13-132 Kim Marie Smith, Consultant Service for Apple Technology TrainingJanuary 22, 2014
Kim Marie Smith
1421 Millich Court
San Jose, CA 95117
Re: Agreement
OFFICE OF THE CITY CLERK
CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
TELEPHONE: (408) 777 -3223 • FAX: (408) 777 -3366
WEBSITE: www.cupertino.org
Enclosed is an original copy of the first amendment to your agreement with the City of
Cupertino. If you have any questions or need additional information, please contact the
Senior Center at 408 -777 -3150.
Sincerely,
DorothDot ivt
nf ott
Senior Office Assistant
Enclosure
cc: Parks & Recreation
x
FIRST AMENDMENT TO AGREEMENT BETWEEN THE CITY OF
CUPERTINO AND Kim Marie Smith FOR Wad Advanced courses for adults 50 plus at
the Cupertino Senior Center
This First Amendment to the Agreement between the City of Cupertino and Kim Marie
Smith , for reference dated November, 2013, is by and between the CITY OF C.UPERTINO, a
municipal corporation (hereinafter "City ") and Kim Marie Smith a (California corporation,
partnership, sole proprietor, individual) whose° address is 1421 Millich Court, San Jose,
California, (hereinafter "Consultant "), and is made with reference to the following:
RECITALS:
A. On June 17, 2.013,-the City andKim Marie Smith entered into an Agreement; and
B. On December 2, 2013, the City and Kim Marie Smith entered into a First Amendment to
the. Agreement between; the City and Kim Marie Smith (collectively, the Agreement and First
Amendment are hereafter referred to as "Agreement "); and
V'
C. City and Kim Marie Smith 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:
The term of the Agreement as set forth in Paragraph A of Exhibit B shall be
extended six months, from January 1, 2014 . until June 30, 2014, unless
terminated earlier as set forth in the Agreement; and
2. Consultant shall receive addifional compensation under City of Cupertino
Senior Center paragraph of Exhibit A of the Agreement as follows: 80 % of
each registered student for iPad Advanced at the Cupertino Senior Center with
a minimum of four students. A $25 Annual Administration Fee will be
deducted from the first payment. The total compensation under the Agreement
is $1226.8, consisting of $187.30 for the term of July 1, 2013 to December 31,
2013; and $1039.00 for the term of January 1, 2014 to June 30, 2014; and
3. On or before the term of this First Amendment, Kim Marie Smith shall provide
the City with a certificate of insurance and additional insured endorsement
demonstrating Kim Marie Smith's ongoing compliance with the Agreement's
insurance obligations and naming the City as an additional named insured; and
4. Kim Marie Smith represents, warrants, and declares that the Agreement Exhibit
"C" the "City of Cupertino Consultant Declaration" remains accurate and
current.
5. Except as expressly modified herein, all other terms, covenants and conditions
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.
CONSULTANT CITY OF CUPERTINO
A Municipal Corporation
Kim Marie Smith, Consultant By: Justin Cecil
Title: Recreation Coordinator
Date %,:�' 1';Z3//3
RECOMMENDED FOR APPROVAL:
By
Tit e SeNim / �� 3�✓
APPROVED AS TO FORM:
By 1/
City Attorney
_ATTEST:
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City Clerk ��
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND KIM MARIE
SMITH FOR CONSULTANT SERVICES FOR APPLE TECHNOLOGY TRAINING
THIS AGREEMENT, for reference dated 6/17/13 is by and between CITY OF
CUPERTINO, a municipal corporation (herejnafter referred to as "City "), and Kim Marie
Smith , an individual whose address is 1421 Millich Court, San Jose,
California(hereinafter referred to as "Consultant "), and is made with reference to the
following:
RECITALS:
A. City is a municipal corporation duly organized and validly existing under
the laws of the State of California with the power to carry on its business as it is now
being conducted under the Constitution and the statutes of the State of California and
the Cupertino Municipal Code.
B. Consultant is specially trained, experienced and competent to perform
the special services which will be required by this Agreement; and
C. Consultant possesses the skill, experience, ability, background,
certification and knowledge to provide the services described in this Agreement on the
terms and conditions described herein.
D. City and Consultant desire to enter into an agreement for
upon the terms and conditions herein.
NOW, THEREFORE, it is mutually agreed by and between the undersigned
parties as follows:
TERM:
The term of this Agreement shall commence on 6/17/13, and shall terminate on
June 30, 2014, unless terminated earlier as set forth herein.
SERVICES TO BE PERFORMED:
Consultant shall perform each and every service set forth in Exhibit "A" which is
attached hereto and incorporated herein by this reference according to the schedule of
performance set forth in Exhibit "B ".
COMPENSATION TO CONSULTANT:
Consultant shall be compensated for services performed pursuant to this
Agreement not to exceed a total amount of ten thousand dollars ($10,000.00) as set forth
in Exhibit "C which is attached hereto and incorporated herein by this reference.
Payment shall be made by checks drawn on the treasury of the City, to be taken from the
IT fund.
STANDARD OF CARE:
Consultant agrees to perform all services hereunder in a manner commensurate
with the prevailing standards of like professionals in the San Francisco Bay Area and
agrees that all services shall be performed by qualified and experienced personnel who
are not employed by the City nor have any contractual relationship with City.
INDEPENDENT PARTIES:
City and Consultant intend that the relationship between them created by this
Agreement is that of employer - independent contractor. The manner and means of
conducting the work are under the control of Consultant, except to the extent they are
limited by statute, rule or regulation and the express terms of this Agreement. No civil
service status or other right of employment will be acquired by virtue of Consultant's
services. None of the benefits provided by City to its employees, including but not
limited to, unemployment insurance, workers' compensation plans, vacation and sick
leave are available from City to Consultant, its employees or agents. Deductions shall
not be made for any state or federal taxes, FICA payments, PERS payments, or other
purposes normally associated with an employer - employee relationship from any fees
due Consultant. Payments of the above items, if required, are the responsibility of
Consultant.
IMMIGRATION REFORM AND CONTROL ACT (I CA):
Consultant assumes any and all responsibility for verifying the identity and
employment authorization of all of his/her employees performing work hereunder,
pursuant to all applicable IRCA or other Federal, or State rules and regulations.
Consultant shall indemnify and hold City harmless from and against any loss, damage,
liability, costs or expenses arising from any noncompliance of this provision by
Consultant.
NON - DISCRIMINATION:
Consistent with City's policy that harassment and discrimination are
unacceptable employer /employee conduct, Consultant agrees that harassment or
discrimination directed toward a job applicant, a City employee, or a citizen by
Consultant or Consultant's employee or subcontractor on the basis of race, religious
creed, color, national origin, ancestry, handicap, disability, marital status, pregnancy,
sex, age, or sexual orientation will not be tolerated. Consultant agrees that any and all
violations of this provision shall constitute a material breach of this Agreement.
HOLD HARMLESS:
Consultant shall, to the fullest extent allowed by law, with respect to all services
performed in connection with the Agreement, indemnify, defend, and hold harmless the
City and its officers, officials, agents, employees and volunteers from and against any
and all liability, claims, actions, causes of action or demands whatsoever against any of
them, including any injury to or death of any person or damage to property or other
liability of any nature, whether physical, emotional, consequential or otherwise, arising
out, pertaining to, or related to the performance of this Agreement by Consultant or
Consultant's employees, officers, officials, agents or independent contractors. Such costs
and expenses shall include reasonable attorneys' fees of counsel of City's choice, expert
fees and all other costs and fees of litigation.
1. INSURANCE:
On or before the commencement of the term of this Agreement, Consultant shall
furnish City with certificates showing the type, amount, class of operations covered,
effective dates and dates of expiration of insurance coverage in compliance with
paragraphs 9A, B, C, D and E. Such certificates, which do not limit Consultant's
indemnification, shall also contain substantially the following statement: "Should any of
the above insurance covered by this certificate be canceled or coverage reduced before
the expiration date thereof, the insurer affording coverage shall provide thirty (30) days'
advance written notice to the City of Cupertino by certified mail, Attention: City
Manager." It is agreed that Consultant shall maintain in force at all times during the
performance of this Agreement all appropriate coverage of insurance required by this
Agreement with an insurance company that is acceptable to City and licensed to do
insurance business in the State of California. Endorsements naming the City as
additional insured shall be submitted with the insurance certificates.
A. COVERAGE:
Consultant shall maintain the following insurance coverage:
(1) Workers' Compensation:
Statutory coverage as required by the State of California.
(2) Liabili
Commercial general liability coverage in the following minimum
limits:
Bodily Injury: ,$500,000
each occurrence
$1,000,000
,aggregate - all other
Property Damage: $100,000 each occurrence
$250,000 aggregate
If submitted, combined single limit policy with aggregate limits in
the amounts of $1,000,000 will be considered equivalent to the
required minimum limits shown above.
(3) Automotive:
Comprehensive automotive liability coverage in the following
minimum limits:
Bodily Injury: $500,000 each occurrence
Property Damage: $100,000 each occurrence
or
Combined Single Limit: $500,000 each occurrence
(4) Professional Liability:
Professional liability insurance which includes coverage for the
professional acts, errors and omissions of Consultant in the
amount of at least $1,000,000.
B. SUBROGATION WAIVER:
Consultant agrees that in the event of loss due to any of the perils for which
he /she has agreed to provide comprehensive general and automotive liability insurance,
Consultant shall look solely to his/her insurance for recovery. Consultant hereby grants
to City, on behalf of any insurer providing comprehensive general and automotive
liability insurance to either Consultant or City with respect to the services of Consultant
herein, a waiver of any right to subrogation which any such insurer of said Consultant
may acquire against City by virtue of the payment of any loss under such insurance.
C. FAILURE TO SECURE:
If Consultant at any time during the term hereof should fail to secure or maintain
the foregoing insurance, City shall be permitted to obtain such insurance in the
Consultant's name or as an agent of the Consultant and shall be compensated by the
Consultant for the costs of the insurance premiums at the maximum rate permitted by
law and computed from the date written notice is received that the premiums have not
been paid.
D. ADDITIONAL INSURED:
City, its City Council, boards and commissions, officers, employees and
volunteers shall be named as an additional insured under all insurance coverage, except
any professional liability insurance, required by this Agreement. The naming of an
additional insured shall not affect any recovery to which such additional insured would
be entitled under this policy if not named as such additional insured. An additional
insured named herein shall not be held liable for any premium, deductible portion of
any loss, or expense of any nature on this policy or any extension thereof. Any other
insurance held by an additional insured shall not be required to contribute anything
toward any loss or expense covered by the insurance provided by this policy.
E. SUFFICIENCY OF INSURANCE:
The insurance limits required by City are not represented as being sufficient to
protect Consultant. Consultant is advised to confer with Consultant's insurance broker
to determine adequate coverage for Consultant.
2. CONFLICT OF INTEREST:
Consultant warrants that it is not a conflict of interest for Consultant to perform
the services required by this Agreement. Consultant may be required to fill out a
conflict of interest form if the services provided under this Agreement require
Consultant to make certain governmental decisions or serve in a staff capacity as defined
in Title 2, Division 6, Section 18700 of the California Code of Regulations.
3. PROHIBITION AGAINST TRANSFERS:
Consultant shall not assign, sublease, hypothecate, or transfer this Agreement, or
any interest therein, directly or indirectly, by operation of law or otherwise, without
prior written consent of City. Any attempt to do so without said consent shall be null
and void, and any assignee, sub - lessee, hypothecate or transferee shall acquire no right
or interest by reason of such attempted assignment, hypothecation or transfer.
However, claims for money by Consultant from City under this Agreement may be
assigned to a bank, trust company or other financial institution without prior written
consent. Written notice of such assignment shall be promptly furnished to City by
Consultant.
The sale, assignment, transfer or other disposition of any of the issued and
outstanding capital stock of Consultant, or of the interest of any general partner or joint
venture or syndicate member or co- tenant, if Consultant is a partnership or joint venture
or syndicate or co- tenancy, which shall result in changing the control of Consultant,
shall be construed as an assignment of this Agreement. Control means fifty percent
(50 %) or more of the voting power of the corporation.
4. SUBCONTRACTOR APPROVAL:
Unless prior written consent from City is obtained, only those people and
subcontractors whose names and resumes are attached to this Agreement shall be used
in the performance of this Agreement.
In the event that Consultant employs subcontractors, such subcontractors shall
be required to furnish proof of workers' compensation insurance and shall also be
required to carry general, automobile and professional liability insurance in reasonable
conformity to the insurance carried by Consultant. In addition, any work or services
subcontracted hereunder shall be subject to each provision of this Agreement.
5. PERMITS AND LICENSES:
Consultant, at his/her sole expense, shall obtain and maintain during the term of
this Agreement, all appropriate permits, certificates and licenses including, but not
limited to, a City Business License, that may be required in connection with the
performance of services hereunder.
6. REPORTS:
A. Each and every report, draft, work product, map, record and other
document, hereinafter collectively referred to as "Report ", reproduced, prepared or
caused to be prepared by Consultant pursuant to or in connection with this Agreement,
shall be the exclusive property of City. Consultant shall not copyright any Report
required by this Agreement and shall execute appropriate documents to assign to City
the copyright to Reports created pursuant to this Agreement. Any Report, information
and data acquired or required by this Agreement shall become the property of City, and
all publication rights are reserved to City. Consultant may retain a copy of any report
furnished to the City pursuant to this Agreement.
B. All Reports prepared by Consultant may be used by City in execution or
implementation of:
(1) The original Project for which Consultant was hired;
(2) Completion of the original Project by others;
(3) Subsequent additions to the original project; and /or
(4) Other City projects as appropriate.
C. Consultant shall, at such time and in such form as City may require,
furnish reports concerning the status of services required under this Agreement.
D. All Reports required to be provided by this Agreement shall be printed
on recycled paper. All Reports shall be copied on both sides of the paper except for one
original, which shall be single sided.
E. No Report, information or other data given to or prepared or assembled
by Consultant pursuant to this Agreement shall be made available to any individual or
organization by Consultant without prior approval by City.
7. RECORDS:
Consultant shall maintain complete and accurate records with respect to sales,
costs, expenses, receipts and other such information required by City that relate to the
performance of services under this Agreement.
Consultant shall maintain adequate records of services provided in sufficient
detail to permit an evaluation of services. All such records shall be maintained in
accordance with generally accepted accounting principles and shall be clearly identified
and readily accessible. Consultant shall provide free access to such books and records to
the representatives of City or its designees at all proper times, and gives City the right to
examine and audit same, and to make transcripts there from as necessary, and to allow
inspection of all work, data, documents, proceedings and activities related to this
Agreement. Such records, together with supporting documents, shall be kept separate
from other documents and records and shall be maintained for a period of three (3)
years after receipt of final payment.
If supplemental examination or audit of the records is necessary due to concerns
raised by City's preliminary examination or audit of records, and the City's
supplemental examination or audit of the records discloses a failure to adhere to
appropriate internal financial controls, or other breach of contract or failure to act in
good faith, then Consultant shall reimburse City for all reasonable costs and expenses
associated with the supplemental examination or audit.
8. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement
shall be given in writing and conclusively shall be deemed served when delivered
personally or on the second business day after the deposit thereof in the United States
Mail, postage prepaid, registered or certified, addressed as hereinafter provided.
All notices, demands, requests, or approvals from Consultant to City shall be
addressed to City at:
City of Cupertino
10300 Torre Ave.
Cupertino CA 95014
Attention: Mariyah Serratos
All notices, demands, requests, or approvals from City to Consultant shall be
addressed to Consultant at:
Kim Marie Smith Consulting
1421 Millich Court
San Jose, CA 95117
9. TERMINATION:
In the event Consultant fails or refuses to perform any of the provisions hereof at
the time and in the manner required hereunder, Consultant shall be deemed in default
in the performance of this Agreement. If such default is not cured within the time
specified after receipt by Consultant from City of written notice of default, specifying
the nature of such default and the steps necessary to cure such default, City may
terminate the Agreement forthwith by giving to the Consultant written notice thereof.
City shall have the option, at its sole discretion and without cause, of terminating
this Agreement by giving seven (7) days' prior written notice to Consultant as provided
herein. Upon termination of this Agreemeni, each party shall pay to the other party that
portion of compensation specified in this Agreement that is earned and unpaid prior to
the effective date of termination.
10. COMPLIANCES:
Consultant shall comply with all state or federal laws and all ordinances, rules
and regulations enacted or issued by City.
11. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State
of California excepting any choice of law rules which may direct the application of laws
of another jurisdiction. The Agreement and obligations of the parties are subject to all
valid laws, orders, rules, and regulations of the authorities having jurisdiction over this
Agreement (or the successors of those authorities.)
Any suits brought pursuant to this Agreement shall be filed with the courts of
the County of Santa Clara, State of California.
12. ADVERTISEMENT:
Consultant shall not post, exhibit, display or allow to be posted, exhibited,
displayed any signs, advertising, show bills, lithographs, posters or cards of any kind
pertaining to the services performed under this Agreement unless prior written
approval has been secured from City to do otherwise.
13. WAIVER:
A waiver by City of any breach of any term, covenant, or condition contained
herein shall not be deemed to be a waiver of any subsequent breach of the same or any
other term, covenant, or condition contained herein, whether of the same or a different
character.
22. INTEGRATED CONTRACT:
This Agreement represents the full and complete understanding of every kind or
nature whatsoever between the parties hereto, and all preliminary negotiations and
agreements of whatsoever kind or nature are merged herein. No verbal agreement or
implied covenant shall be held to vary the provisions hereof. Any modification of this
Agreement will be effective only by written execution signed by both City and
Consultant.
14. INSERTED PROVISIONS:
Each provision and clause required by law to be inserted into the Agreement
shall be deemed to be enacted herein, and the Agreement shall be read and enforced as
though each were included herein. If through mistake or otherwise, any such provision
is not inserted or is not correctly inserted, the Agreement shall be amended to make
such insertion on application by either party.
15. CAPTIONS:
The captions in this Agreement are for convenience only, are not a part of the
Agreement and in no way affect, limit or amplify the terms or provisions of this
Agreement.
IN WITNESS WHEREOF, the parties have caused the Agreement to be executed.
CONSULTANT
Kim Marie Smith, Consultant
Date 61&11,5
CITY OF CUPERTINO
A Municipal Corporation
Carol A. Atwood, Director of
Administrative Services
Date ?-7- /-3
APPROVED AS TO FORM:
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Date V f �2 —13
EXHIBIT A
SCOPE OF SERVICES
CONSULTANT will provide assistance to various departments in the City of Cupertino.
These services include, but are not limited to, the following items:
Information Technology Department
For City Council, Planning Commission and staff, as needed
• Help Desk services for Apple devices; including trouble- shooting and software
installation and /or updating.
• Wad and Whone training and customization, including assistance with setting up
email accounts
• In- person support and /or training will take place at city -owned facilities during
regular business hours.
• Telephone consultation is available from 9 a.m. to 9 p.m., 7 days a week, by
calling (408) 202 -4912. CONSULTANT reserves the right to refer users to Apple's
technical support team if the matter cannot be resolved during a 30- minute
telephone consultation.
City of Cupertino Senior Center
Teach Wad Advanced courses for adults 50 plus at the Cupertino Senior Center,
21251 Stevens Creek Boulevard, Cupertino, 95014. Compensation: 80% of each
registered student for Wad Advanced at the Cupertino Senior Center with a
minimum of four students. A $25 Annual Administration Fee will be deducted
from the first payment.
EXHIBIT B
SCHEDULE OF PERFORMANCE
A. Services
Task /Service
Wad Training, Advanced
Cupertino Senior Center
Wad training for staff,
Council & Commissioners
when assigned a device
Help desk services for Apple
devices, via phone or
at city hall
Amount of time
16 hours
Timeframe or Dates
July -Dec, 2013
2 hours per person as needed June -Dec, 2013
estimate 6 hours total
15 mins to 2 hours per session June -Dec, 2013
as needed, estimate 30 hours total
EXHIBIT C
COMPENSATION
City shall compensate Consultant for professional services described in this Agreement
in accordance with the terms and conditions of this Agreement based on the rates and
compensation schedule set forth below. Compensation shall be calculated based on the
hourly rates set forth below up to the not to exceed budget amount set forth below.
The compensation and reimbursable expenses to be paid to Consultant under this
Agreement for all services described in Exhibit "A" by City and shall not exceed ten
thousand dollars ($10,000.00). Any work performed or expenses incurred for which
payment would result in a total exceeding the maximum amount of compensation set
forth herein shall be at no cost to the City.
Hourly Rates
$90.00 per hour
Invoices
In order to request payment, Consultant shall submit monthly invoices to the CITY
describing the services performed and the applicable charges to each entity (including,
where applicable an identification of personnel who performed the services, hours
worked, task(s) for which work was performed, hourly rates, and reimbursable
expenses), based upon Consultant's billing; rate and reflecting an equal split of
Consultant's charges between City.
Reimbursable Expenses
Administrative, overhead, secretarial time or overtime, word processing, photocopying,
in house printing, insurance and other ordinary business expenses are included within
the scope of payment for services and are not reimbursable expenses. City shall
reimburse consultant for reasonable travel. Travel expenses are limited to the lesser of
actual expenses or expenses that would be authorized for City employee travel pursuant
to City policy, whichever is lower.
Additional Services
Consultant shall provide additional services outside of the services identified in Exhibit
A only by advance written authorization from the City prior to commencement of any
additional services. Consultant shall submit, at the Project Manager's request, a detailed
written proposal including a description of the scope of additional services, schedule,
and proposed maximum compensation.
USAA CASUALTY INSURANCE COMPANY ADDL INFO ON NEXT PAGE MAIL MCH -M -I
AMENDMENT TO
1 (A Stock Insurance Company) State 105 i ven I POLICY NUMBER
USAW 9800 Fredericksburg Road - San Antonio, Texas 78288 5 i�C�Er 00219 67 71C 7101 f
CALIFORNIA AUTO POLICY POLICY PERIOD: (12:01 A.M. standard time)
AMENDED DECLARATIONS EFFECTIVE MAY 08 2012 TO OCT 17 2012
ns
KIM M SMITH
1421 MILLICH CT
SAN JOSE CA 95117 -3629
escri tion of Vehicle(s)
H YEAR TRADE NAME I MODEL BODY TYPE
51051 MINI ICOOPER S 1HCHBK 2D
01 KIM M SMITH
fILEAGE I IDENTIFICATION NUMBER
8000 1 WMWRE33415TD94140
/EH USE" WORK/SCH(
Miles Da,
SYM ane I Pe
av We
it
e Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. r W/C= Wak/School; B =Business; F= Farm;P =Pleasure
EH 05 SAN JOSE CA 95117 -3629
Is po Icy prove es those coverages where a premium Is shown below. a limits shown
meX be reduced by policy provisions and may not be combined regardless of the number of
vehicles for which a premium is listed unless specifically authorized elsewhere in this po licy.
COVERAGES LIMITS OF LIABILITY VEH VEH VEH VEH
05 6 -MONTH
( "ACV" MEANS ACTUAL CASH VALUE) D =DED I PREMIUM %DED PREMIUM D=DED PREMIUM D=DED PREMIUM
AMOUNT $ OUNTI $ MOUNTI $ MOUNTI $
ART A - LIABILITY
BODILY INJURY EA PER
$ 300,000
EA ACC
$ 500,000
83.72
PROPERTY DAMAGE EA ACC
$ 100,000
46.50
kRT B - MEDICAL PAYMENTS
EA PER
$ 10,000
7.35
EXTENDED BENEFITS
WAGE EARNER DISAB $1,000
PER 30-DAY
PERIOD
ESSENTIAL SVCS DISAB
$45 WK
4.37
i,RT C - UNINSURED MOTORISTS
BODILY INJURY EA PER
$ 300,000
EA ACC
$ 500,000
42.36
WAIVER OF COLL DEDUCTIBLE
4.22
kRT D - PHYSICAL DAMAGE
COVERAGE
COMPREHENSIVE LOSS
ACV LESS
D 300
35.49
COLLISION LOSS
ACV LESS
D 300
141.66
=HICLE TOTAL PREMIUM 1 1 365.67
----------------------- - - - - -- ADJUSTMENT REASON --------------------------------
�RT A - 61 L I A B LIMIT CHANGED VEH 05 PART B - MED PAY LIMIT CHANGED VEH
TOTAL PREMIUM - SEE FOLLOWING PAGE(S)
JDORSEMENTS: ADDED 05 -08 -12 - NONE
_MAIN IN EFFECT(REFER TO PREVIOUS POLICY)- A400CA(03) 5100CA(01) A100CA(05)
AOASA(01) A099(01)
1 WI I NESS WHEHtUI -, we have caused this policy to be signed by our Hresldent and Secretary at San Antonio, Texas,
on this date MAY 7, 2012
loo c 5tevi:n Alan Bennett, Secretary Stuart Parker, President
W% USAA CASUALTY INSURANCE COMPANY
(A Stock Insurance Company) State
USAA® 9800 Fredericksburg Road - San Antonio, Texas 78288
CALIFORNIA AUTO POLICY ELI
AMENDED DECLARATIONS
amed Insured and Address
KIM M SMITH
1421 MILLICH CT
SAN JOSE CA 95117 -3629
ascription of Vehicle(s)
H IYEARI TRADE NAME I MODEL BODY TYPE
Van I POLICY NUMBER
f —lx r 00219 67 71C 7101 E
((12:01 A.M. standard time)
MAY OB 2012 TO OCT 17 2012
VEH USE WORK /SCH(
Miles Da,
IDENTIFICATION NUMBER SYM key I wE
Y
Thi s ppo icy provides those coverages where a premium is shown below. a limits shown
may be reduced by policy provisions and may _not be combined regardless of the number of
vehicles for which a premium is Ilstea unless
SPOCITICE111Y aumonzeu e(sewnere
in tniu Liu
IU .
COVERAGES LIMITS OF LIABILITY
VEH
VEH
VEH
VEH
( "ACV" MEANS ACTUAL CASH VALUE)
D =DED PREMIUM
D =DED PREMIUM
D =DED PREMIUM
D =DED PREMIUM
AMOUNT $
AMOUNT $
AMOUNY $
AMOUNTI $
1 -
'
PD LIAB
I-IMI1
CHANGED
VEH
05
ART D - COMPREHENSIVE LOSS CHANGED
VEH
05
kRT D - COLL LOSS LIMIT CHANGED VEH
05
REVISED 6 MONTH PREMIUM
...$
365.67
6 MONTH
IN
REA
E...$
16.8
IE FOLLOWING COVERAGE(S) DEFINED IN
TH13
POLICY
ARE
NOT P
OVIDE
FOR:
VEH 05 - RENTAL REIMBURSEMENT, T
WING
AND LAB
DR
i WITNESS WHEREOF, we have caused this policy to be signed by our �Benned, rresloentand Secretary at San Antonio, I exas,
on this date MAY 7, 201�loo C 07-1 t teven Alan Secretary Stuart Parker, President
383 -07 -1 1
use® SUPPLEMENTAL DECLARATIONS cic 00219 67 71 7101
EFFECTIVE MAY 08 2012 TO OCT 17 2012
We have applied these driver /vehicle discounts or increases to the policy premium listed on your
Declarations page. The amounts listed are approximations.
NOTE: Age or senior citizen status, if allowed by your state, was taken into consideration when your
rates were set and your premiums have already been adjusted.
VEHICLE 05
ANNUAL MILEAGE DISCOUNT -$ 28.43
GOOD DRIVER DISCOUNT -$ 91.41
OPERATOR 01
MULTI - POLICY DISCOUNT -$ 55.66
HOME, ALL OTHER PROPERTY AND CASUALTY LINES
PASSIVE RESTRAINT DISCOUNT -$ 1.45
PERSISTENCY DISCOUNT -$ 55.66
PREMIER OPERATOR DISCOUNT -$ 45.34
SUPDEC Rev. 1-04 MAY 7, 2012
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1 fi a.n't w. t to tkr ar f Ns or hw Woo mpreawdom on W* GTf st1 q�aLePS!34a ,ae un [a [ YarsT ;i
1 a Ps ^.en � Cr�crn s C'�a!e, s =.>�ard b aB tarrm3 5"+.f fi4rv,88i�S DI �e Wa'4ky bntl 9 4'�-' ++hr� - � "n9 t:+a�tr �aae !1
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_ ,n_ pvecr rer as t .:rCFisC:rtsC.fl nag bee,,, maaa or *moo 00,vtne tetd* oft ceder is caneeled n accordance cunt" P= Ilry c +Qv,s<ur:%
P ,,, ;xr�.:,t R 106 SSat.?: r srl "nr Me aO*Waeda fxowg*d try V4 6ax1Mr we be tv No alsnual Gt tum
aco :r;.3'arr, ran :;s!(en msua, axui ,v +u to ,:e rrate[i k;,r the lea[�jda sad' aqb d8 praui0'ed u[�i 3h +s t3rnUar:
7�ora, a m s a „s[rr reptaea� ca rereya ir3 oidteT Pokcve8 tcx!A?ffcGnq Ad 1216cCrt
] Qard T m4J in s e s cA�# uAie of ih g?3'tru5er, Mm f n![ bIt ct ClErt.112 Famd Secs!
.....�. , S' .,.lai 3 . �r.^,ei sirsttga i of 12 r71 am, ;FandSfd Time San.tcya�,CA�.f?91 $
a cecy of m4 6tr:+der ad a comoiofrA OVOWWOm w INS CaT[I,amf On me day ts uw-
2