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15-116 Prime Mechanical to replace VFD on Exhaust Fan City Hall Roof CITY OF AGREEMENT CITY OF-CU'PERTINO 10300 Torre.Avenue Cupertino, CA 95014 l mf CUPERTINO 40&-777-3200 THIS AGREEMENT, made and entered into this 13th day of January is by and between the CITY OF CUPERTINC3 (Hereinafter "CITY") and Prime Mechanical P.O. Box 1023, Pleasanton, CA. ,94566. .(8 77)6354328 Hereinafter "CONTRACTOR"), in consideration of their mutual covenants, the parties agree as follows: CONTRACTOR she'll provide or furnish the following speced services and/or materials: Replace VFD on Exhaust Fan City Hall Raaf Check box if services are further described in an Exhibit. EXHIBITS:: The following attached exhibits hereby:are made part of this Agreement: A; TERM: The services:and/or materials furnished under this Agreement shall commence on July 13" 20`1.5 and:shall be completed no later than 90 Days. COMPENSATION-. For the full performance of this Agreement, CITY shall pay CONTRACTOR Two Thousand Three.Hundred Twelve Dollars&10/100($2,312.10) 3 California:Labor Code, Section 1771 requires:the payment of prevailing wages to all workers employed on a Public Works contract in excess of$1,000.00. F GENERAL TERMS AND CONDITIONS 1 Hold Harmless. Contractor"shall, to the fullest:extent allowed by law; indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers against:any and all liability, claims, stop notices, actions, causes of action or demands whatsoever from and against an of them, including an in'u to or death of an erson or dame a to roe or other liability y g y J ry y P g p p ny ty of any nature, arising out of, pertaining to, or related to the performance of this Agreement by :Contractor or Contractor's employees, officers, officials, agents or independent contractors. Contractor shall not be Obligated kinder this Agreement to indemnify City to the exten.t that the damage is caused by the sole or active negligence or willful: misconduct of City, its agents or employees. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all other.costs and fees of litigation. E Subcontracting. Contractor has been retained due to their unique skills:and Contractor may not substitute another, assign or transfer any rights-or obligations:under this Agreement. Unless prior written consent from City is obtained, only those people whose names are listed this Agreement shall be used in the performance of this Agreement. Assignment. Contractor may not assign or transfer this Agreement, without.prior written consent { Of CITY. Page Iof.3 f Short Form Agreement Insurance. Contractor shall file With City a Certificate of Insurance consistent With the following .requirements Coverage: Contractor shall maintain the followinginsurance coverage; ge (1) Workers' Compensation:. Statutoify coverage:as required.by the State of California. abili H liab " o I Commercial general liability coverage in following minimum limits: Bodily IiijUrY $5001000 each occurrence $1;000000 11 other .aggregate:- Property Ptqnage'.- $100;000 each occurrence $254,000 aggregate If submitted,combined single.limit-policy With aggregate limitsin the amounts of $1,000,000 will be considered equivalent to the required 'minimum limits shown above; '(3) Automotive: Comprehensive automotive liability coverage in the following minimum limits:- Bodily Injury., $5001000 each occurrence Property Damage: $100;000 each Occurrence .of Combined Single.Limit: $500,000 each occurrence (4) Professional Liability: Professional liability insurance,which-includes coverage for the professional acts.,- errors and.omissions of Consultant Mitheamount of at,least$1,00.0,000:. Subrogation Waiver. Contractor agrees that in the-event.of loss dueto any of the perils for which it has agreed to provide comprehensive general a' nd .aUtomotive liability insurance, Contractor shall look solely to its insurance for re0overy. Contractor hereby grants to City, on behalf of any insurer providing comprehensive general and automotive liability insurance to either Contractor or City with respect to the services of Contractor herein, a Waiver of any right to subrogation ion Which any such insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. Termination of,Ageeerneh-t. The City reserves the.right to terminate this Agreement with or without cause with a seven (7)-day notice. The.Contractor may term inateth is Agreement with or without cause with a seven�(7)-da y written ifte n notice. Non-Discrimi notion.. No discrimination Shah l be made in the employment of persons under this Agreement because of the :race, color, national origin,, ancestry, religion, gender or sexual orientation of such person. Interest of Contractor.. It is understood, and agreed that this Agreement it not a contract of employment in the sense that the relationship of Master and servant exists between City- and undersigned. At all times, Contractor shall be ..deemed to be an independent contractor and Contractor is not authorized to blind the City -to any contracts or other obligations in executing this Agreement. Contractor certifies that no one who has or will have any financial interest under this Page bf'3 Short Form Agreement Agreement is an-officeror em to ee of City. City-shall have no right of control as to the manner y Contractor performs the services to be performed. Nevertheless City may, at any time observe the manner in whichsu.6h,services are being, performed by:the contractor. The Contractor shall comply with all applidabloFederall, State., and local laws and.ordinances including, but notlimited to, unemployment insurance-benefits, FICA laws, and the City business license ordinance. Changes. No: changes or Variationsan of 'kind are authorized without the written consent of the y city. CONTRACT C4-ORDINATOR and representative,for CITY shall be:. Chris Orr Facilities Dept. (408) 777-3272 This Agreement shall become effective upon its execution by CITY,. in witness thereof-, the parties have executed this Agreement the day and year first written above. CONTRACTOR: CITY OF CUPE. ?RT . Bly Title:_ TitleGyle APPROVALS EXPENDITURE DISTRIBUTION ADDATE A I COUNT NUMBER �AMQUNT $ 00 09- - Sai- 7 - 7 2 311. 10 . 0 C1 . FORM `DATE TY-A-TjT q R N E Y,4 P VIED A Q1 LE K: ATTE DATE 'Page 3 of 3 Short Form Aareement i POP LICENSE 81911 P_a flax 1028. PLE4SANTON,4�A P4566 BUS'( 77)05 HEAT f ECN NACA,L MX(9� 292-5528 INMMXICc MEPOAL HVACR City of Cupectln® Document#070915TG2 i 't 0300 Torre Ave. Cupertino,.CA I Subject; City Hall Dear Chris Thank you for the opportunity:to assist City of Cupertino with its HVAC needs. On the recent service call,our mechanic found the VFD on exhaust fan#4 dead. Need to replace VFD Scope; • Replace VFD • Start up and verify proper operation The cost for the work specified above is$2312.:16 All work:to be:performed during normal business hours. The price includes Tabor acid maternal for the completion of the work described. If this meets your approval, please sign this proposal in the appropriate space below. Prices are effective for thirty days. Thank you for choosing Prime s Mechanical 0 If you have any questions in regards to this quote,or if 1 may be of further assistance.please do not hesitate to contact us at(8.77)635•HEAT Sincerely; { Teel Gabriel f Prime Mechanical Acceptance of Proposal., 'The price,specifications and:conditions are satisfactory and.are hereby accepted. You are authorized to do the work specified above. The job will be paid on a NET-3o day basis upon completion. Signed. '� �^ - Date:. 2 f 4 3 3 h CERTIFICATE OF LIABILITY INSURANCE . DATE(MM/DD7/144/2015/2015 ACORO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGRATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER OnPoint Underwriting Inc. CONTACT NAME:Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE(A/C,No Ext):(360)828-0644 FAX(A/C,NO):(360)828-0699 Greenwood Village,CO 80111 EMAIL ADDRESS: -� INSURER(S)AFFORDING COVERAGEyaNAIC# INSURER A: ACE American Insurance Company w 122667 INSURED INSURER B. Barrett Business Services,Inc.L/C/F INSURER C: . PRIME MECHANICAL SERVICE, INC.DBA PRIME INSURER D: MECHANICAL SERVICE,INC. INSURER E 264 WRIGHT BROTHERS AVE INSURER F: r LIVERMORE,CA 94551 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUES OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea $ occurence) CLAIMS-MADE ❑OCCUR J MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJ FLOC PRODUCTS-COMP/OP AGGnECT I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 10/07/14 08/01/2015 WC STATU- JOTH LIABILIT Y YM C48095835 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEY E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? N/A Covered states: E.L.DISEASE-EArEMPLOYEE $2,000,000 (Mandatory in NH)If yes,describe under CA DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE City of Cupertino POLICY PROVISIONS. 10300 Torre Ave AUTHORIZED REPRESENTATIVE Cupertino Ca 95014 . Richard Poling c)1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD. 309557 l 1 ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY'THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Construction&Real Estate Practice PHONE FAX (866)358-1487 A/C No Ext): A/C No Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 ADORIess: CertRequests@wellsfargo.com 959 Skyway Road INSURERS AFFORDING COVERAGE NAIC# San Carlos,CA 94070 INSURER A: Tokio Marine Specialty Ins Co 23850 INSURED INSURER B: Prime Mechanical Service, Inc. INSURERC: 264 Wright Brothers Avenue INSURER D: INSURER E Livermore,CA 94551 INSURER F: COVERAGES CERTIFICATE NUMBER: 9360992 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDLiSUBR POLICY EFF POLICY EXP LIMITS LTR IN D!WVD POLICY NUMBER MMIDD MMIDD A X I COMMERCIAL GENERAL LIABILITY X X PPK1259235 11/14/2014 11/14/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE CLAIMS-MADE a OCCUR PREMISES Ea occurre $ 100,000 i MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JE F1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NO OWNED PROPERTY DAMAGE $ HIRED AUTOS I AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ I $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUP RH TE EER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Cupertino is named as additional insured as respects general liability per endorsement attached. CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cupertino Cit Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p Y ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Avenue Cupertino,CA 95014 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) Y POLICY NUMBER:PPK1259235 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT-WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 -Who is An Insured is amended to B. With respect to the insurance afforded to these include. as an additional insured any person or additional insureds, the following _additional ex- organization for. whom you are performing oper- elusions apply: - ations when you -and such person or organiza- This insurance does not apply to. tion have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "per- added as an additional-insured on your policy. sonal" and "advertising injury" arising out.of Such person or organization is an additional in- the rendering of, or the failure to render, any sured only with respect to liability for "bodily professional architectural, engineering or sur- injury", "property damage" or "personal and ad- veying services,including: vertising injury" caused, in whole or in part,by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop 2. The acts or omissions of those acting on drawings, opinions,. reports, surveys, your behalf; field orders, change orders or drawings and specifications;-and in the performance- of your ongoing operations for the additional insured, b. Supervisory, inspection, architectural or engineering activities. A person's or organizatf-on's status as an addi- taonal insured under this endorsement ends 2. "Bodily injury" ,or "property damage" occur- when your operations for that additional insured - ring after: are completed. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(p) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has boor) put to its intended use by any person or organization other than another contrac- tor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. GG 20 33 07 04 ISO Properties, Inc.,2004 POLICY NUMBER: PPK1259235 COMMERCIAL G=ENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s): tions Any person or organization where required by written contract Information required to complete this Schedule, if not shown above will be shown in the declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s)shown In the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by"your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 page 1 of 1 13 POLICY NUMBER: PPK1259235 PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION, 4. Other Insurance, and all subparts thereof, as contained in the policy is deleted in its entirely and replaced with the following condition: 4. Other Insurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and noncontributory, and the "Insured contract" is executed prior to any loss. Where required by a written contract signed by both parties, this insurance will be primary & non-contributing oniy when and to the extent as required by that contract. However, under the contributory 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 contributory by equal shares, we will contribute by limits.- finder this method, each insurer's share is based on the ratio of its applicable limit if insurance to the total applicable limits of insurance of all. insurers. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. All other terms and conditions of this Policy remain unchanged. Page 1 of 1 POLICY NUMBER: PPK1259235 COMMERCIAL GENERAL LIABILITY CG 24 04 05 00 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: WHERE REQUIRED BY WRITTEN CONTRACT Information re uired to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 6.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above 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 waiver applies only to the person or organization shown In the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc.,2008 Page 1 of 1 ❑ Aco CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 07/144/20/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder'in lieu of such endorsement(s). PRODUCER Phone: (925)734-0530 Fax: (925)249-7342 CONTACT Herzog Insurance Agency Inc. HERZOG INSURANCE AGENCY INC. PHONE (925)249-7339 235 MAIN STREET E-MAIL c Est 925 734-0530 (A/C No PLEASANTON CA 94566 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Agency Lic#:0167785 INSURER :Century National Insurance Company 26905 INSURED INSURER B PRIME MECHANICAL SERVICE INC. DBA PRIME MECHANICAL SERVICE INC. INSURER 315 NORTH P STREET INSURER D: LIVERMORE CA 94551 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 68237 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. (NSR I TYPE OF INSURANCE ADDL s VDBRI POLICY NUMBER I MMIDDYEFF POLICY EXP IYYYY MMIDDIIYYYY ( LIMITS LTR (NSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE ]OCCUR PREMISES(Ea occurence) ` $ MED.EXP(Any one person) $ [GENERAL SONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: AGGREGATE $ PRO- POLICY FI JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY BAP01774810 01/03/15 01/03/16 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS A HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ X AUTOS (per accident) X Physical Damage I $ $1,000 DED UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB (CLAIMS-MADE AGGREGATE $ DED I (RETENTION$ 1 PER( I $ WORKERS COMPENSATION I STATUTE ERH I(AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT—1 OFFICERIMEMBER EXCLUDED? F N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE I $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *Except 10 days for non-payment of premium* CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10300 Torre AV THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cuperitno,CA 95014 I ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE G Attention: Robert C Herzog Jr ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD