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20-103 Amendment #2 dated 7-13-22 BMR AHF Affordable Placement Program1 SECOND AMENDMENT TO BELOW MARKET-RATE (BMR) AFFORDABLE HOUSING FUND (AHF) CITY/NON-PROFIT CONTRACT (Services Only) This Second Amendment to Contract is entered into between PROJECT SENTINEL ("CORPORATION") and the CITY OF CUPERTINO ("CITY") as of July 1, 2022 (the "Effective Date") to amend the Below Market-Rate (BMR) Affordable Housing Fund (AHF) Program Contract (the "Contract") dated July 1, 2020. WITNESSETH WHEREAS, CITY has reserved a portion of its BMR AHF funds to be used on activities that benefit Cupertino's residents; and, WHEREAS, CITY has agreed to the use by CORPORATION of a portion of CITY'S BMR AHF budget for the Program as described below to be operated within CITY and will benefit low and very low-income households; THEREFORE, the parties agree as follows: 1. Section I, entitled "Program", is deleted in its entirety and replaced with the following: For the period of July 1, 2020 to June 30, 2021, CITY agreed to allocate a portion of its BMR AHF funds to CORPORATION in the sum of Fifty Thousand Dollars and No Cents ($50,000) for the purpose of implementing the CORPORATION'S program, as more particularly described in Exhibits A-D to the Contract (hereinafter "Program"), and said Exhibits set forth below, as they may be amended or modified, are attached to this Contract and incorporated herein by reference. Exhibit A and A-2: Program Description Exhibit B and B-2: Program Work Plan Exhibit C and C-2: Proposed Implementation Timeline Schedule Exhibit D and D-2: Program Budget Exhibit E: Basic Insurance and Bond Requirements For Non-Profit Contracts For the period of July 1, 2021 to June 30, 2022 CITY agrees to allocate a portion of its current BMR AHF funds to CORPORATION in the sum of Fifty Thousand Dollars and No Cents ($50,000) for the purpose of implementing the CORPORATION'S Program. For the period of July 1, 2022 to June 30, 2023 CITY agrees to allocate a portion of its current BMR AHF funds to CORPORATION in the sum of Fifty Thousand Dollars and No Cents ($50,000) for the purpose of implementing the CORPORATION'S Program. The total allocation for July 1, 2020 through June 30, 2023 shall not exceed One Hundred Fifty Thousand Dollars and No Cents ($150,000). 2 2. The following sentence is added to the end of subsection B of Section II, "Term,": The term of this Contract (the "Term") has been extended once per this Section II.B to end on June 30, 2023, unless otherwise amended or terminated earlier pursuant to Section VII or Section VIII of this Contract. 3. Exhibits A-2, B-2, C-2, and D-2, attached hereto, are added to the CONTRACT. 4. Exhibit E to the CONTRACT is replaced with Exhibit E attached hereto. 5. All terms, covenants and conditions stated in the CONTRACT, which are not herein amended, remain in full force and effect. [Signatures on following page.] Page 3 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment IN WITNESS WHEREOF, the parties have executed this Second Amendment as of the Effective Date. CORPORATION: CITY: PROJECT SENTINEL, a California CITY OF CUPERTINO, a municipal nonprofit public benefit corporation corporation ___________________________________ __________________________________ Carole Conn Date Benjamin Fu Date Executive Director Director of Community Development APPROVED AS TO FORM AND ATTEST: LEGALITY: ___________________________________ _________________________________ Christopher Jensen Date Kirsten Squarcia Date City Attorney City Clerk EXPENDITURE DISTRIBUTION PO # 2021-132 265-72-711-600-623 Original Contract: $50,000 Amendment #1: $50,000 Amendment #2 $50,000 Total: $150,000 Jul 7, 2022 Christopher D. Jensen Jul 7, 2022 Jul 12, 2022 Jul 12, 2022 Page 4 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment EXHIBIT A-2 PROGRAM DESCRIPTION FY 2022/2023 Agency Name: Project Sentinel DUNS #: Not Applicable (Only for CDBG) Executive Director: Carole Conn Program Manager: Luis Espinoza Program # (For Office Use Only)265-72-711 600-623 Street Address: 1490 El Camino Real City: Santa Clara State: CA Zip Code: 95050 Telephone number: 408-470-3735 Fax Number: Program Manager E-mail Address: lei@housing.org Name of Program: Fair Housing & Tenant-Landlord Counseling & Dispute Resolution Services Program Location: 1490 El Camino Real, Santa Clara, CA 95050 Program Description: The proposal is submitted in support of Fair Housing, tenant-landlord counseling and dispute resolution services for the City of Cupertino. The proposed tenant-landlord counseling and dispute resolution activity educates tenants and landlords on their respective rights and responsibilities, provides instruction on how to resolve housing problems, and conducts dispute resolution services like mediation and conciliation to help resolve problems. Fair Housing services address the incidence of illegal housing discrimination by investigating complaints, administering systemic audits, conducting community outreach and education, and seeking redress for victims of such discrimination. Page 5 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment EXHIBIT B-2 PROGRAM WORK PLAN FY 2022/2023 AGENCY NAME: Project Sentinel PROGRAM NAME: Fair Housing & Tenant-Landlord Counseling & Dispute Resolution Services Objectives Benchmarks for Each Quarter 1st 2nd 3rd 4th TOTAL Information and Referral Calls (Total calls for FH and TLL) 20 20 21 21 82 Case Management (Total cases for FH and TLL) 9 8 9 9 35 Households Counseled (part of case management) 9 8 9 9 35 Outreach: Public Presentation, tabling, collaborations s (Fair Housing and TLL ) 5 5 5 5 20 Outreach: Distribution of FH and TLL literature (# of pcs of flyers) 100 100 50 100 350 Conflict resolution training for Cupertino residents and social service providers 0 0 1 0 1 Total Beneficiaries: 523 Page 6 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment EXHIBIT C-2 PROPOSED IMPLEMENTATION TIMELINE SCHEDULE FY 2022/2023 AGENCY NAME: Project Sentinel PROGRAM NAME: Fair Housing & Tenant-Landlord Counseling & Dispute Resolution Services Activity Number & Description: Activity # Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 1. 2. Page 7 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment EXHIBIT D-2 PROGRAM BUDGET FY 2022-2023 AGENCY NAME: Project Sentinel PROGRAM NAME: Fair Housing & Tenant-Landlord Counseling & Dispute Resolution Services Proposed Program Expenses FY 2022-23 Salaries/Benefits/Payroll/Taxes $39,400 Office Supplies Communication $765 Publications/Printing/Advertising $259.80 Travel Rent/Lease/Mortgage Utilities Insurance $380 Equipment Rental/Maintenance $1,000 Audit/Legal/Professional Services (for CDBG portion only) Direct Services (Funding for specific service such as a meal, ride) Contracted Services Other Indirect 20.8% $8,195.20 Total Expenses $50,000 Page 8 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment EXHIBIT E BASIC INSURANCE AND BOND REQUIREMENTS FOR NON-PROFIT CONTRACTS Definition of Contractor: The "Contractor" as the word is used in this Exhibit E is the party contracting with the City of Cupertino for the direct distribution of BMR AHF funds. Indemnity The Contractor shall indemnify, defend, and hold harmless the City of Cupertino (hereinafter "City"), its officers, agents and employees from any loss, liability, claim, injury or damage arising out of, or in connection with performance of this Contract by Contractor and/or its agents, employees or subcontractors, excepting only loss, injury or damage caused solely by the acts or omissions of personnel employed by the City. It is the intent of the parties to this Contract to provide the broadest possible coverage for the City. The Contractor shall reimburse the City for all costs, attorneys' fees, expenses and liabilities incurred with respect to any litigation in which the Contractor is obligated to indemnify, defend and hold harmless the City under this Contract. Insurance Without limiting the Contractor's indemnification of the City, the Contractor shall provide and maintain at its own expense, during the term of this Contract, or as may be further required herein, the following insurance coverages and provisions: A. Evidence of Coverage Prior to commencement of this Contract, the Contractor shall provide on the City's own form or a form approved by the City's Insurance Manager an original plus one copy of a Certificate of Insurance certifying that coverage as required herein has been obtained and remains in force for the period required by this Contract. The contract number and program name must be stated on the Certificate of Insurance. The City's Special Endorsement form shall accompany the certificate. Individual endorsements executed by the insurance carrier may be substituted for the City's Special Endorsement form if they provide the coverage as required. In addition, a certified copy of the policy or policies shall be provided by the Contractor upon request. This verification of coverage shall be sent to the address as shown on the City's Certificate of Insurance form and to the Community Development Department at the address set forth in this Contract at Section VI. PROGRAM COORDINATION, Paragraph C., NOTICES. The Contractor shall not issue a Notice to Proceed with the work under this Contract until it has obtained all insurance required and such insurance has been approved by the City. This approval of insurance shall neither relieve nor decrease the liability of the Contractor. B. Notice of Cancellation of Reduction of Coverage All policies shall contain a special provision for thirty (30) days prior written notice of any cancellation or reduction in coverage to be sent to the Community Development Department, 10300 Torre Avenue, Cupertino, CA 95014. Page 9 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment C. Qualifying Insurers All policies shall be issued by companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII, according to the current Best's Key Rating Guide, unless otherwise approved by the City's Insurance Manager. D. Insurance Required 1. Comprehensive General Liability Insurance - for bodily injury (including death) and property damage which provides limits of not less than one million dollars ($1,000,000) combined single limit (CSL) per occurrence. OR 2. Commercial General Liability Insurance - for bodily injury (including death) and property damage which provides limits as follows: a. General limit per occurrence - $1,000,000 b. General limit aggregate - $2,000,000 c. Products/Completed Operations- $1,000,000 aggregate d. Personal Injury limit - $1,000,000 If coverage is provided under a Commercial General Liability Insurance form, the carrier shall provide the City Insurance Manager with a quarterly report of the amount of aggregate limits expended to that date. If over 50% of the aggregate limits have been paid or reserved, the City may require additional coverage to be purchased by the Contractor to restore the required limits. 3. For either type of insurance, coverage shall include: a. Premises and Operations b. Products/Completed Operations with limits of one million dollars ($1,000,000) per occurrence/ aggregate to be maintained for two (2) years following acceptance of the work by the City. c. Contractual Liability expressly including liability assumed under this Contract. d. Personal Injury liability. e. Independent Contractors' (Protective) liability. f. Severability of Interest clause providing that the coverage applies separately to each insured except with respect to the limits of liability. Page 10 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment 4. For either type of insurance, coverage shall include the following endorsements, copies of which shall be provided to the City: a. Additional Insured Endorsement: Such insurance as is afforded by this policy shall also apply to the City of Cupertino, and members of the City Council, and the officers, agents and employees of the City of Cupertino, individually and collectively, as additional insureds. b. Primary Insurance Endorsement: Such insurance as is afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the City of Cupertino, its officers, agents, and employees shall be excess only and not contributing with insurance provided under this policy. c. Notice of Cancellation or Change of Coverage Endorsement: This policy may not be cancelled nor the coverage reduced by the Company without 30 days prior written notice of such cancellation or reduction in coverage to the City of Cupertino at the address shown on the Certificate of Insurance. d. Contractual Liability Endorsement: This policy shall apply to liability assumed by the insured under written contract with the City of Cupertino. e. Personal Injury Endorsement: The provisions of this policy shall provide Personal Injury coverage. f. Severability of Interest Endorsement: The insurance afforded by this policy shall apply separately to each insured that is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the Company's limit of liability. 5. Comprehensive Automobile Liability Insurance for bodily injury (including death) and property damage which provides total limits of not less than one million dollars ($1,000,000) combined single limit per occurrence applicable to all owned, non-owned and hired vehicles. 6. Worker's Compensation and Employer's Liability Insurance for: a. Statutory California Workers' Compensation coverage including a broad form all- states endorsement. Page 11 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment b. Employer's Liability coverage for not less than one million dollars ($1,000,000) per occurrence for all employees engaged in services or operations under this Contract. c. Inclusion of the City and its governing board(s), officers, representatives, agents, and employees as additional insureds, or a waiver of subrogation. 7. Professional Errors and Omissions Liability Insurance This type of insurance should be provided by persons/entities you contract with to provide you with professional services. a. Limits of not less than one million dollars ($1,000,000). b. If this policy contains a self retention limit, it shall not be greater than ten thousand dollars ($10,000) per occurrence/event. c. This coverage shall be maintained for a minimum of two (2) years following termination of this Contract. The City must first approve any exceptions to the above requirements. 8. Bond Requirements Fidelity Bond - Before receiving compensation under this Contract, Contractor will furnish City with evidence that all officials, employees, and agents handling or having access to funds received or disbursed under this Contract, or authorized to sign or countersign checks, are covered by a BLANKET FIDELITY BOND in an amount of AT LEAST fifteen percent (15%) of the maximum financial obligation of the City cited herein. If such bond is cancelled or reduced, Contractor will notify City immediately, and City may withhold further payment to Contractor until proper coverage has been obtained. Failure to give such notice may be cause for termination of this Contract, at the option of the City. 9. Special Provisions The following provisions shall apply to this Contract: a. The foregoing requirements as to the types and limits of insurance coverage to be maintained by the Contractor and any approval of said insurance by the City or its insurance consultant(s) are not intended to and shall not in any manner limit or qualify the liabilities and obligations otherwise assumed by the Contractor pursuant to this Contract, including but not limited to the provisions concerning indemnification. b. The City acknowledges that some insurance requirements contained in this Contract may be fulfilled by self-insurance on the part of the Contractor. Page 12 of 12 FY 2022-2023 Below Market-Rate (BMR) Affordable Housing Fund (AHF) City/Non-Profit Contract Amendment However, this shall not in any way limit liabilities assumed by the Contractor under this Contract. The City shall approve any self-insurance in writing. c. The City reserves the right to withhold payments to the Contractor in the event of material noncompliance with the insurance requirements outlined above. d. If the Contractor fails to maintain such insurance as is called for herein, the City must order the Contractor to immediately suspend work at Contractor's expense until a new policy of insurance is in effect. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR 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 6/15/2022 (WC)Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek CA 94596 Sarah Field 925-934-8500 925-934-8278 sarahf@heffins.com License#:0564249 Nonprofits Insurance Alliance of California 1184 PROJSEN-01 Hartford Accident &Indemnity Company 22357ProjectSentinel 1490 El Camino Real Santa Clara CA 95050 Berkshire Hathaway Homestate Insurance Company 20044 223290419 A X 1,000,000 X 500,000 20,000 1,000,000 2,000,000 X Y 202200610 7/1/2022 7/1/2023 2,000,000 Sexual Misconduct 1,000,000 A 1,000,000 X X X X 202200610 7/1/2022 7/1/2023 A X X 2,000,000202200610UMB7/1/2022 7/1/2023 2,000,000 C XYPRWC3337767/1/2022 7/1/2023 1,000,000 1,000,000 1,000,000 A B Errors &Omissions Crime 202200610 57BDDID7926 7/1/2022 7/1/2022 7/1/2023 7/1/2023 Per Claim Aggregate Employee Theft/Deduct 1,000,000 2,000,000 6,450 /500 Deduct Certificate holder is included as additional insured on the General Liability policy per the attached endorsement,if required. 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´¿©å ¿²¼ îò ×º ½±ª»®¿¹» °®±ª·¼»¼ ¬± ¬¸» ¿¼¼·¬·±²¿´ ·²-«®»¼ ·- ®»¯«·®»¼ ¾§ ¿ ½±²¬®¿½¬ ±® ¿¹®»»³»²¬ô ¬¸» ·²-«®¿²½» ¿ºº±®¼»¼ ¬± -«½¸ ¿¼¼·¬·±²¿´ ·²-«®»¼ ©·´´ ²±¬ ¾» ¾®±¿¼»® ¬¸¿² ¬¸¿¬ ©¸·½¸ §±« ¿®» ®»¯«·®»¼ ¾§ ¬¸» ½±²¬®¿½¬ ±® ¿¹®»»³»²¬ ¬± °®±ª·¼» º±® -«½¸ ¿¼¼·¬·±²¿´ ·²-«®»¼ò ßò Þò É·¬¸ ®»-°»½¬ ¬± ¬¸» ·²-«®¿²½» ¿ºº±®¼»¼ ¬± ¬¸»-» ¿¼¼·¬·±²¿´ ·²-«®»¼-ô ¬¸» º±´´±©·²¹ ·- ¿¼¼»¼ ¬± Í»½¬·±² ××× Ô·³·¬ Ñº ×²«®¿²½»æ ×º ½±ª»®¿¹» °®±ª·¼»¼ ¬± ¬¸» ¿¼¼·¬·±²¿´ ·²-«®»¼ ·- ®»¯«·®»¼ ¾§ ¿ ½±²¬®¿½¬ ±® ¿¹®»»³»²¬ô ¬¸» ³±-¬ ©» ©·´´ °¿§ ±² ¾»¸¿´º ±º ¬¸» ¿¼¼·¬·±²¿´ ·²-«®»¼ ·- ¬¸» ¿³±«²¬ ±º ·²-«®¿²½»æ ïò Î»¯«·®»¼ ¾§ ¬¸» ½±²¬®¿½¬ ±® ¿¹®»»³»²¬å ±® îò ßª¿·´¿¾´» «²¼»® ¬¸» ¿°°´·½¿¾´» Ô·³·¬- ±º ×²-«®¿²½» -¸±©² ·² ¬¸» Ü»½´¿®¿¬·±²-å ©¸·½¸»ª»® ·- ´»--ò Ì¸·- »²¼±®-»³»²¬ -¸¿´´ ²±¬ ·²½®»¿-» ¬¸» ¿°°´·½¿¾´» Ô·³·¬- ±º ×²-«®¿²½» -¸±©² ·² ¬¸» Ü»½´¿®¿¬·±²-ò w ×²-«®¿²½» Í»®ª·½»- Ñºº·½»ô ×²½òô îðïî Ð¿¹» ï ±º ïÝÙ îð îê ïî ïç Endorsement Effective: Policy No.: Insured: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform wor k under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket W aiver – Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Waiver Premium (prior to adjustments) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement No.: Premium $ Insurance Company: WC 99 04 10 C Countersigned by ______________________________________ (Ed. 01-19) Job Description All CA Operations Oak River Insurance Company PRWC333776 350.00 07/01/2022 BMR AHF Affordable Placement Program Final Audit Report 2022-07-12 Created:2022-06-29 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAESwbVepNjeOWE-nZJETSrsujA1GLjSSD "BMR AHF Affordable Placement Program" History Document created by City of Cupertino (webmaster@cupertino.org) 2022-06-29 - 5:06:15 PM GMT- IP address: 35.229.54.2 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2022-06-29 - 5:08:08 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2022-06-29 - 5:13:44 PM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to cconn@housing.org for signature 2022-06-29 - 5:13:46 PM GMT Email viewed by cconn@housing.org 2022-07-07 - 11:12:06 PM GMT- IP address: 104.47.74.126 Document e-signed by Carole Conn (cconn@housing.org) Signature Date: 2022-07-07 - 11:12:48 PM GMT - Time Source: server- IP address: 73.15.207.95 Document emailed to christopherj@cupertino.org for signature 2022-07-07 - 11:12:50 PM GMT Email viewed by christopherj@cupertino.org 2022-07-07 - 11:14:34 PM GMT- IP address: 104.28.123.112 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2022-07-07 - 11:23:44 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Albert Salvador, P.E. (alberts@cupertino.org) for signature 2022-07-07 - 11:23:46 PM GMT Email viewed by Albert Salvador, P.E. (alberts@cupertino.org) 2022-07-08 - 1:47:24 AM GMT- IP address: 104.28.124.92 Document signing delegated to Benjamin Fu (benjaminf@cupertino.org) by Albert Salvador, P.E. (alberts@cupertino.org) 2022-07-12 - 4:00:06 PM GMT- IP address: 35.229.54.2 Document emailed to Benjamin Fu (benjaminf@cupertino.org) for signature 2022-07-12 - 4:00:06 PM GMT Email viewed by Benjamin Fu (benjaminf@cupertino.org) 2022-07-12 - 4:35:26 PM GMT- IP address: 104.28.124.93 Document e-signed by Benjamin Fu (benjaminf@cupertino.org) Signature Date: 2022-07-12 - 5:19:28 PM GMT - Time Source: server- IP address: 73.189.98.179 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2022-07-12 - 5:19:29 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2022-07-12 - 5:40:55 PM GMT- IP address: 104.47.74.126 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2022-07-12 - 5:41:27 PM GMT - Time Source: server- IP address: 162.245.20.145 Agreement completed. 2022-07-12 - 5:41:27 PM GMT