Loading...
19-004 David Vossbrink, Communications Consulting©�R �b000Of:S' CITY OF PROFESSIONAL/CONSULTING SERVICES AGREEMENT CUPERTINO 1. PARTIES This Agreement is made and entered into as of December 17, 2018 ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and David Vossbrink ("Contractor"), a sole proprietor for communications consulting 2. SERVICES Contractor agrees to provide the services and perform the tasks ("Services") set forth in detail in Scope of Services, attached here and incorporated as Exhibit A. 3. TIME OF PERFORMANCE 3.1 This Agreement begins on the Effective Date and ends on December 31, 2019 ("Contract Time"), unless terminated earlier as provided herein. Contractor's Services shall begin on December 17, 2018 and shall be completed by December 31, 2019 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here Exhibit A. 3.3 Time is of the essence for the performance of all the Services. Contractor must have sufficient time, resources, and qualified staff to deliver the Services on time. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will based on actual costs but that will be capped so as not to exceed $15,000.00 ("Contract Price"), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit A, Compensation attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount. No extra work or payment is permitted without prior written approval of City. 4.2 Invoices and Payments. Monthly invoices must state a description of the deliverable completed and the amount due for the preceding month. Within thirty (30) days of completion of Services, Contractor must submit a requisition for final and complete payment of costs and pending claims for City approval. Failure to timely submit a complete and accurate payment requisition relieves City of any further payment or other obligations under the Agreement. Project Public Affairs Consultant Page t of 8 ProfesslonalfConsulrrng c»nrraersirars.an:.v...y 1.,.0 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. Contractor is not entitled to health benefits, worker's compensation or other benefits from the City. 5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Services in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Services as required by law and have procured a City Business License. 5.4 Subcontractors. Only Contractor's employees are authorized to work under this Agreement. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Agreement will apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools, materials and equipment required to perform the Services under this Agreement. 5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this Agreement. Upon City's request, Contractor will provide proof of payment and will indemnify City for violations pursuant to the indemnification provision of this Agreement. 6. PROPRIETARY/CONFIDENTIAL INFORMATION In performing this Agreement, Contractor may have access to private or confidential information owned or controlled by the City, which may contain proprietary or confidential details the disclosure of which to third parties may be damaging to City. Contractor shall hold in confidence all City information provided by City to Contractor and use it only to perform this Agreement. Contractor shall exercise the same standard of care to protect City information as a reasonably prudent contractor would use to protect its own proprietary data. 7. OWNERSHIP OF MATERIALS 7.1 Property Rights. Any interest (including copyright interests) of Contractor in any product, memoranda, study, report, map, plan, drawing, specification, data, record, document or other information or work, in any medium (collectively, "Work Product"), prepared by Contractor in connection with this Agreement will be the exclusive property of the City and shall not be shown to any third -party without prior written approval of City. 7.2 Copyright. To the extent permitted by Title 17 of U.S. Code, all Work Product arising out of this Agreement is considered "works for hire" and all copyrights to the Work Product will be the property of City. Alternatively, Contractor assigns to City all Work Product copyrights. Contractor may use copies of the Work Product for promotion only with City's written approval. Project Public Affairs Consultant ?(118 Page 2 of 9 Professional/Consulting Contracts Version: A�ay 2? 7.3 Patents and Licenses. Contractor must pay royalties or license fees required for authorized use of any third party intellectual property, including but not limited to patented, trademarked, or copyrighted intellectual property if incorporated into the Services or Work Product of this Agreement. 7.4 Re -Use of Work Product. Unless prohibited by law and without waiving any rights, City may use or modify the Work Product of Contractor or its sub -contractors prepared or created under this Agreement, to execute or implement any of the following: (a) The original Services for which Contractor was hired; (b) Completion of the original Services by others; (c) Subsequent additions to the original Services; and/or (d) Other City projects. 7.5 Deliverables and Format. Contractor must provide electronic and hard copies of the Work Product, on recycled paper and copied -on both sides, except for one single -sided original. 8, RECORDS Contractor must maintain complete and accurate accounting records relating to its performance in accordance with generally accepted accounting principles. The records must include detailed information of Contractor's performance, benchmarks and deliverables, which must be available to City for review and audit. The records and supporting documents must be kept separate from other records and must be maintained for four years from the date of City's final payment. 9. ASSIGNMENT Contractor 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 will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Agreement and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. 10. PUBLICITY / SIGNS Any publicity generated by Contractor for the project under this Agreement, during the term of this Agreement and for one year thereafter, will reference the City's contributions in making the project possible. The words "City of Cupertino" will be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted, exhibited or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend and hold Project Public Affairs Consultant Pa -C 3 of 9 Pmfessional/ConsultingContracts /Version: Mav22, 2018 harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and consultants ("Indemnitees"), through legal counsel acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings) of every nature, arising directly or indirectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Negligent or willful acts or omissions committed during performance of the Services; (c) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor ar is subcontractors or sub=subcontractors (d) Unauthorized use or disclosure of City's confidential and proprietary Information; (e) Claim of infiingement or violation of a U.S. patent or copyright, trade secret, trademark, or service mark or other proprietary or intellectual property rights of any third party. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third -party claim, in accordance with California Public Contract Code Section 9201. At City's request, Contractor will assist City in the defense of a claim, dispute or lawsuit arising out of this Agreement. 11.3 Contractor's duties under this section are not limited to the Contract Price, workers' compensation payments, or the insurance or bond amounts required in the Agreement. Nothing in the Agreement shall be construed to give rise to an implied right of indemnity in favor of Contractor against City or any Indemnitee. 11.4. Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Agreement, a purchase order, or other transaction. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D, and must maintain the insurance for the duration of the Agreement, or longer as required by City. City will not execute the Agreement until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor's compensation or terminating the Agreement. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state and federal laws and regulations applicable to this Agreement. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor's ability to perform. Contractor is responsible for verifying the employment authorization of employees performing the Services, as required by the Immigration Reform and Control Act. Project Public Affairs Consultant Page 4 of 8 Professional/Consulting Contracts Version: Mnv 22, 20/8 13.2 Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a "public works" component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws. 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired -Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti -discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777 and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or its employees or sub -contractors will not be tolerated. 13.4 Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable to this Agreement and must avoid any conflict of interest. Contractor warrants that no public official, employee, or member of a City board or commission who might have been involved in the making of this Agreement, has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. Contractor may be required to file a conflict of interest form if Contractor makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of the California Code of Regulations. Contractor agrees to abide by the City's rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements or terminating this Agreement. City reserves all other rights and remedies available under the law and this Agreement, including the right to seek indemnification under Section 11 of this Agreement. 14. PROJECT COORDINATION City Project Manager. The City assigns Bill Mitchell as the City's representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns David Vossbrink as its single Representative for all purposes under this Agreement, with authority to oversee the progress and performance of the Scope of Services. Contractor's Project manager is responsible for coordinating and scheduling the Services in accordance with the Scope of Services and the Schedule of Performance. Contractor must regularly update the City's Project Manager about the progress with the work or any delays, as required under the Scope of Services. City written approval is required prior to substituting a new Representative. 15. ABANDONMENT OF PROJECT City may abandon or postpone the Project or parts therefor at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment, and will be Project Public Affairs Consultant Page 5 of 8 Professionai/Conselting Contracts /Version: Mav 22, 2018 given reasonable time to assemble the work and close out the Services. With City's pre -approval in writing, the time spent in closing out the Services will be compensated up to a maximum of ten percent (10%) of the total time expended to date in the performance of the Services. 16. TERMINATION City may terminate this Agreement for cause or without cause at any time. Contractor will be paid for satisfactory Services rendered through the date of termination, but final payment will not be made until Contractor closes out the Services and delivers the Work Product. 17. GOVERNING LAW VENUE AND DISPUTE RESOLALTION This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in court. If a dispute arises, Contractor must continue to provide the Services pending resolution of the dispute. If the Parties elect arbitration, the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 18. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. 19. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Agreement. 24. WA ER Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract provision. City's waiver of a breach shall not constitute waiver of another provision or breach. 21. ENTIRE AGREEMENT This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement(s) and understanding(s), either oral or written, between the Parties. Any modification of this Agreement will be effective only if in writing and signed by each Party's authorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsistency between the main Agreement and the attachments or exhibits thereto, the text of the main Agreement shall prevail. Prgject Public Affairs Consultant Page 6 of 9 Professional/Consulting Contracts /Version: May 22, 2018 22. INSERTED PROVISIONS Each provision and clause required by law for this Agreement is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 23. HEADINGS The headings 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. 24. SEVERABILITY/PARTIAL INVALIDITY If any term or provision of this Agreement, or their application to a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling. All other terms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. The Parties agree to work in good faith to amend this Agreement to carry out its intent. 25. SURVIVAL All provisions which by their nature must continue after the Agreement expires or is terminated, including the Indemnification, Ownership of Materials/Work Product, Records, Governing Law and Attorney Fees, shall survive the Agreement and remain in full force and effect. 26. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino 10300 Torre Ave., Cupertino CA 95014 Attention: Bill Mitchell Email: billm cupertino.or9 27. VALIDITY OF CONTRACT To Contractor: David Vossbrink 1177 West McKinley Avenue Sunnyvale, CA 94086 Attention: Email: dvossbrink@yahoo.com This Agreement is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, as amended from time to time, (b) is signed by the City Manager or an authorized designee, and (c) is approved for form by the City Attorney's Office. Project Public Affairs Consultant Puge 7 of S Professional/Consulting Contracts /VerSlon: May -'6, sut o 28. EXECUTION The person executing this Agreement on behalf of Co °Trepresents and out all actions on mtplat d s that Contractor has full right, power, and authority to enter into carry by this Agreement and that he or she is authorized to execute this Agreement, which constitutes a legally binding obligation of Contractor. This Agreement may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. IN WITNESS 'WHEREOF, the parties have caused the Agreement to be executed. CONTRACTOR David Vossbrink mm cations Co el By Name David Vossbrink Title Principal Date December—"—, 2018 Tax LD. No.: 559-74-5062 CITY OF CUPERTINO A Municipal Corporation By Name Bill Mitchell Title CTO Date /' Z•/ PR VED FO �) J C( ROCIO . ffRRO Cupertino Acting City Attorney�� ATTEST: GRACE SCHM T City Clerk Project Public Affairs Consultant Page 8 of 8 ProfessionaUCottsttlting Contracts /Version: May 22, 2018 EXHIBIT A CUPERTINO �..,',��' k� HUM"f77. Statement of Work for City of Cupertino David Vossbrink December 2018 Contact Information: David Vossbrink Communications Counsel 1 177 West McKinley Avenue Sunnyvale, CA 94086 dvossbrink@yahoo.com 408-368-5637 David Vossbrink: Communications Counsel Public Information Support Consulting Services City of Cupertino Scope of Work 1. Provide strategic and tactical guidance for institutional communications, community relations, and public affairs related to the City of Cupertino. a. Review and provide input to the draft Strategic Communications Plan. b. Assist in the development of a shared "Community Vision" to guide the positioning of City messaging. 2. Mentor communications staff members to support their professional development and effectiveness. Assist City staff in the development of a public Communications Work Plan, such as helping to: a. Identify priority projects and necessary resources related to Strategic Plan development and implementation. b. Develop monthly calendar of activities/communications based on priorities and resources. c. Develop communication templates for routine operations and crisis occurrences. d. Develop a policy framework to guide communications functions and services. 4. Provide communications advice and counsel to Cupertino City staff and officials on issue -specific topics, policy and operational matters, and crisis communications. Draft, review, edit, or revise communications products related to City of Cupertino internal and external communications, such as news releases, speeches and talking points, website content, collateral materials, social media posts, and other materials. 6. Assist in preparing City Councilmembers, the City Manager, and other City senior staff and subject matter experts for news media interviews, presentations, and other public interactions, including media relations training. 7. Assist in developing a community outreach plan and program for City staff and Councilmembers, such as helping to: a. Develop a program for neighborhood meetings with City Council and/or staff. b. Develop systems for identifying, assigning, and tracking City relationships with community stakeholders and organizations. 8. Assist in promoting the City's programs, projects, achievements, innovations, and public policy and service goals using appropriate communications channels, such as helping to: a. Create communications processes, procedures, and templates. David Vossbrink/Cupertino Scope of Work v2, December 7, 2018 b. Develop and implement a survey of Cupertino residents to better understand community expectations and needs related to City communications 9. Participate in meetings related to this Scope of Work and communications services with Cupertino City staff and officials as requested. 10. Provide other related public information services as requested. Period of engagement: This agreement shall cover the period from contract execution through December 31, 2019. Terms: Hourly rate: $125.00 Not to Exceed Amount: $15,000.00 David Vossbrink/Cupertino Scope of Work v2, December 7, 2018 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/20/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LGIC INSURANCE SERVICES NAME: PHONE (866) 467-8730 (A/C, No, Ext): FAX (888) 443-6112 (A/C, No): 57152409 451 LOS GATOS BLVD 2ND FLOOR E-MAIL LOS GATOS CA95032 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: The Sentinel Insurance Company 11000 INSURED INSURER B: DAVID VOSSBRINK INSURERC: 1177 W MC KINLEYAVE INSURER D: SUNNYVALE CA 94086-7016 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMEER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBIR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADEOCCUR X F DAMAGE TO RENTED PREMISES Ea occurrence)$1'000'000 MED EXP (Any one person) $10,000 X General Liability A 57 SBM BK4270 04/02/2018 04/02/2019 PERSONAL & ADV INJURY $1,000,000 PLCY❑PRO LOC F,LOAGGREGATE LIMIT APPLIES PER: JECT XTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO ALL OWNEDS SCHEDULED AUTOS AUTOS `/��� B-.� V - ,) S BODILY INJURY (Per person) BODILY INJURY Per accident ( ) NON -OWNED HIRED AUTO AUTOS I(�/ 1 PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? N/A ///� `A `"� O 1., ¢ STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per Additional Insured: Owners, Lessees, or Contractors; Scheduled Person or Organization Form SS4170 and Additional Insured: Owners, Lessees or Contractors; Completed Operations form SS4171, attached to this policy. CERTIFICATE HOLDER CANCELLATION THE CITY OF CUPERTINO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10300 TORRE AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CUPERTINO CA 95014-3202 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U ue"dtrj � L G1,�1�iz�Gt%�L> ©1988-2015 ACORD CORPORATION. All rights reserved. Contractor/Consultant Affidavit of No Employees State of California County of Santa Clara City of Cupertino I, the undersigned, declare as follows: I am an independent contractor and the owner of `YOOya SSt3K1,.*- 4 ��Mw Q -q" I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this 144, day of Psi, 2019, at V California. RI NA E SIGNATURE Revised 1.01.19 POLICY NUMBER: 57 SBM BK4270 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): The City of Cupertino Location(s) Of Covered Operations: 10300 Torre Avenue Cupertino, CA 95014 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section C. — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. Form SS 41 70 06 11 Process Date: 12/20/18 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 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 the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 1 of 1 Policy Expiration Date: 04/02/19 © 2011, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission) POLICY NUMBER: 57 SBM BK4270 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): The City of Cupertino Location And Description Of Completed Operations: 10300 Torre Aenue Cupertino, CA 95014 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section C. — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". Form SS 41 71 06 11 Process Date: 12/20/18 4 Page 1 of 1 Policy Expiration Date: 04/02/19 © 2011, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission) FARMERS Auto Insurance Declaration Page INSURANCE Policy Number: 18501-82-26 Effective.: 1/28/2019 12:01 AM Expiration: 7/28/2019 12:01 AM Narnedlnsured(s): David Vossbrink Underwritten By: Mid -Century Insurance Company 6301 Owensmouth Ave. Woodland Hills, CA91367 Household Drivers Premiums/Fees ................................. Policy Premium $538.10 Fees (*also see Information on Additional $0.88 Fees below) 0- Policy Premium and Fees This is not a bill. Your bill with the amount due will be mailed separately, $538.98 All persons who drive or will occasionally be driving any of the cars on the policy should be listed below. If anyone is missing or needs to be added, such as a newly licensed driver, you should contact your agent or the company' to add that person before they begin to drive any of the cars covered on the policy. Name Driver Status Name Driver Status DavidVossbrink Covered AudreyG Wong Covered Vehicle information Veh. # Year/Make/Modei,NlN 1 Coverage information Coverage Bodily Injury Liability Property Damage Liability Permissive User Limit of Liability** Medical Coverage Uninsured Motorist Bodily Injury Comprehensive Limits (applicable to all vehicles) $250,000 each person $500,000 each accident $100,000 each accident Full (See Permissive User Limit of Liability in your policy) $50,000 each person $100,000 each accident Coverage Deductible Comprehensive: $500 Collision: $1,000 Additional Equipment: Limit $1,000 Premiums by Vehicle Vehicle 1 $105.00 $142.30 Included Not Covered $32.60 $31.60 farmers.com Policy No. 18501-82-26 Questions? Manage your account: r all your aai=!,t Kell! 4Va h :;o io .wru.`armers.con) to access c'45 o, emaa your accojntany time. krnezzettlg)1 armersaoert_^-r•' 55.6176 1st Edition 4.15 12/4/2018 Page 1 of 3 Evidence of Insurance State of California Named Registered David Vossbrink Owner(s): FARAMERS Polky Number. 185018226 Effective: 1/28/2019 Expiration: 7/28/2019 I(EEPVnTHVEHICLE NAIC Number: 21687 Your Agent; Kalil Walsh 451 Los Gatos Blvd Los Gatos, CA 95o32 Agent Phone: (408) 356-6845 Mid -Century Insurance company, Woodland Hills, CA, an aut'On*Zed Cai4iirnia Irs�rer, i, caI'Vianoewlth the CA"inancla ReswwtVifyAct(SeC,icn 16020 oftheveNcieCode), Dertres trat it ras'Issued a policy in an amount not less than teat requ red Ity the CA Franoai Respons'brityi aw br the 0escrioed motorveh;ce(s).'hisac. requires every _-wrier en er oroperator ora v6:ie to cart' evidence ortfnancal responsibility underVehlde Cra. Section 16025 Raney dr,ve, :,, ,d Ir. ar ar:'dant mist Provide eiderCe dfffrar c^ai respons:tantyat tr4a xe-,A- 9 KEEP THIS CERTIFICATE IN YOUR VEHICLE ATALL TIMES. READ REVERSE SIDE CAREFULLY. Em VTQ7004682 Evidence of insurance State of California Named Owner(s): FARMERS INSURANCE Policy Number: 185018226 Effective: l /28/2o19 Expiration: 7/28/2019 DMV REGLSTRATION COPY NAIL Number 21687 YOUrAgent: Kalil Walsh 451 Los Gatos Blvd Los Gatos, CA 9$032 Agent Phone: (408) 3566845 Mkl-Century Insurance company, Woodland HiR6 CA, an authorized Ca9brnia insurer, in COmPiancewlththe CAFirarr_iafR�pOns;tr[yq(Sectior.16020ofthavehicieCode),certlEes;hat it has issued a policy in an amount r 7t less Iran that required by the CA rlrar C:a! ResoarSC Pity Law for the descr;ted nator ve^icie(s). This act requtes erery owner or ape'W, atorota vehlizie to carry evidence crov,de ev reS ce off,'ity. Unaer Vehicle Code Sact'cn 16025 er±y drtrer ^vOlvei in an accktant must crov>de evidence ;f llnarrial resoons;Mityat the sCc+e, KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. READ REVERSE SIDE CAREFULLY