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19-029 Environmental Consulting Services, Noise Impact and Mitigation Study for Agape Christian Preschool CITY OF 0J PROFESSIONAL/CONSULTING SERVICES AGREEMENT CUPERTINO 1. PARTIES This Agreement is made and entered into as of November 20, 2018 ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and Environmental Consulting Services ("Contractor"), a corporation for noise impact and mitigation study for Agape Christian Preschool 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 i 3.1 This Agreement begins on the Effective Date and ends on June 30,2019 ("Contract Time"), unless terminated earlier as provided herein. Contractor's Services shall begin on March 18, 2019 and shall be completed by June 30, 2019 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here Exhibit B. 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 $2850 ("Contract Price"), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C, 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 10505 Miller Ave-Agape Christian Preschool Page 1 of 8 Professional/Consulting Contracts/Version:May 22,2018 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. i 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 10505 Miller Ave-Agape Christian Preschool Page 2 of 8 Professional/Consulting Contracts/Version:May 22,2018 i Q 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 10505 Miller Ave-Agape Christian Preschool J � Page 3 of 8 Professional/Consulting Contracts/Version:May 22,2018 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 or its subcontractors or sub-subcontractors; (d) Unauthorized use or disclosure of City's confidential and proprietary Information; (e) Claim of infringement 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 10505 Miller Ave-Agape Christian Preschool J Page 4 of 8 Professional/Consulting Contracts/version:May 22,2018 I 1 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 Erika Poveda 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 Stan Shelly 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 10505 Miller Ave-Agape Christian Preschool Page 5 of 8 Professional/Consulting Contracts/Version:May 22,2018 i 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 RESOLUTION 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. 20. WAIVER 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. Project 10505 Miller Ave-Agape Christian Preschool Page 6 of 8 Professional/Consulting Contracts/Version:May 22,2018 I 1 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 To Contractor: Environmental Consulting Services 10300 Torre Ave.,Cupertino CA 95014 18488 Prospect Road, Suite 1 Saratoga,CA 95070 Attention:Erika Povda Attention: Stan Shelly Email: erikap@cupertino.org Email:stanshe1199@toast.net 27. VALIDITY OF CONTRACT 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 10505 Miller Ave-Agape Christian Preschool Page 7 of 8 Professional/Consulting Contracts/Version:May 22,2018 28. EXECUTION The person executing this Agreement on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to enter into and carry out all actions contemplated 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 CITY OF CUPERTINO A Municipal Corporation By By ka�Aw Name TT//V �� L�7 Name Benjamin ru Title Title Interim Community Dev Director Date ' �"� Date Tax LD. No.: 77 - 00 67 PS APPROVED AS TO FORM: HEATHER M. MINNER Cupertino City Attorney ATTEST: GRACE SCHMIDT ll�q City Clerk / Project 10505 Miller Ave-Agape Christian Preschool Page 8 of 8 Pro Jessional/Consultinb Contracts lVesion:May 22,2018 Environmental Consulting Services 18488 Prospect Road—Suite 1, Saratoga, CA 95070 Phone: (408) 257-1045 stanshell99@toast.net February 28, 2019 Ms. Erika Poveda Assistant Planner City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 Re: Proposal for Noise Impact and Mitigation Study for Agape Christian Preschool at Creekside Community Church, 10505 Miller Avenue, Cupertino Dear Ms. Poveda, Exhibit A I appreciate the opportunity to respond to your request for a proposal for a noise study related to the new preschool use of the subject church facilities. The key noise issues to be evaluated are the potential noise impacts that could be produced in nearby residential areas by proposed preschool activities, particularly in the outside play areas around it. Ambient noise monitoring would be performed to support the assessment of noise impacts. General recommendations for noise mitigation measures would be developed, if any significant potential impacts are anticipated. The following is a suggested outline for the key elements of the noise study, which would meet City of Cupertino guidelines for preparation of noise impact reports. The relative effort for each phase of the proposed study is estimated in the table following: Data gathering and field monitoring 25% Analysis and modeling 30 Mitigation measure development 15 Report Preparation 30 Exhibit B & C Fees for the noise study would be based upon the actual time and materials required to complete the work described above, at a rate of$150 per hour plus expenses, but not exceeding $2850. The study and report generally can be completed within two weeks after go-head and receipt of all relevant project information, weather permitting convenient noise monitoring. I would need a scale site map and full project description, and how the facilities are to be used. I would need information about any new equipment to be installed for school use, and the anticipated number of kids and the daily activity schedules planned in the outdoor play areas. If there are specific City requirements related to noise, or other noise-related conditions of project approval, please let me know. An $900 retainer is requested as work on the project gets started. I would be responsible for all phases of the project as project manager. have over 35 years of experience in the noise analysis and mitigation field relating to community development and enhancement projects in the South Bay, San Benito, Santa Cruz, and Monterey Counties, and the greater San Francisco Bay area. I have completed several similar school projects in the past few years, including in Cupertino. I have attached a Statement of Qualifications for your information. A representative list of ECS noise studies completed can be provided on request. Noise Study Proposal for Agape Christian Preschool Project, Miller Ave 2 of 3 If you need more details on this proposal, or if the scope or estimated costs of the project are not satisfactory, please let me know immediately, so that we can make a mutually acceptable modification. If this study proposal is acceptable, an authorized signature below will allow this to serve as a Letter of Agreement and an authorization to enter the project site for noise measurements, and thereafter work can proceed at your convenience. I look forward to working with you and your team on this project. Sincerely, H. Stanton Shelly Acoustical Consultant Board Certified Member(1982) Institute of Noise Control Engineering Proposed Noise Study approved for Agape Christian Preschool project: + Signed W� L Date Li q Printed Name Title ' "`Ub 6 tyy Environmental Consulting Services Saratoga Noise Study Proposal for Agape Christian Preschool Project, Miller Ave 3 of 3 Statement of Qualifications H. Stanton Shelly-Acoustical Consultant Professional Interests and Capabilities Architectural noise control, exterior and interior, including California Green Noise Insulation Standards; machinery noise measurement, analysis, and control; traffic noise measurement and modeling; municipal noise ordinance development and enforcement;.land use planning for noise compatibility, including project environmental impact analysis and mitigation. Relevant Experience Developed and managed the municipal noise control program for the City of Palo Alto, including preparing a unique Noise Ordinance and a Noise Element for the Comprehensive Plan; as an independent consultant, prepared over three hundred noise impact assessment and mitigation studies for residential, commercial, industrial, and public facility projects. List of representative ECS noise studies available on request. Education and Training B.S.E. (Electrical Engineering) - University of Michigan M.S. Civil Engineering (Environmental) - Stanford University Institute of Noise Control Engineering (INCE): Associate Member since INCE founding in 1972. Board Certified Member since 1982. Professional Employment Principal Consultant, Environmental Consulting Services - 1977 to present Environmental Specialist, City of Palo Alto- 1971-1976 Systems Test Engineer, Eastman Kodak, Rochester, NY- 1967-1969 Electronic and Acoustical Test Engineer, General Dynamics/Astronautics, San Diego- 1963-1967 Environmental Consulting Services Saratoga EXHIBIT D Insurance Requirements Design Professionals & Consultants Contracts Consultant shall procure prior to commencement of Services and maintain for the duration of the contract, at its own cost and expense, the following insurance policies and coverage with companies doing business in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED 1. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04)or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i)the minimum coverage/limits specified in this agreement; or(ii)the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos)with limits no less than$1,000,000 per accident for bodily injury and property damage. 3. Workers'Compensation: As required by the State of California, with Statutory Limits and Employer's Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease. O Not required. Consultant has provided written verification of no employees. 4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant's profession, with limits no less than $2,000,000 per occurrence or$2,000,000 aggregate. If written on a claims made form: a. The Retroactive Date must be shown and must be before the Effective Date of the Contract. b. Insurance must be maintained for at least five (5) years after completion of the Services. c. If coverage is canceled or non-renewed,and not replaced with another claims-made policy form with a Retroactive Date prior to the Contract Effective Date, the Consultant must purchase"extended reporting" coverage for a minimum of five (5) years after completion of the Services. OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: Exh. D-Insurance Requirements for Design Professionals& Consultants Contracts Form Updated Feb. 2018 1 1 Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers ("Additional Insureds") are to be covered as additional insureds on Consultant's CGL policy. General Liability coverage can be provided in the form of an endorsement to Consultant's insurance (at least as broad as ISO Form CG 20 10(11/85)or both CG 20 10 and CG 20 37 forms, if later editions are used). Primary Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Consultant's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire,except with written notice to City 30 days in advance or 10 days in advance if due to non-payment ofpremiums. Waiver of Subrogation Consultant waives any right to subrogation against City/Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, the Workers' Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants. This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City's option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, claim administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, orbetter. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements(or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the right to demand verification of compliance at any time duringthe Contract term. Subconsultants Consultant shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant's insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above,City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice. Exh. D-Insurance Requirements for Design Professionals& Consultants Contracts Form Updated Feb. 2018 2 i ,aco CERTIFICATE OF LIABILITY INSURANCE F 0ATE(MMIDOfYYYY) 03/05/20 9 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(les)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 WHITTAKER INSURANCE AGENCY INC NAME': DENNIS WHITTAKER lic#0723052 lic#0468490 PAIC,HONNo,E Ext)&408-255-3212 (A/C.No):408-255-0259 StateFarTn 20395 PACIFICA DR SUITE 108 AO-DRRESS:DENNIS.WHITTAKER.B826 STATEFARM.COM (48,10 INSURERS AFFORDING COVERAGE NAIC# @ „. CUPERTINO, CA 95014 INSURER A:State Farm General Insurance Company 25151 INSURED H. STANTON SHELLY DBA ENVIRONMENTAL INSURER B: CONSULTING SERVICES INSURER C: 18488 PROSPECT RD STE 1 INSURER D: SARATOGA, CA 95070-3653 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR 7ypE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY 97-WK-2784-3 G 12/29/2018 12/29/2019 PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 7 PRCT O- LOC $ AUTOMOBILE LIABILITY —10 ❑ COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAR OCCUR El EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICEIMEMBER EXCLUDED? N/A❑ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under I r)F.RQ.R1PTIQN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADDITIONAL INSURED: The City of Cupertino,its City Council,officers,officials,employees,agents,servants and volunteers is Primary and Non-Contributory,with Waiver of Subrogation and 30 day waiting period CERTIFICATE HOLDER CANCELLATION The Cit of Cupertino, its City COUnC1I, officers, OCIBIS, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN employees, agents, servants and volunteers ACCORDANCE WITH THE POLICY PROVISIONS. 10300 TORRE AVENUE 10300CUPERTIRO, CA 95014 AUTHORIZ REPRES TATIV JA 111, 6,19A- 010 Ac4beD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo a e registered marks of ACORD 1001486 132849.8 01-23-2013 MTF Policy No. G 97 WK2784 3 2728—FA4C CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number:G 97 WK2784 3 Named Insured: SHELLY, H STANTON DBA ENVIRONMENTAL CONSULTING SERVICES 18488 PROSPECT RD STE 1 SARATOGA CA 95070-3653 Name And Address Of Additional Insured Person Or Organization: THE CITY OF CUPERTINO ITS CITY COUNCIL OFFICERS EMPLOYEES AGENTS SERVANTS AND VOLUNTEERS 10300 TORRE AVE CUPERTINO CA 95014 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", that which you are required by the contract "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: agreement to provide for such addition- aall insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products –Completed Operations fense or indemnity obligation by Cali- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or"suit" is tendered to us. ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CONTINUED CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur- made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION II — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de- we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION 11 — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad- Insurance shown in the Declarations. ditional insured, the following replaces SEC- TION 11 —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II —GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in- extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. MTF Policy No. G 97 WK2784 3 2728-FA4C CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: G 97 WK2784 3 Named Insured: SHELLY, H STANTON DBA ENVIRONMENTAL CONSULTING SERVICES 18488 PROSPECT RD STE 1 SARATOGA CA 95070-3653 Name And Address Of Person Or Organization: THE CITY OF CUPERTINO ITS CITY COUNCIL OFFICERS EMPLOYEES AGENTS SERVANTS AND VOLUNTEERS 10300 TORRE AVE CUPERTINO CA 95014 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD(YYYY) 03/03/2019 r 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(les) 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 CONTACT NAME: Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PHONE ( )88g 202-3007 FAX A/C No Ext): A/C Nol: 520 Madison Avenue -ADDRESS:32nd Floor S: contact@hiscox.com New York, NY 10022 INSURERS AFFORDING COVERAGE NAIC p INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B Environmental Consulting Services 18488 Prospect Road INSURER C: Suite 1 INSURER D: Saratoga CA 95070 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE ADDL SUBR Y EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1-1 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability UDC-4086382-EO-19 03/04/2019 03/04/2020 Each Claim: $1,000,000 Aggregate: $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Q)Allstate.. You're in good hands. Information as of September 21,2018 David N Grognota Policyholder(s) Page 1 of 2 70520 S.DeAnza#8 H Stanton Shell Il Cupertino CA 95074 y Policv number 034 495 865 Your Allstate agency is David N Gragnola IIIM111111111111111111111111111 11111 (408)252-3830 H STANTON SHELLY 11 davidgragnola@allstate.com 6377 COTTONWOOD CT CUPERTINO CA 95014-4620 Thank you for being a loyal Allstate customer—we're happy to have you with us! Here's your automobile insurance renewal offer for the next six months.I've also included a guide to what's in this package and answers to some common questions. Renewing your policy is easy Keep an eye out for your bill,which should arrive in a couple weeks.Just send your payment by the due date on your bill. If you're enrolled in the Allstate' Easy Pay Plan,you won't receive a bill—we'll send you a statement with your payment withdrawal schedule. How to contact us Give me a call at(408)252-3830 if you have any questions.It's my job to make sure you're in good hands. (ed.2) Sincerely, David N Gragnola Agent License Number: Your Allstate Agent 0594058 RA719-1 Renewal auto policy declarations Q)Allstate., Your policy effective date is November 13,2018 You're in good hands. Page 1of6 Total Amount Due for the Policy Period Information as of September 21,2018 Please review your insured vehicles and verify their VINs are correct. Summary Vehicles covered Identification Number(VIM) Premium Named Insureds) 2004 Infiniti G35 JNKCV51E24M108932 $608.81 H Stanton Shelly 11 2008 Toy.Truck Highlander JTEEW41A982003784 392.52 Mailing address California Fraud Assessment Fee 1,76 6377 Cottonwood _ Cupertino CA 95014-4620 Additional coverages 15.00 Cu P Total* $1,018.09 Policy number 034 495 865 *Your bill will be mailed separately.Before making a payment,please refer to your Your policy provided by latest bill,which includes payment options and installment fee information.If you do Allstate Northbrook Indemnity not pay in full,you will be charged an installment fee(s). Company See the Important payment and coverage information section for details about Policy period installment fees. Beginning November 13,2018 through May 13,2019 at 12:01 a.m.standard time Your Allstate agency is Discounts (included in your total premium) David N Gragnola Anti-theft $0.94 Good Driver(20%) $232.61 10520 S.De Anza#B Multiple Policy $48.36 Distinguished $56.47 Cupertino CA 95014 Driver (408)252-3830 Total discounts $338davidgragnola@allstate.com .38 Some or all of the information on your Policy Declarations is used in the rating Discounts per vehicle of your policy or it could affect your eligibility for certain coverages.Please 2004 Infiniti G35 $162.93 notify us immediately if you believe that Anti-theft $.43 Good Driver(20%) $134.48 any Information on your Policy Multiple Policy $28.02 Declarations is incorrect.We will make 2008 Toy.Truck Highlander $17S.g5 corrections once you have notified us, Anti-theft $,51 Good Driver(20%) $98.13 and any resulting rate adjustments,will Multiple Policy $20.34 Distinguished $56.47 be made only for the current policy Driver period or for future policy periods. Please also notify us immediately if you believe any coverages are not listed or Surcharge (included in your total premium) are inaccurately listed. 2004 Infiniti G35 • Minor Violation.12/26/2015 Listed drivers on your policy H Stanton Shelly Marile 0 Excluded drivers from your policy None a u ��ti� Policy number: y�u 034 495 865 Policy effective date: November 13,2018 Additional interested party A Certificate of Insurance was sent to: County of S C Re Agy 701 Ocean St 510 Santa Cruz, CA 95060-4015 California Water Svc 1720 N First Street San Jose, CA 95112-4508 City of Cupt Pghosh 1033 Torre Avenue Cupertino, CA 95014 0 0 U U F N o w 0 0 v 0 0 w n v rn O O O m_ 0 ry O W Q 0 0 Q v N X �m 0 O �0o O O m o O Q O O T O IV�O X �- Renewal auto policy declarations Policy number: 034495865 Page 3 of 6 Q)Allstate. Policy effective date: November 13,2018 You're in good hands. Coverage detail for 2004 Infiniti G35 Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $414.06 } Bodily Injury $1,000,000 each person $1,000,000 each occurrence Property Damage $100,000 each occurrence wAuto Collision Insurance Actual cash value $500 $114.97 Waiver of deductible applies Auto Comprehensive Insurance Actual cash value $0 $8.27 Rental Reimbursement Not purchased* a Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $1,000,000 each person Not applicable $64.45 Injury $1,000,000 each accident QD Automobile Medical Payments $2,000 each person Not applicable $7.06 Coordinated Medical Protection Not purchased* Lease/Loan Gap Not purchased* Repair or Replacement Cost Option Not purchased* (VSoundSystem Not purchased* Tape Not purchased* Total premium for 2004 Infiniti G35 $608.81 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JNKCV51E24M108932 Rating information Your premium is determined based on certain information, including the following: •This vehicle is driven for business use,married male licensed 61 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:6,500-6,999.The annual mileage figure applicable to this vehicle for the current policy period is:6,500-6,999. The following odometer information was used to determine your annual mileage for current policy period: Odometer Reading:136,500 Odometer Reading:142,680 Date:02/07/2017 Date:01/18/2018 If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. m 0 v Renewal auto policy declarations Page 4 of 6 Policy number: 034 495 865 Policy effective date: November 13,2018 Coverage detail for 2008 Toy. Truck Highlander Coverage Limits _ _ Deductible _ Premium Automobile Liability Insurance _ Not applicable $218.43 01071 Bodily Injury $1,000,000 each person $1,000,000 each occurrence Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $500 $97.44 Waiver of deductible applies . ........_ ........_ Auto Comprehensive Insurance Actual cash value $0 $9.67 V Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $1,000,000 each person Not applicable $60.98 Injury $1,000,000 each accident Automobile Medical Payments $2,000 each person Not applicable $6.00 Coordinated Medical Protection Not purchased* Lease/Loan Gap Not purchased* Repair or Replacement Cost Option Not purchased* Sound System Not purchased Tape Not purchased* Total premium for 2008 Toy.Truck Highlander $392:52 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JTEEW41A982003784 Rating information Your premium is determined based on certain information, including the following: •This vehicle is driven 10-20 miles to work/school,married 0 female licensed 56 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:9,500-9,999.The zz annual mileage figure applicable to this vehicle for the current policy period is:9,500-9,999. o 0 The following odometer information was used to determine your annual mileage for current policy period: Odometer Reading:97,300 Odometer Reading:106,605 0 Date:02/07/2017 Date:01/18/2018 0 tV T If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate o representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. V X x rn rn� �a 0 m0m p m 4 O Q o _ O O�O N�O X.-r Contractor/Consultant Affidavit of No Employees State of California County of Santa CIara City of Cupertino 1, the undersigned, declare as follows: I am an independent contractor and the owner of lv�if k 0 IV M E K'74 L �� t.'gy I—nk.!C, 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 S day of kl14-12-Cq 2019, at S kR A IT C,-A- , California. :E�7A�,i T A� S,ll E V PRINT NAVE Al 0/ t',/ i' SIGNATURE Revised 1.01.19 e®0 HISCOX encourage courage- Hiscox Insurance company Inc. GET THE RIGHT INSURANCE, RIGHT NOW Your Insurance documents Enclosed you will find the policy documents that make up your insurance contract with us. Please read through all of these documents. If you have any questions or need to update any of your information please call us at 888-202-3007(Mon-Fri, 8am-10pm EST). insuranceYour documents Declarations Page This contains specific policy information, such as the limits and deductibles you have selected. Policy Wording This details the terms and conditions of your coverage, subject to policy endorsements. Endorsements These documents modify the Policy Wording or Declarations Page. These include relevant terms and conditions as required by your state and are part of your policy. Notices These documents provide information that may affect your coverage such as optional terrorism coverage(if purchased)and other important items required by your state. Application Summary This is a summary of the information that you provided to us as part of your application. Please review this document and let us know if any of the information is incorrect. Reporting Please inform us immediately if you have a claim or loss to report. Please have your policy number available so we can handle your call quickly. Email: reportaclaim@hiscox.com Phone: 866-424-8508 Mail: Attn: Direct Claims H iscox 520 Madison Avenue-32nd Floor New York, NY, 10022 HISCOX encourage courage- GET THE RIGHT INSURANCE,RIGHT NOW Declarations Page 40 H I SCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage 104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 Professional Liability Insurance Declarations This is a "Claims Made and Reported" Policy in which Claim Expenses are included within the Limit of Liability unless otherwise noted. Those words (other than the words in the captions)which are printed in Boldface are defined in the Policy. Policy No.: UDC-4086382-EO-19 1. Named Insured: Environmental Consulting Services 2. Address: 18488 Prospect Road Suite 1 Saratoga, CA 95070 3.A. Limit of Liability: $ 1,000,000 Each Claim 3.B. $ 1,000,000 Aggregate for all Claims 4. Deductible: $500 Each Claim 5. Notice: Phone: 866-424-8508 Email: reportaclaim@hiscox.com Mail: Hiscox 520 Madison Avenue-32nd Floor Attn: Direct Claims New York, NY, 10022 6. Policy period: From: March 4, 2019 To: March 4, 2020 At 12:01 A.M. (Standard Time)at the address shown above. 7. Retroactive Date: March 4, 2019 8. Premium: $563.00 9. Attachments: DPL D001 CW(01/10)-Professional Liability Errors&Omissions Insurance Declarations DPL P001 CW(05/13)- Professional Liability Coverage Form DPL E5164 CW(09/15)-Architects, Engineers and Drafting Services Endorsement DPL E5102 CA(01/10)-California Amendatory Endorsement DPL E5424 CW(02/15)-Blanket Additional Insured Endorsement(PL) INT N001 CW(01/09)-Economic And Trade Sanctions Policyholder Notice DPL D001 CW(01/10) Page 1 H ISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage 104 South Michigan Avenue,Suite 600, Chicago, Illinois 60603 IN WITNESS WHEREOF,the Insurer indicated above has caused this Policy to be signed by its President and Secretary,but this Policy shall not be effective unless also signed by the Insurer's duly authorized representative. 1 a President yt Secretary J Authorized Representative DPL D001 CW(01/10) Page 2 C)TO H I SCOX encourage courage, GET THE RIGHT INSURANCE, RIGHT NOW Policy Wori HISCOX PROFESSIONAL LIABILITY - US DIRECT ERRORS AND OMISSIONS INSURANCE ©Hiscox Inc.All rights reserved. DPL P001 CW(05/13) Ott PROFESSIONAL LIABILITY - US DIRECT HISCOX ERRORS AND OMISSIONS ABOUT THIS POLICY The Hiscox Professional Liability—US Direct policy is designed to offer coverage for the risks entities face in performing their Professional Services. We urge You to read this Policy carefully so You understand the insurance that You have purchased, and the full extent of Your and Our rights and duties under this Policy. Please note that all words and phrases that appear in bold-type (except headings) have special meaning and are defined in the Definitions section of this Policy. Coverage for all Claims is subject to the entire terms and conditions of the policy. Coverage for Claims Made Against You You have purchased insurance that provides coverage for Claims made against You. We will pay Damages on Your behalf for any Claim that falls within the Insuring Agreement and within all of the terms and conditions outlined in the policy. Covered Claims are for Your Wrongful Acts in providing or failing to provide Professional Services. To determine who is an Insured please refer to the Definitions and Spousal and Domestic Partner section of the policy. Additionally, for coverage to apply, You must comply with all Your obligations as outlined in the Notice of Claims, Notice of Potential Claims, and the rest of the policy. The most We will pay is outlined in the Limits of Liability Section and items We will not pay are outlined in the Exclusions section. You are responsible for payments as outlined in the Deductible section. DPL P001 CW05/13 2 � ) ©Hiscox Inc.All rights reserved. PROFESSIONAL LIABILITY - US DIRECT H I SCOX I , �n In consideration of the premium charged and in reliance on the statements made and information provided to Us, including but not limited to the statements made and information provided in and with the Application, which is made a part of this Policy, as well as subject to the Limits of Liability, the Deductible and all of the terms, conditions, limitations and exclusions of this Policy, We and You agree as follows: 1. INSURING DEFENSE AND SETTLEMENT A. INSURING AGREEMENT We shall pay on Your behalf Damages and Claim Expenses in excess of the Deductible resulting from any covered Claim that is first made against You during the Policy Period and reported to Us pursuant to the terms of the Policy for Wrongful Acts committed on or after the Retroactive Date. We shall also pay on Your behalf all Supplemental Payments in connection with any covered Claim that is first made against You during the Policy Period and reported to Us pursuant to the terms of the Policy for Wrongful Acts committed on or after the Retroactive Date. No Deductible shall apply to Supplemental Payments. B. DEFENSE 1. We shall have the right and the duty to defend any covered Claim, even if such Claim is groundless,false or fraudulent. 2. We shall have the right to appoint defense counsel upon being notified of such Claim. 3. Notwithstanding paragraph 2., We shall have no obligation to pay Claim Expenses until You have satisfied the applicable Deductible. 4. Our duty to defend shall terminate upon the exhaustion of the Limit of Liability as set forth in Item 3. of the Declarations. C. SETTLEMENT 1. We shall have the right to solicit and negotiate settlement of any Claim. 2. We shall not, however, enter into a settlement without Your prior consent, which consent shall not be unreasonably withheld. 3. If You shall refuse to consent to any settlement recommended by Us, Our liability for such Claim shall not exceed the amount for which such Claim could have been settled plus Claim Expenses incurred up to the date of such refusal. DPL P001 CW(05/13) 3 ©Hiscox Inc.All rights reserved. Aev PROFESSIONAL LIABILITY — US DIRECT H I SCOX ERRORS AND OMISSIONS POTENTIAL11. NOTICE OF CLAIMS AND NOTICE OF CLAIMS A. NOTICE OF CLAIMS 1. As a condition precedent to any coverage under this Policy, You shall give written notice to Us of any Claim as soon as practicable, but in all events no later than: a. the end of the Policy Period (or any purchased Optional Extended Reporting Period); or b. 60 days after the end of the Policy Period (or any purchased Optional Extended Reporting Period) so long as such Claim is made within the last 60 days of such Policy Period (or any purchased Optional Extended Reporting Period). 2. Such notice shall be sent to Us at the address set forth in Item 5. of the Declarations. 3. Such notice shall include any and all documents related to such Claim, including every demand, notice, summons or other applicable information received by You or by Your representative. B. NOTICE OF POTENTIAL CLAIMS If You first become aware during the Policy Period of any Wrongful Act that might be reasonably likely give rise to a covered Claim, You may give written notice to Us of such potential Claim during the Policy Period. Such notice must include to the fullest extent possible: 1. the identity of the potential claimant; 2. the identity of the person(s)who allegedly committed the Wrongful Act; 3. the date of the alleged Wrongful Act; 4. specific details of the alleged Wrongful Act; and 5. any written notice from the potential claimant describing the Wrongful Act. If such notice is accepted as a "potential Claim," then any actual Claim that is subsequently made shall be deemed to have been first made on the date such "potential Claim"was first reported to Us. Provided, however, You may not report "potential Claims" during any purchased Optional Extended Reporting Period. C. OPTIONAL EXTENDED REPORTING PERIOD 1. If We or the Named Insured cancel or non-renew this Policy (as described by Endorsement hereto), then the Named Insured shall have the right to purchase for an additional premium an Optional Extended Reporting Period. Provided, DPL P001 CW05/13 4 � ) ©Hiscox Inc.All rights reserved. 40 PROFESSIONAL LIABILITY � — ---- - HISCOX 77PORTS AM.n MAISSIONS however, the right to purchase an Optional Extended Reporting Period shall not apply if: a. this Policy is canceled by Us for nonpayment of premium (as described by Endorsement hereto); or b. the total premium for this Policy has not been fully paid. 2. The Optional Extended Reporting Period will apply only to Claims that: a. are first made against You and reported to Us during such Optional Extended Reporting Period; and b. are for Wrongful Acts committed on or after the Retroactive Date but prior to the effective date of cancellation or non-renewal (as described by Endorsement hereto). 3. The additional premium for such Optional Extended Reporting Period shall not exceed 200% of the annualized expiring premium for an Optional Extended Reporting Period of 3 years. The additional premium for such Optional Extended Reporting Period shall be fully earned at the inception of such Optional Extended Reporting Period. 4. Notice of election and full payment of the additional premium for the Optional Extended Reporting Period must be received within 30 days after the effective date of cancellation or non-renewal (as described by Endorsement hereto). In the event the additional premium is not received within the 30 days, any right to purchase the Optional Extended Reporting Period shall lapse and no further Optional Extended Reporting Period shall be offered. The Limits of Liability applicable during any purchased Optional Extended Reporting Period shall be the remaining available Limits of Liability under this canceled or non-renewed Policy (as described by Endorsement hereto). There shall be no separate or additional Limit of Liability available for any purchased Optional Extended Reporting Period and the purchase of any Optional Extended Reporting Period shall in no way increase the Limit of Liability set forth in Item 3. of the Declarations. EXCLUSIONS This Policy does not apply to and We shall have no obligation to pay any Damages, Claim Expenses or Supplemental Payments for any Claim: A. based upon or arising out of any actual or alleged fraud, dishonesty, criminal conduct, or any knowingly wrongful, malicious, or intentional acts or omissions; provided, however,that: 1. We will pay Claim Expenses until there is a final adjudication establishing such conduct, at which time You shall reimburse Us for such Claim Expenses; and 2. this exclusion shall not apply to otherwise covered intentional acts or omissions resulting in a Personal Injury. DPL P001 CW(05/13) 5 ©Hiscox Inc.All rights reserved. PROFESSIONAL LIABILITY - H I SCOX FRRORS AND OMISSIONS j B. based upon or arising out of any actual or alleged gaining of any profit or advantage to which You were not legally entitled. C. based upon or arising out of any actual or alleged wrongful termination, retaliation or discrimination against or harassment of any past, present, future or potential Employee, including but not limited to any violations of federal, state or local statutory or common law. D. based upon or arising out of any actual or alleged Wrongful Act that: 1. was committed prior to the Retroactive Date; 2. has been the subject of any notice given under any other policy of which this Policy is a renewal or replacement; or 3. You had knowledge of prior to the Policy Period and had a reasonable basis to believe that such Wrongful Act could give rise to a Claim; provided, however, that if this Policy is a renewal or replacement of a previous policy issued by Us providing materially identical coverage, the Policy Period referred to in this paragraph will be deemed to refer to the inception date of the first such policy issued by Us. E. brought by or on behalf of any federal, state or local government agency or professional or trade licensing organization; provided, however, this exclusion shall not apply to claims brought in their capacity as a client receiving Your Professional Services. F. brought by or on behalf of one Insured against another Insured. G. brought by or on behalf of any person or entity maintaining Effective Control of You. H. based upon or arising out of any actual or alleged violation of the following laws, including any similar provisions of any federal, state or local statutory or common law: 1. the Securities Act of 1933 (as amended); 2. the Securities Exchange Act of 1934 (as amended); 3. any state blue sky or securities laws (as amended); 4. the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. § 1961 et seq. (as amended); 5. the Employee Retirement Income Security Act of 1974 (as amended); including any rules or regulations promulgated thereunder. I. based upon or arising out of any actual or alleged obligation under any Workers' Compensation, Unemployment Compensation, Employers Liability or Disability Benefit Law, including any similar provisions of any federal, state or local statutory or common law. J. based upon or arising out of any actual or alleged liability of others that You assume under any contract or agreement unless such liability would have attached in the absence of such contract or agreement. DPL P001 CW(05/13) 6 ©Hiscox Inc.All rights reserved. V$11 PROFESSIONAL LIABILITY ® [JS DIRECT HISCOX OMISSIONS K. based upon or arising out of any actual or alleged Bodily Injury or Property Damage. L. based upon or arising out of any actual, alleged or threatened discharge, dispersal, release or escape of Pollutants, including any direction or request to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize Pollutants. M. based upon or arising out of any actual or alleged infringement of any copyright, trademark, trade dress, trade name, service mark, service name, title, slogan or patent or theft of trade secret. N. based upon or arising out of any actual or alleged false or deceptive advertising of Your goods or services or misrepresentation in advertising of Your goods or services, including but not limited to any wrongful description of prices of Your goods or services or the quality or performance of Your goods or services. O. based upon or arising out of any actual or alleged breach of contract or breach of any implied or express warranty or guarantee; provided, however, this Exclusion shall not apply to: 1. any obligation you have to perform your Professional Services with reasonable skill or care; or 2. any liability You would have had in absence of such contract, warranty or guarantee. P. based upon or arising out of any actual or alleged violation of any federal, state or local statutes, ordinances or regulations regarding or relating to unsolicited telemarketing, solicitations, emails, faxes or any other communications of any type or nature, including but not limited to any "anti-spam" and "do-not-call' statutes, ordinances, or regulations. Q. based upon or arising out of any actual or alleged failure to procure or maintain adequate insurance or bonds. R. based upon or arising out of any actual or alleged failure to protect any non-public, personally identifiable information in Your care, custody or control. S. based upon or arising out of any actual or alleged actuarial services, medical or nursing services, insurance agent/broker services, legal services or services as an architect or engineer. IV. LIMITS OF LIABILITY, DEDUCTIBLE AND RELATED CLAIMS A. LIMIT OF LIABILITY DPL P001 CW(05/13) ©Hiscox Inc.All rights reserved. PROFESSIONAL LIABILITY ® US DIRECT H I SCOX ERRORS AND OMISSIONS Regardless of the number of Claims made during the Policy Period (or applicable Extended Reporting Period), the maximum that We shall be liable to pay for all covered Damages, Claim Expenses and Supplemental Payments shall be as follows: 1. The amount set forth in Item 3.A. of the Declarations as "Each Claim" shall be the maximum amount for each covered Claim. 2. The amount set forth in Item 3.B. of the Declarations as "Aggregate for all Claims" is the maximum amount for all Claims combined. 3. Notwithstanding 1. and 2. above, Our liability for Supplemental Payments shall not exceed $250 per day for each Insured up to $5,000 per Claim, which amounts shall reduce the amounts described in 1. and 2. above. B. DEDUCTIBLE 1. We shall not be responsible for payment of Damages or Claims Expenses until the Deductible amount has been satisfied. 2. We may at Our discretion advance payment of Damages or Claims Expenses within the Deductible amount on Your behalf, but You shall reimburse Us for any such amounts as soon as We request such reimbursement. 3. No Deductible amount shall apply to Supplemental Payments. C. RELATED CLAIMS For purposes of the applicable Deductible and Limit of Liability, all Claims based upon or arising out of continuous, repeated, related or interrelated Wrongful Acts shall be considered a single Claim first made against You in the Policy Period the first such Claim was made. V. OTHER MATTERS AFFECTING COVERAGE A. ESTATES, HEIRS, LEGAL REPRESENTATIVES, SPOUSES & DOMESTIC PARTNERS This Policy shall apply to Claims brought against: 1. the heirs, executors, administrators, trustees in bankruptcy, assignees and legal representatives of any Insured in the event of such Insured's death or disability; or 2. the legal spouse or legal domestic partner of any Insured; but only: 1. for the Wrongful Acts of such Insured; or DPL P001 CW(05/13) 8 ©Hiscox Inc.All rights reserved. 40 PROFESSIONAL LIABILITY -- CJS DIRECT HISCOX F O ,(; ANn OMISSIONS i 2. in connection with their ownership interest in property which the claimant seeks as recovery for actual or alleged Wrongful Acts of such Insured. B. INSURED DUTY TO COOPERATE You shall have the duty to cooperate with Us in the defense, investigation and settlement of any Claim, including but not limited to: 1. upon request, submit to examination and interrogation under oath by Our representative; 2. attend hearings, depositions and trials as requested by Us; 3. assist in securing and giving evidence and obtaining the attendance of witnesses; 4. provide written statements to Our representative and meet with such representative for the purpose of investigation and/or defense; and 5. provide all documents We may reasonably require. C. INSURED OBLIGATION NOT TO INCUR EXPENSE OR ADMIT LIABILITY You shall not, except at Your own cost, make any payment, incur any expense, admit any liability, settle any Claim or assume any obligation without Our prior consent. D. ACTION AGAINST THE INSURER No action shall be taken against Us unless: 1. You have complied fully with all the terms and conditions of this Policy; and 2. the amount of Your obligation to pay shall have been finally determined either by judgment against You after actual trial, or by written agreement between You, Us and the claimant. No person or organization shall have any right under this Policy to join Us as a party to any Claim against You nor shall We be impleaded by You or Your legal representatives in any such Claim. E. OTHERINSURANCE This Policy shall be excess insurance over any other valid and collectable insurance available to You, whether such other insurance is stated to be primary, contributory, excess, contingent or otherwise, unless such other insurance is written only as a specific excess insurance over the Limit of Liability provided in this Policy. F. SUBROGATION 1. In the event of any payment by Us under this Policy,We shall be subrogated to all of Your rights of recovery to such payment. 2. You shall do everything that may be necessary to secure and preserve such subrogation rights, including but not limited to the execution of any documents necessary to allow Us to bring suit in Your name. DPL P001 CW(05113) 9 ©Hiscox Inc.All rights reserved. HISCOX 3. You shall do nothing to prejudice such subrogation rights without first obtaining Our written consent. 4. Any recovery shall first be paid to Us up to the amount of any Damages, Claim Expenses or Supplemental Payments that We have paid. Any remaining amounts shall be paid to You. 5. Notwithstanding the above, no subrogation shall be had against any Insured. G. ALTERATION AND ASSIGNMENT No change in, modification of or assignment of interest under this Policy shall be effective unless made by written endorsement to this Policy signed by Our authorized representative. H. REPRESENTATIONS As a condition precedent of Our obligations under this Policy, You represent that: 1. the statements and representations made by You in the Application are true and are the basis of the Policy and are to be considered as incorporated into and constituting a part of this Policy; 2. the statements and representations made by You in the Application shall be deemed material to the acceptance of the risk assumed by Us under the Policy; 3. this Policy is issued in reliance upon the truth of the statements and representations made by You in the Application; and 4. in the event the Application contains misrepresentations which materially affect the acceptance of the risk assumed by Us under this Policy, this Policy shall be void ab initio. I. BANKRUPTCY OR INSOLVENCY Your bankruptcy or insolvency shall not relieve Us of any of Our obligations under this Policy. J. TERRITORY This Policy shall apply to Wrongful Acts committed anywhere in the world, provided that any action, arbitration, or other proceeding for, in relation to, or arising from the Claim is brought within the United States, its territories or possessions, or Canada. K. FALSE OR FRAUDULENT CLAIMS If any Insured shall commit fraud in proffering any Claim or regarding the amount or otherwise, this Insurance shall become void as to such Insured from the date such fraudulent claim is proffered. L. NAMED INSURED RESPONSIBILITIES DPL P001 CW(05/13) 10 ©Hiscox Inc.All rights reserved. IRECT U UU�~�~~ ^t�j?� ��`s��/� �~� U�� ^ -` '^� ~`^�"^`~ ' ' ' -- -- _ - - _��_-_�__-______��____�� It shall be the responsibility of the Named Insured to act on behalf ofall other Insureds with respect tothe following: 1. giving and receiving notice nfcancellation and/or non-renewal (as described by Endorsement hereto); 2. payment ofpremium 3. receipt ofreturn premiums; 4. acceptance ofchanges to this Po|iny� and 5. payment ofDeductibles. M. EXAMINATION OFYOUR BOOKS AND RECORDS VVemay examine and audit Your books and records as they related to this Policy at any time during the Policy Period (or any purchased '5pdono| Extended Reporting Period) or up to three years after the end of the Policy Period (or any purchased Optional Extended Reporting Porimd). N. TITLES Titles of aanUonm of and endorsements to this Policy any inserted on}e|y for convenience of reference and ehoU not bedeemed to |imit, expand or otherwise affect the provisions towhich they relate. A. DEFINITIONS A. Application means the signed application for the Policy, whether submitted on-line, over the phone or on pnper, including any attachments and other materials or statements submitted in conjunction therewith. If this Policy is a renewal or replacement of previous policy or policies issued by Ue. Application shall also include all signed applications and other materials that were submitted therewith and attached thereto. B. Bodily Injury means physical injury to or sickness, disease or death of peronn, or mental injury, mental anguioh, emotional diatreoo, pain or muffering, or shock sustained byoperson. C. Claim means any written demand for Damages orfor non-monetary relief. D. Claim Expenses means the following that are incurred by Us or by You with Our prior written consent: 1. all reasonable and necessary fees, costs and expenses (including the fees of attorneys and experts) incurred in the inveotigadion, defense and appeal of C(aim` and 2. premiums on appeal bonda, attachment bonds or similar bond. Provided. however, We uhoU have no obligation to apply for orfurnish any such bonds. Claim Expenses shall not mean and Weshall not beobligated topay: 1. salaries, wages orexpenses other than Supplemental Payments; or PROFESSIONAL LIABILITY - H I SCOX FRPORS AND OMISSIONS 2. the defense of any criminal investigation, criminal grand jury proceeding, or criminal action. E. Damages means a monetary judgment or monetary award that You are legally obligated to pay (including pre- or post-judgment interest) or a monetary settlement negotiated by Us with Your consent. Damages shall not mean and We shall not be obligated to pay: 1. fines, penalties, taxes, sanctions levied against You; 2. any punitive or exemplary damages or that portion of any multiplied damages award which exceeds the damage award so multiplied, provided, however, that, if such damages are otherwise insurable under applicable law and regulation, We will pay an award of punitive or exemplary damages in excess of the Deductible and up to a maximum sum of$250,000. This limit shall be a part of and not in addition to the Limit of Liability set forth in Items 3. of the Declarations; 3. the return, reduction or restitution of Your fees, commissions, profits, or charges for goods provided or services rendered, including any over-charges or cost over-runs; 4. liquidated damages; or 5. Your cost of complying with injunctive relief. F. Effective Control means: 1. ownership of more than 50% of the issued and outstanding voting securities; or 2. having the right pursuant to written contract, by-laws, charter, operating agreement or similar documents to elect, appoint or designate a majority of the board of directors, management committee members of a partnership or the members of the management board of a limited liability company (or equivalent management structure). G. Employee means any past, present or future: 1. employee (including any part-time, seasonal or temporary employee or any volunteer); 2. partner, director, officer, member or board member(or equivalent position); 3. independent contractor; or 4. leased worker; of an Organization, but only in their performance of Professional Services on behalf of or at the direction of such Organization. H. Insured means You or Your. I. Named Insured means the individual, corporation, partnership, limited liability company, limited partnership, or other entity set forth in Item 1 of the Declarations. J. Optional Extended Reporting Period means any applicable Optional Extended Reporting Period contemplated by the OPTIONAL EXTENDED REPORTING PERIOD Clause. DPL P001 CW(05/13) 12 ©Hiscox Inc.All rights reserved. �� I H I SCOX l __ K. Organization means the Named Insured and any Subsidiary. L. Personal Injury means injury, other than Bodily Injury, arising out of one of more of the following offenses: 1. false arrest, detention or imprisonment; 2. malicious prosecution; 3. wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of premises; 4. slander, libel, defamation or disparagement of goods, products or services; or 5. oral or written publication of material in connection with Your advertising that violates a person's right of privacy. M. Policy Period means the period of time set forth in Item 6. of the Declarations. N. Pollutants means any solid, liquid, gaseous, biological, radiological or thermal irritant or contaminant, including smoke, vapor, dust, fibers, mold, spores, fungi, germs, soot, fumes, acids, alkalis, chemicals and Waste. "Waste" includes, but is not limited to, materials to be recycled, reconditioned or reclaimed and nuclear materials. O. Professional Services means only those services specified in Endorsement to this Policy as performed by or on behalf of an Organization for others for a fee or other compensation. P. Property Damage means physical loss of or physical damage to or destruction of any tangible property, including the loss of use thereof. For purposes of this definition, "tangible property' shall not include electronic data. Q. Retroactive Date means the date set forth in Item 7. of the Declarations. R. Subsidiary means: 1. any entity of which the Named Insured has Effective Control ("Controlled Entity") on or before the Policy Period, either directly or indirectly through one or more Controlled Entities; 2. any entity of which the Named Insured forms or acquires Effective Control during the Policy Period, either directly or indirectly through one or more Controlled Entities, but only for the first 90 days after such formation or acquisition (or until the end of the Policy Period, whichever is earlier). Provided, however, with respect to a Subsidiary described in paragraph 2. of this definition, We shall only cover Claims alleging Wrongful Acts committed while the Named Insured had Effective Control of such Subsidiary, either directly or indirectly through one or more Controlled Entities. An entity ceases to be a Subsidiary once the Named Insured no longer has Effective Control of such entity, either directly or indirectly through one or more Controlled Entities, and this Policy will not respond to Claims made against such entity thereafter. DPL P001 CW(05/13) 13 ©Hiscox Inc.All rights reserved. 40 PROFESSIONAL LIABILITY ® US DIRECT HIVVO/ \ S. Supplemental Payments means the reasonable expenses incurred by You, including loss of wages, if You are required by Us to attend arbitration proceedings or trial in the defense of a covered Claim. T. We, Us, Our or Insurer means the insurance company set forth in the Declarations. U. Wrongful Act means any actual or alleged breach of duty, negligent act, error, omission or Personal Injury committed by You in the performance of Your Professional Services. V. You or Your means any: 1. Organization; 2. Employee; 3. joint venture in which an Organization participates pursuant to written agreement, but only for: a. Wrongful Acts committed by such Organization; and b. the percentage of otherwise covered Damages and Claims Expenses in proportion to such Organization's participation in the joint venture. DPL P001 CW(05/13) 14 ©Hiscox Inc.All rights reserved. Q)TO HISCOX encourage courage` GET THE RIGHT INSURANCE,RIGHT NOW Endor ns Hiscox Insurance Company Inc. HISCOX encourage courage Endorsement 1 NAMED INSURED: Environmental Consulting Services E5164.2 Architects. Engineers and Drafting Services Endorsement Page 1 of 4 In consideration of the premium charged, it is understood and agreed that the Policy is amended as follows: 1. In Clause VI. DEFINITIONS, paragraph 0., "Professional Services," is amended to read as follows: 0. Professional Services means the below list services performed for others for compensation: 1. architectural services; 2. engineering services; and/or 3. drafting services. 2. In Clause VI. DEFINITIONS, paragraph C., "Claim,"is amended to include the following at the end thereof: Claim will also include any Pollution Liability Claim. 3. Clause VI. DEFINITIONS is amended to include the following at the end thereof: AE-A. Pollution Liability Claim means a Claim against You arising out of any actual, alleged, or threatened discharge, dispersal, release, or escape of Pollutants directly resulting from Your performance of Professional Services and includes the reasonable and necessary fees, costs, and expenses You incur with Our prior consent to test for, monitor, clean up, remove, contain, treat, detoxify, or neutralize Pollutants. 4. In Clause III. EXCLUSIONS, paragraph E. is deleted in its entirety and replaced with the following: E. brought by or on behalf of any federal, state, or local government agency or professional, or trade licensing organization; provided, however, this exclusion will not apply to: 1. Claims brought in their capacity as a client receiving Your Professional Services; or 2. administrative or disciplinary proceedings coverage as described in this Endorsement. 5. Clause III. EXCLUSIONS, paragraph K. is deleted in its entirety and replaced with the following: K. based upon or arising out of any actual or alleged Bodily Injury to an Insured or to any employee of an Insured. 6. Clause III. EXCLUSIONS, paragraph L. is deleted in its entirety and replaced with the following: L. based upon or arising out of any actual, alleged, or threatened discharge,dispersal, release, or escape of Pollutants, including any direction or request to test for, monitor, clean up, remove, contain,treat, detoxify, or neutralize Pollutants; provided, however,this exclusion will not apply to Pollution Liability Claims. 7. Clause III. EXCLUSIONS, paragraph S. is deleted in its entirety and replaced with the following.- S. ollowing:S. based upon or arising out of any actual or alleged actuarial services, medical or nursing services, insurance agent/broker services, legal services, or services as an architect or engineer; provided, however, this exclusion will not apply to Claims based upon or arising out of Your Professional Services. 8. Clause III. EXCLUSIONS is amended to include the following at the end thereof: Hiscox Insurance Company Inc. HISCOX encourage courage Endorsement 1 NAMED INSURED: Environmental Consulting Services E5164.2 Architects Engineers and Drafting Services Endorsement Page 2 of 4 This Policy does not apply to and We will have no obligation to pay any Damages, Claim Expenses, or Supplemental Payments for any Claim: AE-A. based upon or arising out of any tangible goods or products fabricated, manufactured, sold, handled, or distributed by You or anyone on Your behalf; AE-B. based upon or arising out of Your performance of or failure to perform Construction or Construction-related services including, but not limited to, any management, supervision, or monitoring services on projects where You are also directly performing any Construction. For purposes of this exclusion, Construction will mean assembling material, erection,excavation, fabrication, installation, demolition, or other similar or related work or services on any structure, facility, element, or component of whatever nature or size; AE-C. based upon or arising out of any actual or alleged failure to procure or maintain adequate insurance or bonds; AE-D. based upon or arising out of Your performance of or failure to perform Professional Services in connection with the construction, reconstruction,demolition, renovation or any other construction-related activities for the following: 1. amusement rides, pools, or playgrounds; 2. bridges,dams, harbors, mines, piers,or tunnels; 3. condominiums; 4. foundation, sheeting, or retaining walls; or 5. underground storage tanks or utilities; AE-E. based upon or arising out of Your performance of or failure to perform Professional Services in connection with any: 1. emergency response; 2. clean up of hazardous waste; or 3. professional remediation services; AE-F. based upon or arising out of induced hydraulic fracturing, hydrofracturing, or fracking; AE-G. based upon or arising out of Your performance of or failure to perform inspection services related to any residential real estate transaction; AE-H. based upon or arising out of any laboratory testing; AE-I. based upon or arising out of any land surveying, boundary surveying, or construction staking; AE-J. based upon or arising out of Your performance of or failure to perform the following types of engineering services: 1. geotechnical/soils; 2. marine; 3. mechanical; Hiscox Insurance Company Inc. 40 HISCOX encourage courage- Endorsement 1 NAMED INSURED: Environmental Consulting Services E5164.2 Architects.Engineers and Drafting Services Endorsement Page 3 of 4 4. mining; 5. nuclear; 6. oil/gas/well,- 7. il/gas/well;7. petro/chemical; or 8. structural; AE-K. based upon or arising out of the design, testing, manufacture, mining, use, sale, installation, distribution, containment, or removal of asbestos, asbestos products, asbestos fibers, or asbestos dust; provided, however,this exclusion will not apply to any Claim made against You based upon or arising out of Your performance of Professional Services in connection with the specification of a product, material, or equipment containing asbestos, subject to a sublimit of liability of$200,000,which will be part of and not in addition to, any applicable Limit of Liability; 9. Clause IV. LIMITS OF LIABILITY,DEDUCTIBLE,AND RELATED CLAIMS is amended to include the following at the end thereof: AE-A. Notwithstanding anything in the Policy to the contrary,We will pay Damages and Claim Expenses in excess of the Deductible up to$200,000 per Claim for Pollution Liability Claims. Such sublimit of liability will be a part of, and not in addition, any applicable Limit of Liability. AE-B. FHA/OSHA/ADA REGULATORY PROCEEDING COVERAGE We will reimburse You up to$5,000(the"FHA/OSHA/ADA Proceeding Sublimit')for the reasonable and necessary expenses incurred by You with Our prior written consent in the investigation, defense, or appeal of a regulatory or administrative proceeding against You arising out of any actual or alleged violation of the Fair Housing Act(FHA), Occupational Safety and Health Act(OSHA),Americans with Disabilities Act of 1990(ADA), or any state law equivalents,for a regulatory or administrative proceeding first brought against You during the Policy Period for any Wrongful Acts committed or allegedly committed on or after the Retroactive Date and reported to Us in accordance with Clause II. NOTICE OF CLAIMS AND NOTICEOF POTENTIAL CLAIMS. We will have the right, but not the duty,to assume the defense of such regulatory or administrative proceedings as described above. Notwithstanding anything in the Policy to the contrary, no Deductible will apply to payments made under the FHA/OSHA/ADA Proceeding Sublimit, and such payments will be part of and will reduce the available Limit of Liability. We will not be obligated to reimburse You for: (i)any fines, penalties, or sanctions assessed against You; or(ii)any of Your expenses, salaries,wages, benefits, or overhead. The FHA/OSHA/ADA Proceeding Sublimit is the maximum We will pay during the Policy Period, regardless of the number of regulatory or administrative proceedings brought against You during the Policy Period or the number of Insureds involved. AE-C. ADMINISTRATIVE AND DISCIPLINARY PROCEEDING COVERAGE We will reimburse You up to$5,000(the"Administrative and Disciplinary Proceeding Sublimit')for the reasonable and necessary expenses incurred by You with Our prior written consent in the defense of an administrative or disciplinary proceeding first brought against You during the Policy Period for Hiscox Insurance Company Inc. HIscox encourage courage, Endorsement 1 NAMED INSURED: Environmental Consulting Services E5164.2 Architects Engineers and Drafting Services Endorsement Page 4 of 4 any Wrongful Acts committed or allegedly committed on or after the Retroactive Date and reported to Us in accordance with Clause II. NOTICE OF CLAIMS AND NOTICE OF POTENTIAL CLAIMS. We will have the right, but not the duty,to assume the defense of such administrative or disciplinary proceedings as described above. Notwithstanding anything in the Policy to the contrary, no Deductible will apply to payments made under the Administrative and Disciplinary Proceeding Sublimit, and such payments will be part of and will reduce the available Limit of Liability. We will not be obligated to reimburse You for: (i)any fines, penalties, or sanctions assessed against You; or(ii)any of Your expenses, salaries,wages, benefits, or overhead. The Administrative and Disciplinary Proceeding Sublimit is the maximum We will pay during the Policy Period, regardless of the number of administrative or disciplinary proceedings brought against You during the Policy Period or the number of Insureds involved. All other terms and conditions remain unchanged. Endorsement effective: March 4, 2019 Policy No.: UDC-4086382-EO-19 Endorsement No: 1 By: Kevin Kerridge (Appointed Representative) DPL E5164 CW(09/15) Hiscox Insurance Company Inc. HIscox encourage courage,, Endorsement 2 NAMED INSURED: Environmental Consulting Services _E_5102.1 California Amendatory Endorsement Page 1 of 3 This endorsement modifies insurance provided under the following: PROFESSIONAL LIABILITY-ERRORS AND OMISSIONS INSURANCE In consideration of the premium charged, it is understood and agreed that the Policy is modified as follows: 1. Section V. OTHER MATTERS AFFECTING COVERAGE is amended to include the following at the end thereof: CANCELLATION Notice of Cancellation A. The Named Insured may cancel this Policy by giving Us advance written notice stating when thereafter such cancellation shall be effective. If the Named Insured cancels this Policy,the refund may be less than pro rata. Provided, however, if this Policy shall be cancelled by the Named Insured within 14 days of the inception of the Policy Period without having submitted a Claim,We shall return in full any premium amount actually paid to Us. In such event,the effective date of cancellation shall be deemed to be the inception date of the Policy Period. B. Policies In Effect For 60 Days or Less If this Policy has been in effect for sixty(60)days or less, and is not a renewal of a Policy We have previously issued,We may cancel this Policy by mailing or delivering to the Named Insured at the mailing address shown in the Declarations and to the producer of record, if any, advance written notice of cancellation stating the reason for cancellation at least: Ten(10)days before the effective date of cancellation if We cancel for: (a) Non-payment of premium; or (b) Discovery of fraud by: i. The Insured or the Insured's representative in obtaining this insurance; or ii. The Insured or the Insured's representative in pursuing a Claim under the Policy. Thirty(30)days before the effective date of cancellation if We cancel for any other reason. C. Policies In Effect For More Than 60 Days If this Policy has been in effect for more than sixty(60)days,We may also cancel this Policy by mailing or delivering to the Named Insured at the address shown in the Declarations,the producer of record, if any, written notice, including the reason for cancellation, stating when not less than thirty(30)days thereafter (or ten(10)days thereafter when cancellation is due to non-payment of premium or discovery of fraud), the cancellation shall be effective. We may only cancel this Policy for one or more of the following reasons: (a) Nonpayment of premium, including payment due on a prior policy issued by Us and due during the current policy term covering the same risks; (b) Discovery of fraud or material misrepresentation by: i. The Insured or the Insured's representative in obtaining this insurance; or ii. The Insured or the Insured's representative in pursuing a Claim under the Policy. Hiscox Insurance Company Inc. HISCOX encourage courage,, Endorsement 2 NAMED INSURED: Environmental Consulting Services E5102.1 California Amendatory Endorsement Page 2 of 3 (c) A judgment by a court or an administrative tribunal that the Insured has violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against; (d) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards,by the Insured or the Insured's representative,which materially increase any of the risks insured against; (e) Failure by the Insured or the Insured's representative to implement reasonable loss control requirements,agreed to by the Insured as a condition of policy issuance, or which were conditions precedent to Our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against; (f) A determination by the Commissioner of Insurance that the i. Loss of,or changes in, our reinsurance covering all or part of the risk would threaten Our financial integrity or solvency;or ii. Continuation of the policy coverage would: a. Place Us in violation of California law or the laws of the state where We are domiciled; or b. Threaten Our solvency. (g) A change by the Insured or the Insured's representative in the activities or property of the commercial or industrial enterprise,which results in a materially added, increased or changed risk, is included in the Policy. D. The mailing of the notice of cancellation shall be sufficient proof of notice and this Policy shall terminate at the date and hour specified in such notice. If We cancel this Policy, any return premium shall be calculated pro rata. Payment or tender of any unearned premium by Us shall not be a condition precedent to the effectiveness of the cancellation, but such payment shall be made as soon as practicable. Nonrenewal A. If We elect not to renew this Policy,We will mail or deliver to the Named Insured written notice of nonrenewal, stating the reason for nonrenewal, not less than sixty(60)days, but not more than one hundred twenty(120)days before the end of the Policy Period. We will mail the notice of nonrenewal to the Named Insured at the last mailing address known Us.If the notice of nonrenewal is mailed, proof of mailing will be sufficient proof of notice. B. We are not required to send notice of nonrenewal in the following situations: (a) If the transfer or renewal of a policy,without any changes in terms, conditions or rates, is between Us and a member of Our insurance group. (b) If the policy has been extended for 90 days or less, provided that notice has been given in accordance with paragraph A above. Hiscox Insurance Company Inc. "Yo HISC(DA X encourage courage,, Endorsement 2 NAMED INSURED: Environmental Consulting Services E5102.1 California Amendatory Endorsement Page 3 of 3 (c) If the Named Insured has obtained replacement coverage, or if the Named Insured has agreed, in writing,within 60 days of the termination of the Policy, to obtain that coverage. (d) If the Policy is for a period of no more than 60 days and the Named Insured is notified at the time of issuance that it will not be renewed. (e) If the Named Insured requests a change in the terms or conditions or risks covered by the Policy within 60 days of the end of the Policy Period. (f) If We made a written offer to the Named Insured, in accordance with the timeframes shown in paragraph A above,to renew the Policy under changed terms or conditions or at an increased premium rate,when the increase exceeds 25%. 2. Section VII. DEFINITIONS, Paragraph E Damages, is modified to the extent necessary to provide the following: Punitive and exemplary damages shall not be insurable in cases where California law governs the Claim. 3, The Policy is amended by adding the following Clause at the end thereof: Policy Conflicts To the extent any term or condition contained in the Policy or any Endorsement attached thereto conflicts with any term or condition contained in this or any other State Amendatory Endorsement attached to the Policy, such terms and conditions most favorable to the Insured shall apply. All other terms and conditions remain unchanged. Endorsement effective: March 4,2019 Policy No.: UDC-4086382-EO-19 Endorsement No: 2 By: Kevin Kerridge (Appointed Representative) DPL E5102 CA(01/10) HISCOX Hiscox Insurance Company Policy Number: UDC-4086382-EO-19 Named Insured: Environmental Consulting Services Endorsement Number: 3 Endorsement Effective: March 4, 2019 E54241 Blanket Additional Insured Endorsement(PL) In consideration of the premium charged and on the understanding that this endorsement leaves all other terms, conditions, and exclusions unchanged, it is agreed that the Professional Liability — US Direct Errors and Omissions Insurance policy is amended as follows: 1. In Clause VI. DEFINITIONS, paragraph V., "'You' or 'Your'," is amended to include the following at the end thereof: You or Your shall also include any Additional Insured but only for the Wrongful Acts of those contemplated in paragraphs 1., 2. or 3. of the definition of"'You' or'Your"': 2. The following definition is added to Clause VI. DEFINITIONS: AI-A. Additional Insured means any person(s) or organization(s) with whom You have agreed in a written contract or agreement to add them as an additional insured to a policy providing the type of coverage afforded by this Policy, provided the contract or agreement: 1. is currently in effect or becomes effective during the Policy Period;and 2. was executed before the Professional Services from which the Claim arises were performed. 3. In Clause III. EXCLUSIONS, paragraph F. is deleted in its entirety and replaced with the following: F. brought by or on behalf of one Insured against another Insured; provided, however,this Exclusion will not apply to any Claim brought by an Additional Insured in any capacity other than that of an Additional Insured. All other terms and conditions remain unchanged. DPL E5424 CW(02/15) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. n,A H I SCOX encourage courage GET THE RIGHT INSURANCE,RIGHT NOW HI SCOX Hiscox Insurance Company Inc. ECONOMIC AND TRADE SANCTIONS POLICYHOLDER NOTICE Hiscox is committed to complying with the U.S. Department of Treasury Office of Foreign Assets Control (OFAC) requirements. OFAC administers and enforces economic sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous foreign agents,front organizations,terrorists, and narcotics traffickers as Specially Designated Nationals (SDN's) and Blocked Persons. OFAC has also identified Sanctioned Countries. A list of Specially Designated Nationals, Blocked Persons and Sanctioned Countries may be found on the United States Treasury's web site httr)://www.treas.clov/offices/enforcement/ofac/. Economic sanctions prohibit all United States citizens (including corporations and other entities) and permanent resident aliens from engaging in transactions with Specially Designated Nationals, Blocked Persons and Sanctioned Countries. Hiscox may not accept premium from or issue a policy to insure property of or make a claim payment to a Specially Designated National or Blocked Person. Hiscox may not engage in business transactions with a Sanctioned Country. A Specially Designated National or Blocked Person is any person who is determined as such by the Secretary of Treasury. A Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States. In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy may be rendered void from its inception with respect to any term or condition of this policy that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following: (1) Any insured under this Policy, or any person or entity claiming the benefits of such insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to US economic trade sanctions; (2) Any claim or suit that is brought in a Sanctioned Country or by a Sanctioned Country government, where any action in connection with such claim or suit is prohibited by US economic or trade sanctions; (3) Any claim or suit that is brought by any Specially Designated National or Blocked Person or any person or entity who is otherwise subject to US economic or trade sanctions; (4) Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody or control of a Sanctioned Country government, where any activities related to such property are prohibited by US economic or trade sanctions; or (5) Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity who is otherwise subject to US economic or trade sanctions. Please read your Policy carefully and discuss with your broker/agent or insurance professional. You may also visit the US Treasury's website at http://www.treas.gov/offices/enforcement/ofac/. INT N001 CW 01 09 Page 1 of 1 O)VO HISCOX encourage courage' GET THE RIGHT INSURANCE, RIGHT NOW Ap-wplication Summary H I SCOX encourage courage--- Hiscox Insurance Company Inc. Application Summary The following outlines the details you have given us about your business.We have relied on the accuracy of this information in order to issue your policy. If any of the items below are incorrect or have changed, please call us at 888-202-3007 so that we can update your policy details. Your policy Policy number: UDC-4086382-EO-19 Quote reference number: 8105812 Product: Professional Liability Insurance Business name: Environmental Consulting Services Business address: 18488 Prospect Road Suite 1 I City Saratoga State: CA Zip code: 95070 Name: Stanton Shelly Email address: stanshe1199@toast.net Telephone number: 408-218-7651 Per claim limit of liability: $ 1,000,000 Aggregate limit of liability: $ 1,000,000 Deductible: $500 When would you like your policy to start? March 4 2019 Your business What is your primary type of business? Environmental engineering Your business's ownership structure(please select one). Individual/Sole Proprietor Do you currently have an insurance policy in effect for the coverage requested? No Other than the business address provided above, how many additional locations 0 does your business own or rent? - - - I consent to engage in electronic transactions. Agree Approximately when did your business begin? February 01, 1977 For the next 12 months,what is your business's estimated total annual revenue? $30,000.00 Note:Your best estimate is fine. Include all revenues, fees and commissions. ©Hiscox Inc. 2010 Page 1 i During the next 12 months,what is the estimated gross revenue you will earn from $4,000 your largest project? Does your business use a written contract or statement of work? Sometimes(<75%but>0%) ( If required by state law, do you or the principal of your firm maintain current and Yes valid professional training,certifications, licenses or designations for all services you provide? Which of the following does your business implement? -Customer sign-off on deliverables Yes i I -Contracts with indemnification clauses in your favor No Do you subcontract any professional services?Please only answer'Yes' if you No subcontract professional services which are different from your own. Example: An architect who hires construction managers to build their design should answer 'Yes'. In what category do the majority of your projects fall into? Other; please explain Noise impact assessment and reporting Other than any design or project management,do you or any of your No subcontractors directly perform any of the following physical services? • Carpentry • Construction or demolition • Electrical • Equipment installation or repair • Flooring • Lawn or garden maintenance • Painting • Plumbing • Roofing • Tiling • Any other physical maintenance/repair services i I I 0 Hiscox Inc. 2010 Page 2 G Do you or any of your subcontractors provide any of the following services or work No j on any projects involving the following materials or infrastructure? • Aerospace engineering r • Amusement rides, pools or playgrounds • Asbestos, lead, or mold evaluation or abatement • Bridges,dams, harbors, mines, piers or tunnels • Condominiums • Design/build firms • Emergency response or clean up of any hazardous waste I • Foundation, sheeting or retaining wall design • Geotechnical/soils engineering • Home inspections for prospective buyers or lenders • Hydraulic fracturing, hyd rofractu ring,or fracking y • Laboratory testing • Land acquisition • Land surveying, boundary surveying or construction staking • Marine engineering • Mechanical engineering • Mining engineering - • Nuclear engineering • Oil,gas or well engineering • Petro/chemical engineering • Structural engineering • Underground storage tanks or utilities AboutStatements As the individual completing this transaction,you are authorized to purchase and I have read and agree bind this insurance on behalf of the entity applying for coverage. Your Business is not controlled or owned by any other firm,corporation, or entity. I have read and agree For the entire period of time that You have owned and controlled the business,You I have read and agree have not sold, purchased or acquired,discontinued, merged into or consolidated with another business. Your business has never had any commercial insurance cancelled or rescinded. I have read and agree You, your business's current and past partners, officers,directors, board members, I have read and agree trustees,or employees, have never been subject to disciplinary action by authorities as a result of professional activities. HistoryClaims and Loss Based upon your knowledge and the knowledge of your business's current and I have read and agree past partners,officers,directors and employees,during the last five years a third party has never made a claim against your business and you do not know of any reason why someone may make a claim. Professional L The limits of liability represent the total amount available to pay judgments, settlements, and claim expenses(e.g., attorney's fees)incurred in the defense of any claims.We are not liable for any amounts that exceed these limits. a This is a claims-made policy. If coverage is provided, it shall apply to claims made against you and reported to us during the policy period or applicable extended reporting period. ©Hiscox Inc. 2010 Page 3 i i Judgments, settlements and claims expenses incurred are subject to the deductible amount. The deductible is the amount you must pay before we will make any payments under the policy. Some coverage may not be subject to a deductible, in which case you are not required to make payments before any payments are made under the policy. Please consult the policy language for details. If you have knowledge of any circumstance that may lead to a claim being made against you, coverage will be excluded a if such claim is made. Claims made against you prior to the inception of the policy are excluded Other information Fraud Warning _.... ,...3 It is a crime to knowingly and intentionally attempt to defraud an insurance company by providing false or misleading information or concealing material information during the application process or when filing a claim. Such conduct could result in your policy being voided and subject you to criminal and civil penalties. You have confirmed that you agree with the General Statements provided. Yeses agree to accept delivery of my insurance policy via email to the address provided. Yes have read the information above and confirm it is all correct. I understand that Yes by checking this box I am agreeing to enter into a binding agreement with Hiscox Insurance Company Inc. i i i j ©Hiscox Inc.2010 Page 4