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18-208 Starbird Consulting, Regnart Rd ImprovementsCITY OF m PROFESSIONAL/CONSULTING SERVICES AGREEMENT CUPERTINO 1. PARTIES This Agreement is made and entered into as of ~. l 3 1 2-,-0 16 ("Effective Date ") by and between the City of Cupertino, a municipal corporation ("City"), and Starbird Consulting LLC ("Contractor"), a California corporation, for Environmental Consulting service s related to Regnart Road Improvements. 2. SERVICES Contractor agrees to provide the services and perform 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, 2019 ("Contract Time"), unless terminated earlier as provided herein. Contractor's Services shall begin on the Effective Date and shal I be completed by December 31, 2019. 3.2 Schedule of Performance. Contractor must deliver the Services in accordance with the Schedule of Performance, attached and incorporated here Exhibit B. 3.3 Time is of the essence for the performance 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 performance of the Services an amount that will based on actual costs but that will be capped so as not to exceed $20,000.00 ("Contract Price"), based upon the scope of services in Exhibit A and the budget and rates included in Exhibit C, Compensation attached and incorporated here. The ma x imum 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 permitted 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 fu1ther payment or other obligations under the Agreement. C ity Proj ect Page I of 8 Professional!Cons11/ling Con /ra c /s !Ve rsion: May 22, 20 18 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee , partner , or J0111t 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. Contractor is not entitled to health benefits, worker's compensation or other benefits from the City. 5.2 Contractor's Qualifications. Contractor warrants on behalfof itself and its subcontractors that they have the qualifications and skills to perform the Services in a competent and professional manner and according to the highest standards and best practices in the indu stry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered , and/or certified 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 wi II apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools , materials and equipment required to perform the Services under 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 information owned or controlled by the City, which may contain proprietary or confidential details the disclosure of which to third parties may be damaging to City. Contractor shall hold in confidence all City information provided by City to Contractor and use it only to perform this Agreement. Contractor shall exercise the same standard of care to protect City information as a reasonably prudent 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 , report, map, plan , drawing , specification , data, record , document or other information or work, in any medium (collectively, "Work Product"), prepared by Contractor in connection with this Agreement will be the exclusive property of the City and shall not be shown to any third-party without prior written approval of City. 7.2 Copyright. To the extent permitted 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 prope11y of City . Alternatively, Contractor assigns to City all Work Product copyrights. Contractor may use copies of the Work Produ ct for promotion only with City 's written approval. City Proj ec t Pn ge 2 ol' 8 Pr of essio11a/!Cons11/tin g Contrnc t s !Ve rsion: May 22 . 20/8 7.3 Patents and Licenses. Contractor mu st pay royalties or license fees required for authorized use of any third pai1y intellectual property, including but not limited to patented, trademarked , or copyrighted intellectual property if incorporated into the Services 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 prepared 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 generally accepted accounting principles. The records must include detailed information of Contractor's performance , benchmarks and deliverables, which must be available to City for review and audit. The records and suppo11ing 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 unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. 10. PUBLICITY/ SIGNS Any publicity generated by Contractor for the project under this Agreement, during the term of this Agreement and for one year thereafter, will reference the City 's contributions in making the project possible . The words "City of Cupertino" will 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 this Contract, without prior written approval from the City. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law , and except for losses caused by the sole and active negligence or willful misconduct of City personnel , Contractor shall indemnify , defend and hold City Proj ec t Page 3 of8 Proj'essio11a/l C 011s11/1in g Conlracls !Ve rs io n : May 22, 20/8 harmless 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 indir ectly from this Agreement or in any manner relating to any of the following: (a) Breach of contract, obligations , representations or warranties; (b) Negligent or willful acts or omissions committed during performance 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) Unauthorized use or disclosure of City's confidential and proprietary 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 patty. 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 the Contract Price, workers' compensation payments, or the insurance or bond amounts required in the Agreement. Nothing in the Agreement shall be construed to give rise 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 arising 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 terminating the Agreement. 13. COMPLIANCE WITH LAWS 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 perform. Contractor is responsible for verifying the employment authorization of employees performing the Services , as required by the Immigration Reform and Control Act. C ity Proj ect Pa ge 4 of 8 Prof e ssio11a/!C ons11/ti11 g C ontrac ts !Ve rs ion : Mav 22, 20 /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 requir ed 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, reli gious creed, color, ancestry, national origin, ethnicity, handicap , disability , marital status , pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws , including Government Code Sections 12900 and 11135 , and Labor Code Sections 1735 , 1777 and 3077.5. Consistent with City policy prohibiting harassment and discrimination , Contractor understands that harassment and di sc rimination 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 oflnterest. Contractor shall comply with all conflict of intere st laws applicable to this Agreement and must avoid any conflict of interest . Contractor warrants that no public official, employee, or member of a City board or commission who mi ght 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 form if Contractor makes ce1iain 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 rem edies available under the law and this Agreement, including the right to seek indemnification under Section 11 of this Agreement. 14. PROJECT COORDINATION City Project Manager. The City assigns John Raaymakers as the City's representative for all purposes under this Agreement, with authority to oversee the progress and performance 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 Jodi Starbird as its single Representative for all purposes under this Agreement, with authority to oversee the progress and performance 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 Performance. Contractor mu st regularly update the City's Project Manager about the progress with the work or any delay s, 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 therefor at any time . Contractor will be compensated for satisfactory Services performed through the date of abandonment, and will be City Project Page 5 of 8 Projessional/Consu/ting C ontracts /Version: Mav 22 , 20/8 given reasonable time to asse mble 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 max imum often percent ( 10 %) of the total time expended to date in the performance of the Services. 16. TERMINATION City may terminate this Agreement for cause or without cause at any time . Contractor will be paid for satisfactory Services rendered through the date of termination, 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 gove rn ed by the laws of the State of California. Any law suit s filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California . Contractor mu st comply with the claims filing requirements und er the Government Code prior to filing a civil action in cou11. ff a dispute arises, Contractor mu st continue to provide the Services pending resolution of the 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 initiates legal action , files a complaint or cross-complaint, or pursues ar bitration , appeal , or other proceedin gs to enforce its rights or a jud gment in connection with this Agreement , the prevailing party will be entitled to reasonable at torney fees and costs. 19. THIRD PARTY BENEFICIARIES There are no int ended third paity beneficiaries of this Agreement. 20. WAIVER Neither acceptance of the Services nor payment thereof shall constitute a waiver of any contract provision. City's waiver ofa breach shall not constitute waiver of another provision or bre ach. 21. ENTIRE AGREEMENT This Agreement represent s the full and complete understanding of every kind or nature between the Paities , and supersedes any other agreement(s) and understandin g(s), either oral or written , between the Parties. Any modification of this Agreement will be effective o nl y if in writing and signed by each Party 's a uthorized representative. No verbal agreement or implied covenant will be valid to amend or abridge this Agreement. If there is any inconsist ency between the main Agreement and the attachments or exhibits thereto, the text of the main Agreement shall prevail. City Proj ec t Page 6 of8 Professional/Consulting Co111ra cts !Ve rs ion: May 22, 20 18 22. INSERTED PROVISIONS Each provision and clause required by law for this Agreement is deemed to be included and will be inferred her ein. Either party may request an amendment to cure mistak e n inse1iions or omissions of required provisions. The Parties will collaborate to implement this Section , as appropriate. 23. HEADINGS The headings in this Agreement are for convenience only, are not a pati of the Agreement and in no way affect , limit or amplify the terms or provision s of this Agreement. 24. SE VERABILITY /PARTIAL INVALIDITY If any term or provision of this Agreement , or their application to a particular situation , is found by the couti 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 terms and provisions of this Agreement or their application to specific situations shall remain in full force and effect. The Patiies agree to work in good faith to amend this Agreement to carry out its intent. 25. SURVIVAL All provisions which by their nature must continue after the Agreement expires or is terminated, including the Indemnification , Ownership of Materials/Work Product , Record s, 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 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 Cupe1iino 10300 Torre A ve., Cupertino C A 95014 Attention: John Raaymakers Email: johnr@c up ertino.org 27. VALIDITY OF CONTRACT To Contractor: Starbird Consulting LLC 115 S. 14th Street San Jose, CA 95112 Attention: Jodi Starbird Email: jodi@jodistarbird.com 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 de signee , and (c) is a pproved for form by the City Attorney's Office. C ity Proj ec t Page 7 of 8 Pr ofess io11al!Cons11/ti11 g Comrac ts /Ve rs io n: May 22, 20/8 28. EXECUTION The person execut ing this Agreement on behalf of Contractor represents and warrants that Contractor has full ri g ht , power, and authority to enter into and carry out all actions contemplated by this Agreement and that he or she is authorized to execute this Agreement, which constitutes a legally binding obligation of Contracto r. This Agreement may be executed in counterpa11s, each one of which is deemed an original and al I of which, taken together, constitute a single binding instrument. IN WITNESS WHEREOF, the patties have caused the Agreement to be executed. Tax ID. No.: 82-./6./9457 Cupetiino Acting City Attorney ATTEST: ) j &~&11-- GRACE SCHMIDT v City Clerk /'D, f 0' f 0 City Project CITY OF CUPERTINO A Municipal Corporation Title"3::>1c~ a.f: Pub L c: Uo4.8 Date --$/z.-~-F--1-/;1-=----- Page 8 of' 8 Professio11al,IC0 11 s11/1i11g Co 111mcts /l'ersion: MaF 22. 2018 Exhibit A Scope of Services CONSULT ANT s h all perform professional services as detailed in the following sec tion s. SECTION 1. GENERAL A. Scope of Work: The work to be p erforme d under this agreement includes determining the Ordinary High Water Mark (OHWM), riparian extent, and possible special status species within portions of Regnart Creek designate d for repairs. B. General Performance Requirements: 1. The performance of all services by CONSUL TANT shall be to the satisfaction of the CITY, in accordance with the e xpress terms hereof, including but not limited to the terms set out in detail in this scope of services and the standard of care provisions contained in this AGREEMENT. 2. The CITY's Department of Public Works shall manage the AGREEMENT . CONSULTANT shall receive final direction from the CITY 's Director of Public Works or his/her authorized designee (hereinafter collectively "CITY") only. The CITY shall resolve any conflicting direction from other groups, d epar tments or agencies. 3. CONSULTANT shall coordinate this scope of services with the CITY as well as with other CITY consultants and contractors, as needed or as direc t e d by the CITY. 4. CONSULTANT's services shall be performed as expeditiously as is consistent with professional skill and care and the orderly process of the work. The schedule for the performance included in EXHIBIT B, may be adjusted by muh1al agreement. Task 1.0 Site Assessment, Mapping, and Verbal Report of Findings 1.01 Site Analysis: Review aerial imagery and topographic maps to inform an ana lysis of the extent of US Army Corps of Engineers (USACE), Regional Water Quality Control Board (RWQCB), and California Department of Fish and Wildlife (CDFW) jurisdictional control. 1.02 Mapping: Map the Ordinary High Water Mark (OHWM), Top of Bank (TOB), and outer extent of riparian vegetation in the field. Starbird Cons ultin g LLC Regnart Road Preliminary Env ir o nm ental Assessment Exhi bit A, B & C I of 5 1.03 Verbal Report: Consultant to arrange and participate in one conference call with the City, Consultant, and any involved Sub-consultants to discuss the results of the site visit and map . Deliverables: 1.02 Map as described above 1.03 Verbal Report via conference call Task 2.0 Report 2.01 Draft Letter Report: Prepare a draft letter report that describes the methods and results of the site assessment. The report is to review the basis for determining the regulatory agencies' jurisdictions and will provide a high level overview of how the limits of jurisdiction and project impacts influence the cost and schedule for obtaining any permits that may be required for potential project improvements. The report will a lso include identification of special status wildlife and plant species, if any, that may be present in the project reach. 2.02 Final Letter Report: Finalize the Letter Report incorporating comments from. the City and internal Consultant reviewers. Deliverables: 2.01 Draft Letter Repo rt 2.02 Final Letter Report Task 3.0: Project Management Consultant shall provide sub-consultant management as well as overall coordination of the tasks required by this agreement Task 4.0: Additional Services Consultant services not specifically identified in the Scope of Services shall be considered Additional Services . At the City's request, the Consultant shall provide a fee proposal for specific additional services consistent with the professional rate schedule in Exhibit C. ADDITIONAL SERVICES Consultant Services beyond the work in these tasks may be provided by CONSULT ANT as Additional Services only if such Additional Services are authorized in writing by the CITY in advance. An Additional Services amount of $1,441.25 is made a part of this agreement. Additional services may be paid for as a negotiated maximum not to e xceed amount or by a time and materials cost accounting with a maximum not to exceed . Starbi rd Consu lting LLC Regnart Road Preli111inar y Environ111ental A ss essment Exhibit A, B & C 2 o f 5 EXHIBITB SCHEDULE OF PERFORMANCE This Schedule of Performance establishes the milestones for commencen1ent a nd completion of the Tasks for Basic Services as specified in Ex hibit A, Scope of Services . TASK # TASK DESCRIPTION Task #1: Site Assessment, Mapping, Verbal Report Task#2 Letter Report Task #3: Project Management Task #4: Additional Services Sta rbird Consulting LLC Regnart Road Preliminary Enviro nm enta l Assessment DURATION 2 weeks after Notice to Proceed (NTP) for this Task 2 weeks after completion of Task 1 Ongoing throughout agreement term As agreed on Exh ibit A, B & C 3 of 5 EXHIBIT C COMPENSATION Capitalized terms which are defined in the Agreement have the same meaning in this Exhibit C. This Exhibit Con Compensation supplements the provisions of Section 4 of the Agreement on Compensation, as further specified in Section 4. 1. BASIC SERVICES BUDGET SCHEDULE The following budget schedule will be u sed to determine monthly compensation for Basic Services based on the degree of completion, subject to confirmation and agreement by the City, and budget for each listed Task: TASK# TASK DESCRIPTION TASK BUDGET 1 Site Assessment, M a pping, Verbal Report 6,296.25 2 Letter Report 7,762.50 3 Project Management 4,500.00 Total for Basic Services: $18,558.75 Consultant may not bill in excess of the Task Budget arnount for any Task without prior written authorization from the City. The City has the discretion, but not the obligation, to reallocate the budgeted an10unts for each Task, subject to the not to exceed limit specified in Section 4. 2. HOURLY COMPENSATION FOR ADDITIONAL SERVICES A. Hourly Rate Schedule. The City will compensate the Consultant for satisfactory performance of duly authorized Additional Services which are subject to hourly billing, based on the hourly rate(s) set forth below, but subject to the compensation limits in Section 4 of the Agreement. The hourly ra tes are deemed to include all costs including, salary, wages, benefits, taxes, insurance, and the like paid to or on behalf of each individual providing the Services, and are also d eemed to include profit, overhead, vehicle, equipment and supply costs and the like. The hourly rates do not include Reimbursable Expenses, which are addressed below and in Section 4 of the Agreement. These hourly rates will remain in effect for the Term of the Agreement unless changed by written amendment to the Agreen1ent. Starbird Consulting LL C Regnart Road Preliminary Environmental Assessment Ex hibit A, B & C 4 of 5 Consultant Hourl y Rates Prin cip a l $ 22 5.00 p e r h o ur END OF EXHIBITS Starbi rd Co nsul ting LLC Reg nart Road Pre limin ary Env iro nm e nt al Assess me nt Ex hi bit A , 8 & C 5 of 5 EXHIBITD Insurance Requirements Design Professionals & Consultants Contracts Consultant shall procure prior to commencement of Services and maintain for the duration of th e contract , at its own cost and ex pense , the following in surance policies and coverage with companie s doin g bu sine ss in California and acceptable to City. INSURANCE POLICIES AND MINIMUMS REQUIRED ./1. Commercial General Liability (CGL) for bodily injury , property damage, personal injury liability for premises operations , products and completed operations , contractual I iabi I it y, and per sonal 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 occurrence lirnit. \ • \~ a. It shall be a requirement that any available insurance proceeds broader than or in excess of the ~ specified rninimurn insurance coverage requirernents and /or lirnits shall be rnad e available to the ~lfa' Additional Insured and shall be (i) the minimum coverage /limits specified in this agreem e nt ; or (ii) the broader coverage and maximum I imits of coverage of any insurance pol icy , whichever is greater. ~ Additional Insured coverage under Consultant's policy shall be "primary and non-contributory ," ~I 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 rnay be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirernents set forth in this Contract. Any urnbrella or excess insurance shall contain or be endorsed to contain a provi s ion that such coverage shall also apply on a prirnary 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 , a I l~~ • autos) with limits no less than $1,000,000 per accident for bodily injury and property damage. Qr '-'ll l\.. ~l).1:~~ rkers' Co111pe11satio11: As required by the State of California, with Statutory Lirnits and \i U-, E1nployer 's Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease. (.)-'i/Z Not required. Consultant has provided writte n verification of no employees . ~ 4. Professional Liability for professional acts, errors and 01111ss1ons, as appropriate to Consultant 's profession, with limits no less than $2,000,000 per occurrence or $2,000,000 aggreg ate. If written on a claims rnade 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 form with a Ret-rnactive Date prior to the Contract Effective Date , the Consultant must purchase "extended reporti ~" 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 provision s: Exh. D-/nsurance Requirem ents for D esign Professionals & C on s ultants Co ntrncts Form Updated Feb. 2018 1 Additional Insured Status The Ci ty ofCupe1iino, its City Council, officers, officials, emplo yees, age nts , se rva nt s and vo lunt eers ("Addit iona l In sur eds") are to be covered as addi tional in s ur eds on Consultant's CGL polic y. Genera l Liability coverage ca n be provided in the form of an endo rsement to Consultant 's in s ur a nce (at least as broad as ISO For m CG 20 IO (11 / 85) or both CG 20 10 and CG 20 37 forms, if late r ed itio ns are use d). Primru y Coverage Coverage affo rd ed to C it y/Add ition a l In sureds shall be prim ary insurance. Any in s ura nce or se lf-in surance maintained by C it y, its officers, officials, emplo yees, or volunteers shall be excess of Co nsult ant's insurance and sha ll not contribute to it. Notice of Cancellation Eac h insurance policy s ha ll state that coverage shall not be canceled or allo we d to ex pir e, except wit h wr itt en notice to City 30 days in adv ance or 10 days in advance if due to non -pa ym ent of premiums. Waiver of Subrogation Consultant waives any ri ght to subrogation aga in st C it y/Addit ion a l In sur eds for recovery of damages to the \ \:x. ex tent sa id lo sses are cove red by the in surance policies required he rei n. Specifically, the Work ers' ~, Compensation policy shall be endorsed with a wa iv er of s ubro gat ion in favor of City for a ll wo rk performed by Consultant, it s employees, agents a nd sub co nsult ant s. This provi sio n applies rega rdl ess of whet her or not the City has rec eiv ed a waiver of subrogation endor se ment from the insur er. Deductibles and S elf-Insured Retentions Any ded uctibl e or se lf-in sured retention mu st be declared to a nd approv ed by the Cit y. At C it y's optio n, eit her : th e in s ur er mu st red uce or eliminat e th e deductible or self-insured rete ntion s as respects the Cit y/ Additional In sur eds; or Consultant must show proof of ab i I it y to p ay losses and costs related investigations, claim administration and d efense expe nses. The pol icy sha ll provide , or be e nd orsed to provide, that the se lf-in sur ed ret ention ma y be satisfied by either the in sur ed or the C it y. Acceptability of Insurers In sur ers must be licensed to do busin ess in California with an A.M. Best Rating of A-VII , orbetter. Verification of Coverage Co nsult an t mu st furnish acce ptab le in suranc e ce1tificates and mand atory e nd orse m ents ( or copies of the policies effect in g the coverage requir ed by this Contrac t), and a copy of the D ec laration s and Endorseme nt Page of the CGL pol icy I ist in g a ll policy endorsements prior to co mm ence ment of th e Contract. City retai ns the right to demand ve rifi cat ion of co mplian ce at any time durin gt he Co nt ract term. Subconsultants Consultant shall requ ir e and verify that all s ub co nsu lt ants maintai n insurance that m eet the requirements of this Contract, includin g naming the City as an addition al in sured on subconsultant's in sur ance policies. Higher Insurance Limits If Consultant mai ntains bro ade r coverage and/or hi gher limit s th an the minim urns show n above , C it y shall be ent itl ed to coverage for the hi gher insurance limit s maintained byConsultant. Adequacy of Coverage City reserves the ri ght to modify these in sur ance requirements/coverage based on the nature of the ri sk, prior experie nce, insurer or other spec ia l ci r cum sta nces, wit h not less than nin ety (90) da ys prior wr itt en not ice . Exh. D-!n surance Requirements/or Des ign Professionals & Consu lt an ls Co ntrnc ts Form Updated Feb. 2018 2 ACORD@ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM /00/YYYY) '--"' 08/23/2018 THIS CERTIFICATE IS ISS UED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATIVE OR PRODUCER , AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder i s an ADDITIONAL INSURED, the policy{ies) must b e endorsed . If SUBROGATION IS WAIVED , subj ect to th e terms and conditions of the policy, certain policies may requi re an endorsement. A statement on this certificate doe s not confer rights to the certi ficate holder in lieu of such endorsement(s). PRODUCER CONTACT NAM E: Hi scox Inc . d/b/a/ Hi scox In su r ance A ge ncy in CA J it)g Nin Extl : (888 ) 202-3007 f ;t~ No l: 52 0 M adi s on Ave nu e E-MAIL co ntact @ hi scox.co m ADDRESS : 32nd Fl oor INSURE R(S) AFFO RD ING COV ER AGE NAIC# New Yor k , N Y 10022 IN SURER A : Hisco x In surance Co m pany Inc 10200 INSU RED INSURER B : Starbird Co ns ultin g , LLC . INSURER C : 11 5S 14th St INSURERD : INSURER E : San Jose CA 95112 INSURER F: COVERAGES CERTIFICATE NUMBER : REVISION NUMBER: TH IS IS TO CERT IFY TH AT THE POLI CIE S OF INS URANC E LISTED BEL OW HAVE BEE N ISSUED TO THE IN SUR ED NAME D ABOVE FOR TH E PO LI CY PER IOD IND ICATED . NO TW ITHSTAND IN G A NY REQUIR EMENT , TERM OR CONDITI ON OF ANY CON TRAC T OR OTHE R DOCUM ENT WIT H RESPECT TO W HIC H T H IS CE RTI FI CATE MAY BE ISSUED OR MAY PERT AIN , THE INSU RA NCE AFFO RDED BY TH E PO LICIE S DE SC RIBED HEREIN IS SU BJE CT TO ALL THE T ERMS, EXC LU SIONS AND COND ITI ONS OF SU CH POLIC IES. LIMITS SH OW N MAY HAV E BEEN REDU CED BY PAID CLA IM S. INSR ADDL SUBR POLI CY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVD PO LI C Y NUMBE R fMM/DO /Y YYY l fMM/D D/YY YYl LIMITS X COMMERCIAL GENERAL LIA BILITY EA CH OCCURR ENCE $ 2,000 ,000 ~-D CLAIMS-MA DE [X] OCC UR DAMA GE TO RE NTED PREM IS ES fEa occ urr ence) $ 100 ,000 MED EXP (An y one person) $ 5,000 ~ / A UDC-2 345 4 95-CG L-1 8 08/23/201 8 08/23/20 19\ PER SONA L & ADV INJ URY $ 2 ,000 ,000 >-- GEN 'L AGGRE GATE LI MIT APP LI ES PER : GENERA L AGG RE GATE $ 2,000 ,000 ~ D PRO-D LOC PRODU CTS· COMP/OP AG G $ SI T Ge n . Agg. POLICY JECT OTH ER: $ ~ AUTO MOBILE LI A BILITY COMBI NED SINGL E LI MIT $ ~ -fEa accide ntl ANY AUTO 13 0 DIL Y INJURY (P er person) $ ~)/' Cf"'-.,rl -ALL OWNED -SC HED ULED .,...' \ BO DIL Y IN JURY (Per acc iden l ) $ -AUT OS ~ AUTOS V' NON -OWNED I I PR OPERTY DAMAG E $ \V \Y I HIRED AUTOS AUTOS (Per accident) --I tr':' 11X" $ '" ---·-·--·--I I .. UMBRELLA LIAB H OCC UR EA CH OCC URRENCE $ r ,: -I I v"'"" . / EXCESS LIAB CL AIMS-MADE AGG RE GATE $ OED I I RETEN TION $ I I $ ~X WOR KERS COMPENSATION 1 mTUTE 1 I OTH-ER AND EMPLOYERS ' LIABILITY Y I N ANYPROPRIETOR/PAR TNER/EXECUTIVE D N /A OFFICER/MEMBER EXCLUDED ? I E.L. EACH AC CID ENT $ -'0,fy(" I (r \ p (Ma ndatory In NH ) E.L. DI SEASE · EA EMP LOYEE $ (y~ If yes , desc ribe und er DE SCRIP TION OF OPERATION S below E.L. DISEASE · POLICY LI MIT $ ~If , 08 /23/201 , 08/23/201 91 I/E ach Cla im : $1 ,000 ,000 \ t \ A Professional Liability UDC-2345495-E0-1 8 ---~ty . Agg rega t e : $1,000 ,000 ,n ~() D DESC RIPTION OF OP ERA TIONS / LOC ATIONS / VEH ICLES (ACOR D 101, Addition al Remar ks Schedu le, may be att ac hud if more space Is requ ired) vv THE CITY OF CUPERTINO, ITS CITY COUNCIL, OFFICERS , OFFICIALS, EMPLOYEES, AGENTS , SERVANTS v AND VOLUNTEERS ("A DDITION AL INSUREDS") ARE LISTED AS AD DITI ONAL INSUREDS ON CGL POLICY . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WIL L BE DELIVERED IN ACCORDANCE WITH THE POLIC Y PROVISIONS. 10300 Torre Ave Cupertino CA 95014 AUTHORI ZE D REPRESENT ATIVE P1 ' 1;) I ~£.U~L-L-J Yj 7- © 1988-2014 ACORD CORPORATION. All rights reserved . ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Renewal auto policy declarations Your policy effective date is October 1, 2018 Total Amount Due for the Policy Period Please review your insured vehicles and verify their VINs are correct. Pa ge 1 of4 Information as of August 9, 2018 Summary _V_e_h1~·c~le~s~c~ov_e_r~ed~ ________ l_d_en_t~if~ic_a~t~io_n_N~u_m_b~e~r~<~V_IN~>~--~P_r~e~m_iu~m Named Insured (s) 2018 BMW Xl WBXHT3C31JSF92004 $646.45 Sterling A Starbird & Jodi L Starbird ------------------------------ 2014 Audi AS Quattro WAURF AFR4EA056250 403.72 Mailing address California Fraud Assessment Fee 1.76 115 So Fourteenth St ~::~~d ..... , ........ ""'--................................ @ ........ , ... / -· ... ,, .. w ... , .................. ""' . .....J;l'ow· '.w«•""""''"---$-"~"'-' ... °,_s_1_._9 ..... 3 J ::~:o~:~:e:5112-2129 * Your bill will be mailed separately. Before making a payment, please refer to your latest bill, which includes payment options and installment fee information. If you do not pay in full, you will be charged an installment fee(s). See the Important payment and coverage information section for details about installment fees. Discounts (included in your total premium) Anti-theft $2.86 Good Driver (20%) $244.83 Multiple Policy $50.25 Distinguished $201.62 Driver Total discounts Discounts per vehicle (2018 BMWX1 Anti-theft Multiple Policy $1.70 $29.80 Good Driver (20%) $143.91 Distinguished $119.85 Driver $499.56 $295.26) 934 927 398 Your policy provid ed by Allstate Northbrook Indemnity Company Policy period Beginning October 1, 2018 through April 1, 2019 at 12:01 a.m. standard time Your Allstate agency is Lozon Ins Agency 1341 Lincoln Ave. San Jose CA 95125 (408) 292-0555 johnlozon @allstate.com Some or all of the information on your Policy Declarations is used in the rating of your policy or it could affect your eligibility for certain coverages. Please notify us immediately if you believe that any information on your Policy Declarations is incorrect. We will make ( 2014 Audi AS Quattro $204.30) corrections once you have notified us, ~G_o_o_d _D_r_i v-e-r -(2-0~0~Yo_) _$_1_0_0_. 9_2 ______ M_u_l-ti-p-le_P_o_l_i c-y----,-$-2 0-.4-5-~---and any resulting rate adjustments, will Distinguished $81.77 Anti-theft $1.16 be made only for the current policy Driver period or for future policy periods. Listed drivers on your policy Sterling Starbird Jodi Starbird Excluded drivers from your policy None Please also notify us immediately if you believe any coverages are not listed or are inaccurately listed. Renewal auto policy decla~ra_t_io_n_s __ ~ Poli cy number: 1934 927 398 I Policy effe cti ve date : October 1, 2018 Coverage detail for 2018 BMW X1 Coverage Automobile Liability Insurance 9 Bo dily Injury @) Property Dama g e G Auto Collision Insurance Waiver of deductible applies f;f~ Auto Comprehensive Insurance (® Rental Reimbursement ~ Towing and Labor Costs Uninsured Motorists Insurance for Bodily Injury t~ Automobile Medical Payments Coordinated M edical Protection Lease/Loan Gap Repair o r Repla c ement Cost Option $ Sound System Tape [Total premium for 2018 BMW X1 Limits $500,000 each person $500,000 each occurr ence $500,000 each occurr ence Actual cash value Actual cash value Not purchased* Not purchased * $500,000 each person $500,000 each accid ent $5,000 ea c h person Not purchased* Not purchased* Not purchased* Not purchased* Not purchased* * This coverage can provide you with valuable protection. To help you stay current with your insurance needs, contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN WBXHT3C31JSF92004 Rating information Pa ge 2 of 4 Deductible Premium Not appli cable $276.8 2 $1 ,000 $249 .82 $1,000 $32.3 6 Not applicabl e $70.84 Not applicable $16.61 $646.45) Your premium is determined bas ed on ce rtain information, includin g th e following: • This vehicle is driven for pl easur e, married f emal e licen sed 41 y e ars. Allstate uses mileage information as one factor to help determine your premium amount. The estimated number of miles that this vehicle is driven annually is 10,000-10,499. Important Note: The estimated annual mileage figure applicable to this vehicle for the expiring policy period was: 10,000 - 10,499. The estimated annual mileage figure applicable to this vehicle for the current policy period is: 10,000 -10,499. If any of the information shown above is incorrect, missing or changes in the future, please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. 0 CD "" 0 5 <{ u 00 "' M U1 U1 0 r-- 0 0 q 0 0 "' 00 "' r-- 0 0 [,i 5 N 0 "' 0 00 0 00 5 0 0 <{ \..! N X 00 q 00 0 ~ 0 0 0 0 g Thank you for choosing Allstate ~A IS'at You 're in good hand s Proof of Insurance Card Page 1 of 2 For your convenience, two insurance cards have been includ ed for each vehicle. State law requires that one of these cards be kept in each vehicle. Please place them in yo ur vehicles by the effective date. You 're in good hand$ Please use the printed Insurance Cards below. AUstate. You 'n=; in gor.:d h;:,nd5. Please use the printed Insurance Cards below. Allstate Northbrook Indemnity Company PO Box 660598, Dallas, TX 75266-0598 Sterling A St arbird & Jodi L Starbird 115 So Fourteenth St San Jose CA 95112·2129 Ycu're in good h;:,nds. NAIC# 36455 This policy meets the requirements of the appl icable Californ ia financial responsibility law(s). POLICY NUMBER 934 927 398 EFFECTIVE DATE 10/01/18 EXP IR AT ION DATE 04/01/19 YEAR/ MAKE/ MODEL 2014 Audi AS Quattro VEHICLE ID NUMBER WAURFAFR4EA056250 This card must be carried in the vehicle at all times as evidence of insurance. Allstate Nort hbro ok Ind em nity Company PO Box 660598 , Dallas, TX 75266-0598 Sterling A Starbird & Jodi L Starbird 115 So Fourteenth St San Jose CA 95112·2129 NAIC# 36455 Th is polic y meets the requirements of the appli cab le California financial resp onsib il ity la w(s). POLICY NUMBER 934 927 398 EFFECTIVE DATE 10/01/18 EXPIRATION DATE 04/01/19 YEAR/ MAKE/ MODEL 2018BMWX1 VEHICLE ID NUMBER WBXHT3C31J5F92004 This cord must be carried in the vehicle at all times as evidence of insurance. Please use the printed Insurance Cards below . Pleas e us e the printed Insurance Cards below. California Proof of Auto Insurance Card Allstate Northbrook Ind emnity Company PO Box 660598, Dallas, TX 75266-0598 Sterling A Starbird & Jodi L Starbird 115 So Fourteenth St San Jose CA 95112·2129 NAIC# 36455 This polic y meets the requirements of the applicable California financial responsibility la w(s). POLICY NUMBER 934 927398 EFFECTI VE DATE 10/01/18 EXPIRATION DATE 04/01/19 YEAR/ MAKE / MODEL 2014 Audi AS Quattro VEHICLE ID NUMBER WAURFAFR4EA056250 This card must be carried in the vehicle at all times as evidence of insurance. California Proof of Auto Insurance Card Allstate Northbrook Indemnity Company PO Box 660598, Dallas, TX 75266-059 8 Sterling A Starbird & Jodi L Starbird 115 So Fourteenth St San Jose CA 95112·2129 AHstate NAIC# 36455 This policy me ets the req uir ements of the applicable Ca lifo rnia finan cial responsibility law(s). POLICY NUMBER 934 927 398 EFFECTIVE DATE 10/01/18 EXPIR AT ION DATE 04/01/19 YEAR/ MAKE / MODEL 2018BMWX1 VEHICLE ID NUMBER 1NBXHT3C31J5F92004 This card must be carried in the vehicle at all times as evidence of insurance . <( u 0 Important notices Po Ii cy number: ~I 9_3_4_9_2_7_4_2_4~1 Policy effective date: April 1, 2018 POLICY PROVISIONS: Rates, Policy Forms and Payment of Premiums: Applicable only with respect to policies issued on a continuous basis . 1. The rates and policy forms in effect for the company upon the inception date of the insurance evidenced hereby, and upon each successive anniversary date, shall apply. 2. The phrase "Policy Period" as used in the policy shall be deemed to mean that period of time while the applicable coverage of the policy is in force. 3. The named insured shall pay the required premium in advance of each successive premium period, and upon notice of interim amendments . IMPORTANT NOTICE CONCERNING THE INSURANCE YOU MUST MAINTAIN (Not a part of the Policy) Please read the following provisions of the policy carefully: (1) Required Underlying Insurance It establishes the types of insurance and the limits you must maintain. If, during the policy period, additional liability exposures exist, check the list of Required Underlying Insurance on the policy declarations and secure any needed underlying coverage and limits. In the event that you fail to maintain the Required Underlying Insurance you may be required to personally incur or expend substantial sums of money for your legal defense and for payment of damages, and with respect to which Allstate has no obligation to pay or provide reimbursement to you. (2) Retained Limits It identifies the amount of any damages an Insured must pay for any occurrence. (3) In the event that additional exposures are acquired after the issuance of this policy, please notify Allstate of the additional exposure as soon as practicable. None of the terms and conditions of the policy are modified by this Important Notice. XC3621 Page1ofl st l'- N M N D M D D M D D "' M M D D V1 ~ M D °' D "' D co 5 D D <( u D 5 l'- 1'-°' °' D D st st st D "-D M 0 M V1 CO V1 D co°' D oDo 0 c3 0 ~ 00 D 0 r-:= Amended Personal Umbrella Policy Declarations Your policy effective date is April 1, 2018 ~ ---Hstate,, You're in good hand,,. Page 1 of 3 Total Premium for the Premium Period (Your bill will be mailed separately) Information as of June 8, 2 018 Excess Liability $458.71 Summary (~.!!!ri!S.!lEI., u , Hfo¥1 ,,,, sc1tH ·Z.:,..:.U.ii!ciliiliiL"li<h ,.i,<\»"-'iiii'llP,d , siir 11A\iiii™™~ -~-t:-~-1~-:-g-l:-~-~-r~-:-~-~-~-ta_r_b_i-rd------ Your bill will be mailed separately. Before making a payment, please refer to your latest bill, which includes payment options and installment fee information. If you do not pay in full, you will be charged an installment fee(s). See the Important Payment and Coverage Information section for details about installment fees. Your policy premium has been developed using the following information: • 2 Vehicles • Supporting Allstate Home and/or Auto Policy(ies) • 2 Operators in the household Premium includes a charge for 2 automobiles Discount <included in your total premium) Multiple Policy Discount - Auto and Property 33% Policy Coverages and Limits of Liability Coverages Excess Liability -Bodily Injury and Property Damage Annual Aggregate Limit Excess Liability -Personal Injury Annual Aggregate Limit Additional Dwelling Rented To Others Limits of Liability $2,,000,000 each occurrence $4,000,000 during the current policy period · $500,000 each occurrence $1,000,000 during the current policy period Not purchased* * This coverage can provide you with valuable protection. To help you stay current with your insurance needs, contact your agent to discuss available coverage options and other products and services that can help protect you. Mailing address 115 So Fourteenth St San Jose CA 95112-2129 Polic number 934 927 424 Your policy provided by Allstate Insurance Company Policy period Begins on April 1, 2018 Ends on April 1, 2019 Premium period Beginning April 1, 2018 through April 1, 2019 at 12:01 a.m. Pacific Time Your policy change is effective June 7, 2018 Your Allstate agency is Lozon Ins Agency 1341 Lincoln Ave. · San Jose CA 95125 (408) 292-0555 john lozon @allstate.com Some or all of the information on your Policy Declarations is used in the rating of your policy or it could affect your eligibility for certain coverages. Please notify us immediately if you believe that any information on your Policy Declarations is incorrect. We will make corrections once you have notified us, and any resulting rate adjustments, will be made only for the current policy period or for future policy periods. Please also notify us immediately if you believe any coverages are not listed or are inaccurately listed. 0 :?' <{ 00 00 0 <{ u Amended Personal Umbrella Polic Declarations Page 2 of 3 Policy number: 934 927 424 Policy effective date: April 1, 2018 Required Underlying Insurance Limits You must maintain the Required Underlying Insurance, at or above the limits as shown below at all times for each liability exposure any insured person has. Please refer to the "Required Underlying Insurance" provision of the policy. Coverage Required Underlying Limit Personal Liability -Bodily Injury and Property Combined Single Limit Damage Liability 1. Homeowners, Condominium, Renters, Mobilehome, Manufactured Home or other Personal Liability Policy 2. Incidental Office, Private School or Studio One, Two , Three or Four Family Residential Rental Property -Bodily Injury and Property Damage Liabilit Automobiles and Motor Homes Motorcycles, Motor Scooters, Mopeds and Recreational Vehicles Personal Watercraft such as jet skis and wet bikes Watercraft Liability Craft under 26 feet and up to 50 horsepower (U .S. horsepower) Watercraft Liability Craft 26 feet and over or greater than 50 horsepower (U .S. horsepower) $300,000 per occurrence $300,000 per occurrence Bodily Injury $250,000 each person $500,000 each occurrence Property Dama g e $100,000 each occurrence or Combined Single Limit $500,000 per occurrence Bodily Injury $100,000 each person including Passenger Liability when available $300,000 each occurrence Property Dama g e $100,000 each occurrence or Combined Single Limit $300,000 per occurrence Guest Passenger Liability $100 ,000 each person (when available as a separate limit) $300,000 each occurrence or Combined Single Limit $300,000 per occurrence Bodily Injury $100,000 each person $300,000 each occurrence Property Dama g e $100 ,000 each occurrence or Combined Single Limit $100 ,000 per occurrence Bodily Injury $100,000 each person $300,000 each occurrence Property Damage $100,000 each occurrence or Combined Sin g le Limit $100,000 per occurrence Bodily Injury $250,000 each person $500,000 each occurrence Property Dama g e $100 ,000 each occurrence or Combin ed Single Limit $250,000 per occurrence (continued) 0 ~ <( 00 00 0 <( u " r-- N M N 0 M 0 0 N 0 0 '° M ;;; 0 ~ :.: ;;; 0 "' 0 '° 0 00 5 0 0 <( u 0 5 r--r--"' "'0 0" " " 0 I'--0 M 0 M V1 00 V1 0 00"' 0 oOo a~O ~ 00 0 0 r-:= Amended Personal Umbrella Polic Declarations Policy number : 934 927 424 Policy effective date : April 1, 2018 Coverage Employers' Liability -if Workers' Compensation or similar covera ge for Domestic Workers is required or purchased voluntarily Your policy documents Page 3 of 3 ~ '.S~ ~c·· ~~t "'.~ ~~» u /JI ' You're in good hands Required Underlying Limit $300,000 each occurr ence $300,000 each employee $500 ,000 policy aggregate Your Personal Umbrella policy consists of the Policy Declarations and the following documents. Please keep them together. • Personal Umbrella Policy -AS463 • California Personal Umbrella Policy Amendatory Endorsement -AS378-1 Important payment and coverage information Here is some additional, helpful information related to your co verage and payin g your bill: ~ Please note: This is not a request for payment. Any adjustments to your premium will be reflected on your next scheduled bill which will be mailed separately. In the meantime, if you have any outstanding or unpaid bills, please pay at least the minimum amount due to assure your policy continues in force . If you have any questions, please contact your agent. ~ If you decide to pay your premium in installments, there will be a $3.50 installment fee charge for each payment due. If you make 6 installment payments during the policy period, and do not change your payment plan method, then the total amount of installment fees during the policy period will be $21.00. If y ou are on the Allstate ® Easy Pa y Plan , there will be a $1.00 installment fee charge for each payment due . If you make 6 installment payments during the policy period, and remain on the Allstate ® Easy Pay Plan, then th e total amount of installment fees during the policy period will be $6.00. If you change payment plan methods or make additional payments, your installment fee charge for each payment due and the total amount of installment fees during the policy period may change or even increase. Please note that the Allstate® Easy Pay Plan allows you to have your insurance payments automat i cally deducted from your checking or savings account. Allstate Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. Thomas J. Wilson President Susan L. Lees Secretary 0 ::;; <( co co 0 <( u Slate of Cnl1forrri11 County of Snntn Clnrn . City t'.f Cup ertino Contractor/Consultant Affidavit of No Employees I, the und ersigned, declare as follows: ~-b rl · ·, \.Cc · ": LI I+; n ct L. L-C... I an, an independent contractor and the ovvner of ,......./ t-\.: · ::>~_( C\ / V) '·-7 · 1 ..::.J I vvish to enter into c1 services contract with the City of Cupertino. J an1 fully cnvare of the provisions of section 3700 of the Califoi'nia Labor Cod e, which requires every employer to provide Workers' Compensation coverage for employees in accordance ,vith the provisions of that Code. lam also aware that I must provide proof of workers' compensation insurance to the City of Cupertino £or any and all employees I mc1 y hzive , pursuant to Section 12 of the City of Cupertino's contrc1ct. l hereby ce rtify tha t l do not .have any crn.ployccs nor will l 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 in.surance. I declare under penalty of perjury tinder th e hnvs of the State of California th at the foregoing is true and correct. I I X -1·· .c.S . ,-,--];) ?-.,-::-_;, Executed on this _IL_,_day of t\-~0us. , 2018, at ·-·· r. '' · /\...., California. ,_ ·:~:Jc_\D \ ':::i T/1 .. J Z.."f.:> i R D PRl}JTNAME ~~~~ :.~r __ Q ___ .. _c.?-P ~GNATURE Revised 1.05.18 ~I" HISCOX Hiscox Insurance Company Inc. Policy Number : UDC-2345495-CGL-18 Named Insured : Starbird Consulting, LLC . Endorsement Number: 18 Endorsement Effective : October 11, 2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY . ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Cupertino 10300 Torre Ave. Cupertino.CA 95014 City of Cupertino , its City Council , Boards and Commissions , Officers , Officials, Employees , Agents , Servants , Colunteers and Consultants Information required to complete this Schedule , if not shown above, will be shown in the D eclarations. Section II -Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule , but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused , in whole or in part , by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations ; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc ., 2004 Page 1 of 1