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24-049 David Carroll & Associates $5K Contract 1 of 5 Services Agreement ($5,000) /Rev 2024 ☐ ☐ ☐ SERVICES AGREEMENT ($5,000 OR LESS) 1. Parties. This Agreement (“Agreement”) is made by and between the City of Cupertino, a municipal corporation (“City”) and David Carroll Associates, Inc. (“Contractor”), a Corporation, and is effective on the last date signed below (“Effective Date”). 2. Services. Contractor agrees to provide the programs, classes or activities (“Services”) set forth in detail in the Scope of Services, attached and incorporated here as Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID- 19. 3. Time of Performance. This Agreement begins on the Effective Date and ends on July 30, 2024 (“Contract Time”), unless terminated earlier as provided herein. Contractor must deliver the Services in accordance with the Schedule of Performance included or attached to Exhibit A. 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. The City’s designated supervisor for this Agreement may extend the Contract Time by up to six (6) months through a written amendment to this Agreement, provided such extension does not include additional contract funds. 4. Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will based upon actual costs but that will be capped so as not to exceed $ 3,196.66 (“Contract Price”), based upon the Scope of Services and the budget and rates included in Exhibit A. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. Upon City approval of written invoices, Contractor will be paid as follows: (check one; cross out others): A lump sum amount of $ which shall not exceed the Contract Price. At the rate of $ per hour for a total not to exceed the Contract Price. Based on the payment schedule included or attached to Exhibit A which shall not exceed the Contract Price. 5. Independent Contractor. 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, workers compensation or other benefits from the City. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner, and must be licensed, registered, and/or certified and have a City Business License. Contractor will supply all tools, materials and equipment required to perform the Services under this Agreement. 6. Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its 2 of 5 Services Agreement ($5,000) /Rev 2024 employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City, and actual attorney’s fees incurred by City in connection with the above. 7. Assignment. This Agreement is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Agreement without prior written approval of City. Only those persons whose names are included in Exhibit A may perform the Services. 8. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and consultants (“Indemnitees”), through legal counsel 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 or willful acts or omissions committed during performance of the Services; (c) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors; Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from City. 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. 9. Insurance. Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit B, 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. 3 of 5 Services Agreement ($5,000) /Rev 2024 ☐ 10. Compliance with Laws. Contractor shall comply with all laws and regulations applicable to this Agreement, included without limitation the following laws: 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. Sole Proprietor. If Contractor is a sole proprietorship/individual, it must sign the Affidavit of No Employees included in this Agreement. 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, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. 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 rules governing gifts to public officials and employees. 11. Abandonment. City may abandon or postpone the Project at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment. 12. Termination. City may terminate this Agreement for cause or without cause at any time. City reserves the right to terminate the Agreement and the remainder of the Services offered by Consultant without notice based upon Contractor’s cancellation of a Service (i.e., program, class or activity) without giving advance notice or obtaining written approval from City. 13. Governing Law. 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. 4 of 5 Services Agreement ($5,000) /Rev 2024 14. Entire Agreement. This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement or understanding, either oral or written, between the Parties. Any changes to 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 any term, clause, or provision of the main Agreement and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Agreement shall prevail and be controlling. Each provision and clause required by law for this Agreement is deemed to be inserted and will be inferred herein. 15. Services Coordinator. The Parties designate the following persons as Services Coordinators for this Agreement. Contractor’s designation and any substitution are subject to City approval. For Contractor: David Carroll Associates, Inc. For City: Innovation & Technology Name Maria A. Viviani Name Pete Coglianese Position Director of Project Operations Position Multimedia Comms. Specialist Contact mv@davidcarroll.com Contact PeteC@cupertino.gov 16. Contract Interpretation. There are no intended third party beneficiaries of this Agreement. Neither acceptance of the Services nor payment therefor shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. The headings in this Agreement are for convenience only. The Indemnification and Governing Law sections expressly survive this Agreement. 17. Severability. If a term or provision of the Agreement or its application to a particular situation is found by the court to be void, invalid, illegal, or unenforceable, such term or provision shall remain in 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. 18. Notices. All notices, demands, requests, and approvals must be sent to the persons below in writing, and will be considered effective on the date of personal delivery, upon confirmation of delivery by a reputable overnight delivery service, on the fifth calendar day after deposit thereof in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: City Manager Email: Video@cupertino.gov To Contractor: David Carroll Associates, Inc. 5215 Central Ave., Suite A Richmond, CA 94804 Attention: Maria Viviani Email: mv@davidcarroll.com 5 of 5 Services Agreement ($5,000) /Rev 2024 19. Execution. Contractor’s signatory warrants that he or she is authorized to execute the Agreement and to legally bind 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 WHEREOF, the Parties have caused the Agreement to be executed as of the Effective Date written above. CITY OF CUPERTINO A Municipal Corporation CONTRACTOR By:_ By:_ Name: Name: Title: Date: APPROVED AS TO FORM: By: CHRISTOPHER D. JENSEN Cupertino City Attorney Title: Date: APPROVED AS TO FORM: By: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: By: KIRSTEN SQUARCIA City Clerk Date: David Carroll President May 13, 2024 Christopher D. Jensen Teri Gerhardt CTO May 13, 2024 May 13, 2024 Date: No.:9650 4/10/2024 QuoteDavid Carroll Associates, Inc. Phone: (510) 235-1256 Fax: (510) 235-5636 1569 Solano Ave, PMB 186 Berkeley, CA 94707 Prepared for:Prepared by: Maria A. Viviani Pete Coglianese (408) 777-1358 Account No.: 1501 City of Cupertino Cupertino City Hall 10300 Torre Avenue Cupertino, CA 95014 Quantity TotalSellUOMItem ID Description Remove failed QSC Core 110f from conference room C system Install preconfigured DCA loaner QSC core 110f Ship bad core to factory for repair Factory will provide estimate of cost of repair for your approval Return to reinstall repaired unit and test EAService:Standard Routine Engineering Out-of-contract Engineering, Routine SLA $875.005.00 $175.00 Out-of-contract EADCA/Equipment Loaner DCA QSC preconfigured Core 110f $65.001$65.00 Equipment loaner program EATrip Fee 15-30 Flat fee for service call to location 15-30 miles $250.002.00 $125.00 Your Price:$1,190.00 $6.66Sales Tax SubTotal:$1,196.66 Total:$1,196.66 Prices are firm until 5/10/2024 Terms: Net 30 Prepared by:Maria A. Viviani, mv@davidcarroll.com Date: 4/10/2024 QSC Factory will evaluate the unit and provide an estimate of the cost of the repair . Upon your approval, DCA will authorize the repair and add the cost to your service ticket.Shipping will be added to final invoice. Date:__________ ___________ Accepted by: *The Disclaimers & Assumptions listed herein are intended to be applicable as needed and appropriate to the nature and scope of this transaction. Sale Disclaimers - Product availability is dependent upon manufacturer's stock and/or lead times. DCA is not responsible for application to purpose unless otherwise agreed upon in writing Drop Shipments – Client must thoroughly inspect, test and verify product integrity within 72 hours of delivery. DCA is not responsible for damage present upon receipt. Any damage discovered must immediately be reported to DCA upon discovery. Damage claims must be handled directly with shipper/supplier. DISPLAYS – drop shipment(s) of displays – when driver arrives, customer must inspect and test PRIOR to signing the BOL. Do NOT sign the BOL without proper inspection. Once the BOL is signed, insurance is waived and the sale is final. Disclaimer quote-nys.rpt Page 1Printed: 4/10/2024 11:41:04AM EXHIBIT A Contingency: $2,000 May 13, 2024 4/10/2024Date: 9650No.: Quote Equipment Only Sales – NO professional services are included Project Disclaimers - Change Orders – Change Order(s) will be issued for any unforeseen site conditions and/or changes in scope of work, which occur during the course of the installation, and must be approved within 24 hours within receipt for work to continue Final Shipping and Taxes will be added at the time of invoicing DCA is not responsible for damage to ceilings, floors, walls, paint, carpet, etc. (DCA expert installers will take great care in executing our work and provide protective measures wherever possible). Owner Furnished Equipment (OFE) – DCA is not responsible for the received condition of OFE – all OFE is assumed to be in good, functional working order in keeping with product intended use. All OFE will be tested by DCA Engineering to verify application to purpose. Testing fees may apply. Functional Design – the design as indicated within this proposal/quote shall serve as a definition of functional requirements. DCA shall have the right to make changes to said design in order to provide comparable/appropriate functionality within the budget. DCA may make equipment changes based on product availability and schedule. Project Site Assumptions - Access – normal business hours, parking, loading, freight elevator Point of Contact – during onsite work, client shall provide a single point of contact Electrical – Electrical circuits and outlets are assumed to be present and functioning Clean, Dust Free & Safe – it is client responsibility to provide a clean, dust free and safe environment for DCA staff to perform required work Building Permits – not required WIFI/Network Connectivity – client to provide network and internet access A secure location to store equipment, tools and/or project related gear within close proximity to project location will be provided by client and must be pre-approved as suitable by DCA quote-nys.rpt Page 2Printed: 4/10/2024 11:41:04AM Insurance Requirements for Services Agreement ($5,000 or less) 1 Version: Sept. 2019 Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance and results of the Services hereunder by the Contractor, his agents, representatives, employees, or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (“CGL”): Insurance Services Office (“ISO”) Form CG 00 01 covering CGL on an “occurrence” basis, including products and completed operations, contractual liability, property damage, bodily injury, and personal and advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this Project (ISO CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement under this agreement 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 (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor'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 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 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 Form Number CA 00 01 covering any auto (Code 1), or, if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), 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. (Not required if Contractor provides written verification it has no employees). 4. Professional Liability. Insurance which includes coverage for professional acts, errors and omissions, with limits no less than $2,000,000 per occurrence or claim, $2,000,000 aggregate (if applicable). If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and higher insurance limits maintained by Contractor. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed by or on behalf of Contractor including materials, parts, or equipment EXHIBIT B Insurance Requirements Services Agreement ($5,000 or less) Insurance Requirements for Services Agreement ($5,000 or less) 2 Version: Sept. 2019 furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Contract, the Contractor’s insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of Contractor’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 of premiums. Waiver of Subrogation Contractor grants to City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Self-Insured Retentions City may approve self-insured retentions and require proof of Contractor’s ability to pay losses and related investigations, claim administration and defense expenses within the retention. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or City. Acceptability of Insurers Insurers must be acceptable to City and licensed to do business in California, and each insurer must have an A.M. Best’s financial strength rating of “A” or better and a financial size rating of “VII” or better. Claims Made Policies (applicable only to professional liability) If any of the required policies provide coverage on a claims-made basis: 1. The Retroactive Date must be shown and must be before the Effective Date of the Contract. 2. Insurance must be maintained for at least five (5) years after completion of the Services. 3. 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 Contractor must purchase “extended reporting” coverage for a minimum of five (5) years after completion of the Services. Verification of Coverage Contractor shall furnish the City with acceptable original 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 to City prior to commencing the Services. City retains the right to demand verification of compliance at any time during the Contract. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. Insurance coverage shall not limit Contractor’s duties to indemnify, defend and hold City harmless. City reserves the right to modify these requirements based on the nature of the risk, prior experience, insurer, coverage or other special circumstances. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/10/2024 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 be endorsed.If SUBROGATIONIS 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 HARTFORD FIRE INSURANCE COMPANY 76250878 ONE HARTFORD PLAZA HARTFORD CT 06155 CONTACT NAME: PHONE (A/C, No, Ext): (877) 287-1316 FAX (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Hartford Fire and Its P&C Affiliates 00914 INSURED DAVID CARROLL ASSOCIATES, INC. 1569 SOLANO AVE PMB 186 BERKELEY CA 94707-2116 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 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 INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED 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) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS- MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A 76 WEG NH6666 01/01/2024 01/01/2025 X PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION The City of Cupertino and its city council officers, employees and agents 10300 TORRE AVE 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 REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:04/25/24 Policy Expiration Date:01/01/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG NH6666 Endorsement Number:003 Effective Date:04/10/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:DAVID CARROLL ASSOCIATES, INC. 1569 SOLANO AVE PMB 186 BERKELEY CA 94707 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Cupertino 10300 Torre Ave Cupertine, CA 95014 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 99 00 06 A (1)Printed in U.S.A.Page 1 Process Date:04/25/24 Policy Expiration Date:01/01/25 CHANGE IN INFORMATION PAGE INSURER:See Attached Endorsement NCCI Company Number:13161 Audit Period:ANNUAL Policy Effective Date:01/01/24 Policy Expiration Date:01/01/25 Policy Number:76 WEG NH6666 Endorsement Number:003 Effective Date:04/10/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:DAVID CARROLL ASSOCIATES, INC. 1569 SOLANO AVE PMB 186 BERKELEY CA 94707 FEIN Number:26-3903621 Producer Name:HARTFORD FIRE INSURANCE COMPANY Producer Code:76250878 It is agreed that the policy is amended as follows: This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford.If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts. In consideration of no change in premium, it is agreed that: Policy is amended to add the following condition(s): Waiver of Our Right to Recover from Others Endorsement Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. WC990006A(.1P) WC040306 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) INSURER(S) AFFORDING COVERAGE NAIC # PRODUCER INSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : COVERAGES TYPE OF INSURANCE POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: LOCPOLICY OTHER: EACH OCCURRENCE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ $ AUTOMOBILE LIABILITY ANY AUTO $ $ $ $ OCCUR CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION $ $ $ $ $ Y/N CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: FAX (A/C, No): CERTIFICATE NUMBER:REVISION NUMBER: $ UMBRELLA LIAB EXCESS LIAB AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD $ INSURER F : $ N/A SCHEDULED AUTOS NON-OWNED AUTOS ONLY OWNED AUTOS ONLY HIRED AUTOS ONLY 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 LTR ADDL INSD POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) PRO- JECT DAMAGE TO RENTED PREMISES (Ea occurrence) COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER STATUTE OTH- ER SUBR WVD 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). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 04/11/2024 TRUENORTH COMPANIES LC PO BOX 1863 CEDAR RAPIDS, IA 524061863 (888) 661-3938 (888) 661-3938 (877) 872-7604 service.center@travelers.com DAVID CARROLL ASSOCIATES, INC. 1569 SOLANO AVE PMB 186 BERKELEY, CA 94707 TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 801860526121201 A X X X X X 680-7D492158-23 12/12/2023 12/12/2024 1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000 A X BA-8N552104-23 12/12/2023 12/12/2024 1,000,000 B X X X 0 CUP-9D422140-23 12/12/2023 12/12/2024 5,000,000 5,000,000 AS RESPECTS TO GENERAL LIABILITY, CITY OF CUPERTINO, IT'S CITY COUNCIL, BOARDS AND COMMISSIONS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS AND CONSULTANTS ARE ADDITIONAL INSURED - BLANKET ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS, CG D1 05, BUT ONLY AS RESPECTS TO WORK PERFORMED BY THE INSURED.AS RESPECTS TO GENERAL LIABILITY, SUBROGATION AGAINST CITY OF CUPERTINO, IT'S CITY COUNCIL, BOARDS AND COMMISSIONS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS AND CONSULTANTS HAS BEEN WAIVED PER CG D4 17. CITY OF CUPERTINO 10300 TORRE AVENUE CUPERTINO, CA 95014 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 IS AN INSURED (SECTION II)is amended in a written contract for this insurance to to include as an insured any person or organiza-apply on a primary or contributory basis. tion (called hereafter "additional insured")whom 3.This insurance does not apply:you have agreed in a written contract,executed a.on any basis to any person or organizationpriortoloss,to name as additional insured,but for whom you have purchased an Ownersonlywithrespecttoliabilityarisingoutof"your and Contractors Protective policy.work"or your ongoing operations for that addi- tional insured performed by you or for you.b.to "bodily injury,""property damage,""per- sonal injury,"or "advertising injury"arising2.With respect to the insurance afforded to Addi-out of the rendering of or the failure to rendertionalInsuredsthefollowingconditionsapply:any professional services by or for you,in- a.Limits of Insurance The following limits of cluding: liability apply: 1.The preparing,approving or failing to 1.The limits which you agreed to provide;prepare or approve maps,drawings,or opinions,reports,surveys,change or- 2.The limits shown on the declarations,ders,designs or specifications;and whichever is less.2.Supervisory,inspection or engineering services.b.This insurance is excess over any valid and collectible insurance unless you have agreed CG D1 05 04 94 Copyright,The Travelers Indemnity Company,1994.Page 1 of 1 Includes Copyrighted Material from Insurance Services Office,Inc. David Carroll & Associates $5K Contract Final Audit Report 2024-05-13 Created:2024-05-13 By:Marilyn Pavlov (marilynp@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAYOtoxntzfbowIR6OPuzFMSWIfabHiGic "David Carroll & Associates $5K Contract" History Document created by Marilyn Pavlov (marilynp@cupertino.org) 2024-05-13 - 8:39:16 PM GMT- IP address: 64.165.34.3 Document approved by Marilyn Pavlov (marilynp@cupertino.org) Approval Date: 2024-05-13 - 8:44:03 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2024-05-13 - 8:44:05 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2024-05-13 - 8:56:33 PM GMT - Time Source: server- IP address: 71.204.144.228 Document emailed to David Carroll (dc@davidcarroll.com) for signature 2024-05-13 - 8:56:35 PM GMT Email viewed by David Carroll (dc@davidcarroll.com) 2024-05-13 - 9:02:36 PM GMT- IP address: 104.47.58.126 Document e-signed by David Carroll (dc@davidcarroll.com) Signature Date: 2024-05-13 - 9:28:27 PM GMT - Time Source: server- IP address: 208.87.219.102 Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature 2024-05-13 - 9:28:29 PM GMT Email viewed by Christopher Jensen (christopherj@cupertino.org) 2024-05-13 - 9:29:03 PM GMT- IP address: 104.47.73.126 Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen 2024-05-13 - 9:29:31 PM GMT- IP address: 64.165.34.3 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2024-05-13 - 9:29:33 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Teri Gerhardt (terig@cupertino.org) for signature 2024-05-13 - 9:29:34 PM GMT Email viewed by Teri Gerhardt (terig@cupertino.org) 2024-05-13 - 10:11:35 PM GMT- IP address: 104.28.111.133 Document e-signed by Teri Gerhardt (terig@cupertino.org) Signature Date: 2024-05-13 - 10:12:45 PM GMT - Time Source: server- IP address: 174.195.87.240 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2024-05-13 - 10:12:47 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2024-05-13 - 10:38:41 PM GMT- IP address: 104.47.74.126 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2024-05-13 - 10:38:50 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2024-05-13 - 10:38:50 PM GMT