city will understand the optimum
way to build and manage models in the context of the new architecture. If time allow the
Power BI Solution Architect from OmniData will help to build the first reporting models.
OmniData Page 6 of15
o
OMNIDATA
H:.:4,
4. Technical Training and Upskilling:
n this workstream, the City of Cupertino technical team is taken through a series of 4 x 2-hour
technical training sessions that will focus on the following:
Session1: Data ingestion and the core principals of data ingestion in the Azure Data Lakehouse
architecture. This includes the use of API's for ingestion.
Session 2: Data Modelling for efficient dimensional models
Session 3: Data transformations using Spark in the Azure Synapse Data Lakehouse
Session 4: Using Power Bl to create enterprise data assets.
Outcome:
Post the completion of the training and upskilling workstream, the team from the city will have a solid
foundation of all the key aspects of building and managing an modern data lakehouse architecture.
OmniData Page 7 of15
OMNIDATA
EXHIBITB1 ' H;p;4,,
3. Deliverables
As an outcome of the project, we will produce the following pieces of collateral:
* The end-to-end technical architecture for the solution will be deployed for Development,
Testing and Production
* Data from the identified tables/API's for both ZenDesk and Accela is ingested and made
available in the raw layer.
* The physical data models are created and the transformation processes for each table and
system is built out to allow for the seamless population of data into the data model.
* Technical User Acceptance testing is conducted and signed off.
* The base processes for managing the Power Bl models in an enterprise context are
established and the Power Bl team is introduced to these.
4. Project Timeline
Possible Project Timeline
3/10/2023
OmniData Page 8 of15
o
OMNIDATA
§l::i,
5. Project Delivery
From signed SOW we will schedule the project kickoff within15 working days.
Project Kickoff (30 Minutes)
The project is started with the Project Kickoff meeting, attending will be the OmniData
Delivery Team, Project Sponsor, IT Resource (Security, data access, application install), Key
Stakeholders.
Stand-cip meetings (15-min 3 x per week)
Starting after the project kickoff we will have 2 weekly stand-up meetings to cover the
following:
* Identify blocking issues.
Status on current tasks
Test management
Delivery of finished tasks
Key Project Stakeholders
* Teri Gerhardt - TeriG@cupertino.org - Project Owner
Nidhi Mathur - nidhim@cupertino.orq - Subject Matter Expert
ii Bill Mitchell - BillM@cupertino.org - Project Sponsor
OmniData Page 9 of15
o
OMNIDATA
6. Project Costing
EXHIBIT C1 H::4+
1, Cupertino E[)W - Bui3d and Deploy
1. Environment Deployment (Dev, Test, Prod)
1. Azure 'Environment Deployment,.Configuration and Testing
2. Solution Build & Deploy: Accela
1. Data Ingestion to Data Lake (SQL Source)
2. Physical Data Model Design
3. Physical Data Model Build arid Population (6 tables)
4. Internal Data Validation (Warehouse Level)
7. User Acceptance Testing
8. Solution Handover & Acceptance
9. Solution Build & Deploy: ZenDesk
1. Data Ingestion to Data Lake (Rest API)
2. Physical Data Model Design
3. Physical Data Model Build and Population (8 tables)
4. Internal Data Validation (Warehouse Level)
7. User Acceptance Testing
8. Solcition Handover & Acceptance
13. Overall Project - Group 1
Data Engineering Lead
Power BI Solution Architect
Project Management
Solution Architecture
14. Technical Training and Upskilling
Solution Architeeture
176
18
18
45
1l
4
19
5
4
2
50
15
4
1'5
7
7
2
44
7
7
'ig
11
'rg
19
217
23
23
55
14
5
23
6
5
2
61
18
5
18
9
9
2
55
9
9
23
14
23
23 I
OmniData Page10 ofl5
o HsoiuibM'aons"parbiei
OMNIDATA
7. Change Management Process
The project deliverables as indicated in this document constitutes the full and final list of
output for the project. Should the scope of this project change or should the client require a
change or amendment to this output the change should go through a change request
management process and will be billed outside and in addition to this project cost.
Should a change be requested to the original approach, deliverables or services included in
the scope of the document the following change request process will be followed.
Amend Cliange
Request
[OmniData)
lJpdate
Documentalton
(OmniData)
OmniData Page 11 of15
o
OMNIDATA
fflffi Microsoft
ffla Siilniliiiii %rtner
8. Assumptions & Risks
The following assumptions were used to generate the estimates in this proposal. Any materia
changes in these a.<sumptions could affect the successful delivery of the project and may
necessitate the re-evaluation of the estimates and quote contained herein.
People and Roles
* Committed executive sponsorship and open communication between Customer personnel
and OmniData consultants.
* Customer personnel critical to the project's success are available to meet with OmniData as
necessary. Customer personnel that will need to be available during the project to fulfill the
following roles:
o Project Liaison. This person will ensure that the project is moving forward as e:xpected
and that Customer resources needed to meet the deliverables are available and to
advise of resource changes, time off etc.
o Subject Matter Experts (SME). These are experts in either the technical aspects of the
data storage/structures/layouts, system access, hardware set up and/or the business
rules to apply to the data to achieve the desired information deliverables.
o Database Administrator (DBA) for all databases to be used during the project. This
person will have a detailed knowledge of the database structure and application
requirements and will be available initially to create users to grant access to data.
o System Administrator / Network Administrator for all PCs, servers or network
considerations for the project. This person may be required to aSSist with any platform
or Operating System ISSUES encountered during the project, including security.
o Stakeholders as well as other personal relevant to testing, review and sign off on
project deliverables.
Logistics
* Firewall settings must allow for access from servers and data sources to working environments
if applicable.
* Security role information must be provided in advance by the customer, i.e. what roles and
permissions must be assigned at a user or group level.
* In needed, installation of software can typically be performed remotely. If this is not possible
OmniData will schedule onsite visits and expense costs will be incurred by OmniData and
charged to Customer.
* Customer shall provide OmniData consultants with reasonable office space and
communication facilities through the course of this project, including internet access for
consultant's laptops and telephone access in work area
* Customer shall provide OmniData consultants with required desktop and network access
rights necessary to meet the requirements of this project. This includes ability to access the
nternet for retrieving additional technical information and ability to access the OmniData
corporate network.
* Customer shall provide necessary resources to enable OmniData consultants to work offsite
whenever reasonable, at Customer's sole and absolute discretion. This may include VPN, RDP,
etc. and remote access to the Customer's infrastructure.
OmniData Page 12 of15
o RsvM'ao""iiiparbw
Dbla & Al
Amie
OMNIDATA
* Flexibility in work hours to permit reasonable travel scenarios is appreciated. This may result in
9- or 10-hour days onsite and offsite work depending on a mutually agreed upon solution.
* Environments will be fully tested for access, support, and functionality by the Customer. All
environmental system components consistent with production deployment will be made
available in non-production environments. Any testing which will require resolution based on
environmental issues will be the responsibility of the Customer.
* Testing with applicable browsers and any VPN and network configurations will be the
responsibility of the Customer.
Data and Requirements
* Customer shall provide the necessaiy system access, data mapping, reports and applications
as required for the engagement. The Customer has all applicable licensing and connectors
required (e.g. SAP Connector, Salesforce Connector, etc.) and the connectors are already set
up and configured for data connectivity and extraction from source target systems (e.g. SAP
R/3 or SAP B/W) and the Customer has knowledgeable, available technical resources who
have familiarity with the Customer's environment, configuration, and connectors.
* It is assumed that the data is of a reasonable high quality in terms of referential integrity,
internal consistency, cross-referencing and completeness. If this is not the case, and it is
expected that OmniData consultants shall help in cleanup and adjustments of the data as part
of the project, it can and most probably shall inflate the estimated project hours. Source data
will be validated and verified prior to providing to development team.
* OmniData is not responsible for the backing up and/or safekeeping of Customer data or
program files in the Customer's environment. Data will be stored on customer systems and
backup will be handled by customer backup processes. OmniData makes no warranties or
indemnities in this regard.
* It is assumed that all documentation regarding global alignment of data and calculation
methods for primary measures will be provided by the Customer.
* The Customer is responsible for final data validation and end user training, unless otherwise
explicitly stated in this SOW.
* Unique user issues will be the responsibility of the Customer.
* Best effort will be made to meet delivery dates specified. Inability to meet deadline will not be
a default of this agreement.
* Delivered applications are subject to software limitations and may not appear and function
identically to mockups and designs. Requests for customizations shall be scoped and
estimates provided by OmniData via the project Change Control process.
OmniData Page 13 of15
o
OMNIDATA
9. Billing and Payment Terms
Payment terms are governed by the Master Service Agreement.
All billings will be done on a time and materials basis.
85,Mi:'pa'imr
OmniData Page 14 of15
o
OMN}DATA
10.Project Sign-Off
City of Cupertino
BV:
Name:Bill Mitchell
Title:CTO
Date: Mar 1, 2023
fflm Microsoft
xi
OmniData
By:
Name: Douglas Textor
Title:CEO
Date: Mar 1, 2023
OmniData Page 15 of15
EXHIBIT D
Imurance Requirements
Design ProfeSsionals & Consultants Contracts
Consultant shall procure prior to commencement of Services and maintain for tlie duration of tlie contract,
at its own cost and expense, tlie following insurance policies and coverage with companies doing busiiiess in
California and acceptable toCity.
INS'[RANCE POLICIES AND MS REQUIRED
1. Conzmercia/GeneralIiafii/ify(CGL)forbodilyinjury,propertydamage,personalinjuryliabilityfor
premises operations, products and coinpleted operations, contractual liability, and personal and
advertising injury with limits no less tlian $2,000,000 per occurrence (ISO Form CG 00 01). If a
general aggregate limit applies, either tl'ie general aggregate limit shall apply separately to this
project/location (ISO Forin CG 25 03 or 25 04) or it sliall be twice tlie required occurrence limit.
a It sliall be a requirement tliat any available insurance proceeds broader tl'ian or in excess of the
specified minimum insurance coverage requirements and/or limits sliall be made available to the
Additional Insured and shall be (i) the minirmu'n coverage/limits specified in tliis agreement; or (ii) tlie
broader coverage and maximum limits of coverage of any insurance policy, wliicliever is greater.
b. Additional Insured coverage under Consultant's policy sliall be "primaiy and non-contributory,"
will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO
Forin CG 20 10 (04/13).
c. Tlie 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 basis for tlie benefit of City before the City's own insurance or self-
insurance shall be called upon to protect City as a namedinsured.
l ,4utowxobi/effiabi/ify:ISOCAOOOlcoveringanyauto(includingowned,hired,andnon-owned
autos) with limits no less than $1,000,000 per accident for bodily injury and property damage.
3. Workers' Co/71perisation: As required by the State of California, with Statutoiy Limits and
Employer's Liability Insurance of no less than $1,000,000 per occurrence for bodily injury ordisease.
J Not required. Cons'gdtant has provided written verification of no employees.
4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant's
profession, with limits no less than $2,000,000 per occurrence or claim, $2,000,000 aggregate. If written
on a claims made forin:
a TheRetroactiveDatemustbeshownandmustbebeforetheEffectiveDateoftl'ieContract.
b. Insurancemustbemaintainedforatleastfive(5)yearsaftercompletionoftheServices.
c Ifcoverageiscanceledornon-renewed,andnotreplacedwithanotherclaims-madepolicyforin
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.
Exh. D-Insurance Reqtrirements for Design Professionals & Consultant Contracts Form UpdatedJan. 2022
1
OTHF,R INSURANCE PROVISIONS
Tlie aforementioned insurance shall be endorsed and liave all tlie following conditions and provisions:
Additional Imured Status
The City of Cupeitino, its City Council, officers, officials, employees, agents, servants and vohinteers
("Additional Insureds") are to be covered as additional insureds on Consultant's CGL and automobile
liability policies. General Liability coverage can be provided in the foim of an endorsement to Consultant's
insurance (at least as broad as ISO Forin CG 20 10 (11/ 85) or botli CG 20 10 and CG 20 37 forms, if later
editions are used).
Primary Coverage
Coverage afforded to City/Additional Insureds shall be primaiy insurance. Any insurance or self-insurance
maintained by City, its officers, officials, employees, or volunteers sliall be excess of Consultant's insurance
and shall not contribute to it.
Notice of Cancellation
Each insurance policy sliall state tliat coverage sliall 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 of premiums.
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 reqriired lierein. Specifically, the Workers'
Compensation policy sliall be endorsed witli a waiver of subrogation in favor of City for all work performed
by Consultant, its employees, agents and subconsultants. Tliis provision applies regardless of whether or not
tlie City lias received a waiver of subrogation endorsement from the insurer.
Deductibles and Self-Itxsured 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, or better.
Verification ofCoverage
Consultant mustfurnish acceptable insurance ceitificates 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 commencement of the Contract. City retains the riglit to
demand verification of compliance at any time duriiig the Contractterm.
Subcomultants
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
IfConsultantmaintains broader coverage and/or liigher limits than the minimums shown above, City shall be
entitled to coverage for the higher insurance limits maintained by Consultant.
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 Reqtiirements for Design Prqfessionals & Consultant Contracts Form UpdatedJan. 2022
2
DATE IMWDD/YYYY)
8/12/2022
THIS CERTIFICATE IS IS8UED 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
REPRESENT ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSLIRED, 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 Burton A. Harris Insurance Agency, Inc.
4766 Park Granada Suite 104
Calabasas CA 94302
CONTACT
NAME:
I
I
:)
'A :C.No.Extlo"=,818-222-9866 i,,.NO,""",818-222-9177i
l[
VAI
IDR lEsL S, burt.bhinsurance@gmail.com
INSuRERISl AFFORDING COVERAGE NAIC #
-lNsURERA , UNITED ST ATES LIABILITY INSURANCE 25895
rhsunso OMNIDATA INSIGHTS, INC
2158 BROOKFIELD DR
THOUSAND OAKS CA 91362
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLIRED NAMED ABOVE FOR THE POLICY PERIOD
IM)ICATED. 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
LTR TYPE OF INSURANCE :i ISUBR
WVD PC}IICY NUMBER llg8'A87'fflY}' POLICY EXP
(MM/00/YYYYI LIMITS
A
&/
PMc,ERICMlsiLMGAEDNEE51AOBclcLIJYR .
[6 a
I
PPP1555695 105/08/202205/08/2023
EACHOCCURRENCE i $1,000,000
DAMAGETORENTED I
PREMISES iEa occurrence)$ 300,000
MED EXP (Any one person)$10,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
'ElOpoT:iEcRy€ 7(3 € LOC
GENERAL AGGREGATE $ 2,000,000
PRODuCTS - COMP/OF' AGG $ INCLUDED
$
AU-OMOBILE LIABILITY
7 ANY AUTO
OWNED l scheouieo
AUTOS ONLY u AUTOS
a HIRED rl NON-OWNED
% AUTOS ONLY LJ AUTOS ONLY
u Ll COMBINED SINGLE LIMIT
(Ea acr.ident)$
BODILY INJURY (%r person)$
BODILY INJURY (Per accident)$
PROPERTY DAMAGE
(Per accident)$
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS-MADE
u Ll EACH OCCURRENCE s
AGGREGATE $
DED t' j RETENT.ON $$
WOHKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y , N
":';'p%SWoW'e'c"u%'xg"EcuT'vE @(Mandatory in NH)
If yes, descrlbe under
DESCRIPTION OF OPERATIONS below
NIA
LJ l I STATUTE I I gR"-
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
A
TECHNOIOGY PROFESSIONAL
LIABILITf
u
€
€:l PPP1555695 05/08/2022 05/08/2023
EACH CLAIM
ANNUAL AGGREGATE
DEDUCTIBLE EA CLAIM
$2,000,000
$2,000,000
$0
DESCRIPTIONOFOPERATIONS/LOCATIONSIVEHICLES (l.CORDlOl,Additional%marksSchedule,maybiattachedlfmorespacalarequlrtd)
Technology Professional Package. L-712 02/11 Blanket Additional Insured Endorsement is part of this policy.
PRODUCER:
TAPCO-KL (5576) Pa BOX 286 BURLINGTON, NC 27216
AGENT IS BURTON HARRIS
CERTIFICATE HOLDER CANCELLATION
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WIIL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIS10N8.
ALITHORIZED REPRESENT ATIVE
l
I % 'a - -'
@1988-2015ACORDCORPORATION. Allrightsreserved.
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
UNITED STATES LIABILITY INSURANCE GROUP
WAYNE, PENNSYLV ANIA
This endorsement modifies insurance provided ruider the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
BLANKET AJ)DITIONAL INSURED ENDORSEMENT
Section II - Who Is An Insured is amended to include as an additional iiisured anyperson(s) or
organization(s) for whom you are perfori'ning "your work" under a written contract or agreement,
that requires such person(s) or organization(s) to be added as an additional iiisured on your
policy. Such person(s) or organization(s) is an additional insured only with respect to liability
for "bodily iiijury", "property damage" or "personal and advertising iiijury" occutring after the
effective date of such contract or agreement tliat is carised, in whole or in part by:
1) Yorir acts or omissions; or
2) The acts or omissions of those acting on yorir behalf;
iii tlie performance of "yoru- work" for the additional iiisured.
Coverage for an additional inswed under this endorsement ends wlien "your work" for tliat
additional insured ends or is prit to its iiitended rise by any person or organization.
EXCLUSIONS
There is no coverage under this endorsement for loss or expense, including but not limited to the
cost of defense for "bodily iiijury", "property damage" or "personal and advertising injury"
occurring:
1) After all of "your work", iiicluding materials, parts or equipment furnished ii'i connection
with "yorir work" and performed under the above referenced written contract(s) or
agreement(s) has ei'ided; or
2) When that portion of "your work" out of which the "bodily injury", "property damage" or
"personal and advertising injury" arises and performed under the above referenced
written contract(s) or agreement(s) has been put to its intended use by any person or
organization;
whichever occurs first.
All other terms and conditions of this policy remain unchanged. This endorsement is a part of
your policy and takes effect on the effective date of yorir policy unless another effective date is
shown.
L 712 (02-11)Page 1 of l
DATE (MMIDDq
8/12/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC.%TE 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
REPRESENT ATIVE 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).
PRO(XICER Burton A. Harris Insurance Agency, Inc.
4786 Park Granada Suite 104
Calabasas CA 91302
CONTACT
NAME:
PH
kU 'g75o,Xt,,818-222-9866 it,c,.)"",818-222-9177
iN
ADI 5,5,, burt.bhinsurance@gmail.com
INSURER(S)AFFORDINGCOVERAGE II NAIC#
INSURERA: United States Liability Insurance Company 25895
tsst.meo OMNIDATA INSIGHTS, INC
2158 BROOKFIELD DR
THOUSAND OAKS CA 91362
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INStJRANCE 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,
E,:CLUSIONS AND CONDITIONS OF StJCH OOLICIES. LIMITS SHOWN MAY HAVE BEEN REDuCED BY PAID CLAIMS.
1N8R
LTR TYPE OF INSURANCE
ADDL
INSD
SuBR
WVD I POLICY NUMBER Ilsgzg"l i,;j4(,7EXPi LIMITS
COMMERCIAL GENERAL LIABILITY
IC(AIMS-MADE € OCCUR
u u ' EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence)$
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GE+!L AGGREGATE LIMIT APPLIES PER:
rT PRO- l"'I
I POLICY l JECT l LOC
lTHER
GENERAL AGGREGATE $
PRODuCTS - COMP/OP AGG $
$
AU-OMOBIL!_ LIABILITY
= ANY AUTO
OWNEO rl scheouceo
AUTOS ONLY LJ At)TOS- HIRED I NON-OWNED
% AUTOS ONLY L,I AuTOS ONLY
Ll u I
I
I
COMBINED SINGLE LIMIT
(Ea accident)$
BODILY INJLIRY (Per person)$
BODILY INJURY (Per accldent)$
PROPERTY DAMAGE
(Per accident)$
$
A
/UMBRELLA LIAR
EXCESS LIAB
/OCCUR
CLAIMS-MADE
LJ u
CUP1561261C 105/31/202205/31/2023
EACH OCCURRENCE $ 2,000,000
AGGREGATE $ 2,000,000
DED l' I RETENT:ON $$
WOP.KERS COMPENSATION
AND EMPLOYERS' LIABILITY Y , N
:fl;;;:%:4V:W't'x'c':'g%':gHEcuT"E @(Mandatory in NH)
IT yes, descnbe under
DESCRIPTION OF OPERATIONS below
NIA
u I I STATUTE I I gR"-
E.L. EACH ACCIDENT $
E.L DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
u
€
€
J
€
J
DES(:RIPTIONOFOPERATIONS/LOCATIONSfVEHICLES (lCORDlOl,AdditionalRemarksSchedule,mayb=attachedlfmorispacelsrequlrid)
COMMERCIAL UMBRELLA
PRODUCER:
TAPCO-KL (5576) Pa BOX 286 BURLINGTON, NC 27216
AGENT IS BURTON HARRIS
CERTIFICATE HOLDER
REVISION NUMBER:
CANCELLATION
City of Cupertino .
10300 Torre Avenue
Cupertino, CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AuTHORIZED REPRE8ENT ATIVE
%
I % o - - '
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
DATE iMNUDDNYYY)
8/12/2022
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER8 NO RIGHTS UPON THE
ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSulNG INSURER(S), AUTHORIZED REPRESENT ATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
AGENCY I
.1
t'HON
'AtC, IIE ,818-222-9866)to. Exti
COMPANY
UNI rED STATES LIABILITI INSURANCE COMPANY
1190 DEVON PARK DR.
WAYNE, PA 19087-2191
Burton A. Harris Insurance Agency, Inb.
4766 Park Granada Suite 104
Calabasas CA 91302
7::, No): s"i8-222-91 77 i X;%"'Css: burt.bhinsurance@gmail.com
CODE: 18UBCODE:
AGENCY
_CU8TOMER 10 #:
INSUR!:D
OMNIDATA INSIGHTS, INC
2158 BROOKFIELD DR
THOUSAND OAKS CA 91362
LOAN NUMBER POLICY NtlMBER
PPP1555695
EFFECTIVE DATE
05/08/2022
EXPIRATION DATE
05/08/2023
' CONTINUED UNTIL' € TERMINATED IF CHECKED
THIS REPLACES PRIOR EVIDENCE DATED:
PROPERTI INFORMATION
LOCATlOVCIEaCRIPTlON
2158 Brookfield Drive, Thousand Oaks, CA 91362 - Technology Professional Package
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
EVIDENCE OF PROPERTY INSURANCE 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.
COVERAGE INFORMATION PERILS INSURED I I BASIC I BROAD I ISPECIAL I
COVERAGEI PERIISI FORMS AMOUNT OF INSURANCE DEDUCTIBLE
Business Personal Property/Special/80%/RC
Business Income with Extra Expense/Special/Maximum Period of Indemnity
Value Plus Endorsement/Special/100%
$25,000
$50,000
See Value Plus
Endorsement
$500
$0
$500
REMARKS
PRODUCER:
TAPCO-KL (5576) Pa BOX 286 BURLINGTON, NC 27216
AGENT IS BURTON HARRIS
CANCEILATION
ADDITIONAL INTEREST
NAME AND ADDRESS
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
&/ADDITIONAL INSURED
MORTGAGEE
LENDER'S LOSS PAY ABLE LJ LOSS PAYEE
LOAN #
AuTHORIZED REPRESENT ATIVE
I- - - - %
ACORD 27 (2016/03)@ 1993-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ZNO
DATE IMMIDDNYYY)
08/08/2022
THIS CERTiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF CATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NE3ATIVELY 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 holc er in lieu of such endorsement(s).
PRODUCER
AON RISK SERVICES SOUTH INC
3550 LENOX ROAD NORTHEAST
SUITE 1700
ATLANTA GA 30326
jj:#:cT Aon Risk Services, Inc of Florida
P(atHco,:Eo, Ext): 833-506-1544 I F(Ho(,, No):
EMAIL
ADDRESS: work.comp@trinet.com
msupep(sj A-FFORDING COVERAGE NAIC #
INSURER A : ACE American Insurance Company 22667
INSURED
TnNet Gmup. Inc. kJClF OmniData Insights
1 Park Place. Suite 600
Dublln, CA 94568-7983
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES
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 DOCtlMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSLIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SLIBJECT TO ALL THE TERMS,
EXCLuSIONS AND CONDITIONS OF SllCh POLIC,IES. LIMITS SHOWN MAY HAVE BEEN REDIJCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE ADDL
INSR
SuBR
WVD POLICY NUMBER POLICY EPF
IMMIDD/YYYY)
POLICY EXP
(MM+DD/YYYY)LIMITS
COMMERCIAL GENERAL LIAEIILITY
H]CLAIMS-MADE € OCCUR
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occuirencel $
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GE:V'L AGGREGATE LIMIT APPLIES PER
eP(:)L: € PROJECT € LOC
GENERAL AGGREGATE $
PRODUCTS - COMPIOP AGG $
$
AUTOMOBILE LIABILITY
ANY AUTO _
OWNED SCHEDLILED
_ AuTOS ONLY _ AUTOS
HIRED NON-OWNED
_ AUTOS ONLY - AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accldant)$
BODILY INJLIRY (Per person)$
BODILY INJURY (Per accldent)$
PROPERTY DAMAGE
(Per ac6deni)$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
EACH OCCURRENCE $
AGGREGATE $
DEC I :I RETENTION $
A
WCRKERS COMPENSATION
AND EMPLOYERSa LIABILITY Y l N
ANY PROPRIETORPARTNERlEXECUnVE rl
E7 lOFFICEFUMEMBEREXCLUD D.,
(Mandatory in NH)
IT yes. descnbe under
DESCRIPTION OF OPERATIONS below
N/A x WLR_C71352420 07/C)1/2022 07/01/2023
" I STATUTE I I gR"-
E.L. EACH ACCIDENT $ 2,000,000
E.L. DISEASE - EA EMPLOYEE $ 2,ODD,000
E.L. DISEASE - POLICY LIMIT $ 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEIIICLES (ACO RD 1(11, Additional Remarks Schedule. may be attached if more space is required)
Workers Compensation covemge is limited to worksite employees of OmniData Insights through a co-employmeni agreement with TriNet HR Ill, Inc..
Waiver of subrogation in favor of Ci$ of Cupertino, and ITS CIT/ COUNCIL, OFFICERS. OFFICIALS, EMPLOYEES, AGENTS. SERVANTS, VOLuNTEERS as respects of job peformed by OmniData
Insights as requlred by written contract.
CERTIFICATE HOLDER
City of Cupertino
Office of the City Manager
10300 Torre Ave.,
CuptAino. CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEIIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT ATIVE
@flop d';pA 8etvtaeh 8>utA Qna
ACORD 25 (2016/03)
CERTIFICATE NUMBER: aissss*oz REVISION NUMBER:
CANCELLATION
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Workers' Compensation and Employers' Liability Policy
Named Insured
TriNet Ciroup, }nc. L/C/F OmniDala Insights
l Park Place, Suite 600
Dublin, CA 94568-7983
Endorsement Number
Policy Number
Symbol: WLR Number: C71352420
Policy Period
07/01/2022 TO 07/01/2023
Effective Date of Endorsement
08/12/2022
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the infomnation is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in item 3.A. of the
Information Page.
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, but this waiver applies only with respect to
bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to
obtain this waiver from us.
You must maintain payroll records accurately segregating the remuneration of your employees while
engaged in the work described in the Schedule.
Schedule
4. ( X ) Specific Waiver
Name of person or organization:
City of Cupertino, and ITS CITY COiJNCn., OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS
Office of the City Manager
10300 Torre Ave.,
Cupertino, CA 95014
() Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to
furnish this waiver.
2. Operations:
3. Premium:
The premium charge for this endorsement shall be percent of the premium developed on
payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium:
Authorized Representative
WC 90 03 75 (05/18)
First Amendment to Omnidata Agreement
Final Audit Report 2023-03-01
Creatqd:2023-03-01
City of Cupertino (webmaster@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAL-y-uEwd-m-jG-H8G3z5WmncCZJaYM
"First Amendment to Omnidata Agreement" History
'6 Document created by City of Cupertino (webmaster@cupertino.org)
2023-03-01 - 1:17:21 AM GMT- IP address: 35.229.54.2
R Document emailed to Marilyn Pavlov (marilynp@cupertino.org) for approval
2023-03-01 - 1 :27:59 AM GMT
'5 Email viewed by Marilyn Pavlov (marilynp@cupertino.org)
2023-03-01 - 1 :30:34 AM GMT- IP address: 69. 181.110.140
4 Document approved by Marilyn Pavlov (marilynp@cupertino.org)
Approval Date: 2023-03-01 - 1 :34:24 AM GMT - Time Source: server- IP address: 69.1E11.110.140
E"-* Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2023-03-01- I :34:26 AM GMT
4 Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Dafe: 2023-03-01 - 1 :41 :19 AM GMT - Time Source: server- IP address: 73.170.27.253
[E"-> Document emailed to Teri Gerhardt (terig@cupertino.org) for approval
2023-03-01 - 1 :41 :2i AM GMT
'jd Email viewed by Teri Gerhardt (terig@cupertino.org)
2023-03-01 - 2:33:14 AM GMT- IP address: 104.28.50.160
4 Document approved by Teri Gerhardt (terig@cupertino.org)
Approval Date: 2023-03-01 - 3:20:22 PM GMT - Time Source: server- IP address: 73.231.141.55
E"+ Document emailed to Douglas Textor (dtextor@omnidata.com) for signature
2023-03-01 - 3:20:24 PM GMT
5 Email viewed by Douglas Textor (dtextor@omnidata.com)
2023-03-01 - 3:46:55 PM GMT- IP address: 172.225.88.161
Powered by
Adobe
Acrobat Sign
4 Document e-signed by Douglas Textor (dtextor@omnidata.com)
Signature Date: 2023-03-01 - 5:02:55 PM GMT - Time Source: server- IP address: 76.91.143.70
E"+ Document emailed to christopherj@cupertino.org for signature
2023-03-01 - 5:02:58 PM GMT
'5 Email viewed by christopherj@cupertino.org
2023-03-01- 5:07:12 PM GMT- IP address: 404.47.74.126
4 Signer christopherj@cupertino.org entered name at signing as Christopher D. Jensen
2023-03-01 - 5:07:30 PM GMT- IP address: 136.24.22.'l94
4 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org)
Signature Date: 2023-03-01 - 5:07:32 PM GMT - Time Source: server- IP address: 136.24.22.194
(?-> Document emailed to Bill Mitchell (billm@cupertino.org) for signature
2023-03-01- 5:07:34 PM GMT
'!G Email viewed by Bill Mitchell (billm@cupertino.org)
2023-03-01 - 511 :43 PM GMT- IP address: 174.23t20.244
4 Document e-signed by Bill Mitchell (billm@cupertino.org)
Signature Date: 2023-03-01 - 5:13:'19 PM GMT - Time Source: server-IP address: 174.231.20.244
G"-> Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2023-03-01 - 5:13:22 PM GMT
5 Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2023-03-01- 7:25:04 PM GMT- IP address: 104.47.74.126
4 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2023-03-01- 7:25:12 PM GMT - Time Source: server- IP address: 67.188.176.248
0 Agreement completed.
2023-03-01 - 7:25:12 PM GMT
Powerm by
Adobe
Acrobat Sign