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23-118 Amendment #1 dated 4-18-24 Native Digital for Media and Public Relations ServicesFIRST AMENDMENT TO AGREEMENT 775 BETWEEN THE CITY OF CUPERTINO AND NATIVE DIGITAL FOR MEDIA AND PUBLIC RELATIONS SERVICES This First Amendment to Agreement 775 is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and Native Digital, a Corporation for Media and Public Relations Services ("Contractor") whose address is 1612 Grand Blvd. #300 Kansas City, MO 64108, and is made with reference to the following: RECITALS: A. On October 16, 2023, Agreement 775 ("Agreement") was entered into by and between City and Contractor for Media and Public Relations services. 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 the undersigned parties as follows: 1. SERVICES Paragraph 2 of the Agreement is modified to read as follows: 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-1. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 2. Exhibit A to the Agreement is replaced with Exhibit A-1, attached hereto. 3. TIME OF PERFORMACE Paragraph 3 of the Agreement is modified to read as follows: 3.1 This Agreement begins on the Effective Date and ends on August 1, 2024 ("Contract Time"), unless terminated earlier as provided herein. Services shall begin on October 16, 2023 and shall be completed by August 1, 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 as Exhibit B-1. 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. 4. Exhibit B to the Agreement is replaced with Exhibit B-1, attached hereto. 5. COMPENSATION Paragraph 4 of the Agreement is modified to read as follows: 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will be based on actual costs but that will be capped so as not to exceed $38,415.00 ("Contract Price"), based upon the Services in Exhibit A-1 and the budget and rates included in Exhibit C-1, 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. 4.2 Invoices and Payments. Biweekly invoices must state a description of the deliverable completed and the amount due for tasks specified in Exhibit B-1 and Exhibit C-1. Payment invoicing will be initiated upon the satisfactory completion of each task, as outlined in Exhibit B-I and Exhibit C-1. 6. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO By 41r_- Title Deputy City Manager Date Apr 18, 2024 APPROVED AS TO FORM C&4?i O D. ,7m"n, City Attorney ATTEST: City Clerk Date Apr 18, 2024 NATIVE DIGITAL By J)STIN GV,4TKINS Title C E 0 Date Apr 18, 2024 EXHIBIT A-1 Exhibit A-1 (Scope of Work) Goal: Promote Cupertino's business value proposition to key decision makers. HEADWINDS • Advance the narrative beyond "the home of Apple." INSIGHTS • We can springboard off our core strengths to show the full ecosystem and appeal of Cupertino. • We do not have to convince everyone. We can focus on target G213 decision makers. WATCHOUTS • Avoid traditional mass media and PR media relations during early phases. They require higher budgets and invite unwanted scrutiny. STRATEGY MEASURABLES • Craft appealing city narrative. Build comprehensive messaging strategy. • Deploy in targeted & budget efficient digital mediums with strong lead generation & sales cycle opportunities. TASKS, ACTIONS, SUPPORT & DELIVERABLES • Gather target audience and stakeholder input. • Analyze the City's existing public communication platforms. Identify and recommend opportunities for improvement and propose metrics for measuring success. • Develop collateral materials and messaging on Cupertino's business proposition to position the City of Cupertino as the "Center of Innovation" and "Open for Business." Apply storytelling techniques to outbound communications related to City's message. • Emphasize themes: Innovation -based ecosystem, Economic development efforts, educational strengths, Strong job market, "Hidden gems." • Promote resident and business engagement. • Work with City Officials to identify research needed to support overall objectives. Kickoff & Stakeholder Interviews Review project timeline, objectives, goals, and team roles. Client to provide interviewee list and initiate invitation to participate. Phone/Zoom interviews with priority stakeholders, customers, or lapsed customers. Discovery Report Define 3-5 target audience profiles based on inputs. (Motivators, stressors, jobs to be done) Analysis of brand, market, culture, customer Et experience. Develop opportunities, proof points Et springboards for brand messaging. Narrative Messaging Recommend positioning territories with customer insights and brand idea. Develop messaging for primary audiences. Present conceptual directions with mood boards, Et storyboard EXHIBIT B-1 and C-1 Exhibit B-1 and C-1: (Schedule of performance and Compensation) Native Digital will perform the below tasks at the below rates. Invoicing for payment will be processed upon the successful completion of each task. Tasks and Deliverables Task I (Completed) $11,700 • Kickoff and stakeholder interviews • Review project timeline, objectives, goals, and team roles. • Client to provide interviewee list and initiate invitation to participate. • Phone/Zoom interviews with priority stakeholders, customers, or lapsed customers. Task 2 (Begin on 4/22/24 and complete on 5/3/24) $69678.75 • Review interviews and kick off Discovery Report • Develop opportunities/Proof Points + Audience Profiles Task 3 (Begin on 5/6/24 and complete on 5/ 17/24) $6,678.75 • Develop Position Directions • Positioning Directions - Consultation Task 4 (Begin on 5/20/24 and complete on 5/31/24) $69678.75 • Develop Full Narrative • Full Narrative - Edit for Voice Task 5 (Begin on 6/3/24 and complete on 6/ 14/24) $6,678.75 • Finalize Narrative and send to Client / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (M M/DD/YYYY) 10/03/2023 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 Madi Poindexter NAME: RSC Insurance Brokerage, Inc. PHONE (617) 737-6201 FAx A/C No Ext : AIC,No): E-MAIL m oindexter risk-strate ies.com ADDRESS: p @ g 160 Federal Street INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Travelers Casualty Ins.Co of America 19046 Boston, MA 02110 INSURED INSURER B : Travelers Property Casualty Company of America 25674 INSURER C : The Travelers Indemnity Co 25658 Native Digital LLC INSURER D : AXIS Insurance Company 1612 Grand Blvd INSURER E : Ste 300 INSURER F : Kansas City, MO 64108-1494 COVERAGES CERTIFICATE NUMBER: 22-23 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW'NAVE BEEN1'SSt7EQT0 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 LTR TYPE OF INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE OCCUR PREM SES Ea oNcE ante $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 A Y Y 68081_759241 10/17/2023 10/17/2024 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 X JECT LOC PRODUCTS-COMP/OPAGG $POLICY❑PRO 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS BA8L763291 10/17/2023 10/17/2024 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LAB CLAIMS -MADE CUP81_76299A 10/17/2023 10/17/2024 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N /A UB8L764712 10/17/2023 10/17/2024 XPER STATUTE I ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ Limit $1,000,00 D Professional Liability P-001-000052894-05 10/17/2023 10/17/2024 Retention $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AS RESPECTS TO GENERAL LIABILITY, SUBROGATION AGAINST THE CITY OF CUPERTINO, ITS CITY COUNCIL, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS AND VOLUNTEERS, HAS BEEN WAIVED PER CG D8 42. AS RESPECTS TO GENERAL LIABILITY, THE CITY OF CUPERTINO, ITS CITY COUNCIL, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS AND VOLUNTEERS ARE ADDITIONAL INSURED - BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS CG D1 05. AN ENDORSEMENT HAS BEEN ADDED TO THE POLICIES THAT PROVIDES 30 DAY EARLIER NOTICE OF CANCELLATION, SUBJECT TO THE TERMS OF THAT ENDORSEMENT. AS RESPECTS TO GENERAL LIABILITY, COVERAGE IS AFFORDED ON A PRIMARY AND NON-CONTRIBUTORY BASIS AS PER CG T1 00. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF CUPERTINO ACCORDANCE WITH THE POLICY PROVISIONS. 10300 TORRE AVENUE AUTHORIZED REPRESENTATIVE CUPERTINO, CA 95014 fYCr f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO 1S AN INSURED (SECTION II) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance - The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy, b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professiona! services by or for you, in- cluding: 1. The preparing, approving or tailing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. POLICY NUMBER: 680-8L759241-23-42 EFFECTIVE DATE: 10/17/2023 ISSUE DATE: 08/28/2023 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS x IL TO 25 08 01 RENEWAL CERTIFICATE * MP TO Ol 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS * IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 15 09 07 COMMON POLICY CONDITIONS BUSINESSOW'NERS MP Tl 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP T1 05 02 05 AMENDATORY PROVISIONS - OFFICES * MP T3 63 03 15 POWER PAC PREMIER ENDORSEMENT MP T3 25 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE * MP T3 34 02 05 ELECTRONIC DATA PROCESSING - INCREASED LIMIT MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS CP 01 24 07 00 NEBRASKA CHANGES MP T5 37 04 22 MISSOURI CHANGES COMMERCIAL GENERAL LIABILITY CG TO 34 02 19 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG T1 00 02 19 CG Tl 00 02 19 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 24 04 12 19 WVR OF TRANS OF RIGHTS OF RECOVERY CG D3 09 02 19 AMENDATORY ENDORSEMENT - PRODUCTS -COMPLETED OPERATIONS HAZARD CG D9 10 09 21 AMENDMENT OF INTELLECTUAL PROPERTY EXCLUSION CG Dl 05 04 94 BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC * CG T4 91 11 88 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION CG D8 42 02 19 XTEND ENDORSEMENT FOR SMALL BUSINESSES CG D4 21 07 08 AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS CG D6 18 10 11 EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS * CG D9 44 01 23 EXCLUSION - VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS * CG D9 48 01 23 EXCLUSION - VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS CG Di 42 02 19 EXCLUSION - DISCRIMINATION CG D2 26 06 15 EXCLUSION - TOBACCO OR NICOTINE * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 01 01 PAGE: 1 OF 2 POLICY NUMBER: 680-8L759241-23-42 EFFECTIVE DATE: 10/17/2023 ISSUE DATE: 08/28/2023 COMMERCIAL GENERAL LIABILITY (CONTINUED) * CG T4 81 11 88 EXCLUSION - ALL HAZARDS IN CONNECTION WITH A DESIGNATED EXPOSURE CG 26 50 04 13 MISSOURI CHANGES - MEDICAL PAYMENTS CG F2 50 09 08 MISSOURI CHANGES - DEFINITION OF POLLUTANTS CG F9 34 02 19 AMENDMENT OF DUTIES IN EVENT OF AN OCCURRENCE, OFFENSE, CLAIM OR SUIT CONDITION EMPLOYEE BENEFITS LIABILITY CG TO 09 09 93 EMPLOYEE BENEFITS LIABILITY COVERAGE PART DECLARATIONS CG TO 43 01 16 TABLE OF CONTENTS - EMPLOYEE BENEFITS LIABILITY COVERAGE FORM CG T1 01 01 16 EMPLOYEE BENEFITS LIABILITY COVERAGE FORM CG F8 93 01 16 MISSOURI CHANGES - EBL MULTIPLE SUBLINE ENDORSEMENTS CG T3 33 11 03 LIMITATION WHEN TWO OR MORE POLICIES APPLY CG 26 25 04 05 MISSOURI CHANGES - GUARANTY ASSOCIATION INTERLINE ENDORSEMENTS * IL TO 63 07 22 ACTUAL CASH VALUE IL T3 68 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE lL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 21 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL T4 27 02 19 ADDITIONAL BENEFITS IL T4 40 10 20 PROTECTION OF PROPERTY IL T3 82 05 13 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 01 05 10 08 MISSOURI CHANGES - POLLUTION IL 02 74 02 13 MISSOURI CHANGES - CANCELLATION AND NONRENEWAL IL FO 61 09 07 MISSOURI CHANGES - DEFINITION OF POLLUTANTS IL T3 25 02 93 NEBRASKA CHANGES - APPRAISAL IL T4 00 05 19 DESIG PERSON, ORG-NOTICE PROVIDED BY US POLICY HOLDER NOTICES * PN MP 59 04 19 IMPORTANT NOTICE - PRODUCT AVAILABILITY * PN T4 54 01 08 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT :-AND BROKER COMPENSATION PN MP 38 01 11 IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS PN T2 04 05 10 IMPORTANT NOTICE - CONTACT INFO - MISSOURI * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 01 01 PAGE: 2 OF 2 One Tower Square, Hartford, Connecticut 06183 POLICY DECLARATIONS EXCESS FOLLOW -FORM AND UMBRELLA POLICY NO.: CUP-8L76299A-23-42 LIABILITY INSURANCE POLICY ISSUE DATE: 08/29/2023 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: NATIVE DIGITAL LLC 1612 GRAND BLVD STE 300 KANSAS CITY MO 64108-1494 2. POLICY PERIOD: From 10/17/2023 to 10/17/202412:01 A.M. Standard Time at your mailing address. 3. LIMITS OF INSURANCE: COVERAGES LIMITS OF LIABILITY AGGREGATE LIMITS OF LIABILITY $5, 000, 000 General Aggregate EXCESS FOLLOW -FORM AND UMBRELLA LIABILITY CRISIS MANAGEMENT SERVICE EXPENSES 4. SELF -INSURED RETENTION: 5. PREMIUM: $ 1,890 6. TAXES AND SURCHARGES: $5, 000, 000 Products -Completed Operations Aggregate $5, 000, 000 Occurrence Limit $50, 000 all Crisis Management Events $5, 000 any one occurrence or event X Flat Charge Adjustable (See Premium Schedule) 7. On the effective date shown in Item 2., the Excess Follow -Form And Umbrella Liability Insurance Policy numbered above includes this Declarations Page and any forms and endorsements shown on the Listing Of Forms, Endorsements And Schedule Numbers. 8. If the Schedule Of Underlying Insurance includes any coverage provided on a claims -made basis, then the following disclaimer applies. COVERAGE WILL APPLY ON A CLAIMS -MADE BASIS WHEN FOLLOWING CLAIMS -MADE UNDERLYING INSURANCE. 9. If the Schedule Of Underlying Insurance includes any coverage which includes defense expenses within the limits of liability, then the following disclaimer applies: DEFENSE EXPENSES ARE PAYABLE WITHIN, AND ARE NOT IN ADDITION TO, THE LIMITS OF INSURANCE WITH RESPECT TO SOME OR ALL OF THE COVERAGES PROVIDED. NAME AND ADDRESS OF AGENT OR BROKER: RSC INSURANCE BROKERAGE - X5032 160 FEDERAL ST 4TH FL BOSTON MA 02110 COUNTERSIGNED BY: Authorized Representative DATE: OFFICE: ELMIRA NY SRV CTR EU 00 02 09 20 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-8L764712-23-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 08-28-23 STASSIGN: PAGE 1 OF POLICY NUMBER: BA-8L763291-23-42-G EFFECTIVE DATE: 10/17/2023 ISSUE DATE: 08/28/2023 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 02 11 89 COTTON POLICY DECLARATIONS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL TO 01 01 07 COMMON POLICY CONDITIONS COMMERCIAL AUTO CA TO 01 02 15 BA- COVERAGE PART DECS (ITEMS 1 & 2) CA TO 02 02 15 BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEM 3) CA TO 03 02 15 BUS AUTO COV PART DECLARATIONS-4&5 CA TO 30 02 16 BUSINESS AUTO/MC COV PART -UM SUPPL SCHD CA TO 31 02 15 TABLE OF CONTENTS -BUSINESS AUTO COV FORM CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM CA 01 65 07 16 MISSOURI CHANGES CA O1 66 10 13 MO CHANGES POLLUTION EXCL CA 05 02 04 16 MISSOURI ALTERNATE LOSS PAYMENT - PHYSICAL DAMAGE COVERAGES CA 21 04 10 13 MISSOURI UNINSURED MOTORISTS COVERAGE CA 31 04 02 18 MISSOURI UrDERINSURED MOTORISTS COVERAGE CA 99 03 10 13 AUTO MEDICAL PAYMENTS COVERAGE CA 99 33 10 13 EMPLOYEES AS INSUREDS CA T4 59 02 15 AMENDMENT OF EMPLOYEE DEFINITION CA T4 74 02 16 BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE CA T6 25 07 18 ROADSIDE ASSISTANCE COVERAGE CA T3 53 02 15 BUSINESS AUTO EXTENSION ENDORSEMENT CA 02 19 01 16 MISSOURI CHANGES - CANCELLATION AND NONRENEWAL INTERLINE ENDORSEMENTS IL T4 05 05 19 DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US IL T4 27 02 19 ADDITIONAL BENEFITS IL T8 00 10 23 GENERAL PURPOSE ENDORSEMENT IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) POLICY HOLDER NOTICES PN CB 28 07 17 IMPT NOTICE RENEWAL CONSUMER RPT OPT -IN PN CB 31 07 17 USE OF CREDIT INFORMATION DISCLOSURE IL T8 01 01 01 PAGE: 1 OF 1 TRAVELERS One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO COVERAGE PART DECLARATIONS ISSUE DATE: 08-28-23 SD ITEM ONE Policy Number: BA-8L763291-23-42-G INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA Declarations Period: From 10-17-23 to 10-17-24 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Commercial Auto Coverage Part consists of these Declarations and the Business Auto Coverage Form shown below. FORM OF BUSINESS: Limited Liability Company (LLC) ITEM TWO A. COVERAGE AND LIMITS OF INSURANCE Coverage applies only to those "autos" shown as Covered "Autos". "Autos" are shown as covered "autos" for the applicable coverages by the entry of one or more of the symbols from Section I — Covered Autos of the Business Auto Coverage Form next to the name of the coverage. COVERAGES COVERED LIMITS OF INSURANCE AUTO The most we will pay for any one accident or loss SYMBOL COVERED AUTOS LIABILITY 1 $1,000,000 AUTO MEDICAL PAYMENTS 2 $5,000 Each Insured UNINSURED and UNDERINSURED 2 See CA TO 30 MOTORISTS COVERAGE PHYSICAL DAMAGE 7 g Actual Cash Value or Cost of Repair, Comprehensive Coverage whichever is less, minus deductible shown in ITEM THREE --SCHEDULE OF COVERED AUTOS YOU OWN for each covered Auto. See Item Four for Hired or Borrowed Autos. PHYSICAL DAMAGE 7 g Actual Cash Value or Cost of Repair, Collision Coverage whichever is less, minus deductible shown in ITEM THREE --SCHEDULE OF COVERED AUTOS YOU OWN for each covered Auto. See Item Four for Hired or Borrowed Autos. B. AUDIT PERIOD: ANNUALLY PRODUCER RSC INSURANCE BROKERAGE X5032 OFFICE ELMIRA NY SRV CTR 700 CA TO 01 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. TRAVELERS One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO COVERAGE PART DECLARATIONS ISSUE DATE: 08-28-23 SD Policy Number: BA-8L763291-23-42-G C. DESCRIPTION OF COVERED AUTO DESIGNATION SYMBOLS: Symbols 1-9, 19: SEE BUSINESS AUTO COVERAGE FORM Section 1 Covered Autos PRODUCER RSC INSURANCE BROKERAGE X5032 OFFICE ELMIRA NY SRV CTR 700 CA TO 0102 15 C 2015 The Travelers Indemnity Company. All rights reserved. Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Media and Public Relations Services Final Audit Report 2024-04-18 Created: 2024-04-17 By: Webmaster Admin (webmaster@cupertino.org) Status: Signed Transaction ID: CBJCHBCAABAAaOajv5gKOH_p3BoQDPX4aWnpzoye0asx "Media and Public Relations Services" History Document created by Webmaster Admin (webmaster@cupertino.org) 2024-04-17 - 7:14:36 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2024-04-17 - 7:17:08 PM GMT Email sent to Webmaster Admin (webmaster@cupertino.org) bounced and could not be delivered 2024-04-17 - 7:18:09 PM GMT =; Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2024-04-17 - 8:06:55 PM GMT - Time Source: server- IP address: 71.204.144.228 Document emailed to jwatkins@nativedigital.com for signature 2024-04-17 - 8:07:05 PM GMT Email viewed by jwatkins@nativedigital.com 2024-04-17 - 8:07:06 PM GMT- IP address: 66.249.92.144 Email sent to Webmaster Admin (webmaster@cupertino.org) bounced and could not be delivered 2024-04-17 - 8:08:04 PM GMT LA6 Signer jwatkins@nativedigital.com entered name at signing as JUSTIN WATKINS 2024-04-18 - 2:09:41 PM GMT- IP address: 76.205.183.252 t Document e-signed by JUSTIN WATKINS Qwatkins@nativedigital.com) Signature Date: 2024-04-18 - 2:09:43 PM GMT - Time Source: server- IP address: 76.205.183.252 Document emailed to christopherj@cupertino.org for signature 2024-04-18 - 2:09:54 PM GMT Email sent to Webmaster Admin (webmaster@cupertino.org) bounced and could not be delivered 2024-04-18 - 2:10:59 PM GMT Powered by Q I Adobe tVFLE IN4 Acrobat Sign Email viewed by christopherj@cupertino.org 2024-04-18 - 2:41:37 PM GMT- IP address: 104.47.73.254 Signer christopherj@cupertino.org entered name at signing as Christopher D. Jensen 2024-04-18 - 2:42:00 PM GMT- IP address: 136.24.22.194 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2024-04-18 - 2:42:02 PM GMT - Time Source: server- IP address: 136.24.22.194 Document emailed to Tina Kapoor (tinak@cupertino.org) for signature 2024-04-18 - 2:42:12 PM GMT Email sent to Webmaster Admin (webmaster@cupertino.org) bounced and could not be delivered 2024-04-18 - 2:43:14 PM GMT Email viewed by Tina Kapoor (tinak@cupertino.org) 2024-04-18 - 2:44:25 PM GMT- IP address: 146.75.154.1 j; Document e-signed by Tina Kapoor (tinak@cupertino.org) L' Signature Date: 2024-04-18 - 2:55:44 PM GMT - Time Source: server- IP address: 73.189.148.103 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2024-04-18 - 2:55:54 PM GMT Email sent to Webmaster Admin (webmaster@cupertino.org) bounced and could not be delivered 2024-04-18 - 2:56:44 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2024-04-18 - 3:01:11 PM GMT- IP address: 172.225.89.13 c' Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2024-04-18 - 3:01:27 PM GMT - Time Source: server- IP address: 174.194.132.23 Agreement completed. 2024-04-18 - 3:01:27 PM GMT Powered by Adobe c4rersrinv Acrobat Sign