Loading...
17-183 City Data Services, Technology Software-As-A Services (SaaS) AgreementTECHNOLOGY SOFTWARE-AS-A-SERVICE (SaaS} AGREEMENT AGREEMENT BETWEEN THE CITY OF CUPERTINO AND CITY DATA SERVICES FOR SOFTWARE-AS-A-SERVICE THIS AGREEMENT ("Agreement"), by and between the CITY OF CUPERTINO, a California municipal corporation ("City"), and City Data Services a California corporation whose address is 403 Alvarado Street, Brisbane, CA 94005 ( "Software Provider") (collectively referred to as the "Pm1ies"). RECITALS: The following Recitals are a substantive portion of this Agreement: A. City is a ·municipal corporation duly organized and validly existing under the laws of the State of California. B. Software Provider is specially trained , expe1ienced and competent to perfo1m the special services which will be required by this Agreement. C. City and Software Provider desire to enter into an agreement for Software Provider's provision of software-as-a-service (SaaS) pe11aining to City 's online systems. Through this Agreement, Software Provider shall provide to City cloud based data management services for the Community Service module and a component of the Single Family module relating to the City's network. The full scope of services covered by this agreement is described in the attached Exhibit A: Service Level Agreement (the "SLA"). NOW, THEREFORE, the Pm1ies mutually agree as follows : 1. TERM The te1m of this Agreement shall conunence on July 1, 2017. The termination of this Agreement is June 30, 2018 , unless the Agreement is te1minated prior thereto under the provisions of Section 16, below. 2 . SCOPE OF SERVICES AND CONDITIONS THEREOF Subject to the te1ms and conditions set fo11h in this Agreement, Software Provider shall perfonn each and every service to the schedule of perfonnance set f011h in the SLA ( collectively "Services"), as described below. A. Responsibilities of Software Provider. Software Provider shall provide the software services as fu11her described in the SLA. The Services provided under this Agreement shall include (a) any software, plug-ins or extensions related to the Services or upon which the Services are based including any and all updates, upgrades , bug fixes, dot releases , version upgrades or any similar changes that may be made available to the Software Provider from time to time (the "Software"), (b) any and all technical documentation necessary or use of the Services , in hard copy f01m or online (the "Documentation"), (c) regular maintenance of Software Provider's system, and (d) other technology, user interfaces, know-how and other trade secrets , techniques, designs, inventions , data, images , text , content, APis, and Page 1 of 12 090517 tools provided in conjunction with the Services. B. Equipment. If necessary to enable Software Provider to fulfill its obligations under the SLA, Software Provider shall, at its sole cost and expense, furnish all facilities, personnel and equipment to City necessary to provide the Services (the "Equipment"). City agrees, if necessary, to install the Equipment at the location(s) and in the manner specified by Software Provider and as directed by Software Provider. Any Equipment installed by City is a pai1 of the Service and loaned to City by Software Provider, not sold . City agrees to return the Equipment to Software Provider at the te1mination of this Agreement in an undamaged condition, less ordinary wear and tear. c. Registration. Prior to using the Services, City shall identify the administrative users for its account ("Administrators"). Each Administrator will be provided an administrator ID and password. D. License Grant. Software Provider hereby grants City a license to use the Software and the Documentation for the pe1mitted purpose of accessing the Services. E. Reservation of Rights and Data Ownership. City shall own all right, title and interest in its data that is related to the services provided by this contract. Software Provider shall not access City user accounts or City data, except (1) as essential to fulfillment of the objectives of this Agreement, (2) in response to service or technical issues, or (3) at City's written request. F. Data Protection. In carrying out the Services , Software Provider shall endeavor to protect the confidentiality of all confidential, non-public City data ("City Data") as follows: 1. Implement and maintain appropriate security measures to safeguard against unauthorized access, disclosure or theft of City Data in accordance with recognized industry practice. 2 . City Data shall be encrypted at rest and in transit with controlled access. Unless otherwise stipulated, Software Provider is responsible for encryption of the City Data. 3. Software Provider shall not use any City Data collected by it in connection with the Service for any purpose other than fulfilling the obligations under this Agreement. G. Software Ownership. Software Provider owns the Services , Software, Documentation, and any underlying infrastmcture provided by Service Provider in connection with this Agreement. City acknowledges and agrees that (a) the Services, any Software and Documentation are protected by United States and international copyright, trademark, patent, trade secret and other intellectual prope11y or proprietary rights laws , (b) Software Provider retains all 1ight, title and interest (including, without limitation, all patent, copyright, trade secret and other intellectual prope11y rights) in and to the Services, the Software, any Documentation, any other deliverables , any and all related and underlying technology and any derivative works or modifications of any of the foregoing, including, without limitation, (c) the Software and access to the Services are licensed on a subsc1iption basis, not sold, and City acquires no ownership or other interes t in or to the Services , the Software or the Documentation other than the license rights expressly stated herein, and ( d) the Services are offered as an on-line, hosted solution, and that City has no 1ight to obtain a copy of the Services. Page 2 o f 12 090517 H. Restrictions. City agrees not to, directly or indirectly: (i) modify, translate, copy or create derivative works based on the Service or any element of the Software, (ii) interfere with or disrnpt the integrity or perfo1mance of the Services or the data contained therein or block or disrnpt any use or enjoyment of the Services by any third pruty, (iii) attempt to gain unauth01ized access to the Services or their related systems or networks or (iv) remove or obscure any prop1ietary or other notice contained in the Services, including on any repo11s or data printed from the Se1vices. I. Security Incident. In the event a data breach occurs with respect to City Data, Software Provider shall immediately notify the approp1iate City contact by telephone in accordance with the agreed upon security plan or secmity procedures if it reasonably believes there has been a secmity incident. Software Provider shall (1) cooperate with City to investigate and resolve the data breach, (2) promptly implement necessary remedial measures, if necessary, and (3) document responsive actions taken related to the data breach, including any post-incident review of events and actions taken to make changes in business practices in providing the se1vices, if necessary. J. Notification of Legal Requests. Software Provider shall contact City upon receipt of any electronic discovery, litigation holds, discovery searches and expe11 testimonies related to City Data. Software Provider shall not respond to subpoenas, se1vice of process and other legal requests related to City without first notifying City, unless prohibited by law from providing such notice. K. Access to Security Logs and Reports. Software Provider shall provide reports to City in a f01mat as specified in the SLA agreed to by both Software Provider and City. Repo11s shall include latency statistics, user access, user access IP address, user access history and security logs for all City files related to this Agreement. L. Responsibilities and Uptime Guarantee. Software Provider shall be responsible for the acquisition and operation of all hardware, software and network support related to the se1vices being provided. The technical and professional activities required for establishing, managing and maintaining the environments are the responsibilities of Software Provider. The system shall be available for City's use on a 24/7/365 basis (with agreed-upon maintenance downtime). M. Subcontractor Disclosure. Software Provider shall identify all of its strategic business prutners related to se1vices provided under this Agreement, including all subcontractors or other entities or individuals who may be a pruty to a joint venture or similar agreement with Software Provider, and who shall be involved in any application development and/or operations. N. Business Continuity and Disaster Recovery. Software Provider shall provide to City a written business continuity and disaster recovery plan prior to or at the time of execution of this agreement and shall ensure that it meets City's recovery time objective (RTO) of four (4) hours or less . o. Compliance with Accessibility Standards. Software Provider shall comply with and adhere to the Americans with Disabilities Act of 1990 (42 U.S .C . § 12101). P. Web Services. Software Provider shall use Web services exclusively to interface with City Data in near real time when possible. Q. Encryption of Data at Rest. Software Provider shall ensure hard drive encryption consistent with validated cryptography standards as referenced in FIPS 140-2, Page 3 o f 12 090517 Security Requirements for Cryptographic Modules for all personal data, unless City approves the storage of personal data on Software Provider 's p011able device in order to accomplish work as defined in the statement of work. 3. COMPENSATION TO SOFTWARE PROVIDER Software Provider shall be compensated for services perfo1med pursuant to this Agreement in a total amount not to exceed Six Thousand dollars ($6 ,000.00). The payments specified in this section shall be the only payments to be made to Software Provider for services rendered pursuant to this Agreement. Software Provider shall invoice City according to the following schedule of milestones/ deliverables: Upon completion of Quai1er 1, FY 17-18 $1,500.00 Upon completion of Quai1er 2, FY 1 7-18 $1,500.00 Upon completion of Quai1er 3, FY 17-18 $1,500.00 Upon completion of Quarter 4, FY 17-18 $1 ,500.00 City shall pay Contractor within thi11y (30) days after receipt of Service Provider's invoice. City shall return to Contractor any payment request dete1mined not to be a proper payment request as soon as practicable, but not later than seven (7) days after receipt, and shall explain in writing the reasons why the payment request is not proper. 4. TIME IS OF THE ESSENCE Software Provider and City agree that time 1s of the essence regarding the perfo1mance of this Agreement. 5. LICENSES; PERMITS; ETC. Software Provider represents and wa1rnnts to City that it has ali licenses , pe1mits, qualifications, and approvals of whatsoever nature which are legally required to caITy out the purposes of this Agreement. 6. ASSIGNMENTS. Software Provider may assign, sublease, or transfer this Agreement, or any interest therein, to a third pai1y with the prior written consent of City. Such consent shall not be umeasonably withheld. City's withholding of consent shall be deemed reasonable if it appears that the intended assignee in question is not financially or technically capable of perfmming Software Provider 's obligations under this Agreement, or if City has reason to conclude that the proposed assignee is othe1wise incapable of fulfilling Software Provider's duties hereunder. 7. INDEPENDENT PARTIES City and Software Provider intend that the relationship between them created by this Agreement is that of independent contractor. No civil service status or other right of employment will be acquired by vi11ue of Software Provider's services. None of the benefits provided by City to its employees, including but not limited Page 4 ofI2 to, unemployment insurance, workers' compensation plans, vacation and sick leave are available from City to Software Provider, its employees or agents. Software Provider is not a "public official" for purposes of Government Code §§ 87200 et seq. 8. IMMIGRATION REFORM AND CONTROL ACT {IRCA) Software Provider assumes any and all responsibility for verifying the identity and employment authorization of all of his/her employees perfo1ming work hereunder, pursuant to all applicable IRCA or other federal or state rnles and regulations. Software Provider shall indemnify and hold City hmmless from and against any loss, damage, liability, costs or expenses arising from any noncompliance of this provision by Software Provider. 9. NON-DISCRIMINATION Consistent with City's policy prohibiting harassment and discrimination, Software Provider agrees that neither it nor its employee or subcontractors shall harass or disc1iminate against a job applicant, a City employee, or a citizen on the basis of race, religious creed, color, national origin, ancestry, handicap, disability, mmital status, pregnancy, sex, age, sexual orientation, or any other protected class status. Software Provider agrees that any and all violations of this provision shall constitute a material breach of this Agreement. 10 . INTELLECTUAL PROPERTY INDEMNIFICATION Software Provider agrees to, at its expense, defend and/or settle any claim made by a third pmty against City alleging that the City's use of the Services infiinges such third pmty's United States patent, copyright, trademark or trade secret (an "IP Claim"), and pay those amounts finally awarded by a comt of competent jurisdiction against City with respect to such IP Claim. 11 . DUTY TO INDEMNIFY AND HOLD HARMLESS 12 . Software Provider shall indenmify, defend, and hold harmless City and its officers, officials, agents, employees and volunteers from and against any and all liability, claims, actions, causes of action or demands whatsoever against any of them, including for any injury to or death of any person or damage to prope11y or other liability of any nature, whether physical, emotional, consequential or otherwise, arising out, pe1taining to, or related to the perf01mance of this Agreement by Software Provider or Software Provider's employees, officers, officials, agents or independent contractors, except where such liability arises solely as a result of the active negligence or to1tious conduct of City or its agent. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice, expe11 fees and all other costs and fees of litigation. The provisions of this Section survive the completion of the Services or tennination of this Contract. INSURANCE: A. General Requirements. On or before the conunencement of the te1m of this Agreement, Software Provider shall furnish City with ce1tificates showing the type, amount, class of operations covered, effective dates and dates of expiration of Page 5 of 12 insurance coverage in compliance with the requirements listed in Exhibit "B". Software Provider shall maintain in force at all times during the perfomrnnce of this Agreement all appropriate coverage of insurance required by this Agreement. B. Subrogation Waiver. Software Provider agrees that in the event ofloss due to any of the perils for which it has agreed to provide comprehensive general and automotive liability insurance, Software Provider shall look solely to its insurance for recovery. Software Provider hereby grants to City, on behalf of any insurer providing comprehensive general and automotive liability insurance to either Software Provider or City with respect to the services of Software Provider herein, a waiver of any right to subrogation which any such insurer of said Software Provider may acquire against City by virtue of the payment of any loss under such msurance. 13. RECORDS Software Provider shall maintain internal records reflecting that the Services were perfo1med by Software Provider hereunder in accordance with customary recordkeeping practices in the software development industry. Software Provider shall provide free access to such records to the representatives of City or its designee's at all reasonable and proper times, and gives City the right to examine and audit same, and to make transc1ipts therefrom as necessary. No such examination and audit shall give City the right to access records relating to other Software Provider customers. Such records shall be maintained for a period of three (3) years after Software Provider receives final payment from City for all services required under this agreement. 14. NONAPPROPRIATION This Agreement is subject to the fiscal provisions of the Cupertino Municipal Code and Agreement will te1minate without any penalty (a) at the end of any fiscal year in the event that funds are not appropriated for the following fiscal year, or (b) at any time within a fiscal year in the event that funds are only appropiiated for a p011ion of the fiscal year and funds for this Agreement are no longer available. This Section shall take precedence in the event of a conflict with any other covenant, te1m, condition, or provision of this Agreement. 15. NOTICES All notices, demands, requests or approvals to be given under this Agreement shall be given in writing and conclusively shall be deemed served when delivered personally or on the second business day after deposit in the U.S. Mail, postage prepaid, addressed as hereinafter provided. All notices, demands, requests, or approvals shall be addressed as follows: TO CITY: City of Cupe1iino 10300 T01Te Ave. Cupe11ino CA 95014 Attention: Bill Mitchell Page 6 of 12 Copy to: Randolph Hom, Esq. City Attorney, City of Cupertino 20410 Town Center Lane, Suite 210 Cupertino, CA 95014-3255 TO SOFTWARE PROVIDER: City Data Services, LLC 403 Alvarado Street Brisbane, CA 94005 Attention: Steve Crounse 16. TERMINATION A. Basis for Termination. In the event Software Provider fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder, Software Provider shall be deemed in default in the perfornrnnce of this Agreement. If Software Provider fails to cure the default within the time specified and according to the requirements set f01th in City 's written notice of default, and in addition to any other remedy available to the City by law, the City Manager may terminate the Agreement by giving Software Provider written notice thereof, which shall be effective immediately. The City Manager shall also have the option, at its sole discretion and without cause, of terminating this Agreement by giving seven (7) calendar days' prior w1itten notice to Software Provider as provided herein. Upon receipt of any notice of tennination, Software Provider shall immediately discontinue perfonnance. B . Pro Rata Payments. City shall pay Software Provider for services satisfactorily performed up to the effective date of tennination. In such event, a calculation of the amounts due shall be deemed c01Tect as computed on a pro rat a basis with compensation provided for the period of service paid as a percentage of the total contract amount. C. Handling of City Data. In the event of a termination of this Agreement, Software Provider shall implement an orderly return of City data in a CSV or another mutually agreeable fonnat at a time agreed to by the parties and the subsequent secure disposal of City data. Dming any period of service suspension, Software Provider shall not take any action to intentionally erase any City data for a period of 30 days after the effective date of termination, unless autho1ized by City . City shall be entitled to any post-tennination assistance generally made available with respect to the Services; unless a unique data retrieval anangement has been established as part of the SLA. Software Provider shall securely dispose of all requested data in all of its fonns, such as disk, CD/ DVD, backup tape and paper, when requested by City. Data shall be permanently deleted and shall not be recoverable, according to National Institute of Standards and Technology (NIST)- approved methods. Ce1tificates of destruction shall be provided to City. 17. \VARRANTY AND WARRANTY DISCLAIMER Software Provider warTants that, (i) the services shall be provided in a diligent , professional , and workmanlike manner in accordance with industry standards, (ii) Page 7 of 12 the services provided under this agreement do not infiinge or misappropriate any intellectual prope1ty rights of any third patty, and (iii) the services shall substantially perforn1 in all material respects as described in the SLA in the event of any breach of section (iii), above, Software Provider shall , as its sole liability and your sole remedy, repair or replace the services that are subject to the warranty claim at no cost to City or if Software Provider is unable to repair or replace, then it will refund any pre-paid fees for services not rendered. Except for the watrnnty described in this section, the services are provided without wan-anty of any kind, express or implied including, but not limited to , the implied watrnnties or conditions of design, merchantability, fitness for a pmticular purpose, and any watrnnties of title and non-infringement. 18. COMPLIANCE Software Provider shall comply with all state or federal laws and all ordinances, rnles , policies and regulations enacted or issued by City. 19. CONFLICT OF LA \V This Agreement shall be interpreted under, and enforced by the laws of the State of California excepting any choice of law rnles which may direct the application of laws of another jurisdiction. Any suits brought pursuant to this Agreement shall be filed with the Superior Comt for the County of Santa Clara, State of California. 20 . ADVERTISEMENT Software Provider shall not post, exhibit, display or allow to be posted, exhibited, displayed any signs, adve1tising, show bills, lithographs, posters or cards of any kind pe1taining to the services perforn1ed under this Agreement unless prior written approval has been secured from City to do otherwise. 21. INTEGRATED CONTRACT This Agreement, including all appendices, represents the full and complete understanding of every kind or nature whatsoever between the Patties, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof Any modification of this Agreement will be effective only by written execution signed by both City and Software Provider. In the event that any Service Level Agreement, Exhibit, associated instrnment or agreement executed by the Patties in conjunction with this Agreement or prior thereto contains a tern1 that conflicts with the tenns of this Agreement, the te1ms of this Agreement shall govern and supersede any other document or Exhibit. 22 . AUTHORITY The individual(s) executing this Agreement represent and watTant that they have the legal capacity and authoiity to do so on behalf of their respective legal entities . IN WITNESS WHEREOF, the parties have caused this Agreement to be executed . Page 8 of 12 Exhibits: Exhibit A: Exhibit B: SOFTWARE PROVIDER City Data Services, LLC By c.::;:;?'''.P,;:;::£---- Title/' -..L----'"-..µ'---'--'---'--'"'-'-""- Date CITY OF CUPERTINO A Municipal Corporation By ~ Title~ 's?l Q... 4-ezD Date l l -z,=. ( l '] D Over $175,000-Council Approval Required D Over $45,000-Department Head Approval Required [gJ Up to $45,000-Designated Supervisor Approval Required RECOM1\1ENDED FOR APPROVAL Kerri Heusler, Service Level Agreement APPROVED AS TO FORM: $city Attorney \f Randolph Hom City Clerk f L.-/ 1 --f 7 Insurance Requirements and Proof of Insurance Page 9 of 12 Exhibit A Scope of Services 'C_ 5erv1ces '-..-,/ Brisbane , California citydataservices@yahoo.com Kerri Heusler, Housing Senior Planner City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Dear Ms. Heusler, June2017 City Data SeNices provides cloud-based data management seNices . As per your request , please find the following Scope of SeNices for work for City of Cupertino for FY 2017-18 . These seNices are provided for maintaining the Community SeNices module and a component of the Single Family module: SCOPE OF SERVICES -System Maintenance Under the scope of the maintenance contract , CDS will provide: Ability to store , display , and summarize application information ; Ability to store , display, and summarize individual program administration information ; Ability to store , display , and summarize individual program contract information ; Ability to enter, store , display, and summarize compliance information ; Maintain all database and report elements created under the initial setup agreement ; Maintain data backups and download on a determined schedule ; Modify database as needed to add or remove fields , or improve presentation of data ; Modify existing reports as needed to meet City's requirements ; Provide customer seNice to City and their clients throughout the contract ; and Promptly respond to request for assistance , training or database repair. Maintenance fee for Community Service (formerly Public SeNice) is in the amount of $350 per month for an annual total of $4,200 and the maintenance fee for component of Single Family is in the amount of $100 per month for an annual amount of $1 ,200 for a combined total amount of $5,400. An additional $600 will cover the additional insurance limits required by the City of Cupertino . For the term of the agreement, this fee remains constant regardless of the number of users , trainings, units , programs , projects or reports included in this module. HOURLY RATES Maintenance and ongoing operations of C ity 's CDS database are included in the monthly maintenance fee . All new reports or forms are covered under the maintenance contract without additional charge . In the event that forms outside of this module and component are required , the typ ical charge for developing a new form or report , and integrating it into the database , will be $850 per page , with discounts for larger documents. Maintenance invoices are billed quarterly and require payment within 30 days of submission of invoice. A one percent fee will be incurred for bills that are 30 days past due. Steve Crounse, Partner City Data SeNices , LLC www. citydataseNices . com 415 .572.4572 650.533 .5933 Contract No. __ _ Exhibit B: Insurance Requirements and Proof of Insurance Proof of insurance coverage described below is attached to this Exhibit, with City named as additional insured. 1. MINIMUM SCOPE AND LIMITS OF REQUIRED INSURANCE POLICIES Additional Insureds: City, its City Council, boards and commissions, officers, employees and volunteers shall be named as additional insureds under all insurance coverages, except any professional liability insurance, required by this Agreement. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible pmiion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy. Workers' Compensation : Statutory coverage as required by the State of California and Liability Insurance with limit of no less than $1 ,000,000 per accident for bodily injury or disease. General Liability: Commercial general liability coverage in the following minimum limits: Bodily Injury: $1,000,000 each occmTence $1,000 ,000 aggregate -all other Prope1iy Damage: $500,000 each occmTence $1,000 ,000 aggregate If submitted, combined single limit policy with aggregate limits in the amounts of $2,000,000 will be considered equivalent to the required minimum limits shown above. Cyber Liability: Insurance, with limits not less than: $2,000,000 each occmTence $2,000,000 aggregate -all other Coverage shall be sufficiently broad to respond to the duties and obligations as is unde1iaken by Software Provider in this agreement and shall include, but not be limited to, claims involving infringement of intellectual prope1iy, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destrnction of electronic information, release of private infonnation, alteration of electronic infonnation, exto11ion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monito1ing expenses with limits sufficient to respond to these obligations. 11 Contract No. __ _ If the Sofuvare Provider maintains broader coverage and /or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or higher limits maintained by the Software Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. 2 . ABSENCE OF INSURANCE COVERAGE. City may direct Software Provider to immediately cease all act1v1ties with respect to this Agreement if it detem1ines that Software Provider fails to caITy, in full force and effect, all insurance policies with coverages at or above the limits specified in this Agreement. At the City's discretion, under conditions of lapse, City may purchase appropriate insurance and charge all costs related to such policy to Software Provider. 3 . PROOF OF INSURANCE COVERAGE AND COVERAGE VERIFICATION. A Ce11ificate of Insurance, on an Accord f01m, and completed coverage verification shall be provided to City by each of Software Provider's insurance companies as evidence of the stipulated coverages p1ior to the Commencement Date of this Agreement, and annually thereafter for the tem1 of this Agreement. All of the insurance companies providing insurance for Software Provider shall be licensed to do insurance business in the State of California and shall have, and provide evidence of, a Best Rating Service rate of A VI or above. The Ce11ificate of Insurance and coverage verification and all other notices related to cancellation or non-renewal shall be mailed to: City Clerk City of Cupe11ino 10300 ToITe Avenue Cupe11ino, CA 95014-3202 12 Contractor/Consultant Affidavit of No Employees State of California County of Santa Clara City of Cupertino I, the undersigned, declare as follows: I am an independent contractor and the owner of City Data Services, LLC I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code , which requires every ernployer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code . I am also aware that I must provide proof of workers ' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section I 2 of the City of Cupetiino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this ~day of_S_ep~t ___ , 2017, at __ B_r_is_b_a_n_e ______ , California. Steven J. Crounse PRINT NAME Sig~ USAA INSURANCE AGENCY INC/PHS PO BOX 33015 SAN ANTONIO TX 78265 THE CITY OF CUPERTINO, IT'S OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS 10300 TORRE AVE CUPERTINO CA 95014 ACORD 25 (2016/03) _____, 1MB I ;7~ ;l;~;;YY) ACC>RC::,® CERTIFICATE OF LIABILITY INSURANCE ..___....-R05 4 THIS CERTIFICATEIS 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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 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(sl. PRODUCER CONTACT NAME: USAA INSURANCE AGENCY INC/PHS PHONE (NC, No, Ext); (888) 242 -1 430 rAX (NC,No): (888) 443 -6112 812845 P: (888) 242-1430 F: ( 888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAIC # SAN ANTONIO TX 78265 INSURER A : Sentinel Ins Co LTD 11000 INSURED INSURER B ; INSU~ERC ; STEVEN CROUNSE D/B/A CITY DATA SERVICES IN SURER D ; 403 ALVARADO ST INSURERE : BRISBANE CA 94005 IN SURER F ; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TH AT 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 INSU RANC E AF FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Alt THE TERMS.EXCLUS ION S AND CON DITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HJ')V E BEEN REDUCED BY PAID CLAIMS. INSR Tn TJ 'PE OF INSURANCE COMMERCIAL GENERAL LIABILITY --~, CLAIMS-MADE ~OCCUR A x General Liab · --GEN'L AGGREGATE LI MIT APPLIES PER: RPOLICY D j:gi-0 LOC OTHER: f J : AUTOMOBILE LIABILITY - ANY AUTO -OWNED -SCHEDULED _ AUT OS ON LY _ AUTOS HIRED NON-OWNED AUTOS ONL Y AUTOS ONLY ->- -UMBRELLA LIAB EXCESS LIAB DED I !RE TENTI ON s WORKERS COMPENS,IT/ON AND EMPLOJ'ERS' LIABIL/Ti' HOCCUR CLAIMS-MADE ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? D (Ma ndatory in NH) If yes, describe under DESCRIPTION OF OPERATI ONS below ADDL SUBR POLICY NUMBER 11VC"D n r l/n X 65 ~BM R04156 NI A- POL/CYEFF • /MMIDDIYYYl'J p2/10/2017 l 1 POLICY EXP LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) s2 ,000 ,000 s l,000 ,000 02/10/2018 MEDEXP(Anyoneperson) s l0 ,000 s2,000 ,000 PERSONAL & ADV INJ URY GENERAL AGGREGATE PRODUCTS· COMP/OP AGG COMB INED SINGLE LIMIT (Ea accident) s 4, 000, 000 s 4, 000 , 000 BODILY IN JURY (Per person ) s BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENC E AGGREGATE l~~=TU TE I E.L. EACH ACCIDEN T I OTH· ER E.L. DISEASE-EA EMPLOYEE E.L. DISEASE -POLICY LIMIT s s s s s s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations . City of Cupertino is Additional Insured per endorsement to the policy. CERTIFICATE HOLDER CANCELLATION THE CITY OF CUPERTINO, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX PIRATION DATE THEREOF , NOTICE WILL BE IT 'S OFFICERS , AGENTS , EMPLOYEES DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AND VOLUNTEERS AUTHORIZED REPRESENT AT/VE - 10300 TORRE AVE /,1l,z_ /t?--JL~ CUPERTINO , CA 95014 © 1988-2015 ACORD CORPORATION. All rights reserved . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER : 6 5 SBM R0 4 156 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PERSON-ORGANIZATION T HE CITY OF CUPERTI NO , I T 'S OFF ICE RS , AG E NT S , E MPLOY EE S AND VOLUNTEE R S 1 0300 T ORRE AV ENUE CUPERTI NO , CA 950 1 4 Form IH 12 00 11 85 T SEQ. NO. 0 11 Printed in U.S.A. Page 001 Process Date: 11 /2 4 / 1 6 Expiration Date : o 2 / 1 o / 1 8 Select Customer Insurance Center 3600 WI S EMAN BL VD. SAN AN TONI O TX 782 51 Policyholder , please call us at: (888) 242 -1 430 Agent,pleasecallusat: (888) 242 -1 430 S ER VI CE .TX@THEHA RTF ORD .COM INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE*** THEX HARTFORD Enclosed is an endorsement for you r business insu rance policy. Please review it at your convenience . If you have questions or need to make further changes : Policyholder, please call us at: (888) 2 4 2-1 430 Agent , please call us at: (888) 242-1 430 between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs . USAA INSURANCE AGENCY INC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Ha rtford Fire Insu rance Co mpany and its Affili ates One Ha rt ford Pl aza , Hart ford , Co nnect icut 06155 l THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is ind icated below: Policy Number: 65 SBM R04156 DX Named Insured and Mailing Address; S TEVEN CROUNSE OBA CI T Y DATA S E RV I CES 403 ALVARADO ST BRISBANE CA 94005 Policy Change Effective Date : 12/19/16 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 002 Agent Name : USAA I NSURANCE AGENCY I NC/PHS Code: 8 1 2845 POLI CY CHANGES : SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING S TAT EM _ENT. IF YOU ARE ENROLLED IN REPET I T IVE EFT DRAWS FROM YOUR BANK ACCOUN T , CHANGES IN PREMIUM WI L L CHANGE F UT URE DRAW AMOUN T S. T H IS I S NO T A B I LL . NO P REM IUM DU E AS OF POLI CY CHANGE E FFEC T IVE DA T E FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED -PERSON-ORGANIZATION PRO RATA FACTOR: 0. 145 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Process Date: 12/19/16 Page 001 Policy Effective Date : 02/10/16 Policy Expiration Date : 02/10/17 POLICY NUMBER: 6 5 SBM R04156 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PERSON-ORGANIZATION THE CITY OF CUPERTINO I IT Is OFFICERS I AGENTS I EMPLOYEES AND VOLUNTEERS 10 300 TORRE AVENUE CUPERTINO, CA 95014 CITY OF EMERYVILLE IT'S OFFICERS , AGENTS, EMPLOYEES AND VOLUNTEERS 1333 PARK AVENUE EMERYVILLE, CA 94608-3517 THE CITY OF HAYWARD, IT'S OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS 777 B ST HAYWARD, CA 94541-5007 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 02 /25/15 Expiration Date: 02/10/16 POLICY NUMBER: 65 SBM R04156 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PERSON-ORGANIZATION THE CITY OF CUPERTINO I IT Is OFFICERS I AGENTS I EMPLOYEES AND VOLUN TEERS 10 300 TORRE AVENUE CUPE R TINO, CA 95014 Form IH 12 00 11 85 T SEQ . NO . Oll Printed in U.S.A. Page 001 Process Date: 0 2/26/1 5 Expiration Date : 0 2/10 /1 6 10050254 C ity Data Services ACORD25 (Page 1 of 1) 11 /19/2 017 11 :00:07 AM ~ ACORD® CERTIFICATE OF LIABILITY INSURANCE I DA TE (MM /DD /YYYY) ~ 11 /19/2017 THIS CERTIFICATE IS ISSUED AS A MATIER 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 : £insureon m~>N,t ~." (800) 688-1984 I FA X 877-826-9067 fA/C Nol: E-MA IL lnsureon (BIN Insurance Holdings LLC .) ADDRESS : 1101 Central Ex py . South , Suite 250, Allen , TX INSURER(S) AFFORDING COVERAGE NAIC# 75013 INSURER A : Hartford Fire Insurance ComDanv 19682 INSURED INSURER B: City Data Services INSURER C : 403 Alvarado St INSURER D: Brisbane, CA 94005 INSURER E: INSURER F : 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 POLI CY 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 DES CRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLIC IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR ' ADDL SUBR POLIC Y EFF POLIC Y EXP LTR TYPE OF INSURANCE HJ~n wvn POLICY NUMBER fMM/DD/YYYY\ fMM/DD/YYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -~ CLAIMS-MADE D OC~UR i DAMAGE TO RENTED -PREMI SES fEa occurrence\ $ ' -MED EXP (Any one person) $ PERSONAL & ADV INJURY $ -GEN'L AGGR EGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ~ DPRO-DL~C PRODUCTS · CO MP/OP AGG $ POLICY JECT OT HE R: $ AUTOMOBILE LIABILITY ' COMBINED SIN GLE LIMIT $ fEa accident\ - ANY AUTO BOD IL Y INJ URY (Per person) $ --ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ --NON-OWNED PROPERTY DAMAGE HIRED AUTOS ' AUTOS f Per acc ident\ $ -- $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ -EXC ESS LIAS CLA IM S-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION I ~ffTuTE I I OTH - AND EMPLOYERS' LIABILITY ER Y/N ANY PR OPR IETOR/PARTNER/E XEC UT IV E D N/A E.L. EAC H ACCIDENT $ OFFICER/MEMBER EXC LUDED ? (Mandatory in NH) E.L. DISEASE· EA EMPLOYEE $ If yes , describe und er DESCRIPT ION OF OPERAT IONS below E.L. DISEASE · POLICY LIMIT $ A Professional Liab ility (Erro rs an d Omissions) 46TE0323528 7/7/2017 ln/2018 $2,000,000 I $2,000 ,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the lnsured's Operations . C ity of Cupertino, its officers , employees and vo lunte e rs , individually and collectively per the professional liabil ity/ errors & omissions policy per Policy Form FSOOG003001016 in the attached policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertin o THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10300 Torre Avenue ACCORDANCE WITH THE POLICY PROVISIONS . Cupertino , CA 95014 AUTHORIZED REPRESENTATIVE I i\~----1 ~--- © 1988-2014 ACORD CORPORATION. All rights reserved . ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD This endorsement, effective 12:01 am, 11/28/17 ENDORSEMENT N0:11 forms part of policy number 46 TE 0323528-17 issued to: CITY DATA SERVICES LLC HARTFORD FIRE INSURANCE CO . by: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL YOU You and we agree that: Section II -Definitions is changed to add the following to the definition of you or your: 8. City of Cupertino, including its City Council, boards and commissions. officers. officials. agents. employees. consultants and volunteers. 10300 Torre Avenue. Cupertino. CA 95014 as an additional you . but only if: a. the claim is caused by a wrongful act committed by the named insured, or by parties described in items 2 through 4 of the definition of you or your in Section II -Definitions. in the named insured's performance of enterprise services ; and b. there are no allegations of independent misconduct by City of Cupertino. including its City Council, boards and commissions . officers . officials. agents . employees. consultants and volunteers . 10300 Torre Avenue. Cupertino. CA 95014. Section Ill -Exclusions. Subsection B.1 is deleted and replaced with the following: 1. any of you; however. this exclusion will not apply to claims made : a. by any of you described in items 3. 4 or 5 of the definition of you when the claim is made in their capacity as a client as a result of enterprise services performed by the named insured on their behalf; b. against the na!lled insured by any of you described in items 3 or 4 of the definition of you when the claim is the result of the named insured's failure to prevent identity theft or disclosure of nonpublic personal information ; or c. by City of Cupertino, including its City Council, boards and commissions. officers. officials . agents. employees . consultants and volunteers . 10300 Torre Avenue . Cupertino. CA 95014 when the claim is made in their capacity as a client as a result of enterprise services performed by the named insured on their behalf. All other terms and conditions remain unchanged. Douglas Elliot. President FS 00 H301001016 Fai1Safe ® Page 1 of 1 © 2016 . The Hartford This endorsement, effective 12:01 am, 11/28/17 of policy number 46 TE 0323528-17 issued to: by: CITY DATA SERVICES LLC HARTFORD FIRE INSURANCE CO . ENDORSEMENT N0:12 forms part THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITS OF LIABILITY CHANGE (INCREASE) In consideration of your payment of the additional premium of $75, Item 4 . Limits of Liabil ity of the Declarations is deleted and replaced with the following : 4 . Limits of Liability Each Wrongful Act Limit Aggregate Limit $2.000 .000 $2,000 .000 Th is endorsement will not apply to any claim made against any of you before 11/28/17; nor will it apply to any claim resulting from a wrongful act or circumstance known by any partner. executive officer, director or manager of the named insured prior to 11 /28/17 All other terms and conditions remain unchanged. Douglas Elliot, President FS 00 H312 00 1016 Fai1Safe® Page 1 of 1 © 2016. The Hartford This endorsement, effective 12:01 am, 11/28/17 of policy number 46 TE 0323528-17 issued to: by: CITY DATA SERVICES LLC HARTFORD FIRE INSURANCE CO . ENDORSEMENT N0:13 forms part THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIOR ACTS LIMIT RESTRICTION ENDORSEMENT (ONE LIMIT CHANGE) You and we agree that: Solely with regards to the Limits of Liability stated in item 4 of the Declarations that are: A. $1.000.000 in excess of the first $1.000.000 under the Each Wrongful Act Limit B. $Q__in excess of the first $2.000 .000 under the Aggregate Limit Section Ill -Exclusions . is changed to add the following sub-section : We will not pay damages . first party expenses . or claim expenses or defend any of you for any actual or alleged wrongful act that occurred prior to: 11/28/17. Nothing in this endorsement is intended . nor shall it be construed . to : • increase the Limits of Liability under this Policy stated in item 4 of the Declarations. or • obligate or require us to pay damages. first party expenses. or claims expenses under this Policy in any amount exceeding the Limits of Liability under this Policy stated in item 4 of the Declarations . All other terms and conditions remain unchanged . Douglas Elliot. President FS 00 H328 00 1016 FailSafe ® Page 1 of 1 © 2 016 . The Hartford ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 02/17/2017 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 : USAA INSURANCE AGENCY INC PHONE I FAX (A/C, No, Ext): (888) 661-3938 (A/C, No): (877) 552-6091 9800 FREDERICKSBURG RD E-MAIL SAN ANTONIO, TX 78288 ADDRESS: Service.center@.travelers.com (888) 661-3938 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : TRAVELERS CASUAL TY INSURANCE COMPANY OF AMERICA INSURED INSURER B : CITY DATA SERVICES 403 ALVARADO STREET INSURERC : BRISBANE, CA 94005 INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· 767889947531840 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 DE SCR IBED HEREIN IS SUBJECT TO ALL THE TERMS , EXC LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV E BEEN REDUCED BY PAID CLAIMS. INSR ADDI SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY\ IMM/DD/YYYY\ LIMITS -EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED - O cLA IMS-MADE OoccuR PREMISES /Ea occurrence) $ >--MED EXP (Any one person) $ >--PERSONAL & ADV INJU RY $ >-- GEN 'L AGGREGATE LIMIT APP LIE S PER: GENERAL AGGREGATE $ gPOLICY DPRO-D JECT LOC PRODUCTS · COMP/OP AGG $ OTH ER: $ A AUTOMOBILE LIABILITY X BA-3B500875-17 02/10/2017 02/10/2018 COMBINED SINGLE LI MIT $1 ,000,000 (Ea accidenl) -BODILY INJUR Y (Per person) $ ANY AUTO -ALL OWNED §srnrnme >--AU TOS AU TOS BODILY INJURY (Per accident) $ HI RED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE >--(Per accident) $ >--$ -UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGR EGATE $ -DEDLJ RET ENTI ON$ $ WORKERS COMPENSATION N/A I PER I I OTH-STATU TE ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT $ OFF ICER/MEMBER EXCLUDED? $ (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE g~;M1~"fi~t;J 0Fdc5~ERA TIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remark s Schedul e, may be attached if more space is required) AS RESPECTS TO AUTO LIABILITY -CERTIFICATE HOLDER IS ADDITIONAL INSURED AS PER CA 20 48 - DESIGNATED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF CUPERTINO , ITS OFFICERS, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AGENTS, EMPLO YEES AND VOLUNTEERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10300 TORRE AVE ACCORDANCE WITH THE POLICY PROVISIONS . CUPERTINO, CA 95014 AUTHORIZED REPRESENTATIVE ~ ~-~~ I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BA-3B500875-17-SEL COMMERCIAL AUTO ISSUE DATE : 12-20-16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following : BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement , the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name of Person(s) or Organization(s): CITY OF CUPERTINO, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS 10300 TORRE AVE CUPERTINO, CA 95014 (If no entry appears above , information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured " under the Who Is An Insured Provision contained in Section II of the Coverage Form . CA 20 48 02 99 Copyright , Insurance Services Office , Inc ., 1998 Page 1 of 1