Loading...
18-001 Madhu Marathe CITY OF No. ; — FY2018-20 CUPERTINO RECREATION SERVICES AGREEMENT 1. Parties. This contract is made and entered into as of 8/1/2018 ("Effective Date'),by and between the City of Cupertino,a municipal corporation("City"),and with MADHU MARATHE, ("Contractor"), a CALIFORNIA SOLE PROPRIETOR for YOUTH CLASSES. 2. Services. Contractor agrees to provide the Services included in the Scope of Work and in accordance with the Schedule of Performance attached in Exhibit A. 3. Term. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract Time"), unless extended or terminated as provided herein. Time is of the essence and Contractor must have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must promptly notify City of any actual or potential delays to afford the Parties adequate opportunity to address or mitigate such delays. 4. Compensation. City will pay Contractor for satisfactory performance of the Services an amount that will based upon actual costs but that will be capped so as not to exceed$5,000 FOR FY18- 19, $5,000 FOR FY19-20 ("Contract Price"), based upon the Scope of Services, budget, performance schedule, and rates included in Exhibit A. The maximum compensation includes all costs, expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount. Contractor must submit invoices and the information required in Exhibit A in order to receive payment. City will compensate Contractor within 30 days after approval of written invoices. Invoices are subject to review and audit by City during regular business hours upon 24-hours' notice. Contractor must maintain complete and accurate records of payrolls, expenditures, disbursements and other cost items charged to City or establishing the basis for an invoice, for a minimum of four (4)years from the date of final payment. 5. Independent Contractor.Contractor is an independent Contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Services and for the persons hired to work under this Agreement.No civil service status or other right of employment will be acquired by virtue of Contractor's performance of the Services. Contractor is not entitled to City's health benefits, worker's compensation or any other benefit. Contractor must have the skills and qualifications to perform the Services in a competent and professional manner. Contractor will supply all tools, materials and equipment required to perform the Services under this Contract. Contractor is responsible for obtaining permits and licenses required by law and must obtain a City business license. 6. Proprietary/Confidential Information.To the extent Contractor may have access to private or confidential information owned or controlled by the City, Contractor agrees to treat it confidential and use it solely to perform this Agreement. Contractor must exercise the same standard Recreation Services Agreement/Rev. 3-27-2018 Page 1 of 6 of care to protect City information as a reasonably prudent Contractor would use to protect its own proprietary data. 7. Ownership of Materials.To the extent Contractor prepares written material, drawings or data in connection with this contract, City will have the property rights to those materials and all copyrights, if any, to such work product will constitute City property. 8. Records.Contractor must maintain complete,accurate,and detailed accounting records relating to its performance in accordance with generally accepted accounting principles and procedures. The records must include detailed information about Contractor's services, benchmarks, deliverables and costs/fees,and must be made reasonably available to City.The records and supporting documents must be kept separate from other files and maintained for four years from the date of City's final payment. 9. Assignment.This Contract is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Contract without prior written approval of City.Only those persons whose names are included in Exhibit A may perform the Services. 10. Publicity and Signs. Any publicity generated by Contractor related to this contract or the Services during the Contract Time and for one year thereafter must reference City contributions. The words "City of Cupertino' shall be displayed in all pieces of publicity, including flyers, press releases, posters, brochures, public service announcements, interviews and newspaper articles. No signs may be posted,exhibited or displayed on or about City property,except signage required by law or under this Agreement without prior written approval from City. 11. Indemnification. To the fullest extent allowed by law and except for losses caused by the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend, and hold harmless the City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel acceptable to City, from and against any liability for damages, claims, actions, causes of action, demands, charges, losses, costs and expenses (including attorney fees,legal costs and expenses related to litigation, arbitrations, administrative and regulatory proceedings), of every nature, arising out of or in any way related to Contractor's or Contractor's agents performance of this contract or the Services. This includes but is not limited to Liability resulting in personal injury, death, property damage, or economic losses. Contractor must pay any costs City may incur in enforcing this provision and must accept a tender of defense upon receiving notice from City.Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract. 12. Insurance. Contractor shall comply with the insurance requirements in Exhibit B. City will not execute the Agreement until it has received and approved satisfactory certificates of insurance and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole discretion may purchase insurance and deduct the costs from payments to Contractor,or terminate the contract. Recreation Services Agreement/Rev. 3-27-2018 Page 2 of 6 13. Compliance with Laws and Other City Requirements. Requirements for all Contracts. This contract is subject to local, state and federal laws and regulations prohibiting discrimination,including Title VII of the Civil Rights Act of 1964,the California Fair Employment Practices Act,the Americans with Disabilities Act of 1990,and other laws that pertain to fair employment and anti-discrimination practices. Contractor must comply with labor laws pertaining to prevailing wages, working hours, overtime, payroll records, and other requirements imposed by the Department of Industrial Relations.If Contractor does not have employees,it must sign the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying employment eligibility of employees pursuant to the Immigration Reform and Control Act of 1986. Contractor must comply with conflict of interest laws and regulations applicable to this Agreement and avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in governmental decisions or serving in a staff capacity, and is hereby advised to review the requirements of California Political Reform Act and the California Code of Regulations. Services may only be performed by persons who are not employed by City and who do not have a contractual relationship with City other than this contract. Contractor agrees to abide by City policies and administrative rules prohibiting gifts to City officials and employees. Additional Requirements for Services Provided to Minors: Contractor and its employees who provide services under this Agreement must comply with these additional requirements: A. Undergo fingerprinting and a criminal background check and verify all employees providing services under this contract have met this requirement. B. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D. C. Comply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with the protocols, reporting, and training required under California Health and Safety Code Section 124235, AB2007, and other laws pertaining to concussion evaluation, removal from play, and return to play protocols. (Refer to Center for Disease Control & Prevention, https://www.cdc.gov/headsup/index.html). D. Submit required forms and acknowledgments included in Exhibit D, and ensure its each participant is provided with a concussion information sheet, signs and returns the forms to the City as required by Health and Safety Code Section 124235. Require coaches and administrators to successfully complete the concussion and head injury education at least once either online or in person, before supervising a participant. Contractor shall offer training, educational materials, or both to each Contractor administrator on a yearly basis. (Training resources are available at the Center for Disease Control&Prevention(link cited above). E. If providing instruction, Contractor must acknowledge and comply with all requirements set forth in the Recreation&Community Services Instructor Manual. Check one (if applicable): ® This contract requires services for children. Recreation Services Agreement/Rev. 3-27-2018 Page 3 of 6 I ❑ This contract currently does not require services for children. If in the future, services for children are required, the contract will require a'written amendment' to include the appropriate insurance coverages as required in'Exhibit B-Insurance Requirements for Recreation Contracts', proof of finger printing and additional requirements under Paragraph 13. The contract amendment will also require the approval of the Director of Recreation and Community Services and City Attorney. 14. Coordination of Services. The Parties designate the following persons as Services Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of this Agreement. Contractor's designation and any substitution are subject to City approval. For City: For Contractor: Name:Marilu Mejia Name:MADHU MARATHE Position: RECREATION COORDINATOR Position:PROGRAM INSTRUCTOR Contact:MARILUM@CUPERTINO.ORG/408- Contact: 777-3124 15. Abandonment. City may abandon or postpone the Activity or Program and will notify Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the date of abandonment upon submission of final invoices approved by City. 16. Termination. City may terminate this contract for cause or without cause at any time and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered through the date of termination upon submission of final invoices approved by City. 17. Governing Law,Venue and Dispute Resolution.This contract is governed by the laws of the State of California. Any legal actions or proceedings filed against City in connection with this contract must comply with the government claims filing requirements and must be filed with the Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is required to continue to provide Services pending resolution of any dispute. If the Parties elect arbitration, the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will be entitled to reasonable attorney fees and costs.This Section survives this Agreement. 19. Third Party Beneficiaries.There are no third party beneficiaries under this Contract. 20. Waiver. Neither acceptance of Services nor payment thereof constitutes a waiver of any contract provision. City waiver of a breach shall not constitute waiver of another term, provision, covenant or condition, or a subsequent breach,whether of the same or a different character. 21. Entire Agreement.This Agreement and all referenced Exhibits are hereby attached and incorporated into the Agreement by this reference and represent the full and complete understanding as to those matters contained herein, and supersede any other contract or understanding,either oral or Recreation Services Agreement/Rev. 3-27-2018 Page 4 of 6 written,between the Parties.This Agreement may not be modified or amended except in writing signed by both Parties.If there is any inconsistency between the main contract and any attachments or exhibits thereto, the main contract shall prevail. 22. Inserted Provisions.Each provision or clause required by law or this contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure any mistaken insertion or omission of a required provision. 23. Headings. The headings are for convenience only and are not a part of the contract or intended to affect, limit or amplify the terms or provisions of this Agreement. 24. Severability/Partial Invalidity. If any contract term or provision, or their application to a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or provision shall remain in force and effect to the extent allowed by such ruling.All other contract terms and provisions and their application to specific situations will remain in full force and effect. 25. Survival.All provisions which by their nature must continue after the Agreement ends, including without limitation Indemnification, Insurance, Ownership of Materials,Records, Governing Law and Attorney Fees, will survive the expiration or termination of this Agreement. 26. Notices.All notices and instruments pertaining to material provisions of this contract or significant disputes which are required by law or under this contract to be in writing must be sent to the persons listed below. The notices will be deemed effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission. To City of Cupertino: To Contractor: Office of the City Manager 10300 Torre Ave., Cupertino CA 95014 CALIFORNIA 95070 cc: Representative/Coordinator: cc: Representative/Coordinator: Marilu Mejia MADHU MARATHE Email: marilum@cupertino.org Email: 27. Validity of Contract. This contract is valid and enforceable only if it complies with the provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or authorized designee, and is approved for form by the City Attorney's Office. 28. Execution. The person executing this contract on behalf of Contractor represents and warrants that Contractor has full right, power, and authority to execute this contract and to carry out all actions and services required. This contract constitutes a legally binding obligation of Contractor, and may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. Recreation Services Agreement/Rev. 3-27-2018 Page 5 of 6 IN WITNESS WHEREOF,the parties have caused this contract to be executed. CONTRACTOR CITY OF CUPERTINO MADHU MARATHE A Municipal Corporation ti By 111( � k,1M', By Name l� ��►'1 y� Name�fl�I Title) S �'�' Title /*5f �e� Date _ / / Date Tax I.D. No.: )k1ek- io W7 APP ED AS TO FORM: ATTEST: IiANDLPH STEVENSON HOM GRACE SCHMIDT Cuper ' o City Attorney City Clerk ContractlEncumbered Amount: FY18-19$5,000. FY19-20$5,000. Account No.:580-62-613-700-702 Recreation Services Agreement/Rev. 3-27-2018 Page 6 of 6 EXHIBIT A SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES The CONTRACTOR will provide YOUTH CLASSES in,but not limited to,the following: SPEED & MENTAL MATH Location and Time of CONTRACTOR Services: Refer to the Recreation Schedule dated SUMMER 2018-SPRING 2020 for agreed upon dates, times, and class locations. The City, at its sole discretion, may change the agreed terms. Compensation for CONTRACTOR Services: Contractor shall be compensated for services performed pursuant to this Agreement. Compensation shall consist of the following: 70%OF RESIDENT FEE, PER PARTICIPANT,BASED ON FINAL ROSTER. MINUS$10 ADMINISTRATIVE FEE PER PARTICIPANT. The total compensation to the Contractor shall not exceed FYI 18-19$5,000. FY 19-20 $5,000. Eligible Participant Minimum and Maximums for CONTRACTOR Services: Minimum: 4 Maximum: 20 If less than the required minimum number of participants enroll in and pay for a particular class as identified in the schedule before the class is scheduled to start, the City may cancel the particular class and/or terminate this Agreement without additional notice or payment to Contractor. List of all Contractor Employees working for the City of Cupertino (if no Employees, identify "self'): Performance of CONTRACTOR Services: In the case Contractor unilaterally cancels performance of a class, camp, activity or service without City approval,City reserves the right to immediately and without notice cancel the remainder of programs/services offered and or performed by Contractor. The Contractor shall follow all guidelines pertaining to registration procedures as listed in the quarterly recreation schedule.Participants may not take part in the program unless they are listed on the class roster or can show proof of enrollment. All participants and volunteers need to complete the City's Waiver of Liability form prior to taking part in the program.If applicable, contractors who are responsible for supervising minors must remain with the class until a parent of legal guardian has arrived and all minors are released to them. In the event of an injury occurring to a participant, the Contractor will notify the City within 1 hour and complete an Incident Report in the form approved by the City. The Incident Report must be submitted to the City within 24 hours of the injury occurring. Exhibit B Insurance Requirements for Recreation Contracts As required by Section 12 of the Agreement, Contractor shall procure and maintain the following insurance for the duration of the contract against claims arising from or in connection with Contractor, its agents, representatives, employees or subcontractors Services under this Agreement. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this project/location(CG 25 03 or 25 04)or be twice the required occurrence limit. 2. Automobile Liability: ISO CA 0001 covering Code 1 (any auto), or if Contractor has no owned autos, Code 8 (hired) and 9 (non-owned), with limits no less than$1,000,000 per accident for bodily injury and property damage. ❑ Required if automobile is used to perform work under this contract. .X Otherwise, proof of Contractor's personal auto insurance with limits required by state law suffices. Contractor shall not transport or use its personal vehicle to transport participants or perform work under this contract. 3. Workers' Compensation: As required by the State of California, with Statutory and Employer's Liability Insurance limits of no less than$1,000,000 per accident for bodily injury or disease. ❑ Required if Contractor has employees. 1� If no employees, Contractor must sign Affidavit of No Employees. 4. Sexual Abuse/Molestation: Insurance or the equivalent as required for activities/services involving minors, (i.e., after school activities, recreational programs, athletics, study/training events and transportation of minors). Coverage may be included under General Liability or be obtained in a separate policy, such as Educators Legal Liability (ELL) policy, with a limit of no less than $1,000,000 per occurrence. If a general aggregate limit applies, it must apply separately to this contract or be twice the required occurrence limit. X Required if Contract involves services to children. Insurance coverage required may be satisfied by a combination of Primary and Excess/Umbrella insurance. Self-Insured Retentions: Self-insured retentions must be approved by City. City may require Contractor to provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language must provide, or be endorsed to provide, that the self- insured retention may be satisfied by either the named insured or City. Acceptability of Insurers:Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California,with an A.M.Best's financial strength rating of"A"or better and a financial size rating of"VII"or better. OTHER INSURANCE PROVISIONS: The CGL policy must contain, or be endorsed to contain, the following provisions: 1. The City, its City Council, boards and commissions, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds with respect to liability arising out of work or Exh.B Insurance for Recreation Contracts Updated 3-26-18 1 operations performed by or on behalf of the Contractor including materials, parts or equipment furnished in connection with such work or operations. 2. Contractor's insurance shall be primary insurance coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers, officials, employees, agents, and volunteers. 3. The Insurance Company agrees to waive all rights of subrogation against the City, its elected or appointed officers,officials, agents, and employees for losses paid under the terms of any policy which arise from work performed by Contractor for City. This provision also applies to the Contractor's Workers' Compensation policy. 4. Each insurance policy required by this contract shall provide that coverage shall not be canceled, except with notice to the City. Primary Coverage: The Additional Insured coverage under Contractor's policy shall be primary non- contributory and at least as broad as ISO CG 20 01 04 13 as respects the City and all the insureds/indemnitees. If the limits of insurance required are satisfied in part by Umbrella/Excess Insurance, the Umbrella/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 the Additional Insureds before City's own insurance is triggered. Notice of Cancellation: Each insurance policy shall provide that coverage shall not be canceled or allowed to expire without written notice to City 30 days in advance or 10 days in advance if due to non-payment of premiums. Such notice must be sent to City via email or certified mail to the attention of the City Manager. Waiver of Subrogation:Contractor grants City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of payment of any loss under such insurance. Contractor will obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Verification of Coverage:Contractor shall furnish the City with original certificates and amendatory endorsements effecting coverage required by this clause.All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications, at any time. At a minimum Contractor must provide acceptable copies of the policy declarations and endorsement page verifying the required insurance coverages. Homeowner's Insurance:Contractor's homeowner's liability insurance may provide coverage sufficient to meet these requirements. Contractor should provide these requirements to his or her agent to confirm and provide verification to City. Special Events Coverage:Insurers may provide special events coverage for a reduced fee, or City may be able to offer this coverage. Contractor should contact the City Manager's Office for information or assistance. Special Risks or Circumstances:City reserves the right to modify these requirements based on the nature of the risk,prior experience, insurer,coverage, or other special circumstances. Exh.B Insurance for Recreation Contracts Updated 3-26-18 2 EXHIBIT C 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 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 employer 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 12 of the City of Cupertino'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 gay of MGA 2018, at CGc.DCalifornia. M hu, lL4 4, PRINT NAME m � SIGNATURE EXHIBIT D Contractor's Mandated Reporter Declaration The undersigned does hereby certify that: 1. I am a representative of MADHU MARATHE; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. I declare that MADHU MARATHE has complied with fingerprinting and criminal background investigation requirements with respect to all Contractor's employees who may have contact with minors in the course of providing services pursuant to the Agreement, and the California Department of Justice has determined that none of those employees has been convicted of a felony, as that term is defined in California Penal Code Section 11105.3. 3. 1 declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once, either online or in person, before supervising a participant, as required by California Health and Safety Code Section 124235, et seq. 4. On a yearly basis, all participants shall be required to sign and return a concussion and head injury information sheet in compliance with California Health and Safety Code Section 124235, which may be in the form attached as D-1. 5. That a complete and accurate list of Contractor's employees, who may come in contact with minors during the course and scope of the Agreement, are included below. 6. All of the below mentioned employees have tested negative for TB, or X-ray results for TB, and have current documentation on file with Contractor. 7. All of the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws of this state and are willing and able to comply. List of all Contractor Employees working for the City (if no Employees, identify "self"): r 8. The Contractor will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino. I declare under penalty of perjury that the foregoing is true and correct. MADHU MARATHE By: MADHU MARATHE Title: PROGRAM INSTRUCTOR Date: i ® CERTIFICATE OF LIABILITY INSURANCE o503r22018' 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 CONTAMIKE MYERS,AGENT LIC.#OG58440 NAME: MIKE MYERs PHONE 250 E HAMILTON AVE,STE B 4O8-41248585 — StateFarm CAMPBELL, CA 95008 — — - _ AFFORDING COVERAGE Nuc: INSURER A State Fann Fye and Casually Company 25M MADHURANI MARATHE INSURERS: �.._ INSURER 0: NSURER E NSURER F: COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE L POLICY NUMBER POLICY EFF POLICY V LAM A i %'o COW ERCIAL GENERAL LIABILITY Y Y 97-CF-P283-1 G 09/2412017 09124!2018 EAcm occuRRENcE s 1,000,000 M M-MMENTED CLJYMSMADE OCCLtt PREDAMI5E5(Ea — i »d MED E !Arry me er on S 5.0w _ PERSONAL a ADV MAY 5 t.aoo•� Wrl.AcK.REGATELWAPPLIES PER. I GENERAL AGGREGATE $ $000,000 I1 ! OMPIOPAGO S PiX_ECV L...._J��� I.00 PRODUCTS OTHER. COMBINED j S AUTOMOBILE LUIDAJTY Ea cl t LIl i ANY AUTO BODILY WJURT(Per peren) S AUTOS ISD SCHEDULED 9004.Y INJURY(Por 1x4.'0 i AUTOS NON.0VACD PROPERTY ONVIAGE Is HIRED AUTOS AUTOS xdd6n i tIIABREWtLJA6 OCCUR EACH OCCURRENCE i EXCESSLIA11 I cLABISAVDE AGGREGATE f DFD I I RETENTIONS WORKERS COWINSATIOM ( $TA AND EMPLOYERS LIAEIUTY Y I N AKYPROPRILtORPARTNFRPE)MCUTIVE Q NIA E'LEACH AOC9CENT i (M Ktai�t n BNN))EcG1UDE[Yt E.L OISEASE•EA 2n:OM i N qes,degwI)BUrxw CESCRIPTIDN OF OrXRATIOW;belay EL OSEASE•POLICY OMIT 1 S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACOAD 1M.Additi"O Remota Schedub,msy be attached V muco space Is r*"kod) ADDITIONAL INSURED ENDORSEMENT F-E-6609 WAIVER OF SUBROGATION ADDITIONAL INSURED: CITY OF CUPERTINO,ITS CITY COUNCIL,BOARDS AND COMMISSIONS.OFFICERS,OFFICIALS,EMPLOYEES,AGENTS, SERVANTS,VOLUNTEERS.AND CONSULTANTS CERTIFICATE HOLDER CANCELLATION CITY OF CUPERTINO OFFICE OF THE CITY MANAGER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10300 TORRE AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CUPERTINO,CA 95014 ACCORDANCE WITH TME POLICY PROVISIONS. AUTHORIZED R9'fffiSENTATIVB 0 1988-201AC D CORPORATION.All rights reserved. ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 DJA Policy No. 97 CFP283 1 3797—FBOC CMP-4787 Page 1 of 1 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: 97 CFP283 1 Named Insured: MARATHE, MADHURANI Name And Address Of Person Or Organization: CITY OF CUPERTINO ITS CITY COUNCIL, BOARDS, & COMMISSIONS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS, & CONSULTANTS C/O CITY OF CUPERTINO OFFICE OF THE CITY MANAGER 10300 TORRE AVE CUPERTINO CA 95014 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 organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 V,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. DJA Policy No. 97 CFP283 1 3797—FBOC CMP-4786.1 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:97 CFP283 1 Named Insured: MARATHE, MADHURANI Name And Address Of Additional Insured Person Or Organization: CITY OF CUPERTINO ITS CITY COUNCIL, BOARDS, & COMMISSIONS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, SERVANTS, VOLUNTEERS, & CONSULTANTS C/O CITY OF CUPERTINO OFFICE OF THE CITY MANAGER 10300 TORRE AVE CUPERTINO CA 95014 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury', that which you are required by the contract "property damage", or "personal and advertis- or agreement to provide for such addition- ing injury" caused, in whole or in part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products–Completed Operations fense or indemnity obligation by Cali- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or"suit" is tendered to us. O,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CONTINUED CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur- made or a "suit' brought for damages for rence"or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit' to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION II — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de- we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION II — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad- Insurance shown in the Declarations. ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II—GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in- extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.11 1007033 148011 08-21-2014 «?,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Marilu Mejia From: Madhurani Marathe <madhurani@comcast.net> Sent: Monday, May 21, 2018 3:51 PM To: Marilu Mejia Subject: Auto insurance authorization 1 2 TRAVELERS JW Report Claims Immediately by Calling* 1-800-238-6225 Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting COMMERCIAL INSURANCE A Custom Insurance Policy Prepared for: LUMILEDS LLC LUMILEDS USA(HOLDING) CORP 370 WEST TRIMBLE ROAD SAN JOSE CA 95131 Presented by: AON RISK INS SERV WEST TRAVELERS) One Tower Square, Hartford, Connecticut 06183 TRAVELERS CORP. TEL: 1-800-328-2189 COMMON POLICY DECLARATIONS ISSUE DATE: 07/17/17 POLICY NUMBER: H-810-5J507644-TCT-17 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 1. NAMED INSURED AND MAILING ADDRESS: LUMILEDS LLC LUMILEDS USA (HOLDING) CORP 370 WEST TRIMBLE ROAD SAN JOSE, CA 95131 2. POLICY PERIOD: From 07/01/17 to 07/01/18 12:01 A.M. Standard Time at 3. LOCATIONS your mailing address. Premises Bldg. Loc. No. No. Occupancy Address 4. COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COMMERCIAL AUTOMOBILE COV PART DECLARATIONS CA TO O1 02 15 TCT 5. NUMBERS OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY: SEE IL T8 01 10 93 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions: Policy Policy No. Insuring Company SEE CALCULATION OF PREMIUM COMPOSITE RATES ENDORSEMENT 7. PREMIUM SUMMARY: Provisional Premium $ 56,558 Due at Inception $ 14,141 Due at Each 3 MONTHS $ 14,139 NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: AON RISK INS SERV WEST (F2757) 425 MARKET ST STE 2800 SAN FRANCISCO, CA 94105 Authorized Representative DATE: IL TO 02 11 89(REV. 09-07) PAGE 1 OF 1 OFFICE: SP-SAN FRANCISCO TRAVELERS J� POLICY NUMBER: H-810-5J507644-TCT-17 EFFECTIVE DATE: 07-01-17 ISSUE DATE: 07-17-17 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL TO O1 01 07 COMMON POLICY CONDITIONS IL T3 02 07 86 CALCULATION OF PREMIUM-COMPOSITE RATE(S) IL T8 25 GENERAL PURPOSE ENDORSEMENT COMMERCIAL AUTOMOBILE CA TO O1 02 15 BA- COVERAGE PART DECS (ITEMS 1 & 2) CA TO 03 02 15 BA COVERAGE PART DECS (ITEMS 4 & 5) CA TO 30 02 16 BA/AD/MC COV PART SUPPL SCH - ITEM TWO CA TO 31 02 15 TABLE OF CONTENTS-BUSINESS AUTO COV FORM CA 00 01 10 13 BUSINESS AUTO COVERAGE FORM MM 99 11 10 13 MA MANDATORY ENDORSEMENT CA T4 59 02 15 AMENDMENT OF EMPLOYEE DEFINITION CA O1 09 10 13 GEORGIA CHANGES CA O1 10 09 16 MI CHANGES CA O1 11 08 15 NH CHANGES IN POLICY CA O1 26 10 13 NORTH CAROLINA CHANGES CA O1 43 10 13 CALIFORNIA CHANGES CA O1 48 02 14 RHODE ISLAND CHANGES CA 04 24 10 13 CA AUTO MEDICAL PAYMENTS COVERAGE CA 21 16 10 13 NORTH CAROLINA UM COVERAGE CA 21 31 10 13 MICHIGAN UNINSURED MOTORISTS COVERAGE CA 21 33 10 13 OH UI AND UIM MOTORISTS COV-BI CA 21 43 06 15 RI UNINSURED MOTORISTS COV-BODILY INJURY CA 21 54 10 13 CALIFORNIA UM COVG - BODILY INJURY CA 21 59 10 13 ALABAMA UNINSURED MOTORISTS COVERAGE CA 22 20 04 16 MI PERSONAL INJURY PROTECTION CA 22 22 10 13 MICHIGAN BROADENED COLLISION COVERAGE CA 22 24 10 13 MICHIGAN PROPERTY PROTECTION COVERAGE CA 31 26 02 15 NEW HAMPSHIRE UNINSURED MOTORISTS CVG CA 31 37 10 13 GA UM COV ADDED TO AT-FAULT LIAB LMTS CA 99 03 10 13 AUTO MEDICAL PAYMENTS COVERAGE CA 99 41 10 13 MI PROP DMGE LIAB COV BUYBACK ENDT MM 99 13 10 13 AUTO MED PAYMENTS COV - MA MM 99 67 10 13 MASSACHUSETTS CHANGES CA T3 53 02 15 BUSINESS AUTO EXTENSION ENDORSEMENT CA 02 62 10 13 NH CHANGES - CANCELLATION AND NONRENEWAL CA 02 73 10 13 RI CHANGES-CANCELLATION & NONRENEWAL MM 99 17 10 13 WAIVER OF DEDUCTIBLE - MASSACHUSETTS CA T8 00 MI CATASTROPHIC CLAIMS ASSOC ASSESSMENT IL T8 01 10 93 PAGE: 1 OF 2 TRAVELERSJ� POLICY NUMBER: H-810-5J507644-TCT-17 EFFECTIVE DATE: 07-01-17 ISSUE DATE: 07-17-17 INTERLINE ENDORSEMENTS IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL 00 21 04 98 NUCLEAR ENERGY LIABILITY EXCLUSION IL 00 21 09 08 NUCLEAR ENERGY LIAB EXCL END-BROAD FORM IL 01 61 03 12 RHODE ISLAND CHANGES - CIVIL UNION IL 01 87 09 07 NH CHANGES - CONCEAL, MISREP OR FRAUD IL 02 44 09 07 OHIO CHANGES-CANCELLATION & NONRENEWAL IL 02 62 02 15 GEORGIA CHGS-CANCELLATION AND NONRENEWAL IL 02 70 09 12 CALIFORNIA CHANGES - CANC AND NONRENEWAL IL 02 86 09 08 MI CHANGES-CANCELLATION AND NONRENEWAL IL T3 05 07 15 INSURER AMENDMENT ENDORSEMENT IL T9 11 01 89 NH-CHANGES POLICYHOLDER NOTICES PN T5 62 01 15 LIBERALIZATION LETTER PN CA 36 09 15 CA AUTO BODY REPAIR CONS BILL OF RIGHTS IL T8 01 10 93 PAGE: 2 OF 2 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: A. Cancellation during the policy period and up to three years 1. The first Named Insured shown in the Decla- afterward. rations may cancel this policy by mailing or D. Inspections And Surveys delivering to us advance written notice of 1. We have the right to: cancellation. 2. We may cancel this policy or any Coverage a. Make inspections and surveys at any Part by mailing or delivering to the first Named Insured written notice of cancellation b. Give you reports on the conditions we at least: find; and a. 10 days before the effective date of can- c. Recommend changes. cellation if we cancel for nonpayment of 2. We are not obligated to make any inspec- premium; or tions, surveys, reports or recommendations b. 30 days before the effective date of can- and any such actions we do undertake relate cellation if we cancel for any other rea- only to insurability and the premiums to be son. charged. We do not make safety inspections. 3. We will mail or deliver our notice to the first We do not undertake to perform the duty of any person or organization to provide for the Named Insured's last mailing address known health or safety of workers or the public. And to us. we do not warrant that conditions: 4. Notice of cancellation will state the effective a. Are safe or healthful; or date of cancellation. If the policy is cancelled, that date will become the end of the policy b. Comply with laws, regulations, codes or period. If a Coverage Part is cancelled, that standards. date will become the end of the policy period 3. Paragraphs 1. and 2. of this condition apply as respects that Coverage Part only. not only to us, but also to any rating, advi- 5. If this policy or any Coverage Part is can- sory, rate service or similar organization celled, we will send the first Named Insured which makes insurance inspections, surveys, any premium refund due. If we cancel, the re- reports or recommendations. fund will be pro rata. If the first Named In- 4. Paragraph 2. of this condition does not apply sured cancels, the refund may be less than to any inspections, surveys, reports or rec- pro rata. The cancellation will be effective ommendations we may make relative to certi- even if we have not made or offered a re- fication, under state or municipal statutes, or- fund. dinances or regulations, of boilers, pressure 6. If notice is mailed, proof of mailing will be vessels or elevators. sufficient proof of notice. E. Premiums B. Changes 1. The first Named Insured shown in the Decla- This policy contains all the agreements between rations: you and us concerning the insurance afforded. a. Is responsible for the payment of all pre- The first Named Insured shown in the Declara- miums; and tions is authorized to make changes in the terms b. Will be the payee for any return premi- of this policy with our consent. This policy's terms can be amended or waived only by endorsement ums we pay. issued by us as part of this policy. 2. We compute all premiums for this policy in C. Examination Of Your Books And Records accordance with our rules, rates, rating plans, premiums and minimum premiums. The pre- We may examine and audit your books and mium shown in the Declarations was com- records as they relate to this policy at any time puted based on rates and rules in effect at IL TO 01 01 07(Rev.06-09) Includes the copyrighted material of Insurance Services Office,Inc.with its permission. Page 1 of 2 the time the policy was issued. On each re- acting within the scope of duties as your legal newal continuation or anniversary of the ef- representative. Until your legal representative is fective date of this policy, we will compute appointed, anyone having proper temporary cus- the premium in accordance with our rates tody of your property will have your rights and and rules then in effect. duties but only with respect to that property. F. Transfer Of Your Rights And Duties Under This Policy G. Equipment Breakdown Equivalent to Boiler Your rights and duties under this policy may not and Machinery be transferred without our written consent except On the Common Policy Declarations, the term in the case of death of an individual named in- Equipment Breakdown is understood to mean sured. and include Boiler and Machinery and the term If you die, your rights and duties will be trans- Boiler and Machinery is understood to mean and ferred to your legal representative but only while include Equipment Breakdown. This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company(IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company(COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut(TCT) The Travelers Indemnity Company of America (TIA) Travelers Casualty Insurance Company of America (ACJ) Secretary President Page 2 of 2 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. IL TO 01 01 07 (Rev.06-09) POLICY NUMBER: H-810-5J507644-TCT-17 ISSUE DATE: 07-17-17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM - COMPOSITE RATES A. SCHEDULE 1. This endorsement modifies insurance provided under the following Coverage Part(s): COMMERCIAL AUTOMOBILE COVERAGE 2. This endorsement applies to the Declarations from 07-01-17 to 07-01-18 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. 3. Definition of Premium Base (Bases): PER UNIT 4. Exceptions (if any) to compositing of premium calculation: 5. Premium Schedule PREMIUM COVERAGE BASE SEE IL T8 25 ESTIMATED ADVANCE EXPOSURE RATE PREMIUM (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) B. PROVISIONS premium shall be computed in accordance with 1. Referring to the Schedule above, the premium the policy and this endorsement. If the earned for the Coverage Parts shown in item 1, except premium thus computed exceeds the estimated with respect to any exceptions shown in item 4, advance premium paid, you shall pay the ex- shall be computed in accordance with the cess to us; if less, we shall return to you the premium base (bases) and rate (rates) desig- unearned paid portion. Rates and premiums nated in item 5. for any subsequent Declarations Periods shall 2. The premium for the excepted hazards shall be be determined at the inception date of those respective periods and shall be specified in en- rules filed by computed in us or on our behalf.accordance with the rates and dorsements to be added to the policy. After termination of each period, the earned premium 3. The advance premium stated above is an es- shall be computed in accordance with the timated premium for the Declarations Period. policy and this endorsement. Upon termination of this period, the earned IL T3 02 07 86 (Rev.12-08) Page 1 of 1 POLICY NUMBER H-810-5J50764-4-TCT-17 ISSUE DATE: 07/17/17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM - COMPOSITE RATE(S) THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE PART VEHICLE TYPE: PRIVATE PASSENGER POL LEVEL DED COMPOSITE COVERAGE PHYSICAL DAMAGE MOD RATE #VEHS PREMIUM LIABILITY 767 31 23777 COMPREHENSIVE 01000 32 31 992 COLLISION 01000 106 31 3286 VEHICLE TYPE: LIGHT TRUCKS POL LEVEL DED COMPOSITE COVERAGE PHYSICAL DAMAGE MOD RATE #VEHS PREMIUM LIABILITY 1105 16 17680 COMPREHENSIVE 01000 20 16 320 COLLISION 01000 69 16 1104 MISCELLANEOUS COVERAGES PREMIUM TOTAL PREMIUM 9399 SYMBOL NO IL T8 25 PAGE 1 PRODUCER AON RISK INS SERV WEST OFFICE 08F COMMERCIAL AUTOMOBILE Ate► TRAVELERS J One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO COVERAGE PART DECLARATIONS Issue Date: 07-17-17 EC ITEM ONE: Policy Number: H-810-5J507644-TCT-17 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT Declarations Period: From: 07-01-17 to 07-01-18 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Commercial Automobile Coverage Part consists of these Declarations and the Business Auto Coverage Form shown below. FORM OF BUSINESS: LIMITED LIABILITY CO ITEM TWO: A. COVERAGE AND LIMITS OF INSURANCE: Coverage applies only to those "Autos" shown as Covered "Autos". "Autos" are shown as covered "autos" for the applicable coverages by the entry of one or more of the symbols from Section 1 - Covered Autos of the Business Auto Coverage Form next to the name of the coverage. COVERED LIMITS OF COVERAGE AUTO SYMBOL INSURANCE The most we will pay for any one accident or loss. COVERED AUTOS LIABILITY 1 $ 11000,000 COMPULSORY BODILY INJURY 1 $20,000 EACH PERSON (Massachusetts Only) $40,000 EACH ACCIDENT PERSONAL INJURY 5 Separately stated in each PROTECTION PIP endorsement minus (No Fault) deductible shown in ITEM THREE-SCHEDULE OF COVERED AUTOS YOU OWN. PERSONAL INJURY 5 $8,000 PROTECTION (Massachusetts Only) PROPERTY PROTECTION 5 Separately stated in the (COVERAGE) Endorsement Minus $ 0 (Michigan Only) deductible. CA TO O1 02 15 PAGE (CONTINUED) PRODUCER AON RISK INS SERV WEST F2757 OFFICE SPSANFR 08F .�► TRAVELERS J One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO COVERAGE PART DECLARATIONS Issue Date: 07-17-17 EC Policy Number: H-810-5J507644-TCT-17 COVERED LIMITS OF COVERAGE AUTO SYMBOL INSURANCE AUTO MEDICAL PAYMENTS 2 $10,000 EACH INSURED UNINSURED AND 2 SEE CA TO 30 UNDERINSURED MOTORISTS COVERAGE PHYSICAL DAMAGE 2 8 Actual Cash Value or Cost Comprehensive Coverage of Repair, whichever is less, minus deductible shown in ITEM THREE- SCHEDULE OF COVERED AUTOS YOU OWN for each covered Auto. SEE ITEM FOUR FOR HIRED OR BORROWED "AUTOS". SEE IL T8 25 PHYSICAL DAMAGE 2 8 Actual Cash Value or Cost Collision Coverage of Repair, whichever is less, minus deductible shown in ITEM THREE-SCHEDULE OF COVERED AUTOS YOU OWN for each covered auto. SEE ITEM FOUR FOR HIRED OR BORROWED "AUTOS". SEE IL T8 25 B. AUDIT PERIOD: COMPOSITE AUTO C. DESCRIPTION OF COVERED AUTO DESIGNATION SYMBOLS: Symbols 1-9, 19: SEE BUSINESS AUTO COVERAGE FORM Section 1 Covered Autos D. LOSS PAYEE: Any loss under Physical Damage Coverages is payable as interest may appear to you and the Loss Payee named in the Declarations (see Loss Payable Clause on reverse side) E. NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART: SEE IL T8 01 10 93 CA TO O1 02 15 PAGE (CONTINUED) PRODUCER AON RISK INS SERV WEST F2757 OFFICE SPSANFR 08F AA. TRAVELERS J One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO COVERAGE PART DECLARATIONS Issue Date: 07-17-17 EC Policy Number: H-810-5J507644-TCT-17 LOSS PAYABLE CLAUSE A. We will pay you and the loss payee named in the policy for "loss" to a covered "auto", as interest may appear. B. The insurance covers the interest of the loss payee unless the "loss" results from conversion, secretion or embezzlement on your part. C. We may cancel the policy as allowed by the CANCELLATION Common Policy Condition. Cancellation ends this agreement as to the loss payee's interest. If we cancel the policy we will mail you and the loss payee the same advance notice. D. If we make any payment to the loss payee, we will obtain their rights against any other party. SCHEDULE OF LOSS PAYEES VEHICLE NUMBER LOSS PAYEE (Name and Address) CA TO 01 02 15 PAGE (CONTINUED) PRODUCER AON RISK INS SERV WEST F2757 OFFICE SPSANFR 08F AA. TRAVELERS J One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO POLICY NUMBER: H-810-5J507644-TCT-17 COVERAGE PART DECLARATIONS ISSUE DATE: 07-17-17 ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS. COVERED AUTOS LIABILITY COVERAGE —COST OF HIRE RATING BASIS FOR AUTOS USED IN YOUR MOTOR CARRIER OPERATIONS (OTHER THAN MOBILE OR FARM EQUIPMENT) COVERED AUTOS LIABILITY ESTIMATED ANNUAL COST OF PREMIUM COVERAGE HIRE FOR ALL STATES PRIMARY $ $ COVERAGE EXCESS $ $ COVERAGE TOTAL HIRED AUTO PREMIUM 1$ For"autos" used in your motor carrier operations, cost of hire means: 1. The total dollar amount of costs you incurred for the hire of automobiles (includes "trailers" and semitrail- ers)and if not included therein, 2. The total remunerations of all operators and drivers' helpers, of hired automobiles whether hired with a driver by the lessor or an "employee" of the lessee, or any other third party, and 3. The total dollar amount of any other costs (e.g., repair, maintenance, fuel, etc.) directly associated with operating the hired automobiles whether such costs are absorbed by the "insured", paid to the lessor or owner, or paid to others. COVERED AUTOS LIABILITY COVERAGE — COST OF HIRE RATING BASIS FOR AUTOS NOT USED IN YOUR MOTOR CARRIER OPERATIONS (OTHER THAN MOBILE OR FARM EQUIPMENT) COVERED AUTOS STATE ESTIMATED ANNUAL COST OF HIRE PREMIUM LIABILITY COVERAGE FOR EACH STATE PRIMARY COVERAGE $ $ EXCESS COVERAGE $ $ INCL TOTAL HIRED AUTO PREMIUM $ INCL For"autos" NOT used in your motor carrier operations, cost of hire means the total amount you incur for the hire of"autos" you don't own (not including "autos" you borrow or rent from your partners or"employees" or their fam- ily members). Cost of hire does not include charges for services performed by motor carriers of property or pas- sengers. CA TO 03 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.with its permission. PRODUCER: F2757 OFFICE: 08F PHYSICAL DAMAGE COVERAGES—COST OF HIRE RATING BASIS FOR ALL AUTOS (OTHER THAN MOBILE OR FARM EQUIPMENT) COVERAGE STATE LIMIT OF INSURANCE ESTIMATED ANNUAL PREMIUM COST OF HIRE FOR EACH STATE (Excluding Autos Hired With a Driver) COMPREHENSIVE ACTUAL CASH VALUE OR COST 100,000 $ INCL OF REPAIR,WHICHEVER IS LESS, MINUS$ 1,000 DEDUCTIBLE. FOR EACH COVERED AUTO. SPECIFIED ACTUAL CASH VALUE OR COST $ CAUSES OF OF REPAIR, WHICHEVER IS LESS, LOSS MINUS$ DEDUCTIBLE. FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. COLLISION ACTUAL CASH VALUE OR COST 100,000 $ INCL OF REPAIR, WHICHEVER IS LESS, MINUS$ 1,000 DEDUCTIBLE. FOR EACH COVERED AUTO. TOTAL HIRED AUTO PREMIUM $ For Physical Damage Coverages, cost of hire means the total amount you incur for the hire of"autos" you don't own (not including "autos"you borrow or rent from your partners or"employees"or their family members). Cost of hire does not include charges for any"auto"that is leased, hired, rented, or borrowed with a driver. ITEM FIVE SCHEDULE FOR NON-OWNERSHIP COVERED AUTOS LIABILITY NAMED INSURED'S BUSINESS RATING BASIS NUMBER PREMIUM OTHER THAN GARAGE SERVICE NUMBER OF EMPLOYEES $INCL OPERATIONS AND OTHER THAN SOCIAL SERVICE AGENCIES NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) NUMBER OF EMPLOYEES $ WHOSE PRINCIPAL DUTY GARAGE SERVICE OPERATIONS INVOLVES THEOPERATION OF AUTOS NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) NUMBER OF EMPLOYEES $ NUMBER OF $ SOCIAL SERVICE AGENCIES VOLUNTEERS WHO REGULARLY USE AUTOS TO TRANSPORT CLIENTS NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) TOTAL NON-OWNERSHIP COVERED AUTOS LIABILITY PREMIUM $ INCL Page 2 of 2 ©2015 The Travelers Indemnity Company.All rights reserved. CA TO 03 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. TRAVELERS J� One Tower Square, Hartford, Connecticut 06183 BUSINESS AUTO/AUTO DEALERS/ POLICY NUMBER: H-810-5J507644-TCT-17 MOTOR CARRIER COVERAGE PART ISSUE DATE: 07-17-17 SUPPLEMENTARY SCHEDULE ITEM TWO COVERAGE AND LIMITS OF INSURANCE UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE The LIMIT OF INSURANCE for the coverages shown below is the LIMIT OF INSURANCE shown for the State where a covered "auto" is principally garaged. Refer to the specific coverage endorsement for description of the coverage provided for each State listed below. Coverage UNINSURED MOTORISTS LIMIT OF INSURANCE "Bodily Injury' and "Property Damage" "Bodily Injury" "Bodily Injury" "Property Damage" State Each "Accident" Each"Accident" Each Person Each "Accident" Each"Accident" AL $ 11000,000 CA $ 11000,000 GA $ 11000,000 MA $ 1,000,000 MI $ 11000,000 NH $ 1,000,000 $ 25,000 NC $ 11000,000 OH $ 1,000,000 RI See CA 21 43 UNDERINSURED MOTORISTS LIMIT OF INSURANCE (When not included in Uninsured Motorists Coverage) "Bodily Injury" and "Property Damage" "Bodily Injury" "Bodily Injury" "Property Damage" State Each "Accident" Each "Accident" Each Person Each"Accident" Each"Accident" OH $ 11000,000 CA TO 30 02 16 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. TABLE OF CONTENTS BUSINESS AUTO COVERAGE FORM SECTION I—COVERED AUTOS Beginning on Page Description Of Covered Auto Designation Symbols ...................................................................... 1 Owned Autos You Acquire After The Policy Begins ...................................................................... 2 Certain Trailers And Temporary Substitute Autos ......................................................................... 2 SECTION II—COVERED AUTOS LIABILITY COVERAGE Coverage ..................................................................................................................................... 2 WhoIs An Insured ........................................................................................................................ 2 Coverage Extensions SupplementaryPayments ...................................................................................................... 3 Outof State ........................................................................................................................... 3 Exclusions ..................................................................................................................................... 3 Limitof Insurance .......................................................................................................................... 5 SECTION III—PHYSICAL DAMAGE COVERAGE Coverage ...................................................................................................................................... 6 Exclusions ..................................................................................................................................... 7 Limitsof Insurance ........................................................................................................................ 7 Deductible ..................................................................................................................................... 8 SECTION IV—BUSINESS AUTO CONDITIONS Loss Conditions Appraisal For Physical Damage Loss .................................................................................... 8 Duties in the Event Of Accident, Claim, Suit or Loss ............................................................. 8 LegalAction Against Us ........................................................................................................ 8 Loss Payment—Physical Damage Coverage ........................................................................ 9 Transfer Of Rights Of Recovery Against Others To Us .......................................................... 9 General Conditions Bankruptcy ........................................................................................................................... 9 Concealment, Misrepresentation Or Fraud ............................................................................ 9 Liberalization ........................................................................................................................ 9 No Benefit To Bailee—Physical Damage Coverages ............................................................ 9 OtherInsurance .................................................................................................................... 9 PremiumAudit ...................................................................................................................... 9 Policy Period, Coverage Territory ....................................................................................... 10 Two Or More Coverage Forms Or Policies Issued By Us .................................................... 10 SECTION V—DEFINITIONS ............................................................................................................ 10 CA TO 31 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. ARCH ,r ; , INTERMEDIARIES CLAIMS MADE SEXUAL MISCONDUCT AND MOLESTATION INSURANCE Form: SML Safeguard Wording- 623AFB00213 Policy Number: TBA Renewal of: N/A Named Insured: City of Cupertino—Dept of Recreation&Community Services Principal Address: 10185 N Stelling Road, Cupertino, CA, 95014 Policy Period: From: 1St July 2018 To: 1St July 2019 Both dates at 12:01 a.m. Local Time at the Principal Address stated in Item 1. Limit of Liability: a) USD 5,000,000 for all Claims for Wrongful Acts against any one Victim b) USD 5,000,000 for all Claims for Wrongful Acts against all Victims, but sub-limited to: c) USD 50,000 for all Safeguard Costs resulting from all Circumstances Such Sub-limit of Liability shall be part of, and not in addition to,the overall Limit of Liability stated in 3.b) above. Retention: USD 35,000 any one Victim Premium: USD 27,000 to be paid within 25 days of attachment Notification pursuant to Clause IX. shall be given to: Claims Department Beazley 30 Batterson Park Road, Farmington, CT 06032. claims@_beazley.co (860) 677 3765 (phone) (860) 679 0247 (fax) Retroactive Date: 1"July 2018 Pending or Prior Litigation Date: 1St July 2018 Service of Suit: Eileen Ridley,FLWA Service Corp., c/o Foley&Lardner LLP, 555 California Street, Suite 1700, San Francisco, CA 94104-1520 Choice of Law: New York Conditions: Application Dated: TBA California Surplus Lines Notice 1-LMA9098A Small Additional or Return Premiums Clause(U.S.A.)—NMA 1168 Nuclear Incident Exclusion Clause-Liability-Direct—NMA 1256 Radioactive Contamination Exclusion Clause-Liability-NMA 1477 War and Terrorism Exclusion—NMA 2918 Sanctions Limits Clause-LMA 3100 Beazley Safeguard Education Document Arch Safeguard Enhancement Endorsement U.S Classification: Surplus Lines Broker and State filed in: TBA License Number: TBA Subject to: 1) Satisfactory re-signed and dated SML application within 30 days of inception 2) Confirmation of the Surplus Lines Broker.Including name of individual, company name, address and license number All subjectivities to be received within 7 working days of binding otherwise Underwriters reserve the right to amend terms or cancel ab initio. Brokerage: 22.5%or same net equivalent downwards,plus taxes as applicable Information: Employees—36 full time+250 part time+63 IC's Exposure Units—97,000 Nature of Business—Municipality Cancellation by an Insured may result in a short rate calculation to determine the return premium, subject to 5%minimum earned of the total premium. Underwriting Security: 100%Lloyd's(Infonnation about Lloyds)