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20-073 Amendment #1 11-05-2020
1 FIRST AMENDMENT TO AGREEMENT BETWEEN THE CITY OF CUPERTINO AND KOFF AND ASSOCIATES FOR STAFFING AND ORGANIZATIONAL ASSESSMENT This First Amendment to Agreement between the City of Cupertino and Koff & Associates is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and Koff & Associates, a (“Contractor”) whose address is 2835 7th St, Berkeley, CA 94710, and is made with reference to the following: RECITALS: A. On June 30, 2020, an Agreement (“Agreement”) was entered into by and between City and Contractor for Staffing and Organizational Assessment. 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 2 of the Agreement is modified to read as follows: Contractor agrees to provide the services and perform the tasks ("Services") set forth in detail in Scope of Services, attached here and incorporated as Exhibits A1 and B. Contractor further agrees to carry out its work in compliance with the City's Shelter In Place and Social Distancing Requirements, attached here and incorporated as Exhibit A-A. 2. 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 based on actual costs but that will be capped so as not to exceed $62,300 (“Contract Price”), based upon the scope of services in Exhibit A1 and the budget and rates included in Exhibit C1, Compensation, attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. No extra work or payment is permitted without prior written approval of City. 3. Exhibits A1 and C1 are added to the Agreement. 4. 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. SIGNATURES CONTINUE ON THE FOLLOWING PAGE 2 IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO By Title ______________ Date APPROVED AS TO FORM City Attorney ATTEST: City Clerk Date KOFF AND ASSOCIATES By Title Date Katie Kaneko President Nov 4, 2020 Heather M. Minner Nov 5, 2020 Director of Administrastive Services Nov 5, 2020 Submittal date: October 27, 2020 Cost Proposal for PW Staffing Assessment Project City of Cupertino Koff & Associates KATIE KANEKO President 2835 Seventh Street Berkeley, CA 94710 www.KoffAssociates.com kkaneko@koffassociates.com Tel: 510.658.5633 Fax: 510.652.5633 Exhibit A1 and C1 (re Amendment 1) 2835 Seventh Street, Berkeley, California 94710 | 510.658.5633 | www.KoffAssociates.com October 27, 2020 Submitted by Email Ms. Kristina Alfaro Administrative Services Director City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Dear Ms. Alfaro: Thank you for the opportunity to provide a cost quote for the Phase II portion of the Staffing Assessment Project at the City of Cupertino. As you know, Koff & Associates is an experienced public-sector Human Resources and Recruitment Services firm that has been conducting similar studies for cities, counties, and special districts, for 35 years. The firm has achieved a reputation for working successfully with management, employees, and union representatives. We believe in a high level of dialogue and input from employees and management and our proposal speaks to that level of effort. That extra effort has resulted in close to 100% implementation of all of our classification and compensation studies. We are very proud of the fact that our firm has never had a formal appeal to any of our studies in its history. I can be reached at our Berkeley address and phone number listed at the bottom of this page. My email is kkaneko@koffassociates.com. Please call me with any questions or if you wish additional information. We look forward to the opportunity to again provide professional assistance to the City of Cupertino with this important project. Sincerely yours, Katie Kaneko President Cost Quote for Staffing Assessment Project City of Cupertino 2835 Seventh Street, Berkeley, California 94710 | 510.658.5633 | www.KoffAssociates.com TABLE OF CONTENTS Cost Proposal 1 Signature Page Cost Quote for PW Staffing Assessment Project City of Cupertino 2835 Seventh Street, Berkeley, California 94710 | 510.658.5633 | www.KoffAssociates.com 1 COST PROPOSAL Deliverables Staffing Assessment Project Hours A. Comparator Agency detailed Interviews on PW Operations 16 B. Final report write up on PW Operational detail 8 C. Total Professional Hours 24 Combined professional and clerical composite rate: $150/hour $ 3,600 Expenses are included in the composite hourly rate: N/A Expenses include but are not limited to duplicating documents, binding reports, phone, supplies, postage, parking, meals, travel time, etc. TOTAL PROJECT COST NOT TO EXCEED: $3,600 *Additional consulting will be honored at composite rate ($150/hr) Cost Quote for PW Staffing Assessment Project City of Cupertino 2835 Seventh Street, Berkeley, California 94710 | 510.658.5633 | www.KoffAssociates.com Proposal Signature Page Koff & Associates intends to adhere to all of the provisions described above. This proposal is valid for 90 days from date of submittal. Respectfully submitted, By: KOFF & ASSOCIATES State of California Katie Kaneko October 27, 2020 President 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-MAIL ADDRESS: 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 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED 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 ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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) 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 2835 Seventh Street 10/01/20 NIL X No Ded BrunyArgo X X X 1-925-682-7001 03/01/20 Berkeley, CA 94710 1,000,000 1,000,000 10/01/21 Cupertino, CA 95014 Eileen.Hollander@epicbrokers.com 1,000,000 B Professional Liability Applicable Form(s): 391-1006 0816, 401-1235 1214, 461-0155 0997; 461-0478 1212, 401-1236 1214, WC000313, 331-0342 0911 Claims Made Date: 04/16/14 30 Days Notice of Cancellation, except for Non-Payment which shall be 10 days Subrogation as per the attached endorsements Named Insured for the above agreement-General/Auto Liability coverage only-Primary/Non-Contributory/Waiver of Additional Insured(s): The Certificateholder is included as Additional Insured but only as respects to operations of the RE: Professional Services Contract 10/01/21 1,000,000 Eileen Hollander X AWF-D709922-02 09/16/2020 OBF-D709934-02 925-852-0445 10,000 CLAIMS-MADE H720-115004 LIC #0B29370 X 4,000,000 2,000,000In the Aggregate C A 42374 X 5,000Ded$1MM/$2MM 41840 31534Pleasant Hill, CA 94523 2,000,000 Koff & Associates, Inc. X 03/01/21 10/01/20 N 10/01/20 employees, agents, servants and volunteers City of Cupertino, its City Council, officers, officials, 60205127 60205127 10/01/21 10/01/20 X 925-852-0495 1,000,000 1,000,000 2,000,000 OBF-D709934-02 X X USA Edgewood Partners Insurance Center X 10300 Torre Ave. WBF-D709926-02 4,000,000 HOUSTON CAS CO B ALLMERICA FIN BENEFIT INS CO CITIZENS INS CO OF AMER A X X X No Ded 10/01/21 Suite 375 1,000,000 2300 Contra Costa Blvd 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 80 of 81 insured's rights against all those other insurers. c. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. d. We will share the remaining loss, if any, with any other insurance that is not described in this provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations for this Coverage. e. Method of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable Limit of Insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer’s share is based on the ratio of its applicable Limit of Insurance to the total applicable limits of insurance of all insurers. f. When this insurance is excess, we will have no duty under Business Liability Coverage to defend any claim or "suit" that any other insurer has a duty to defend. If no other insurer defends, we will undertake to do so; but we will be entitled to the insured's rights against all those other insurers. I. Premiums 1. The first Named Insured shown in the Declarations: a. Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. On each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with paragraph 2. above. Our forms then in effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Undeclared exposures or change in your business operation, acquisition or use of locations may occur during the policy period that is not shown in the Declarations. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect. J. Premium Audit 1. This policy is subject to audit if a premium designated as an advance premium is shown in the Declarations. We will compute the final premium due when we determine your actual exposures. 2. Premium shown in this policy as advance premium is a deposit premium only. At the close of each audit period, we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. 3. The first Named Insured must keep records of the information we need for premium computation and send us copies at such times as we may request. K. Transfer of Rights of Recovery Against Others to Us 1. Applicable to SECTION I – PROPERTY Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 81 of 81 a. Prior to a loss to your Covered Property. b. After a loss to your Covered Property only if, at time of loss, that party is one of the following: (1) Someone insured by this insurance; (2) A business firm: (a) Owned or controlled by you; or (b) That owns or controls you; or (3) Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. 2. Applicable to SECTION II – LIABILITY Coverage: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair such rights. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them. We waive any right of recovery we may have against any person or organization with whom you have a written contract, permit or agreement to waive any rights of recovery against such person or organization because of payments we make for injury or damage arising out of your ongoing operations or “your work” done under a contract with that person or organization and included in the “products- completed operations hazard”. This condition does not apply to Medical Expenses Coverage. L. Transfer of Your Rights and Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while that legal representative is acting within the scope of their duties as your legal representative. Until your legal representative is appointed, anyone with proper temporary custody of your property will have your rights and duties but only with respect to that property. 401-1235 12 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO DESIGNATED ENTITY(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART HANOVER COMMERCIAL FOLLOW FORM EXCESS AND UMBRELLA POLICY COMMERCIAL PROPERTY COVERAGE PART BUSINESS AUTO COVERAGE FORM BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Designated Entity Mailing Address or Email Address Number Days Notice (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) If we cancel this policy for any reason other than nonpayment of premium, we will give written notice of such cancellation to the Designated Entity(s) shown in the Schedule. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity(s) will state the effective date of cancellation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated Entity(s) no more than the number of days in advance of the effective date of cancellation that we are required to provide to the Named Insured for such cancellation. Such notice of cancellation is solely for the purpose of informing the Designated Entity(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Page 1 of 1 ([FHSWIRU1RQ3D\PHQW ZKLFKVKDOOEH'D\V 1DPHG,QVXUHG .DQHNR .UDPPHU,QF'%$ .RII $VVRFLDWHV,QF 3ROLF\2%)' -02 461- 01 55 ( 9- 97)Pa ge 1 o f 71of7 C o py rig h t,In su ra n ce Se rvic es O ffic e,I nc .,199 6 In clu d e s co py rig h te d m at e ria l o f In su ra nc e Se rv ice s Off ice ,In c.wi th its p e rmi ssio n , above. bu si ne ss e n ti ty d e scri be d in d . yo ur a cq u iri ng o r fo rmin g th e ac cid e nt th a t o ccu rre d pr io r to da ma g e "a risi ng fro m a n Is A n In su re d provision: "bodily injury"nor "property LIABILITY COVERAGE Who ,Paragraph 1. pr ov isio n do e s n ot ap p ly t o SECTIONII- Th e fo llo win g is a dd e d t o t h e The coverage provided by this BROADENED NAMED INSURED 3. of the insurer. policy limits or the insolvency SECTION II -LIABILITY COVERAGE for the exhaustion of the ha ve b ee n an in su re d e xc ep t partners or members of their households. as a n am ed in su re d o r wo u ld borrow from any of your "employees"or issu e d t o t h at bu si ne ss e n ti ty in clu d e a n y "a u to "yo u le as e,h ir e,r en t ,or au t om ob il e li ab il ity p o lic y conducting your business.This does not in su re d u n de r a n y ot h er yo ur d ir ec tio n ,fo r th e pu rp o se of in d.above that qualifies as an including "autos"your employee hires at an y b u sin e ss e nt it y de sc rib e d "a u to s"y ou le a se ,hi re ,re nt or b o rro w; pr ov isio n do e s n ot ap p ly t o 8 =Hired "Autos"Only -Only those The coverage provided by this replaced by the following: ea rl ie r. D e sig n at io n Sy mb ol s;Sym bo l 8 is th is p o licy ,wh ich e ve r oc cu rs D e scr ip tio n Of C o ver ed Au t o ex pi ra tio n or t e rmin a ti on o f E MPL OY EE H IR E D " A UT OS " 2. pr ov isio n is a ffo rd e d u n til The coverage provided by this SECTION I -COVERED AUTOS the term of this policy. any other reason. ac qu ir ed o r fo rme d b y yo u d u rin g of cancellation if we cancel for this policy or that is newly b.60 d ay s be fo re th e ef fe cti ve d a te interest after the effective date of re pl ac ed wit h t h e fo ll ow in g: ot h er wise h av e a co nt ro lli ng CO MMON P OL IC Y C ON D IT I ON S is than50%ofthe voting stockor A.CANCELLATION 2.b Pa ra gr ap h .of the ha ve a f in an ci al i nt e re st g re a te r d.Any business entity for which you CANCELLATION EXTENSION 1. apply unless modified by the endorsement. With respect to coverage provided by this endorsement,the provisions of the Fo rmC o ve ra ge BU SI N E SS A UT O C OVE R A GE F OR M This endorsement modifies insurance provided under the following: BR OAD E NI NG EN DO RS EME N T BUSINESS AUTO COVERAGE . THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY 5701660 054300 $:)' 461- 01 55 ( 9- 97)Pa ge 2 o f 72of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 Includes copyrighted material of Insurance Services Office,Inc.with its permission. Declarations as applicable to the A n y d ed u ct ib le s ho wn in th e or Mi ssil es : collectible insurance Hi tt in g a B ir d o r A ni mal -F all in g Ob je ct s coverage is excess over any other CO VE RA GE 3.Glass Breakage - paragraph covered "auto"you own or hire.This PH YSI C AL D AMA GE C OVE R AG E,A . "bodily injury"arises from the use of a SECTION III - Th e fo llo win g is a dd e d t o This exclusion does not apply if the GLASS BREAKAGE DEDUCTIBLE 8. F ell ow Em pl oy ee LIABILITY COVERAGE E xcl us io ns ,B. 3.$2,0 00. SECTIONII- Th e fo llo win g is a dd e d t o t h e quality;or property of like kind and EXCLUSION stolen property with other AMENDED FELLOW EMPLOYEE 6. re pl ac in g t he d am ag e d o r 2.The cost of repairing or of f fro m wo rk. time of the "loss";or up to $50 0 a d a y be ca u se of t ime thepropertyasofthe including actual loss of earnings 1.The actual cash value of by t h e " in su re d"at ou r re q u es t, (4)All reasonable expenses incurred of : Pa ra gr ap h (4 )is r ep la ce d by t h e fo ll ow in g: any one "accident"is the lesser Th e mo st we wil l pa y fo r " lo ss"i n not have to furnish these bonds. of an "accident"we cover.We do di sp la ye d o n a co ve re d " a ut o ". la w vio la ti on s)re q ui re d b e ca us e as part of equipment,which are (i nc lu di ng b on d s fo r re la te d tra ff ic mu ra ls,p a in tin g s o r gr ap h ics , (2)Up to $25 00 fo r co st o f b a il b on d s We will pay for loss to signs, Pa ra gr ap h (2 )is r ep la ce d by t h e fo ll ow in g: Sig n C o ve rag e e. Co ve ra ge Ex te ns io ns provision: LIABILITY COVERAGE ,Paragraph 2. re tu rn in g a co ve re d " a ut o "to yo u . SECTION II - Th e fo llo win g am en d s We will pay for the expense of SUPPLEMENTARY PAYMENTS 5. "A u to " Ex pe n se Of Re tu rn in g A St o len d. pe rs on a l a ffa irs . borrow in your business or your CO VE RA GE : "a u to "yo u do n ot ow n,h ir e o r PH YSI C AL D AMA GE C OVE R AG E,A .1 . "insured"while using a covered SECTION III - Th e fo llo win g is a dd e d t o e.An y e mp lo ye e o f yo u rs is a n "AUTO"SI GN C OV ER A GE an d Is A n In su re d provision: EXPENSE OF RETURNING A STOLEN 7. LIABILITY COVERAGE Who ,Paragraph 1. SE CTION II - Th e fo llo win g is a dd e d t o t h e CO VE RA GE . E MPL OY EE S A S I NS UR E D S SECTION III -PHYSICAL DAMAGE 4. 461- 01 55 ( 9- 97)Pa ge 3 o f 73of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 In clu d e s co py rig h te d m at e ria l o f In su ra nc e Se rv ice s Off ice ,In c.wi th its p e rmi ssio n . hires,without a driver,at your without a driver or your employee el ec tro n ic e q ui pm en t t h at re ce ive s extended to "autos"you hire We will pay for "loss"to any Damage Coverage(s)provided is "auto" youown,thenthePhysical Equipment Coverage under this Coverage Form for any Au d io ,Vis ua l an d Da ta El ec tro n ic 6. of Loss,or Collision is provided Comprehensive,Specified Causes CO VE RA GE : if Physical Damage Coverage of PH YSI C AL D AMA GE C OVE R AG E,A . "autos"for Liability Coverage and SECTION III - Th e fo llo win g is a dd e d t o If hired "autos"are covered ELECTRONIC EQUIPMENT COVERAGE Hi red A ut o P hy sic al D am ag e 5. AUDIO,VISUAL AND DATA CO VE RA GE : $1,0 00 p er a cc id en t . PHYSICAL DAMAGE COVERAGE,A. th e a cc id en t ,su bj ec t to a l imit of SECTION III - Th e fo llo win g is a dd e d t o co ns ec ut ive d ay s fro m th e da t e o f "a u to "fo r a pe ri od o f up to se ve n HIRED AUTO PHYSICAL DAMAGE 10. financial loss of use of the hired we w ill co ve r t he le sso r s a ct ua l o r we pa y fo r it s "l os s". fin a nc ia l lo ss fro m t ha t a cc id en t , co ve re d "a u to "is r et u rn ed to u se and the lessor incurs an actual t he p ol icy s e xp ira t io n,w he n th e fo r wh ich yo u a re le ga ll y lia b le the theft and ending,regardless of If th e lo ss a rise s fr om a n ac cid e nt period beginning 24 hours after expenses incurred during the is applicable to the loss. pay for temporary transportation any covered "auto"you own,that Causes of Loss Coverage.We will broadest coverage provided to Comprehensive or Specified provide coverage equal to the wh ic h yo u ca rry e it he r deductible stated above,we will fo r t ho se co ve re d " a ut o s"fo r lig h tn in g .S ub je ct to th e l imit an d passenger type.We will pay only to "lo ss "ca u se d b y fir e o r a covered "auto"of the private in the Declarations does not apply by you because of the total theft of co ve ra ge .A ny d e d uc tib le sh o wn transportation expense incurred any owned "auto"for that ma xi mu m of $ 1500 f or t e mp or ar y lo we st d e du ct ib le ap p lic ab le to We will pay up to $50 per day to a minus the deductible equal to the Co ve ra ge Ex te ns io n 4. c.the cost of repair, b.ca sh va lu e ,or wit h t he fo llo wi ng : a.$5 0,00 0 pe r a cci de n t,o r CO VE RA GE ,A .C OVE R AG E is replaced SECTION III -PHYSICAL DAMAGE loss is the lesser of the following: 4.Coverage Extension Pa ra gr ap h .of Th e mo st we wil l pa y fo r a n y on e TRANSPORTATION EXPENSE 9. own,subject to the following: kind and use as the "autos"you r at h er t h an re p la ce d.period of 30 days or less,of like breakage if such glass is repaired,co n d uc tin g yo ur b u sin e ss,f or a covered "auto"will not apply to glass direction,for the purpose of 5701660 054301 $:)' 461- 01 55 ( 9- 97)Pa ge 4 o f 74of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 Includes copyrighted material of Insurance Services Office,Inc.with its permission. co ve ra ge p ro vid e d h e re in i s data electronic equipment,the th e s ou n d re p ro d uc in g by this policy for audio,visual and reproduction of sound if If th e re is o th e r co ve ra ge p ro vid e d so le ly f or t h e e q ui pm en t d e sig n e d Coverage. sound reproducing Electronic Equipment same unit housing any to this Audio,Visual and Data a.An integral part of the CO VE RA GE ,d o n o t a p pl y PHYSICAL DAMAGE 2.Bo t h: 3.Deductibles applicable to operating system;or at th e t ime o f th e " lo ss" . th e c ov er ed "a u to s" determining actual cash value "auto"or the monitoring of co nd it io n w ill b e m ad e in operation of the covered depreciation and physical 1.Ne ce ss ar y fo r th e n o rma l 2.An adjustment for th a t is: c.$5 00. wit h su ch e le ctr on ic e q u ip me nt quality;or eq u ip me n t o r ac ce sso rie s u se d property of like kind and co ve ra ge ,fo r e it he r a n y el ec tro n ic stolen property with other We w ill n o t p ay ,u n d er t h is replacing the damaged or b.The cost of repairing or fo llo win g ex clu sio n s a pp ly : the "loss";or pr ov id ed h er ei n.In a dd it io n ,th e p ro p er ty a s o f th e t ime o f Equipment,also apply to coverage the damaged or stolen Audio,Visual and Data Electronic a.The actual cash value of ex ce pt fo r th e e xc lu sio n r el at in g t o PH YSIC A L D A MA GE CO VE RA GE , on e "a cci de n t"is th e le sse r o f The exclusions that apply to equipment as a result of any ac ce sso rie s u se d w ith th is ta p es ,re co rd s or d is cs. electronic equipment and any Ho we ve r ,t hi s do e s n ot in clu d e "loss"to audio,visual or data antennas and other accessories. 1.Th e mo st we wil l pa y fo r a ll covered "auto",including its el ec tri ca l syst e m,in or u p o n t he fo ll ow in g: useofthe powerfromthe"auto s" COVERAGE i s re pl ac ed b y th e de si gn e d t o b e so le ly o pe ra t ed b y PHYSICAL DAMAGE p ro vis io n o f the "loss",and such equipment is LIMIT OF INSURANCE theth e c ov er ed au t o a t th e tim e o f wh ich is p er ma ne n tl y in sta ll ed in With respect to coverage herein, re mo va bl e fr om a h ou si ng u ni t "loss"or the equipment is th e i ns ta lla t io n o f a r ad io . co ve re d " au t o"at th e t ime o f th e by the manufacturer for pe rm an e n tly i ns ta lle d in t h e or c on so le n or ma lly u se d on ly i f th e e q u ip me nt is in the openingofthe dash sound.This coverage applies b.Pe rma n e nt ly in st a lle d so le ly fo r th e re pr od u ct io n o f "auto",and signals and that is not designed in sta ll ed in th e c ov er ed or transmits audio, visual or data equipment is permanently 461- 01 55 ( 9- 97)Pa ge 5 o f 75of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 In clu d e s co py rig h te d m at e ria l o f In su ra nc e Se rv ice s Off ice ,In c.wi th its p e rmi ssio n . re p a ir o r re pl ac e t he re a so n ab ly r eq u ire d to Co ve ra g e . 1.The number of days deductible applies to this Airbag collectible insurance or warranty.No following number of days: ai rb ag .T hi s co ve ra ge is e xce ss o f o th e r ex pi ra tio n ,wit h t h e le ss er o f t he no t a p p ly to th e ac cid e nt a l di sch a rg e o f a n re ga rd le ss o f t he p ol icy s me ch an ic al o r e le ct rica l b re a kd ow n d o es hours after the "loss"and ending, The portion of this exclusion relating to the policy period beginning 24 re nt a l ex pe n se s in cu rre d du ri ng Ex clu si on s 3 ,paragraph . We will pay only for those auto PH YSI C AL D AMA GE C OVE R AG E,B . SECTION III - th is co ve ra g e . "a u to ".N o d e d uc tib le s a p pl y to AIRBAG COVERAGE 13. co ve ra ge yo u h a ve on a c ov er ed applicable amount of each Ex te n sio n . addition to the otherwise CO VE RA GE ,A .4.C o ve ra ge "auto".Payment applies in III -PHYSICAL DAMAGE equipment from the covered pr ov id ed fo r u nd e r th e SE CT IO N an d tra n sfe r yo u r ma te ri al s an d expenses which is not already to a covered "auto",to remove yo ur r en t al r ei mb ur se me nt incurred by you because of "loss" this coverage only that amount of expenses and the expenses, pa ss en g e r typ e ,we will p a y u nd e r We will pay for auto rental of a covered "auto"of the private If "l os s"re su lt s fro m t he to t al t h ef t Damage Coverages apply. de si gn a te d to wh ich th e P hy sica l to yo u fo r yo u r o pe ra t io ns . covered "auto"described or spare or reserve "autos"available De cl ar at io n s.It a p pl ie s on ly t o a does not apply while there are wh er e a pr em iu m is sh o wn i n t he This auto rental expense coverage Ph ysic al D a ma g e C o ve ra ge s Th is c ov er ag e pr ov id es o n ly t ho se 2.$3 000. Mat eri al T ra ns fe r Ex pe n se in cl ud in g lo ss o f us e. Re n ta l Re imb u rse me nt an d 7. expenses incurred, 1.Necessary and actual CO VE RA GE : PHYSICAL DAMAGE COVERAGE,A. le sse r o f th e f ol lo win g a mo u n ts: SECTION III - Th e fo llo win g is a dd e d t o Ou r pa ym en t i s limi te d t o t h e MATERIAL TRANSFER EXPENSE 2.60 d a ys. .R E N TA L RE I MB UR SE ME N T a nd 12 repair shop. of t h e o th e r co ve ra g e."auto"and transport it to a is applicable under the provisions t ak es t o l oc at e t h e co ve re d herein to pay any deductible that to the number of days it thereof of coverage provided number of days is added to ap p ly t he lim it o r a ny p o rt io n caused by theft,this ex ce ss.H ow ev er ,yo u ma y e le ct co ve re d "a u to " .If lo ss is 5701660 054302 $:)' 461- 01 55 ( 9- 97)Pa ge 6 o f 76of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 Includes copyrighted material of Insurance Services Office,Inc.with its permission. an y o ve rd u e p a yme n ts;f in an ci al p e n al tie s fo llo win g : pay:less any fees to dispose of the auto; Lo ss C o n di tio n s is replaced by the leased "auto"which you are required to IV -B US IN E SS A U TO C ON D I TI ON S,A . the lease agreement applicable to the Re co ve ry A g ain st Oth e rs T o U s,SE C T IO N at th e t ime o f "lo ss "u nd e r th e te rms o f IN SU R A NC E 1 2 .or .and the amount due 5.Transfer Of Rights Of Pa ra gr ap h C .LI MI T O F amount paid under paragraph BLANKET WAIVER OF SUBROGATION "we"will pay the difference between the 17. between you and the lessor is terminated, le as ed "a u to " ,th e l ea se a gr ee me n t a co rp o ra ti on . of a covered "auto",which is a long-term insurance manager if you are If,b e ca us e o f d am ag e ,d es tru ct io n o r t he ft (3 )An e xe cu tiv e o ffi ce r or partnership;or Of Insurance provision: ma na g e r if yo u a re a PHYSICAL DAMAGE COVERAGE,C.Limit (2)Any partner or insurance SECTION III - Th e fo llo win g is a dd e d t o (1)You,if you are an individual; EXTENSION re ce ive d b y: cla im," su it "o r "lo ss "h as b e e nAUTOLEASEPHYSICALDAMAGE 15. notice of such "accident", deemed knowledge by you when lo an s. cla im," su it "o r "lo ss "wil l be carry-over balances from previous d.Knowledge of any "accident", pu rc ha se d wit h t he lo a n,a n d Ac cid e nt or D is ab il ity I ns ur an ce Ac ci de n t,C la im,Su it Or L os s : Credit Life Insurance,Health, Co n d iti on s,2 .Du t ies I n Th e E ve n t Of termination of the loan,costs for BUSINESS AUTO CONDITIONS,A.Loss in te re st ,a n y ch a rg es f or e a rly SECTION IV - pa ym en t c ha rg e s,p e na lt ie s,Th e fo llo win g is a dd e d t o taxes,overdue payments,overdue in iti al l oa n ,le ss a n y am ou n ts f or CLAIM,SUIT OR LOSS 2.The outstanding balance of the DUTIES IN THE EVENT OF ACCIDENT, 16. the time of the "loss";or SECTION IV -CONDITIONS damaged or stolen property as of 1.Th e ac tu a l ca sh v al ue o f th e in su ra nc e. ex ce ss o ve r al l ot h er c ol le cti bl e "accident"is the greater of: pr ev io us ly b ee n le as ed .T hi s co ve ra ge is mo st we wil l pa y fo r " lo ss"i n a n y on e lease for the covered "auto"which has not Pa ye e is d e sig n a te d i n t hi s po li cy,t he Th is c ov er ag e ap p lie s o n ly to th e in iti al covered auto you own for which a Loss Wh en a " lo ss"re su lts i n a to ta l lo ss t o a pr ev io us l ea se s. loan;and carry over balances from Of Insurance provision: Di sa bi lit y In su ra nc e p u rch a se d wi th th e PH YSI C AL D AMA GE C OVE R AG E,C .L imi t Cr ed it Li fe I ns ur an ce ,H e al th ,A ccid e n t o r SECTION III - Th e fo llo win g is a dd e d t o le sso r;co st fo r ex te n de d wa rra n tie s, se cu rit y de p o sit s no t r ef un d e d b y th e EXTENSION abnormal wear and tear or high mileage; AUT O LO AN PH YSI C A L D A MAG E 14.imposed under a lease for excessive use, 461- 01 55 ( 9- 97)Pa ge 7 o f 77of7 C op yr ig ht ,In su ra n ce S er vice s Of fice ,In c. ,1996 In clu d e s co py rig h te d m at e ria l o f In su ra nc e Se rv ice s Off ice ,In c.wi th its p e rmi ssio n . nonrenewal. or exercise our right of cancellation or o u r rig h t t o co ll ec t a dd it io n al p re mi um However,this provision does not affect your rights under this Coverage Form. anguish resulting from any of these. Coverage Form shall not prejudice person including death or mental e xi sti ng a fte r t he e ffe ct ive da t e o f th is sickness or disease sustained by a o r fa il ur e t o d isc lo se ,an y ma t er ia l fa ct C."Bodily injury"means bodily injury, Your unintentional error in disclosing, DE F I NI T I ON S is re p la ce d b y th e fo llo win g :Concealment,Misrepresentation Or Fraud : C." B od il y in ju ry" ,SE CT I ON V - Pa ra gr ap hGeneralConditions2. ,paragraph BUSINESS AUTO CONDITIONS.B. MENTAL ANGUISH 20. SECTION IV Th e fo llo win g is a dd e d t o SECTION V -DEFINITIONS DISCLOSE INFORMATION UNINTENTIONAL FAILURE TO 18. po ss es sio n s. of America or its territories or imp a ir th e m. brought within The United States af te r th e "a cci de n t"or " lo ss"t o or l es s,p ro vid e d t he su it i s our rights and must do nothing business,foraperiodof30days ev er yth in g ne ce ss ar y to se cu re for the purpose of conducting your or o rg a n iza ti on mu st d o without a driver,at your direction, ar e t ra ns fe rre d t o u s.T h at pe rs on driver,or your employee hires re co ve r da ma g e s fro m a no t he r covered "auto"you hire,without a the payment,those rights to re su lti ng fro m t he u se o f a "a cci de n t"or " lo ss"gi vin g r ise to ab o ve fo r an "a cc id en t "o r "lo ss " ag re e me n t,o r p er mit ,pr io r to th e de sc rib e d in a .,b .,c.,a n d d . an "i ns ur ed co n tra ct ",w rit te n e.Ou tsi de th e co ve ra ge te rr ito ry waived through the execution of an o th e r,wh ic h h a ve n o t b e en Co ve ra ge Te rri to ry provision: rig h ts t o re co ve r d a ma ge s fr om Co n d iti on s 7.Po li cy Pe rio d , ,paragraph under this Coverage Form has Bu si ne ss A u to Co n d iti on s,B .Ge n era l for whom we make payment SECTION IV - Th e fo llo win g is a dd e d t oIfanypersonororganizationtoor Ag a in st Ot h ers T o Us COVERAGE Tr an sf er Of Ri gh t s Of R ec o ver y HIRED AUTO -WORLDWIDE 5.19. 5701660 054303 $:)' 46 1- 04 78 12 1 2 ermission Pa g e 1 o f 1IncludescopyrightedmaterialofISOInsuranceServicesOffice,Inc.,with its p ALL OTHER TERMS,CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. any other "insured"under this Coverage Part. wi ll n o t be b ro a d er th a n co ve ra g e pr ov id ed t o D. C o ve ra ge p ro vi de d t o a n a dd it io n al "i ns ur ed " In su ra n ce : Gen e ral Conditions,5.Ot he r subparagraph be provided to the additional "insured". BUSINESS AUTO CONDITIONS,B. Pa ra g ra p h or written permit requires such insurance to B.SECTION IV - Th e fo llo wi ng is added to that the written contract,written agreement 3. Prior to the expiration of the period of time De cl ar at io n s. In su ra nc e fo r L ia b ilit y C ov er ag e sh ow n i n t he is su an ce o f th e w rit te n p e rmi t;a n d re su lti ng fr om a ny on e "a cc id en t "i s th e L imit o f co n tr ac t or w rit te n agreement or th e "covered pollution cost or expense"combined 2. Subsequent to the execution of the written will pa y for th e to ta l of all da ma g e s and 1. During the policy period; ve hi cle s in vo lv ed i n t h e "a cci de n t" ,t he mo st we "in su re d s" ,pr em iu ms paid,cl ai ms ma d e or "accident"occurs: C. Regardless of the number of covered "autos",This endorsement wil l apply only if th e De cl ar at io n s ap p lic ab le to th is C o ve ra g e Pa rt . p o licy . to th e Limits of Insurance sh o wn in the a d di tio n a l "i ns ur ed "u n d er an o th e r li ab il ity Such amount shall be part of and not in addition (3) Wh e n t he a dd it io n al " in su re d"i s al so a n ap p lic ab le to th is C o ve ra g e Pa rt . by you;or Co ve ra g e sh ow n in the Declarations "auto"owned by the additional "insured"or (2 ) Th e Limits of In su ra n ce fo r Liability that "auto"is a "trailer"connected to an ag re e me n t o r writ te n pe rm it;o r b y th e a dd it io n al " in su re d "o r b y yo u,un le ss sp ec ifie d in the wri tt en co n tra ct ,wri tt en maintenance or use of any "auto"not owned (1 )(2) The Limits of Insurance for liability coverage F or n eg li ge n ce a risi ng o u t o f th e ow ne rs hi p, "in su re d "is t h e le ss er o f:"insured";or (1) we will pay on be h a lf of su ch additional For the sole negligence of the additional "insured"under this Coverage Part,the most except: or ga n iza t io n be added as an additional insurance available to the additional "insured" ag re e me n t o r writ te n pe rm it t ha t a p er so n o r We wi ll n o t s ee k co nt rib u ti on fr om an y ot h er If yo u agree in a wr itt e n contract,wri tt en to the additional "insured"as a Named Insured. of t h is Se ct io n.Pa rt is pr ima ry to a ny o th e r in su ra n ce a va ila b le A .1.c . qu a lif ie s a s a n " in su re d"u nd e r p a ra gr ap h T h e li ab il ity co ve ra ge p ro vid e d b y t hi s Co ve ra g e to t he e xt e nt t ha t su ch p e rso n o r o rg a n iza ti on applies: person or organization is an "insured";but only p rim ar y and non-contributory,the following "in su re d "under th is C o ve ra ge Pa rt,su ch A d di tio n al I n su red if Re q ui red by C o nt ra ct is or ga n iza t io n be added as an a d d iti on a l A.1.Who Is An I n su red , subparagraph agreement or written permit that a person or SECTION II -LIABILITY COVERAGE, Paragraph If yo u agree in a wr itt e n contract,wri tt en q u al ifie s as an additional "insured"under Additional Insured if Required by Contract provided to a pe rs on or organization wh o agreement or written permit that the insurance An Insured: If yo u agree in a writ te n co n tra ct ,w rit te n LIABILITY COVERAGE,A. 1.Wh o I s Paragraph A.SECTION II -Primary and Non-Contributory Th e fo ll ow in g is added to BUSINESS AUTO COVERAGE PART This endorsement modifies insurance provided under the following: BLA NK ET ADD ITI ONA L IN SU RE D -P RI MAR Y AN D N ON -C ON TRI BU TORY THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. 5701660 054315 AWF-D709922-02 401-1236 12 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO DESIGNATED ENTITY(S) (Including Nonpayment of Premium) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART HANOVER COMMERCIAL FOLLOW FORM EXCESS AND UMBRELLA POLICY COMMERCIAL PROPERTY COVERAGE PART BUSINESS AUTO COVERAGE FORM BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Designated Entity Mailing Address or Email Address Number Days Notice (In formation required to complete this Schedule, if not shown above, will be shown in the Declarations.) If we cancel this policy for any reason, including nonpayment of premium, we will give written notice of such cancellation to the Designated Entity(s) shown in the Schedule. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity(s) will state the effective date of cancellation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated Entity(s) no more than the number of days in advance of the effective date of cancellation that we are required to provide to the Named Insured for such cancellation. If the reason for cancellation is nonpayment of premium, however, we will provide ten days notice. Such notice of cancellation is solely for the purpose of informing the Designated Entity(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. -02 (Ed .4-8 4)Copyright 1983 National Council on Compensation Insurance. WC 00 03 13 Ins ura nc e Co mpa ny Co unt ers igned by KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK Ins ure d Pre mium End ors eme nt Effe ct ive Polic y No.Endo rse men t No. ( The inf ormat ion be low is re quired on ly w hen t his en dors em ent is is s ued s ub se quen t to pre parat ion of the p olic y.) T his en dors em ent c han ges t he polic y to wh ich it is a tt ac hed and is e ffec t ive on the da te is su ed unles s o the rwis e st at ed. WC POL ICY HOL DER EM PLO YE ES HOL DER REQ UI RING W OS F OR CONTR ACT WIT H T HE POL ICY - FOR TH OS E HAV ING A WR ITTE N APPL IES A S BLANK ET WAI VE R Schedule Th is a g re e me nt sh al l no t o p e ra te di re ctl y or i nd ir ec tly t o b e n ef it a n yo ne n ot na me d in t h e Sc he d u le . fro m u s.) only to the extent that you perform work under a written contract that requires you to obtain this agreement not enforce our right against the person or organization named in the Schedule.(This agreement applies We h av e th e rig h t to re co ve r ou r pa ym en t s fr om a ny on e li ab le f or a n in ju ry c ov er ed b y Weth is p ol icy.will WA IVE R O F OU R RIG HT TO RE COVE R FROM OT HE RS E ND ORS EM E NT 2 10-01-20 3 31- 034 2 (0 9 11)Pag e 1 o f 1 Includes copyrighted materials from ISO,Inc.2003 Cou nte rsig ned By KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK CITIZENS INSURANCE COMPANY OF AMERICAInsuranceCompany Premium $0 01EndorsementNo. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. A L L OT H E R T E RM S AN D CO ND IT IO NS O F T HI S POL IC Y R EM AI N U N CH A N GE D. d a te of c an ce ll at io n a n d d o e s no t g ra n t,a lt e r,o r ex te n d a n y rig h ts o r o bl ig at io n s un d e r th is p o licy . Such notice of cancellation is solely for the purpose of informing the Designated of theEn t ity (s )e ffe ct ive vi de to th e Na me d In su re d fo r su ch ca n ce lla ti on . more than the number of days in advance of the effective date of cancellation that we are required to pro- Unless otherwise noted in the Schedule above,such notice will be provided to the Designated Entity(s)no la t io n. by any means of our choosing.The notice to the Designated Entity(s)will state the effective date of cancel- such cancellation to the Designated Entity(s)shown in the Schedule.Such notice may be delivered or sent If w e ca n ce l t hi s po li cy fo r a ny r ea so n o th e r th a n n o np a yme n t o f p re miu m,w e wi ll g ive writ te n no t ice o f In fo rma t io n re q ui red t o co mp le te th is Sc he d ul e,if n o t sh o wn ab o ve,w ill b e sh o wn i n t h e D ecl ara t io ns. ON FILE WITH COMPANY AS PER WRITTEN CONTRACT ON FI LE WIT H CO MPA N Y AS P ER WR IT T EN C ON TR A C T 30 Days Notice Name of Designated Entity Mailing Address or Email Address Number SC H E DU L E WORKERS’COMPENSATION AND EMPLOYERS’LIABILITY INSURANCE POLICY This endorsement modifies insurance provided under the following: N OTI CE OF CAN CE L LA TI ON TO DE SI GN ATE D EN TI TY( S) 5701660 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 ::((( 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 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1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 ::(::(([FHSWIRUQRQSD\PHQWZKLFKVKDOOEHGD\V Endorsement Effective: 10/01/2020 Insured Policy No. WBF-' 6 WBF-D709926-02 First Amendment to Agreement btwn Cupertino and Koff & Asssociates Final Audit Report 2020-11-05 Created:2020-11-04 By:Mariela Vargas (marielar@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAgeNxPMNRvJYb8q71hmbL7GfeK7Eg3yoK "First Amendment to Agreement btwn Cupertino and Koff & Asss ociates" History Document created by Mariela Vargas (marielar@cupertino.org) 2020-11-04 - 11:29:04 PM GMT- IP address: 47.7.63.118 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2020-11-04 - 11:32:34 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2020-11-04 - 11:34:49 PM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to Katie Kaneko (kkaneko@koffassociates.com) for signature 2020-11-04 - 11:34:51 PM GMT Email viewed by Katie Kaneko (kkaneko@koffassociates.com) 2020-11-04 - 11:37:31 PM GMT- IP address: 104.47.44.254 Document e-signed by Katie Kaneko (kkaneko@koffassociates.com) Signature Date: 2020-11-04 - 11:38:19 PM GMT - Time Source: server- IP address: 66.117.153.58 Document emailed to Heather M. Minner (minner@smwlaw.com) for signature 2020-11-04 - 11:38:21 PM GMT Email viewed by Heather M. Minner (minner@smwlaw.com) 2020-11-05 - 0:26:26 AM GMT- IP address: 45.41.142.117 Document e-signed by Heather M. Minner (minner@smwlaw.com) Signature Date: 2020-11-05 - 0:26:52 AM GMT - Time Source: server- IP address: 52.39.49.65 Document emailed to Kristina Alfaro (kristinaa@cupertino.org) for signature 2020-11-05 - 0:26:55 AM GMT Email viewed by Kristina Alfaro (kristinaa@cupertino.org) 2020-11-05 - 4:50:37 PM GMT- IP address: 104.47.46.254 Document e-signed by Kristina Alfaro (kristinaa@cupertino.org) Signature Date: 2020-11-05 - 4:51:09 PM GMT - Time Source: server- IP address: 198.135.177.41 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2020-11-05 - 4:51:11 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2020-11-05 - 5:13:24 PM GMT- IP address: 104.47.44.254 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2020-11-05 - 5:13:33 PM GMT - Time Source: server- IP address: 69.110.137.176 Agreement completed. 2020-11-05 - 5:13:33 PM GMT