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20-037 NexInite, LLC, Microsoft Teams Implementation and OneDrive Migration1 FIRST AMENDMENT TO AGREEMENT 20-037 BETWEEN THE CITY OF CUPERTINO AND NEXINITE, LLC., FOR MICROSOFT TEAMS IMPLEMENTATION AND ONEDRIVE MIGRATION This First Amendment to Agreement 20-037 between the City of Cupertino and NexInite, LLC., for reference dated 6/22/2020, is by and between the CITY OF CUPERTINO, a municipal corporation (hereinafter "City") and NexInite, LLC., a Limited Liability Company (“Contractor”) whose address is P.O. Box 749, Napa, CA 94559, and is made with reference to the following: RECITALS: A. On 4/3/2020, Agreement 20-037 (“Agreement”) was entered into by and between City and Contractor for Microsoft Teams Implementation and OneDrive Migration. B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as follows: 1. Paragraph 4.1 of the Agreement is modified to read as follows: Maximum Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will be based on actual costs but that will be capped so as not to exceed $60,000 (“Contract Price”), based on the scope of potential services and the budget and rates included in Exhibit A, attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. No extra work or payment is permitted without prior written approval of City. 2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CONTRACTOR By Title Date CITY OF CUPERTINO By Title Date APPROVED AS TO FORM City Attorney ATTEST: City Clerk Managing Partner Jun 22, 2020 Heather M. Minner Bill Mitchell Jun 24, 2020 CTO 06/24/20 2 EXPENDITURE DISTRIBUTION PO #2020-450 Click here to enter text. Original $20,000 Amendment #1: $40,000 Amendment #2: Total: $60,000 First Amendment to NexInite Contract Final Audit Report 2020-06-24 Created:2020-06-22 By:Marilyn Monreal (Marilynm@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAFfmgRX1_f5IEgfZu3Nc6vodf37kbRTUI "First Amendment to NexInite Contract" History Document created by Marilyn Monreal (Marilynm@cupertino.org) 2020-06-22 - 9:15:40 PM GMT- IP address: 69.181.1.100 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2020-06-22 - 9:20:44 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2020-06-22 - 10:46:48 PM GMT - Time Source: server- IP address: 24.23.184.82 Document emailed to Jeff Wright (jeff@nexinite.com) for signature 2020-06-22 - 10:46:50 PM GMT Email viewed by Jeff Wright (jeff@nexinite.com) 2020-06-22 - 11:04:00 PM GMT- IP address: 50.237.246.58 Document e-signed by Jeff Wright (jeff@nexinite.com) Signature Date: 2020-06-22 - 11:04:46 PM GMT - Time Source: server- IP address: 50.237.246.58 Document emailed to Heather M. Minner (minner@smwlaw.com) for signature 2020-06-22 - 11:04:48 PM GMT Email viewed by Heather M. Minner (minner@smwlaw.com) 2020-06-24 - 9:15:54 PM GMT- IP address: 45.41.142.207 Document e-signed by Heather M. Minner (minner@smwlaw.com) Signature Date: 2020-06-24 - 9:16:32 PM GMT - Time Source: server- IP address: 52.39.49.65 Document emailed to Bill Mitchell (billm@cupertino.org) for signature 2020-06-24 - 9:16:33 PM GMT Email viewed by Bill Mitchell (billm@cupertino.org) 2020-06-24 - 9:18:52 PM GMT- IP address: 73.63.193.45 Document e-signed by Bill Mitchell (billm@cupertino.org) Signature Date: 2020-06-24 - 9:25:35 PM GMT - Time Source: server- IP address: 73.63.193.45 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2020-06-24 - 9:25:36 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2020-06-24 - 9:47:50 PM GMT- IP address: 104.47.46.254 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2020-06-24 - 9:47:58 PM GMT - Time Source: server- IP address: 148.64.105.190 Signed document emailed to cyrahc@cupertino.org, Araceli Alejandre (aracelia@cupertino.org), Jeff Wright (jeff@nexinite.com), Bill Mitchell (billm@cupertino.org), and 3 more 2020-06-24 - 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D-Insurance Requirements for Design Professionals & Consultant Contracts 1 Form Updated Sept. 2019 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 toCity. INSURANCE POLICIES AND MINIMUMS REQUIRED 1.Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limitsspecifiedinthisagreement; or (ii)the broader coverage and maximum limits of coverage of any insurance policy, whichever isgreater. 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 basis for the benefit of City before the City’s own insurance or self- insurance shall be called upon to protect City as a named insured. 2.Automobile Liability:ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $1,000,000 per accident for bodily injury and property damage. 3.Workers’ Compensation:As required by the State of California, with Statutory Limits and Employer’s Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease. ¼¼Not 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 coverageiscanceled or non-renewed, and not replacedwith another claims-made policy form with a Retroactive Date prior to the Contract Effective Date, the Consultant must purchase “extended reporting” coverage for a minimum of five (5) years after completion of the Services. EXHIBIT % Insurance Requirements Design Professionals & Consultants Contracts Exh. D-Insurance Requirements for Design Professionals & Consultant Contracts 2 Form Updated Sept. 2019 OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions: 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 and automobile liability policies. 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 of premiums. 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, or better. Verification of Coverage Consultant mustfurnish acceptableinsurancecertificates and mandatoryendorsements (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 during the Contractterm. 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 IfConsultantmaintainsbroadercoverageand/orhigherlimitsthantheminimumsshownabove,Cityshall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSR 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-TORY LIMITSWC STATU- LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD 07/24/2018 Applegate-Beard Insurance Solutions PO Box 2213 Yountville, CA. 94599 Michael Applegate 707.235.1059 707.637.8136 mike@binsurancesolutions.com A 57 SBM BL6316 DX 10,0001,000,000 2,000,000 2,000,000 B Progressive Commercial 00481506 3.1.20 M Applegate 57 WEC AC8PCGY Hartford/Trumbull Insurance Hartford/Sentinel Insurance C D Professional Liability EKS3310776 CSL10.31.19 10.31.20 $ 2,000,000 3.1.19 1 1 Scottsdale Insurance City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 02.25.20 Nexinite Inc PO Box 749 Napa, CA. 94559 2.21.20 2.21.21 2.21.20 2.21.21 2,000,000 2,000,000 2,000,000 2,000,000 Additional Insured includes:The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers 1,000,000 1,000,000 1,000,000 2,000,000 100,000 Form_SCTNID_CTGRY.XX10025241_OTHER <docindex><index>OTHER</index></docindex> Policy number:00481056-1 Underwritten by: United Financial Cas Co Page of12 March 5, 2020 Progressive PO Box 94903 Cleveland, OH 44101 1-800-444-4487 Certificate of Insurance Certificate Holder…………………………………………………………………………………………………………………………………………………………………………… Additional Insured CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO, CA 95014 Insured Agent/Surplus Lines Broker ……………………………………………………………………………………………………………………………………………………………………………NEXINITE INC PO BOX 749 NAPA, CA 94559 WORLDWIDE FACILITIES PO BOX 12279 SANTA ROSA, CA 95406 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Effective Date:Policy Expiration Date: ……………………………………………………………………………………………………………………………………………………….. Mar 1, 2021Mar 1, 2020 Insurance coverage(s) Limits………………………………………………………………………………………………………………………………………………………..Bodily Injury/Property Damage $2,000,000 Combined Single Limit………………………………………………………………………………………………………………………………………………………..Uninsured/Underinsured Motorist $2,000,000 Combined Single Limit………………………………………………………………………………………………………………………………………………………..Employer's Non-Owned Auto BIPD $2,000,000 Combined Single Limit Description of Location/Vehicles/Special Items Scheduled autos only……………………………………………………………………………………………………………………………………………………….. 2018 FORD 3FA6P0PU7JR167977FUSION HYBRID Comprehensive $500 Ded Collision $500 Ded Roadside Assistance Selected……………………………………………………………………………………………………………………………………………………….. 2018 FORD 1FTEW1EG7JFE49318F150 Comprehensive $500 Ded Collision $500 Ded Roadside Assistance Selected 4 Continued <docindex><index>OTHER</index></docindex> Policy number:00481056-1 Page of22 Certificate number 06520A13056 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241 (10/02) 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 (866) 467-8730 (866) 467-8730 SERVICE.TX@THEHARTFORD.COM (866) 467-8730 (866) 467-8730 WORLDWIDE FACILITIES LLC/PHS The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 Select Customer Insurance Center Policyholder, please call us at: Agent, please call us at: INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: Agent, please call us at: between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. THE HARTFORD SELECT CUSTOMER INSURANCE CENTER 001 (CONTINUED ON NEXT PAGE) 02/20/20 02/21/20 02/21/21 57 SBM BL6316 DX NEXINITE INC. PO BOX 749 NAPA CA 94559 02/21/20 001 WORLDWIDE FACILITIES LLC/PHS 110788 SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE LOCATION 001 BUILDING 001 IS REVISED PRO RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: Named Insured and Mailing Address; Policy Change Effective Date: Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: Agent Name: Code: POLICY CHANGES: 002 02/20/20 02/21/20 02/21/21 57 SBM BL6316 001 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSURED(S) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 PERSON/ORGANIZATION: SEE FORM IH 12 00 WAIVER OF SUBROGATION IS ADDED: FORM SS 12 15 LOCATION 001 BUILDING 001 SEE FORM IH 12 00 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 12 15 03 00 IH12001185 ADDITIONAL INSURED - PERSON-ORGANIZATION IH12001185 WAIVER OF SUBROGATION IH12001185 . Form SS 12 11 04 05 T Page Process Date: Policy Effective Date: Policy Expiration Date: POLICY CHANGE (Continued) Policy Number: Policy Change Number: 57 SBM BL6316 ADDITIONAL INSURED - PERSON-ORGANIZATION CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 002 001 02/20/20 02/21/21 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date: 57 SBM BL6316 WAIVER OF SUBROGATION CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 003 001 02/20/20 02/21/21 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date: 57 SBM BL6316 . . 004 001 02/20/20 02/21/21 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form IH 12 00 11 85 T SEQ. NO. Printed in U.S.A. Page Process Date: Expiration Date: SCPHS016 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 March 5, 2020 NEXINITE INC. PO BOX 749 NAPA CA 94559 Policy Information: Policy Number:57 WEC AC8PCG Contact Us Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone:(866) 467-8730 Fax:(888) 443-6112 Email:agency.services@thehartford.com Website:www.thehartford.com INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes, Please contact us. The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. Sincerely, Your Hartford Service Team THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 99 00 06 A (1)Printed in U.S.A.Page 1 Process Date:03/05/20 Policy Expiration Date:02/21/21 CHANGE IN INFORMATION PAGE INSURER:Trumbull Insurance Company NCCI Company Number:19666 Audit Period:ANNUAL Policy Effective Date:02/21/20 Policy Expiration Date:02/21/21 Policy Number:57 WEC AC8PCG Endorsement Number:2 Effective Date:03/05/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:NEXINITE INC. PO BOX 749 NAPA CA 94559 FEIN Number:83-1068725 Producer Name:WORLDWIDE FACILITIES LLC/PHS Producer Code:57110788 It is agreed that the policy is amended as follows: This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. If you are enrolled in repetitive EFT draws from your bank account, changes in premium will change future draw amounts. In consideration of no change in premium, it is agreed that: Policy is amended to change the following condition(s): Waiver of Our Right to Recover from Others Endorsement Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy. WC660346 WC990006A(.1P) WC040306 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:03/05/20 Policy Expiration Date:02/21/21 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:57 WEC AC8PCG Endorsement Number:2 Effective Date:03/05/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:Nexinite Inc. PO BOX 749 NAPA CA 94559 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description The City of Cupertino 10300 Torre Ave Cupertino, CA 95014 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:03/05/20 Policy Expiration Date:02/21/21 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:57 WEC AC8PCG Endorsement Number:2 Effective Date:03/05/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:Nexinite Inc. PO BOX 749 NAPA CA 94559 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Form WC 66 03 46 Printed in U.S.A. INSTALLMENT PREMIUM SCHEDULE The Total Estimated Annual Premium of $ 891 Will be payable in installments as outlined in the SCHEDULE OF PAYMENTS SCHEDULE OF PAYMENTS NO DUE DATE OF PAYMENT ESTIMATED ADVANCE PREMIUM