Loading...
18-041 Schoolhouse Services, an Analysis of the Impacts of the Vallco Specific Plan on Local School DistrictsCITY OF fl PROFESSIONAL/CONSULTING SERVICES AGREEMENT CUPERTINO 1. PARTIES This Agreement is made and entered into as of _M_a_i_·c_h_l_,__2_0_1_8 ____________ _ ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and Schoolhouse Services ("Contractor"), a Cor oration for an analysis of the impacts of the Vallco Specific Plan on local school districts 2. SERVICES Contractor agrees to provide the services and perfo1m the tasks ("Services ") set forth in detail in Scope of Services, attached here and incorporated as Exhibit A . 3. TIME OF PERFORMANCE 3.1 This Agreement begins on the Effective Date and ends on December 31 , 2018 ("Contract Time"), unless te1minated earlier as provided herein . Contractor 's Services shall begin on March 1, 2018 and shall be completed by December 31 , 2018 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Perf01mance, attached and incorporated here Exhibit B . 3.3 Time is of the essence for the perfo1mance of all the Services. Contractor must have sufficient time, resources, and qualified staff to deliver the Services on time. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory perfo1mance of the Services an amount that will based on actual costs but that will be capped so as not to exceed $ 19 ,373.00 ("Contract Piice"), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C, Compensation attached and incorporated here. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor 's actual costs exceed the capped amount. No extra work or payment is pe1mitted without prior written approval of City. 4.2 Invoices and Payments. Monthly invoices must state a description of the deliverable completed and the amount due for the preceding month. Within thirty (30) days of completion of Services, Contractor must submit a requisition for final and complete payment of costs and pending claims for City approval. Failure to timely submit a complete and accurate payment requisition relieves City of any fm1her payment or other obligations under the Agreement. Proj ect Val/co Specific Plan Profess ional/Cons ulting Contracts /Vers ion: Nov 16, 20 17 Pa ge I o f 8 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, pai1ner, or joint venture of City. Contractor is solely responsible for the means and methods of perfonning the Services and for the persons hired to work under this Agreement. Contractor is not entitled to health benefits, worker 's compensation or other benefits from the City. 5.2 Contractor's Qualifications. Contractor waiTants on behalf of itself and its subcontractors that they have the qualifications and skills to perfo1m the Services in a competent and professional manner and according to the highest standards and best practices in the indust1y. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or ce11ified to perform the Services as required by law and have procured a City Business License . 5.4 Subcontractors. Only Contractor's employees are authorized to work under this Agreement. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Agreement will apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools, materials and equipment required to perfonn the Servi ces und er this Agreement. 5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this Agreement. Upon City 's request, Contractor will provide proof of payment and will indemnify City for violations pursuant to the indemnification provision of this Agreement. 6. PROPRIETARY/CONFIDENTIAL INFORMATION In performing this Agreement, Contractor may have access to private or confidential infonnation owned or controlled by the City, which may contain proprietary or confidential details the disclosure of which to third pa11ies may be damaging to City . Contractor shall hold in confidence all City inf01mation provided by City to Contractor and use it only to perfo1m this Agreement. Contractor shall exercise the same standard of care to protect City infonnation as a reasonably prndent contractor would use to protect its own proprietary data . 7. OWNERSHIP OF MATERIALS 7.1 Property Rights. Any interest (including copyright interests) of Contractor in any product, memoranda, study, repo11 , map , plan, drawing, specification, data , record , document or other infornrntion or work, in any medium ( collectively, "Work Product"), prepared by Contractor in connection with this Agreement will be the exclusive prope11y of the City and shall not be shown to any third-pai1y without prior written approval of City. 7.2 Copyright. To the extent pennitted by Title 17 of U.S. Code, all Work Product arising out of this Agreement is considered "works for hire " and all copyrights to the Work Product will be the property of City . Alternati vely, Contractor assi gns to City all Work Product cop yrights . Contractor may use copies of the Work Product for promotion only with City's w1itten approval. Proj ect Va ll co Specifi c Pla n Pro.fession al!Consulting Con tracts !Ve rs ion: Nov I 6, 20 I 7 Page 2 of 8 7.3 Patents and Licenses . Contractor must pay royalties or license fees required for authorized use of any third paity intellectual prope1ty , including but not limited to patented , trademarked, or copyrighted intellectual property if incorporated into the Serv ices or Work Product of this Agreement. 7.4 Re-Use of Work Product. Unless prohibited by law and without waiving any rights, City may use or modify the Work Product of Contractor or its sub-contractors prep ared or created under this Agreement , to execute or implement any of the following: (a) The original Services for which Contractor was hired ; (b) Completion of the original Services by others ; (c) Subsequent additions to the original Services ; and/or ( d) Other City projects. 7.5 Deliverables and Format. Contractor must provide electronic and hard copies of the Work Product, on recycled paper and copied on both sides , except for one single-sided original. 8. RECORDS Contractor must maintain complete and accurate accounting records relating to its performance in accordance with gen erally ac cepted accounting principles. The records mu st include detailed infonnation of Contractor 's perfo1mance, benchmarks and deliverables , which must be available to City for review and audit. The records and supporting documents must be kept separate from other records and must be maintained for four years from the date of City 's final payment. 9. ASSIGNMENT Contractor shall not assign, sublease , hypothecate , or transfer this Agreement , or any interest therein, directly or indirectly, by operation of law or otherwise , without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Agreement and subject to City approval, which shall not be umeasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. 10. PUBLICITY I SIGNS Any publicity generated by Contractor for the project under this A greement , during the tern1 of this Agreement and for one year thereafter, will reference the City 's contributions in making the project possible. The words "City of Cupe1tino " will be displayed in all pieces of publicity, including flyers , press releases , posters , brochures , public service announcements , interviews and newspaper aiticles. No signs may be posted, exhibited or displayed on or about City prope1ty, except signage required by law or this Contract, without prior written approval from the City. 11. INDEMNIFICATION 11.1 To the full es t ex tent allowed by l aw , and except for loss es cau se d by th e sol e and acti ve ne gli gence or willful mi sconduct of City p ersonn el, Contractor shall ind emnify, defend and hold Proj ec t Va llco Spec ifi c Pl a n Pro.fessio na//Consulting Con tracts /Vers ion: Nov 16. 201 7 Page 3 of8 hannless City, its City Council , boards and commissions , officers , officials , employees, agents , servants, volunteers and consultants ("Indemnitees "), through legal counsel acceptable to City, from and against any and all liability, damages , claims, actions , causes of action, demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings) of every nature, arising directly or indirectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract , obligations , representations or waiTanties ; (b) Negligent or willful acts or omissions committed during perf01mance of the Services; ( c) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors; (d) Unautho1ized use or disclosure of City 's confidential and prop1ietary Information; ( e) Claim of infringement or violation of a U.S . patent or copyright, trade secret, trademark, or service mark or other proprietary or intellectual prope11y rights of any third pai1y . 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-pa11y claim, in accordance with California Public Contract Code Section 9201. At City 's request , Contractor will assist City in the defense of a claim, dispute or lawsuit arising out of this Agreement. 11.3 Contractor's duties under this section are not limited to th e Contract Price , workers ' compensation payments, or the insurance or bond amounts required in the Agreement. Nothing in the Agreement shall be constrned to give 1ise to an implied right of indemnity in favor of Contractor against City or any Indemnitee. 11.4. Contractor 's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim a1ising out of this Agreement, a purchase order, or other transaction. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit D, and must maintain the insurance for the duration of the Agreement, or longer as required by City. City will not execute the Agreement until City approves receipt of satisfactory ce11ificates of insurance and endorsements evidencing the type, amount , class of operations covered , and the effective and expiration dates of coverage. Failure to comply with this provision may result in City , at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor 's compensation or te1minating the Agreement. 13. COMPLIANCE \VITH LA \VS 13.1 General Laws. Contractor shall comply with all local , state and federal laws and regulations applicable to this Agreement. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor 's ability to perfonn. Contractor is responsible for verifying the employment authorization of employees perfonning the Services , as required by the Immigration Reform and Control Act. Proj ec t Va ll co Sp ec ifi c Pl an Profess ional/Cons ulting Contracts /Vers ion: Nov I 6, 20 I 7 Page 4 o f 8 13.2 Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a "public works " component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws . 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap , disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Inmmne Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws , including Go vernment Code Sections 12900 and 11135, and Labor Code Sections 1735 , 1777 and 3077.5 . Consistent with City policy prohibiting harassment and disc1imination , Contractor understands that harassment and disc1imination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or its employees or sub-contractors will not be tolerated. 13.4 Conflicts of Interest. Contractor shall comply with all conflict of interest laws applicable to this Agreement and must avoid any conflict of interest. Contractor wmnnts that no public official, employee, or member of a City board or commission who might have been involved in the making of this Agreement, has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. Contractor may be required to file a conflict of interest f01m if Contractor makes ce11ain governmental decisions or serves in a staff capacity, as defined in Section 18700 of the California Code of Regulations . Contractor agrees to abide by the City's rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements or terminating this Agreement. City reserves all other rights and remedies available under the law and this Agreement, including the right to seek indenmification under Section 11 of this Agreement. 14. PROJECT COORDINATION City Project Manager. The City assigns Piu Ghosh as the City 's representative for all purposes under this Agreement, with authority to oversee the progress and perfo1mance of the Scope of Services. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval , Contractor assigns J. Richard Recht ______ as its single Representative for all purposes under this Agreement, with authority to oversee the progress and perfonnance of the Scope of Services. Contractor 's Project manager is responsible for coordinating and scheduling the Services in accordance with the Scope of Services and the Schedule of Perfonnance. Contractor must regularly update the City 's Project Manager about the progress with the work or any delays, as required under the Scope of Services. City written approval is required prior to substituting a new Representative . 15. ABANDONMENT OF PROJECT City may abandon or postpone the Project or parts th ere for at any time . Contractor will be compensated for satisfactory Services perfonned through the date of abandonment, and will be Projec t Vall co Specific Plan Profess ional/Co nsulting Contracts /Ve rs ion : Nov 16, 2017 Page 5 o f 8 given reasonable time to assemble the work and close out the Services . With City 's pre-approval in writing, the time spent in closing out the Services will be compensated up to a maximum of ten percent (10%) of the total time expended to date in the perfonnance of the Services. 16. TERMINATION City may te1111inate this Agreement for cause or without cause at any time. Contractor will be paid for satisfactory Services rendered through the date of tennination, but final payment will not be made until Contractor closes out the Services and delivers the Work Product. 17. GOVERNING LAW, VENUE AND DISPUTE RESOLUTION This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Comt for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in comt. If a dispute aiises, Contractor must continue to provide the Services pending resolution of the dispute . If the Parties elect arbitration, the arbitrator's award must be supp01ted by law and substantial evidence and include detailed written findings of law and fact. 18 . ATTORNEY FEES If City initiates legal action , files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Agreement, the prevailing paity will be entitled to reasonable attorney fees and costs. 19. THIRD PARTY BENEFICIARIES There are no intended third paity beneficiaries of this Agreement. 20. \VAIVER Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract provision. City's waiver of a breach shall not constitute waiver of another provision or breach. 21. ENTIRE AGREEMENT This Agreement repre sents the full and complete understanding of every kind or nature between the Paities, and supersedes any other agreement(s) and understanding(s), either oral or written , between the Paities. Any modification of this Agreement will be effective only if in writing and signed by each Paity's authorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsistency between the main Agreement and the attachments or exhibits thereto , the text of the main Agreement shall prevail. Project Val lee Specific Pl an Pro_fessional/Consuiling Contracts !Vers ion: Nov 16, 2017 Page 6 of8 22. INSERTED PROVISIONS Each provision and clause required by law for this Agreement is deemed to be included and will be infeITed herein. Either patty may request an amendment to cure mistaken inse1tions or omissions of required provisions. The Patties will collaborate to implement this Section, as appropriate. 23. HEADINGS The headings in this Agreement are for convenience only, are not a patt of the Agreement and in no way affect, limit or amplify the tern1s or provisions ohhis Agreement. 24. SEVERABILITY/P ARTIAL INVALIDITY If any te1m or provision of this Agreement, or their application to a patticular situation, is found by the comt to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such rnling. All other te1ms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. The Patties agree to work in good faith to amend this Agreement to caITy out its intent. 25. SURVIVAL All provisions which by their nature must continue after the Agreement expires or is tenninated, including the Indemnification, Ownership of Materials/Work Product, Records , Governing Law and Attorney Fees, shall survive the Agreement and remain in full force and effect. 26. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confomed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or ce1tified, or the next business day following electronic submission: To City of Cupe1tino 10300 Torre Ave ., Cupertino CA 95014 Attention: Piu Ghosh -------------Em ail: PiuG @cupe 27. VALIDITY OF CONTRACT To Contractor: Schoolhouse Services 2255 Tioga Drive, Menlo Park, CA 94025 Attention: J Richard Recht Email: richard recht@yahoo .co m This Agreement is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupe1tino Municipal Code Chapters 3.22 and 3.23, as amended from time to time, (b) is signed by the City Manager or an authorized designee, and (c) is approved for f01m by the City Attorney's Office . Project Yallco Specific Plan ProJessional/Consulring Contracts /Version: Nov 16, 20 17 Page 7 of8 IN WITNESS WHEREOF, the parties have caused the Agreement to be executed. CONTRACTOR CITY OF CUPERTINO Schoolhouse Services :y:Z°?a~ Name A~1'1 $~IVA-!>1'A-Vk Title losts-r~...sr lt'f'f ..M.A-t-lA{~ Date o:BfaJ;I Title p:teS, Date :;,/ 1 /\ ~ -~<+l~(+--~--- Tax 1.D. No.: q '"1·-3 o2..Q tf.1· /)..1 APPROVED AS TO FORM: ~ V t2:vn--kl {];/ A41 7 RAND~PH STEVENSON HOM 7 Cupertino City Attorney ('f/~;j} 3/;J.f )iq 1 <3,r--ft 3/» f,1 ~~-J.--(8' City Clerk City Project!Program_V_all_co_S..:._pe_ci_fic_P_la_n ___________________ _ Projessio11al!Comuiling Contracts !Re ,·. Nol' 16. 20 17 Pa ge 9 of9 3/1 /2018 Piu Ghosh via e-mail Hello Piu, Schoolhouse Services E_conomists & flanners EXHIBIT A SCOPE OF SERVICES The City has initiated a project to prepare a specific plan for about fifty-eight acres of the Vallco Shopping District Special Area. Several alternative land use layouts need to be evaluated, but they could include residential units as well as significant amounts of retail and office space along with infrastructure to supp01i these uses, in varying combinations. An analysis must be perfonned to include infonnatio n relevant to consideration of the impacts of the project on the local school districts , Cupertino Union School District (CUSD) and Fremont Union High School District (FUHSD .) Schoolhouse Services has prepared evaluations of this nature frequently in past years for the City of Cupertino. The scope of such a report on this project will be similar to that of the prior studies , except that there will have to be a comparative evaluation of four ( or five) alternative scenarios. The work tasks will include: • Communication with City of Cupe1iino staff regarding program elements of the different alternatives. The infonnation sought will focus especially on the housing units , including their size, expected sales or rental p1ices (relevant to prope1iy tax revenues), and projected development timing. • Communication with Tom Williams (Enrollment Projection Consultants), the demographer for both school districts, regarding up-to-date data about student generation of various types of housing in the districts and projected enrollment loads at the vaiious schools the students residing in these housing units would attend . This task will include consideration of the effects of recent changed socioeconomic and demographic trend s in the area. • Communication with (1) Chris Jew, Assistant Superintendent of CUSD, and (2) Jason Crutchfield, Director of Business Services, and Clu·istine Mallery, Director of Facilities, for FHUSD, regarding cun-ent enrollment capacities and facility plans at the schools that would be impacted by enrollment generated by the residential units in the project, and for the districts as a whole. Piu Ghosh , page 2 • Preparation of other relevant information, including construction costs, fiscal parameters, etc. A draft report will be prepared for the City of Cupertino's review; the draft report will then be edited appropriately in response to feedback from both the City and upon discussion with the school districts. The report will include: 1. An executive summary 2. Analysis structured as follows: • A section describing the student generation rates of the housing units and the project's enrollment impacts for the alternative scenarios, • Infonnation about the affected schools, including their enrollment capacity and comparison of this capacity with projected future enrollment with and without the project, and • Infonnation for the entire districts, including their enrollment capacity and comparison of this capacity with projected future enrollment with and without the project 3. The remainder of the report will address the financial impacts of the project on the school districts, including both: • Capital facilities costs and revenues, and • Operating costs and revenues. The Vall co specific plan area is large. The study includes a variety of land uses and the analysis must evaluate multiple scenaiios. The cost for these services will not exceed $17,500. In addition, the cost to obtain the Errors and Omissions Insurance required by the City is $1,873 . The total not to exceed amount is thus $19,373. Please contact me if you have any questions or if any additional infonnation would be helpful. Thank you, Dick J . Richard Recht 2255 T ioga Drive • Men lo F a rk, CA 9-1·025 • fax: 650.85+.0 10+ fhone: 650.J7°?T';7J March 1, 2018 Schoolhouse Services E_conomists & flanners EXHIBITB SCHEDULE OF PEFORMANCE It is expected and planned that the study will be completed in no more than 90 days from the receipt of infonnation about the Vallco Specific Plan . J. Richard Recht 225 5 Tioga Drive • Men lo f ark, CA 9"1·025 March 1, 2018 Schoolhouse Services E_conomists & flanners EXHIBIT C COMPENSATION My time will be billed at $170 per hour. I will be the only person working on the study . Expenses will be billed at cost. The $1,873 cost to obtain Errors & Omissions Insurance required by the City of Cupertino shall be fully reimbursed upon contract execution. The total cost of hours billed and expenses incurred will not exceed $19,373. A total of no more than three itemized invoices will be submitted, no more than one invoice in any month. J. Richard Recht 225 5 Tioga Drive• Men lo f ark, CA 94·025 fhone: 650.";l"J-l"Jl"J EXHIBITD Insurance Requirements Design Professionals & Consultants Contracts Consultant shall procure prior to commencement of Services and maintain for the duration of the contract, at its own cost and expense, the following insurance policies and coverage with companies doing business in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED l. Commercial General Liability (CGL) for bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrencelimit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Consultant's policy shall be "primary and non-contributory," will not seek contribution from City 's insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13). c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: As required by the State of California, with Statuto1y Limits and Employer's Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease. D Not required. Consultant has provided written verification of no employees. 4. Professional Liability for professional acts, errors and omissions, as appropriate to Consultant's profession, with limits no less than $2,000,000 per occurrence or $2,000,000 aggregate. If written on a claims made form: a. The Retroactive Date must be shown and must be before the Effective Date of the Contract. b. Insurance must be maintained for at least five (5) years after completion of the Services. c. If coverage is canceled or non-renewed, and not replaced with another claims-made policy fonn with a Retroactive Date prior to the Contract Effective Date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of the Services. OTHER INSURANCE PROVISIONS The aforementioned insurance shall be endorsed and have all the following conditions and provisions : Ex h . D-In s urance R equirements for Design Profess ionals & Consultants Contracts Form Upda ted F eb. 2018 1 Additional Insured Status The City of Cupertino , its City Council , officers, official s, employees, agents, servants and volunteers ("Additional Insureds") are to be covered as additional insureds on Consultant 's CGL policy. General Liability coverage can be provided in the form of an endorsement to Consultant 's insurance (at least as broad as ISO Form CG 20 10 (11 / 85) or both CG 20 10 and CG 20 37 forms , if later editions are used). Prima,y Coverage Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self-insurance maintained by City, its officers, officials, employees , or volunteers shall be excess of Consultant's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums . Waiver of Subrogation Consultant waives any right to subrogation against City/ Additional Insureds for recovery of damages to the extent said losses are covered by the insurance policies required herein. Specifically, the Workers' Compensation policy shall be endorsed with a waiv er of subrogation in favor of City for all work performed by Consultant, its employees, agents and subconsultants . This provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Deductibles and Self-Insured Retentions Any deductible or self-insured retention must be declared to and approved by the City. At City's option, either: the insurer must reduce or eliminate the deductible or self-insured retentions as respects the City/Additional Insureds; or Consultant must show proof of ability to pay losses and costs related investigations, clain1 administration and defense expenses. The policy shall provide, or be endorsed to provide, that the self-insµred retention may be satisfied by either the insured or the City. Acceptability of Insurers Insurers must be licensed to do business in California with an A.M. Best Rating of A-VII, or better. Verification of Coverage Consultant must furnish acceptable insurance certificates and mandatory endorsements ( or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements prior to commencement of the Contract. City retains the ri ght to demand verification of compliance at any time duringthe Contract term. Subconsultants Consultant shall require and v erify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant's insurance policies. Higher Insurance Limits If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Consultant. Adequacy of Coverage City re serves the right to modify these insurance requirements/coverage based on th e nature of the risk, prior exp erience , insurer or other sp ecial circumstances , w ith not les s tha n ninety (90) days prior written notice . Exh. D-In suran ce R equirem ents for D es ig n P rof ess io na ls & Co nsu ltants Co ntra cts Form Updated Feb. 201 8 2 ACORD® a G" ,,.. ,., ,-:::1 I DA TE (MMIDDIYYYYJ cERT1F1cATE OFzt1A1mDm"CfifsuRANce ~ 03/05/2018 THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH1S CERTIFICATE DOES NOT AFFIRMATNELY 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln polic!es may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endor.,ement(s). PRODUCER CONTACT MARKS. BECK -AGENT NAME : :~. -...... ;:/~ :~~::·, :-~·.:-: MARK BECK -AGENT rAHJNJo. <Cv<t• 626-331-2281 I r.ifc Nol: 626-967-5906 (~, 637 S . SECOND AVE . f~J~..... mark.beck.b9lx@statefarm .com ,· . , ""·: , .............. __ COVINA, CA 91723 INSURER(SI AFFORDING COVERAGE NAIC # INSURER A: State Farm General Insurance Company 25151 INSURED INSURERS: SCHOOL HOUSE SERVICES INC INSURERC: 2255 TIOGA DR INSURERD: MENLO PA RK CA 94025-6671 INSURERE: INSURERF: 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 . NOT1MTHSTAN DING ANY REQUIREMENT, TERM OR COND!TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF ICATE MAY BE ISSU ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TME POLICIES DESCRIBED HEREIN (S SUBJECT TO ALL THE TERMS , EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS . INSR 1YPE OF INSURANCE AO DL:SUBR POLICY EFF l~~hl%~1 LIMITS LTR lt11,1e"'j u n,n POLICY NUMBER IM MIDDIYYYY\ ElziMIAERCIAL GENERAL LlA.BlUTY 1 EA CH OCCURRENCE s 2,000 ,000 Cl.A IMS-MA DE [ZJ OCCUR i DAMAG E TO REN t tc u $ i PR EMI SES IE a occumm::e l I I MED EX? (A ny one perso n) 1~ 5,000 A ---! 92-El-E0 93-1 G 01/1 1/2018 01/11/2019 _j PERSON AL & f,JJV INJURY $ GEN 'L AGGREGATE LIM IT APPLI ES PER: GENERAL AGGREGATE s 4 ,000 ,000 Zl DPRO-DLOC i s 4 ,000,000 POLICY JECT \ PRODUCTS • COM P/OP AGG l J OT HER: j DEDUCTlBLE $ 500 ~OP.IOBILE UAB 1U1Y ! COMBI NED SINGLE LIM IT $ /Ea accide.otl j ANY AUTO i BODILY INJURY (Per person) $ t-O'Mv.ED .---SCH EDULED I BODI LY INJURY (Per ac.cident) $ AUTO S ON LY AUTOS ,__ HIRE D ,__ NON-OWNED PROPERTY DAMAGE AUTOS ON LY AU TOS ONLY i IPeracciceo t\ $ --' I $ I UMBRELI.A UAB H OCCUR EAC H OCCURRE NCE $ ,__ EXCESSU AB CLAIM S-MADE AGG RE GATE $ OED I I RETEN TI ON s i WORKERS CO MPENSATION I ~TUTE I I OTH- AND EMPLOYER S' LIABILITY y / N ER ANY PRO PR IETORIPAR TNER /£X ECUTI VE D NIA E.L EACH ACC IDENT $ OFFIC ER/MEM BER EXCLUD ED? (Mandatory In NHJ E.L DI SEASE • EA EMPLOYEE $ ~~rc ifi'Pir~ 'o'°t~PERA TI ONS below E.L. DISEASE . POLICY LIMIT $ I I DES CRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Ad dl~ona l Re ma rks Schedule, may b e attached if more s pace i• required) CONSUL TING SERV ICES 2255 TIOGA DR MENLO PAR K CA 9402 5-667 1 ADDI T ION AL INSU RED ; "The C ity of Cupertino , its C ity Council , officers, offi cial s, employee s , agents , servants and voluntee rs". CERTIFICATE HOLDER Ci ty of Cu pertin o 10300 To rre Av enue Cupertino, CA 95 01 4-3202 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF , NOTICE WILL BE J;:>ELIVERED IN ACCORDANCE WITH THE P91,1 CY P · VISIONS ,/' © 1988-2015 ACORD CORPORATION. All rights reserved . The ACORD name and logo are registered marks of ACORD 1001~e'3 132849.12 03-1&-20 1s <DICK@SCHOOLHOUS E SERVICES.COM> ~Rt, CERTIFICATE Of LIABILITY INSURANCE MTt #IIJlllOli t t tJ ~ lttl$ cemttJCATE IS-ISSUED AS A Ul1£R OF INF\ONIA"flON (JlfL'( AHO ~ MO fllQlfn Uf'ON 1tiE ~Ti ltOI.DER. ffli$ Cf.llJ'IACAT& DOD N01' AfflRll41M!1.Y OR NEGAT!Ya.Y A1181D. EXT!HO: °" Al.tat 1lC ~ ~ r, nte: PCIJCID 8E1QW. ·Tlffl ~Tl! Oft MSU!WiCE DCIE$ NOT ~ A ec»mw:T e£l'W£EN THE S$$UIIC ~""~ ~Al"MSOA~ANDffilCElmftCAfE~ ... IIPORtA.fff: •• cwtfflcala f!Oidlr' la• ADllfflCliML ltSURm.. n ~ lpQllt t.w ~ 1R$URE.O ~ or tJt llnlb1M. If SUIROQl.tiON iS WAIIU.,~" b illlM *lid w ..... et 1ti1t pc,lk,y, CoNt11ii ~-, ~ 911 ~ A~ Oft lblit~--l'IOC'*-lltl'M~"'°"111f'llllllillt:tllolldr .. ,._,_ :::.:..~ ~S.eE<:K-AGEHT I Sfateflrfm ~-D£e,{-NJBff ~-CW31~1 ! • .;;-~~ A. a7 & SSX)tC) Al/£. ~~ ~CA.$tm ~--_ .... ==-::~~ ..... ~ l&tSJ ----.. ·-·-· --·1 ... ~!10U$S~INC ~Cl· lW~M ·-----~PN!KC-' ~t -· -I[· ->-= t--· covetAGt<t CEliTIFlCA 11! liUMBi:R: . .. ~ tUil8'l!Jt: 114$ IS ffl CSll'lh' 'IHA.l Tl€ POI.JeiU. OF M~ ~TEP IIELOW' k.\\l! e£EH J$lJUE'D TO ml! ~ ~ likN'c f!lR TM: POUCY PERlOO ~lm NO~ A1tf ~ls-Oft~ Of NI'( COffflW;T"' 01lQ ~Vfflf~.ltln«:1-11lU C8t'J1flCA'JI; -.U.Y 8fi lSSU!t> CIA a.!A.Y. FEJHAIN, till! ~~ff '!Hf~~ IS ~ lO AU. nE ~ EXCI.IJ$iOtCSNC>~OF$Ueff POUQAtM'rS~W.YKlVE8EB.f~AYPAOClAIIB. --,~ _fiMDI'-= = ' ,_ -l2S ~__,,_~ ~~ .2.~ tz'ic ••• ""°'-l8} 0C01Jt ..• • ...._ ....... ----· l .om£Jfl',---•.!!! -A 112.E~t G Otll 1t70111 Ol/W201t -,;M(M,IU ,-~ • ,__ ---~~~-~ ~~ff • .uco.ooo_ P(Ul'f ~ 0 l.llC ~-~MIC • <t.000,-flOO -~ "'6£6uciiiiT' '500 ~~ ' 1--M((NJTO OJS~t ~'7SA OV1 ~ll OtJ1 om)\~ tdll.Y'tlull«,.._. t 1m.MO ~ =-¥ :J .-------• 300.ooo -'f riitt~ ._ =CM.Y ,_j 't ·' 10&.(IOQ • " f.o<IQ ._ ~I.N H::-J ~~ I & -UNI I -re • 1..., .. 1 (--........ .... • ~~fiOII J _}='--I I n ~ ~~ -·-IM&rJY TIit ,~~~Mt o li t .il l IE.l.GloCH~ " --· J.!,. DIQll!-;a_~ • ·-·---FL QllilLf,aE -tl«M!Y i.lliit ' I l l I ~Cli"Cf'Mil1!0NsJ~'!IQIIII VIIIIUl~----IIMii1ot......__ .. _if_.....,...,......,,.. COt$!1.11NO SEJMCSG 2'2SS 110Ct\ M Mi£m.O PARK CA ~7t ~lNSURED: 'Tl!eet'J olC~ b tlyC®ld, G11br1. offlcllill. ~ ~ ~Andwll,,_,..._ ~ffWl'lll .. ~ ,.. .............. _ ~ N4 Of'ntf ~ oac:..a, l'ClUCft IE CAIICEJ...C~ ml!! CXll'IMtlOlil ~ ~. JiOneli WI.I. • Ctl.M'lit'.I) .. ~fl~ ~Wffll'QE~~ A t 0300 Tiin~ -,. ~·- ~dl:?5-"2 Cupilliino.CA CISOf ~ . I _. --~ ..._ . I O lteUOtl ACOJU> CORPORATION. ,*'I...,_~ BM Policy No. 92 ELE093 1 BECK , MARKS CMP-4 786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY . PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED -OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following : BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 ELE093 1 Named Insured: SCHOOL HOUSE SERVICES I NC 2255 TIOGA DR MENLO PARK CA 94025 -6671 Name And Address Of Additional Insured Person Or Organization: THE CI TY OF CUPERT I NO , ITS CITY COUNCIL , OFFICERS , OFFICIALS , EMPLOYEES , AGENTS , SERVA NTS AND VOLUNTEERS 10300 TORRE AVE CUPERTINO , CA 95014 -3202 1. SECTION II -WHO IS AN INSURED of SECTION II -LIABILITY is amended to in- clude , as an additional insured, any person or organization shown in the Schedule, but only w ith respect to liability for "bod ily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part , by : a. Ongoing Operations (1) Your acts or omissions ; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured ; or b. Products -Completed Operations "Your work" performed for that add itional insured and included in the "products- completed operations hazard ". However, Paragraph 1. above is subject to the following : a . The insurance afforded to the additional insured only applies to the extent permit - ted by law ; b. If coverage provided to the additional in- sured is required by a contract or agree- ment , the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782 .05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability ; or (2) You are required by contract or agreement to provide for such addi- tional insured . We have no duty to defend or indemn ify the add itional insured under this endorsement un- til a claim or "suit " is tendered to us. ©, Copyright, State Fa rm Mutual Autom o bil e In suran ce Co mpan y, 201 3 Includ es copyri ghted materi al of In surance Services Office, In c ., w ith its permiss ion. CO NTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II -LIMITS OF INSURANCE: If coverage provided to the additional insured is requ ired by contract or agreement , the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance : a. Required by the contract or agreement; or b. Available under the applicable Lim its Of Insurance shown in the Declarations. Th is endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations . 4. With respect to the insurance afforded to the additional insured , the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II -GENERAL CONDITIONS : The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence " or an of- fense which may result in a cla im. To the extent possible , notice should include: (1) How , when and where the "occur- rence " or offense took place ; (2) The names and addresses of any in - jured persons and witnesses ; and CMP-4786 .1 CMP-4786 .1 Page 2 of 2 (3) The nature and location of any injury or damage aris ing out of the "occur- rence " or offense ; b. Tender the defense and indemnity of any cla im or "suit" to us and to all other insur- ers who may have insurance potentially ava ilable to the addit ional insured ; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for wh ich we would provide coverage under SECTION II - LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II -LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II - COMMON POLICY CONDITIONS: a. This insurance is primary to and w ill not seek contribut ion from any other in surance available to the additional insured , provided that the additional insured is a named in - sured under such other insurance. b. Regardless of any agreement between you and the additional insured , this insur- ance is excess over any other insurance whether primary, excess , contingent or on any other basis for wh ich the additional in - sured has been added as an addit ional in- sured on other polic ies. There will be no refund of premium in the event this endorsement is cancelled . All other pol icy provisions apply . 1007033 1480 11 08 -21 -2014 ©, Co pyrig ht , State Fa rm Mu tual Aut omobile In surance Co mpa ny, 20 13 In clud es co pyrighted ma te ri al of In surance Services Office , Inc ., w ith its permissio n. BM Policy No. 92 ELE093 1 BECK , MARKS THIS ENDORSEMENT CHANGES THE POLICY . PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following : BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 ELE093 1 Named Insured: SCHOOL HOUSE SERVICES INC 2255 T I OGA DR MEN LO PARK CA 94025 -6671 Name And Address Of Person Or Organization: THE CITY OF CUPERTINO , ITS CITY COUNCIL , OFFICERS , OFFICIALS , EMPLOYEES , AGENTS , SERVANTS AND VO LUNTEERS 10300 TORRE AVE CUPERTINO, CA 95014 -3202 CMP -47 87 Page 1 of 1 The following is added to Paragraph 10.b. of SECTION I AND SECTION II -COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organ ization and included in the "products- completed operations hazard". This waiver applies only to the person or organ ization shown in the Schedule. All other policy provisions apply . CMP-47 87 100622 5 13771 5.1 11-19-20 13 ©. Co pyri ght, State Fa rm Mutual Au tomob il e In surance Co mp any, 20 08 In clud es copyri g ht ed mate ri a l of Ins ura nce Services Office, Inc., wi th it s pe rmi ss ion. ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/D D/YYYY) ~ 03 /06 /2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION JS 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 Dana Schiller NAME: SelectSolutions Insurance Services iA~8NJ0 Extl : (866)500-6359 I FAX (A/C, No): (925)951-0077 1107 Investment Bl vd E-M AIL danas@selectsolutionsins.com ADDRESS: Suite 100 INSURER(S) AFFORDING COVERAGE NAIC # El Dorado Hills CA 95762 INSURER A: The Hanove r Insurance Group, Inc. INSURED INSURER B: Schoolhouse Services INSURER C: 2255 Tioga Dr INSURER D: Menlo Park , CA 94025 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: CL 183626743 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIC ATED . 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 , EXCLUS IONS AN D CONDITIONS OF SUCH POLICIES. LI MITS SHOWN MAY HAV E BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AUUL SUo" POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER {MM/DD/YYYYI {MM/DD/YYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1--D CLAIMS-MADE D OCCUR UA,v"'"'" I U KE ccD -PREMISES /Ea occurrence) $ MED EXP (Any one person ) $ - PERSONAL & ADV INJ URY $ - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGR EG AT E $ Fl DPRO-DLoc POLICY JECT PRODUCTS -COMP/OP AGG $ OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE L IMIT $ (Ea accident) -ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) s --HIRED NON-OWNED PROPERTY DAMAG E AUTOS ONLY AUTOS ONLY <Per accident) $ -- $ UMBRELLA LIAB H OCCUR EACH OCCURRENC E s 1-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION s s WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOY EE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ AGGREGATE $1,000 ,000 PROFESSIONAL LIABILITY A LHFD519 974 00. 03/03/2018 03 /03 /2019 EACH CLAIM $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101 , Additional Remarks Schedule. may be attached if more space is required) For Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Evidence Only ACCORDANCE WITH THE POLICY PROVISIONS . AUTHORIZED REPRESENTATIVE I t7~ (:f}-tiA~~ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Stale of California CounhJ of Santa Clara City of Cupertino Contra ctor/Co nsultant Affidavit o f No Employees I, the undersigned, declare as follows: I am an independent contractor and the owner of S "-~O Ct-\ ~o ()-. S' ~ S"~ v ~· C.2.:; I \Vish t o enter into a services contract with t he City of Cu pertino. I am fully aware of the provisions of section 3700 of the California Labor Co d e, which requires every employer to p rovide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that 1 must p rovide proof of workers' compensation insurance to the City of Cupertino for a ny and all employees 1 may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees \·Vorking 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. Execute d on th is 't·t-~y of ~c..°k_ 2018, at ~~-~"-\ .... 11 __ ~~A.~Y~~........,. California . Revised 1.05.18 • Carrier: • A.M. Best Rating: • Premium: • Broker Fee: • Total Premium : • Payment Plan : • Terms: Coverage Limits: Professional Liability • $1,000,000 • $1,000,000 • $2,500 Binding Subjectivities: Items required to start coverage: 1 1. Initialed Coverage Option Recommendations **Page 2 Propo~al Disclosure .. · 2. Signed Terms and Conditions **Page 3 ?rop-0sal _ Disclos ure 3. For Payment of $200.00 Broker fee, Please click on The Hanover Insurance Company A $1,123.00 $200.00 $1 ,323 .00 D irect Bill Please see Applicant Quote for terms & conditions General Aggregate Each Claim Limit Deductible If you are unable to click the above link, please copy and paste the below entire URL in your web browser: https://payments .selectsolutionsinsurance . net/bill-pay.a5w?rid=3DA 150DA4F7244CCA29088D8AD18A 191 3 We value your business and appreciate your confidence in us . I look forward to talking with you , If you have any questions after reviewing this proposal please contact me . r ,/H E FF ERN A N IP' ~I NSUil.ANCf BROKtlr.S ·-· -PAmA Dana Schiller. C li ent F ul fillment Execut ive main (866) 500-6359 direct (925) 278-1522 fax l 925) 951-0077 web www.sekctso lut io 11 si 11 s.co111 1107 In vest ment Bl vd # 100 El Dorado Hills , CA 95762 4