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22-046 PYRO SPECTACULARS NORTH, INC for Public Firework Displays___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 1 of 12 No. ___________ FY2022 - 2023 RECREATION SERVICES AGREEMENT 1. Parties. This contract is made by and between the City of Cupertino, a municipal corporation (“City”), and PYRO SPECTACULARS NORTH, INC (“Contractor”), a California Corporation for Public Fireworks Displays and is effective on the last date signed below (“Effective Date”). 2. Services. Contractor agrees to provide the Services included in the Scope of Work and in accordance with the Schedule of Performance attached in Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID - 19. 3. Term. This contract begins on the Effective Date and ends on 07/05/2022 (“Contract Time”), unless extended or terminated as provided herein. Time is of the essence and Contractor must have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to address or mitigate such delays. The City’s appropriate department head or the City Manager may extend the Contract Time through a written amendment to this Agreement, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy. 4. Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will be based upon actual costs but that will be capped so as not to exceed $37,950.00 (“Contract Price”), based upon the Scope of Services, budget, performance schedule, and rates included in Exhibit A. The maximum compensation includes all costs, expenses, and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. Contractor must submit invoices and the information required in Exhibit A in order to receive payment. City will compensate Contractor within thirty (30) days after approval of written invoices. Invoices are subject to review and audit by City during regular business hours upon 24 hours’ notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursements and other cost items charged to City or establishing the basis for an invoice, for a minimum of four (4) years from the date of the final payment. 5. Independent Contractor. 5.1 Contractor is an independent Contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement. No civil service status or other right of employment will be acquired by virtue of ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 2 of 12 Contractor’s performance of the Services. Contractor is not entitled to City’s health benefits, worker’s compensation or any other benefit. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner. Contractor will supply all tools, materials, and equipment required to perform the Services under this Contract. Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license, if required by the Cupertino Municipal Code. 5.2 Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS), the Internal Revenue Service or the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this Agreement, or to promptly remit to City any payments due by the City as a result of such determination, so that the City’s total expenses under this Agreement are not greater than they would have been had the determination not been made. 6. Proprietary/Confidential Information. To the extent Contractor may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it as confidential and use it solely to perform this Agreement. Contractor must exercise the same standard of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Proprietary Rights. Contractor represents and warrants that it owns all copyrights, including performance rights, to this Production, except that Contractor does not own City-owned material or third-party-owned material that has been included in the Production, and as to such City - owned and third-party-owned material, City assumes full responsibility therefore. City agrees that Contractor shall retain ownership of, and all copyrights and other rights to, the Production, except that Contractor shall not acquire or retain any ownership or other rights in or to City-owned material and third-party-owned material and shall not be responsible in any way for such material. Contractor reserves the ownership rights in its trade names that are used in or are a product of the Production. Contractor grants to City the non-exclusive right to make and use recordings and photographs of the Production and to create and use pictures, and other reproductions of the Production in all media ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 3 of 12 known and unknown throughout the universe in perpetuity without any additional compensation to Contractor. 8. Records. Contractor must maintain complete, accurate, and detailed accounting records relating to its performance in accordance with generally accepted accounting principles and procedures. The records must include detailed information about Contractor’s services, benchmarks, deliverables, and costs/fees, and must be made reasonably available to City. The records and supporting documents must be kept separate from other files and maintained for four (4) years from the date of City’s final payment. 9. Assignment. This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract without prior written approval of City. Only those persons whose names are included in Exhibit A may perform the Services. 10. Publicity and Signs. Any publicity generated by Contractor related to this contract or the Services during the Contract Time and for one (1) year thereafter must reference City contributions. The words “City of Cupertino” shall 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 under this Agreement, without prior written approval from City. 11. Indemnification. Contractor represents and warrants that it is capable of furnishing the necessary experience, personnel, equipment, materials, providers, and expertise to produce the Production in a safe and professional manner. Notwithstanding anything in this Agreement to the contrary, Contractor shall indemnify, hold harmless, and defend City and the additional insureds from and against any and all claims, actions, damages, liabilities and expenses, including but not limited to, attorney and other professional fees and court costs, in connection with the loss of life, personal injury, and/or damage to property, arising from or out of the Production and the presentation thereof to the extent such are occasioned by any act or omission of Contractor, their officers, agents, c ontractors, providers, or employees. City shall indemnify, hold harmless, and defend Contractor from and against any and all claims, actions, damages, liability and expenses, including but not limited to, attorney and other professional fees and court costs in connection with the loss of life, personal injury, and/or damage to property, arising from or out of the Production and the presentation thereof to the extent such are occasioned by any act or omission of City, its officers, agents, contractors, providers, or employees. In no event shall either party be liable for the consequential damages of the other party. 12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City will not execute the Agreement until it has received and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. 13. Compliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination, including Title VII of the Civil Rights Act of 1964, the California Fair Employment Practices Act, the Americans with Disabilities Act of 1990, and other laws that pertain to fair employment and anti-discrimination practices. Contractor agrees to provide records and ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 4 of 12 documentation to the City on request necessary to monitor compliance with this provision. Contractor must comply with labor laws pertaining to prevailing wages, working hours, overtime, payroll re cords, and other requirements imposed by the Department of Industrial Relations. If Contractor does not have employees, it must sign the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in governmental decisions or serving in a staff capacity, and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Services may only be performed by persons who are not employed by City and who do not have a contractual relationship with City other than this contract. Contractor agrees to abide by City policies and administrative rules prohibiting gifts to City officials and employees. Additional Requirements for Services Provided to Minors. Contractor and its employees who provide services under this Agreement must comply with these additional requirements: A. Undergo fingerprints and a criminal background and verify all employees providing services under this contract have met this requirement. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, AB 2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, https://www.cdc.gov/headsup/index.html). D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each participant is provided with a concussion information sheet, signs and returns the forms to the City as required by Health and Safety Code Section 124235. Require coaches and administrators to successfully complete the concussion and head injury education at least once either online or in person, before supervising a participant. Contractor shall offer training, educational materials, or both to each Contractor administrator on a yearly basis. (Training resources are available at the Center for Disease Control & Prevention (link cited above). E. If providing instruction, Contractor must acknowledge and comply with all requirements set forth in the Parks & Recreation Services Instructor Manual. 14. Coordination of Services. The Parties designate the following persons as Services Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of this Agreement. Contractor’s designation and any substitution are subject to City approval. For City: Name: Sonya Lee Position: Recreation Manager Contact: sonyal@cupertino.org For Contractor: Name: Pat Dyas Position: Show Producer Contact: pdyas@pyrospec.com ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 5 of 12 15. Termination. City may terminate this contract for cause or without cause at any time and will notify Contractor as soon as possible. If City chooses to terminate this Agreement, City agrees to pay to Contractor, as liquidated damages, the following percentages of the Fee as set forth in paragraph 4 and Exhibit A. 1) 50% if cancellation occurs 30 to 90 days prior to the scheduled date, 2) 75% if cancellation occurs 15 to 29 days prior to the scheduled date, 3) 100% thereafter. In the e vent City cancels the Production, it will be impractical or extremely difficult to fix actual amount of Contractor’s damages. The foregoing represents a reasonable estimate of the damages Contractor will suffer if City cancels the Production. 16. Governing Law, Venue, and Dispute Resolution. This contract is governed by the laws of the State of California. Any legal actions or proceedings filed against City in connection with this contract must comply with the government claims filing requirements and must be filed with the Superior Court for the County of Santa Clara, State of California. At City’s request, Contractor is required to continue to provide Services pending resolution of any 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. 17. Attorney Fees. If City is required to pursue litigation, arbitration or other administrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs. This Section 17 survives this Agreement. 18. Third Party Beneficiaries. There are no third-party beneficiaries under this Contract. 19. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant, or condition, or a subsequent breach, whether the same or a different character. 20. Entire Agreement. This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein, and supersede any other contract or understanding, either oral or written, between the Parties. This Agreement may not be modified or amended except in writing signed by both Parties. If there is any inconsistency between any term, clause, or provision of the main contract and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main contract shall prevail and be controlling. 21. Inserted Provisions. Each provision or clause required by law or this contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure any mistaken insertion or omission of a required provision. 22. Headings. The headings are for convenience only and are not a part of the contract or intended to affect, limit, or amplify the terms or provisions of this Agreement. 23. Severability/Partial Invalidity. If any contract term or provision, 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 contract terms and provisions and their application to specific situations will remain in full force and effect. ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 6 of 12 24. Survival. All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownership of Materials, Records, Governing Law, and Attorney Fees, will survive the expiration or termination of this Agreement. 25. Notices. All notices and instruments pertaining to material provisions of this contract or significant disputes which are required by law or under this contract to be in writing must be sent to the persons listed below. The notices will be deemed effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth (5th) 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: Office of the City Manager 10300 Torre Ave., Cupertino, CA 95014 Cc: Representative/Coordinator: Sonya Lee Email: sonyal@cupertino.org To Contractor: PYRO SPECTACULARS NORTH, INC 5301 Lang Ave, McClellan, CA 95652 Cc: Representative/Coordinator: Gary E. Brown Email: gbrown@pyrospec.com 26. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to execute this contract and to carry out all actions and services required. This contract constitutes a legally binding obligation of Contractor, and may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. Signatures Continue on the Next Page ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 7 of 12 IN WITNESS WHEREOF, the parties have caused this contract to be executed. CITY OF CUPERTINO A Municipal Corporation By Name Title Date CONTRACTOR Pyro Spectaculars North, Inc. By Name Title Date Tax I.D. No.: Refer to W9 APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date james souza President Apr 4, 2022 Christopher D. Jensen Joanne Magrini Director Apr 5, 2022 Apr 5, 2022 ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 8 of 12 EXHIBIT A SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide Public Fireworks Displays in, but not limited to, the following: 4th of July Fireworks Display and Coordination Meetings Prior to Event Location and Time of CONTRACTOR Services: 1. Attend coordination meetings as required by the City either virtually or at the Quinlan Community Center, 10185 North Stelling Road, Cupertino, CA 95014; 2. Provide Fireworks display at Hyde Middle School, 19325 Bollinger Road, Cupertino, CA 95014 on July 4, 2022 at approximately 9:30 p.m. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of the following: The City will pay Pyro Spectaculars North, Inc. a total of $37,950 (Thirty- Seven Thousand Nine Hundred and Fifty Dollars), $18,975 (Eighteen Thousand Nine Hundred and Seventy Five Dollars) of the fee plus estimated permit and standby fees, specified production costs, and other regulatory costs approximated at $432 OR an amount to be determined, for a total of $19,407 (Nineteen Thousand Four Hundred and Seven Dollars) as a deposit upon the execution of this agreement by both parties but no later than April 1, 2022. The balance shall be paid no later than July 15, 2022. List of all Contractor Employees working for the City of Cupertino (if no Employees, identify “self”): Donald Groshart Laury Smith Laura Richardson Zachary Carr Paul Hand Alan Koczorowski Amy Greever * List is preliminary and subject to revision on the day of the event. Performance of CONTRACTOR Services: The CONTRACTOR will provide all pyrotechnic equipment, trained pyro technicians, shipping, pyrotechnic products, application for specific pyrotechnic permits (the cost of which, including standby fees, shall be paid by City) relating to the production, insurance covering the production (limits below) and the other things on its part to be performed as more specifically set forth below in this agreement and in this scope of work (“SCOPE OF WORK”), herein by this reference, and made a part of this agreement as though set forth fully herein.  One Pyro Spectaculars North, Inc., production on July 4, 2022, at approximately 9:30 p.m. at Hyde Middle School, 19325 Bollinger Road, Cupertino, CA 95014  All pyrotechnic equipment, trained pyro technicians, shipping, and pyrotechnic products. ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 9 of 12  Application for specific pyrotechnic permits relating to the production.  The fireworks display will include: Opening 3” Sky Concert Opening Salutes Quantity – 60 Main Body – Aerial Shells 3” Sky Concert Selections Quantity – 810 Grand Finale 3” Sky Concert Bombardment Shells Quantity – 330  The show is expected to last between 20 to 25 minutes. Performance of CITY Services: The City will provide: A suitable site (“site”) for the production, security for the site, access to the site, any permissions necessary to utilize the site for the production, and the other things on its part to be performed as more specifically set forth below in this agreement and in the scope of work. All site arrangements are subject to Contractor’s reasonable approval as to pyrotech nic safety, suitability, and security. All other conditions of the site shall be the responsibility of City, including, but not limited to, parking and general safety with respect to the public, city personnel and other contractors. In addition, City shall:  Provide all on-site labors costs, if any, not provided or performed by contractor personnel including, but no limited to, all site security, police and fire dept. standby personnel, and clean-up crew.  Coordinate any applicable non-pyrotechnic permitting with the local, state or federal government that may hold authority within the production.  Be responsible for costs of all permits required for the presentation of the production and the event as a whole.  Provide a safety zone in accordance with applicable standards and all requirements of the authorities having jurisdiction throughout the entire time that the pyrotechnics are at the site or the load site (if different) on the date of the production and all set-up and load-out dates.  Provide general services including, but not limited to, site and audience security, fencing, adequate work light, dumpster accessibility, a secure office for contractor personnel within the venue, secure parking for contractor vehicles, access to washrooms, tents, equipment storage, hazmat storage, electrical power, fire suppression equipment, access to worksites, necessary credentialing, etc., will be required as necessary. ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 10 of 12 EXHIBIT B INSURANCE REQUIREMENTS PROFESSIONAL/CONSULTING SERVICES CONTRACTS Contractor shall procure prior to commencement of Services and maintain for the duration of the contract, at its own cost and expense, the following insurance policies and coverage with companies doing business in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED 1. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $5,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (I) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City’s own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $5,000,000 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. 4. Professional Liability for professional acts, errors and omissions, as appropriate to Contractor’s profession, with limits no less than $1,000,000 per occurrence or $1,000,000 aggregate. If written on a claims made form: a. The Retroactive Date must be shown and must be before the Effective Date of the Contract. b. Insurance must be maintained for at least five (5) years after completion of the Services. c. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a Retroactive Date prior to the Contract Effective Date, the Contractor must purchase “extended reporting” coverage for a minimum of five (5) years after completion of the Services. ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 11 of 12 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 , and Hyde Middle School, Cupertino Union School District, Santa Clara County Fire Department, County of Santa Clara their officers, agents, and employees (“Additional Insureds”) are to be covered as additional insureds on Contractor’s CGL policy. General Liability coverage can be provided in the form of an endorsement to Contractor’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 Contractor’s insurance and shall not contribute to it. Notice of Cancellation Contractor shall give City written notice within five (5) business days of giving or receiving notice of material alteration, cancellation, non-renewal or expiration of coverage contained in such policy or such certificate of insurance. Waiver of Subrogation Contractor 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 Contractor, its employees, agents and subcontractors. 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 Contractor 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 authorized to do business in California with an A.M. Best Rating of A-VII, or better. Verification of Coverage Contractor 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 during the Contract term. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subcontractor’s insurance policies. Higher Insurance Limits If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Contractor. Adequacy of Coverage ___________________________________________________________________________________________________ Recreation Services Agreement/ Rev. June 2021 Page 12 of 12 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. ACORD® CERTIFICATE OF LIABILITY INSURANCE I DA lE (MM/00/YYYY) ~ 3/17/2022 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lleu of such endorsement(s). PRODUCER NAMe~" Britton Gallagher r ... ~RN,t .... ,. 215.55a-1100 I FAX One Cleveland Center, Floor 30 IA/C Nol, 216-658-7101 E-MAIL 1375 East 9th Street ADDRESS : Cleveland OH 44114 INSURER($) AFFORDING COVERAGE NA.IC# INSURER A: Everest Indemnity Insurance Co. 10851 INSURED INSURER e : Axis Surolus Ins Comoanv 26620 Pyro Spectaculars North, Inc. INSURER c : Everest Denali Insurance Comoany 16044 P. 0. Box 2329 Rialto CA 92377 INSURER D: Arch Soecialitv Ins Co 21199 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1836996378 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. 1rt: ·~· r:~M&~. 1,,~%~, TYPE OF INSURANCE , .. ~~ .... ,-POLICY NUMBER LIMITS A GENERAL LIABILITY y Sl8GL00282-221 1/13/2022 1/13/2023 EACH OCCURRENCE $1 ,000,000 I-- X COMMERCIAL GENERAL LIABILI TY ~~~l's'HYtc •rn= ., $500,000 I--0 CLAIMS-MADE 0 OCCUR a oco.,rronce MED EXP {An'/ one PQfSOl'II $ 1-- I--PERSONAL & ADV INJURY $1,000,000 ,__ GENERAL AGGREGATE $2,000 .000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS· COMP/OP AGG $2.000,000 n POLICY rx7 ~f~ n LOC $ C AUTOMOBILE LIABILITY y Sl8CA00031-221 I- 1/13/2022 1/13/2023 l'E';;~di~i1'1N1.>Lt wMI 1 !, "'"'"'"" X ANY AUTO BODILY INJURY (Per person) $ I-ALL OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ ~ AUTOS ~ AUTOS X X NON-OWNED fROPERTY11r MAGE $ ~ HIRED AUTOS '--AUTOS Per eccidenl $ B UMBRELLA LlAB ~OCCUR y P--001--000063846-04 1/13/2022 1/13/2023 EACH OCCURRENCE $5,000,000 ..._ X EXCESS LIAB CLAlMS-MAOE AGGREGATE $5,000,000 OED I I RETENT-ION$ $ WORKERS COMPENSATION I T~J[f J,¥;; I 1°Jr· AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE s ~m:~rtif~ ~t8PERATIONS below E.L DISEASE · POLICY LIMIT $ D Excess Liability #2 UXP1047946-00 1/13/2022 1/13/2023 Each Occ/ Aggregale $4,000,000 Tolel Limits $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attlch ACORD 101, Addlllon1I Rom1rk1 Schadule, II more apace la requlredl Certificate Holder Is named as an additional Insured in rerrds to General Liability and Excess Liability Additional Insured extension of coverage Is provided by a ove referenced General Liability policy where required by written agreement. Date of Display : July 4 , 2022 Local.ion of Display : Hyde Middle School, Cupertino, CA Additional Insureds Include: City of Cupertino, Hyde Middle School, Cupertino Union High School District, Santa Clara County Fire Department, County of Santa Clara their officers . agents and employees when acting in their official capacity as such. Primary noncontributory and waiver of subrogation shall apply. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS. Quinlan Center 10185 N . Stellin~ Road AUTliORIZED REPRESENTATIVE Cupertino CA 9 014 ~-y I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD PYRO SPECTACULARS NORTH, INC. POLICY NUMBER: Sl8GL00282-221 COMMERCIAL GENERAL LIABILITY ECG 20 592 05 09 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 Person(s) Or Organization(s) ANY PERSON OR LEGAL ENTITY IN WHICH YOU HAVE A WRITTEN CONTRACT, AGREEMENT, OR PERMIT WHICH REQUIRES THAT YOU NAME THE CONTRACTING PARTY AS AN ADDITIONAL INSURED. City of Cupertino Date: July 4, 2022 Quinlan Center 10185 N. Stelling Road Location of Display: Cupertino, CA 95014 Hyde Middle School Cupertino, CA Additional Insureds include: City of Cupertino, Hyde Middle School, Cupertino Union High School District, Santa Clara County Fire Department, County of Santa Clara and their officers, agents and employees when acting in their official capacity as such. Information required to complete this Schedule , if not shown above , will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule , but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" but only to the extent caused, in whole or in part , by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. B. The insurance afforded to an additional insured shall only include the insurance required by the terms of the written agreement and shall not be broader than the coverage provided within the terms of the Coverage Part . C. The Limits of Insurance afforded to an additional insured shall be the lesser of the following: 1. The Limits of Insurance required by the written agreement between the parties; or 2. The Limits of Insurance provided by this Cov- erage Part. D. With respect to the insurance afforded to an addi- tional insured, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising in- jury" arising out of any act or omission of an addi- tional insured or any of its employees. ECG 20 592 05 09 Copyright, Everest Reinsurance Company 2009 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. □ Policy# Sl8GL00282-221 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following : City of Cupertino, CA COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary : Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an add iti onal insured under your policy provided that: (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured . (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: Sl8GL00282-221 COMMERCIAL GENERAL LIABILITY CG 29 8810 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following : OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Cupertino, CA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV) is amended by the addition of the following: We waive any rights of recovery we may have against the person or organization shown in the Schedule above because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations . This waiver applies only to the person or organization shown in the Schedule above. CG 29 8810 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 □ Policy#: Sl8CA00031-221 COMMERCIAL AUTO ECA 04 506 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: City of Cupertino, Ca BUSINESS AUTO COVERAGE FORM The following is a summary of the Limits of Insurance and additional coverage provided by this endorsement. For complete details on specific coverage, please refer to policy language in this endorsement and the underlying Business Auto Coverage Fonn. Coverage Applicable Enhancement Subsidiaries As Insureds Broadened Newly Acquired Organizations As lnsu i'eaa , ~iiiia\ , ... ~mds. lfiia~ Emolovees As Insureds (Non-Ownershiol Broadened Suoolernentarv Pavrnents -Bail Bonds $3,000 Limit Suoolementary Payments -Loss Of Earnings $1,000 per day Fellow Emolovee Bodily lnjurv Broadened Towina Coverage-All Covered Autos Broadened Glass Breakage Coverage -Waiver of Deductible Broadened Loss of Use Expenses $50 per day $1,000 Limit Stolen Vehicle Extra Exoense Broadened Airbaa Discharae Broadened Electronic Eauioment I Permanentlv Installed\ Broadened Single Deductible Provision Broadened Notice To Comoanv Broadened Blanl<et W aiver Of Subroaatlon (Sfoacljjjjcl/ Unintentional Failure To Disclose Hazards Broadened Bodllv lniurv Includes Mental Anauish Broadened Coveraae Terrltorv Extension -Mexico Broadened ECA 04 506 0310 Copyright, Everest Reinsurance Company, 2010 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. INSURED CC.PY Page 1 of 4 □ A. Who Is An Insured The follow ing is add ed to Paragraph A.1. of Sec- tion II -Liability Coverage: d. Any: (1) Sub sidiary which is a lega lly incorporated en tity of which you own greater than 50% interest in the voting stock on the effective date of this Coverage Form. However, the insurance afforded by this provision does not apply to any subsidiary that is an '"In- sured " under any other automobile liabil ity po licy , or would be an "insured" under such policy but for the termination of such policy or the exhaustion of such policy's limits of insurance. (2) Organization you newly acquire or form, and over which you maintain majority inter- est. The coverage afforded by this provision: (a) Is effective on the acquisition date, and is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; (b) Does not apply to "bodily injury" or "property damage" resulting from an "ac- cident" that occurred before you ac- quired or formed the organization: and (c) Does not include any newly acquired or formed organization that is: (i) A joint venture or partnership ; or (ii) An "insured" under any other auto- mobile liability policy or would be an "insured" under such policy but for the termination of such policy or the exhaustion of such policy's limits of insurance. e. Any person, organization or governmental entity with respect to the operation, mainte- nance, or use of a covered "auto" if you are re- quired to add such person, organization or go- vernmental entity to this policy as an additional insured in order to comply with the terms of a written "insured contract" or written agreement. This does not apply when such contract or agreement: (1) Involves the owner or anyone else from whom you hire or borrow a covered "auto" unless it is a 'lrailer" connected to a covered "auto" you own: or (2) Is executed after the date of loss. Paragraph e.(2) does not apply if: (1) The terms and conditions of the written '"Insured con tract" had been agreed upon prior to th e "accident" or '1oss"; and (2) You can definitively establish that the terms and conditions of the written ''Insured con- tract" ultimately executed are the same as those which had been agreed upon prior to the "accident" or '1oss". f. Any of your "employees" while using a covered "auto" in your business or your personal af- fairs, provided you do not own, hire or borrow that "auto". B. Coverage Extensions -Supplementary Payments Paragraphs A.2.a.(2) and A.2.a.(4) of Section II - Liability Coverage are replaced by the following : (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "in- sured" at our request, including actual loss of earnings up to $1,000 a day because of time off from work. C. Fellow Employee The following exception is added to exclusion 5. Fellow Employee under paragraph B. Exclusions of Section II -Liability Coverage: This exclusion does not apply if the "bodily injury" results from the use of a "covered auto" you own or hire. The coverage provided under this excep- tion is excess over any other collectible insurance. D. Towing Paragraph A.2. of Section Ill -Physical Damage Coverage is replaced by the following: 2. We will pay for towing and labor costs each time that a covered "auto" is disabled . All labor must be performed at the place of disablement of the covered "auto". If the auto is not a private passenger type, a $250 deductible will apply to this coverage but it will not reduce the available limit of insurance. For all types of "auto", the most we will pay under this coverage is $1,000 per disablement. "Autos" which are disabled do not include stolen vehicles . Page 2 of4 Copyright, Everest Reinsurance Company, 2010 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. ECA 04 506 0310 INSURED COPY □ E. Glass Breakage -Hitting A Bird Or Animal - Falling Objects or Missiles The following is added to Paragraph A3. of Sec- tion Ill -Physical Damage Coverage: Any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. If the glass must be repl aced and there is no other damage associated with the "loss", the deductible will be $100 unless a lower deductible is shown in the Declarations applicable to this coverage. F. Loss Of Use Expenses Para gra ph A4.b. of Section Ill -Physical Damage Coverage is re p laced by the following : b. Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an '"Insured" becomes le- gally responsible to pay for loss of use of a ve- hicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by : (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Decla- rations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any ex- penses for loss of use is $50 per day, to a maxi mum of $1,000. G. Extra Expense -Stolen Vehicle The following is added to Paragraph A4. of Sec- tion Ill -Physical Damage Coverage: c. Stolen Vehicle We will pay for all reasonable and necessary expenses to return a stolen covered "auto" to you. H. Airbag Coverage The following exception is added to Paragraph B.3.a. of Section 111-Physical Damage Coverage: The accidental discharge of an airbag shall not be considered mechanical breakdown if it occurs in a covered "auto" for whic h Comprehensive cover ag e is purchased. This provis ion does not apply to "au- tos" you hire with a driver and is excess over any warranty specifically designed to provide this cov- erage . I. Electronic Equipment Coverage Section Ill -Physical Damage Coverage is amended as follows: 1. The sublimit in Paragraph C.2. of the Limit Of Insurance Provision is increased to $3,000. 2. No Physical Damage Coverage ded uctible ap - plies to the firs t $3,000 of '1oss" to electro nic equipment described in Paragraph C.2. of the Limit Of Insurance Provision. J. Single Deductible Provision The following is added to Paragraph D. of Section Ill -Physical Damage Coverage: If a Comprehensive or Specified Causes of Loss Coverage '1oss" from "accident" involves two or more covered "autos", only the highest deductible applicable to those coverages will be applied to the "accident", if the cause of the loss is covered for those vehicles. This provision only applies if you carry Compre- hensive or Specified Causes of Loss Coverage for those vehicles, and does not extend coverage to any covered "autos" for which you do not carry such coverage. If a "loss" covered under this Coverage Part also involves a '1oss" to other property from the same "accident", wh ich is covered under a Commercial Property or Inland Marine Coverage Part issued by us to you, only the highest deductible applicable to those coverages will be applied to the "accident". K Notice To Company Paragraph A2. of Section IV -Business Auto Conditions is amended as follows: 1. With respect to notification requirements, your obligation under Paragraph A2.a. applies only when the "accident" or "loss" is known to: a. You, if you are an individual; b. A partner, if you are a partnership; c. A member, if you are a joint venture or limited liability company; or d. An executive officer or insurance manager, if you are an organization other than a part- nership, joint venture or limited liability com- pany. 2. With respect to the requirements pertaining to you providing us with document concerning a claim or "suit", your obligation under Paragraph A2.b. will not be considered breached unless the breach occurs after such claim or "suit" is known to: a. You, if you are an individual; b. A partner, if you are a partnership; c. A member, if you are a joint venture or limited liability company; or ECA 04 506 0310 Copyright , Everest Reinsurance Company, 2010 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. Page 3 of4 INSURED CO'Y □ d. An executive officer or insurance manager, if you are an organization other than a part- nership, joint venture or limited liability com- pany. L. Blanket Waiver Of Subrogation The following is added to Paragraph A.5. of Sec- tion IV -Business Auto Conditions: a. However, we waive any right of recovery we may have against a person, organization or government entity when you have waived such right of recovery under a written ''Insured con- tract" that is: (1) Currently in effect or becoming effective during the term of this policy; and (2) Executed prior to the "accident" or '1oss", or executed after the "accident" or '1oss" if: (a) The terms and conditions of the written "insured contract" had been agreed upon prior to the "accident" or "loss"; and (b) You can definitively establish that the terms and conditions of the written '"in- sured contract" ultimately executed are the same as those which had been agreed upon prior to the "accident" or '1oss". b. We hereby waive any right of subrogation against any of your officers, directors or em- ployees which might arise by reason of any payment under the insurance afforded by the policy for the operation, maintenance, use, loading or unloading of a non-owned "auto". This waiver extends only to payments in excess of other valid and collectible insurance available to the officer, director or employee. M. Unintentional Failure To Disclose Hazards The following is added to Paragraph B.2. of Sec- tion IV -Business Auto Conditions: If you unintentionally fail to disclose any hazards existing on the effective date of this Coverage Form , we will not deny coverage under this Cover- age Form because of such failure. However, this provision does not affect our right to collect addi- tional premium due to us as a result of these un- disclosed hazards in accordance with our filed rat- ing plans. N. Bodily Injury -Including Mental Anguish Paragraph C. of Section V -Definitions is replaced by the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including "men- tal anguish" or death resulting from any of these at any time. For the purpose of this provision, the term "mental anguish" shall mean any type of mental or emotional illness or distress. 0. Mexico Coverage The coverage provided by this policy for covered "autos" you own or lease on a long term basis without drivers are extended to "accidents" or '1osses" occurring in Mexico if: 1. The covered "auto" is in Mexico for a period not exceeding 10 days; and 2. The covered "auto" is principally garaged and used in the United States; and 3. The driver of the covered "auto" does not re- side in Mexico; For Liability Coverage to apply to "accidents" oc- curring in Mexico, the following must also apply: 1. Valid and collectible auto liability insurance for the covered "auto" has been purchased from a licensed Mexican Insurance Company and is in force at the time of the "accident": and 2. The original "suit" for damages is brought with- in the United States. For '1osses" payable under Physical Damage Cov- erage this additional restriction applies: We will pay '1osses" under Physical Damage Cov- erage in the United States, not in Mexico. If the covered "auto" must be repaired in Mexico in order to be driven, then the most we will pay for '1oss" is the lesser of the following: 1. The cost of repairing the "auto" or replacing its parts in Mexico; or 2. The cost of repair or replacement at the nearest point in the United States where the repairs or replacement could be made. Other Insurance: The insurance provided by this section will be ex- cess over any other collectible insurance. Page 4 of4 Copyright, Everest Reinsurance Company, 2010 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. ECA 04 506 0310 INSUREDCCPY □ Pyro Spectaculars, Inc. Pyro Spectaculars North, Inc. Policy # S18CA00031-221 COMMERCIAL AUTO ECA 24 509 0414 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION -BLANKET This endorsement modifies insurance provided under the following: City of Cupertino, CA BUSINESS AUTO COVERAGE PART Paragraph c. of the Other Insurance General Condition is replaced by the following: c. Regardless of the prov isions of Paragraph a. above , this Coverage Form 's Liability Coverage is primary and we will not seek contribution from any other Insurance for any liability assumed under an "insured contract" that requires liability to be assumed on a primary noncontributory basis. Additionally, only the coverage and limit of insurance requirements of the "insured contract" shall apply, and in no event shall those requirements exceed the coverage and limits of insurance provided under this policy. E A 24 509 04 14 Copyright, Everest Reinsurance Company, 2014 Includes copyrighted material of Insurance Services Office, Inc., used with its permission INSURED COPY Page 1 of 1 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: - CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): City of Cupertino 10300 Torre Ave Cupertino, CA 95014 EVENT INFORMATION: TYPE: 4th of July Fireworks Display DATE(S): July 4th, 2022 LOCATION: Hyde Middle School, Miller Avenue, Sedgwick Elementary, Creekside Park and West Valley Presbyterian Church *Liquor Liability Yes No **Liquor Liability after 12 am ends before 2 am This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER MKLV7PBC000935 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2022 EXPIRATION: JANUARY 1, 2023 COMMERCIAL GENERAL LIABILITY General Aggregate Limit Products & Completed Operations Personal & Advertising Injury Each Occurrence Limit Damage To Premises Rented To You (Any One Premises) Medical Payments (Any One Person) Liquor Liability (If purchased) Optional Limits Purchased $1,000,000/$3,000,000 $2,000,000/$2,000,000 Damage To Property (If purchased) $ 2,000,000 1,000,000 1,000,000 1,000,000 100,000 5,000 1,000,000 OCCURRENCE FORM DEDUCTIBLE: NONE SPECIAL CONDITIONS: The following endorsements attached to the Master Policy do not apply to this Certificate Of Insurance: MEGL643 The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS West Valley Presbyterian Church Cupertino Union School District CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 3/21/22 MPIL 1039-CA 01 20 Page 1 of 2 EVANSTON INSURANCE COMPANY IMPORTANT NOTICE CALIFORNIA SURPLUS LINES NOTICE (D-2) 1. The insurance policy that you have purchased is being issued by an insurer that is not licensed by the State of California. These companies are called “nonadmitted” or “surplus lines” insurers. 2. The insurer is not subject to the financial solvency regulation and enforcement that apply to California licensed insurers. 3. The insurer does not participate in any of the insurance guarantee funds created by California law. Therefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised. 4. The insurer should be licensed either as a foreign insurer in another state in the United States or as a non-United States (alien) insurer. You should ask questions of your insurance agent, broker, or “surplus line” broker or contact the California Department of Insurance at the toll-free number 1-800-927-4357 or internet website www.insurance.ca.gov. Ask whether or not the insurer is licensed as a foreign or non-United States (alien) insurer and for additional information about the insurer. You may also visit the NAIC’s internet website at www.naic.org. The NAIC – the National Association of Insurance Commissioners – is the regulatory support organization created and governed by the chief insurance regulators in the United States. 5. Foreign insurers should be licensed by a state in the United States and you may contact that state’s department of insurance to obtain MPIL 1039-CA 01 20 Page 2 of 2 more information about that insurer. You can find a link to each state from this NAIC internet website: https://naic.org/state_web_map.htm. 6. For non-United States (alien) insurers, the insurer should be licensed by a country outside of the United States and should be on the NAIC’s International Insurers Department (IID) listing of approved nonadmitted non-United States insurers. Ask your agent, broker, or “surplus line” broker to obtain more information about that insurer. 7. California maintains a “List of Approved Surplus Line Insurers (LASLI).” Ask your agent or broker if the insurer is on that list, or view that list at the internet website of the California Department of Insurance: www.insurance.ca.gov./01-consumers/120-company/07- lasli/lasli.cfm. 8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker’s fee charged for this insurance will be returned to you. Public Fireworks Displays Final Audit Report 2022-04-05 Created:2022-04-01 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAA9iLA8GFOYBsb-kCKIDqNIj8-NixBEsTy "Public Fireworks Displays" History Document created by City of Cupertino (webmaster@cupertino.org) 2022-04-01 - 8:54:12 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2022-04-01 - 8:56:45 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2022-04-02 - 3:02:02 AM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to Laura Collins (lcollins@pyrospec.com) for signature 2022-04-02 - 3:02:06 AM GMT Email viewed by Laura Collins (lcollins@pyrospec.com) 2022-04-02 - 3:15:02 AM GMT- IP address: 104.28.85.142 Document signing delegated to james souza (jsouza@pyrospec.com) by Laura Collins (lcollins@pyrospec.com) 2022-04-04 - 8:33:09 PM GMT- IP address: 12.164.30.226 Document emailed to james souza (jsouza@pyrospec.com) for signature 2022-04-04 - 8:33:10 PM GMT Email viewed by james souza (jsouza@pyrospec.com) 2022-04-04 - 10:28:32 PM GMT- IP address: 74.125.209.39 Document e-signed by james souza (jsouza@pyrospec.com) Signature Date: 2022-04-04 - 10:33:00 PM GMT - Time Source: server- IP address: 12.164.30.226 Document emailed to Christopher D. Jensen (christopherj@cupertino.org) for signature 2022-04-04 - 10:33:02 PM GMT Email viewed by Christopher D. Jensen (christopherj@cupertino.org) 2022-04-04 - 10:37:17 PM GMT- IP address: 104.28.124.87 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2022-04-05 - 0:05:40 AM GMT - Time Source: server- IP address: 136.24.42.212 Document emailed to Joanne Magrini (joannema@cupertino.org) for signature 2022-04-05 - 0:05:43 AM GMT Email viewed by Joanne Magrini (joannema@cupertino.org) 2022-04-05 - 0:07:36 AM GMT- IP address: 172.225.214.171 Document e-signed by Joanne Magrini (joannema@cupertino.org) Signature Date: 2022-04-05 - 8:28:32 PM GMT - Time Source: server- IP address: 24.23.210.203 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2022-04-05 - 8:28:36 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2022-04-05 - 8:34:19 PM GMT- IP address: 104.47.73.126 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2022-04-05 - 8:34:27 PM GMT - Time Source: server- IP address: 69.110.137.176 Agreement completed. 2022-04-05 - 8:34:27 PM GMT