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20-007 David Wellhouse & Associates, Inc., Services Agreement CITY OF OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 CUPERTINO CUPERTINO.ORG January 22, 2020 David Wellhouse & Associates, Inc. Attn: Renee M. Wellhouse 3609 Bradshaw Rd., Ste. H382 Sacramento, CA 95827 Re: Services Agreement Enclosed is a fully executed copy of the above-stated agreement with the City of Cupertino. If you have any questions or need additional information, please contact the City Manager's Office at (408) 777-3212. Sincerely, Cyrah Caburian Senior Office Assistant Enclosure CITY OF SERVICES AGREEMENT ($5,000 OR LESS) CUPERTINO 1. Parties.This Agreement("Agreement")is made by and between the City of Cupertino,a municipal corporation("City")and David Wellhouse&Associates,Inc. _("Contractor"), a Comoration , and is effective on the last date signed below("Effective Date"). 2. Services. Contractor agrees to provide the programs,classes or activities("Services")set forth in detail in the Scope of Services,attached and incorporated here as Exhibit A. 3. Time of Performance.This Agreement begins on the Effective Date and ends on June 30.2020 ("Contract Time"),unless terminated earlier as provided herein. Contractor must deliver the Services in accordance with the Schedule of Performance included or attached to Exhibit A.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.The City's designated supervisor for this Agreement may extend the Contract Time by up to six(6)months through a written amendment to this Agreement,provided such extension does not include additional contract funds. 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$4.000.00 ("Contract Price"),based upon the Scope of Services and the budget and rates included in Exhibit A. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor's actual costs exceed the capped amount. Upon Cityapproval of written invoices, Contractor will be paid as follows: (check one; cross out others): 0✓A lump sum amount of$4,000.00 which shall not exceed the Contract Price. E]At the rate of$_per hour for a total not to exceed the ContractPrice. MBased on the payment schedule included or attached to Exhibit A which shall not exceed the Contract Price. 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.Contractor is not entitled to health benefits,workers compensation or other benefits from the City.Contractor must have the skills and qualifications to perform the Services in a competent and professional manner,and must be licensed, registered, and/or certified and have a City Business License.Contractor will supply all tools,materials and equipment required to perform the Services under this Agreement. 6. Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees,agents,and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority,vacation time,vacation pay, sick leave,personal time off,overtime,health Select one 1 of 5 Services Agreement($5,000)/Rev Sept.2019 insurance,medical care,hospital care,insurance benefits, social security,disability,unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes,fees, contributions,or charges applicable to Contractor's business including,but not limited to.,federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any court, arbitrator,or administrative authority, including but not limited to the California Public Employees Retirement System (PERS),the Internal Revenue Service,or the State Employment Development Division, determine that Contractor,or any of its employees,agents, or subcontractors, is an employee for any purpose,then Contractor agrees to a reduction in amounts payable under this Agreement,or to promptly remint to City any payments due by the City as a result of such determination,so that the City's total expenses under this Agreement are not greater than they would have been had the determination not been made. 7. Assignment. This Agreement is not assignable. Contractor may not substitute another or transfer any rights or obligations under this Agreement without prior written approval of City. Only those persons whose names are included in Exhibit A may perform the Services. 8. Indemnification.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 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 indirectly 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; 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 j any money the City lost due to a claim or counterclaim arising out of this Agreement. 9. Insurane . Contractor shall comply with the Insurance Requirements, attached and incorporated here j as Exhibit B,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 certificates 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. 10. Compliance with Laws. Contractor shall comply with all laws and regulations applicable to this Agreement, included without limitation the following laws: 2of5 Services Agreement($5,000)/Rev Sept.2019 Labor Laws. Contractor shall comply with all labor laws applicable to this Agreement. If the Scope of Services includes a"public works" component, Contractor is required to comply with prevailing wage laws under Labor Code Section 1720 and other labor laws. FZ Sole Proprietor. If Contractor is a sole proprietorship/individual, it must sign the Affidavit of No Employees included in this Agreement. Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-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, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors will not be tolerated. Conflicts of Interest. Contractor shall comply with all conflict of interest 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 might have been involved in the making of this Agreement,has or will receive a direct or indirect financial interest in this Agreement, in violation of California Government Code Section 1090 et seq. Contractor may be required to file a conflict of interest form if Contractor makes certain 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. 11. Abandonment. City may abandon or postpone the Project at any time. Contractor will be compensated for satisfactory Services performed through the date of abandonment. 12. Termination. City may terminate this Agreement for cause or without cause at any time. City reserves the right to terminate the Agreement and the remainder of the Services offered by Consultant without notice based upon Contractor's cancellation of a Service (i.e.,program, class or activity) without giving advance notice or obtaining written approval from City. 13. Governing Law. This Agreement is governed by the laws of the State of California. Any lawsuits filed related to this Agreement must be filed with the Superior Court for the County of Santa Clara, State of California. Contractor must comply with the claims filing requirements under the Government Code prior to filing a civil action in court. If a dispute arises, Contractor must 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. 14. Entire Agreement.This Agreement represents the full and complete understanding of every kind or nature between the Parties, and supersedes any other agreement or understanding, either oral or written, between the Parties. Any changes to this Agreement will be effective only if in writing and signed by each Party's authorized representative.No verbal agreement or implied covenant will be 3 of 5 Services Agreement($5,000)/Rev Sept.2019 valid to amend or abridge this Agreement. If there is any inconsistency between any term, clause, or provision of the main Agreement and any term, clause, or provision of the attachments or exhibits thereto,the terms of the main Agreement shall prevail and be controlling. Each provision and clause required by law for this Agreement is deemed to be inserted and will be inferred herein. 15. Services Coordinator. The Parties designate the following persons as Services Coordinators for this Agreement. Contractor's designation and any substitution are subject to City approval. For Contractor: For City: David Wellhouse&Associates,Inc. Office of the City Clerk Narne Renee M.Wellhouse Name Kirsten Squarcia Position President Position Acting City Clerk Contact (916)797-4883 Contact (408)777-3224 16. Contract Interpretation. There are no intended third party beneficiaries of this Agreement.Neither acceptance of the Services nor payment therefor shall constitute a waiver of any contract provision. City's waiver of a breach shall not constitute waiver of another provision or breach. The headings in this Agreement are for convenience only.The Indemnification and Governing Law sections expressly survive this Agreement. 17. Severability. If a term or provision of the Agreement or its application to a particular situation is found by the court to be void, invalid, illegal, or unenforceable, such term or provision shall remain in 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. 18. Notices. All notices, demands, requests, and approvals must be sent to the persons below in writing, and will be considered effective on the date of personal delivery,upon confirmation of delivery by a reputable overnight delivery service, on the fifth calendar day after deposit thereof in the United States Mail,postage prepaid,registered or certified, or the next business day following electronic submission: To Contractor:David Wellhouse&Associates,Inc. To City of Cupertino: 3609 Bradshaw Rd.,Ste H382,Sacramento CA 95827 10300 Torre Ave.,Cupertino,CA 95014 Attention:Renee M.Wellhouse,President Attention:Kirsten Squarcia,Acting City Clerk Email:cityclerk(a�cupertino.org Small: dws-renee�iilsurewest.net 4 of 5 Services Agreement($5,000)/Rev Sept.2019 19. Validity of Contract. This Agreement is valid and enforceable only if(a) it complies with the contract provisions of Cupertino Municipal Code Sections 3.22 and 3.23, (b) is signed by the City Manager or an authorized designee, and(c) is approved for form by the City Attorney's Office. 20. Execution. Contractor's signatory warrants that he or she is authorized to execute the Agreement and to legally bind Contractor. This Agreement may be executed in counterparts,each one of which is deemed an original and all of which,taken together, constitute a single binding instrument. IN WITNESS WHEREOF,the Parties have caused the Agreement to be executed as of the Effective Date written above. CONTRACTOR CITY OF CUPERTINO A Municipal Cor oration By By: Name: A Jkl1lbuse, Name: Title: /P�S/(�E'yIZ Title: cf5C-L,� Date: ��� ) Date: I 1 lra �.C�.P—p Tax I.D.No.: 901 APPROVED AS TO FORM: By: HEATHER M. MINNER Cupertino City Attorney ATTEST: By: 41kSTEN SQUARCIA, Xcting City Clerk 5 of 6 Services Agreement($5,000)/Rev Sept.2019 Contractor's Affidavit of No Employees State o f California County of Santa Clara City of Cupertino I,the undersigned, declare as follows: I am an independent contractor and the owner oQiv,,4 �h 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. P— / �0 Executed on this day of , 2&ff, at� YCG/ i"t�7� , California. . :TJV PNAM --//( #&&I IGNATURE Select one Services Agreement($5,000)/Rev. May 28, 2018 Page 6 of 6 Exhibit A Scope of Work Claims To Be Filed. CONSULTANT shall prepare and file with the State Controller's Office on behalf of CITY, the following state mandated cost (SB 90) claims during the 2018/2019 fiscal year. A. February 2020 Annual Claims for fiscal year 2018/2019 to be prepared and filed on or before February 18, 2020 as required by the State Controller's Claiming Instructions. CITY acknowledges that CONSULTANT does not warrant that claims will be filed for all of the mandates listed in Scope of Work. CONSULTANT shall only prepare and file claims for those mandates listed in Scope of Work which the CITY has reimbursable costs. The claims and services described in this Section 1 shall hereinafter be referred to as "PROJECT". CONSULTANT hereby designates Renee Wellhouse to be sole contact and agent in all consultations with CITY during the performance of services as stated in PROJECT. Time For Performance CONSULTANT shall file all claims in accordance with the State Controller's claim filing deadline contained in the applicable State Controller Claiming Instructions. City Assistance CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this agreement. CITY shall provide CONSULTANT with requested information in a timely manner, pursuant to PROJECT. CITY represents and warrants that all financial documents and other information provided are accurate and correct. CONSULTANT shall not be liable for claims that are not filed or incorrectly filed due to inaccurate or untimely data. Disposition Of Documents CONSULTANT shall furnish to CITY copies of all claims filed with the State within 30 days after filing. CONSULTANT shall, upon written request, make copies of work papers available to CITY. CITY acknowledges that all such work papers are the property of CONSULTANT, and may not be disclosed to any third party, provided, however, that such work papers may be disclosed to appropriate governmental authorities for audit purposes or in response to any Public Records Act request, where responsive to that request and not otherwise exempt. CONSULTANT shall be entitled to retain copies of all data prepared. Consultant Assistance If Audited Upon notice of audit, CONSULTANT shall make available to CITY and state auditors claim file information, and provide assistance to CITY in defending claims submitted. Indirect Costs CONSULTANT shall make every effort to prepare departmental Indirect Cost Rate Proposals for claims submitted, provided CITY financial information and departmental costs support such rates. CONSULTANT may utilize the ten percent (10%) indirect cost rate allowed by the State Controller if financial information and departmental costs do not support a higher rate. S t #. EXHIBIT B .Insurance Requirements =_ Services Agreetltent ($5000 or less) Eck = , 77 Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in eomzection with the performance and results of the Services hereunder by the Contractor,his agents, representatives, employees,or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability("CGL"): Insurance Services Office("ISO")Forin CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, contractual liability, property damage,bodily injury,and personal and advertising injury with limits no less than$2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this Project(ISO CG 25 03 or 25 04)or it shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement;or(2)the broader coverage and maximum limits of coverage of any insurance policy,whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non- contributory," will not seek contribution from City's insurance/self-insurance,and shall be at least as broad as ISO CG 20 0104 13 c. The liinits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance,provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the Ci.ty's own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability:ISO Form Number CA 00 01 covering any auto(Code 1),or,if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), with limits no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers'Compensation:As required by the State of California,with Statutory Limits,and Employer's Liability hnsurance of no less than$1,000,000 per occurrence for bodily injury or disease. (Not required if Contractor provides written verificationn it has no employees). 4. Professional Liability. Insurance which includes coverage for professional acts,errors and onussions, with limits no less than$2,000,000 per occurrence or claim,$2,000,000 aggregate(ifapplicable). If Contractor maintains broader coverage and/or higher limits than the minimums shown above,City requires and shall be.entitled to the broader coverage and higher insurance limits maintained byContractor. OTHER INSURANCE PROVISIONS The insurance policies are to contain,or be endorsed to contain,the following provisions: Additional Insured Stains The City of Cupertino,its City Council,officers,officials,employees,agents,servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed by or on behalf of Contractor including materials, parts, or equipment Insurance Requirements for Services Agreement($5,000 or less) Version:Sept. 2019 1 famished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available,through the addition of both CG 20 10,CG 20 26,CG 20 33,or CG-20 38;and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Contract,the Contractor's insurance coverage shall be primary coverage at least as broad as ISO CO 20 0104 13 as respects the City, its officers,officials, employees and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of Contractor's insurance and shall not contribute to it. Notice of Cancellation Each insurance policy shall state that coverage shall not be canceled or allowed to expire,except with written notice to City 30 days in advance or 10 days in advance if due to non-payment ofpremiums. Waiver of Subrogation Contractor grants to City a waiver of any right to subrogation which any insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. Contractor agrees to obtain any endorsement that may be necessary to affect 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. Self-Insured Retentions City may approve self-insured retentions and require proof of Contractor's ability to pay losses and related investigations,claim administration and defense expenses within the retention. The policy shall provide, or be endorsed to provide,that the self-insured retention may be satisfied by either the named insured or City. Acceptability of Insurers Insurers must be acceptable to City and licensed to do business in California,and each insurer must have an A.M.Best's financial strength rating of"X'or better and a financial size rating of"VII"orbetter. Claims Made Policies(applicable only to professional liability) If any of the required policies provide coverage on a claims-made basis: 1. The Retroactive Date must be shown and must be before the Effective Date of the Contract. 2. Insurance must be maintained for at least five(5)years after completion of the Services. 3. If coverage is canceled or non-renewed,and not replaced with another claims-made policy form with a Retroactive Date prior to the Contract Effective Date, the Contractor must purchase "extended reporting"coverage for a minimum of five(5)years after completion of the Services. Verification of Coverage Contractor shall famish the City with acceptable original certificates and mandatory endorsements(or copies of the policies effecting the coverage required by this Contract), and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City prior to commencing the Services. City retains the right to demand verification of compliance at any time duringthe Contract. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. Insurance coverage shall not limit Contractor's duties to indemnify, defend and hold City harmless. City reserves the right to modify these requirements based on the nature of the risk, prior experience, insurer, coverage or other special circumstances. Insurance Requirements for Services Agreement($5,000 or less) Version:Sept.2019 2 TE -�► CERTIFICATE OF LIABILITY INSURANCE DA12/11/2019I) �----r� 12/1112019 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 SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT USAA INSURANCE AGENCY INC/PHSNAME: 65812845 PHONE (888)242-1430 FAX (888)443-6 112 (A/C,No,Exq; (Alc,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: Sentinel insurance Company Ltd. 11000 DAVID WELLHOUSE&ASSOCIATES INSURER B 3609 BRADSHAW RD STE H382 SACRAMENTO CA 95827-3275 INSURERC: INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD fMMIDDIYYYYl (MMIDD1Y YYYl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMSWADEF_X�OCCUR DAMAGE TO RENTED $1,000,000 PREMISES oCCURence X General Liability MED EXP(Any one person) $10.000 A X 65 SBA NH5072 08131/2019 08/31/2020 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY❑PRO- ❑LOC PRODUCTS-COMP/OP AGG $4,000.000 JECT X OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S2,000,000 Me accident ANY AUTO - BODILY INJURY(Per person) A ALL OWNED SCHEDULED 65 SBA NH5072 08/31/2019 08/31/2020 BODILY INJURY(Per accident) AUTOS AUTOS HIRED NOWOWNEO PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE ED RETENTION WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATl1TE ER ANY YIN - E.L.EACH ACCIDENT PROP RI ETORIPARTNERIEXECUTIVE - OFFICERIMEMBEREXCLUDED9 NIA E.L.DISEASE-EA EMPLOYEE (Mandatory In NH) . It yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Those usual to the Insured's Operations.Please see Additional Remarks Schedule Acord Form 101 attached. CERTIFICATE HOLDER CANCELLATION City Of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 10300 TORRE AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED CUPERTINO CA 95014-3202 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED USAA INSURANCE AGENCY INC/PHS DAVID WELLHOUSE&ASSOCIATES POLICY NUMBER 3609 BRADSHAW RD STE H382 SEE ACORD 25 SACRAMENTO CA 95827-3275 CARRIER NAIC CODE - SEE ACORD 25 EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Cupertino, its City council, boards and commissions,officers,agents,employers, servants and volunteers are an additional insured per Additional Insured:Owners,Lessees,or Contractors; Scheduled Person or Organization Form SS4170 and Additional Insured: Owners, Lessees or Contractors; Completed Operations form SS4171,attached to this policy. ACORD 101(2014/01) ©2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD i POLICY NUMBER: 65 SBA NH5072 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION Form IH 12 00 11 85 T SEQ.NO. 001 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 06/12/19 Expiration Date: 08/31/20 i 1 POLICY NUMBER: 65 SBA NH5072 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO, CA 95014 CITY OF CUPERTINO, ITS CITY COUNCIL, BOARDS AND COMMISSIONS, OFFICERS, AGENTS, EMPLOYERS, SERVANTS AND VOLUNTEERS ARE AN ADDITIONAL INSURED PER ADDITIONAL INSURED: OWNERS, LESSEES, OR CONTRACTORS; SCHEDULED PERSON OR ORGANIZATION FORM SS4170 j AND ADDITIONAL INSURED: OWNERS, LESSEES OR CONTRACTORS; COMPLETED OPERATIONS FORM SS4171, ATTACHED TO THIS POLICY. Form IH 12 00 11 85 T SEQ.NO. 003 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 06/12/19 Expiration Date: 08/31/20 i F 7 } } i 1 f 1 f t I i 1 I POLICY NUMBER: 65 SBA NH5072 i Ito THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. E ADDITIONAL INSURED - PERSON-ORGANIZATION j CITY OF CUPERTINO ITS CITY COUNCIL, BOARDS AND COMMISSIONS, OFFICERS, AGENTS, EMPLOYERS, SERVANTS AND VOLUNTEERS ARE AN ADDITIONAL INSURED PER ! ADDITIONAL INSURED: OWNERS, LESSEES, OR CONTRACTORS; SCHEDULED PERSON OR ORGANIZATION FORM SS4170 AND ADDITIONAL INSURED: OWNERS, LESSEES OR CONTRACTORS; COMPLETED OPERATIONS FORMA SS4171, I ATTACHED TO THIS POLICY. 10300 TORRE AVE CUPERTINO, CA 95014 t t v 1 t f Form IH 12 00 11 85 T SEQ.NO. 002 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 06/12/19 Expiration-Date: 08/31/20 f { i I i pay THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, HIRED AUTO AND NON-OWNED AUTO This endorsement modifies Insurance provided under the following; BUSINESS LIABILITY COVERAGE FORM This coverage is subject to all provisions In the moved from the place where they are BUSINESS LIABILITY COVERAGE FORM not accepted by the"Insured"for movement into expressly modified herein: or onto the covered"auto";or c. After the "pollutants" or any property in A. Amended Coverage: which the "pollutants" are contained are Coverage is extended to "bodily Injury" and moved from the covered "auto"to the place "property damage"arising out of the use of a"hired where they are finally delivered,disposed of or abandoned by the"insured". auto"and"non-owned auto". Paragraph a.above does not apply to fuels, B. Paragraph B. EXCLUSIONS Is amended as lubricants, fluids, exhaust gases or other follows: similar "pollutants" that are needed for or 1. Exclusion g.Aircraft,Auto or Watercraft does result from the normal electrical, hydraulic not apply to a "hired auto" or a "non-owned or mechanical functioning of the covered auto". "auto"or its parts,if: 2. Exclusion e, Employers Liability does not (1) The "pollutants' escape, seep, migrate, apply to"bodily injury" to domestic"employees" or are discharged or released directly not entitled to workers' compensation benefits from an 'auto" part designed by its or to liability assumed by the"Insured"under an manufacturer to hold, store, receive, or "insured contract". dispose of such"pollutants";and 3. Exclusion If. Pollution is replaced by the (2) The "bodily injury' and "property following: damage" does not arise out of the "Bodily Injury" or"property damage" arising out operation of any equipment listed in of the actual, alleged or threatened discharge, paragraphs 15.b, and 15.c. of the dispersal, seepage, migration, release or definition of"mobile equipment". escape of"pollutants": Paragraphs b.and c.above do not apply to a. That are, or that are contained in any "accidents' that occur away from premises property that Is: owned by or rented to an "insured" with (1) Being transported or towed by,handled, respect to "pollutants" not in or upon a or handled for movement into, onto or covered"auto"if: from,the covered"auto"; (1) The "pollutants" or any property in (2) Other4vise In the course of transit by or which the"pollutants" are contained are on behalf of the"insured";or upset, overturned or damaged as a result of the maintenance or use of a (3) Being stored, disposed of, treated or covered"auto";and processed in or upon the covered "auto". b. Before the "pollutants" or any property In which the "pollutants" are contained are Form SS 04 38 09 09 Page 1 of 3 2009,The Hartford (Includes copyrighted material of ISO Properties,Inc.,with its permission) (2) The discharge, dispersal, seepage, company)for an"auto"owned by him or her migration, release or escape of the or a member of his or her household. "pollutants" Is caused directly by such d. Anyone liable for the conduct of an 'Insured' upset,overtum or damage as a result of described above but only to the extent of that the maintenance or use of a covered liability. "auto". D. With respect to the operation of a "hired auto" and 4. With respect to this coverage, the following "non-owned auto", the following additional additional exclusions apply: conditions apply: a. Fellow employee 1. OTHER INSURANCE Coverage does not apply to"bodily injury"to a. Except for any liability assumed under an 5riy fellow "elployee" bf the 'Insured" "insured contract"the insurance provided by arising out of the operation of an "auto" this Coverage Form is excess over any owned by the"insured'in the course of the other collectible insurance. fellow"employee's"employment. 6. Care,custody or control However, if your business is the selling, servicing, repairing, parking or storage of Coverage does not apply to "property "autos', the Insurance provided by this damage' Involving property owned or endorsement is primary when covered transported by the "insured" or in the "bodily injury" or "property damage" arises "Insured's"care,custody or control. out of the operation of a customer's 'auto" C, With respect to"hired auto" and "non-owned auto" by you or your"employee". coverage, Paragraph C, WHO IS AN INSURED is b. When this Coverage Form and any other deleted and replaced by the following: Coverage Form or policy covers on the The following are"insureds": same basis, either excess or primary, we will pay only our share, Our share is the a. You. proportion that the Limit of Insurance of our b, Your "employee' while using with your Coverage Form bears to the total of the permission; limits of all the Coverage Forms and policies (1) An"auto"you hire or borrow;or covering on the same basis. (2) An "auto" you don't own, hire or borrow in 2. TWO OR MORE COVERAGE FORMS OR your business or personal affairs:or POLICIES ISSUED BY US (3) An "auto" hired or rented by your If the Coverage Form end any other Coverage "employee" on your behalf and at your Form or policy issued to you by us or any direction. company affiliated with us apply to the same c, Anyone else while using a"hired auto" or"non- °accident", the aggregate maximum Limit of owned auto"with your permission except: Insurance under all the Coverage Forms or policies shall not exceed the highest applicable (1) The owner or anyone else from whom you Limit of Insurance under any one Coverage hire or borrow an"auto'. Form or policy. This condition does not apply to (2) Someone using an auto while he or she is any Coverage Form or policy Issued by us or an working in a business of selling, servicing, affiliated company specifically to apply as repairing, parking or storing "autos" unless excess insurance over this Coverage Form. that business Is yours. E. The following definitions are added: (3) Anyone other than your "employees", G. LIABILITY AND MEDICAL EXPENSES partners(if you are a partnership),members DEFINITIONS: (if you are a limited liability company), or a 1. "Hired auto" means any "auto" you lease, ) lessee or borrower or any of their hire, rent or borrow. This does not include 'employees", while moving property to or any auto you lease, hire, rent or borrow from an`auto". from any of your"employees",your partners (4) A partner (if you are a partnership), or a (if you are a partnership), members (if you member (if you are a limited liability are a limited liability company), i I i Page 2 of 3 Form SS 04 38 09 09 i i I i 1 i i i or your "executive officers" or members of their households, This does not include a long-term leased "auto" that you Insure as an owned "auto' i under any other auto liability insurance policy or a temporary substitute (oi an "auto" you own that is out of service becouse of its breakdown, repair, servicing or destruction, 1 2. 'Non-ovmed auto " means any "auto" you do not own, lease, hire, rent or borrow which Is used In connection with your business, This includes; a, "Autos"owned by your"employees"your partners (if you are a partnership), members (If you are a limited liability company), or your "executive officers". or members of their households, but only while used In your business or your personal affairs. b. Customer's "auto" that is In your care, custody or control for service. t � I i i 1 Form SS 04 38 09 09 Page 3 of 3