19-137 Starbird Consulting LLC, Environmental Consulting Services on Various City ProjectsCITY OF
I MASTER PROFESSIONAL/SPECIALIZED SERVICES AGREEMENT
WITH STARBIRD CONSULTING, LLC
CUPERTINO
1. PARTIES
This Master Agreement is made and entered into as of J LtAj,I a l IVI Effective
Date"), by and between the City of Cupertino, a municipal corporation ("City"), and
Starbird Consulting,LLC Contractor"), a Limited Liability Company for
Environmental Consulting Services on various City projects.
2. SERVICES
2.1 Scope of Services. Contractor agrees to provide the Services set forth in the Scope of Services,
attached and incorporated here as Exhibit A, on an as-needed basis. The Services must comply with
this Agreement and with each Service Order issued by the City's Project Manager or his/her designee,
in accordance with the following procedures,unless otherwise specified in Exhibit A.
2.2 Service Orders.Before issuing a Service Order, the City Project Manager will request
Services in writing and hold a meeting with Contractor to discuss the Service Order. Contractor will
submit a written proposal that includes a specific Scope of Services, Schedule of Performance and
Compensation,which the Parties will discuss. Thereafter, City will execute a Service Order Form for
the Services, attached and incorporated here as Exhibit B. The Service Order will specify the Scope of
Services, Schedule of Performance, Compensation and any other conditions applicable to the Service
Order. Issuance of a Purchase Order is discretionary. The City Project Manager is authorized to
streamline these procedures based on the City's best interests. Contractor will not be compensated for
Services performed without a duly authorized and executed Service Order.
3. TIME OF PERFORMANCE
3.1 Term. This Agreement begins on the Effective Date and ends on December 31,2020
Contract Time"), unless terminated earlier as provided herein.
3.2 Schedule of Performance. Contractor must deliver the Services within the time specified in
each Service Order, and under no circumstances should the Services go beyond the Contract Time.
3.3 Time is of the essence for the performance of all the Services required in this Agreement and
in each Service Order. Contractor must have sufficient time,resources and qualified staff to deliver the
Services on time. Contractor must respond promptly to each Service Order request.
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4. COMPENSATION
4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the
Services a total amount that will based upon actual costs but that will be capped so as not to exceed
100,000 Contract Price"), based upon the Scope of Services in Exhibit A and the
budget and rates included. The maximum compensation includes all expenses and reimbursements
and will remain in place even if Contractor's actual costs exceed the capped amount.
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4.2 Per Service Order. Compensation for Services provided under a Service Order will be based
on the rates set forth in the Service Order, which shall not exceed the capped amount specified in the
Service Order.
4.2 Invoices and Payments. Except as otherwise provided in a Purchase Order, monthly invoices
must state a description of the deliverables completed and the amount due for the preceding month.
Thirty days prior to expiration of the Agreement, Contractor must submit a requisition for final and
complete payment of costs and pending claims for City approval.Noncompliance with this
requirement relieves City of any further payment or other obligations under the Agreement.
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 j
the persons hired to work under this Agreement. Contractor is not entitled to health benefits,worker's
compensation or other benefits from the City.
5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that
they have the qualifications and skills to perform the Services in a competent and professional manner
and according to the highest standards and best practices in the industry.
5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they
are properly licensed,registered, and/or certified to perform the Services as required by law and have
procured a City Business License.
5.4 Subcontractors. Only Contractor's employees are authorized to work under this Agreement.
Prior written approval from City is required for any subcontractor, and the terms and conditions of this
Agreement will apply to any approved subcontractor.
5.5 Tools,Materials and Equipment. Contractor will supply all tools,materials and equipment
required to perform the Services under this Agreement.
5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this
Agreement. Upon City's request, Contractor will provide proof of payment and will indemnify City for
violations pursuant to the indemnification provision of this Agreement.
6. PROPRIETARY/CONFIDENTIAL INFORMATION
In performing this Agreement, Contractor may have access to private or confidential information
owned or controlled by the City,which may contain proprietary or confidential details the disclosure of
which to third parties may be damaging to City. Contractor shall hold in confidence all City
information 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.
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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.
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.
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7.5 Deliverables and Format. Contractor must provide electronic and hard copies of the Work 1
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 n
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 1
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 will be considered an assignment of the Agreement and subject to City i
approval. Control means fifty percent(50%)or more of the voting power of the business entity.
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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
harmless City, its City Council,boards and commissions,officers, officials, employees, agents,
servants,volunteers and Contractors ("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
C, 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
1H
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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.
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 Contractor's 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 j
this Agreement,has or will receive a direct or indirect financial interest in this Agreement, in violation i
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.
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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 Alex Acenas,PW Proj. Mgr. 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.
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Contractor Project Manager. Subject to City approval, Contractor assigns Jodi Starbird,Principal Consultant
as its single Representative for all purposes under this Agreement,with authority to oversee the
progress and performance of the Services. Contractor's Project manager is responsible for
coordinating and scheduling the Services in accordance with City instructions, service orders and the
Schedule of Performance. Contractor must regularly update the City's project manager about the
status,progress and any delays with the work. City's written approval is required prior to Contractor
substituting a new Representative which shall result in no additional costs to City.
15. ABANDONMENT OF PROJECT
City may abandon or postpone the Project or parts thereof at any time. Contractor will be compensated
for satisfactory Services performed through the date of abandonment, and will be 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.
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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.
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 1
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: Starbird Consulting LLC
10300 Torre Ave.,Cupertino CA 95014 115 S. 14th St.
San Jose,CA 95112
Attention:Alex Acenas,PW Project Manager Attention: Jodi Starbird
Email:AlexA@cupertino.org Email: Jodi@jodistarbird.com
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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.
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
Starbird Consulting,LLC A Municipal on
By By
Name Jodi Starbird Name Roger ee
Title Principal Consultant Title Acting-Director of Public works
Date &/I V `mil Date
Tax I D.N5,i`I—3-3 01 ek
APPROVED AS TO F'ORMb
HEATHER M.MINNER
Cupertino City Attorney
ATTEST:
E Scffmi6t
City Clerk
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Master FrofessionatlSpccialized Services Agreement/Rev.May 22,2018
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EXHIBIT A
SCOPE OF SERVICES
CONSULTANT shall provide to the CITY's Department of Public Works environmental
consulting services for various CITY projects.
CONSULTANT'S services shall be provided as requested by the Director on an as-needed
basis, and only upon written request, as set forth in a specific project service order.
CONSULTANT shall provide general assistance on issues pertaining to City projects and shall
prepare other environmental consultant services for Public Works as determined by the
Director.
SECTION 1. GENERAL PROVISIONS
A. CONSULTANT shall perform all services to the satisfaction of the CITY'S Director of Public
Works.
B. All of the services furnished by CONSULTANT under this AGREEMENT shall be of the
currently prevailing professional standards and quality which prevail among
environmental consultant professionals of similar knowledge and skill engaged in
related work throughout California under the same or similar circumstances. All
documentation prepared by CONSULTANT shall provide for a completed project that
conforms to all applicable codes, rules,regulations and guidelines which are in effect at the
time such documentation is prepared.
C. All work performed under this AGREEMENT shall be authorized by a specific Service
Order. Each Service Order given by CITY shall detail the nature of the specific services to be
performed by CONSULTANT,the time limit within which such services must be completed
and the compensation for such services. Such details shall include a description of the
project for which CONSULTANT shall perform the services, the geographic limits of the
project, the type and scope of services to be performed, the format and schedule for
deliverables, the schedule of performance, and the schedule of compensation.
CONSULTANT shall not perform any services unless authorized by a fully executed Service
Order. Any unauthorized services performed by CONSULTANT shall be at no cost to the
CITY.
D. CONSULTANT shall manage its SUBCONSULTANTS, and administer the PROJECT.
SUBCONSULTANTS will be identified on each Service Order and provide all required
insurance as specified in this master agreement.
E. CONSULTANT shall begin work under the service order only after receipt of the service
order bearing the approval signature of the Director or the Director's designee and the
signature of the City Attorney approving the service order as to form. Each authorized
Service Order issued under this AGREEMENT by CITY shall be incorporated into the
terms and conditions of this AGREEMENT.
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 1 of 7
F. CITY will assign a Project Manager to facilitate each Service Order authorized under
this AGREEMENT. CONSULTANT shall coordinate with the designated Project Manager on
the performance of each Service Order.
G. CONSULTANT shall be responsible for the coordination with CITY and federal, state and
local agencies that are necessary for all services authorized under this AGREEMENT.
SECTION 2. BASIC SERVICES.
A. CONSULTANT shall provide environmental consulting services for various City projects,
as more particularly described in the authorized service order. The authorized service
order may include any of the specific environmental tasks set forth below in Section 3.
The authorized service order may also include any other environmental services described
and agreed to be performed by the CONSULTANT, including, but not limited to, the
following:
1. Input regarding environmental/land use compatibility issues during the initial evaluation
of potential sites for the various CITY projects; and
2. Preparation of the appropriate project-level analysis and documents for each
improvement as necessary to comply with the CITY's environmental requirements, the
requirements of the California Environmental Quality Act and its implementing
regulations and guidelines, and/or the requirements of the National Environmental
Policy Act and its implementing guidelines.
B. In addition to any specific services (described below in Section 3) that the CONSULTANT
must provide as part of each authorized service order,the CONSULTANT shall perform
any other general environmental services specified in the authorized service order. The
following shall apply to such general services.
1. CONSULTANT shall be responsible for providing thorough environmental
consulting services in compliance with all applicable federal, state, and local
regulations. All environmental work shall be conducted in conformance with applicable
California state law.
2. CONSULTANT shall meet with the Project Manager at the CITY offices to discuss the
project details. CONSULTANT shall be made aware of the project description, location,
schedule of deliverables, and requirements. CONSULTANT and CITY shall agree on
the terms of the Service Order including the specific tasks to be performed, the schedule for
deliverables, and compensation.
3. After approval of Service Order and upon receipt of an authorized Service
Order, CONSULTANT shall visit project site to note existing conditions, collect
data, locate utilities, and familiarize himself with the surrounding area. CONSULTANT
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 2 of 7
shall make note of any issues that may need to be addressed in fulfilling the service
request.
4. CONSULTANT shall cooperate and communicate w i t h CITY staff,project design firms,
utility and regulatory agencies, and others who are involved with the CITY project, on an
as-needed basis, to perform a comprehensive service. CONSULTANT shall perform their
work in their offices.
5. CONSULTANT shall perform service in accordance with the specific requirements and
tasks stated in Service Order.
6. CONSULTANT shall make allowance for u p t o four meetings at CITY offices
during the execution of the Service Order to discuss any issues that may need further
evaluation or clarification. These meetings shall be in addition to the initial meeting at
CITY offices to discuss project Service Order and the required on-site visit to the project
location.
7. Project Record - CONSULTANT shall develop and maintain a detailed record of
the chronology of the project tasks and milestones completed that are decisive,
conclusive or relevant to the outcome of each Project. CONSULTANT shall submit a
copy of the Project Record to the Project Manager prior to final payment for services
performed on the Project.The Record shall be submitted in both paper and electronic
format.
8. Project Documents - Aside from deliverables specified in the Service Order, and before
the conclusion of the Project and final payment for services performed on the Project,
CONSULTANT shall submit to the Project Manager a copy of all project documents that
are decisive, conclusive or relevant to the outcome of the Project. Such documents may
include,without limitation, electronic files of all drawings and specifications, reports and
studies, calculations, utility applications and permits, records of meetings, and
communication documents. Documents shall be submitted in both paper and electronic
format, as available.
SECTION 3.SPECIFIC ENVIRONMENTAL SERVICES.
A. In addition to any other environmental services contained in the authorized Service Order,
the Service Order may incorporate any of the services set forth below in this Section 3 by
simply identifying the particular Task, in which case the Task is considered to have been
incorporated into the authorized Service Order and CONSULTANT shall perform the Task as
set forth herein.
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 3 of 7
B. Tasks: Listed below are the Tasks which may be included in the Service Order.
1. CEQA Initial Studies/Mitigated Negative Declarations and Addendums
2. CEQA Mitigation Monitoring or Reporting Programs
3. CEQA Notices of Intent
4. CEQA Notices of Completion
5. CEQA Notices of Determination
6. CEQA Categorical Exemptions
7. NEPA Categorical Exclusions
8. Caltrans Local Assistance Consulting and Preparing/Contracting for Technical Memos:
a. Preliminary Environmental Study (PES)
b. Equipment Staging
c. Traffic/Detour Information
d. Air Quality Memo(Review by MTC)
e. Tree Removal/Migratory Bird Treaty Act
f. Water Quality
g. Natural Environment Study(NES)
h. Archaeological Survey Report(ASR)
i. Historic Properties Survey Report(HPSR)
j. Historic Resources Evaluation Report(HRER)
k. Location Hydraulic Study(LHS)
1. Summary of Floodplain Encroachment Report
m. Programmatic Section 4(f)Evaluation
9. Biological Surveys
10. Biological Monitoring
11. Tree Surveys
12. USACE, California Department of Fish and Wildlife,Santa Clara Valley Water District,and
Regional Water Quality Control Board Permits
END OF EXHIBIT
City of Cupertino Exhibits
Environmental Services Master Agreement—Starbird Consulting,LLC Page 4 of 7
EXHIBIT B
SERVICE ORDER PROCESS
CONSULTANT shall provide services under this Master Agreement on an"as needed"basis and
only (1)upon written request from the CITY's Director of Public Works or authorized Agent as
defined in Article 14 of the Master Agreement,Project Coordination, and (2)as defined in a fully
executed Service Order.
SECTION 1—SERVICE ORDER INITIATION
A. The CITY's Public Works Director or his designee shall provide written request for
CONSULTANT services as defined in this agreement.After which, CONSULTANT shall
provide to CITY a written proposal including specific scope of services,performance schedule
and compensation. Scope of Services will reference Tasks from Exhibit A where possible.
B. CITY and CONSULTANT shall discuss the proposal in detail and agree upon the terms of the
Service Order.
C. CITY shall prepare a Project Service Order and Attachment A. The Service Order shall, at a
minimum,include(1) specific scope of services, deliverables, schedule of performance, and
compensation.An exemplar of the Service Order form follows this Exhibit.
SECTION 2- SERVICE ORDER EXECUTION
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D. Both parties shall execute the Service Order as evidenced by the signatures of the authorized
representatives defined in Article 14 of the Master Agreement,Project Coordination, and the
date signed.
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E. CONSULTANT shall begin work on the scope of services only after receipt of a fully executed
authorized Service Order defining those services. CONSULTANT understands and agrees that E
work performed before the date of the authorized Service Order or outside the scope of services
once a Service Order is signed and authorized shall be at no cost to the City.
F. The maximum compensation authorized by a single Service Order and/or the aggregate of
Service Orders shall not exceed the maximum compensation set forth in Article 4 of the Master
Agreement.
END OF EXHIBIT
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 5 of 7
CITY OF CUPERTINO
MASTER AGREEMENT CONSULTANT SERVICES
SERVICE ORDER NO.
MASTER AGREEMENT NO.: M A Date:
MA Maximum Compensation:
MA Term:NTP:MA END DATE:
Consultant: Name:
Address:
Contact:Phone:
Project Description:
Project Name:
FX Description: (simple project description if appropriate)
Attachment A: Includes Description of Project,Scope of Service,Schedule of Performance
and Compensation
City Project Management
Managing Department: Public Works Project Manager:
Fiscal/Budget
Amount
Master Agreement Maximum Compensation:0.00
Total Previously Encumbered to Date: 0.00
Encumbrance this Service Order: 0.00
Total Liquidated Encumbrance: 0.00
Master Agreement Unencumbered Balance: 0.00
Account No.:
Project Manager: Date:
APPROVALS
Consultant: Date:
CIP Manager: Date:
Appropriation Certification: I hereby certify that an unexpended appropriation is available in the above fund
for the above contract as estimated and that fund are available as of this date of signature.
City Finance: Date:
Management Analyst
City of Cupertino
Master Agreement Page 1 of 1 Service Order No.
EXHIBIT C
COMPENSATION
CITY shall compensate CONSULTANT according to the hourly rate(s)stated in this Exhibit which
shall remain in effect for the Master Agreement schedule of performance unless changed by written
amendment to the Master Agreement.
Each authorized Service Order under this Master Agreement shall identify the method of
compensation consistent with the scope of services provided by CONSULTANT.In any case,
CONSULTANT's total payment for each authorized Service Order shall not exceed the maximum
compensation identified in that Service Order,unless authorized by a written amendment executed
by CITY and CONSULTANT, and the total compensation for all authorized Service Orders shall not
exceed the maximum compensation stated in Article 4, Consultant Compensation,of the Master
Agreement.
Work exceeding the total authorized amount for a Service Order or the total compensation for the
Master Agreement shall be at no cost to CITY.
Consultant Hourly Rate(s)
CONSULTANT shall be compensated according to the following hourly rate(s)for all work
performed under authorized Service Orders:
PRINCIPAL 225.00
Reimbursable Expenses
Reimbursable expenses represent the acquisition cost of items,other than direct labor, specifically
required to perform the scope of services and beyond normal business operating expenses which
are included in the direct labor rate.Such expenses include,but are not limited to:
Individual or multiple document reproductions that exceed 50 pages;
Drawing or bid set reproductions;
Software required by City other than Microsoft Word, Excel,PowerPoint, and Project;
Adobe Acrobat;and a photo editor program.
Travel expenses to the extent allowed by City policy;
Sub-consultants required by project scope of services;
Safety equipment required by City policy or the project scope of services;
Mass mailing notifications;
Expenses for public meetings, such as refreshments,interpreters, security,valet parking,
facility rental, tents or booths, easels,markers,paper,presentation equipment.
CITY shall compensate CONSULTANT for such reimbursable expenses o_ywith prior written
authorization by CITY representative designated in Article 14,Project Coordination, of the Master
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 6 of 7
Agreement.All compensation,including reimbursable expenses,shall not exceed the maximum
compensation for the Service Order.
CITY shall compensate CONSULTANT for reimbursable expenses for the documented actual cost
only, allowing for no surcharge for Consultant administration.Reimbursable expenses shall be
separately identified on CONSULTANT's invoice.
Method of Payment
CONSULTANT shall submit an invoice to CITY by the 5th business day of each month that clearly
identifies the work performed in the previous month and authorized reimbursable expenses. All
invoices from CONSULTANT shall be sent via email to CITY representative designated in Article
14,Project Coordination,of the Master Agreement.
I
The invoice shall identify the applicable period of work, a description of the work performed
consistent with the.Service Order scope of services,the number of hours,hourly rate, reimbursable
expenses,Service Order maximum compensation,Service Order compensation to date including
invoice number,total invoice amount for current invoice,Service Order maximum compensation
balance remaining.
All payments to CONSULTANT will be addressed to:
Starbird Consulting,LLC
Attn:Jodi Starbird
115 S. 14th Street j
San Jose,CA 95112
E-mail:jodi@jodistarbird.com
END OF EXHIBIT
City of Cupertino Exhibits
Environmental Services Master Agreement-Starbird Consulting,LLC Page 7 of 7
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 MIMMUMS 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
proj ect/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.
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.
t
c &kot 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
Retroactive Date prior to the Contract Effective Date,the Consultant must purchase"extended
rTElRrNSURANCEporting"coverage for a minimum of five(5)years after completion of the Services.
0
PROVISIONS
x"
he 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
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 byConsultant.
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
ACCA?" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
IllAugust 29,2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PHONE ggg 202-3007 FAX
A/C No Ext: ( ) A/C No):
520 Madison Avenue E-MAIL
32nd Floor
ADDRESS: contact@hiscox.com
New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC#
INSURER A: Hiscox Insurance Company Inc 10200
INSURED INSURER B
Starbird Consulting,LLC.
115 S 14th St INSURER C
San Jose CA 95112 INSURER D
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR TYPE OF INSURANCE INSD POLICY
POLICY NUMBER MM/DDfYYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 2,000,000
OCCUR DAMAGES(RENTED
CLAIMS-MADE PREMISES Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
A UDC-2345495-CGL-19 08/23/2019 08/23/2020 PERSONAL&ADV INJURY s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
X POLICY jEO LOC PRODUCTS-COMP/OP AGG $ S/T Gen.Agg.
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LAB HCLAIMS-MADE AGGREGATE
DED RETENTION$
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
N/A E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
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
j/
r
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
i 7 ® DATE(MM/DD/YYYY)
Ac"R" CERTIFICATE OF LIABILITY INSURANCE August 29,2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER NAME:
Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PHONE ggg 202-3007
FAX
A/C No Ext: ( ) A/C No):
520 Madison Avenue E-MAILADDRES s: contact@hiscox.com
32nd Floor
New York, NY 10022
INSURERS AFFORDING COVERAGE NAIC#
INSURER A: Hiscox Insurance Company Inc 10200
INSURED INSURER B:
Starbird Consulting,LLC.INSURER C
115 S 14th St
San Jose CA 95112 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
ADDL SUBR POLICY EFF POLICY EXP
LTR INS. WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
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 $
JECTPOLICY
PRO
LOC PRODUCTS-COMP/OPAGG $
OTHER:
AUTOMOBILE LIABILITY Ea acccidentSINGLE LIMIT $
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
l AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION$
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS'LIABILITY
STATUTE ER
YIN
OFFICER/MEMBERFFICE /MEMB REXC
N
EXCLUDED?
CUTIVE
N/A
E.L.EACH ACCIDENT
Mandatory
EREXCLUDED?
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-2345495-EO-19 08/23/2019 08/23/2020 Each Claim: 2,000,000
Aggregate: 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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
i
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
VAA
HI SCOX Hiscox Insurance Company Inc.
Policy Number: UDC-2345495-CGL-19
Named Insured: Starbird Consulting, LLC.
Endorsement Number: 16
Endorsement Effective: August 23,2019
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Persons Or Organization(s)
City of Cupertino, its City Council, Boards and Commissions, Officers, Officials, Employees,Agents, Servants,
Volunteers and Consultants
10300 Torre Ave.
Cupertino,CA 95014
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zation(s) shown in the Schedule, but only with respect
to liability for "bodily injury", "property damage" or
personal and advertising injury" caused, in whole or
in part, by your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04 ISO Properties, Inc., 2004 Page 1 of 1
Q) j Instate&
You're in good hands.
Information as of February 19,2019
Lozon Ins Agency Policyholder(s) Page 1 of 2
7341 Lincoln Ave. SterlingA Starbird&Jodi L StarbirdSonloseCA9SI25
Policy number
934 927 398
Your Allstate agency is
Lozon Ins Agency
IIIIII'III"III II II"'II'I'IIII IIIIIIIIIIIIII''I I
408)292-0555
johnlozon@allstate.com
STERLING A STARBIRD
JODI L STARBIRD
115S14THST
SAN JOSE CA 95112-2129
We're confirming your policy change
Thank you for choosing Allstate to help protect what's important to you.I've enclosed documents that confirm
the policy change(s)you requested.You'll find your coverage details listed on the enclosed amended policy
declarations.
The following change(s)are effective as of 02/11/2019:
A change in insurance coverage.
Your premium for the current policy period has been decreased by a total of$12.00,Your discount savings for
this policy period are:$551.19.
How to contact us
Give me a call at(408)292-0555 if you have any questions. It's my pleasure to keep you in good hands.
Sincerely,
Lozon Ins Agency Agent License Number:
Your Allstate Agent 0778840
EA120-1
0N.41
Policy number: 1934927398 Page 2 of 2
Policy effective date: April 1,2019
Your Insurance Coverage Checklist
We're happy to have you as an Allstate customer! This checklist outlines what's in this package and provides answers to some
basic questions,as well as any"next steps"you may need to take.
What's in this package? What about my bill?
See the guide below for the documents that are included. Unless you've already paid your premium in full,we'll send
Next steps:review your Policy Declarations to confirm you your bill separately.Nextsteps:please pay the minimum
have the coverages,coverage limits,premiums and amount by the due date listed on it.
savings that you requested and expected. Read any You can also pay your bill online at allstate.com or by
Endorsements or Important Notices to learn about new calling 1-800-ALLSTATE(1-800-255-7828). Para
policy changes,topics of special interest,as well as espanol,Ilamar al 1-800-979-4285. If you're enrolled in
required communications. Keep all of these documents the Allstate® Easy Pay Plan,we'll send you a statement
with your other important insurance papers. detailing your payment withdrawal schedule.
Am I getting all the discounts I should?
Confirm with your Allstate Agent that you're benefiting What if I have questions?
from all the discounts you're eligible to receive. You can either contact your Allstate Agent or call us 24/7
at 1-800-ALLSTATE(1-800-255-7828)-para espanol,
Ilamar al 1-800-979-4285-with questions about your
coverage,or to update your coverages, limits,or
deductibles.Or visit us online at allstate.com.
A guide to your amended package
made simple
Proof of Policy Insurance Made
O
Insurance Declarations* Simple o
ID Cards The Policy Insurance seem
Your insurance Declarations complicated? o
cards are legally lists policy Our online
0
required,so details,such as guides explain
please keep your specific coverage terms o
them in your drivers,vehicles and features:
vehicle at all and coverages. www.allstate.com/ o
times. madesimole oN
Esoano1.aIIstate.com o
facildeentender o
00
To make it easier to see where you may have gaps in your protection,we've highlighted any coverages you do not have U
in the Coverage Detail section in the enclosed Policy Declarations. N
ry m
m`m 40
V 00Om
O Q O
O_O 00
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Thank you for choosing Allstate Q) Allstate ,,
You're in good hands.
Proof of Insurance Card Page 1 of 2
For your convenience,two insurance cards have been included for each vehicle.State law requires that one
of these cards be kept in each vehicle.Please place them in your vehicles by the effective date.
Allstate Allstate.
You're in good hands. You're in good hands. U
Please use the printed Insurance Cards below. Please use the printed Insurance Cards below.
Allstate Allstate.
You're in good hands. You're in good hands.
Please use the printed Insurance Cards below. Please use the printed Insurance Cards below.
California Proof of Allstate. California Proof of Allstate.
Auto Insurance Card
You're in good hands
Auto Insurance Card You're in good hands.
Allstate Northbrook Indemnity Company NAIC#36455 Allstate Northbrook Indemnity Company NAIC#36455
PO Box 660598,Dallas,TX 75266-0598 PO Box 660598,Dallas,TX 75266-0598
Sterlingg A Starbird Sterling A Starbird
Jodi L Starbird Jodi L Starbird
115 So Fourteenth St 115 So Fourteenth St
San Jose CA 95112-2129 San Jose CA 95112-2129
This policy meets the requirements of the applicable California financial This policy meets the requirements of the applicable California financial
responsibility law(s). responsibility law(s).
POLICY NUMBER YEAR/MAKE/MODEL POLICY NUMBER YEAR/MAKE/MODEL
934 927 398 2018 Audi A6 Quattro 934 927 398 2018 Audi A6 Quattro
EFFECTIVE DATE VEHICLE ID NUMBER EFFECTIVE DATE VEHICLE ID NUMBER
04/01/19 WAUGBAFC9JN037063 04/01/19 WAUG8AFC9JN037063
EXPIRATION DATE EXPIRATION DATE
10/01/19 10/01/19
This card must be carried in the vehicle at all times as evidence of insurance. ; This card must be carried in the vehicle at all times as evidence of insurance. i
California Proof of Allstate California Proof of A I I state..
Auto Insurance Card You're in good hands.
Auto Insurance Card
You're in good hands.
Allstate Northbrook Indemnity Company NAIC#36455 Allstate Northbrook Indemnity Company NAIC#36455
PO Box 660598,Dallas,TX 75266-0598 PO Box 660598,Dallas,TX 75266-0598
Sterling A Starbird Sterling A Starbird
Jodi L Starbird Jodi L Starbird
115 So Fourteenth St 115 So Fourteenth St
San Jose CA 95112-2129 San Jose CA 95112-2129
This policy meets the requirements of the applicable California financial This policy meets the requirements of the applicable California financial
responsibility law(s). responsibility law(s).
POLICY NUMBER YEAR/MAKE/MODEL i POLICY NUMBER YEAR/MAKE/MODEL
934 927 398 2018 BMW X1 934 927 398 2018 BMW X1
EFFECTIVE DATE VEHICLE ID NUMBER EFFECTIVE DATE VEHICLE ID NUMBER
04/01/19 WBXHT3C31J5F92004 i 04/01/19 WBXHT3C31J5F92004
EXPIRATION DATE EXPIRATION DATE
L
10/01/19 10/01/19
This card must be carried in the vehicle at all times as evidence of insurance. i This card must be carried in the vehicle at all times as evidence of insurance.
Policy number: 1934927 398 Page 2 of 2
Policy effective date: April 1,2019
Please use the printed Insurance Cards below. Please use the printed Insurance Cards below.
Please use the printed Insurance Cards below. Please use the printed Insurance Cards below.
If you have an accident or loss: If you have an accident or loss:
Get medical attention if needed. Get medical attention if needed.
Notify the police immediately. Notify the police immediately.
Obtain names,addresses,phone numbers(work&home)and Obtain names,addresses,phone numbers(work&home)and
license plate numbers of all persons involved,including license plate numbers of all persons involved,including
passengers and witnesses. passengers and witnesses.
iv Call 1-800-ALLSTATE(1-800-255-7828), Call 1-800-ALLSTATE(1-800-255-7828),
o logon to allstate.com or contact your Allstate agent logon to allstate.com or contact your Allstate agent
o as soon as possible. as soon as possible.
a
o Lozonlns Agency Lozonlns Agency
o 408)292-0555 408)292-0555
1341 Lincoln Ave. 1341 Lincoln Ave.
00
o San lose,CA 95125 San Jose,CA 95125
0
0
o If you have an accident or loss: If you have an accident or loss:
N0 Get medical attention if needed. Get medical attention if needed.
C
0 Notify the police immediately. Notify the police immediately.
a Obtain names,addresses,phone numbers(work&home)and Obtain names,addresses,phone numbers(work&home)andNlicenseplatenumbersofallpersonsinvolved,including license plate numbers of all persons involved,including
and witnesses.
N M passengers passengers and witnesses. I
00 0 Call 1-800-ALLSTATE(1-800-255-7828), Call 1-800-ALLSTATE(1-800-255-7828),
oo logon to allstate.com or contact your Allstate agent logon to allstate.com or contact your Allstate agent
0 0 o as soon as possible. as soon as possible.
X o o Lozon Ins Agency Lozon Ins Agency
408)292-0555 408)292-0555
1341 Lincoln Ave. 1341 Lincoln Ave.
San Jose,CA 95125 San Jose,CA 95125
Amended auto policy declarations An I I state
Your policy effective date is April 1,2019 You're in good hands.
Page 1 of 4
Information as of February 19,2019
Total Amount Due for the Policy Period
Please review your insured vehicles and verify their VINs are correct. Summary
Vehicles covered Identification Number(VIN) Premium Named Insured(s)
2018 BMW Xl WBXHT3C3115F92004 601.84 Sterling A Starbird&Jodi L Starbird
2018 Audi A6 Quattro WAUG8AFC9JN037063 544.14 Mailing address
California Fraud Assessment Fee 1.76 115 So Fourteenth St
Total* 1,147.74 San Jose CA 95112-2129
z « x
Polic number
Your bill will be mailed separately.Before making a payment,please refer to your
934 927 398
latest bill,which includes payment options and installment fee information.If you do Your policy provided by
not pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity
See the Important payment and coverage information section for details about Company
installment fees. Policy period
Beginning April 1,2019 through October
1,2019 at 12:01 a.m.standard time
Discounts (included in your total premium) Your policy changes are effective
Good Driver(20%) $268.78 Multiple Policy $55.03 February 11,2019
Distinguished 223.24 Anti-theft 4.14 Your Allstate agency is
Driver Lozon Ins Agency
Total
Lincoln Ave.
discounts 551.19
1341
San Jose CA 95125
408)292-0555
johnlozon@allstate.com
Discounts per vehicle
2018 BMW X1 268.89
Some or all of the information on your
Policy Declarations is used in the rating
Good Driver(20%) $132.75 Multiple Policy $27.15 of your policy or it could affect your
Distinguished 107.29 Anti-theft 1.70
eligibility for certain coverages.Please
Driver notify us immediately if you believe that
2018 Audi A6 Quattro 282.30 any information on your Policy
Anti-theft 2.44 Good Driver(20%) $136.03 Declarations is incorrect.We will make
Multiple Policy $27.88 Distinguished 115.95 corrections once you have notified us,
Driver and any resulting rate adjustments,will
be made only for the current policy
Listed drivers on your policy period or for future policy periods.
Please also notify us immediately if you
Sterling Starbird believe any coverages are not listed or
Jodi Starbird are inaccurately listed.
Excluded drivers from your policy
None
0
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Amended auto policy declarations Page 2 of 4
Policy number: 1934927 398
Policy effective date: April 1,2019
Coverage detail for 2018 BMW X1
Coverage Limits Deductible Premium
Automobile Liability Insurance Not applicable 276.82
Bodily Injury 500,000 each person
500,000 each occurrence
W Property Damage 500,000 each occurrence
AM-Auto Collision Insurance Actual cash value 2,000 205.21
Waiver of deductible applies
Auto Comprehensive Insurance Actual cash value 1,000 32.36
Rental Reimbursement Not purchased*
Towing and Labor Costs Not purchased*
Uninsured Motorists Insurance for Bodily $500,000 each person Not applicable 70.84
Injury 500,000 each accident
Automobile Medical Payments $5,000 each person Not applicable 16.61
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 2018 BMW X1 601.84
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 WBXHT3C31J5F92004 Rating information
Your premium is determined based on certain
information,including the following:
This vehicle is driven for pleasure,married female o
licensed 42 years.
Allstate uses mileage information as one factor to help determine your premium amount.The estimated number of miles that 0
this vehicle is driven annually is 10,000-10,499. N
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Important Note:The estimated annual mileage figure applicable to this vehicle for the expiring policy period was:10,000- o
10,499.The estimated annual mileage figure applicable to this vehicle for the current policy period is:10,000-10,499.
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.
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Amended auto policy declarations
Policy number: 1934 927 3981 Page 3 of 4 Q) Allstate.,,
Policy effective date: April 1,2019
You're in good hands.
Coverage detail for 2018 Audi A6 Quattro
Coverage Limits Deductible Premium
Automobile Liability Insurance Not applicable 172.07
Bodily Injury 500,000 each person
500,000 each occurrence
Property Damage 500,000 each occurrence
Auto Collision Insurance Actual cash value 2,000 259.74
Waiver of deductible applies
Auto Comprehensive Insurance Actual cash value 1,000 46.41
Rental Reimbursement Not purchased*
Towing and Labor Costs Not purchased*
Uninsured Motorists Insurance for Bodily $500,000 each person Not applicable 54.06
Injury 500,000 each accident
Automobile Medical Payments $5,000 each person Not applicable 11.86
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 2018 Audi A6 Quattro 544.14
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 WAUG8AFC9JN037063 Rating information
Your premium is determined based on certain
information,including the following:
This vehicle is driven 3-9 miles to work/school,
married male licensed 42 years.
Allstate uses mileage information as one factor to help determine your premium amount.The estimated number of miles that
this vehicle is driven annually is 7,000-7,499.
Important Note:The estimated annual mileage figure applicable to this vehicle for the expiring policy period was:7,000-
7,499.The estimated annual mileage figure applicable to this vehicle for the current policy period is:7,000-7,499.
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.
Additional coverages 0
Automobile Death Indemnity Insurance Not purchased* o
continued)au
Amended auto policy declarations Page 4 of 4
Policy number: 1934927398
Policy effective date: April 1,2019
Automobile Disability Income Protection Not purchased*
Identity Theft Expenses Not purchased*
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.
Your policy documents
Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together.
Allstate Automobile Policy-AU104-3 California Amendatory Endorsement-AU14629-2
Amendment of Policy Provisions-AU14626-1
Important payment and coverage information
Here is some additional,helpful information related to your coverage and paying your bill:
Your rate is lower because you are insuring multiple cars.
Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay
your premium in installments,your first bill will reflect your available payment options,including the option to pay in full or to
pay in monthly installments.Please note that any amounts payable for the first renewal bill will not include an installment fee
unless you have an unpaid balance from a previous policy period,in which case the Minimum Amount Due will include an
installment fee,or unless you are participating in the Allstate Easy Pay Plan).The following applies to installment payments
made after your first renewal bill.
If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you
make 6 installment payments during the policy period,and do not change your payment plan method,then the total amount of
installment fees during the policy period will be$21.00.
If you are on the Allstate®Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due.If you make 6
installment payments during the policy period,and remain on the AllstateO Easy Pay Plan,then the total amount of installment
fees during the policy period will be$6.00.
If you change payment plan methods or make additional payments,your installment fee charge for each payment due and the a
total amount of installment fees during the policy period may change or even increase. 0
0
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Please note that the Allstate®Easy Pay Plan allows you to have your insurance payments automatically deducted from your 0
checking or savings account.
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Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, 0
Illinois.
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You're in good hands.
Information as of February 8,2019
Lozon Ins Agency Policyholder(s) Page 1 of 2
1347 Lincoln Ave. Sterling and Jodi Starbird
San Jose CA 9S12S
Policv number
934 927 424
Your Allstate agency is
Lozon Ins Agency
408)292-0555
johnlozon@allstate.com
STERLING AND JODI
STARBIRD
115 S 14TH ST
SAN JOSE CA 95112-2129
Thank you for being a loyal Allstate customer—we're happy to have you
with us!
Here's your Personal Umbrella insurance renewal offer for the next 12 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 of 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.You also won't receive a bill if a mortgage company or lienholder pays
your insurance premium for you.
How to contact us
Give me a call at(408)292-0555 if you have any questions. It's my job to make sure you're in good hands.
Sincerely,
Lozon Ins Agency
Your Allstate Agent
RP378-4
Policy number: 1934927 424 Page 2 of 2
Policy effective date: April 1,2019
Your Insurance Coverage Checklist
We're happy to have you as an Allstate customer!This checklist outlines what's in this package and provides answers to some
basic questions,as well as any"next steps"you may need to take.
What's in this package? What about my bill?
See the guide below for the documents that are included. Unless you've already paid your premium in full,we'll send
Nextsteps: review your Policy Declarations to confirm you your bill separately.Next steps:please pay the minimum
have the coverages,coverage limits,premiums and amount by the due date listed on it.
savings that you requested and expected.Read any You can also pay your bill online at allstate.com or by
Endorsements or Important Notices to learn about new calling 1-800-ALLSTATE(1-800-255-7828). Para
policy changes,topics of special interest,as well as espanol, Ilamar al 1-800-979-4285. If you're enrolled in
required communications. Keep all of these documents the AllstateO Easy Pay Plan,we'll send you a statement
with your other important insurance papers. detailing your payment withdrawal schedule.
What if I have questions?
You can either contact your Allstate Agent or call us 24/7
at 1-800-ALLSTATE(1-800-255-7828)-para espanol,
Ilamar al 1-800-979-4285-with questions about your
coverage,or to update your coverages,limits,or
deductibles.Or visit us online at allstate.com.
A guide to your renewal package
made simple
Policy Important Insurance Made
Declarations* Notices Simple m
The Policy We use these Insurance seem o
Declarations notices to call complicated? s
lists policy attention to Our online o
details,such as particularly guides explain s
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Policy number: 934 927 424
Policy effective date: April 1,2019 Page 1 of 1 WAllstate.
You're in good hands.
Important Privacy Choices For Consumers
You have the right to control whether we share some of your personal information.
Please read the following information carefully before you make your choices below.
Your Rights
You have the following rights to restrict the sharing of personal and financial information with our affiliates(companies we
own or control)and outside companies that we do business with. Nothing in this form prohibits the sharing of information
necessary for us to follow the law,as permitted by law,or to give you the best service on your accounts with us.This includes
sending you information about some other products or services.
Your Choices
Restrict Information Sharing With Companies We Own or Control(Affiliates):
Unless you say"No,"we may share personal and financial information about you with our affiliated companies.
NO,please do not share personal and financial information with your affiliated companies.
Restrict Information Sharing With Other Companies We Do Business With To Provide Financial Products And Services:
Unless you say"No,"we may share personal and financial information about you with outside companies we contract with to
provide financial products and services to you.
NO,please do not share personal and financial information with outside companies you contract with to provide financial
products and services.
Time Sensitive Renly
You may make your privacy choice(s)at any time.Your choice(s) marked here will remain unless you state otherwise.
However,if we do not hear from you we may share some of your information with affiliated companies and other companies
with whom we have contracts to provide products and services.
Name:Sterling and Jodi Starbird
ACCOUNT OR POLICY NUMBER(S): 934 927 424
Signature:
To exercise your choices do one of the following:
1) Call our toll-free number 1-800-856-2518;
2) Fax our toll-free number 1-855-219-7425;or
3) Fill out,sign and send back this form to us using the envelope provided
you may want to make a copy for your records).
X73499
ME
it
Policy number: 1934 927 424
Policy effective date: April 1,2019 A I I statePage1of2
You're in good hands.
Privacy Policy Statement In addition,Allstate and its business partners gather
information through Internet activity,which may include,for
Thank you for choosing Allstate.We value you, respect your example,your operating system,links you used to visit
privacy and work hard to protect your personal information. allstate.com,web pages you viewed while visiting our site or
applications, Internet Protocol(IP)addresses,and cookies.We
This statement is provided on behalf of Allstate Insurance use cookies,analytics and other technologies to help:
Company and the affiliates("Allstate")listed at the end of this
notice.We would like to explain how we collect,use and share • Evaluate our marketing campaigns
the information we obtain about you in the course of doing Analyze how customers use our website and applications
business.Develop new services
Our Privacy Assurance
Know how many visitors have seen or clicked on our ads
We do not sell your personal or medical information to Also,our business partners assist us with monitoring
anyone.information including,but not limited to, IP addresses,domain
We do not share your information with non-affiliate names and browser data,which can help us to better
companies that would use it to contact you about their understand how visitors use allstate.com.
own products and services,unless permitted pursuant to a How We Use and Share Your Personal Information
joint marketing agreement. In the course of normal business activities,we use and share
We require persons or organizations that represent or your personal information.We may provide your information
assist us in servicing your policy and claims to keep your to persons or organizations within and outside of Allstate.This
information confidential.
would be done as required or permitted by law. For example,
We require our employees to protect your personal we may do this to:
information and keep it confidential. Fulfill a transaction you requested or service your policy
As you can see,protecting your personal information is Market our products
important to us. In addition to the practices described above, • Handle your claim
we use a variety of physical,technical and administrative Prevent fraud
security measures that help to safeguard your information. For • Comply with requests from regulatory and law
Social Security Numbers(SSN),this includes restricting access enforcement authorities
to our employees,agents and others who use your SSN only as • Participate in insurance support organizations
permitted by law:to comply with the law,to provide you with The persons or organizations with whom we may share your
products and services,and to handle your claims.Also,our personal information may include,among others:
employees'and agents'access to and use of your SSN are Your agent,broker or Allstate-affiliated companies
limited by the law,our policies and standards,and our written . Companies that perform services,such as marketing,
agreements.
credit card processing,and performing communication
Our privacy practices continue to apply to your information services on our behalf
even if you cease to be an Allstate customer.Business partners that assist us with tracking how visitors
use allstate.com.
What Personal Information Do We Have and Where . Other financial institutions with whom we have a joint
Do We Get It marketing agreement
We gather personal information from you and from outside • Other insurance companies that play a role in an insurance
sources for business purposes.Some examples of the transaction with you
information we collect from you may include your name,phone • Independent claims adjusters
number,home and e-mail addresses,driver's license number, • A business or businesses that conduct actuarial or
social security number,marital status,family member research studies
information and healthcare information.Also,we maintain Those who request information pursuant to a subpoena or
records that include,but are not limited to,policy coverages, court order
premiums,and payment history.We also collect information • Repair shops and recommended claims vendors
from outside sources that may include,but is not limited to,
The Internet and Your Information Securityyourdrivingrecord,claims history,medical information and
credit information. We use cookies,analytics and other technologies to help us
provide users with better service and a more customized web
S
Page 2 of 2
Policy number: 934 927 424
Policy effective date: April 1,2019
experience.Additionally,our business partners use tracking you previously opted to limit some sharing of your personal
services,analytics and other technologies to monitor visits to information.Please keep in mind that regardless of your
allstate.com.The website may also use Web beacons(also choices,Allstate may share your personal information with its
called"clear GIFs"or"pixel tags") in conjunction with cookies. affiliates,outside companies and other entities to comply with
If you prefer,you can choose to not accept cookies by changing the law,provide you with the best service on your Allstate
the settings on your web browser.Also,if you would like to accounts,or as otherwise permitted by law.
learn about how we gather and protect your information over
the Internet,please see our online privacy statement located at We Appreciate Your Business
the bottom of the allstate.com homepage. Thank you for choosing Allstate.We understand your concerns
about privacy and confidentiality,and we hope this notice has
To learn more,the allstate.com Privacy Statement provides been helpful to you.We value our relationship with you and
information relating to your use of the web site. look forward to keeping you in Good Hands®.
This includes,for example,information regarding: If you have questions or would like more information,please
1) how we collect information such as IP address(the don't hesitate to contact your Allstate agent or call the Allstate
number assigned to your computer when you use the Customer Information Center at 1-800-ALLSTATE.
Internet),browser and platform types,domain names,
access times,referral data,and your activity while using We reserve the right to change our Privacy practices,
procedures,and terms.
our site;
2) who should use our web site;
3) the security of information over the Internet;and Allstate Insurance Company
4) links and co-branded sites.Allstate affiliates to which this notice applies: Allstate County
How You Can Review and Correct Your Personal Mutual Insurance Company,Allstate Finance Company,
Information Allstate Financial Services,LLC(LSA Securities in LA and PA),
You can request to review your personal information contained Allstate Fire and Casualty Insurance Company,Allstate
in our records at any time.To do this,please send a letter to Indemnity Company,Allstate Investment Management
the address below requesting to see your information for the Company,Allstate Life Insurance Company,Allstate Life
previous two years. If you believe that our information is Insurance Company of New York,Allstate Motor Club,Inc.,
incomplete or inaccurate,you can request that we correct it. Allstate New Jersey Insurance Company,Allstate New Jersey
Please note we may not be able to provide information relating Property and Casualty Insurance Company,Allstate
to investigations,claims,litigation,and other matters.We will Northbrook Indemnity Company,Allstate Property and
be happy to make corrections whenever possible. Casualty Insurance Company,Allstate Texas Lloyd's,Allstate
Texas Lloyd's,Inc.,Allstate Vehicle and Property Insurance
Please send requests to: Company,Deerbrook General Agency,Inc.,Deerbrook
Allstate Insurance Company Customer Privacy Inquiries Insurance Company, Lincoln Benefit Life Company,North Light
PO Box 660598 Specialty Insurance Company.
Dallas,TX 75266-0598
Please Note:Allstate affiliates American Heritage Life
Sharing Personal Information: Privacy Choices for Insurance Company,Castle Key Insurance Company and
California Customers Castle Key Indemnity Company participate in information
Unless you request otherwise,we may share your personal sharing with the affiliates listed above,but have a separate o
information with one or more Allstate affiliates.We may do privacy notice for their customers. o
this for a number of reasons,including making you aware of the (ed.2/11/2014)
0
different products,services and offers they can provide.X73497-1
Similarly,unless you request otherwise,we may share your 0
personal information with outside companies with which we
have a written agreement to jointly offer you products and 0
services that we believe may be of interest to you.o
You have the right to limit some sharing of your personal o
0
information by reviewing and completing an"Important Privacy Q
Choices for Consumers"form.We've enclosed this form unless o
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Renewal Personal Umbrella Policy
Declarations Q) Allstate.
You're in good hands.
Your policy effective date is April 1,2019
Page 1 of 3
Total Premium for the Premium Period (Your bill will be mailed separately) Information as of February 8,2019
Excess Liability 489.28 Summary
Total 489.28 Named Insured(s)
Sterling and Jodi Starbird
Your bill will be mailed separately.Before making a payment,please refer to your Mailing address
latest bill,which includes payment options and installment fee information.If you do
MaMa
So Fourteenth St
not pay in full,you will be charged an installment fee(s). San Jose CA 95112-2129
See the Important Payment and Coverage Information section for details about Policy number
installment fees.934 927 424
Your policy premium has been developed using the following information:
2 Vehicles Supporting Allstate Home and/or Auto
Your policy provided byAllstateInsuranceCompanyPolicy(ies)
2 Operators in the household Policy period
Begins on April 1,2019
Premium includes a charge fort automobiles Ends on April 1,2020
Premium period
Discount (included in your total premium)Beginning April 1,2019 through April 1,
Multiple Policy Discount-
2020 at 12:01 a.m. Pacific Time
Auto and Property 33% Your Allstate agency is
Lozon Ins Agency
1341 Lincoln Ave.
Policy Coverages and Limits of Liability San Jose CA 95125
Coverages Limits of Liability
408)292-0555
Excess Liability-Bodily Injury and Property Damage $2,000,000 each occurrence
johnlozon@allstate.com
Annual Aggregate Limit 4,000,000 during the Some or all of the information on your
current policy period Policy Declarations is used in the rating
Excess Liability-Personal Injury 500,000 each occurrence of your policy or it could affect your
Annual Aggregate Limit 1,000,000 during the eligibility for certain coverages.Please
current policy period notify us immediately if you believe
Additional Dwelling Rented To Others Not purchased* that any information on your Policy
Declarations is incorrect.We will make
corrections once you have notified us,
This coverage can provide you with valuable protection. To help you stay current and any resulting rate adjustments,will
with your insurance needs,contact your agent to discuss available coverage be made only for the current policy
options and other products and services that can help protect you.period or for future policy periods.
Please also notify us immediately if you
believe any coverages are not listed or
are inaccurately listed.
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Renewal Personal Umbrella Policy Declarations Page 2 of 3
Policy number: 1934 927 424
Policy effective date: April 1,2019
Required Underlying Insurance Limits
You must maintain the Required Underlying Insurance,at or above the limits as shown below at all times for each liability
exposure any insured person has.Please refer to the"Required Underlying Insurance"provision of the policy.
Coverage Required Underlying Limit
Personal Liability-Bodily Injury and Property Combined Single Limit
Damage Liability
1. Homeowners,Condominium, Renters, 300,000 per occurrence
Mobilehome,Manufactured Home or other
Personal Liability Policy
2. Incidental Office, Private School or Studio
One,Two,Three or Four Family Residential Rental 300,000 per occurrence
Property-Bodily Injury and Property Damage
Liability
Automobiles and Motor Homes Bodily Injury $250,000 each person
500,000 each occurrence
Property Damage $100,000 each occurrence
or
Combined Single Limit
500,000 per occurrence
Motorcycles, Motor Scooters,Mopeds Bodily Injury $100,000 each person
and Recreational Vehicles including Passenger Liability when available $300,000 each occurrence
Property Damage $100,000 each occurrence
or
Combined Single Limit
300,000 per occurrence
Guest Passenger Liability $100,000 each person
when available as a separate limit) $300,000 each occurrence
or
Combined Single Limit
300,000 per occurrence
Personal Watercraft such as jet skis and wet bikes Bodily Injury $100,000 each person
300,000 each occurrence
Property Damage $100,000 each occurrence
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100,000 per occurrence U
Watercraft Liability Bodily Injury $100,000 each person
Craft under 26 feet and up to 50 horsepower 300,000 each occurrence
U.S. horsepower) Property Damage $100,000 each occurrence o
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Combined Single Limit o
100,000 per occurrence
Watercraft Liability Bodily Injury $250,000 each person o
Craft 26 feet and over or greater than 50 500,000 each occurrence o
horsepower(U.S.horsepower)Property Damage $100,000 each occurrence o
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Renewal Personal Umbrella Policy Declarations
Policy number: 1934 927 4241 Page 3 of 3 WAllstate.Policy effective date: April 1,2019
You're in good hands.
Coverage Required Underlying Limit
Employers' Liability-if Workers'Compensation or 300,000 each occurrence
similar coverage for Domestic Workers is required 300,000 each employee
or purchased voluntarily 500,000 policy aggregate
Your policy documents
Your Personal Umbrella policy consists of the Policy Declarations and the following documents. Please keep them together.
Personal Umbrella Policy-AS463 California Personal Umbrella Policy Amendatory Endorsement
AS378-1
Important payment and coverage information
Here is some additional,helpful information related to your coverage and paying your bill:
Please note:This is not a request for payment. Your bill will be mailed separately.
If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you
make 6 installment payments during the policy period,and do not change your payment plan method,then the total amount
of installment fees during the policy period will be$21.00.
If you are on the Allstate° Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due. If you make 6
installment payments during the policy period,and remain on the Allstate@ Easy Pay Plan,then the total amount of
installment fees during the policy period will be$6.00.
If you change payment plan methods or make additional payments,your installment fee charge for each payment due and
the total amount of installment fees during the policy period may change or even increase.
Please note that the Allstate®Easy Pay Plan allows you to have your insurance payments automatically deducted from your
checking or savings account.
Allstate Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois.
1*112-1— 54.0-Al
Thomas J.Wilson Susan L. Lees
President Secretary
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Important notices
Page 1 of 1
Policy number: 934927424
Policy effective date: April 1,2019
POLICY PROVISIONS: Rates, Policy If You Have a Problem with Your
Forms and Payment of Premiums:Insurance
Applicable only with respect to policies issued on a continuous Please contact your Allstate representative if you have any
basis. questions or concerns about your insurance.If a problem
1. The rates and policy forms in effect for the company
arises that you and your Allstate representative are unable to
upon the inception date of the insurance evidenced
resolve satisfactorily,please call or write to:
hereby,and upon each successive anniversary date, Allstate Customer Service
shall apply. PO Box 660598,Dallas,TX 75266-0598
2. The phrase"Policy Period"as used in the policy shall 1-800-ALLSTATEsm(1-800-255-7828)
be deemed to mean that period of time while the If the problem remains unresolved,you may contact the
applicable coverage of the policy is in force. California Department of Insurance at:
3. The named insured shall pay the required premium in
advance of each successive premium period,and upon Consumer Services Division
notice of interim amendments. California Department of Insurance
300 South Spring Street,Los Angeles,CA 90013
IMPORTANT NOTICE Consumer Hotline: 1-800-927-4357
CONCERNING THE INSURANCE YOU MUST MAINTAIN Website:
Not a part of the Policy)http:/Zwww.insurance.ca.gov/`01-consumers/-101-help/index
cfm
Please read the following provisions of the policy carefully:please contact the Department of Insurance only if you have
1) Required Underlying Insurance been unable to satisfactorily resolve the problem with your
It establishes the types of insurance and the limits you Allstate representative and with Allstate.
must maintain. X3380-6
If,during the policy period,additional liability
exposures exist,check the list of Required Underlying
Insurance on the policy declarations and secure any
needed underlying coverage and limits.
In the event that you fail to maintain the Required
Underlying Insurance you may be required to
personally incur or expend substantial sums of money
for your legal defense and for payment of damages,
and with respect to which Allstate has no obligation to
pay or provide reimbursement to you.
2) Retained Limits
m
It identifies the amount of any damages an Insured M
must pay for any occurrence.
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3) In the event that additional exposures are acquired o
after the issuance of this policy,please notify Allstate
of the additional exposure as soon as practicable. o
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Contractor/Consultant Affidavit of No Employees
State of California
County of Santa Clara
City of Cupertino
I, the undersigned, declare as follows:
I am an independent contractor and the owner of :54 6 y) LL—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 (D day ofV S 2018, at 2 , California.
PRI T NAME
SIGNATURE
Revised 1.05.18
DA11state.
You're in good hands.
Information as of February 8,2019
Lozon Ins Agency Policyholder(s) Page 1 of 2
7347
SonJos CAoln 95e. Sterlingand Jodi StarbirdSanloseCA95125
Policv number
934 927 424
Your Allstate agency is
Lozon Ins Agency
408)292-0555
johnlozon@allstate.com
STERLING AND JODI
STARBIRD
115 S 14TH ST
SAN JOSE CA 95112-2129
Thank you for being a loyal Allstate customer—we're happy to have you
with us!
Here's your Personal Umbrella insurance renewal offer for the next 12 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 of 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.You also won't receive a bill if a mortgage company or lienholder pays
your insurance premium for you.
How to contact us
Give me a call at(408)292-0555 if you have any questions. It's my job to make sure you're in good hands.
Sincerely,
Lozon Ins Agency
Your Allstate Agent
RP378-4
Policy number: 1934 927 424 Page 2 of 2
Policy effective date: April 1, 2019
Your Insurance Coverage Checklist
We're happy to have you as an Allstate customer!This checklist outlines what's in this package and provides answers to some
basic questions,as well as any"next steps"you may need to take.
What's in this package? What about my bill?
See the guide below for the documents that are included. Unless you've already paid your premium in full,we'll send
Next steps: review your Policy Declarations to confirm you your bill separately.Next steps:please pay the minimum
have the coverages,coverage limits,premiums and amount by the due date listed on it.
savings that you requested and expected. Read any You can also pay your bill online at allstate.com or by
Endorsements or Important Notices to learn about new calling 1-800-ALLSTATE(1-800-255-7828).Para
policy changes,topics of special interest,as well as espanol,Ilamar al 1-800-979-4285.If you're enrolled in
required communications.Keep all of these documents the Allstate° Easy Pay Plan,we'll send you a statement
with your other important insurance papers.detailing your payment withdrawal schedule.
What if 1 have questions?
You can either contact your Allstate Agent or call us 24/7
at 1-800-ALLSTATE(1-800-255-7828)-para espanol,
Ilamar al 1-800-979-4285 -with questions about your
coverage,or to update your coverages,limits,or
deductibles.Or visit us online at allstate.com.
A guide to your renewal package
made simple
Policy Important Insurance Made
Declarations* Notices Simple i
The Policy We use these Insurance seem
Declarations notices to call complicated?
lists policy attention to Our online
details,such as particularly guides explain
your property important coverage terms i
details and coverages,policy and features:
coverages. changes and www.allstate.com/
dISCOUntS. madesimple
Espanol.allstate.com
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To make it easier to see where you may have gaps in your protection,we've highlighted any coverages you do not have in the a
Coverage Detail section in the enclosed Policy Declarations. o
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Policy number: 1934927 424
Policy effective date: April 1,2019
Page 1 of 1 Q) Allstate,e7
You're in good hands.
Important Privacy Choices For Consumers
You have the right to control whether we share some of your personal information.
Please read the following information carefully before you make your choices below.
Your Rights
You have the following rights to restrict the sharing of personal and financial information with our affiliates(companies we
own or control)and outside companies that we do business with. Nothing in this form prohibits the sharing of information
necessary for us to follow the law,as permitted by law,or to give you the best service on your accounts with us.This includes
sending you information about some other products or services.
Your Choices
Restrict Information Sharing With Companies We Own or Control(Affiliates):
Unless you say"No,"we may share personal and financial information about you with our affiliated companies.
NO, please do not share personal and financial information with your affiliated companies.
Restrict Information Sharing With Other Companies We Do Business With To Provide Financial Products And Services:
Unless you say"No,"we may share personal and financial information about you with outside companies we contract with to
provide financial products and services to you.
NO, please do not share personal and financial information with outside companies you contract with to provide financial
products and services.
Time Sensitive Reply
You may make your privacy choice(s)at any time.Your choice(s) marked here will remain unless you state otherwise.
However,if we do not hear from you we may share some of your information with affiliated companies and other companies
with whom we have contracts to provide products and services.
Name: Sterling and Jodi Starbird
ACCOUNT OR POLICY NUMBER(S): 934 927 424
Signature:
To exercise your choices do one of the following:
1) Call our toll-free number 1-800-856-2518;
2) Fax our toll-free number 1-855-219-7425;or
3) Fill out,sign and send back this form to us using the envelope provided
you may want to make a copy for your records).
X73499
No
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Policy number: 1934 927 424
Policy effective date: April 1,2019
Page 1 of 2 Q) Allstate.
You're in good hands.
Privacy Policy Statement In addition,Allstate and its business partners gather
information through Internet activity,which may include,for
Thank you for choosing Allstate.We value you, respect your example,your operating system,links you used to visit
privacy and work hard to protect your personal information. allstate.com,web pages you viewed while visiting our site or
applications, Internet Protocol (IP) addresses,and cookies.We
This statement is provided on behalf of Allstate Insurance use cookies,analytics and other technologies to help:
Company and the affiliates("Allstate")listed at the end of this
notice.We would like to explain how we collect, use and share • Evaluate our marketing campaigns
the information we obtain about you in the course of doing Analyze how customers use our website and applications
business. Develop new services
Our Privacy Assurance
Know how many visitors have seen or clicked on our ads
We do not sell your personal or medical information to Also,our business partners assist us with monitoring
anyone.information including,but not limited to, IP addresses,domain
We do not share your information with non-affiliate names and browser data,which can help us to better
companies that would use it to contact you about their understand how visitors use allstate.com.
own products and services, unless permitted pursuant to a How We Use and Share Your Personal Information
joint marketing agreement.In the course of normal business activities,we use and share
We require persons or organizations that represent or your personal information.We may provide your information
assist us in servicing your policy and claims to keep your to persons or organizations within and outside of Allstate.This
information confidential. would be done as required or permitted by law. For example,
We require our employees to protect your personal we may do this to:
information and keep it confidential. Fulfill a transaction you requested or service your policy
As you can see,protecting your personal information is Market our products
important to us. In addition to the practices described above, • Handle your claim
we use a variety of physical,technical and administrative Prevent fraud
security measures that help to safeguard your information. For • Comply with requests from regulatory and law
Social Security Numbers(SSN),this includes restricting access enforcement authorities
to our employees,agents and others who use your SSN only as • Participate in insurance support organizations
permitted by law:to comply with the law,to provide you with The persons or organizations with whom we may share your
products and services,and to handle your claims.Also,our personal information may include,among others:
employees'and agents'access to and use of your SSN are Your agent, broker or Allstate-affiliated companies
limited by the law,our policies and standards,and our written • Companies that perform services,such as marketing,
agreements. credit card processing,and performing communication
Our privacy practices continue to apply to your information services on our behalf
even if you cease to be an Allstate customer. Business partners that assist us with tracking how visitors
use allstate.com.
What Personal Information Do We Have and Where • Other financial institutions with whom we have a joint
Do We Get It marketing agreement
We gather personal information from you and from outside • Other insurance companies that play a role in an insurance
sources for business purposes.Some examples of the transaction with you
information we collect from you may include your name, phone • Independent claims adjusters
number,home and e-mail addresses,driver's license number, • A business or businesses that conduct actuarial or
social security number, marital status,family member research studies
information and healthcare information.Also,we maintain Those who request information pursuant to a subpoena or
records that include, but are not limited to,policy coverages, court order
premiums,and payment history.We also collect information • Repair shops and recommended claims vendors
from outside sources that may include,but is not limited to,
your driving record,claims history, medical information and The Internet and Your Information Security
credit information. We use cookies,analytics and other technologies to help us
provide users with better service and a more customized web
t
Page 2 of 2
Policy number: 1934927 424
Policy effective date: April 1,2019
experience.Additionally, our business partners use tracking you previously opted to limit some sharing of your personal
services,analytics and other technologies to monitor visits to information. Please keep in mind that regardless of your
allstate.com.The website may also use Web beacons(also choices,Allstate may share your personal information with its
called "clear GIFs"or"pixel tags") in conjunction with cookies. affiliates,outside companies and other entities to comply with
If you prefer,you can choose to not accept cookies by changing the law,provide you with the best service on your Allstate
the settings on your web browser.Also,if you would like to accounts,or as otherwise permitted by law.
learn about how we gather and protect your information over
the Internet,please see our online privacy statement located at We Appreciate Your Business
the bottom of the allstate.com homepage. Thank you for choosing Allstate.We understand your concerns
about privacy and confidentiality,and we hope this notice has
To learn more,the allstate.com Privacy Statement provides been helpful to you.We value our relationship with you and
information relating to your use of the web site. look forward to keeping you in Good Hands®.
This includes,for example,information regarding: If you have questions or would like more information,please
1) how we collect information such as IP address(the don't hesitate to contact your Allstate agent or call the Allstate
number assigned to your computer when you use the Customer Information Center at 1-800-ALLSTATE.
Internet),browser and platform types,domain names,
access times,referral data,and your activity while using We reserve the right to change our Privacy practices,
procedures,and terms.
our site;
2) who should use our web site;
3) the,security of information over the Internet;and Allstate Insurance Company
4) links and co-branded sites.
Allstate affiliates to which this notice applies: Allstate County
How You Can Review and Correct Your Personal Mutual Insurance Company,Allstate Finance Company,
Information Allstate Financial Services, LLC(LSA Securities in LA and PA),
You can request to review your personal information contained Allstate Fire and Casualty Insurance Company,Allstate
in our records at any time.To do this,please send a letter to Indemnity Company,Allstate Investment Management
the address below requesting to see your information for the Company,Allstate Life Insurance Company,Allstate Life
previous two years.If you believe that our information is Insurance Company of New York,Allstate Motor Club, Inc.,
incomplete or inaccurate,you can request that we correct it. Allstate New Jersey Insurance Company,Allstate New Jersey
Please note we may not be able to provide information relating Property and Casualty Insurance Company,Allstate
to investigations,claims, litigation,and other matters.We will Northbrook Indemnity Company,Allstate Property and
be happy to make corrections whenever possible. Casualty Insurance Company,Allstate Texas Lloyd's,Allstate
Texas Lloyd's, Inc.,Allstate Vehicle and Property Insurance
Please send requests to: Company,Deerbrook General Agency, Inc., Deerbrook
Allstate Insurance Company Customer Privacy Inquiries Insurance Company, Lincoln Benefit Life Company, North Light
PO Box 660598 Specialty Insurance Company.
Dallas,TX 75266-0598
Please Note:Allstate affiliates American Heritage Life
Sharing Personal Information: Privacy Choices for Insurance Company, Castle Key Insurance Company and
California Customers Castle Key Indemnity Company participate in information I
Unless you request otherwise,we may share your personal sharing with the affiliates listed above,but have a separate
information with one or more Allstate affiliates.We may do privacy notice for their customers.
this for a number of reasons,including making you aware of the (ed.2/11/2014)
different products,services and offers they can provide. X73497-1
Similarly, unless you request otherwise,we may share your
personal information with outside companies with which we
have a written agreement to jointly offer you products and
services that we believe may be of interest to you.
You have the right to limit some sharing of your personal
information by reviewing and completing an"Important Privacy
Choices for Consumers"form.We've enclosed this form unless
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Renewal Personal Umbrella Policy AllstateDeclarations
You're in good hands.
Your policy effective date is April 1,2019
Page 1 of 3
Total Premium for the Premium Period(Your bill will be mailed separately)
Information as of February 8,2019
Excess Liability 489.28 Summary
Total 489.28 Named Insured(s)
Sterling and Jodi Starbird
Your bill will be mailed separately.Before making a payment,please refer to your Mailing addresslatestbill,which includes payment options and installment fee information.If you do
Ma Ma
So Fourteenth St
not pay in full,you will be charged an installment fee(s).
115
San Jose CA 95112-2129
See the Important Payment and Coverage Information section for details about Policy number
installment fees.934 927 424
Your policy premium has been developed using the following information:
2 Vehicles Supporting Allstate Home and/or Auto
Your policy provided byAllstateInsuranceCompanyPolicy(ies)
2 Operators in the household Policy periodBeginsonApril1,2019
Premium includes a charge for 2 automobiles Ends on April 1,2020
Premium period
Discount (included in your total premium)Beginning April 1,2019 through April 1,
2020 at 12:01 a.m. Pacific Time
Multiple Policy Discount-
Auto and Property 33% Your Allstate agency is
Lozon Ins Agency
1341 Lincoln Ave.
Policy Coverages and Limits of Liability San Jose CA 95125
Coverages Limits of Liability
408)292-0555
johniozon@allstate.com
Excess Liability-Bodily Injury and Property Damage $2,000,000 each occurrence
Annual Aggregate Limit 4,000,000 during the Some or all of the information on your
current policy period Policy Declarations is used in the rating
Excess Liability- Personal Injury 500,000 each occurrence of your policy or it could affect your
Annual Aggregate Limit 1,000,000 during the eligibility for certain coverages.Please
current policy period notify us immediately if you believe
Additional Dwelling Rented To Others Not purchased* that any information on your Policy
Declarations is incorrect.We will make
corrections once you have notified us,
This coverage can provide you with valuable protection. To help you stay current and any resulting rate adjustments,will
with your insurance needs,contact your agent to discuss available coverage be made only for the current policy
options and other products and services that can help protect you. period or for future policy periods.
Please also notify us immediately if you
believe any coverages are not listed or
are inaccurately listed.
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Renewal Personal Umbrella Policy Declarations Page 2 of 3
Policy number: 1934927424
Policy effective date: April 1,2019
Required Underlying Insurance Limits
You must maintain the Required Underlying Insurance,at or above the limits as shown below at all times for each liability
exposure any insured person has.Please refer to the"Required Underlying Insurance" provision of the policy.
Coverage Required Underlying Limit
Personal Liability-Bodily Injury and Property Combined Single Limit
Damage Liability
1. Homeowners,Condominium, Renters, 300,000 per occurrence
Mobilehome,Manufactured Home or other
Personal Liability Policy
2. Incidental Office,Private School or Studio
One,Two,Three or Four Family Residential Rental 300,000 per occurrence
Property- Bodily Injury and Property Damage
Liability
Automobiles and Motor Homes Bodily Injury $250,000 each person
500,000 each occurrence
Property Damage $100,000 each occurrence
or
Combined Single Limit
500,000 per occurrence
Motorcycles, Motor Scooters,Mopeds Bodily Injury $100,000 each person
and Recreational Vehicles including Passenger Liability when available $300,000 each occurrence
Property Damage $100,000 each occurrence
or
Combined Single Limit
300,000 per occurrence
Guest Passenger Liability $100,000 each person
when available as a separate limit) $300,000 each occurrence
or
Combined Single Limit
300,000 per occurrence
Personal Watercraft such as jet skis and wet bikes Bodily Injury $100,000 each person
300,000 each occurrence
Property Damage $100,000 each occurrence
or
Combined Single Limit
100,000 per occurrence
Watercraft Liability Bodily Injury $100,000 each person
Craft under 26 feet and up to 50 horsepower 300,000 each occurrence
U.S.horsepower) Property Damage $100,000 each occurrence I
or
Combined Single Limit
100,000 per occurrence I
Watercraft Liability Bodily Injury $250,000 each person
Craft 26 feet and over or greater than 50 500,000 each occurrence
horsepower(U.S.horsepower) Property Damage $100,000 each occurrence
or
Combined Single Limit
250,000 per occurrence
continued) <
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Renewal Personal Umbrella Policy Declarations
Policy number: 1934 927 4241 Page 3 of 3 WAllstate,Policy effective date: April 1,2019
You're in good hands.
Coverage Required Underlying Limit
Employers' Liability-if Workers' Compensation or 300,000 each occurrence
similar coverage for Domestic Workers is required 300,000 each employee
or purchased voluntarily 500,000 policy aggregate
Your policy documents
Your Personal Umbrella policy consists of the Policy Declarations and the following documents. Please keep them together.
Personal Umbrella Policy-AS463 California Personal Umbrella Policy Amendatory Endorsement
AS378-1
Important payment and coverage information
Here is some additional,helpful information related to your coverage and paying your bill:
Please note:This is not a request for payment. Your bill will be mailed separately.
If you decide to pay your premium in installments,there will be a $3.50 installment fee charge for each payment due. If you
make 6 installment payments during the policy period,and do not change your payment plan method,then the total amount
of installment fees during the policy period will be$21.00.
If you are on the Allstate@ Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due.If you make 6
installment payments during the policy period,and remain on the Allstate® Easy Pay Plan,then the total amount of
installment fees during the policy period will be$6.00.
If you change payment plan methods or make additional payments,your installment fee charge for each payment due and
the total amount of installment fees during the policy period may change or even increase.
Please note that the AllstateO Easy Pay Plan allows you to have your insurance payments automatically deducted from your
checking or savings account.
Allstate Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook,Illinois.
A-41—
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Thomas J.Wilson Susan L. Lees
President Secretary
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Important notices
Page 1 of 1
Policy number: 1934 927 424
Policy effective date: April 1,2019
POLICY PROVISIONS: Rates, Policy If You Have a Problem with Your
Forms and Payment of Premiums:Insurance
Applicable only with respect to policies issued on a continuous Please contact your Allstate representative if you have any
basis. questions or concerns about your insurance.If a problem
1. The rates and policy forms in effect for the company
arises that you and your Allstate representative are unable to
upon the inception date of the insurance evidenced
resolve satisfactorily,please call or write to:
hereby,and upon each successive anniversary date, Allstate Customer Service
shall apply. PO Box.660598,Dallas,TX 75266-0598
2. The phrase"Policy Period"as used in the policy shall 1-800-ALLSTATEsm(1-800-255-7828)
be deemed to mean that period of time while the If the problem remains unresolved,you may contact the
applicable coverage of the policy is in force. California Department of Insurance at:
3. The named insured shall pay the required premium in
advance of each successive premium period,and upon Consumer Services Division
notice of interim amendments. California Department of Insurance
300 South Spring Street,Los Angeles,CA 90013
IMPORTANT NOTICE Consumer Hotline: 1-800-927-4357
CONCERNING THE INSURANCE YOU MUST MAINTAIN Website:
Not a part of the Policy) http://www.insurance.ca.gov/01-consumers/-101-help/--index
cfm
Please read the following provisions of the policy carefully:please contact the Department of Insurance only if you have
1) Required Underlying Insurance been unable to satisfactorily resolve the problem with your
It establishes the types of insurance and the limits you Allstate representative and with Allstate.
must maintain. X3380-6
If,during the policy period, additional liability
exposures exist,check the list of Required Underlying
Insurance on the policy declarations and secure any
needed underlying coverage and limits.
In the event that you fail to maintain the Required
Underlying Insurance you may be required to
personally incur or expend substantial sums of money
for your legal defense and for payment of damages,
and with respect to which Allstate has no obligation to
pay or provide reimbursement to you.
2) Retained Limits
It identifies the amount of any damages an Insured I
must pay for any occurrence.
3) In the event that additional exposures are acquired
after the issuance of this policy,please notify Allstate I
of the additional exposure as soon as practicable.i
None of the terms and conditions of the policy are modified by I
this Important Notice. I
XC3621
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