16-133 CSG Consultants, Inc., On-Call Plan Review Services a� �� � —��
AGREEMENT BETWEEN THE CITY OF CUPERTINO AND CSG
CONSULTANTS, INC FOR"ON-CALL" PLAN REVIEW SERVICES
THIS AGREEMENT, is entered into this 1 st day of July, 2016, by and between the
CITY OF CUPERTINO, a California municipal corporation ("City"), and CSG
Consultants, Inc, a California Corporation whose address is 550 Pilgrim Drive,Foster City,
California 94404, (hereinafter referred to as "Consultant") (collectively referred to as the
"Parties").
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.
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 "on-call" plan
review upon the terms and conditions herein.
NOW, THEREFORE, the Parties mutually agree as follows:
1. TERM
The term of this Agreement shall commence on July 1, 2016, and shall tei•minate
on June 30, 2017, unless terminated earlier as set forth herein.
2. SERVICES TO BE PERFORMED
Consultant shall perform each and eveiy service set forth in Exhibit "A," attached
hereto and incorporated herein by this reference.
3. COMPENSATION TO CONSULTANT
Consultant shall be compensated for services performed pursuant to this Agreement
in a total amount not to exceed FORTY TWO THOUSAND FIVE HUNDRED dollars
($42,500.00) based on the rates and terms set forth in Exhibit "A," which is attached hereto
and incorporated herein by this reference.
4. TIME IS OF THE ESSENCE
Consultant and City agree that time is of the essence regarding the performance of
this Agreement. Standard plan checks for commercial and residential project shall be
completed in ten (10) business days. Due dates for plan checks for larger projects shall be
detetmined by a pre-submittal conference with the Building Official, plan checker, project
engineers and engineers.
5. STANDARD OF CARE
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Consultant contract- CSG Consultinq, Inc, "on-call" Plan Revieia, FY 16-17
Consultant agrees to perform all services required by this Agreement in a manner
commensurate with the prevailing standards of like professionals in the San Francisco Bay
Area and agrees that all services shall be perfoimed by qualified and experienced personnel
who are not employed by the City nor have any contractual relationship with City.
6. INDEPENDENT PARTIES
City and Consultant intend that the relationship between them created by this
Agreement is that of 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.
7. IMMIGRATION REFORM AND CONTROL ACT (IRCA)
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 fi�om and against any loss, damage, liability, costs
oi•expenses arising from any noncompliance of this provision by Consultant.
8. NON-DISCRIMINATION
Consistent with City's policy prohibiting harassment and discrimination,
Consultant agrees that it shall not harass or discriminate against a job applicant, a City
employee,or a citizen by Consultant or Consultant's employee or subcontractor on the basis
of t•ace, religious creed, color,national origin, anceshy, handicap,disability, marital status,
pregnancy, sex, age, sexual orientation, or any other protected class. Consultant agrees that
any and all violations of this provision shall constitute a material breach of this Agreement.
9. HOLD HARMLESS
0 Standard Indemnification:
Consultant shall, to the fullest extent allowed by law and without limitation of the
provisions of this Agreement related to insurance,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 injuiy 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 negligent perfotmance 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. The acceptance of the Services by City shall not operate
as a waiver of the right of indemnification. The pi•ovisions of this Section survive the
Page 2 of I 1
� Cor.sulcan� contract- CSG Consultinq, Inc, "on-ca1_1" Plan Review, FY 16-17
completion of the Services or termination of this Contt•act.
10. INSURANCE:
A. General Requirements. 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 the requirements listed in Exhibit "D". Such certificates, which do not
limit Consultant's indemnification,shall also contain substantially the following statement:
"Should any of the above insui•ance 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." 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.
B. Subro�ation Waiver. Consultant agrees that in the event of loss due to any
of the perils for which he/she has agreed to pt•ovide 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 genei•al
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 insui•er of said
Consultant may acquire against City by virtue of the payment of any loss under such
insurance.
C. Failure to secure or maintain insurance. 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 fi•om 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 coverages, 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
thereo£ 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.
F. Maximum Covera�e and Limits. It shall be a requirement under this
Agreement that any available insurance proceeds broader than or in excess of the specified
minimum Insurance coverage reqliirements and/or limits shall be available to the additional
insured City. Furthermore, the requirements for coverage and limits shall be the minimum
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Consultant contract- CSG Consulting, Inc, "on-ca11" Pian Review, FY 16-17
coverage and limits specified in this Agreement, or the broader coverage and maximum
limits of coverage of any insurance policy or proceeds available to the named insured,
whichever is greater.
11. CONFLICT OF INTEREST
Consultant warrants that it presently has no interest, and will not acquire any
interest, direct or indirect, financial or otherwise, that would conflict in any way with the
performance of this Agreement, and that it will not employ any person having such an
interest. Consultant agrees to advise City immediately if any conflict arises and understands
that it 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.
12. 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, sublessee, 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
venturer or syndicate member or cotenant, if Consultant is a partnership or joint venture or
syndicate or cotenancy, 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.
13. SUBCONTRACTOR APPROVAL
Unless prior written consent from City is obtained, only those people and
subconh�actois 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' campensation insurance and shall also be required to
carry general, automobile and pi•ofessional 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.
Consultant agrees to include with all subcontractors in their subcontract the same
requirements and provisions of this Agreement including the indemnity and insurance
requirements to the extent they apply to the scope of the subcontractor's work.
Subcontractors hired by Consultant agree to be bound to Consultant and City in the same
manner and to the same extent as Consultant is bound to City under this Agreement.
Subcontractor further agrees to include these same provisions with any sub-subcontractor.
A copy of the Owner Contract Document Indemnity and Insurance provisions will be
furnished to the subcontractor upon request. Consultant shall require all subcontractors to
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Consultant contract- CSG Consultinq, Inc, "on-call" Plan Revie�d, FY 16-17
provide a valid certificate of insurance and the required endorsements included in the
agreement prior to commencement of any work and will provide proof of compliance to
City.
14. 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.
15. 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 City deems 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.
16. RECORDS
Consultant shall maintain complete and accurate records with respect to sales,costs,
expenses, receipts and other such infot•mation required by City that relate to the
performance of services under this Agreement, 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 therefrom 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 Consultant receives final payment from
City for all services required under this agreement.
If supplemental examination or audit of the records is necessary due to concerns
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Consultant contract- CSG Consulcinq, Inc, "on-call" Plan Review, FY 1'0-17
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.
17. NONAPPROPRIATION
This Agreement is subject to the fiscal provisions ofthe Cupertino Municipal Code
and Agreement will terminate without any penalty (a) at the end of any fiscal year in the
event that funds are not appropriated for the following fiscal year, or(b) at any time within
a fiscal year in the event that funds are only appropriated for a portion of the fiscal year
and funds for this Agreement are no longer available. This Section shall take precedence
in the event of a conflict with any other covenant, term, condition, or provision of this
Agreement.
18. ENVIRONMENTALLY PREFERABLE PURCHASING
Consultant shall comply with the City's Environmentally Preferable Procurement
Policy whenever practicable in completing any work under this agreement, including but
not limited to:
• Using paper products made with recycled content and recycled/t•emanufactured
toner and ink jet cartridges;
• Printing with soy or low volatile organic cotnpounds (VOC) inks;
• Using energy-star compliant equipment;
� Using cleansers and working with janitorial contractoi•s to meet Green Seal's
Industrial and Institutional Cleaners Standard; and
• Ordering supplies electronically and practicing other internal waste reduction
and reuse protocols.
19. 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 shall be addressed as follows:
TO CITY:
City of Cupertino
10300 Torre Ave.
Cupertino CA 95014
Attention: Albert Salvador, Building Official
TO CONSULTANT:
CSG Consulting, Inc
550 Pilgrim Drive
Foster City, CA 94404
Cyrus Kianpour, Principal
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Consultant contract- CSG Consultinq, Inc, 'bn-call" Plan Revie�i, FY 16-17
20. 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 Consultant fails to cure the default within the time
specified and according to the requirements set forth in City's written notice of default, and
in addition to any other remedy available to the City by law, the City Manager may
terminate the Agreement by giving Consultant written notice thereof, which shall be
effective immediately. The City Manager shall also have the option, at its sole discretion
and without cause, of terminating this Agreement by giving seven (7) calendar days'prior
written notice to Consultant as provided herein. Upon receipt of any notice of termination,
Consultant shall immediately discontinue performance.
City shall pay Consultant for services satisfactorily performed up to the effective
date of termination. If the termination is for cause, City may deduct from such payment the
amount of actual damage, if any, sustained by City due to Consultant's failure to perform
its material obligations under this Agreement. Upon termination, Consultant shall
immediately deliver to the City any and all copies of studies, sketches, drawings,
computations, and other material or products, whether or not completed, prepared by
Consultant or given to Consultant, in connection with this Agreement. Such materials shall
become the property of City.
21. COMPLIANCE
Consultant shall comply with all state or federal laws and all ordinances, rules,
policies and regulations enacted or issued by City.
22. 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 Superior Court of the County of Santa Clara, State of
California.
23. 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.
24. 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.
25. INTEGRATED CONTRACT
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Consultant contract- CSG Consultinq, Inc, "on-call" Plan Review, FY 1'0-17
�
i
This Agreement represents the full and complete understanding of every kind or
nature whatsoever between the Pat-ties, 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.
26. AUTHORITY
The individual(s) executing this Agreement represent and warrant that they have
the legal capacity and authority to do so on behalf of their respective legal entities.
27. 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.
28. CAPTIONS AND TERMS
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.
All unchecked boxes do not apply to this Agreement.
IN WITNESS WHEREOF, the parties have caused the Agreement to be executed.
CONSULTANT CITY OF CUPERTINO
CSG Consultan , Inc A Municipal Corporation
By By 1��,���1" S��� ����--
Title Title ��IU�JLO1 !S � t C�1(� �,
Date 9-14• Date �l( I ��1 (�
❑Over$175,000-Council Approval Required
❑Over$45,000-Department Head Approval Required
��Up to$4�,000-Designated Supervisor Approval Required
APROVED AS TO FORM: RECOMMENDED FOR APPROVAL
�
.�l i/�" `��/,�,�l�/0���
�Q�d' City Attorney A�bert Salvador, Building Official
ATTEST:
a--�
��.����� � �
Cit Clerk
y c �,p� /(�
l�
Page 8 of 11
Consultant contrzct- CSG Consultinq, ir.c, "on-call" P1an Re-view, FY 16-17
Exhibits: (Check box for exhibits that apply to this contract and attach)
❑X Exhibit"A"- Scope of Services
❑ Exhibit`B"- Schedule of Performance
❑ Exhibit"C"- Compensation
0 Exhibit"D"- Insut•ance Requirements and Proof of Insurance
❑ Exhibit"E"- Mandated Reporting Acknowledgement
❑ Exhibit"F"- Background/Fingerprint/TB Declaration
❑ Exhibit"G"-Nondiscrimination- State/Federal/HUD funded project
❑ Exhibit"H"—Request for City Manager to Waive Informal Bidding Requirements
EXPENDITURE DISTRIBUTION
ACCOUNT NUMBER AMOUNT
I PO #2017-260 I
I100-73-714 700-702 I $42,500.00 I
TotaL• I $42,500.00
Page 9 of 11
Consultant contract- CSG Consultinq, Inc, "on-call" Plan Review, FY 16-17
Exhibit A
Scope of Services and Compensation
I. Scope of Services: Consultant shall provide plan review services as requested by
the City of Cupei-tino.
II. Compensation:
City shall compensate Consultant for professional services 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 to be paid to Consultant under this Agreement for all services described
under Section 1 of this Exhibit shall not exceed FORTY TWO THOUSAND, FIVE
HUNDRED DOLLARS ($42,500.00). 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.
III. Rates:
- 1 St and 2"d plan checks included in the initial plan check fee will be 65% of the
agency fee
- Additional plan reviews, revisions, deferred item submittal #3 or more, $125
per hour, 2 hour minimum
N. Invoices
In order to request payment, Consultant shall submit monthly invoices to the CITY
describing the services performed and the applicable charges (including a summary of
work performed during that quarter, personnel who performed the services, hours worked,
task(s) for which work was performed).
V. Reimbursable Expenses
Normal project related reimbursable expenses such as printing, postage, delivery
service, long distance phone calls, facsimile transmissions, mileage, and special
project-related supplies.
VI. Additional Services
Consultant shall provide additional services outside of"on-call" plan review as requested
by the Building Division only by advance written authorization from the City's Building
Official 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.
10
Exhibit D
Insurance Requirements and Proof of Insurance
Proof of insurance coverage described below is attached to this Exhibit, with City named
as additional insured.
Consultant shall maintain the following minimum insurance coverage:
A. COVERAGE:
(1) Workers' Compensation:
Statutory coverage as required by the State of California.
(2) Liabilitv:
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 i•equired
minimum limits shown above.
(3) Automotive:
� Comprehensive automotive liability coverage in the following minimum limits:
Bodily Injury: $500,000 each occun�ence
Property Damage: $100,000 each occurrence
or
Coinbined Single Limit: $500,000 each occurrence
0 (4) Professional Liabilitv
Professional liability insurance which includes coverage far the professional acts,
errors and omissions of Consultant in the amount of at least$1,000,000.
11
i
ACORO� I DATE(MM/DD/YYW)
�� CERTIFICATE OF LIABILITY INSURANCE g/13/2016
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 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 ICONTACT
NAME:
Arthur J. Gallagher&Co. I PHONE Fa,x
Insurance Brokers of CA, Inc. LIC#0726293 �o�� N�.Frt,•415-536-8617 I�arc.n,���415-536-8627
E-MAIL
1255 Battery Street, Suite 450 I ADDRESS�
San Francisco CA 94111 � INSURER(S)AFFORDING COVERAGE NAIC#
� wsuReRa:Arch Insurance Company 11150
INSURED CSGCONS-01 I INSURERB:AfII@flCafl FI�@ 2f1C� C8SU8ItY COIllp2ll�/ 24066
CSG Consultants, Inc. � iNsuReRc:CYPRESS INS CO 10855
550 Pilgrim Drive
Foster City, CA 94404 I INSURER D:
I INSURER E:
IINSURER F: I
COVERAGES CERTIFICATE NUMBER:672951040 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 7ypE OP INSURANCE Auu�'autsrt' ' POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MMIDD/YYYYI IMM/DD/YYYYI
B X COMMERCIAL GENERAL LIABILITY Y Y BKA1656382766 12/4/2015 12/4/2016 EACH OCCURRENCE I 51,000,000 I
� CLAIMS-MADE �X OCCUR I PREM SES Ea occurzencel I 5500,000 I
_ I MED EXP(Any one person) I 55,000 I
_ I PERSONAL&ADVINJURY I$1,000,000 �
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE IS2,000,000
� POLICY❑ PR� � LOC PRODUCTS-COMP/OPAGG 52,000,000
JECT
OTHER: S I
B AUTOMOBILE LIABILITY Y Y gqq�656382766 12/4/2015 12/4/2016 COM8INED SINGLE LIMIT I 5 �
(Ea accident) 1,000,000
X ANY AUTO BODILY INJURY(Per person) I$ �
ALL OWNED SCHEDULED I BODILY INJURY(Per accident)I 5
AUTOS AUTOS
HIREDAUTOS NON-OWNED I PROPERTYDAMAGE I S I
AUTOS (Per accident)
S I
B X UMBRELLA LIAB X OCCUR USA1656382766 12/4/2015 12/4/2016 EACH OCCURRENCE 55,000,000
� EXCESS LIAB CLAIMS-MADE I AGGREGATE 55,000,000 ,
DED I I RETENTION 5 I S �
C WORKERS COMPENSATION CSWC607956 12/4/2015 12/4/2016 I y` I STATUTE I I�ERH I
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ I E.L EACH ACCIDENT I 5"I,000,000 I
OFFICER/MEMBER EXCLUDED? N N I A
(Mandatory in NH) I E.L.DISEASE-EA EMPLOYEd 51,000,000 I
If yes,describe under
DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I 51,000,000 I
A Professional Liability PAAEP0008800 12/4/2015 12/4/2016 Each Claim $4,000,000
retro date: 1/1/1991 Aggregate $4,000,000
Deductible: $50,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
re: Agreement for On-Call Plan Review Services entered 7/1/16. City of Cupertino, its City Council, boards and commissions, officers,
employees and volunteers are included as additional insureds on GL&Auto with Waiver of Subrogation and 30 Day Notice of Cancellation
per attached. 30 Day Notice of Cancellation on Professional per attached. Additional Insured status and 30 Day Notice of Cancellation on
WC is not available.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10300 Torre Avene ACCORDANCE WITH THE POLICY PROVISIONS.
Cupertino CA 95014
U SA AUTHORIZED REPRESENTATIVE
� � ����
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LfABlLITY
Policy#: BKA1656382766 CG 88 10 4413
TFiIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ !T CARE�ULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
This endorsement modifies insurance provided under the folfowing;
COMMERCIAL GENERAt LIABiUTY COVERAGE PART
INDEX
SUBJECT PAGE
N�N-OWNED AIaCRAFT �
NON-OWNED WATERCRA�T 2
PROPERTY DAMAGE LIABIUTY-ELEVATORS 2
EXTENDED DAMAGE TO PRQPERTY REIVTED TO YOU (Tenant's Property Damage) 2
MEDICAL PAYMENTS EXTENSION 3
EXTENSION OF SUPPLEMENTARY PAYMENTS-COVERAGES A AND B 3
ADDITIONAL INSUREDS-BY CONTRACT,AGREEMENT OR PERMIT 3
PRIMARY AND NON-CONTRI8UTQRY-AD�ITIONAL INSURED EXT�NSlQN 5
AiIDITIONAL INSUREDS-EXTENDED PROTECTION OF YOUR "LlMITS OF INSURANCE" 6
WHO IS AN INSURED-INCIDENTAL MEQICAL ERRORSlMALPRACTICE AND WHO IS AI�
INSURED-FELLOW EMPLOYEE EXTENSION-MANAGEMENT EMPLOYEES 6
NEWLY FORMED OR ADDITEONALLY ACQUIRED ENTITIES 7
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7
KNC�WLEDGE OF OCCURRElVCE,�FFENSE,CLAIM OR SUI'f 7
LIBERALIZATION CLQUSE 7
BODILY INJURY REDEFINED 7
EXTENDED PRQPERTY DAMAGE 8
WAIVER OF TRANSFER 0�RIGIiTS OF RECOVERY AGAINST OTHERS TO US- 8
WHEN REaUIRED IN A CONTRACT QR AGREEMENT WITH YOU
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CG 88 10 04 13 Includes copyrighted rnaterial of Insurance Services Office,lnc.,with its permission. Page 1 nf 8
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modifi�d by
the endorsement.
A. NON-OWNED AIRGRAFT
Under f'aragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property �amage L.iability,
exclusion g.Aircraft,Auto Or Watercraf#does not apply to an aircraft provided:
1. It is not owned by any insured;
2. It is hired,chartered or loaned with a trained paid crew;
3. The pilot in command hoids a currently effecti�e certifi�ate, issued by the duly canstituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons ar property for a charge.
However, the insurance afforded by this provision does not apply if there is available to the insured other
valicf and collectible insurance, whether primary, excess {other than insurance written to appfy specifically
in excess of this policy), contingent or on any other basis, that would also appfy to the loss c�vered under
this provision.
B. NQN-0WNED WATERCRAF7
Under Paragraph 2. Exclusions of Section I-Coverage A-Bodily InjuryAnd Property Damage L�a6ility,
Subparagraph (Z}of exclusion g.Aircraft,Au#o Dr Watercraft is replaced by the#vllowing:
This exclusion does nat apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b� Not being used to carry persons ar property for a charge.
C. PROF'ERTY RAMAGE LlABILITY-ELEVATORS
1. Under Paragraph 2, Exclusions af Sectian E - Coverage A - Bodily Injury And Praperty Damage Liabel-
ity, Subparagraphs (3), (4j and {6) of excfusion j. Damage To Property do not apply if such "property
damage" results from the use of elevators. For the purpose of this provision, elevators do not include
vehicle lifts.Vehicle fifts are lifts or hoists used in automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditio�s, Canditian 4. Other
InsuranGe,Paragraph b. Excess Insurance:
The insurance afforded by this provision af ihis enciorsement is excess over any property insurance,
whether primary,excess,contingent or on any other basis.
D. EX7'ENDEQ DAMAGE TO PRQPERTY RENTED TO YOU {Tenant's Property Damage}
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2. Exclusions of Section I-Coverage A- Bodily Injury and Property Damage Liability:
a. The fourth from the last paragraph of exclusian j. Damage To Property is replaced by the follow-
ing:
Paragraphs (7), (3) and (4} of this exclusion do not ap�ly to "property dam�ge" (ather than damage
by fire, lightning,explosion,smoke, or leakage from an automatic fire protection systern)to;
{i) Premises rented to you for a period of 7 or fewer consecutive days; or
{ii} Contents that you rent or lease as part of a premises rental or Iease agreement for a period of
more than 7 days.
Paragraphs j1y, (3} and (4) ot this exclusion do not apply to "property damage" to contents of
premises renteci to you for a periocf of 7 ar fewer eonseeutive days.
A separate lirnit ot insurance applies to this coverage as describad in Section 111 - Limits af
Insurance.
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�G 88 10 Q4 '�3 Includes copyrighted material of Insurance Services dffice,Inc.,with its permission. Page 2 Of 8
b. The Igst paragraph of subsection 2. Exclusians is replaced by Ihe following:
Exclusions c. through n. do not apply to damage by fire, ligfitning, expiosion, smoke or leakage
from automatic fire protection systems to premises while rented to you ar temporarify occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described in Section fli-Limits Of Insu�ance.
2. Paragraph 6. under Section IH-Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we wil!
pay under Coverage A for damages because of"property damage"to:
a. Any one premise:
(1) While rented to you; or
(2) While rented to you or temporarily occupied by yau with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems; ar
b. Contents that you rent or lease as part of a premises rental or fease agreement.
3. As regards coverage provided by this provision D. EXTENQED DAMAGE TO PR�PERTY RENTED TO
YOU(7enant's Property Damage)-Paragraph 9.a.af Definitions is repiaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or tempvrarily
occupied by you with tf�e permission of the owner, or for damage to contents of such premises
that are included in yaur premises rentat or lease agreement, is not an "insured contract".
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not atherwise excluded, the Medical Payrnents provided by this policy
are amended as follows:
Under Paragra�h 1. lnsuring Agraement of 5ectian I -Coverage C-Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the#ollowing;
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS-COVERAGES A AND B
1. Under Supplementary Payments-Coverages A an�B, Paragraph 9.b. is replaced by the follawing:
b. Up to $3,OU0 for cost of bail bonds required because of accidents or traffic law violations arising
out af the use of any vehicle ta which the Bodily Injury Liability Coverage applies, We do not have
to furnish these bonds.
2. Paragraph 1,d. is replaced by the following:
d. A!f reasonable expenses incurred by the insured at aur request to assist us in the investigation or
defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time
off from work.
G. AQD1TiONAL INSUREDS- BY CONTRACT,AGREEMENT OR PERMfT
1. Paragraph 2. under Sectian 11 - Who Is An Ensured is amended to include as an insured any person or
organization whom you have agreed to add as an additional insured in a written contract, written
agreement or permit, Such per5on ar organ+zation is an additional insured but only with respect to
liability far "bodily injury", "property damage" or "personal and advertising injury" caused in whole
or in part by:
a. Your acts or omissions, or the acis or omissions of those acting on your behalf,in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided tf�at the "bodily injury" or "praperty damage" occurs, or the "per-
sonaf and advertising injury" is comrnitted, subsequent to the signing of such written contract or
written agreement; or
� 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted materiaf of Insurance Services Office,lnc.,w�m rcs perm�ss�o�,. Page 3 af 8
b. Premises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or
organizatian; or
d. Operations performed by you ar on your behaif for which the state or poliiical subdivision has
issued a permit subject to the following additiona! provisions:
f�J �his insurance does not apply to "bodily injury", "property damage", or "personal and ad-
vertising injury" arising out of the operations perfarmed for the state or political subdivision;
(2) This insurance does not apply to "bodily injury" or "property damage" included within the
. "completed operations hazard".
(3} Insurance applies to premises you own, rent, or cantrol but only with respect to the followin�
hazards.
(a) The existence, maintenance, repair, construction, erection, pr removal of advertising
signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marque�s,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) 7he construction,erection,or rernoval of elevators; or
(c) The ownership, maintenance,or use of any elevators covered by this insuranc2.
However.
1. The insurance afforded ta such additional insured only applies#o the extent permitted ay law; ar,d
2. if coverage provided to the additional insured is required by a contract or agreernent, the insut-
ance afforded to such additional insured will not be braader than that which you are required by
the contract or agreement to provide for such adciitional insured.
With respect to Paragraph 7.a. above, a person's ar organization's status as an additiona! i�surec�
under this endorsement ends when:
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project {other than service, maintenance or repairs)to be performed by or on behalf of th�
additional insured(s)at the location of the covered operations lias been completed; or
{2) That portion of "your work" out of which the injury or damage arises has been put to irs
intended use by any person or organization other thaiz 2nofher contractor or subcontractor
engaged in performing operations for a principal as a part of t�e same project,
With respect to Paragraph 1.b. above, a person's or organization's status as an additional insu�ed
under this endarsement ends when their written contract or written agreement with you for s�ch
premises or facifities ends.
With respects to Paragraph 1.c. above, this insurance does nQt appiy to any "occurrence" �rohich ±akes
place after the equipment rentaf or lease agreement has expire!: ar you have returr�ed such eGuipment
to the lessor,
The insurance provided by this endorsement apnlies only if the writien cantract ar writt�n agreemsnt
is signed prior to the "bodily injury" or"property damage".
We have no duty to defend an additio�al insured under this e�dorsement until we receive written
notice af a "suit" by the additional insured as required in Paragraph b. of Conditior� ?.. Dutias in the
E�ent Of Qccurrence, qffense, Claim Or Suit under Section !V- Gvrnmercial General Liabiiity �ondi-
tions.
� 7013 Libeny Mutuai Insurance
CG 88 10 04 '[3 Includes eopyrighted material oi Insurance Services Office,Inc.,with its permission. PBgB!b Uf$
2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section I�Coverage A-Badily Injury And Praperty�amage Liability:
This insurance does not apply to:
a. "Bodily injury" or "property damage" arising fram the sole negligence of the additianal insured.
b. "Badily injury" or "property damage" that occurs priar ta yau corrtmencing operations at the
location where such "bodily injury" ar "property damage" occurs.
c. "Badily injury", "property damage" or "personal and advertising injury" arising out of the render-
ing of, or the failure to render, any prafessional architectural, engineering or surveying services,
including:
(1� The preparing, approving, ar failing to prepare or approve, maps, shop drawings, opinions,
rep�rts, surveys,field orders,change arders ar drawings and specifications; ar
(2) Supervisory, inspection,architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in
the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur-
rence" which caused the "bodily injury" or "property damage", or the offense which caused the
"personal and advertising inJury", involved the rendering of, or the failure to render,any professional
architectural,engineering or surveying services.
d. "Bodily injury" or"property damage" occurring after:
{1} Alk work, including materials, parts or equipment furnished in connection with such work, on
the project{other than service, maintenance or repairs)to be performed by or on behalf ofthe
additional insured(s)at the location af the covered operations has been completed; or
(Z) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by a�y person or organization other than another contractor ar suhcontractor
engaged in performing operations for a principal as a part ofthe same project.
e. Any persan or organization specifically designated as an additional insured for on�oing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
sued by us and made a part o#this policy.
3. With respect to the insurance afforded to these additional insureds,the following is added to Section ill
-Limits Of Insurance:
If coverage provided to ihe additional insured is required by a contraci or agreement,the most we will
pay on behalf of the additional insured is the amaunt of insurance:
a. Required by the contract or agreement; or
b. Available under the applicable Limits of Insurance shown in the Decfarations;
whichever is less,
This endorsement shail not increase the appiicable Limits of Insurance shown in the Decfarations.
H. PRIMARY AND NOAi-CONTRIBUT�RY ADDITIpNAL INSURED EXTENSION
This provision applies to any person or arganization who qualifies as an additional insured under any form
or endarsement under this policy.
Conditian 4. Other Insurance of SECTION IV- COMMERCIAL GENERAL LtABILIT'Y COND{TIDNS is amend-
ed as follows:
a. The following is added to Paragraph a. Primary Insurance:
!f an additional insured's policy has an Other Insurance provision making its policy excess, and you
have agreed in a written contract or w�itten agreement to provide the additional ir►sured coverage or►a
primary and noncontributory basis, this policy shall be primary and we will not seek contribut�on from
the additional insured's policy for damages we cover.
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CG 88 14 04 13 Includes copyrighted material oi Insurance Services�(fice,Inc.,with its permission. Pdge 5 of$
b. The fo(lowing is added to Paragraph b.Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental contract or
agreement, an equipment ren#al or lease contract or agreement,or permit issued by a state or political
subdivision between you and an additional insured does nat require this insurance to be primary or
primary and non-cantributory, this insurance is excess over any other insurance for which the addi-
tional insured is designated as a Named Insured,
Regardless of the written agreement between you and an aclditiona! insured, this insurance is excess
over any other insurance whether primary, excess, contingent ar on any other basis for which the
additional insured has been adt�ed as an additional insured on other poli�ies.
I. ADDITIONAL INSUREDS-EXTENDED PROTECTION OF YQUR "LIMITS OF IIVSURAI�CE"
This pravisian applies to any person ar organization wt�o qualifies as an additional insured under any form
or endorsement under this policy.
1. The following is added to Condition 2. Dut+es In The Event Of�ccurrence,Offense,Ctaim or Suit:
An additional insured under this endorsement wilf as soan as practicable;
a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under
this insurance to us;
b. Tender the defense and indemnity of any claim or "suit" to all insurers whom aiso have
insurance available to the additional insured; and
c. Agree to make avaiiable any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
d. We have na duty to defend or indemnify an additionaf insured under this endorsement until
we receive written notice of a "suit" by the additional insured.
2. The limits of insurance applicabie ta the additional insured are ihose specified in a written contract
or written agreement or the limits of insurance as statecf in ihe Declarations of this policy and
defined in Section 111 - Limits of Insurance of this pfllicy, whichever are less, These limits are
inclu5ive of and not in addition to the limits of insurance available under this policy.
J. WHO IS AN INSURED-INClDENTAI MEDICAL ERRORS/MALPRACTICE
WHO IS AN iNSURED-FELLpW�MPLOYEE EXT�NSIQN-MANAGEMENT EMPLOYEES
Paragraph 2.a.(1j of Section II -Who!s An Insured is replaced with the folfowing:
(1) "godily injury" or "pe�sonal and advertising injury":
(a) To you,to your partners or members(if you are a partnership or joint venture),to your members(if
you are a IimitecE iiability company), to a co-"employee" while in the course of his or her employ-
ment or performing duties related ta the conduct of your business, or io your other "volunteer
workers" while performing dutiss related to the conduct of your business;
{bJ To the spouse, child, parent, brother or sister of that co-"emplayee" or "volunteer worker" as a
consequence of Paragraph (i) (a)above;
(c) For which there is any obligatian to share damages with or repay someone else who must pay
damages because af the injury described in Paragraphs(t)(a)or(b) above; or
�d} Arising out of his or her providing or failing to provide prafessional health care services. However,
if you are not in the business of providing pro#essional health care services or providing profes-
sional health care personnel to o#hsrs, or if coverage for providing pro#essional health care ser-
vices is not otherwise exGluded by separate endorsement, this provision (Paragraph {d)) does not
apply.
Paragraphs {a) and {b) above do nat apply to "badily injury" or "personal and advertising injury" caused by
an "employee" who is acting in a supervisory capacity#or you, Supervisory capacity as used herein means
the "employee's" jab responsibilf#ies assigned by you, includes the direct supervision of other "employ-
ees" of yours. However, none of these "emplayees" are insureds for "bodily injury" or "persona! and
� 2013 Liberty Mutual lnsurance
CG 88 10 04 13 InrliiriP¢�nnvri�hYarl matarial ni InciiranrP Cnrvi�Ae flffiro Inr �e�ith if� �orr+.�r�i,,., Pann R n�S2
i
advertising injury" arising out of their willful conduct, which is defined as the purposeful or w�llful intent to
cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica-
tion by li�uar or controlled substances.
The coverage provided by pravision.!.is excass aver any other valid and collectab(e insurance available to
your"employee".
K. NEWLY FORMEp OR ApQI710NALLY ACaUIRED ENTiTfES
Paragraph 3.of SeGtion II•Wha Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
interest, will qualify as a Named Insured if there is no other sirnilar insurance avaifable to that
organization. However:
a. Coverage under this provision is afforded only until the expiration of the policy period in
which the entity was acquired or formed by you;
b. Coverage A does not apply to "bodify injury" or "praperty damage" that occurred before you
acquired or formed the organization; and
c. Coverage g does not apply to "personal and advertising injury" arising out of an oifense
committed before you acquired or formed tha organization.
d. Records and descriptions of operations rnust be maintained by the first IVamed Insured.
No person or organization is an insured with respect to the conduct of any current or past partnership,joint
venture or limiteci liability company that is not shown as a Named Insured in the Declarations or qualifies
as an insured under this provision.
L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV -Commercial General Liability Conditions,the following is added to Condition 6.Repre-
sentatians:
Your failure to disclose all hazards or p�ior "occurrences" existing as of the ineeptian date of the policy
shall not prejudice the coverage afforded by this palicy provided such failure to disclose all hazards or
prior "occurrences" is not intentional.
M. KNOWLEDGE OF OCCtJRRENCE,�FFENSE,CLAlM OR StJiT
Under Sectian IV -Commercial General Liability Conditions,the follawing is addect to Condition 2. Duties
!n 7'he�vent of Occurrence,Offense,Claim Or Suit:
Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any
insured shaif not in itself constitute knowledge of the insured unless an insured listed under Paragraph
1. of Section II - Who Is An Insured or a person who has been designated by them ta receive reports of
"occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or
"employee"_
N. LIBERALIZATION CLAUSE
If we revise this Commercial Genera! Liability Extension Endorsement to provide more coverage withaut
additional premium charge, yoUr policy will automaticaffy provide the coverage as of the day the revision is
effective in your state.
D. BODILY INJURY REDEFINED
Under Sectian V-Qefinitions,Qe#inition 3. is replaced by the following�
3. "Bodify lnjury" means physical injury, sickness or disease sustained by a person. This includes
menta[ anguish, mental injury, shock, fright or death that results from such physical injury, sick-
ness ar disease.
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P. EXTENDED PROPERTY DAMAGE
Exclusian a. of COVERAGE A. BODILY INJURY AND PAOPER7Y DAMAGE LIABILITY is replaced by the
falfowing:
a. Expected Or Intended Injury
"Bodily injury" or "property darrzage" expected or infended from the standpoint of the insured.
This exclusion does not ap{�ly to "b�dily injury" or "property damage" resulting from tha use of
reasonable iores to protect persons or property.
Q. WAIVER OF TRANSFER UF RIGHTS OF RECOVERY AGAiNST OTHERS TO US - WHEN REQUlREQ iN A
CONTRACT OR AGREEMENT W1TH YOIf
Under Section IV- Commerciai General Lia6ility Canditions, the following is added ta Condition �. Trans-
fer Of Rights Of Recovery Against Others Ta Us:
We waive any right of recovery we may have aga�nst a persan or organization because of payments we
make for injury or damage arising out af your ongoing operations or "you� work" done under a
contract with that person or organizetion and incluCed in the "products-completed operations ha?ar�"
provided:
1. You and that persan ar organization hav2 agE�eed in writing in a contrar,i or agreeinent that yau
waive su�h rights against that perscn or organ+zation; and
2. The injury or damage occurs subsequent to the exeeution of tf�e written contract ar writtPn 2gree-
rnent.
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CG $$ 1fl d4 13 Includes copyrighied maierial of Insurance Servic2s Office,Inc.,with its permission. Pel_]e 8 0f$
i
Policy#gKA1656382766
COMMERCIAL GENERAL LIABILITY
CG 89 70 05 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED —AMENDMENT OF CANCELLATION PROVISIONS
�R COVERAGE CHANGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replacing such Conditions
is amended by the following:
If you have agreed in a written contract or�vritten agreement to provide a person or organization who qualifies as an
additional insured under this policy a notice of cancellation and/or material change that reduces or restricts the
insurance afforded by this Coverage Part we agree to the following:
a. Provide 30 days prior written cancellation notice for reasons other than nonpayment of premium
and/or 30 days prior vdritten notice of coverage change per schedule of additional insureds provided to
us.
�:2011 Liberty Mutuai Agency Corporalion. All rights reserved.
CG 89 7d 05 11 Includes copyrighted material of Insurance Services Office,Inc.,�vith its permission. Pag2 1 Of 1
Policy#gAA1656382766
COMMERCIAL AUTO
CA 88 10 01 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO GOVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BU5INESS AUTO COVERAGE FORM
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement.
COVERAGEINDEX
SUBJECT PR�VISION NUMBER
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3
ACCIDENTAL AIRBAG DEPLOYMENT 12
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 19
AMENDED FELLOW EMPLOYEE EXCLUSION 5
AUDIO, VISUAL AND DATA ELECTRONIC EC�UIPMENT COVERAGE 13
BROADFORMINSURED 1
BODILY INJURY REDEFINED 22
EMPLOYEES AS INSUREDS (including employee hired auto) 2
EXTENDED CANCELLATION CONDITION 23
EXTRA EXPENSE—BROADENED COVERAGE 10
GLASS REPAIR—WAIVER OF DEDUCTIBLE 15
HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use} 6
HIRED AUTO COVERAGE TERRITORY 20
LOAN / LEASE GAP 14
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16
PERSONAL EFFECTS COVERAGE 11
PHYSICAL DAMAGE —ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8
RENTAL REIMBURSEMENT 9
SUPPLEMENTARY PAYMENTS 4
TOWING AND LABOR 7
TWO OR MORE DEDUCTIBLES 17
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 18
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 20
SECTION II — LIABILITY CaVERAGE is amended as follows:
1. BROAD FORM INSURED
SECTION II — LIABILITY COVERAGE, paragraph A.1. —WH� IS AN INSURED is amended to include the
following as an insured:
d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the
policy period. However, "insured' does not include any organization that:
(1} Is a partnership orjoint venture; or
(2} Is an insured under any other automobile policy; or
(3) Has exhausted its Limit of Insurance under any other automobile policy.
Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of
this policy.
e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you
o�vn more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days
from the date of acquisition or formation. Ho4vever; coverage under this provision does not apply:
(1) If there is similar insurance or a self-insured retention plan available to fhat organization;
OO 2013 Liberty Mutual Insurance
CA 88 10 01 13 Includes copyrighted material of Insurance Services Offce, Inc.,v�ith its permission. Page 1 of 7
(2) If the Limits of Insurance of any other insurance policy have been exhausted; or
(3) To "bodily injury" or "property damage" that occurred before you acquired or formed the
organization.
2. EMPLOYEES AS INSUREDS
SECTION II — LIABILITY COVERAGE, paragraph A.1. —WHO 15 AN INSURED is amended to include the
following as an insured:
f. Any"employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts
within the scope of their employment by you. Insurance provided by this endorsement is excess over
any other insurance available to any"employee".
g. An "employee" of yours while operating an "auto' hired or borro4ved under a written contract or
agreement in that "employee's" name, with your permission, while performing duties related to the
conduct of your business and within the scope of their employment. Insurance provided by this
endorsement is excess over any other insurance available to the "employee".
3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SECTION II — LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to include the
following as an insured:
h. Any person or organization with respect to the operation, maintenance or use of a covered "auto',
provided that you and such person or organization have agreed in a written contract, agreement, or
permit issued to you by governmental or public authority, to add such person, or organization, or
governmental or public authority to this policy as an "insured".
Ho4vever, such person or organization is an"insured":
(1) Only with respect to the operation, maintenance or use of a covered "auto";
(2} Only for "bodily injury' or "property damage° caused by an "accident" which takes
place after you executed the written contract or agreement, or the permit has been
issued to you; and
(3} Only for the duration of that contract, agreement or permit
4. SUPPLEMENTARY PAYMENTS
SECTION II — LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, paragraphs (2)
and (4) are replaced by the follovring:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations} required because of
an 'accident'we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings up to
�500 a day because of time off from work.
5. AMENDED FELLOW EMPLOYEE EXCLUSION
In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the
employer by the workers compensation exclusivity rule; or similar protection, the following provision is added:
SECTION II — LIABILITY, exdusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from
the use of a covered "auto"you own or hire.
SECTION III— PHYSICAL DAMAGE COVERAGE is amended as follows:
6. HIRED AUTO PHYSICAL DAMAGE
Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended by
adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or
Collision coverage are provided under the Business Auto Coverage Form for any "auto" you o4vn, then the
Physical Damage coverages provided are extended to"autos":
a. You hire, rent or borrow; or
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b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but
only if the damage occurs while the vehicle is being used in the conduct of your business,
subject to the follo4ving limit and deductible:
A. The most we will pay for�loss" in any one "accident"or"loss" is the smallest of:
(1} �50,000; or
(2} The actual cash value of the damaged or stolen property as of the time of the"loss"; or
(3) The cost of repairing or replacing the damaged or stolen property writh other property of like
kind and quality, minus a deductible.
B. The deductible will be equal to the largest deductible applicable to any owned "auto"for that coverage.
C. Subject to the limit, deductible and excess provisions described in this provision, we will provide
coverage equal to the broadest coverage applicable to any covered "auto"you own.
D. Subject to a maximum of $1,D00 per "accidenY`, we will also cover the actual loss of use of the hired
"auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial
loss.
E. This coverage extension does nof apply to:
(1} Any"auto" that is hired, rented or borro�ved with a driver; or
(2) Any"auto" that is hired, rented or borrowed from your"employee".
For the purposes of this provision, SECTION V— DEFINITIONS is amended by adding the following:
"Total loss" means a �loss"in which the cost of repairs plus the salvage value exceeds the actual cash value.
7. TOWING AND LABOR
SECTION III — PHYSICAL DAMAGE COVERAGE, paragraph A.2. To�ving, is amended by the addition of the
following:
We will pay towing and labor costs incurred, up to the limits shown below; each time a covered "auto'
classified and rated as a private passenger type, "light truck"or°medium truck" is disabled:
a. For private passenger type vehicles, we will pay up to $50 per disablement.
b. For "light trucks", we vrill pay up to $50 per disablement. "Light trucks" are trucks that have a gross
vehicle weight (GVW)of 10,000 pounds or less.
c. For "medium trucks" , we will pay up to �150 per disablement. "Medium trucks' are trucks that have a
gross vehicle weight (GVW) of 10,001 —20,OQ0 pounds.
However, the labor must be pertormed at the place of disablement.
8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a., Coverage Extension of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to
provide a limit of�50 per day and a maximum limit of 51,500
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9. RENTAL REIMBURSEMENT
SECTION III —PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following:
a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an
"auto" because of "accidenY' or "loss", to an "auto" for �vhich �ve also pay a "loss" under
Comprehensive, 5pecified Causes of Loss or Collision Coverages. We will pay only for those
expenses incurred after the first 24 hours following the "accident"or"loss'�to the covered "auto."
b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may
be substantially less than $75 per day, and will only be allowed for the period of time it should take to
repair or replace the vehicle wlth reasonable speed and similar quality, up to a maxfmum of 30 days.
c. We will also pay up to $500 for reasonable and necessary expenses fncurred by you to remove and
replace your tools and equipment from the covered `auto".
d. This coverage does not apply unless you have a business necessity that other "autos" available for
your use and operatio� cannot fill.
e. If"loss" results from the total theft of a covered "autfl" of the private passenger type, we will pay under
this coverage only that amount of your rental reimbursement expenses v��hich is not already provided
under Paragraph 4. Coverage Extension.
f. No deductible applies to this coverage.
For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as
defined in provision 11.
10. EXTRA EXPENSE - BROADENED COVERAGE
Under SECTION III — PHYSICAL DAMAGE COVERAGE; A. COVERAGE; we will pay for the expense of
returning a stolen covered "auto"to you. The maximum amount we will pay is $1,000.
11. PERSONAL EFFECTS COVERAGE
A. SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the
following:
If you have purchased Comprehensive Coverage on this policy for an "auto' you own and that�`auto" is stolen,
we�vill pay, without application of a deductible, up to $600 for"personal effects" stolen with the"auto."
The insurance provided under this provision is excess over any other collectible insurance.
B. SECTION V— DEFINITIONS is amended by adding the following:
For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an
insured." "Personal effects"does not include tools, equipment,jewelry, money or securities.
12. ACCIDENTAL AIRBAG DEPLOYMENT
SECTION III —PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for"loss" relating
to mechanical breakdown does not apply to the accidental discharge of an airbag.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by
manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or
warranty.
13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III — PHYSICAL DAMAGE COVERAGE, B. EXCLU510N5, exception paragraph a. to exclusions
4.c. and 4.d. is deleted and replaced vrith the following:
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Exclusion 4,c, and 4.d. do not apply to:
a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed
solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at
the time of the "loss" and such equipment is designed to be solely operated by use of the power from
the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are
provided for the covered �auto"; or
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this
equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced
by a �100 deductible.
14. LOAN/ LEASE GAP COVERAGE
A. Paragraph C., LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE is
amended by adding the following:
The most v�re will pay for a "total loss" to a covered "auto" owned by or leased to you in any one
"accidenf' is the greater of the:
1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is
subject at the time of the "loss"less the amount of:
a. Overdue payments and financial penalties associated with those payments as of the
date of the"loss",
b. Financial penalties imposed under a lease due to high mileage, excessive use or
abnormal wear and tear,
c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease,
d. Transfer or rollover balances from previous loans or leases,
e. Final payment due under a"Balloon Loan",
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss"of
a covered °auto",
g. Security deposits not refunded by a lessor,
h. All refunds payable or paid to you as a result of the early termination of a lease
agreement or as a result of the early termination of any�r✓arranty or extended service
agreement on a covered "auto",
i. Any amount representing taxes,
j, Loan or lease termination fees; or
2. The actual cash value of the damage or stolen property as of the time of the"loss".
An adjustment for depreciation and physical condition will be made in determining the actual cash
value at the time of the "loss". This adjustment is not applicable in Texas.
B. ADDITIONAL CONDITIONS
This coverage applies only to the original loan for which the covered "auto' that incurred the loss
serves as collateral, or lease written on the covered "auto"that incurred the loss.
C. SECTION V—DEFINTI�NS is changed by adding the follov�iing:
As used in this endorsement provision, the following definitions apply:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash
value.
A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term
of the loan; thereby requiring a large final payment_
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15. GLASS REPAIR -WAIVER OF DEDUCTIBLE
Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of
the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
16. PARKED AUTO COLLISION COVERAGE (WAIVER �F DEDUCTIBLE)
Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of
the following:
The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger
type or light weight truck with a gross vehicle weight of 10,Q00 Ibs. or less as defined by the manufacturer as
maximum loaded v�✓eight the "auto"is designed to carry while it is:
a. In the charge of an "insured";
b. Legally parked; and
c. Unoccupied.
The "loss" must be reported to the police authorities within 24 hours of kno�vn damage.
The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations.
This provision does not apply to any`�loss' if the covered "auto" is in the charge of any person or organization
engaged in the automobile business.
17. TWO OR MORE DEDUCTIBLES
Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms
apply to the same accident, the following applies to paragraph D. Deductible:
a. If the applicable Business Auto deductible is the smaller{or smallest) deductible it will be waived; or
b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced
by the amount of the smaller(or smallest) deductible; or
c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest)
deductible will be v�iaived.
For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group.
SECTION IV— BUSINESS AUTO CONDITIONS is amended as follows:
18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the follo�ving:
If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date
or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy �vill not be
prejudiced.
However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and
we have the right to collect additional premium for any such hazard or exposure.
19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS
SECTION IV— BUSINESS AUTO CONDITI�NS, paragraph A,2.a. is replaced in its entirety by the following:
a. In the event of"accident", claim, "suit'or"loss", you must promptly notify us when it is kno4vn to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. Member, if you are a limited liability company;
4. An executive offcer or the "employee" designated by the Named Insured to give such notice,
if you are a corporation.
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To the extent possible, notice to us should include:
(1} Ho��v, when and��vhere the"accident"or"loss"took place;
(2} The "insureds" name and address; and
(3J The names and addresses of any injured persons and witnesses.
20. WAIVER OF TRANSFER OF RIGHTS OF RECt�VERY AGAINST OTHERS TO US
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery Against
Others to Us, is amended by the addition of the following:
If the person or organization has waived those rights before an "accident"or 'loss', our rights are�vaived also.
21. HIRED AUTO COVERAGE TERRITORY
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is
amended by the addition of the following:
f. For "autos" hired 30 days or less, the coverage territory is anywhere in the 4vorid, provided that the
insured's responsibility to pay for damages is determined in a "suiY', on the merits; in the United
States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a
settlement�ve agree to.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver.
SECTION V— DEFINITIONS is amended as follows:
22. BODILY INJURY REDEFINED
Under SECTION V—DEFINTIONS, definition C. fs replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish,
mental injury, shock, fright or death resulting from any of these at any time.
CQMMMON POLICY C�NDITIONS
23. EXTENDED CANCELLATION CONDITION
COMMON POLICY CONDITIONS, paragraph A.—CANCELLATION condition applies except as follows:
If v✓e cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written
notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply
in those states which require more than 60 days prior notice of cancellation.
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POLICY NUMBER: BAA1656382766 COMMERCIAL AUT�
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGECOVERAGEFORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-
sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
EfFective Date: 12/4/14
Named Insured: CSG Consultants, Inc.; Precision Inspection-CSG
SCHEDULE
Name of Person(s} or Organization(s}: as required by written contract
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage; but only to the extent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained
in Section II of the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑
i
Policy#BAA1656382766
COMMERCIAL AUTO
CA8866OS13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
DESIGNATED INSURED — NONCONTRIBUTING
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this
endorsement.
This endorsement identifies person{s)or organization{s)who are "insureds" under the Who Is An Insured Provision of the
Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
Schedule
Name of Person(s) or Organization(s}: Any entity with respect to a covered "auto" provided that you and such entity have
agreed in a written contract, agreement, or permit to add such entity as an "insured"
Regarding Designated Contract or Project: N/A
Each person or organization shown in the Schedule of this endorsement is an "insured"for Liability Coverage, but only to the
extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision conlained in Section II of the
Coverage Form_
The following is added to the Other Insurance Condition:
If you have agreed in a written agreement that this policy will be primary and without right of contribution from any
insurance in force for an Additional Insured for liability arising out of your operations, and fhe agreement was executed
prior to the "bodily injury"or"property damage", then this insurance vrill be primary and we v✓ill not seek contribution
frflm such insurance.
OO 2013 Liberty Mutual Insurance.All rights reserved.
CA 88 f6 05 13 Includes copyrighted material of Insurance Services Office, Inc.,v�ith its permission. Page 1 of 1
I
Policy#BAA1656382766
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT OF CANCELLATIQN PROVISIONS
This endorsement modifies insurance provided under the following:
BU51NE5S AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
GARAGE COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by this endorsement.
Any term or provision of the Cancellation Conditions of the policy or any endorsement emending or replacing such Conditions is
amended by the following:
If you have agreed in a written contract or written agreement to provide a person or organization notice of cancellation we
agree to the following:
a. Provide a 30 days prior written cancellation notice to such persons or organization for reasons other than
nonpayment of premium, but only if v✓e are provided �vith a schedule of persons or organizations with whom
you have agreed to provide notification more than 30 days before the cancellation is to take effect.
As a condition of this endorsement, you must notify your agent of any written contract or agreement where you have agreed to
provide notice of cancellation, other than nonpayment of premium, to a specific person or organization.
Failure to provide to a person or organization in accordance with the terms of this endorsement shall not extend the effective
date of the cancellation or otherwise affect cancellation of the policy as to any insured_
CA 88 76 03 14 OO 2013 Liberty Mutual Insurance.All rights reserved. Page 1 Of 1
Indudes copyrighted material of Insurance Services Office,Inc.,with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10A (Ed 07-07)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
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.)
The additional premium for this endorsement shall be 2.00 %of the total policy premium otherwise due on such
remuneration.
The minimum premium for this endorsement is$ ��� ��
Schedule
Person or Organization Job Description
ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS
ISSUED
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 12/4/15 Policy No. CSWC607956
Insured CSG CONSULTANTS, INC. Premium $
Insurance Company Cypress Insurance Company
WC 99 04 10A
(Ed 07-07)
i
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION - CERTIFICATE HOLDERS
This endorsement modifies insurance provided under the Design Professional Liability Policy.
The person(s) or organization(s} listed or described in the Schedule below have requested that they
receive not less than thirty(30) days written notice of cancellation when this policy is cancelled by us_ We
will endeavor to mail or deliver to the Person(s) or organization(s) listed or described in the 5chedule a
copy of the written notice of cancellation that we sent to you. Such copies of the notice will be mailed as
soon as practicable to the address or addresses provided by your broker or agent.
This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such
notification to the person(s} or organization(s) shown in the Schedule will not extend any policy
cancellation date or impact or negate any cancellation of the policy. This endorsement does not entitle
the person(s) or organization(s} listed or described in the Schedule below to any benefit, rights or
protection under this policy.
Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to
that statute or rule.
Schedule
Person(s) or Organization{sj including mailing address:
All certificate holders where written notice of the cancellation of this policy is required by written
contract, permit or agreement with the Named Insured and whose names and addresses v✓ill be
provided by the broker or agent listed in the Declarations page of this policy for the purpose of
complying with such request.
All other terms and conditions of this policy remain unchanged.
Policy Number: PAAEP0008800
Named Insured: CSG Consultants
This endorsement is effective on the inception date of this Policy unless otherwise stated herein:
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